Institution
Amiri Hospital
Healthcare•Kuwait City, Kuwait•
About: Amiri Hospital is a healthcare organization based out in Kuwait City, Kuwait. It is known for research contribution in the topics: Population & Fingolimod. The organization has 541 authors who have published 652 publications receiving 9332 citations.
Papers published on a yearly basis
Papers
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Ludwig Maximilian University of Munich1, Hannover Medical School2, University Medical Center Freiburg3, Gazi University4, Helsinki University Central Hospital5, Boston Children's Hospital6, University of São Paulo7, University of Padua8, Seattle Children's9, Amiri Hospital10, University College London11
TL;DR: It is indicated that infantile IBD patients with perianal disease should be screened for IL-10 and IL-11R deficiency and that allogeneic HSCT can induce remission in those with IL- 10R deficiency.
368 citations
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TL;DR: The Koran specifically exempts the sick from the duty of fasting, especially if fasting might lead to harmful consequences for the individual, and patients with diabetes fall under this category because their chronic metabolic disorder may place them at high risk for various complications if the pattern of their meal and fluid intake is markedly altered.
Abstract: It is estimated that there are 1.1–1.5 billion Muslims worldwide, comprising 18–25% of the world population (1,2). Fasting during Ramadan, a holy month of Islam, is an obligatory duty for all healthy adult Muslims. An ∼4.6% prevalence of diabetes worldwide (3) coupled with the results of the population-based Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, which showed (in 12,243 people with diabetes from 13 Islamic countries) that ∼43% of patients with type 1 diabetes and ∼79% of patients with type 2 diabetes fast during Ramadan (4), lead to the estimation that some 40–50 million people with diabetes worldwide fast during Ramadan.
Ramadan is a lunar-based month, and its duration varies between 29 and 30 days. Its timing changes with respect to seasons. Depending on the geographical location and season, the duration of the daily fast may range from a few to more than 20 h. Muslims who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after sunset; however, there are no restrictions on food or fluid intake between sunset and dawn. Most people consume two meals per day during this month, one after sunset, referred to in Arabic as Iftar (breaking of the fast meal), and the other before dawn, referred to as Suhur (predawn). Fasting is not meant to create excessive hardship on the Muslim individual. The Koran specifically exempts the sick from the duty of fasting (Holy Koran, Al-Bakarah, 183–185), especially if fasting might lead to harmful consequences for the individual. Patients with diabetes fall under this category because their chronic metabolic disorder may place them at high risk for various complications if the pattern and amount of their meal and fluid intake is markedly altered. This exemption represents more than a simple permission not to …
333 citations
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University of Cambridge1, University College London2, University of Melbourne3, Charles University in Prague4, Université du Québec à Montréal5, University of Bari6, Amiri Hospital7, University of Queensland8, Cliniques Universitaires Saint-Luc9, Ondokuz Mayıs University10, John Hunter Hospital11, Flinders University12, Isfahan University of Medical Sciences13, University of Parma14, Royal Melbourne Hospital15, University Hospital of Wales16, University of Bristol17, University College Dublin18, Cardiff University19, Monash University20
TL;DR: The probability of conversion was lower when glatiramer acetate or interferon beta was started within 5 years of disease onset vs later, and initial treatment with fingolimod, alemtuzumab, or natalizumab was associated with a lower risk of conversion.
Abstract: Importance:
Within 2 decades of onset, 80% of untreated patients with relapsing-remitting multiple sclerosis (MS) convert to a phase of irreversible disability accrual termed secondary progressive MS. The association between disease-modifying treatments (DMTs), and this conversion has rarely been studied and never using a validated definition.
Objective:
To determine the association between the use, the type of, and the timing of DMTs with the risk of conversion to secondary progressive MS diagnosed with a validated definition.
Design, Setting, and Participants:
Cohort study with prospective data from 68 neurology centers in 21 countries examining patients with relapsing-remitting MS commencing DMTs (or clinical monitoring) between 1988-2012 with minimum 4 years’ follow-up.
Exposures:
The use, type, and timing of the following DMTs: interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab. After propensity-score matching, 1555 patients were included (last follow-up, February 14, 2017).
Main Outcome and Measure:
Conversion to objectively defined secondary progressive MS.
