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  1. Article ; Online: Prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy

    Fayez Alshamsi / Roman Jaeschke / Bandar Baw / Waleed Alhazzani

    Saudi Journal of Medicine and Medical Sciences, Vol 5, Iss 3, Pp 201-

    A systematic review and meta-analysis

    2017  Volume 209

    Abstract: Background: Patients with upper gastrointestinal bleeding (UGIB) often require urgent or emergent esophagogastroduodenoscopy (EGD) and are at risk of complications such as aspiration of gastric content or blood. The role of prophylactic endotracheal ... ...

    Abstract Background: Patients with upper gastrointestinal bleeding (UGIB) often require urgent or emergent esophagogastroduodenoscopy (EGD) and are at risk of complications such as aspiration of gastric content or blood. The role of prophylactic endotracheal intubation (PEI) in the absence of usual respiratory status-related indications is not well established. Methods: We searched Medline, EMBASE, Cochrane Library's Central Register of Controlled Trials (CENTRAL) and SCOPUS from inception through July 2017 without date or language of publication restriction. We included studies that compared PEI with usual care (UC) in patients with acute UGIB, and reported any of the following outcomes: aspiration, pneumonia, mortality and length of stay. We excluded studies in which majority of included patients required intubation due to respiratory failure or decreased level of consciousness. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence for each outcome. Results: We did not identify any randomized trials on this topic. We included 10 observational studies (n = 6068). We were not able to perform any adjusted analyses. PEI was associated with a significant increase in aspiration (OR 3.85, 95% CI, 1.46, 10.25; P = 0.01; I2 = 56%; low-quality evidence), pneumonia (OR 4.17, 95% CI, 1.82, 9.57; P = 0.0007; I2 =52%; low-quality evidence) and hospital length of stay (mean difference 0.86 days, 95% CI 0.13, 1.59; P = 0.02; I2 = 0; low-quality evidence), without clear effect on mortality (OR 1.92, 95% CI, 0.71, 5.23; P = 0.2; I2 = 95%; very low-quality evidence). Conclusions: Low- to very low-quality evidence from observational studies suggests that PEI in the setting of UGIB may be associated with higher rates of respiratory complications and, less likely, with increased mortality. Although the results are alarming, the lack of higher quality evidence calls for randomized trials to inform practice.
    Keywords Endoscopy ; systematic review ; meta-analysis ; prophylactic endotracheal intubation ; upper gastrointestinal bleeding ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2017-01-01T00:00:00Z
    Publisher Wolters Kluwer Medknow Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: The efficacy and safety of hydroxychloroquine for COVID-19 prophylaxis

    Kimberley Lewis / Dipayan Chaudhuri / Fayez Alshamsi / Laiya Carayannopoulos / Karin Dearness / Zain Chagla / Waleed Alhazzani / GUIDE Group

    PLoS ONE, Vol 16, Iss 1, p e

    A systematic review and meta-analysis of randomized trials.

    2021  Volume 0244778

    Abstract: Background Populations such as healthcare workers (HCW) that are unable to practice physical distancing are at high risk of acquiring Coronavirus disease-2019 (COVID-19). In these cases pharmacological prophylaxis would be a solution to reduce severe ... ...

    Abstract Background Populations such as healthcare workers (HCW) that are unable to practice physical distancing are at high risk of acquiring Coronavirus disease-2019 (COVID-19). In these cases pharmacological prophylaxis would be a solution to reduce severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) transmission. Hydroxychloroquine has in vitro antiviral properties against SARS CoV-2. We therefore sought to determine the efficacy and safety of hydroxychloroquine as prophylaxis for COVID-19. Methods and findings We electronically searched EMBASE, MEDLINE, the Cochrane COVID-19 Register of Controlled Trials, Epistemonikos COVID-19, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to September 28th, 2020 for randomized controlled trials (RCTs). We calculated pooled relative risks (RRs) for dichotomous outcomes with the corresponding 95% confidence intervals (CIs) using a random-effect model. We identified four RCTs (n = 4921) that met our eligibility criteria. The use of hydroxychloroquine, compared to placebo, did not reduce the risks of developing COVID-19 (RR 0.82, 95% CI 0.65 to 1.04, moderate certainty), hospitalization (RR 0.72, 95% CI 0.34 to 1.50, moderate certainty), or mortality (RR 3.26, 95% CI 0.13 to 79.74, low certainty), however, hydroxychloroquine use increased the risk of adverse events (RR 2.76, 95% CI 1.38 to 5.55, moderate certainty). Conclusion Although pharmacologic prophylaxis is an attractive preventive strategy against COVID-19, the current body of evidence failed to show clinical benefit for prophylactic hydroxychloroquine and showed a higher risk of adverse events when compared to placebo or no prophylaxis.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Venous and arterial thrombosis in COVID-19

