ORCID Profile
0000-0002-0053-2184
Current Organisations
NHS Lothian
,
The University of Edinburgh
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Publisher: BMJ
Date: 06-08-2021
Abstract: Inflammatory responses to intracerebral haemorrhage (ICH) are potential therapeutic targets. We aimed to quantify molecular markers of inflammation in human brain tissue after ICH compared with controls using meta-analysis. We searched OVID MEDLINE (1946–) and Embase (1974–) in June 2020 for studies that reported any measure of a molecular marker of inflammation in brain tissue from five or more adults after ICH. We assessed risk of bias using a modified Newcastle-Ottawa Scale (mNOS mNOS score 0–9 9 indicates low bias), extracted aggregate data, and used random effects meta-analysis to pool associations of molecules where more than two independent case–control studies reported the same outcome and Gene Ontology enrichment analysis to identify over-represented biological processes in pooled sets of differentially expressed molecules (International Prospective Register of Systematic Reviews ID: CRD42018110204). Of 7501 studies identified, 44 were included: 6 were case series and 38 were case–control studies (median mNOS score 4, IQR 3–5). We extracted data from 21 491 analyses of 20 951 molecules reported by 38 case–control studies. Only one molecule (interleukin-1β protein) was quantified in three case–control studies (127 ICH cases vs 41 ICH-free controls), which found increased abundance of interleukin-1β protein after ICH (corrected standardised mean difference 1.74, 95% CI 0.28 to 3.21, p=0.036, I 2 =46%). Processes associated with interleukin-1β signalling were enriched in sets of molecules that were more abundant after ICH. Interleukin-1β abundance is increased after ICH, but analyses of other inflammatory molecules after ICH lack replication. Interleukin-1β pathway modulators may optimise inflammatory responses to ICH and merit testing in clinical trials.
Publisher: BMJ
Date: 21-11-2013
Abstract: There is uncertainty about the long-term prognosis after spontaneous intracerebral haemorrhage (ICH). Therefore, we systematically reviewed the literature for studies reporting long-term survival and ICH recurrence, and their predictors. We searched Ovid Medline 1946-2011 inclusive for cohort studies of ≥50 patients reporting long-term (>30 days) outcome after ICH. Two reviewers independently extracted data from each study. We meta-analysed 1-year and 5-year survival data from population-based studies using a random effects model (and quantified inconsistency using the I2 statistic). We identified 122 eligible studies. The pooled estimate of 1-year survival was 46% (95% CI 43% to 49% nine population-based studies (n=2408) I2=27%) and 5-year survival was 29% (95% CI 26% to 33% three population-based studies (n=699) I2=6%). In 27 cohort studies, predictors most consistently associated with death were increasing age, decreasing Glasgow Coma Scale score, increasing ICH volume, presence of intraventricular haemorrhage, and deep/infratentorial ICH location. The annual risk of recurrent ICH varied from 1.3% to 7.4% in nine studies and this risk was higher after lobar ICH than non-lobar ICH in two of three hospital-based studies. Four studies reporting the risks of recurrent ICH and ischaemic stroke after ICH found no significant differences between these risks. Less than a half of patients with ICH survive 1 year and less than a third survive 5 years. Risks of recurrent ICH and ischaemic stroke after ICH appear similar after ICH, provoking uncertainties about the use of antithrombotic drugs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-07-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
DOI: 10.1161/STROKEAHA.117.019227
Abstract: The absence of treatments for intracerebral hemorrhage with significant consistent benefit in randomized controlled trials (RCTs) could be because of lack of treatment efficacy or the design of RCTs. We searched the Cochrane Stroke Group Trials Register in December 2015 for completed and published RCTs reporting clinical outcome in adults with intracerebral hemorrhage. We collected data on publication year and language, study characteristics, and effect size. We regarded RCTs to be at lower risk of bias if they performed ≥2 of describing randomization, using blinding, or specifying the primary outcome. We registered this systematic review (PROSPERO, international prospective register of systematic reviews CRD42016051103). We found 136 eligible RCTs: 57% were phase II, 76% were single center, 98% studied acute treatments, 49% involved drug interventions, 24% were placebo-controlled, the primary outcome was death or disability in 30%, and median s le size was 77 (interquartile range, 47–160). Forty-six percent explained randomization, 24% blinded treatment allocation, and 24% specified the primary outcome such that 38 (28%) were at lower risk of bias. RCTs at lower risk of bias were more likely to use multicenter recruitment (adjusted odds ratio, 6.95 95% confidence interval, 2.2–21.5) and be published in English (adjusted odds ratio, 12.9, 95% confidence interval, 2.7–62.5). RCTs with larger s le sizes were independently more likely to be phase III/IV ( P .01) and use multicenter recruitment ( P .01). RCTs at lower risk of bias had smaller pooled treatment effects on death/disability ( P =0.02). Intracerebral hemorrhage RCTs have often been at high risk of bias, and these RCTs have been characterized by small s le sizes and larger effect sizes.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2017
DOI: 10.1007/S10143-017-0860-X
Abstract: In view of their age and vascular co-morbidities, people are often taking an antithrombotic drug when diagnosed with chronic subdural haematoma (CSDH). It is unclear whether antithrombotic use at CSDH diagnosis, or resumption afterwards, is associated with recurrent CSDH or vaso-occlusive events. We systematically reviewed the literature for studies reporting CSDH recurrence or vaso-occlusive events after drainage of CSDH associated with antithrombotic drug use. We searched Medline 1946-2016 and Embase 1974-2016 inclusive for cohort studies reporting the risk of CSDH recurrence or vaso-occlusive events after CSDH associated with antithrombotic (anticoagulant or antiplatelet) drug use. We meta-analysed outcome data using a random effect model and assessed inconsistency between studies using the I-squared (I
Publisher: S. Karger AG
Date: 12-11-2015
DOI: 10.1159/000437109
Abstract: Intracerebral haemorrhage (ICH) has an overall incidence of 24.6 per 100,000 person-years and is associated with a high case fatality. Understanding the risk factors for ICH occurrence informs primary prevention strategies. This article provides an update on the current global patterns of ICH incidence and the common and emerging risk factors associated with ICH. We searched Ovid Medline (from 1980 to Oct 2014) for systematic reviews that addressed the epidemiology of ICH and for recent original studies that revealed new insights into the frequency of and the risk factors associated with ICH. The incidence of ICH has not changed over the last 30 years, and this consistency is thought to be due to changes in the risk factor profiles of ICH patients. It appears that ICH is more common in men and during the winter months. ICH affects Asian populations more frequently than other populations. In addition to the known risk factors of hypertension and increasing age, alcohol consumption, the presence of the apolipoprotein ε2 or ε4 allele, extremes of body mass index, diabetes, and ophthalmic conditions have been suggested to be associated with ICH. Factors associated with a reduced risk of ICH include hypercholesterolaemia and a diet high in fruits and vegetables. The overall incidence of ICH has remained unchanged, but its regional incidence varies by race, sex, season and geographical location. In high income countries, the beneficial effect of improving blood pressure control may be counterbalanced by the increased use of antithrombotic drugs. Emerging modifiable risk factors include alcohol consumption, body mass index, diabetes, and fruit and vegetable intake, all of which may be amenable to interventions for the primary prevention of ICH (as well as many other diseases).
Publisher: Elsevier BV
Date: 06-2021
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Michael Poon.