Results:
Of the 1555 patients, 1123 were female (mean baseline age, 35 years [SD, 10]). Patients initially treated with glatiramer acetate or interferon beta had a lower hazard of conversion to secondary progressive MS than matched untreated patients (HR, 0.71; 95% CI, 0.61-0.81; P < .001; 5-year absolute risk, 12% [49 of 407] vs 27% [58 of 213]; median follow-up, 7.6 years [IQR, 5.8-9.6]), as did fingolimod (HR, 0.37; 95% CI, 0.22-0.62; P < .001; 5-year absolute risk, 7% [6 of 85] vs 32% [56 of 174]; median follow-up, 4.5 years [IQR, 4.3-5.1]); natalizumab (HR, 0.61; 95% CI, 0.43-0.86; P = .005; 5-year absolute risk, 19% [16 of 82] vs 38% [62 of 164]; median follow-up, 4.9 years [IQR, 4.4-5.8]); and alemtuzumab (HR, 0.52; 95% CI, 0.32-0.85; P = .009; 5-year absolute risk, 10% [4 of 44] vs 25% [23 of 92]; median follow-up, 7.4 years [IQR, 6.0-8.6]). Initial treatment with fingolimod, alemtuzumab, or natalizumab was associated with a lower risk of conversion than initial treatment with glatiramer acetate or interferon beta (HR, 0.66; 95% CI, 0.44-0.99; P = .046); 5-year absolute risk, 7% [16 of 235] vs 12% [46 of 380]; median follow-up, 5.8 years [IQR, 4.7-8.0]). The probability of conversion was lower when glatiramer acetate or interferon beta was started within 5 years of disease onset vs later (HR, 0.77; 95% CI, 0.61-0.98; P = .03; 5-year absolute risk, 3% [4 of 120] vs 6% [2 of 38]; median follow-up, 13.4 years [IQR, 11-18.1]). When glatiramer acetate or interferon beta were escalated to fingolimod, alemtuzumab, or natalizumab within 5 years vs later, the HR was 0.76 (95% CI, 0.66-0.88; P < .001; 5-year absolute risk, 8% [25 of 307] vs 14% [46 of 331], median follow-up, 5.3 years [IQR], 4.6-6.1).
Conclusions and Relevance:
Among patients with relapsing-remitting MS, initial treatment with fingolimod, alemtuzumab, or natalizumab was associated with a lower risk of conversion to secondary progressive MS vs initial treatment with glatiramer acetate or interferon beta. These findings, considered along with these therapies’ risks, may help inform decisions about DMT selection.
299 citations
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University of Melbourne1, Royal Melbourne Hospital2, Monash University3, Charles University in Prague4, University of Bari5, University of Bologna6, Amiri Hospital7, Karadeniz Technical University8, University of Newcastle9, John Hunter Hospital10, Cliniques Universitaires Saint-Luc11, University of Parma12, Flinders Medical Centre13, University of Florence14, University of Queensland15, Westmead Hospital16, University of Sydney17, Liverpool Hospital18, Geelong Hospital19, Jewish General Hospital20
TL;DR: In this article, the authors evaluated the accuracy and feasibility of an objective definition for secondary progressive multiple sclerosis, to enable comparability of future research studies, using MSBase, a large, prospectively acquired, global cohort study, and analyzed the accuracy of 576 data-derived onset definitions for SPM and compared these to a consensus opinion of three neurologists.
Abstract: A number of studies have been conducted with the onset of secondary progressive multiple sclerosis as an inclusion criterion or an outcome of interest. However, a standardized objective definition of secondary progressive multiple sclerosis has been lacking. The aim of this work was to evaluate the accuracy and feasibility of an objective definition for secondary progressive multiple sclerosis, to enable comparability of future research studies. Using MSBase, a large, prospectively acquired, global cohort study, we analysed the accuracy of 576 data-derived onset definitions for secondary progressive multiple sclerosis and first compared these to a consensus opinion of three neurologists. All definitions were then evaluated against 5-year disease outcomes post-assignment of secondary progressive multiple sclerosis: sustained disability, subsequent sustained progression, positive disability trajectory, and accumulation of severe disability. The five best performing definitions were further investigated for their timeliness and overall disability burden. A total of 17 356 patients were analysed. The best definition included a 3-strata progression magnitude in the absence of a relapse, confirmed after 3 months within the leading Functional System and required an Expanded Disability Status Scale step ≥4 and pyramidal score ≥2. It reached an accuracy of 87% compared to the consensus diagnosis. Seventy-eight per cent of the identified patients showed a positive disability trajectory and 70% reached significant disability after 5 years. The time until half of all patients were diagnosed was 32.6 years (95% confidence interval 32-33.6) after disease onset compared with the physicians' diagnosis at 36 (35-39) years. The identified patients experienced a greater disease burden [median annualized area under the disability-time curve 4.7 (quartiles 3.6, 6.0)] versus non-progressive patients [1.8 (1.2, 1.9)]. This objective definition of secondary progressive multiple sclerosis based on the Expanded Disability Status Scale and information about preceding relapses provides a tool for a reproducible, accurate and timely diagnosis that requires a very short confirmation period. If applied broadly, the definition has the potential to strengthen the design and improve comparability of clinical trials and observational studies in secondary progressive multiple sclerosis.
