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Elsharkawy M, Sharafeldeen A, Khalifa F, Soliman A, Elnakib A, Ghazal M, Sewelam A, Thanos A, Sandhu HS, El-Baz A. A Clinically Explainable AI-Based Grading System for Age-Related Macular Degeneration Using Optical Coherence Tomography. IEEE J Biomed Health Inform 2024; PP:1-12. [PMID: 38231804 DOI: 10.1109/jbhi.2024.3355329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We propose an automated, explainable artificial intelligence (xAI) system for age-related macular degeneration (AMD) diagnosis. Mimicking the physician's perceptions, the proposed xAI system is capable of deriving clinically meaningful features from optical coherence tomography (OCT) B-scan images to differentiate between a normal retina, different grades of AMD (early, intermediate, geographic atrophy (GA), inactive wet or active neovascular disease [exudative or wet AMD]), and non-AMD diseases. Particularly, we extract retinal OCT-based clinical imaging markers that are correlated with the progression of AMD, which include: (i) subretinal tissue, sub-retinal pigment epithelial tissue, intraretinal fluid, subretinal fluid, and choroidal hypertransmission detection using a DeepLabV3+ network; (ii) detection of merged retina layers using a novel convolutional neural network model; (iii) drusen detection based on 2D curvature analysis; (iv) estimation of retinal layers' thickness, and first-order and higher-order reflectivity features. Those clinical features are used to grade a retinal OCT in a hierarchical decision tree process. The first step looks for severe disruption of retinal layers' indicative of advanced AMD. These cases are analyzed further to diagnose GA, inactive wet AMD, active wet AMD, and non-AMD diseases. Less severe cases are analyzed using a different pipeline to identify OCT with AMD-specific pathology, which is graded as intermediate-stage or early-stage AMD. The remainder is classified as either being a normal retina or having other non-AMD pathology. The proposed system in the multi-way classification task, evaluated on 1285 OCT images, achieved 90.82% accuracy. These promising results demonstrated the capability to automatically distinguish between normal eyes and all AMD grades in addition to non-AMD diseases.
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De Sanctis V, Daar S, Soliman A, Tzoulis P, Yassin M, Kattamis C. A retrospective study of glucose homeostasis, insulin secretion, sensitivity/resistance in non- transfusion-dependent β-thalassemia patients (NTD- β Thal): reduced β-cell secretion rather than insulin resistance seems to be the dominant defect for glucose dysregulation (GD). Acta Biomed 2023; 94:e2023262. [PMID: 38054678 PMCID: PMC10734240 DOI: 10.23750/abm.v94i6.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023]
Abstract
AIMS Non-transfusion - dependent β-thalassemias (NTD-βThal) can cause iron overload and serious iron-related organ complications as endocrine dysfunction, including glucose dysregulation (GD). PATIENTS AND METHODS We retrieved data of all NTD- β Thal patients referred consecutively to a single Outpatient Italian Clinic from October 2010 to April 2023. All patients underwent a standard 3-h oral glucose tolerance test (OGTT) for analysis of glucose homeostasis, insulin secretion and sensitivity/resistance (IR), using conventional surrogate indices derived from the OGTT. The collected data in NTD- β Thal patients were compared to 20 healthy subjects. RESULTS Seventeen of 26 (65.3 %) NTD- β Thal patients (aged: 7.8 -35.1 years) had normal glucose tolerance, 1/26 (3.8 %) had impaired fasting glucose (IFG), 5/26 (19.2 %) impaired glucose tolerance (IGT), 1/26 (3.8%) IFG plus IGT and 2/26 (7.6%) plasma glucose (PG) level ≥155 mg/dL 1-h after glucose load. GD was observed exclusively in young adult patients; none of them had diabetes mellitus (DM). These findings were associated with a low insulinogenic index (IGI) and oral disposition index. HOMA-IR and QUICKI were not significantly different compared to controls. Interestingly, in young adult patients, ISI-Matsuda index was statistically higher compared to the control group, suggesting an increased insulin sensitivity. CONCLUSIONS This study reported a high prevalence of GD in young adults with NTD- β Thal. The documented reduction of IGI rather than the presence of IR, indicates reduced insulin secretory capacity as the pathophysiological basis of dysglycemia that may represent a novel investigational path for future studies on the mechanism(s) responsible for GD in NTD- β Thal patients.
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Affiliation(s)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar .
| | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK.
| | - Mohamed Yassin
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Christos Kattamis
- Τhalassemia Unit, First Department of Paediatrics, National Kapodistrian University of Athens 11527, Greece.
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Khalil A, Mohamed A, Hassan M, Magboul S, Ali H, Elmasoudi AS, Ellithy K, Qusad M, Alhothi A, Al Maslamani E, Al Amri M, Soliman A. Efficacy and Safety of Remdesivir in Hospitalized Pediatric COVID-19: A Retrospective Case-Controlled Study. Ther Clin Risk Manag 2023; 19:949-958. [PMID: 38023628 PMCID: PMC10680468 DOI: 10.2147/tcrm.s432565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction While most children experience mild coronavirus disease 2019 (COVID-19) infections, a minority of cases progress to severe or critical illness. This study aimed to assess the efficacy and safety of Remdesivir (RDV) therapy in children with moderate to severe COVID-19, enhancing clinical decision-making and expanding our understanding of antiviral treatments for pediatric patients. Methods The study included 60 patients, 38 receiving RDV treatment and 22 serving as the control group. Data was collected retrospectively from January 2021 to January 2022 through electronic hospital records. Results Regarding the main clinical symptoms reported, most patients experienced Upper Respiratory Tract Infections (93.3%), indicating respiratory involvement. Additional symptoms included Central Nervous System (11.7%) and Gastrointestinal (10.0%). Among the 38 cases in the RDV group included in the study, the adverse effects associated with using RDV: Hypoalbuminemia in 19 cases (50.0%) and anemia in 18 cases (47.4%), making them the most common adverse effects. Only one case in the RDV group experienced non-RDV-related death with a different clinical diagnosis. The results showed that RDV treatment was well-tolerated in pediatric patients, with no significant differences in hospital stay and oxygen treatment compared to the control group with P values (0.2, 0.18), respectively. Conclusion The outcomes indicate that Remdesivir may represent a safe and therapeutic choice for children with coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Ahmed Khalil
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Asmaa Mohamed
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Manasik Hassan
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Samar Magboul
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Hossamaldein Ali
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Ahmed Salah Elmasoudi
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Khaled Ellithy
- Section of Pediatric Intensive Care Unit, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Mohammad Qusad
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Abdulla Alhothi
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Eman Al Maslamani
- Section of Infectious Diseases, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | | | - Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
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Khater D, Al-Mulaabed S, Alomairi A, Elshinawy M, Soliman A, Elshinawy N, Wali Y, Al Yaarubi S. Effect of Hydroxyurea Therapy on Growth Parameters in Older Children (6-15 Year-Old) with Sickle Cell Disease: Low Dose Versus High Dose. Hemoglobin 2023; 47:157-162. [PMID: 37691435 DOI: 10.1080/03630269.2023.2254238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
Growth impairment is a known complication of sickle cell disease (SCD). Few studies explored the potential effects of hydroxyurea (HU) on growth in children with SCD in relation to HU dose and response. This is a prospective study conducted at Sultan Qaboos University Hospital, Oman, and included 91 SCD patients with age below 16 years when started on HU, aiming to explore the potential effect/s of HU on growth parameters of older children with SCD in relation to their clinical improvement and the dose required for this improvement. Weight, height, and body mass index (BMI) were collected at baseline, 6 and 18 months after initiation. Anthropometric data were compared to WHO standards. Initial height and BMI Z scores (HAZ and WAZ) were lower compared to WHO norms. HAZ and WAZ did not change significantly after 6 and 18 months on HU therapy. However, BMI Z-scores improved significantly after 6 and 18 months of follow-up (p value 0.044 and 0.028 respectively). No significant changes were observed in WAZ or HAZ among patients on low dose versus those on high dose. BMI Z score improved significantly after 18 months of low dose group (p = 0.014) but did not change in those on high dose HU. In conclusion, HU therapy did not adversely affect weight and height growth in older children with SCD. BMI Z scores improved at 18 months in patients on low dose but not in those on high dose (p = 0.014).
