Publications by authors named "S Said"

1,170 Publications

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Contemporary management of patients with atrial fibrillation in the Netherlands and Belgium: a report from the EORP-AF long-term general registry.

Neth Heart J 2021 Sep 15. Epub 2021 Sep 15.

Arlon and Clinique Ste Thérèse, Department of Cardiology, Cliniques du Sud-Luxembourg, Bastogne, Belgium.

Background: Contemporary data regarding the characteristics, treatment and outcomes of patients with atrial fibrillation (AF) are needed. We aimed to assess these data and guideline adherence in the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) long-term general registry.

Methods: We analysed 967 patients from the EORP-AF long-term general registry included in the Netherlands and Belgium from 2013 to 2016. Baseline and 1‑year follow-up data were gathered.

Results: At baseline, 887 patients (92%) received anticoagulant treatment. In 88 (10%) of these patients, no indication for chronic anticoagulant treatment was present. A rhythm intervention was performed or planned in 52 of these patients, meaning that the remaining 36 (41%) were anticoagulated without indication. Forty patients were not anticoagulated, even though they had an indication for chronic anticoagulation. Additionally, 63 of the 371 patients (17%) treated with a non-vitamin K antagonist oral anticoagulant (NOAC) were incorrectly dosed. In total, 50 patients (5%) were overtreated and 89 patients (9%) were undertreated. However, the occurrence of major adverse cardiac and cerebrovascular events (MACCE) was still low with 4.2% (37 patients).

Conclusions: Overtreatment and undertreatment with anticoagulants are still observable in 14% of this contemporary, West-European AF population. Still, MACCE occurred in only 4% of the patients after 1 year of follow-up.
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http://dx.doi.org/10.1007/s12471-021-01634-yDOI Listing
September 2021

Ex Vivo Normothermic Preservation of Amputated Limbs with a Hemoglobin-Based Oxygen Carrier (HBOC-201) Perfusate.

J Trauma Acute Care Surg 2021 Sep 10. Epub 2021 Sep 10.

Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH Department of Gastroenterology Cleveland Clinic, Cleveland, OH, USA Hemoglobin Oxygen Therapeutics, LLC, Souderton, PA, USA.

Background: Ex vivo normothermic limb perfusion (EVNLP) preserves amputated limbs under near-physiologic conditions. Perfusates containing red blood cells (RBCs) have shown to improve outcomes during ex vivo normothermic organ perfusion, when compared to acellular perfusates. To avoid limitations associated with use of blood-based products, we evaluated the feasibility of EVNLP utilizing a polymerized Hemoglobin-Based Oxygen Carrier-201 (HBOC-201).

Methods: Twenty-four porcine forelimbs were procured from Yorkshire pigs. Six forelimbs underwent EVNLP with an HBOC-201-based perfusate, six with an RBC-based perfusate, and twelve served as static cold storage controls (SCS). EVNLP was terminated in presence of systolic arterial pressure ≥ 115 mmHg, fullness of compartments, or drop of tissue oxygen saturation by 20%. Limb contractility, weight change, compartment pressure, tissue oxygen saturation, oxygen uptake rates (OUR) were assessed. Perfusate fluid-dynamics, gases, electrolytes, metabolites, methemoglobin (MetHb), creatine kinase (CK) and myoglobin concentration were measured. Uniformity of skin perfusion was assessed with indocyanine green (ICG) angiography and infrared thermography (IRT).

Results: Warm ischemia time before EVNLP was 35.50 ± 8.62 min (HBOC-201), 30.17 ± 8.03 min (RBC) and 37.82 ± 10.45 (SCS) (p = 0.09). EVNLP duration was 22.5 ± 1.7 (HBOC-201) and 28.2 ± 7.3 (RBC) hours (p = 0.04). Vascular flow (325 ± 25 vs. 444.7 ± 50.6 ml/min; p = 0.39), OUR (2.0 ± 1.45 vs. 1.3 ± 0.92 mlO2/min*g of tissue; p = 0.80), lactate (14.66 ± 4.26 vs. 13.11 ± 6.68 mmol/L; p = 0.32), perfusate pH (7.53 ± 0.25 HBOC-201; 7.50 ± 0.23 RBC; p = 0.82), flexor (28.3 ± 22.0 vs. 27.5 ± 10.6; p = 0.99) and extensor (31.5 ± 22.9 vs. 28.8 ± 14.5; p = 0.82) compartment pressures, and weight changes (23.1 ± 3.0% vs. 13.2 ± 22.7; p = 0.07) were not significantly different between HBOC-201 and RBC groups, respectively. In HBOC-201 perfused limbs, MetHb levels increased, reaching 47.8 ± 12.1% at endpoint. Methemoglobin saturation did not affect OUR (ρ = -0.15, r2 = 0.022; p = 0.45). A significantly greater number of necrotic myocytes was found in the SCS group at endpoint (SCS: 127 ± 17 cells; HBOC-201: 72 ± 30 cells; RBC-based: 56 ± 40 cells; vs. p = 0.003).

Conclusion: HBOC-201- and RBC-based perfusates similarly support isolated limb physiology, metabolism, and function.

Level Of Evidence: N/A.
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http://dx.doi.org/10.1097/TA.0000000000003395DOI Listing
September 2021

Clinicopathologic predictors of early relapse in advanced epithelial ovarian cancer: development of prediction models using nationwide data.

