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Article ; Online: In Reply to the Letter to the Editor Regarding "Determining the Diagnostic Utility of Lumbar Punctures in CT Negative Suspected Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis".

Kameda-Smith, Michelle / Farrokhyar, Forough

2021 Volume 147, Page(s) 249

MeSH term(s)	Humans ; Spinal Puncture/adverse effects ; Subarachnoid Hemorrhage/diagnostic imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-03-08
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2020.12.151
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Article ; Online: Identification of clinically relevant patient endotypes in traumatic brain injury using latent class analysis.

Qiu, Hongbo / Zador, Zsolt / Lannon, Melissa / Farrokhyar, Forough / Duda, Taylor / Sharma, Sunjay

Scientific reports

2024 Volume 14, Issue 1, Page(s) 1294

Abstract: Traumatic brain injury (TBI) is a complex condition where heterogeneity impedes the advancement of care. Understanding the diverse presentations of TBI is crucial for personalized medicine. Our study aimed to identify clinically relevant patient ... ...

Abstract	Traumatic brain injury (TBI) is a complex condition where heterogeneity impedes the advancement of care. Understanding the diverse presentations of TBI is crucial for personalized medicine. Our study aimed to identify clinically relevant patient endotypes in TBI using latent class analysis based on comorbidity data. We used the Medical Information Mart for Intensive Care III database, which includes 2,629 adult TBI patients. We identified five stable endotypes characterized by specific comorbidity profiles: Heart Failure and Arrhythmia, Healthy, Renal Failure with Hypertension, Alcohol Abuse, and Hypertension. Each endotype had distinct clinical characteristics and outcomes: The Heart Failure and Arrhythmia endotype had lower survival rates than the Renal Failure with Hypertension despite featuring fewer comorbidities overall. Patients in the Hypertension endotype had higher rates of neurosurgical intervention but shorter stays in contrast to the Alcohol Abuse endotype which had lower rates of neurosurgical intervention but significantly longer hospital stays. Both endotypes had high overall survival rates comparable to the Healthy endotype. Logistic regression models showed that endotypes improved the predictability of survival compared to individual comorbidities alone. This study validates clinical endotypes as an approach to addressing heterogeneity in TBI and demonstrates the potential of this methodology in other complex conditions.
MeSH term(s)	Adult ; Humans ; Latent Class Analysis ; Alcoholism ; Hypertension ; Brain Injuries, Traumatic/epidemiology ; Arrhythmias, Cardiac ; Heart Failure ; Renal Insufficiency
Language	English
Publishing date	2024-01-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-51474-0
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Article ; Online: Identification of clinically relevant patient endotypes in traumatic brain injury using latent class analysis

Hongbo Qiu / Zsolt Zador / Melissa Lannon / Forough Farrokhyar / Taylor Duda / Sunjay Sharma

Scientific Reports, Vol 14, Iss 1, Pp 1-

2024 Volume 14

Abstract: Abstract Traumatic brain injury (TBI) is a complex condition where heterogeneity impedes the advancement of care. Understanding the diverse presentations of TBI is crucial for personalized medicine. Our study aimed to identify clinically relevant patient ...

Abstract	Abstract Traumatic brain injury (TBI) is a complex condition where heterogeneity impedes the advancement of care. Understanding the diverse presentations of TBI is crucial for personalized medicine. Our study aimed to identify clinically relevant patient endotypes in TBI using latent class analysis based on comorbidity data. We used the Medical Information Mart for Intensive Care III database, which includes 2,629 adult TBI patients. We identified five stable endotypes characterized by specific comorbidity profiles: Heart Failure and Arrhythmia, Healthy, Renal Failure with Hypertension, Alcohol Abuse, and Hypertension. Each endotype had distinct clinical characteristics and outcomes: The Heart Failure and Arrhythmia endotype had lower survival rates than the Renal Failure with Hypertension despite featuring fewer comorbidities overall. Patients in the Hypertension endotype had higher rates of neurosurgical intervention but shorter stays in contrast to the Alcohol Abuse endotype which had lower rates of neurosurgical intervention but significantly longer hospital stays. Both endotypes had high overall survival rates comparable to the Healthy endotype. Logistic regression models showed that endotypes improved the predictability of survival compared to individual comorbidities alone. This study validates clinical endotypes as an approach to addressing heterogeneity in TBI and demonstrates the potential of this methodology in other complex conditions.
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Review and Quality Assessment of Systematic Reviews and Meta-analyses on the Management of Pediatric Inguinal Hernias: A Descriptive Study.