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Affiliation(s)
- Doaa Khater
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sharef Al-Mulaabed
- Department of Pediatrics, Presbyterian Medical Group, Albuquerque, NM, USA
| | - Anwar Alomairi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohamed Elshinawy
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ashraf Soliman
- Pediatric Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Noor Elshinawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Wali
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Saif Al Yaarubi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
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Said Ahmed WM, Soliman A, Ahmed Amer AE, El Shahat RM, Amin MM, Taha RS, Awad MMY, Abdel Hamid AM, El-Sayed MS, Eid EA, Dmerdash M, Ali HE, Fayed EMM, Naeem SAM, Elsharawy AF, Elzahaby OMAM, Ayoub MK, Mohammed DA. Effect of dapagliflozin against NAFLD and dyslipidemia in type 2 diabetic albino rats: possible underlying mechanisms. Eur Rev Med Pharmacol Sci 2023; 27:8101-8109. [PMID: 37750638 DOI: 10.26355/eurrev_202309_33570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The aim was to investigate the effect of dapagliflozin on non-alcoholic fatty liver disease and dyslipidemia in type 2 diabetic rats by studying the histopathological structure of the liver and detecting possible underlying mechanisms for this impact by evaluating the potential anti-inflammatory action of dapagliflozin. MATERIALS AND METHODS 100 albino rats were used in this work and divided into five equal groups: group I (Control group), group II (Control diabetic group), group III (was administered dapagliflozin, 0.75 mg/kg, p.o.), group IV (was administered dapagliflozin, 1.5 mg/kg, p.o.), and group V (was administered dapagliflozin, 3 mg/kg, p.o.). RESULTS In our study, the total body weight, liver weight, liver index, blood glucose level, insulin level, insulin resistance, total cholesterol, triglycerides, liver enzymes, IL-1 β, and MDA were significantly higher in the control diabetic group than the normal group. The dapagliflozin reduced all the above variables significantly in a dose-dependent manner compared to the control diabetic group (p-value = 0.001 for all). CONCLUSIONS Dapagliflozin may be a promising novel treatment strategy for treating T2DM-related non-alcoholic fatty liver disease (NAFLD), and dyslipidemia where it possesses anti-oxidative, anti-inflammatory and anti-dyslipidemic effects.
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Affiliation(s)
- W M Said Ahmed
- Department of Medical Physiology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
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De Sanctis V, Daar S, Soliman A, Tzoulis P, Di Maio S, Kattamis C. Retrospective study on long-term effects of hormone replacement therapy (HRT) and iron chelation therapy on glucose homeostasis and insulin secretion in female ß- thalassemia major (β-TM) patients with acquired hypogonadotropic- hypogonadism (AHH). Acta Biomed 2023; 94:e2023195. [PMID: 37539597 PMCID: PMC10440782 DOI: 10.23750/abm.v94i4.14631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIM Hypogonadism and abnormalities of glucose homeostasis, resulting from iron-induced pituitary and pancreatic β-cell dysfunction respectively, are the most frequently reported endocrine abnormalities in patients with ß-thalassemia major (β-TM), also identified as transfusion-dependent thalassemia (TDT). STUDY DESIGN AND PATIENTS The aim of the present retrospective study was to evaluate the long-term effects of hormone replacement therapy (HRT) on glucose metabolism and insulin secretion/sensitivity during 3-h oral glucose tolerance test (OGTT) in adolescent and young β-TM women with acquired hypogonadototropic -hypogonadism (AHH).Twelve hypogonadal β-TM females with AHH on HRT were followed for 8.26 ± 1.49 years. RESULTS At baseline, 10 patients (83.3%) had normal OGTT, 1 patient presented with impaired glucose tolerance (IGT) and 1 patient had an isolated PG level of 165 mg/dL at 1-h during OGTT (H-NGT). At last evaluation, 7 patients (58.4 %) had normal OGTT, while 5 patients (41.6%) had abnormal OGTT. Reduced insulin sensitivity and impaired first-phase insulin secretion were also documented. Three of 4 β-TM patients on treatment with estradiol hemihydrate MX 50 patches plus oral medroxyprogesterone acetate (MPA), associated with a very effective iron chelation therapy, maintained normal glucose tolerance from baseline to last evaluation. Significant adverse events due to HRT or additional endocrine complications were not documented in any cases during the follow-up. CONCLUSION Deterioration of glycemia (dysglycemia) occurred in 45.4% (5/11) of thalassemic females on long-term HRT. Additional studies are needed to elucidate the validity of our preliminary observations.
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Affiliation(s)
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman & Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch 7600, South Africa.
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK.
| | - Salvatore Di Maio
- Emeritus Director in Pediatrics, Children's Hospital "Santobono-Pausilipon", Naples, Italy.
| | - Christos Kattamis
- Τhalassemia Unit, First Department of Pediatrics, National Kapodistrian University of Athens 11527, Greece.
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Ferih K, Elsayed B, Elshoeibi AM, Elsabagh AA, Elhadary M, Soliman A, Abdalgayoom M, Yassin M. Applications of Artificial Intelligence in Thalassemia: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13091551. [PMID: 37174943 PMCID: PMC10177591 DOI: 10.3390/diagnostics13091551] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Thalassemia is an autosomal recessive genetic disorder that affects the beta or alpha subunits of the hemoglobin structure. Thalassemia is classified as a hypochromic microcytic anemia and a definitive diagnosis of thalassemia is made by genetic testing of the alpha and beta genes. Thalassemia carries similar features to the other diseases that lead to microcytic hypochromic anemia, particularly iron deficiency anemia (IDA). Therefore, distinguishing between thalassemia and other causes of microcytic anemia is important to help in the treatment of the patients. Different indices and algorithms are used based on the complete blood count (CBC) parameters to diagnose thalassemia. In this article, we review how effective artificial intelligence is in aiding in the diagnosis and classification of thalassemia.
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Affiliation(s)
- Khaled Ferih
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Basel Elsayed
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Amgad M Elshoeibi
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ahmed A Elsabagh
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohamed Elhadary
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ashraf Soliman
- Hematology Section, Pediatrics Department, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Mohammed Abdalgayoom
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Mohamed Yassin
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Hematology Section, Medical Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
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Iqbal M, Soliman A, Ibrahim O, Gad A. Analysis of the Outcomes of the Screen-Time Reduction in Computer Vision Syndrome: A Cohort Comparative Study. Clin Ophthalmol 2023; 17:123-134. [PMID: 36644605 PMCID: PMC9833323 DOI: 10.2147/opth.s399044] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose To analyze the outcomes of screen-time reduction on the foveal responses that associates computer vision syndrome (CVS) using multifocal electroretinogram (mfERG) examination. Methods This prospective multicenter cohort comparative study included 49 eyes of 49 medical students divided into two groups. Group A (control group) included 25 eyes with no CVS diagnosis while group B (CVS group) included 24 eyes with CVS diagnosis. All students responded to the valid and reliable CVS-Form 3 (CVS-F3) questionnaire and underwent complete ophthalmic and mfERG examinations twice at the time recruitment in the study and four weeks after strict reduction of the daily screen-hours to ≤1 screen-hour daily to document associated foveal responses. Results We documented statistically significant reduction in foveal responses in CVS versus control groups in mean mfERG Rings 1, 2, and 5 with Quadrants 1, 2, and 4 (P=<0.0001, 0.0001, 0.0003, 0.001, 0.002, and 0.006, respectively). Following the screen-time reduction, the second mfERG examination revealed significant post-reduction improvements in foveal responses in CVS group particularly in mean mfERG Rings 1, 2, 3, and 5 with Quadrants 1 and 4 (P=<0.0001, <0.0001, 0.0005, 0.02, <0.0001, and 0.04, respectively). Conclusion This study documented the screen-induced foveal dysfunction that associates CVS using mfERG examination, which revealed remarkable significant improvements in foveal responses in the 4 weeks following strict screen-time reduction. These improvements were also associated with corresponding improvements in the visual performances. We suggest that the potential screen-induced foveal dysfunction outcomes might be reversible with strict screen-time reduction. We also recommend that educational institutional policies should limit online education-hours and redesign the mandated computer system use program to guard against visual sequelae of CVS. Clinical Trials Registration ClinicalTrials.gov (ID: NCT04405648).
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt,Correspondence: Mohammed Iqbal, Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, 82425, Egypt, Tel +2 01068559840, Fax +2 093 2159080, Email
| | - Ashraf Soliman
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ola Ibrahim
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Gad
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Ahmed AI, Saad JM, Alahdab F, Han Y, Alfawara M, Soliman A, Nabi F, Al-Mallah MH. Outcome of sedentary patients: does the power of zero cac make a difference? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Coronary artery calcium score (CACS) and exercise capacity (EC) are both independent prognostic tests in coronary artery disease (CAD).
Purpose
We aimed to assess the incremental prognostic role of EC to CACS, particularly in those with absent or low coronary calcification.
