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  1. Article: Extensive Brainstem Posterior Reversible Encephalopathy Syndrome in a Hemodialysis Non-Adherent Patient.

    Sallah, Ya Haddy / Zubair, Adeel S / Dewey, Jeffrey J

    Cureus

    2021  Volume 13, Issue 4, Page(s) e14523

    Abstract: Posterior reversible encephalopathy syndrome (PRES) refers to a disorder of reversible vasogenic edema caused by rapid hyperperfusion of the brain that classically involves areas supplied by the posterior circulation such as the parieto-occipital region. ...

    Abstract Posterior reversible encephalopathy syndrome (PRES) refers to a disorder of reversible vasogenic edema caused by rapid hyperperfusion of the brain that classically involves areas supplied by the posterior circulation such as the parieto-occipital region. It may present with atypical features such as brainstem and spinal cord involvement. Common causes include renal failure, pre-eclampsia/eclampsia among pregnant women, rapid changes in systemic blood pressure, and autoimmune diseases. The most prevalent presenting signs and symptoms are encephalopathy, seizures and headache. A 64-year-old female presented to a dialysis unit after missing several sessions with twitching in her extremities and elevated blood pressure. Additionally, she recently terminated clonidine use and was likely experiencing rebound hypertension. The continuous electroencephalogram (EEG) demonstrated generalized, non-convulsive seizures. MRI findings were notable for hyperintensities in the pons, middle cerebellar peduncles, cerebellar hemispheres, and periventricular and subcortical matter with medulla and proximal spinal cord involvement. A notable clinical sequela of PRES in this patient was coma. Aggressive blood pressure control led to significant improvement and return to her neurologic baseline. PRES can present with extensive brainstem involvement with a clinical sequela of coma. Multiple underlying causes such as dialysis non-adherence and rebound hypertension following clonidine discontinuation contributed to the development of this condition in this patient.
    Language English
    Publishing date 2021-04-16
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.14523
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  2. Article ; Online: The effectiveness of treatment supporter interventions in antiretroviral treatment adherence in sub-Saharan Africa: a systematic review and meta-Analysis.

    Nyoni, Thabani / Sallah, Ya Haddy / Okumu, Moses / Byansi, William / Lipsey, Kim / Small, Eusebius

    AIDS care

    2020  Volume 32, Issue Suppl 2, Page(s) 214–227

    Abstract: This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten ... ...

    Abstract This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.
    MeSH term(s) Adult ; Africa South of the Sahara ; Anti-HIV Agents/therapeutic use ; Anti-Retroviral Agents/therapeutic use ; HIV Infections/drug therapy ; Humans ; Medication Adherence ; Pharmaceutical Preparations
    Chemical Substances Anti-HIV Agents ; Anti-Retroviral Agents ; Pharmaceutical Preparations
    Language English
    Publishing date 2020-03-20
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 1012651-x
    ISSN 1360-0451 ; 0954-0121
    ISSN (online) 1360-0451
    ISSN 0954-0121
    DOI 10.1080/09540121.2020.1742870
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  3. Article ; Online: COVID-19 Outcomes and Sequencing of SARS-CoV-2 isolated from Veterans in New England

    Lee, Megan / Sallah, Ya Haddy / Ringer, Matthew / Petrone, Mary / Grubaugh, Nathan D / Gupta, Shaili

    medRxiv

    Abstract: Background: Clinical outcomes of Veterans with COVID-19 in New England and respective genomic variants of SARS-CoV-2 have not been described. Factors impacting outcomes will inform triage and management algorithms. We proposed to conduct these clinical ... ...

    Abstract Background: Clinical outcomes of Veterans with COVID-19 in New England and respective genomic variants of SARS-CoV-2 have not been described. Factors impacting outcomes will inform triage and management algorithms. We proposed to conduct these clinical and genomic evaluations. Methods: We recorded demographics, comorbidities, and outcomes for 274 patients with COVID-19 in 6 states (CT, MA, ME, NH, RI, VT) from 4/8/20-9/16/20, and used STATA v16 for logistic regressions. Peak disease severity was defined from grade 1-5 as no O2 requirement, 1-3 liters (L) by nasal cannula (NC), 4-6 L NC, >6 L O2 or non-invasive positive pressure ventilation, and mechanical ventilation. We generated 64 whole genomes from 3/31/20-5/11/20 using Illumina (238) and Nanopore (61) platforms and built a phylogenetic tree (Nextstrain). Results: Of 274 Veterans, 92.7% were male, 83.2% white, and mean age was 63 years (IQR: 51 to 74 years). Over a third resided in a long-term care facility, and most common comorbidities were coronary artery disease (27%), diabetes (25%), and tobacco use (23%). 11.7% of patients required O2 within 24 hours of admission, with 20.8% of all patients requiring O2 support above their baseline during the hospitalization. Overall, 28.8% were hospitalized, with the highest rates in people with COPD (50%), CAD (45.9%), and those over age 80 years (44.4%). The overall mortality rate was 10.6%, with the highest rates in people with dementia (33.3%), age >80 (28.9%), and those from LTC (23.9%). On multivariate regression, significant predictors of hospitalization were age (OR: 1.05) and Non-white race (OR: 2.39). Peak severity also varied by age (OR: 1.07) and O2 requirement on admission (OR: 45.7). Mortality was predicted by age (OR: 1.06), dementia (OR: 3.44), and O2 requirement on admission (OR: 6.74). Most of our samples were in the A (2.36%) and B (97.3%) lineages. One genome was part of the N.1 lineage. Notably, the majority of genomes (97%) are part of the B1 lineage, which is defined by a D614G substitution. Conclusions: Our study found that in an older cohort of Veterans from the six New England states with a high comorbidity burden, age was the single strongest predictor of hospitalization, peak severity, and mortality. Non-white Veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Furthermore, patients with dementia were more likely to die. Multiple genomic variants of SARS-CoV-2 were distributed in patients in New England early in the COVID-19 era, mostly in the New York clade with a D614G mutation.
    Keywords covid19
    Language English
    Publishing date 2021-04-30
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.04.27.21256222
    Database COVID19

