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Daigle, Jean-Marc

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Université Laval. Département de mathématiques et de statistique
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  • Publication
    Accès libre
    Metabolic syndrome increases operative mortality in patients undergoing coronary artery bypass grafting surgery
    (Elsevier Biomedical, 2007-08-28) Daigle, Jean-Marc; Baillot, Richard; Mohty, Dania; Voisine, Pierre; Pibarot, Philippe; Després, Jean-Pierre; Mathieu, Patrick; Echahidi, Najmeddine
    OBJECTIVES: The aim of this study was to determine the impact of the metabolic syndrome (MS) on operative mortality after a coronary artery bypass grafting surgery (CABG). BACKGROUND: Diabetes and obesity are highly prevalent among patients undergoing CABG. However, it remains unclear whether these factors have a significant impact on operative mortality after this procedure. We hypothesized that the metabolic abnormalities associated with MS could negatively influence the operative outcome of CABG surgery. METHODS: We retrospectively analyzed the data of 5,304 consecutive patients who underwent an isolated CABG procedure between 2000 and 2004. Of these 5,304 patients, 2,411 (46%) patients met the National Cholesterol Education Program-Adult Treatment Panel III criteria for MS. The primary end point was operative mortality. RESULTS: The operative mortality after CABG surgery was 2.4% in patients with MS and 0.9% in patients without MS (p < 0.0001). The MS was a strong independent predictor of operative mortality (relative risk 3.04 [95% confidence interval (CI) 1.73 to 5.32], p = 0.0001). After adjusting for other risk factors, the risk of mortality was increased 2.69-fold (95% CI 1.43 to 5.06; p = 0.002) in patients with MS and diabetes and 2.36-fold (95% CI 1.26 to 4.41; p = 0.007) in patients with MS and no diabetes, whereas it was not significantly increased in the patients with diabetes and no MS. CONCLUSIONS: This is the first study to report that MS is a highly prevalent and powerful risk factor for operative mortality in patients undergoing a CABG surgery. Thus, interventions that could contribute to reduce the prevalence of MS in patients with coronary artery disease or that could acutely modify the metabolic perturbations of MS at the time of CABG might substantially improve survival in these patients
  • Publication
    Cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients : two systematic reviews and meta-analyses
    (Elsevier, 2019-06-04) Picard, Matthieu; Biron, Éric; Robitaille, Geneviève; Daigle, Jean-Marc; Karam, Fatiha; Bédard, François; Tardif, Mélanie; Lacombe-Barrios, Jonathan; Bégin, Philippe
    BACKGROUND: There is no recent systematic review on therisk of cross-reactivity to cephalosporins and carbapenems inpenicillin-allergic patients despite many new studies on the subject. All past reviews have several limitations such as not including any patient with a T-celle mediated penicillin allergy. OBJECTIVES: To determine the risk of cross-reactivity to cephalosporins and carbapenems in patients with a proven IgE-or T-cellemediated penicillin allergy. To measure the association between R1 side chain similarity on cephalosporins andpenicillins and the risk of cross-reactivity. METHODS: MEDLINE and EMBASE were searched fromJanuary 1980 to March 2019. Studies had to include at least 10 penicillin-allergic subjects whose allergy had been confirmed bya positive skin test (ST) or drug provocation test (DPT) result.Cross-reactivity had to be assessed to at least 1 cephalosporin orcarbapenem through ST or DPT. Both random-effects andfixed-effect models were used to combine data. A bioinformaticmodel was used to quantify the similarity between R1 sidechains. RESULTS: Twenty-one observational studies on cephalosporincross-reactivity involving 1269 penicillin-allergic patientsshowed that the risk of cross-reactivity varied with the degree ofsimilarity between R1 side chains: 16.45% (95% CI, 11.07-23.75) for aminocephalosporins, which share an identical sidechain with a penicillin (similarity score[1), 5.60% (95% CI,3.46-8.95) for a few cephalosporins with an intermediate simi-larity score (range, 0.563-0.714), and 2.11% (95% CI, 0.98-4.46) for all those with low similarity scores (below 0.4), irre-spective of cephalosporin generation. The higher risk associatedwith aminocephalosporins was observed whether penicillin al-lergy was IgE- or T-cellemediated. Eleven observational studieson carbapenem cross-reactivity involving 1127 penicillin-allergicpatients showed that the risk of cross-reactivity to any carba-penem was 0.87% (95% CI, 0.32-2.32). CONCLUSIONS: Although it remains possible that these meta-analyses overestimated the risk of cross-reactivity, cliniciansshould consider the increased risk of cross-reactivity associatedwith aminocephalosporins, and to a lesser extent withintermediate-similarity-score cephalosporins, compared with thevery low risk associated with low-similarity-score cephalosporinsand all carbapenems when using beta-lactams in patients with asuspected or proven penicillin allergy.