Methods
The cohort consisted of patients who had clinically indicated exercise stress testing and CACS assessment with a median of 27 days of each other. EC was defined based on peak metabolic equivalents (METS) achieved during exercise stress test. CACS was determined using the Agatston method. Patients were followed from the latest test date to incident MACE (inclusive of all-cause death, non-fatal myocardial infarction, late revascularization and admission for heart failure).
Results
There were a total of 1932 patients in the study population (mean age 56±12, 42% female, 48% hypertension, 21% diabetes, 48% dyslipidemia). Peak METS <6 was achieved in 8% of patients, and the median (IQR) CACS was 9 (0–203). Patients with EC <6 METS had doubling of their event rate across strata of CACS, even amongst patients with absent or low coronary calcifications (CACS 0: 4.6 vs 10.9; CACS 1–99: 10.4 vs 20.4; MACE per 1000 person year in patients with peak METS ≥ vs <6 respectively) (Figure 1).
Conclusion
Our findings showed that poor exercise capacity was associated with higher risk even in patients with absent or low coronary calcification.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A I Ahmed
- Houston Methodist Hospital , Houston , United States of America
| | - J M Saad
- Houston Methodist Hospital , Houston , United States of America
| | - F Alahdab
- Houston Methodist Hospital , Houston , United States of America
| | - Y Han
- Houston Methodist Hospital , Houston , United States of America
| | - M Alfawara
- Houston Methodist Hospital , Houston , United States of America
| | - A Soliman
- Houston Methodist Hospital , Houston , United States of America
| | - F Nabi
- Houston Methodist Hospital , Houston , United States of America
| | - M H Al-Mallah
- Houston Methodist Hospital , Houston , United States of America
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Alassaf A, Ellithy K, Mehta T, Aljbawi W, Ali H, Soliman A, Al Amri M, Nashwan AJ. Severe pulmonary hemorrhage in a 3‐week‐old neonate with
COVID
‐19 infection: A case report. Clin Case Rep 2022; 10:e6189. [PMID: 35957799 PMCID: PMC9360337 DOI: 10.1002/ccr3.6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022] Open
Abstract
Our patient is a 3‐week‐old female neonate, presented with complaints of low‐grade fever and a congested nose for one day. Eventually, she developed progressive desaturation, hypotension, and poor perfusion due to severe pulmonary hemorrhage. Then, she developed cardiac arrest and was declared dead.
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Affiliation(s)
- Anood Alassaf
- Pediatrics Department Sidra Medicine Doha Qatar
- Pediatrics Department Hamad Medical Corporation Doha Qatar
| | - Khaled Ellithy
- Pediatric Intensive Care Unit Hamad Medical Corporation Doha Qatar
| | - Tejas Mehta
- Pediatric Intensive Care Unit Hamad Medical Corporation Doha Qatar
| | - Walid Aljbawi
- Pediatric Intensive Care Unit Hamad Medical Corporation Doha Qatar
| | | | - Ashraf Soliman
- Pediatric Endocrinology Department Hamad Medical Corporation Doha Qatar
| | - Mohammed Al Amri
- Pediatric Emergency Department Hamad Medical Corporation Doha Qatar
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Yassin MA, Ghasoub R, Soliman A, Ismail O, Nashwan AJ, Alshurafa A, Ghori F, Sideeg D, Hamad A, Hussein R, Al-Okka R, Chandra P, Alasmar A. The Impact of Ethnicity on the Response to Eltrombopag in Patients With Immune Thrombocytopenia (ITP) in Qatar: A Single Institution Experience. Cureus 2022; 14:e25701. [PMID: 35812564 PMCID: PMC9260130 DOI: 10.7759/cureus.25701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Eltrombopag olamine (ELT) is a synthetic nonpeptide with a low molecular weight that has been investigated in various phase-3 studies and shown to be efficacious at a typical dose of 50 mg. Varied ethnic groups have reported different responses to ELT. Aim: The aim is to examine the efficacy of ELT in Asian and Arab patients with immune thrombocytopenia (ITP) from the Indian subcontinent by starting with (12.5 mg, as a minimum dose) and gradually increasing to a maximum dose of 50 mg. Methods: Between January 2015 and January 2019, we reviewed the electronic health records of non-Arab Asian (n = 17) versus Arab (n = 41) patients who were ≥18 years old, residing in Qatar, and with confirmed diagnoses with chronic ITP and under active treatment with a platelet count of 30,000/L, and bleeding symptoms. Following receiving ELT for three months or longer at various dosages, patients' response was examined. Results: After three months of ELT therapy, the response rate (platelet count of 50,000/L) was equivalent in non-Arab (88.2%) versus Arab (87.5%) patients. However, to achieve an adequate response, 26% of Arab patients required a lower dose of 12.5 or 25 mg, and 41.5% required a higher dose of 50 mg. Conclusion: In adult chronic ITP patients, ELT is typically well-tolerated and delivers the desired outcomes. In 67.5% of Arab patients, smaller dosages of ELT (12.5-50 mg) were helpful in sustaining acceptable PLT levels. This helps patients get the most benefit at the lowest feasible dose, reducing toxicity and expense.
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de Sanctis V, Soliman A, Tzoulis P, Daar S, Di Maio S, Millimaggi G, Kattamis C. Hypomenorrhea in Adolescents and Youths: Normal Variant or Menstrual Disorder? Revision of Literature and Personal Experience. Acta Biomed 2022; 93:e2022157. [PMID: 35315382 PMCID: PMC8972894 DOI: 10.23750/abm.v93i1.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Menstrual health affects a large number of women throughout reproductive life since adolescence. Knowledge of the duration and variation of the menstrual cycle is necessary for patient education and to identify deviations from normal to guide clinical evaluation. The average duration of menstrual flow is between 4 to 6 days, with anormal range from 2 up to 8 days ; the mean blood loss per menstrual cycle is 25- 30 mL. In general, descriptive data falling outside the normal range are considered to be indicative of menstrual disorders. Although the American Academy of Pediatrics and American College of Obstetricians and Gynecologists advocate for clinicians to consider the menstrual cycle as a vital sign in adolescents, the identification of subjects with hypomenorrhea is neither well defined nor routinely practiced. In this paper we have summarized the published prevalence of hypomenorrhea (lighter and/or shorter menstrual bleeding) in adolescents and youths in different countries and report the personal experience in four adolescents.
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Affiliation(s)
- Vincenzo de Sanctis
- Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
| | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Salvatore Di Maio
- Emeritus Director in Pediatrics, Children’s Hospital “Santobono-Pausilipon”, Naples, Italy
| | | | - Christos Kattamis
- First Department of Pediatrics, National Kapodistrian University of Athens, Greece
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Alyafei F, Soliman A, De Sanctis V, Hamed N, Alaaraj N, Ahmad S, AlKhori F, Abbasi S. Postnatal Growth and Prevalence of Obesity in Infants Born Large-for-Gestational Age during the First 3 years of Life: Personal Experience and Exploration of Current Literature. Acta Biomed 2022; 93:e2022327. [PMID: 36533739 PMCID: PMC9828894 DOI: 10.23750/abm.v93i6.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/16/2022] [Indexed: 01/21/2023]
Abstract
AIMS OF THE STUDY We evaluated the growth patterns in a cohort of infants (n = 120) born large-for-gestational-age (LGA) [birth weight (Bwt) > 4 kg] from birth to age 3 years of age in comparison with normal age and sex-matched children (WHO). RESULTS LGA infants had high weight for age Z score (WAZ) at birth that decreased significantly during the first 6 months of life (by a mean of - 0.67 SD) that was followed by significant gain during the following 6 months of life (around + 0.4 SD). These children grew on a higher centile of WAZ with no significant change during the second and third years of life. The prevalence of obesity (WAZ > 2) increased markedly from 24% at the end of their first year to 34% and 36% at the end of their second and third years of life, respectively. The mean length for age Z score (LAZ) decreased significantly during the first 6 months (by a mean of -0.9 SD) but was maintained at high centile (> 1 SD) during the second and 3rd years. The weight for length SDS (WLZ) increased significantly during the first 18 months of life and decreases gradually during the second half of the 2nd year and the 3rd year. Their head circumference SDS decreased significantly in the first 6 months and then sustained around the 70th centiles (+1 SD) in the following 18 months. CONCLUSION Our study showed that in LGA babies obesity increased progressively after the first year of life to reach 36% at the end of the third year. Therefore, it is important to apply the early nutritional intervention to decrease the occurrence of obesity and reduce later cardiometabolic risks.
