Department of Medicine Faculty Publications

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    How Generalizable are Randomized Controlled trials (RCTs) in Staphylococcus aureus Bacteremia? A Description of the Mortality Gap Between RCTs and Observational Studies
    (Oxford University Press, 2022-03-04) Bai, Anthony; Lo, Carson K. L.; Komorowski, Adam; Suresh, Mallika; Guo, Kevin; Garg, Akhil; Tandon, Pranav; Senecal, Julien; Del Corpo, Olivier; Stefanova, Isabella; Fogarty, Clare; Butler-Laporte, Guillaume; McDonald, Emily; Cheng, Matthew P.; Morris, Andrew M.; Loeb, Mark; Lee, Todd
    In Staphylococcus aureus bacteremia, mortality rates in randomized controlled trials (RCTs) are consistently lower than observational studies. Stringent eligibility criteria and omission of early deaths in RCTs contribute to this mortality gap. Clinicians should acknowledge the possibility of a lower treatment effect when applying RCT results to bedside care.
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    Mycobacterium Tuberculosis Peritonitis in Peritoneal Dialysis Patients: A Scoping Review
    (Wiley, 2021-11-07) Thomson, Benjamin; Vaughan, Stephen; Momciu, Bogdan
    Background: The clinical syndrome of Mycobacterium tuberculosis (TB) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local TB patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown. Methods: A scoping review identified published cases of TB PD peritonitis. Cases from low and high TB burden areas were compared, and cases that did or did not suffer a poor clinical outcome were compared. Results: There were 216 cases identified. Demographics, presentation, diagnosis, treatment and outcomes were described. Significant delays in diagnosis were common (6.1 weeks) and were longer in patients from low TB burden regions (7.3 vs 3.7 weeks). In low TB burden areas, slower diagnostic methods were more commonly used like PD fluid culture (64.3 vs. 32.7%), and treatment was less likely with quinolone antibiotics (6.9 vs 34.1%). Higher national TB incidence and lower GDP per capita were found in cases that suffered PD catheter removal or death. Diagnostic delays were not longer in cases in which a patient suffered PD catheter removal or death. Cases that suffered death were older (51.9 vs 45.1 years) and less likely female (37.8 vs. 55.7%). Removal of PD catheter was more common in cases in which a patient died (62.0 vs 49.1%). Conclusions: Outcomes in TB PD peritonitis are best predicted by national TB incidence, patient age and sex. Several unique features are identified to alert clinicians to use more rapid diagnostic methods that might enhance outcomes in TB PD peritonitis.
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    Update on long QT syndrome
    (Wiley, 2019) Neira, Victor; Enriquez, Andrés; Simpson, Chris; Baranchuk, Adrian
    Long QT syndrome (LQTS) is an inherited disorder characterized by a prolonged QT interval in the 12‐lead electrocardiogram and increased risk of malignant arrhythmias in patients with a structurally normal heart. Since its first description in the 1950s, advances in molecular genetics have greatly improved our understanding of the cause and mechanisms of this disease. Sixteen genes linked to LQTS have been described and genetic testing had become an integral part of the diagnosis and risk stratification. This article provides an updated review of the genetic basis, diagnosis, and clinical management of LQTS.
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    Ambulatory ECG predictors of atrial fibrillation are ineffective in severe sleep apnea
    (Elsevier BV, 2019-07-01) Yeung, Cynthia; Crinion, Derek; Hammond, Sharlene; Chacko, Sanoj; Enriquez, Andres; Redfearn, Damian; Simpson, Chris; Abdollah, Hoshiar; Baranchuk, Adrian
    Background Obstructive sleep apnea (OSA) is strongly associated with atrial fibrillation (AF). Long-term ECG monitoring with implantable loop recorders facilitates the identification of undiagnosed AF in 20% of severe OSA cases. However, ambulatory ECG (AECG) monitoring is less resource intensive, and various parameters have been shown to predict AF. The aim of this study was to assess the efficacy of such AECG-based AF predictors in identifying patients with severe OSA most at risk. Methods Prospective observational study including patients with severe OSA and no history of AF. Patients had two 24-h AECG recordings, and if no AF was detected, implanted with a loop recorder (maximum 3 years). Results Of 25 patients implanted, AF ≥ 10 s was detected in 5 patients. None of the parameters from the AECG recordings were significantly different between patients who did and did not develop AF. Conclusions AECG-based parameters were not effective for the prediction of AF in this severe OSA cohort.
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    Pharmacological Treatment for Insomnia in Patients with Major Depressive Disorder
    (Taylor and Francis, 2019-05-16) Brietzke, Elisa; Vazquez, Gustavo; Kang, Melody J. Y.; Soares, Claudio
    Introduction: Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice.Areas covered: Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD.Expert opinion: Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.