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  4. Article ; Online: COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis.

    Lee, Megan / Sallah, Ya Haddy / Petrone, Mary / Ringer, Matthew / Cosentino, Danielle / Vogels, Chantal B F / Fauver, Joseph R / Alpert, Tara D / Grubaugh, Nathan D / Gupta, Shaili

    JMIRx med

    2021  Volume 2, Issue 4, Page(s) e31503

    Abstract: Background: Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes ... ...

    Abstract Background: Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes among men and older adults, making the veteran population an especially vulnerable group for COVID-19.
    Objective: This study aims to evaluate clinical and virologic factors impacting COVID-19 outcomes.
    Methods: This retrospective chart review included 476 veterans in six New England states with confirmed SARS-CoV-2 infection between April and September 2020. Whole genome sequencing was performed on SARS-CoV-2 RNA isolated from these veterans, and the correlation of genomic data to clinical outcomes was evaluated. Clinical and demographic variables were collected by manual chart review and were correlated to the end points of peak disease severity (based on oxygenation requirements), hospitalization, and mortality using multivariate regression analyses.
    Results: Of 476 veterans, 274 had complete and accessible charts. Of the 274 veterans, 92.7% (n=254) were men and 83.2% (n=228) were White, and the mean age was 63 years. In the multivariate regression, significant predictors of hospitalization (C statistic 0.75) were age (odds ratio [OR] 1.05, 95% CI 1.03-1.08) and non-White race (OR 2.39, 95% CI 1.13-5.01). Peak severity (C statistic 0.70) also varied by age (OR 1.07, 95% CI 1.03-1.11) and O2 requirement on admission (OR 45.7, 95% CI 18.79-111). Mortality (C statistic 0.87) was predicted by age (OR 1.06, 95% CI 1.01-1.11), dementia (OR 3.44, 95% CI 1.07-11.1), and O2 requirement on admission (OR 6.74, 95% CI 1.74-26.1). Most (291/299, 97.3%) of our samples were dominated by the spike protein D614G substitution and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sublineages, with none representing more than 8.7% (26/299) of the cases.
    Conclusions: In a cohort of veterans from the six New England states with a mean age of 63 years and a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-White veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York State with D614G mutation.
    Language English
    Publishing date 2021-12-17
    Publishing country Canada
    Document type Journal Article
    ISSN 2563-6316
    ISSN (online) 2563-6316
    DOI 10.2196/31503
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  5. Article ; Online: Laparoscopic Hysterectomy Route, Resource Use, and Outcomes: Change After Power Morcellation Warning.

    Desai, Vrunda B / Wright, Jason D / Lin, Haiqun / Gross, Cary P / Sallah, Ya Haddy / Schwartz, Peter E / Xu, Xiao

    Obstetrics and gynecology

    2019  Volume 134, Issue 2, Page(s) 227–238

    Abstract: Objective: To examine changes in utilization of different types of laparoscopic hysterectomy, as well as their associated resource use and surgical outcomes, after the U.S. Food and Drug Administration (FDA) safety statement in April 2014 regarding ... ...