    Zainab Al Duhailib / Simon Oczkowski / Kamil Polok / Jakub Fronczek / Wojciech Szczeklik / Joshua Piticaru / Manoj J. Mammen / Fayez Alshamsi / John Eikelboom / Emilie Belley-Cote / Waleed Alhazzani

    Journal of Infection and Public Health, Vol 15, Iss 6, Pp 689-

    An updated narrative review

    2022  Volume 702

    Abstract: Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic ... ...

    Abstract Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer’s role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. Take-home points: • The prevalence of venous thromboembolism (VTE) in hospitalized COVID-19 patients is high, therefore, clinicians should have a high index of suspicion. • The pathophysiology of thrombosis is likely related to a combination of SARS-CoV-2 direct endothelial injury and dysregulated inflammation causing coagulation activation. • The current evidence on the value of D-dimer guided therapy is limited. • The rate of VTE post-hospital discharge is very low, supporting the safety of current discharge practice without VTE prophylaxis in most patients. • The role of higher-intensity VTE prophylaxis or therapeutic anticoagulation in critically ill COVID-19 patients without documented or suspected VTE remains uncertain. • Therapeutic anticoagulation in hospitalized non-critically ill patients with COVID-19 may improve outcomes but more research is warranted.
    Keywords Anticoagulation ; COVID-19 ; Thrombosis ; Venous thromboembolism prophylaxis ; Critically ill ; D-dimer level ; Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
    Subject code 610
    Language English
    Publishing date 2022-06-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU

    Waleed Alhazzani / Mohammed Alshahrani / Fayez Alshamsi / Ohoud Aljuhani / Khalid Eljaaly / Samaher Hashim / Rakan Alqahtani / Doaa Alsaleh / Zainab Al Duhailib / Haifa Algethamy / Tariq Al-Musawi / Thamir Alshammari / Abdullah Alqarni / Danya Khoujah / Wail Tashkandi / Talal Dahhan / Najla Almutairi / Haleema A. Alserehi / Maytha Al-Yahya /
    Bandar Al-Judaibi / Yaseen M. Arabi / Jameel Abualenain / Jawaher M. Alotaibi / Ali Al bshabshe / Reham Alharbi / Fahad Al-Hameed / Alyaa Elhazmi / Reem S. Almaghrabi / Fatma Almaghlouth / Malak Abedalthagafi / Noor Al Khathlan / Faisal A. Al-Suwaidan / Reem F. Bunyan / Bandar Baw / Ghassan Alghamdi / Manal Al Hazmi / Yasser Mandourah / Abdullah Assiri / Mushira Enani / Maha Alawi / Reem Aljindan / Ahmed Aljabbary / Abdullah Alrbiaan / Fahd Algurashi / Abdulmohsen Alsaawi / Thamer H. Alenazi / Mohammed A. Alsultan / Saleh A. Alqahtani / Ziad Memish / Jaffar A. Al-Tawfiq

    Journal of Infection and Public Health, Vol 15, Iss 1, Pp 142-

    Therapy section

    2022  Volume 151

    Abstract: Background: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based ... ...

    Abstract Background: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). Methods: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. Results: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. Conclusion: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.
    Keywords COVID-19 ; Therapy ; Practice guideline ; Intensive care unit ; Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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