Cancer Epidemiol 2021 Sep 8:102008. Epub 2021 Sep 8.

Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.

Objective: To identify clinicopathologic factors predictive of early relapse (platinum-free interval (PFI) of ≤6 months) in advanced epithelial ovarian cancer (EOC) in first-line treatment, and to develop and internally validate risk prediction models for early relapse.

Methods: All consecutive patients diagnosed with advanced stage EOC between 01-01-2008 and 31-12-2015 were identified from the Netherlands Cancer Registry. Patients who underwent cytoreductive surgery and platinum-based chemotherapy as initial EOC treatment were selected. Two prediction models, i.e. pretreatment and postoperative, were developed. Candidate predictors of early relapse were fitted into multivariable logistic regression models. Model performance was assessed on calibration and discrimination. Internal validation was performed through bootstrapping to correct for model optimism.

Results: A total of 4,557 advanced EOC patients were identified, including 1,302 early relapsers and 3,171 late or non-relapsers. Early relapsers were more likely to have FIGO stage IV, mucinous or clear cell type EOC, ascites, >1 cm residual disease, and to have undergone NACT-ICS. The final pretreatment model demonstrated subpar model performance (AUC = 0.64 [95 %-CI 0.62-0.66]). The final postoperative model based on age, FIGO stage, pretreatment CA-125 level, histologic subtype, presence of ascites, treatment approach, and residual disease after debulking, demonstrated adequate model performance (AUC = 0.72 [95 %-CI 0.71-0.74]). Bootstrap validation revealed minimal optimism of the final postoperative model.

Conclusion: A (postoperative) discriminative model has been developed and presented online that predicts the risk of early relapse in advanced EOC patients. Although external validation is still required, this prediction model can support patient counselling in daily clinical practice.
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http://dx.doi.org/10.1016/j.canep.2021.102008DOI Listing
September 2021

Membranous Nephropathy With Extensive Tubular Basement Membrane Deposits Following Allogeneic Hematopoietic Cell Transplant: A Report of 5 Cases.

Am J Kidney Dis 2021 Sep 8. Epub 2021 Sep 8.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

Tubular basement membrane (TBM) deposits are very uncommon in non-lupus membranous nephropathy. We report a series of 5 patients with membranous nephropathy and extensive TBM deposits following allogeneic hematopoietic cell transplant. Patients presented with nephrotic syndrome with (n=3) acute kidney injury, late post-transplant in association with chronic graft-vs-host disease (cGVHD). Kidney biopsies revealed global subepithelial and extensive TBM immune complex deposits, accompanied by acute tubular injury (n=4) and tubulointerstitial inflammation (n=4). Proteomic analysis of glomeruli in 4 cases revealed spectra for PLA2R in 1 and no significant protein spectra for PLA2R, THSD7A, EX1/2, NELL-1, PCDH7, NCAM1, or SEMA3B in the remaining 3. On follow up (mean 42 months), 4 patients had complete and 1 partial remission following prednisone and/or rituximab therapy. We propose that membranous nephropathy with extensive TBM deposits is a distinctive clinicopathologic lesion associated with allogeneic hematopoietic cell transplant. Pathogenesis likely involves cGVHD-driven antibodies against glomerular and TBM components, the identity of which remains to be elucidated.
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http://dx.doi.org/10.1053/j.ajkd.2021.07.021DOI Listing
September 2021

Voice alerting as a medical alarm modality for next-generation patient monitoring: a randomised international multicentre trial.

Br J Anaesth 2021 Aug 25. Epub 2021 Aug 25.

Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.

Background: Acoustic alarms in medical devices are vital for patient safety. State-of-the-art patient monitoring alarms are indistinguishable and contribute to alarm fatigue. There are two promising new sound modalities for vital sign alarms. Auditory icons convey alarms as brief metaphorical sounds, and voice alerts transmit information using a clear-spoken language. We compared how reliably healthcare professionals identified alarms using these two modalities.

Methods: This investigator-initiated computer-based multicentre simulation study included 28 anaesthesia providers who were asked to identify vital sign alarms in randomised order, once with voice alerts and once with auditory icons. We further assessed time to decision, diagnostic confidence, and perceived helpfulness. We analysed the results using mixed models, adjusted for possible confounders.

Results: We assessed 14 alarms for each modality, resulting in 392 comparisons across all participants. Compared with auditory icons, healthcare providers had 58 times higher odds of correctly identifying alarms using voice alerts (odds ratio 58.0; 95% confidence interval [CI]: 25.1-133.6; P<0.001), made their decisions about 14 s faster (coefficient -13.9; 95% CI: -15.8 to -12.1 s; P<0.001), perceived higher diagnostic confidence (100% [392 of 392] vs 43% [169 of 392; P<0.001]), and rated voice alerts as more helpful (odds ratio 138.2; 95% CI: 64.9-294.1; P<0.001). The participants were able to identify significantly higher proportions of alarms with voice alerts (98.5%; P<0.001) and auditory icons (54.1%; P<0.001) compared with state-of-the-art alarms (17.9%).

Conclusions: Voice alerts were superior to auditory icons, and both were superior to current state-of-the-art auditory alarms. These findings demonstrate the potential that voice alerts hold for patient monitoring.
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http://dx.doi.org/10.1016/j.bja.2021.07.015DOI Listing
August 2021
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