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Affiliation(s)
- Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Shayma Ahmad
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Fatima AlKhori
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Saleha Abbasi
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
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de Sanctis V, Soliman A, Tzoulis P, Daar S, Kattamis A, Delaporta P, Karimi M, Yassin MA, Zarei T, Saki F, Sapunarova K, Banchev A, Galati MC, Raiola G, Messina G, Campisi S, Kattamis C. The The use of oral glucose-lowering agents (GLAs) in β-thalassemia patients with diabetes: Preliminary data from a retrospective study of ICET-A Network. Acta Biomed 2022; 93:e2022162. [PMID: 35546014 PMCID: PMC9171892 DOI: 10.23750/abm.v93i2.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The management of prediabetes and hyperglycemia is an increasingly important aspect of care in patients with thalassemia. In light of the limited evidence about the management of GD (glucose dysregulation) with glucose-lowering agents (GLAs), we have conducted a retrospective survey in TDT and NTDT patients with diabetes mellitus to collect more detailed information on GLA use in order to make preliminary recommendations. STUDY DESIGN AND METHOD A questionnaire was prepared and distributed to the tertiary thalassemia care Centers of ICET-A Network. RESULTS Eight thalassemia care Centers [Bulgaria, Greece, Iran, Italy (4 Centers) and Qatar], following 1.554 with transfusion-dependent thalassemia (TDT), 132 (8.4%) with diabetes and 687 with non-transfusion-dependent thalassemia (NTDT), 27 (3.9%) with diabetes, participated in the retrospective survey. The records of 117 TDT patients and 9 NTDT patients with diabetes treated with GLAs were analyzed. Metformin, a biguanide, was the most frequently used drug (47.6 %), followed by alpha-glucosidase inhibitors (5.5 %), incretins (4.7%) and insulin secretagogues (3.1%). In 68 (61.2) patients GLAs was prescribed as monotherapy, while the remaining 49 (38.8%), who had inadequate glucose control with metformin, were treated with combination treatment. Fifty-one patients of 126 (40.4%) initially treated with oral GLA, for a mean duration of 61.0 ± 35.6 months (range: 12- 120 months), required insulin therapy for better metabolic control. CONCLUSION This retrospective study covers an unexplored area of research in patients with thalassemia and GD. Oral GLAs appear to be safe and effective for the treatment of diabetes mellitus in patients with thalassemia, and can achieve adequate glycemic control for a substantial period of time.
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Affiliation(s)
- Vincenzo de Sanctis
- Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
| | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Antonis Kattamis
- Thalassemia Unit, Division of Pediatric Hematology-Oncology, First Department of Pediatrics, University of Athens, “Agia Sofia” Children’s Hospital, Athens, Greece
| | - Polyxeni Delaporta
- Thalassemia Unit, Division of Pediatric Hematology-Oncology, First Department of Pediatrics, University of Athens, “Agia Sofia” Children’s Hospital, Athens, Greece
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamed A. Yassin
- National Center for Cancer Care and Research, Medical Oncology Hematology Section HMC, Doha, Qatar
| | - Tahereh Zarei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Forough Saki
- Shiraz Endocrinology and Metabolism Research Center, Shiraz, Iran
| | - Katia Sapunarova
- Department of Hematology, University Hospital “Sv Georgi”, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Atanas Banchev
- Pediatric Hematology-Oncology, University Hospital “Tzaritza Giovanna - ISUL”, Sofia, Bulgaria
| | - Maria Concetta Galati
- Department of Pediatric Haematoncology, Thalassaemia and Prenatal Diagnosis Regional Center, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Giuseppe Raiola
- Department of Paediatrics, Pugliese-Ciaccio Hospital,Catanzaro, Italy
| | - Giuseppe Messina
- UOSD Microcitemie, Grande Ospedale Metropolitano “Bianchi- Melacrino- Morelli”, Reggio Calabria, Italy
| | | | - Christos Kattamis
- First Department of Pediatrics, National Kapodistrian University of Athens, Greece
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Soliman A, Alaaraj N, Hamed N, Alyafei F, Ahmed S, Shaat M, Itani M, Elalaily R, Soliman N. Review Nutritional interventions during adolescence and their possible effects. Acta Biomed 2022; 93:e2022087. [PMID: 35315384 PMCID: PMC8972883 DOI: 10.23750/abm.v93i1.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022]
Abstract
Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini-review sums up some important findings in this important complex that links between nutrition, nutritional interventions, and pubertal development.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Shayma Ahmed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Mona Shaat
- Dietetics and Nutrition, Hamad General Hospital
| | - Maya Itani
- Dietetics and Nutrition, Hamad General Hospital
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16
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Soliman A, Hamed N, De Sanctis V, Elbaba M, Alyafei F, Alaaraj N, Ahmad S, Itani M, Al-Naimi F, Khater D. The long-term (five years) effects of prednisone therapy in children with frequently relapsing nephrotic syndrome: A controlled study of anthropometric parameters and metabolic abnormalities. Acta Biomed 2022; 93:e2022303. [PMID: 36300219 PMCID: PMC9686183 DOI: 10.23750/abm.v93i5.13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Steroids are the main drugs used for the treatment of nephrotic syndrome (NS) in children. AIM OF THE STUDY We investigated the steroid effect on linear growth and weight gain as well as the prevalence of different metabolic components and dysglycemia in children with NS with multiple relapses for 5 years in relation to the cumulative dose of steroids. Study population and sample size: Data of 30 children with NS were analyzed retrospectively. They received prednisolone treatment as advised by international guidelines. The cumulative dose of prednisolone (CDP) over the 5 years was calculated for each child. Their growth and different metabolic criteria, including impaired fasting glucose (IFG), high LDL and cholesterol, lower HDL, and high blood pressure studied over this period and compared with the data for 66 age-matched obese non-nephrotic children. RESULTS The mean CDP was 100 ± 63 mg /kg/yr given over an average duration of 5 years. The height-SDS was not affected after 3 years but decreased by -0.4 SD after 5 years. The body mass index-SDS increased from 0.65 to 0.97 and 1.1 after 3 and 5 years, respectively. Obesity and overweight increased from 25% pre-treatment to 59.2% after 5 years of treatment. After 5 years of treatment, IFG was detected in 35 %, hypertension in 40%, high LDL in 77%, and high cholesterol in 80%. CONCLUSION In children with frequently relapsing NS, long-term steroid therapy was associated with a higher rate of obesity, short stature as well as the occurrence of different metabolic syndrome (MetS.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mostafa Elbaba
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Shayma Ahmad
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Maya Itani
- Department of Dietetics and Nutrition, Hamad General Hospital, Doha, Qatar
| | - Fatima Al-Naimi
- Department of Dietetics and Nutrition, Hamad General Hospital, Doha, Qatar
| | - Doaa Khater
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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17
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Ahmed S, Soliman A, De Sanctis V, Alyafei F, Alaaraj N, Hamed N, Yassin M. A Short Review on Growth and Endocrine Long-term Complications in Children and Adolescents with β-Thalassemia Major: Conventional Treatment versus Hematopoietic Stem Cell Transplantation. Acta Biomed 2022; 93:e2022290. [PMID: 36043958 PMCID: PMC9534255 DOI: 10.23750/abm.v93i4.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022]
Abstract
The conventional treatment of β-thalassemia (β-TM) patients is based on the correction of anemia through regular blood transfusions and iron chelation therapy. However, allogeneic hematopoietic stem cell transplantation (HSCT) remains the only currently available technique that has curative potential. Variable frequency and severity of long-term growth and endocrine changes after conventional treatment as well as after HSCT have been reported by different centers. The goal of this mini-review is to summarize and update knowledge about long-term growth and endocrine changes after HSCT in patients with β-TM in comparison to those occurring in β-TM patients on conventional treatment. Regular surveillance, early diagnosis, treatment, and follow-up in a multi-disciplinary specialized setting are suggested to optimize the patient's quality of life (www.actabiomedica.it).
