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Osamah M. Alfayez Majed S. Al Yami Mohannad Alshibani Saad B. Fallatah Nasser M. Al Khushaym Razan Alsheikh Nimer Alkhatib 《Primary Care Diabetes》2019,13(3):204-211
The aim of this network meta-analysis (NMA) was to indirectly compare the cardiovascular (CV) safety of new antidiabetic medications in patients with type 2 diabetes mellitus (T2DM).Data synthesisA search of the Embase and MEDLINE databases was conducted systematically to identify cardiovascular outcome trials (CVOTs) of new antidiabetic medications (DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors) in patients with T2DM. The primary outcomes were the composite endpoint of CV death, nonfatal MI, and nonfatal stroke (MACE), death from CV causes, nonfatal MI, nonfatal stroke and death from any cause. Hospitalization for HF and unstable angina were evaluated as secondary endpoints. A total of 9 trials, including 87,162 patients, met the eligibility criteria and were retained for the analysis.The NMA results showed no significant differences among the DPP-4 inhibitors (sitagliptin, alogliptin, and saxagliptin) in any of the CV endpoints. Similarly, no significant changes were seen in the NMA among the GLP-1 receptor agonists nor the SGLT-2 inhibitors. The pairwise meta-analysis showed that DPP-4 inhibitors have a CV safety profiled comparable to placebo. GLP-1 agonists on the other hand, showed significant reduction in MACE (RR 0.92; 95% CI 0.87–0.97), death from CV causes (RR = 0.88; 95% CI 0.80–0.97), and death from any cause (RR = 0.89; 95% CI 0.82–0.96). SGLT-2 inhibitors showed significant reduction in hospitalization for heart failure events (RR 0.72; 95% CI 0.6–0.86) compared to placebo.ConclusionThis meta-analysis has shown that new antidiabetic medications do not impose any additional CV risk. The indirect comparison among the medications of each class resulted in no significant changes regarding CV endpoints and death from any cause. 相似文献
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Alshouimi Reema A. Al Rammah Shahad M. Alzahrani Mohammed Y. Badreldin Hisham A. Al Yami Majed S. Almohammed Omar A. 《Journal of thrombosis and thrombolysis》2019,48(3):422-429
Journal of Thrombosis and Thrombolysis - The extended use of thromboprophylaxis with direct oral anticoagulants (DOACs) for more than 30 days has been evaluated as an alternative... 相似文献
85.
Yassir Turki Suha Saleh Shatha Albaik Yasmeen Barham Dorien van de Vrie Yousef Shahin Majed Hababeh Akihiro Seita 《Lancet》2019
Background
Mental health is a major public health priority, particularly among refugees worldwide. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary health-care services in Jordan in late 2017. This baseline study aimed to assess the knowledge, attitudes, practices, and perceived barriers among UNRWA health staff regarding the implementation of the MHPSS programme.Methods
The UNRWA Health Programme conducted a cross-sectional study of a sample of 220 out of the 390 male and female doctors, dentists, nurses, and midwives who work at 16 of the 25 UNRWA health centres in Jordan during November, 2017. Individuals on duty at the health centres on the day of the survey were included. The 16 health centres were selected based on their size and accessibility to surveyors (reflecting proximity to Amman, and the size of population served). Of the selected health centres, seven were large, seven were medium, and two were small according to the UNRWA classification of health centres (based on the number of medical doctors). A validated self-administered questionnaire was used. Ethics approval was granted by the UNRWA Health Programme ethics committee, and informed written consent was obtained from all participants. Data analysis was performed using SPSS (version 22).Findings
Of the participants, 73% (161 of 220) believed that their knowledge of MHPSS programmes was insufficient, with no significant difference (p=0·116) between different categories of staff. Furthermore, 88% (194 of 220) said that they needed more training, 67% (147 of 220) reported that the number of mental health cases is increasing, and 50% (110 of 220) that dealing with these cases is difficult. Reflecting on the past 12 months, 31% of staff (69 out of 220) reported meeting between one and ten children, and 45% (100 out of 220) reported meeting between one and ten adults suspected of having mental illnesses. The most suspected condition was depression (84%; 150 of 220), followed by epilepsy (64%; 140 of 220). The main perceived barriers to implementation included the limited availability of MHPSS policies (87%; 192 of 220), MH professionals (86%; 190 of 220), resources (86%; 189 out of 220), and lack of privacy (14%; 31 out of 220).Interpretation
Most health staff had positive attitudes towards MHPSS programme implementation but felt they lacked the required knowledge. There is a need for training and clear technical guidelines. Perceived barriers to MHPSS programme implementation need to be tackled with a structured plan of action.Funding
The UNRWA Health Programme, UNRWA Headquarters, Amman, Jordan. 相似文献86.