Alshahwani, Noora / Briatico, Daniel / Lee, Wonjae / Farrokhyar, Forough

The Journal of surgical research

2022 Volume 278, Page(s) 404–417

Abstract: Introduction: Research quality in pediatric surgery has been challenged by multiple factors, including the low incidence of some congenital pathologies and rare event rates. With the rapid increase of pediatric surgical literature, there is a need for ... ...

Abstract	Introduction: Research quality in pediatric surgery has been challenged by multiple factors, including the low incidence of some congenital pathologies and rare event rates. With the rapid increase of pediatric surgical literature, there is a need for systematic reviews to synthesize evidence. It is important to assess the quality of these systematic reviews. Objective: This study aims to examine the reporting of systematic reviews and meta-analyses, using inguinal hernia repair as an index diagnosis. Methods: MEDLINE, Embase, and CINAHL databases were searched for systematic reviews and/or meta-analyses of interventions on inguinal hernia in the pediatric population. The quality reporting was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2 tools. Results: Of 1449 unique reports, 21 studies were included (15 meta-analyses and six systematic reviews). Median percent reported items for PRISMA and AMSTAR 2 were 72.2% and 70.5%, respectively. The least reported items in PRISMA were protocol registration (27.6%), synthesis of results (13.0%), and a risk of bias across studies (20.6%). For AMSTAR 2, the least reported items were reporting of source of funding (14.3%), appropriate methods for statistical combination of results (25.0%), and pre-establishment of protocol (28.6%). All critical items were completely or partially fulfilled in 5/21 (23.8%) of the studies and completely absent in 1/21 (4.8%) studies. Conclusions: The results of this study highlight relatively good reporting quality, yet a poor methodological quality of systematic reviews/meta-analyses in the pediatric surgery literature on inguinal hernia management.
MeSH term(s)	Child ; Humans ; Bias ; Hernia, Inguinal/diagnosis ; Hernia, Inguinal/surgery ; Research Report ; Systematic Reviews as Topic ; Meta-Analysis as Topic
Language	English
Publishing date	2022-06-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.04.008
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Article ; Online: The burden of flashes and floaters in traditional general emergency services and utilization of ophthalmology on-call consultation: a cross-sectional study.

Shen, Carl / Liu, Alicia / Farrokhyar, Forough / Fava, Mark

BMC ophthalmology

2022 Volume 22, Issue 1, Page(s) 394

Abstract: Purpose: To characterize the healthcare utilization and clinical characteristics of patients presenting with flashes and/or floaters (F/F) in general emergency service (GES) settings.: Methods: All adults presenting to GESs (emergency departments ( ... ...