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Affiliation(s)
- Shayma Ahmed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Mohamed Yassin
- Department of Hematology, Cancer Research Center, Hamad Medical Center, Doha, Qatar
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Al-Mashaikhi N, Al-Rawas A, Wali Y, Soliman A, Khater D. The prevalence of sickling abnormality in Oman: A review of relevant publications. Acta Biomed 2022; 93:e2022289. [PMID: 36043956 PMCID: PMC9534257 DOI: 10.23750/abm.v93i4.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/11/2022] [Indexed: 11/08/2022]
Abstract
Sickle cell disease (SCD), caused by a mutation in the β-globin gene HBB, is widely distributed in malaria endemic regions. The prevalence of sickle cell trait and disease reaches up to 4.8-6% and 0.2% respectively, which is the highest among the Arab Gulf states. Omani population represents a variability of HbS genotype combinations with other Hb genotypes modify the clinical severity of the disease. The most prevalent sickling abnormality in Oman is Hb S/S (SCA) followed by Hb S/β-thalassemia. Omani children with SCD with high Hb F level had less severe disease. More than two-thirds of SCD cases were running a mild course of the disease due to the high prevalence of a-thalassemia trait. The severity index has been correlated with the early age of presentation, the absence of a-thalassemia trait and the lower level of HbF as well as to the existence of different β-globin gene haplotypes. S/ β0 presented with the same clinical severity of S/S while those with S/ β+ had some splenic function into adulthood and were more prone to splenic sequestration. The unique existence of HbS-Oman (a severe variant of sickle hemoglobinopathy) markedly increased the severity of the disease. Compound heterozygotes HbS-Oman resulted in very severe clinical manifestations with transfusion-dependency and hypersplenism early in life. This paper summarizes and reviews βs gene haplotypes in patients with sickle cell anemia (SCA) in Oman. (www.actabiomedica.it).
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Affiliation(s)
- Nawal Al-Mashaikhi
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Abdulhakim Al-Rawas
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Yasser Wali
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | - Ashraf Soliman
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar
| | - Doaa Khater
- Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
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Hamed N, Soliman A, De Sanctis V, Shaat M, Alaaraj N, Ahmed S, Qusad M, Siddiq K, Alyafei F. Linear growth and prevalence of the different components of the metabolic syndrome (MetS) in young obese nondiabetic children (below 5 years) in comparison to older obese children (6-12 years). Acta Biomed 2022; 93:e2022213. [PMID: 36300244 PMCID: PMC9686177 DOI: 10.23750/abm.v93i5.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND In Qatar, the prevalence of metabolic syndrome (MetS) in children and adults is increasing in parallel with the markedly increasing trends in obesity rates. OBJECTIVE The aim of our study was to assess the prevalence of different components of MetS, measure plasma atherogenic indexes (AIP), and to evaluate linear growth in young obese nondiabetic children (< 5 years) in comparison to older obese children (6-12 years). Methods: We analysed the anthropometric and biochemical profile of 135 random sample obese children who attended to the Paediatric Clinic of Hamad Medical Centre (HGH) in Doha (Qatar) from January 2018 to December 2019. RESULTS A large proportion of children presented with obesity, around the age of 5 years, were obese at the end of their first year of life (63.8%) and more were obese at the 2 years of age (82.6%). Significantly rapid gain in weight and linear growth occurred during the first 6 months of postnatal life. Moreover, some metabolic risk factors and high AIP occurred more frequently in older obese children compared to young obese children. CONCLUSIONS This study documented the early occurrence of different components of the MetS in young obese children and the progressive increase of their prevalence in older prepubertal children. Most of obese children who presented at or below 5 years of age had significant obesity and rapid linear growth during the first two years (infancy). These two findings pointed out to the necessity to impose early detection and preventive measures on a national scale.
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Affiliation(s)
- Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mona Shaat
- Dietetics, Hamad General Hospital, Doha, Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
| | - Shaymaa Ahmed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
| | | | | | - Fawzia Alyafei
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
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Soliman A, De Sanctis V, Alaaraj N, Alyafei F, Hamed N, Ahmed S. Trend in the incidence of type 1 diabetes (T1DM) among Qatari and Arab gulf children and adolescents over the past 20 years. Acta Biomed 2022; 93:e2022163. [PMID: 35546016 PMCID: PMC9171868 DOI: 10.23750/abm.v93i2.11979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
Letter to Editor.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha (Qatar)
| | - Vincenzo De Sanctis
- Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara (Italy)
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha (Qatar)
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha (Qatar)
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha (Qatar)
| | - Shayma Ahmed
- Department of Pediatrics, Hamad General Hospital, Doha (Qatar)
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21
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De Sanctis V, Soliman A, Daar S, Tzoulis P, Yassin MA, Di Maio S, Kattamis C. Insulin-Like Growth Factor -1 (IGF-1) and Glucose Dysregulation in Young Adult Patients with β-Thalassemia Major: Causality or Potential Link? Acta Biomed 2022; 93:e2022331. [PMID: 36533767 PMCID: PMC9828921 DOI: 10.23750/abm.v93i6.13288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Insulin-like growth factor-1 (IGF-1) has been shown to lower blood glucose through stimulating glucose transport to fat and muscle and inhibiting hepatic glucose output. Although previous cross-sectional reports reported an association between low circulating concentrations of IGF-1 and glucose dysregulation (GD), its role is still debated. AIMS OF STUDY The present retrospective study was designed to assess the circulating IGF-1 levels in β-thalassemia major (β -TM) patients with normal oral glucose tolerance test (NGT-OGTT) and (GD) referred for an endocrine evaluation to explore the potential link between low IGF-1 and GD. STUDY DESIGN AND METHODS Our study included 34 young adult patients with β-TM; 12 patients with NGT after OGTT, 7 with impaired glucose tolerance (IGT), 9 with impaired fasting glucose (IFG) plus IGT, and 6 patients with β-TM-related diabetes mellitus (β-TM- DM). RESULTS Twenty-two β-TM patients with GD or β-TM- DM and 1 patient with NGT had IGF-1 levels below the 2.5th percentile. Correlation of IGF-1 with fasting plasma glucose, HOMA-IR (homeostatic model assessment for insulin resistance) and OGIS (oral glucose insulin sensitivity) was found. Moreover, a negative correlation was documented between ALT and the Insulinogenic Index (IGI) and a positive correlation between serum ferritin and PG 2-h after OGTT. CONCLUSION This study reports for the first time an association between low levels of IGF-1 and GD in β-TM patients. Despite some limitations, our study can serve to generate proposals for more convenient and efficient methods to identify and treat early GD in patients with β-TM, and to conduct more extensive studies. www.actabiomedica.it).
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Affiliation(s)
- Vincenzo De Sanctis
- Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman, Oman
| | - Ploutarchos Tzoulis
- Department of Metabolism and Experimental Therapeutics, Division of Medicine, University College London, London, UK
| | - Mohamed A. Yassin
- Hematology-Oncology Department, National Centre for Cancer Care and Research, Doha, Qatar
| | - Salvatore Di Maio
- Emeritus Director in Pediatrics, Children’s Hospital “Santobono-Pausilipon”, Naples, Italy
| | - Christos Kattamis
- First Department of Pediatrics, National Kapodistrian University of Athens, Greece
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De Sanctis V, Soliman A, Alyafei F, Alaaraj N, Ahmed S, Elawwa A, Hamed N. Clinical and metabolic characteristics of children with hybrid diabetes mellitus (HD) compared to children with type 2 diabetes mellitus (T2DM): A preliminary comparative study. Acta Biomed 2021; 92:e2021511. [PMID: 34738571 PMCID: PMC8689319 DOI: 10.23750/abm.v92i5.11598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
Background: The term double diabetes or “Hybrid Diabetes (HD)” describes diabetes with combined features of type 1 and type 2 diabetes (T2DM). Typically, HD is characterized by insulin resistance, obesity, and the presence of markers of β-cell autoimmunity. Differentiating HD from other forms of diabetes is important for a better understanding of the disease process and course, as well as for an appropriate management plan to prevent future complications. Patients and Methods: We report the clinical and biochemical characteristics of 7 children with HD and the course of their disease including the response to treatment. The data were compared to 59 children with a diagnosis of T2DM. Variables examined included age, height, weight, body mass index (BMI), triglycerides (Tg), high-density lipoprotein (HDL), and blood pressure. The Weiss criteria were used to diagnose metabolic syndrome (MetS). The atherogenic index of plasma (AIP) was calculated from the standard lipid profile. Four autoantibodies against pancreatic β-cell were measured in all patients. Results: Significant clinical and biochemical differences were detected among children with HD versus T2DM. The mean BMI of children with T2DM was significantly higher than for the HD group. At presentation, the mean C peptide level was significantly lower in HD versus T2DM group and 28% presented with diabetic ketoacidosis (DKA). The percentage of those with full criteria of MetS was significantly higher in T2DM versus HD group as well as the percentage of children with high atherogenic index. After a mean duration of 2.3 months from diagnosis, 4/7 of HD patients stopped insulin therapy and 3 patients had a marked reduction in the insulin requirement. During the follow-up (after 15 ±5 months), 5/7 HD patients required an increase in their insulin dose, one was controlled on a markedly low dose of basal insulin and the last patient did not require any insulin therapy for 40 months. Conclusion: Classifying a clinical condition is very important in disease diagnosis and treatment as it can guide clinicians to translate scientific understanding to clinical practice. Appropriate assessment of HD is necessary for early and correct diagnosis. Increasing awareness of HD among the general population and primary care practitioners is necessary for successfully and properly treating this complex disease. (www.actabiomedica.it)
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
| | - Fawzia Alyafei
- Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
| | - Nada Alaaraj
- Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
| | - Shayma Ahmed
- Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
| | - Ahmed Elawwa
- Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
| | - Noor Hamed
- Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
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23
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De Sanctis V, Soliman A, Daar S, Di Maio S, Alhumaidi N, Alali M, Sabt A, Kattamis C. The Myxedema coma in children and adolescents: A rare endocrine emergency - Personal experience and review of literature. Acta Biomed 2021; 92:e2021481. [PMID: 34738556 PMCID: PMC8689309 DOI: 10.23750/abm.v92i5.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
Decompensated hypothyroidism, formerly known as myxedema coma, represents the most extreme clinical expression of severe primary or secondary hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. The exact incidence of myxedema coma in adults is not known, but some authors have estimated that is approximately 0.22 per 100.0000 per year in the western world. Myxedema coma is more common in females and during winter months. The diagnosis of myxedema coma is primarily clinical with supportive evidence of the abnormal thyroid function tests. Clinical features vary depending on a several factors including the age of onset and the severity of the disease. In the majority of patients (95%), the cause of underlying hypothyroidism is autoimmunity, i.e., Hashimoto thyroiditis or congenital abnormalities. Rarely it occurs in secondary (central) hypothyroidism, due to thyrotropin deficiency related to pituitary disease, or pituitary-thyroid damage due to iron overload. Treatment consists of thyroid hormone replacement, correction of electrolyte disturbances, passive rewarming, treatment of infections, respiratory and hemodynamic support, and administration of stress-dose glucocorticoids. Prognosis seems to be better in children and adolescents compared to adults. The present review reports personal experience and the literature data on 13 patients. (www.actabiomedica.it)
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Affiliation(s)
- Vincenzo De Sanctis
- Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt.