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Jumanah Alshenaifi Nour Ewida Shams Anazi Hanan E. Shamseldin Nisha Patel Sateesh Maddirevula Tarfa Al-Sheddi Rana Alomar Eman Alobeid Niema Ibrahim Mais Hashem Firdous Abdulwahab Minnie Jacob Amal Alhashem Hamad I. Alzaidan Mohammed Z. Seidahmed Nadia Alhashemi Rifaat Rawashdeh Wafaa Eyaid Zuhair N. Al-Hassnan Zuhair Rahbeeni Abdulrahman Alswaid Adnan Hadid Alya Qari Dia A. Mohammed Heba Y. El Khashab Majid Alfadhel Mohammad Abanemai Rawda Sunbul Saeed Al Tala Salwa Alkhalifi Turki Alkharfi Mohamed Abouelhoda Dorota Monies Nada Al Tassan Saud H. AlDubayan Wesam Kurdi Mohammed Al-Owain Majed J. Dasouki Amal Y. Kentab Suha Atyani Nawal Makhseed Eissa Faqeih Ranad Shaheen Fowzan S. Alkuraya 《Clinical genetics》2019,95(2):310-319
Defects in the peroxisomes biogenesis and/or function result in peroxisomal disorders. In this study, we describe the largest Arab cohort to date (72 families) of clinically, biochemically and molecularly characterized patients with peroxisomal disorders. At the molecular level, we identified 43 disease-causing variants, half of which are novel. The founder nature of many of the variants allowed us to calculate the minimum disease burden for these disorders in our population ~1:30 000, which is much higher than previous estimates in other populations. Clinically, we found an interesting trend toward genotype/phenotype correlation in terms of long-term survival. Nearly half (40/75) of our peroxisomal disorders patients had documented survival beyond 1 year of age. Most unusual among the long-term survivors was a multiplex family in which the affected members presented as adults with non-specific intellectual disability and epilepsy. Other unusual presentations included the very recently described peroxisomal fatty acyl-CoA reductase 1 disorder as well as CRD, spastic paraparesis, white matter (CRSPW) syndrome. We conclude that peroxisomal disorders are highly heterogeneous in their clinical presentation. Our data also confirm the demonstration that milder forms of Zellweger spectrum disorders cannot be ruled out by the “gold standard” very long chain fatty acids assay, which highlights the value of a genomics-first approach in these cases. 相似文献
88.
Majed S. Al Yami Matthew A. Silva Jennifer L. Donovan Abir O. Kanaan 《Journal of thrombosis and thrombolysis》2018,45(1):36-47
The American College of Chest Physicians guidelines recommend unfractionated heparin (UFH), low molecular weight heparins (LMWHs) or fondaparinux for prevention of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), in medically-ill patients. Direct oral anticoagulants (DOACs) have been evaluated relative to enoxaparin for VTE prophylaxis though head-to-head comparisons of these agents are lacking. Therefore, we conducted a mixed treatment comparisons meta-analysis to evaluate the safety and efficacy of established treatments and DOACs for VTE prophylaxis in medically-ill patients. A comprehensive literature search was conducted to identify randomized trials evaluating UFH, LMWHs or DOACS for the prevention of VTE in medically ill patients. Articles were retrieved and cross-referenced for additional trials, evaluated and entered into ADDIS (version 1.16.6) to generate direct and indirect treatment comparisons for VTE, DVT, PE, death from any cause, and bleeding. Ten articles were included and eight anticoagulants were evaluated in a treatment network representing data on 28,382 patients. We found each treatment had similar efficacy in preventing VTE, DVT, PE, death from any cause and each had similar risk of minor and major bleeding. Overall, placebo was associated with more VTE and DVT events compared to LMWHs and DOACs. We found that UFH, LMWHs and DOACs are comparable in preventing VTE, DVT, PE, and death from any cause and in association with minor and major bleeding. Anticoagulant selection for VTE prophylaxis in medically-ill patients should be individualized by patient characteristics, risks and preferences along with specific pharmacokinetic and pharmacodynamic considerations. 相似文献
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90.
Mohammed H. Alanazy Majed A. Alomar Bandar N. Aljafen Taim A. Muayqil 《Neurosciences (Riyadh, Saudi Arabia)》2018,23(2):158
Weight loss has substantial health benefits, but it is not risk-free. Various neurological disorders have been reported following bariatric surgery-induced weight loss. Here, we report 3 patients who developed multiple sclerosis (MS), one of whom also developed myasthenia gravis (MG), shortly after significant weight loss. Two patients lost weight by following a diet plan and one underwent bariatric surgery. There may be an association between significant weight loss and the development of an autoimmune neurological disorder such as MS or MG; a high index of suspicion is required.Obesity is a major worldwide health problem and is associated with increased morbidity and mortality. Common weight loss strategies include diet, exercise, and bariatric surgery. Weight loss has health, social, and economic benefits. However, several neurological disorders have been reported following bariatric surgery-induced weight loss.1 Fad dieting is also a potential health problem for those who try to achieve short-term weight loss. However, the mechanism by which weight loss, whether induced by bariatric surgery or other methods, triggers immune-mediated neurological disorders is largely unknown. In a recent case series, Bitarafan et al2 reported 4 patients who developed multiple sclerosis (MS) following weight loss. We herein report 3 patients who developed MS, one of whom also developed myasthenia gravis (MG), following significant weight loss. 相似文献