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Nadine Shehata

Publications and source records attributed to Nadine Shehata.

6 recordsLinked to original sources
PubMed2006

Factors affecting perioperative transfusion decisions in patients with coronary artery disease undergoing coronary artery bypass surgery.

BACKGROUND: A high proportion of patients having cardiac bypass surgery receive erythrocyte transfusions. Decisions about when to transfuse patients having surgery for coronary artery disease may impact on erythrocyte utilization and patient morbidity and mortality. There are no published data about the factors that influence physicians' decisions to transfuse erythrocytes to these patients. The objectives of this study were to determine the hemoglobin concentration for transfusion and the factors that influence physicians' perioperative transfusion decisions for coronary artery bypass patients. METHODS: The authors conducted a cross-sectional study using pretested, self-administered, mailed questionnaires sent in 2004 to all cardiac surgeons and anesthesiologists in Canada who participate in coronary artery bypass surgery. The questionnaire included four intraoperative and four postoperative vignettes. Factors assessed included patient age, sex, cardiac index, and myocardial ischemia. RESULTS: The response rates were 70% (345 of 489) for the intraoperative and 61% (297 of 489) for the postoperative case scenarios. The mean hemoglobin concentrations for transfusion were 7.0 g/dl for the intraoperative case scenarios and 7.2 g/dl for the postoperative case scenarios. Older age, the presence of myocardial ischemia, and a low cardiac index were factors that increased the hemoglobin concentration for transfusion (P < 0.0001). Physicians ranked myocardial ischemia as the most significant factor affecting their transfusion decisions. CONCLUSIONS: Factors such as the presence of a low cardiac index, myocardial ischemia, and older age increase the hemoglobin concentrations at which physicians transfuse coronary bypass surgery patients. Future studies are required to elucidate whether transfusions based on these variables affect patient morbidity and mortality.

Adult↗
PubMed2004

The cost-effectiveness of screening blood donors for malaria by PCR.

BACKGROUND: The cost-effectiveness of four blood donor screening strategies for malaria was estimated to determine whether transmission by transfusion can be reduced. STUDY DESIGN AND METHODS: A decision analysis model was developed to compare 1) not screening allogeneic blood donors for malaria (Strategy 1); 2) using the standard questionnaire (Strategy 2); 3) using the standard questionnaire followed by testing blood donors with risk factors for malaria with PCR (Strategy 3); and 4) screening all blood donors using PCR (Strategy 4). The expected costs and the number of cases of malaria for each strategy were compared and incremental cost-effectiveness ratios were calculated as the cost per case of malaria averted. All costs are in Canadian dollars. RESULTS: Strategies 2 and 3 had the same effectiveness but different costs, with Strategy 3 being less costly. Compared to Strategy 1, the incremental cost effectiveness ratio was 6463 dollars per case of malaria averted for Strategy 3. Strategy 4 resulted in less transmission of malaria (0.4/million donors), but the cost compared to Strategy 3 was 3,972,624 dollars per case of malaria averted. CONCLUSION: The addition of PCR to the standard screening questionnaire is economically attractive compared to the current standard screening questionnaire.

Blood Banks↗
PubMed2002

A review of randomized controlled trials using therapeutic apheresis.