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman.
| | - Salvatore Di Maio
- Emeritus Director in Pediatrics, Children's Hospital "Santobono-Pausilipon", Naples, Italy.
| | - Noora Alhumaidi
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Mayam Alali
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | | | - Christos Kattamis
- First Department of Pediatrics, National Kapodistrian University of Athens, Greece.
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24
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Badawy H, Dawood W, Soliman A, Fahmy A, Mahfouz W, Moussa A, Assem A, Eid A, Elsayed S, Gawan A, Hanno A, Youssef M. Reply to letter to the editor: Staged repair of proximal hypospadias-reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg 2021; 56:2124. [PMID: 34229877 DOI: 10.1016/j.jpedsurg.2021.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Waleed Dawood
- Department of Urology, University of Alexandria, Egypt
| | | | - Ahmed Fahmy
- Department of Urology, University of Alexandria, Egypt
| | - Waly Mahfouz
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, University of Alexandria, Egypt
| | - Akram Assem
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Eid
- Department of Urology, University of Alexandria, Egypt
| | - Shaymaa Elsayed
- Department of Pediatrics, Section of Endocrinology, University of Alexandria, Egypt
| | - Ahmed Gawan
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Egypt
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25
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Elsafty A, Ahmed Y, Soliman A, Morsy AA. A Novel Automated Hematopathologist-Styled Commenter for Complete Blood Count and Smear Review. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Prevention of errors and increasing productivity are essential for managing the workflow in hematopathology labs, particularly under stress and fatigue conditions. The proposed automated commenter system is designed to directly address these critical issues. Care was also taken to ensure ease of use and minimum training time.
Methods/Case Report
Using 20 quantitative and qualitative parameters in 3 groups (RBCs, WBCs and platelets), our novel automated commenter is able to generate a hematopathologist’s report/interpretation for CBC and smear review. Built-in reference ranges can be adjusted to accommodate variability in cutoffs. There are alarms for entry of seemingly odd values, differential counts not adding up to 100% or suspected cold agglutination, lipemia and hemolysis in the specimen. Our automated commenter was developed and tested against more than 1,000 hematopathology reports. These reports included clinicopathologic correlations for different type hematopathology neoplasms and benign disorders. At least 100 reports were selected for each disease category covering all subclasses and grades. Ample user acceptance testing was conducted using feedback surveys from hematopathologists, hemato-oncologists and clinicians.
Results (if a Case Study enter NA)
Generated comments are narrative, concise, comprehensive and accurate. The abnormal findings are arranged by their grade and significance. For example, the following comment was generated using the system: “CBC and smear review reveals mild macrocytic pancytopenia with anisocytosis, increased peripheral circulating blasts above the cutoff of Acute Leukemia and critically severe neutropenia (Hgb 11.0 g/dL, MCV 103.5 fL, RDW 14.9%, WBC 3.2 K/µL, blasts 29%, promyelocytes 2%, myelocytes 5%, metamyelocytes 1%, nRBCs 5/100 WBCs, ANC 0.3 K/µL & Plt 125 K/µL) with mild dysgranulopoiesis and dacrocytosis (teardrops).”
Conclusion
Absence of clerical and scientific errors, reportedly positive user experience and saving 50-80% of pathologists’ working time are all advantages that indicate feasibility of large-scale adoption of our system by hematopathology labs. Workflow fitness, standardization, minimizing the manual variations and using the system as a professional training tool also strongly support this conjecture. The system could be used to fully automate clinicopathologic correlation with phenotypic and genetic tests and to develop an automated test selector (Triage Advisor).
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Affiliation(s)
- A Elsafty
- HematoPathology, SiParadigm Diagnostic Informatics, Pine Brook, New Jersey, UNITED STATES
| | - Y Ahmed
- HematoPathology, SiParadigm Diagnostic Informatics, Pine Brook, New Jersey, UNITED STATES
| | - A Soliman
- Science and Engineering, American University of Sharjah, Sharjah, UNITED ARAB EMIRATES
| | - A A Morsy
- Biomedical Engineering, Faculty of Engineering, Cairo University, Giza, Giza, EGYPT
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26
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Soliman A, Rogol AD, Elsiddig S, Khalil A, Alaaraj N, Alyafie F, Ahmed H, Elawwa A. Growth response to growth hormone (GH) treatment in children with GH deficiency (GHD) and those with idiopathic short stature (ISS) based on their pretreatment insulin-like growth factor 1 (IGFI) levels and at diagnosis and IGFI increment on treatment. J Pediatr Endocrinol Metab 2021; 34:1263-1271. [PMID: 34291621 DOI: 10.1515/jpem-2021-0389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Some idiopathic short stature (ISS) patients may have varying degrees of insulin-like growth factor 1 (IGFI) deficiency. Others with growth hormone deficiency (GHD) (peak GH < 7 ng/dL after provocation) have normal IGFI levels. Do children with ISS or those with GHD with variable pretreatment IGFI standard deviation score (IGFISDS) have different IGFI and growth responses to recombinant human growth hormone (rhGH) therapy? METHODS We studied the effect of GH therapy (0.035-0.06 mg/kg/day) on linear growth and weight gain per day (WGPD) in children with ISS (n=13) and those with GHD (n=10) who have low pretreatment IGFISDS (IGF SDS < -1.5) and compared them with age-matched prepubertal children with ISS (n=10) and GHD (n=17) who had normal pretreatment IGFISDS. An untreated group of children with ISS (n=12) served as a control group. RESULTS At presentation, the height standard deviation score (HtSDS) of children with ISS who had low pretreatment IGFISDS was significantly lower compared to the normal IGFI group. The age, body mass index (BMI), BMISDS, peak GH response to clonidine provocation and bone age did not differ between the two study groups. After 1 year of treatment with rhGH (0.035-0.06 mg/kg/day) IGFISDS increased significantly in both groups (p<0.05). Both had significantly increased HtSDS (catch-up growth). The increase in the HtSDS and WGPD were significantly greater in the lower pretreatment IGFISDS group. The IGFSDS, BMISDS, HtSDS and difference between HtSDS and mid-parental HtSDS were significantly greater in the rhGH treated groups vs. the not treated group. In the GHD groups (normal and low IGFISDS), after 1 year of GH therapy (0.03-0.05 mg/kg/day), the HtSDS increased significantly in both, (p<0.01). The WGPD and increment in BMI were significantly greater in children who had low pretreatment IGFISDS. There was a significant increase in the IGFSDS in the two treated groups (p<0.05), however, the WGPD was greater in the pretreatment low IGFISDS. CONCLUSIONS IGFI deficiency represents a low anabolic state. Correction of IGFI level (through rhGH and/or improved nutrition) in short children (ISS and GHD) was associated with increased linear growth and WGPD denoting significant effect on bone growth and muscle protein accretion.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Sohair Elsiddig
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Ahmed Khalil
- Department of Clinical Pharmacy, Hamad General Hospital, Doha, Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Fawzia Alyafie
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Hannah Ahmed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Ahmed Elawwa
- Department of Pediatrics, Alexandria University, Alexandria, Egypt
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27
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Ahmed AI, Soliman A, Han Y, Qureshi WT, Al-Mallah MH. Racial disparities of internet access in the united states: a multiyear analysis of the national behavioral risk factors surveillance system. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The COVID 19 pandemic has led to a dramatic rise in the use of Telehealth. Studies have shown racial/ethnic disparities in internet access, a basic prerequisite for telehealth. However, little is known on the extent of this “digital divide” amongst racial minorities with cardiovascular comorbidities.