Abstract	Purpose: To characterize the healthcare utilization and clinical characteristics of patients presenting with flashes and/or floaters (F/F) in general emergency service (GES) settings. Methods: All adults presenting to GESs (emergency departments (EDs) and urgent care centers (UCCs)) with symptoms of F/F in Hamilton, Ontario between Jan. 1 - Dec. 31, 2018 were reviewed. Primary outcome was the proportion of patients presenting to GESs with F/F for which ophthalmology emergency services (OESs) were consulted. Secondary outcomes included features predictive of OES consultation by logistic regression and cost of GES utilization. Results: Of 6590 primary eye-related visits to GESs, 10.4% (687) involved symptoms of F/F. Mean age of patients with F/F was 57 ± 15 years, and 61% were female. Consultation rate to OESs for F/F presentations was 89% (608/687). Logistic regression identified symptoms ≤ 2 weeks (OR 8.0; 95% CI 2.3-28), ≥ 45 years age (OR 2.4; 95% CI 1.4-4.3), UCC setting (OR 2.7; 95% CI 1.6-4.6), headache (OR 0.22; 95% CI 0.12-0.41), and neurologic symptoms (OR 0.1; 95% CI 0.19-0.49) as variables predictive of OES consultation. Mean time from triage to discharge in GESs for F/F patients was 2.43 ± 2.36 h. Mean cost per visit was $139.11 ± $113.93 Canadian dollars. Patients for which OES were consulted waited a total of 1345 h in GESs and accounted for $81,879.70 in costs. Conclusion: Patients presenting with F/F in GESs consume considerable resources in healthcare expenditure and time spent in GESs and most receive OES consultation. Identifying these patients at triage may allow for increased efficiency for the healthcare system and patients.
MeSH term(s)	Adult ; Aged ; Canada ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Ophthalmology ; Referral and Consultation ; Retinal Detachment ; Retinal Perforations ; Vision Disorders/etiology ; Vitreous Detachment
Language	English
Publishing date	2022-10-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2050436-6
ISSN	1471-2415 ; 1471-2415
ISSN (online)	1471-2415
ISSN	1471-2415
DOI	10.1186/s12886-022-02613-6
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Article ; Online: Effects of the COVID-19 lockdown on Canadian ophthalmologists: a survey.

Fathalla, Zina / Chaudry, Emaan / Aminnejad, Minoo / Farrokhyar, Forough / Albreiki, Danah

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

2022 Volume 58, Issue 2, Page(s) e55–e57

MeSH term(s)	Humans ; COVID-19/epidemiology ; Ophthalmologists ; Canada/epidemiology ; Communicable Disease Control ; SARS-CoV-2 ; Surveys and Questionnaires
Language	English
Publishing date	2022-07-18
Publishing country	England
Document type	Letter
ZDB-ID	80091-0
ISSN	1715-3360 ; 0008-4182
ISSN (online)	1715-3360
ISSN	0008-4182
DOI	10.1016/j.jcjo.2022.06.022
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Article ; Online: Evaluation of wound fluid biomarkers to determine healing in adults with venous leg ulcers: A prospective study.

Stacey, Michael / Farrokhyar, Forough

Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society

2019 Volume 28, Issue 1, Page(s) 158

MeSH term(s)	Adult ; Biomarkers ; Humans ; Prospective Studies ; Varicose Ulcer ; Wound Healing
Chemical Substances	Biomarkers
Language	English
Publishing date	2019-12-09
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1174873-4
ISSN	1524-475X ; 1067-1927
ISSN (online)	1524-475X
ISSN	1067-1927
DOI	10.1111/wrr.12784
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Article ; Online: Letter to the Editor: Accuracy of Referrals to Canadian Pediatric Ophthalmology Services.

Vo, Kim / Lee, Grace Yeeun / Jindani, Yasmin / Gulamhusein, Husayn / Farrokhyar, Forough / Sabri, Kourosh

Optometry and vision science : official publication of the American Academy of Optometry

2022 Volume 99, Issue 11, Page(s) 792–793

MeSH term(s)	Humans ; Child ; Ophthalmology ; Canada ; Referral and Consultation
Language	English
Publishing date	2022-10-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1001706-9
ISSN	1538-9235 ; 1040-5488
ISSN (online)	1538-9235
ISSN	1040-5488
DOI	10.1097/OPX.0000000000001946
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Article: Inflammatory cytokines associated with mild traumatic brain injury and clinical outcomes: a systematic review and meta-analysis.

Malik, Shazia / Alnaji, Omar / Malik, Mahnoor / Gambale, Teresa / Farrokhyar, Forough / Rathbone, Michel P

Frontiers in neurology

2023 Volume 14, Page(s) 1123407

Abstract: Mild traumatic brain injuries (mTBIs) trigger a neuroinflammatory response, which leads to perturbations in the levels of inflammatory cytokines, resulting in a distinctive profile. A systematic review and meta-analysis were conducted to synthesize data ... ...