Apheresis has developed into a common therapeutic modality. The evidence for the clinical benefit of apheresis, however, is generally from uncontrolled and nonrandomized trials. Although the effectiveness of therapeutic apheresis may be established from uncontrolled trials, well-designed, randomized controlled trials provide the best evidence for a clinical benefit because this type of trial design minimizes bias. We assess the evidence for the use of apheresis, the optimal schedules for apheresis, and the replacement solutions used, based on randomized controlled trials. The databases, MEDLINE and EMBASE, and reference lists from relevant articles were searched. The literature search was restricted to articles published in English and included adult patients only. Two of the authors (NS, CK) independently reviewed the citation list to identify reports for retrieval, and the kappa statistic was used to quantify agreement between the reviewers. Articles were included if they used apheresis as an intervention and had clinical endpoints. The quality of the studies was assessed by using a validated instrument. Five hundred and ninety-two citations were identified, and a total of 85 reports were included in this review. There are only a few well-established indications for therapeutic apheresis. Randomized, controlled trials have clearly shown a benefit for patients treated with apheresis who have Guillain-Barre syndrome and patients who have thrombotic thrombocytopenic purpura. A clinical benefit has not been shown for a variety of conditions, including systematic lupus erythematosus, polyarteritis nodosa/Churg-Strauss syndrome, and for the treatment of renal allograft rejection. The effectiveness of apheresis needs to be clarified for several other diseases. As better-designed, randomized trials are performed, the role of apheresis for these indications will be further elucidated.

Blood Component Removal↗
PubMedDate not supplied

Canadian multicenter pilot trial of haploidentical donor transplantation.

BACKGROUND: Canadian multicenter pilot study of haploidentical donor. AIMS: To assess (1) ability to collect suitable graft (CD34+ > or = 5 x 10(6)/kg and CD3 < 1 x 10(5)/kg recipient body weight), (2) toxicity, (3) survival to day +100. ELIGIBILITY: All hematological malignancies and ages; accrual to end after 20 transplants of patients with AML in remission and age less than 55 years. METHODS: Preparation: Modified Perugia regimen, chemotherapy alone; melphalan 140 mg/m2 day -9, thiotepa 10 mg/kg day -7, fludarabine 40 mg/m2 days -7 to -3, and ATG (Thymoglobulin, Sangstat) days -6 to -2 (total 10.5 mg/kg). Infection prophylaxis: Ganciclovir (GC) 5 mg/kg days 5-20 then x5/week until day +100 then x3/week until 210 (subjects 1-3), foscarnet (FC) 90 mg/kg days 4-21 then short course pre-emptive GC or FC (subjects 4-11); fluconazole; cotrimoxazole. Donors: G-CSF 16 microg/kg daily x5 until second pheresis day. T-cell depletion: CliniMACS (MiltenyiBiotec). RESULTS: Eleven patients with AML have been transplanted from four centers, eight female, three male, median age 34 (range 19-60). Disease status, first CR 1/11, second CR 4/11, third CR1/11, relapse 5/11. Graft CD34+ > or = 5 x 10(6)/kg was achieved in all cases, median 13.72 x 10(6)/kg (Q1, Q3: 8.26, 17.72; min 5.59, max 22.22), and CD3+ was < 1 x 10(5)/kg in all cases, median of 0.49 x 10(4)/kg (Q1, Q3: 0.30, 2.20; min 0.22, max 4.10). Ten of the 11 patients have died, median survival 103.5 days (Q1, Q3: 61.0, 151.0; min 0, max 290.0). Survival to day +100 6/11 (55%). Four patients died of leukemic relapse, six of infection. Of six patients dying of infection, CMV was a definite cause in four. Of four dying with relapse, CMV was significant in one. Engraftment was assessed in 10 patients who survived >0 days. Granulocyte engraftment (> 0.5 x 10(9)/l) was achieved in all patients, median 11.5 days (Q1, Q3: 10, 17; min 8, max 70). Platelet engraftment (> 20 x 10(9)/l) was achieved in 8 of 10 patients, median 15 days (Q1, Q3: 9, 16; min 9, max 97). The two platelet non-engrafters died on days +45 and +61. Toxicity was low, with one toxic death (day 0), and the Bearman organ toxicity gradings were < or = grade 2 in all other patients. There were no instances of graft-vs.-host disease or graft rejection. CONCLUSIONS: The problems of graft-vs.-host disease and graft rejection have been removed as barriers to haploidentical transplantation but the slow immune reconstitution limits its general application. Late referrals contribute to a high relapse rate and have delayed an optimal evaluation of the procedure.

Adult↗