Purpose
To investigate racial disparities in internet access amongst those with cardiovascular diseases and risk factors, and explore the degree to which this exists amongst those with different levels of comorbidities.
Methods
Behavioral Risk Factors Surveillance System data from the years 2013–2017, during which survey respondents were asked the main outcome of interest (“Have you used the internet in the past 30 days”) were pooled. Respondents were included if they responded yes to questions on selected cardiovascular diseases and risk factors of interest. Multivariable logistic regression was used to analyze the odds of internet use by racial groups adjusting for several socioeconomic factors.
Results
There were a total of 1,478,214 individuals representing 150,235,244 million adults (non-Hispanic Blacks 11.31% and Hispanics 13.75%). Hispanics and Non-Hispanic Blacks reported the lowest prevalence of internet use (66.1% and 64.4% respectively) compared to Non-Hispanic Whites (81.9%). On regression analysis, racial minorities consistently reported lower rates of internet use, averaging 50% lower odds compared to non-Hispanic Whites. Results remained statistically significant even after controlling for several sociodemographic variables.
Conclusion
Using a large nationally representative cohort, we demonstrated differences in internet access amongst racial minorities and those with multiple comorbidities, placing them at distinct disadvantage with access to telecare. Our study adds to a growing body of literature that shows the disproportionate impact of the pandemic on minorities and calls for a concerted effort to reduce disparities in healthcare delivery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A I Ahmed
- Houston Methodist Hospital, Houston, United States of America
| | - A Soliman
- Houston Methodist Hospital, Houston, United States of America
| | - Y Han
- Houston Methodist Hospital, Houston, United States of America
| | - W T Qureshi
- UMass Memorial Healthcare, Worcester, United States of America
| | - M H Al-Mallah
- Houston Methodist Hospital, Houston, United States of America
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28
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Ade PAR, Ahmed Z, Amiri M, Barkats D, Thakur RB, Bischoff CA, Beck D, Bock JJ, Boenish H, Bullock E, Buza V, Cheshire JR, Connors J, Cornelison J, Crumrine M, Cukierman A, Denison EV, Dierickx M, Duband L, Eiben M, Fatigoni S, Filippini JP, Fliescher S, Goeckner-Wald N, Goldfinger DC, Grayson J, Grimes P, Hall G, Halal G, Halpern M, Hand E, Harrison S, Henderson S, Hildebrandt SR, Hilton GC, Hubmayr J, Hui H, Irwin KD, Kang J, Karkare KS, Karpel E, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Lau K, Leitch EM, Lennox A, Megerian KG, Minutolo L, Moncelsi L, Nakato Y, Namikawa T, Nguyen HT, O'Brient R, Ogburn RW, Palladino S, Prouve T, Pryke C, Racine B, Reintsema CD, Richter S, Schillaci A, Schwarz R, Schmitt BL, Sheehy CD, Soliman A, Germaine TS, Steinbach B, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Umiltà C, Vergès C, Vieregg AG, Wandui A, Weber AC, Wiebe DV, Willmert J, Wong CL, Wu WLK, Yang H, Yoon KW, Young E, Yu C, Zeng L, Zhang C, Zhang S. Improved Constraints on Primordial Gravitational Waves using Planck, WMAP, and BICEP/Keck Observations through the 2018 Observing Season. Phys Rev Lett 2021; 127:151301. [PMID: 34678017 DOI: 10.1103/physrevlett.127.151301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220 GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8 μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - Z Ahmed
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - M Amiri
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - D Barkats
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - R Basu Thakur
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - C A Bischoff
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - D Beck
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - H Boenish
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - V Buza
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - J R Cheshire
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Connors
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - J Cornelison
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - M Crumrine
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Cukierman
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E V Denison
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - M Dierickx
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - M Eiben
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - S Fatigoni
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J P Filippini
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Astronomy, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - N Goeckner-Wald
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D C Goldfinger
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - J Grayson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - P Grimes
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - G Hall
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - G Halal
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - E Hand
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - S Harrison
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - S Henderson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - S R Hildebrandt
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Hubmayr
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H Hui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Kang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K S Karkare
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - E Karpel
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Kefeli
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K Lau
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E M Leitch
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - A Lennox
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - K G Megerian
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Minutolo
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - L Moncelsi
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - Y Nakato
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - T Namikawa
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), UTIAS, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Palladino
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - T Prouve
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Racine
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Aix-Marseille Université, CNRS/IN2P3, CPPM, Marseille 13288, France
| | - C D Reintsema
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Richter
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - A Schillaci
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B L Schmitt
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - C D Sheehy
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Soliman
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T St Germaine
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B Steinbach
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K L Thompson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Tucker
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - C Umiltà
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - C Vergès
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - A G Vieregg
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - A Wandui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - A C Weber
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D V Wiebe
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - W L K Wu
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - H Yang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K W Yoon
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E Young
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Yu
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - L Zeng
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - C Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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Elsafti Elsaeidy AM, Alsaleh OI, van Berlaer G, Alhallak AA, Saeed SS, Soliman A, Hubloue I. Effects of Two Chlorine Gas Attacks on Hospital Admission and Clinical Outcomes in Kafr Zita, Syria. Cureus 2021; 13:e17522. [PMID: 34603892 PMCID: PMC8475639 DOI: 10.7759/cureus.17522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background In 2014, Hama Governorate was exposed twice to chlorine gas, with 15 patients presenting to Kafr Zita Hospital in Northwest Syria. This study aimed to describe clinical manifestations of chlorine gas exposure to identify factors leading to facility admission and the need for ICU/intubation in conflict-affected areas with limited healthcare infrastructure. Methods We conducted a case-series study, using medical records of suspected chlorine-exposed patients presenting at Kafr Zita Hospital on either 11 April or 22 May 2014. Data on age, sex, initial clinical presentation, therapeutic management, and outcome were compared by hospital admission/non-admission and attack date. All patients provided verbal informed consent. Results Fifteen patients with signs of chlorine gas exposure had detailed medical records. The mean age was 25.7 years (range 2-59), eight were male (53%), and three (20%) were under age 16. At initial presentation, all experienced respiratory distress, due to severe airway inflammation confirmed by nonspecific pulmonary infiltrates on chest x-ray, and similar intestinal, neurological, dermatological, ophthalmological, and psychological signs and symptoms. Acute management consisted of oxygen and bronchodilators for all patients, hydrocortisone (93%), antiemetics (80%), and dexamethasone (13%). Seven (47%) made a rapid symptomatic recovery and were discharged the same day and eight (53%) were admitted for a median of two days (range 1-6 days), one of whom required intubation and later died. The only significant associations found were higher mean pulse rate (i.e. 138 versus 124; p=0.043) and body temperature (37.0 versus 36.5; p=0.019) among admitted patients compared to non-admitted. Conclusion Our results demonstrated that even in low-resource humanitarian settings the survival rate for chlorine gas exposed patients is fair. Despite the small sample, this study provides insight into the clinical presentation, management, and outcomes of weaponized chlorine gas exposure, though further research is required to understand any chronic consequences.
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Affiliation(s)
- Abdallah M Elsafti Elsaeidy
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, BEL.,Emergency Department, Hamad Medical Corporation, Doha, QAT.,Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), University of Eastern Piedmont (Università del Piemonte Orientale), Novara, ITA
| | - Osama I Alsaleh
- Disaster Medicine, Al-Sham Humanitarian Foundation, Istanbul, TUR
| | - Gerlant van Berlaer
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussel, BEL
| | | | - Saad S Saeed
- Pediatrics, Hamad Medical Corporation, Doha, QAT
| | | | - Ives Hubloue
- Department Emergency Medicine - Research Group on Emergency and Disaster Medicine, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, BEL
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Iqbal M, Elzembely H, Elmassry A, Elgharieb M, Assaf A, Ibrahim O, Soliman A. Computer Vision Syndrome Prevalence and Ocular Sequelae among Medical Students: A University-Wide Study on a Marginalized Visual Security Issue. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students.