Abstract	Mild traumatic brain injuries (mTBIs) trigger a neuroinflammatory response, which leads to perturbations in the levels of inflammatory cytokines, resulting in a distinctive profile. A systematic review and meta-analysis were conducted to synthesize data related to levels of inflammatory cytokines in patients with mTBI. The electronic databases EMBASE, MEDLINE, and PUBMED were searched from January 2014 to December 12, 2021. A total of 5,138 articles were screened using a systematic approach based on the PRISMA and R-AMSTAR guidelines. Of these articles, 174 were selected for full-text review and 26 were included in the final analysis. The results of this study demonstrate that within 24 hours, patients with mTBI have significantly higher levels of Interleukin-6 (IL-6), Interleukin-1 Receptor Antagonist (IL-1RA), and Interferon-γ (IFN-γ) in blood, compared to healthy controls in majority of the included studies. Similarly one week following the injury, patients with mTBI have higher circulatory levels of Monocyte Chemoattractant Protein-1/C-C Motif Chemokine Ligand 2 (MCP-1/CCL2), compared to healthy controls in majority of the included studies. The results of the meta-analysis also confirmed these findings by demonstrating significantly elevated blood levels of IL-6, MCP-1/CCL2, and Interleukin-1 beta (IL-1β) in the mTBI population compared to healthy controls (
Language	English
Publishing date	2023-05-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1123407
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Article ; Online: Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy.

Duda, Taylor / Lannon, Melissa / Gandhi, Pranjan / Martyniuk, Amanda / Farrokhyar, Forough / Sharma, Sunjay

Neurosurgery

2023 Volume 93, Issue 1, Page(s) 4–23

Abstract: Background: Scalp block is regional anesthetic injection along nerves innervating the cranium. Scalp blocks for craniotomy may decrease postoperative pain and opioid consumption. Benefits may extend beyond the anesthetic period.: Objective: To ... ...

Abstract	Background: Scalp block is regional anesthetic injection along nerves innervating the cranium. Scalp blocks for craniotomy may decrease postoperative pain and opioid consumption. Benefits may extend beyond the anesthetic period. Objective: To analyze evidence for scalp block on postoperative pain and opioid use. Methods: This systematic review and meta-analysis, Prospective Register of Systematic Reviews registration (CRD42022308048), included Ovid Medical Literature Analysis and Retrieval System Online, Embase, and Cochrane Central Register of Controlled Trials inception through February 9, 2022. Only randomized controlled trials were included. We excluded studies not reporting either main outcome. Duplicate reviewers performed study selection, risk of bias assessment, data extraction, and evidence certainty Grading of Recommendations Assessment, Development, and Evaluation appraisal. Main outcomes were postoperative pain by visual analog scale within 72 hours and opioid consumption as morphine milligram equivalent (MME) within 48 hours. Results: Screening filtered 955 studies to 23 trials containing 1532 patients. Risk of bias was overall low. Scalp block reduced postoperative pain at 2 through 72 hours, visual analog scale mean differences of 0.79 to 1.40. Opioid requirements were reduced at 24 hours by 16.52 MME and 48 hours by 15.63 MME. Conclusion: Scalp block reduces postoperative pain at 2 through 48 hours and may reduce pain at 72 hours. Scalp block likely reduces opioid consumption within 24 hours and may reduce opioid consumption to 48 hours. The clinical utility of these differences should be interpreted within the context of modest absolute reductions, overall care optimization, and patient populations. This is the first level 1A evidence to evaluate scalp block efficacy in craniotomy.
MeSH term(s)	Humans ; Analgesics, Opioid ; Nerve Block/adverse effects ; Scalp/surgery ; Randomized Controlled Trials as Topic ; Anesthetics, Local ; Pain, Postoperative/etiology ; Craniotomy
Chemical Substances	Analgesics, Opioid ; MME (78185-58-7) ; Anesthetics, Local
Language	English
Publishing date	2023-02-10
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002381
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