    Abstract Objective: To examine changes in utilization of different types of laparoscopic hysterectomy, as well as their associated resource use and surgical outcomes, after the U.S. Food and Drug Administration (FDA) safety statement in April 2014 regarding power morcellation.
    Methods: We retrospectively analyzed data from the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program and identified 145,746 women undergoing hysterectomy for benign indications. We measured use of laparoscopic supracervical hysterectomy compared to total laparoscopic hysterectomy (including laparoscopic-assisted vaginal hysterectomy) in these patients, as well as operative time, surgical setting (inpatient vs outpatient), length of stay, and 30-day surgical outcomes (wound complication, medical complication, reoperation, and readmission). We used an interrupted time series analysis to examine the association between FDA warning and changes in utilization and outcomes of laparoscopic hysterectomy.
    Results: After adjusting for patient characteristics and background trends in practice, use of laparoscopic supracervical hysterectomy was significantly lower in the postwarning than prewarning period (odds ratio [OR]=0.49, 95% CI 0.45-0.53), whereas use of total laparoscopic hysterectomy was not affected (OR 1.01, 95% CI 0.96-1.06). Overall, after an initial reduction, use of laparoscopic hysterectomy (laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy combined) increased over time in the postwarning period (adjusted OR of utilization for each calendar quarter elapsed=1.03, 95% CI 1.02-1.03). After the FDA warning, operative time for laparoscopic supracervical hysterectomy increased by 11.45 minutes (95% CI 6.22-16.69), whereas the decreasing trend in the likelihood of inpatient stay for total laparoscopic hysterectomy was attenuated (OR for each calendar quarter elapsed=0.92 in prewarning period, 95% CI 0.91-0.93; and 0.97 in postwarning period, 95% CI 0.97-0.98). There was no significant change in 30-day surgical outcomes after the FDA warning.
    Conclusion: Rates of laparoscopic supracervical hysterectomy fell in association with power morcellation safety warnings, whereas rates of other laparoscopic hysterectomies continued to rise. There was no change in patient outcomes among laparoscopic hysterectomies.
    MeSH term(s) Adult ; Female ; Genital Diseases, Female/surgery ; Humans ; Hysterectomy/adverse effects ; Hysterectomy/methods ; Hysterectomy/statistics & numerical data ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Laparoscopy/statistics & numerical data ; Middle Aged ; Morcellation/adverse effects ; Morcellation/methods ; Odds Ratio ; Postoperative Complications ; Practice Patterns, Physicians'/trends ; Quality Improvement ; Retrospective Studies ; Treatment Outcome ; United States ; United States Food and Drug Administration
    Language English
    Publishing date 2019-07-26
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000003375
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  6. Article ; Online: Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study.

    Durkin, Michael J / Jafarzadeh, S Reza / Hsueh, Kevin / Sallah, Ya Haddy / Munshi, Kiraat D / Henderson, Rochelle R / Fraser, Victoria J

    Infection control and hospital epidemiology

    2018  Volume 39, Issue 5, Page(s) 584–589

    Abstract: OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data ... ...

    Abstract OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39-1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44-3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42-1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68-2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584-589.
    MeSH term(s) Ambulatory Care ; Anti-Bacterial Agents/therapeutic use ; Cohort Studies ; Databases, Factual ; Drug Utilization/statistics & numerical data ; Drug Utilization/trends ; Insurance Claim Reporting ; Outpatients/statistics & numerical data ; Poisson Distribution ; Prescriptions ; Retrospective Studies ; Seasons ; United States
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2018-02-27
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2018.26
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    Zs.A 1714: Show issues Location:
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  7. Article ; Online: An evaluation of dental antibiotic prescribing practices in the United States.

    Durkin, Michael J / Hsueh, Kevin / Sallah, Ya Haddy / Feng, Qianxi / Jafarzadeh, S Reza / Munshi, Kiraat D / Lockhart, Peter B / Thornhill, Martin H / Henderson, Rochelle R / Fraser, Victoria J

    Journal of the American Dental Association (1939)

    2017  Volume 148, Issue 12, Page(s) 878–886.e1

    Abstract: Background: Antibiotic prescribing practices among general dentists and dental specialists in the United States remains poorly understood. The purpose of this study was to compare prescribing practices across dental specialties, evaluate the duration of ...

    Abstract Background: Antibiotic prescribing practices among general dentists and dental specialists in the United States remains poorly understood. The purpose of this study was to compare prescribing practices across dental specialties, evaluate the duration of antibiotics dentists prescribed, and determine variation in antibiotic selection among dentists.
    Methods: The authors performed a retrospective cross-sectional analysis of dental care provider specialties linked to deidentified antibiotic claims data from a large pharmacy benefits manager during the 2015 calendar year.
    Results: As a group, general dentists and dental specialists were responsible for more than 2.9 million antibiotic prescriptions, higher than levels for several other medical and allied health care provider specialties. Antibiotic treatment duration generally was prolonged and commonly included broad-spectrum agents, such as amoxicillin clavulanate and clindamycin. Although amoxicillin was the most commonly prescribed antibiotic among all dental specialties, there was substantial variation among other antibiotics each specialty selected. The most common antibiotic treatment durations were 7 and 10 days.
    Conclusions: This study's results demonstrate that dentists frequently prescribe antibiotics for prolonged periods and often use broad-spectrum antibiotics. Further studies are necessary to evaluate the appropriateness of these antibiotic prescribing patterns.
    Practical implications: The clinically significant variation in antibiotic selection and treatment duration identified among all dental specialties in this study population implies that further research and guidance into the treatment of dental infections is necessary to improve and standardize antibiotic prescribing practices.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Cross-Sectional Studies ; Humans ; Practice Patterns, Dentists'/statistics & numerical data ; Retrospective Studies ; United States
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2017-09-20
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 220622-5
    ISSN 1943-4723 ; 0002-8177 ; 1048-6364
    ISSN (online) 1943-4723
    ISSN 0002-8177 ; 1048-6364
    DOI 10.1016/j.adaj.2017.07.019
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