254 citations
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University of Melbourne1, Royal Melbourne Hospital2, University of Alabama3, Charles University in Prague4, University of Bari5, University of Chieti-Pescara6, Karadeniz Technical University7, Unica Corporation8, Amiri Hospital9, Cliniques Universitaires Saint-Luc10, Ondokuz Mayıs University11, Flinders University12, Craigavon Area Hospital13, Monash University14
TL;DR: The results suggest that the disability outcomes based on 3-6-month confirmed disability progression overestimate the accumulation of permanent disability by up to 30%.
Abstract: Prevention of irreversible disability is currently the most important goal of disease modifying therapy for multiple sclerosis. The disability outcomes used in most clinical trials rely on progression of Expanded Disability Status Scale score confirmed over 3 or 6 months. However, sensitivity and stability of this metric has not been extensively evaluated. Using the global MSBase cohort study, we evaluated 48 criteria of disability progression, testing three definitions of baseline disability, two definitions of progression magnitude, two definitions of long-term irreversibility and four definitions of event confirmation period. The study outcomes comprised the rates of detected progression events per 10 years and the proportions of the recorded events persistent at later time points. To evaluate the ratio of progression frequency and stability for each criterion, we calculated the proportion of events persistent over the five subsequent years once progression was achieved. Finally, we evaluated the clinical and demographic determinants characterising progression events and, for those that regressed back to baseline, determinants of their subsequent regression. The study population consisted of 16 636 patients with the minimum of three recorded disability scores, totalling 112 584 patient-years. The progression rates varied between 0.41 and 1.14 events per 10 years, with the length of required confirmation interval as the most important determinant of the observed variance. The concordance among all tested progression criteria was only 17.3%. Regression of disability occurred in 11-34% of the progression events over the five subsequent years. The most important determinant of progression stability was the length of the confirmation period. For the most accurate set of the progression criteria, the proportions of 3-, 6-, 12- or 24-month confirmed events persistent over 5 years reached 70%, 74%, 80% and 89%, respectively. Regression post progression was more common in younger patients, relapsing-remitting disease course, and after a smaller change in disability, and was inflated by higher visit frequency. These results suggest that the disability outcomes based on 3-6-month confirmed disability progression overestimate the accumulation of permanent disability by up to 30%. This could lead to spurious results in short-term clinical trials, and the issue may be magnified further in cohorts consisting predominantly of younger patients and patients with relapsing-remitting disease. Extension of the required confirmation period increases the persistence of progression events.
154 citations
Authors
Showing all 546 results
Name | H-index | Papers | Citations |
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Suzanne Hodgkinson | 34 | 122 | 4581 |
Ahmed R. El-Nahas | 30 | 133 | 3083 |
Raed Alroughani | 29 | 187 | 3398 |
Mohamed A.A. Moussa | 23 | 55 | 1476 |
Salman Al-Sabah | 19 | 82 | 1050 |
Iqbal Siddique | 17 | 48 | 1370 |
Raed Behbehani | 17 | 51 | 816 |
Monira Al-Arouj | 15 | 28 | 1446 |
Adel Al-Awadhi | 14 | 38 | 544 |
Abdullah Bennakhi | 13 | 21 | 688 |
John Patrick Madda | 13 | 31 | 520 |
Ossama M. Reslan | 12 | 23 | 590 |
Basil Al-Nakib | 12 | 23 | 520 |
Sulaiman Almazeedi | 11 | 34 | 442 |
Osama Al-Saeed | 10 | 20 | 260 |