Methods:
This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group).
Results:
The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P<0.0001), >2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses.
Conclusion:
CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction.
Clinical Trials Registration:
PACTR201811618954630.
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De Sanctis V, Soliman A, Elsiddig S, Alyafei F, Alaaraj N, Itani M, Jour C, Elawwa A. Impact of oral nutritional supplements (ONS) on growth outcomes and IGF-1 level in underweight older children and young adolescents (5-14 years) with short stature and no systemic disease: High versus normal calories density formula. Acta Biomed 2021; 92:e2021320. [PMID: 34487062 PMCID: PMC8477105 DOI: 10.23750/abm.v92i4.11868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022]
Abstract
Objectives: This controlled trial investigated the effects of energy-dense pediatric oral nutritional supplements ONS versus standard ONS in pediatric patients requiring oral nutritional support for low body mass index (BMI) or weight gain per day (WGD) below the average for age and sex. Patients and Methods: 34 children and adolescents (mean age 10.2 years) with faltering growth requiring ONS were randomized to cONS (n =22) or sONS (n = 12) for a year. We recorded their weight (WT), height (HT) and calculated height growth velocity (GV), Ht-SDS, BMI, WGD, every 3 months for a year. Results: The WGD, height growth velocity (GV: cm/year), and Ht-SDS increased significantly, in both groups, during the year of ONS. The use of the cONS resulted in significantly greater mean total WGD and BMI-SDS after 6 months and 1 year, compared to the sONS group. The increase in IGF1-SDS was significantly higher in the cONS groups versus the sONS group. Moreover, the WGD was correlated significantly with the height GV during the year of ONS intake. Conclusions: ONS improved the growth of underweight old children and adolescents who had no systemic illness. There was a significantly higher WGD and BMI-SDS in the group on cONS compared to those on sONS. In both groups, long-term use of ONS significantly improved Ht-SDS. (www.actabiomedica.it)
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar.
| | - Suhair Elsiddig
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar.
| | - Fawziya Alyafei
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar.
| | - Nada Alaaraj
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar.
| | - Maya Itani
- Department of Nutrition and Dietetics, Hamad Medical Center, Doha. Qatar .
| | - Celine Jour
- Department of Nutrition and Dietetics, Hamad Medical Center, Doha. Qatar .
| | - Ahmed Elawwa
- Department of Pediatrics, University of Alexandria, Egypt.
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De Sanctis V, Ahmed S, Soliman A, Alyafei F, Alaaraj N, Al Maadheed M, Clelland C. A rare case of Ovarian Juvenile Granulosa Cell Tumor in an Infant with Isosexual Pseudo Puberty and a Revision of Literature. Acta Biomed 2021; 92:e2021319. [PMID: 34487069 PMCID: PMC8477099 DOI: 10.23750/abm.v92i4.11572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022]
Abstract
Juvenile ovarian granulosa cell tumors (JGCTs) are described infrequently in pediatrics, and their finding in infants is exceptional. We highlight the presenting symptoms, radiologic images, operative management, and histopathologic findings of a 9-month-old female with isosexual pseudopuberty. An updated revision of literature in infants below the age of 12 months is also reported.
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Affiliation(s)
| | - Shayma Ahmed
- Pediatric Endocrinology Department, Hamad Medical Corporation.
| | - Ashraf Soliman
- Pediatric Endocrinology Department, Hamad Medical Corporation .
| | - Fawzia Alyafei
- Pediatric Endocrinology Department, Hamad Medical Corporation.
| | - Nada Alaaraj
- Pediatric Endocrinology Department, Hamad Medical Corporation .
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Hamed N, Soliman A, De Sanctis V, Alaaraj N, Alyafei F, Shaat M, Aljaffali N, Itani M, Jour C. The Prevalence of the Different Components of the Metabolic Syndrome (MetS) in Obese Nondiabetic Children and Young Adolescents and their Anthropometric Data in Relation to Parents. Acta Biomed 2021; 92:e2021321. [PMID: 34487087 PMCID: PMC8477109 DOI: 10.23750/abm.v92i4.11116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 01/19/2023]
Abstract
In Qatar, the prevalence of metabolic syndrome (MetS) in children and adolescents is increasing in parallel with the increasing trends in obesity rates. In Qatar, the prevalence of obesity is relatively high. AIM To assess the prevalence of the different components of MetS and plasma atherogenic indexes (AIP) in obese children and adolescents and to compare their anthropometric data with their parents (genetic background). METHODOLOGY We analysed the anthropometric and biochemical profile of 91 randomly selected obese children and young adolescents (age: 10.5 ± 2.7 years) who attended to the Paediatric Clinic of Hamad Medical Center (HGH) in Doha (Qatar) form January 2017 to December 2019. Data recorded included: age, gender, weight and height, body mass index (BMI), systolic and diastolic blood pressures. Biochemical data including lipid profile, glycated hemoglobin (A1C), and alanine transferase level (ALT) were recorded and compared with normal lab data for the same age group. RESULTS Obese children had a high prevalence of dyslipidaemia, dysglycemia and non-alcoholic fatty liver disease (NAFLD). Using the modified adult MetS criteria, MetS was present in 30.2% of this obese cohort. AIP was high in 76.7% of the patients. Standing height standard deviation score (Ht-SDS) of obese children was significantly higher compared to Ht-SDS of their parents as well as to mid-parental height SDS (MPHt-SDS) (-0.37± 0.79). The BMI and BMI-SDS did not differ between obese children and their parents. CONCLUSION The occurrence of MetS in 30% of our obese non-diabetic children and young adolescents pointed out to the necessity to impose early detection and preventive measures on a national scale.
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Affiliation(s)
- Noor Hamed
- Department of Pediatrics, Hamad Medical Center (HMC), Doha, Qatar.
| | - Ashraf Soliman
- Department of Pediatrics, Hamad Medical Center (HMC), Doha, Qatar.
| | | | - Nada Alaaraj
- Department of Pediatrics, Hamad Medical Center (HMC), Doha, Qatar.
| | - Fawziya Alyafei
- Department of Pediatrics, Hamad Medical Center (HMC), Doha, Qatar.
| | - Mona Shaat
- Department of Dietetics, Hamad Medical Center (HMC), Doha, Qatar.
| | - Noora Aljaffali
- Department of Dietetics, Hamad Medical Center (HMC), Doha, Qatar.
| | - Maya Itani
- Department of Dietetics, Hamad Medical Center (HMC), Doha, Qatar.
| | - Celine Jour
- Department of Dietetics, Hamad Medical Center (HMC), Doha, Qatar.
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De Sanctis V, Soliman A, Tzoulis P, Daar S, Pozzobon GC, Kattamis C. A study of isolated hyperglycemia (blood glucose ≥155 mg/dL) at 1-hour of oral glucose tolerance test (OGTT) in patients with β-transfusion dependent thalassemia (β-TDT) followed for 12 years. Acta Biomed 2021; 92:e2021322. [PMID: 34487089 PMCID: PMC8477110 DOI: 10.23750/abm.v92i4.11105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Subjects with normal glucose tolerance (NGT) but 1-hour post-load plasma glucose (1-h OGTT) ≥ 155 mg/dl (8.6 mmol/L; H-NGT) have an increased risk for developing Type 2 diabetes mellitus (T2DM), determining a new risk factor category with deeper metabolic impairment. The aim of this study was to evaluate the H-NGT as a diagnostic predictor of future dysglycemia in β-transfusion dependent thalassemia (β-TDT). Indices of insulin secretion and insulin sensitivity derived at baseline from OGTTs, were also reviewed. STUDY DESIGN AND METHODS OGTT and indices of insulin secretion and insulin sensitivity, derived at baseline during OGTT, in 17 β-TDT with H-NGT and 29 β-TDT with normal OGTT (NGT) and without H-NGT followed for 12 years were studied. RESULTS H-NGT was associated with decreased insulin sensitivity and progressive deterioration of glucose tolerance. At baseline, serum ferritin and serum alanine aminotransferase (ALT) levels were higher in patients with H-NGT compared to patients with NGT. A strong correlation was observed between ALT and 1-hour plasma glucose value during OGTT in the total group of 36 patients . Compliance to iron chelation therapy was poor in β-TDT patients with H-NGT. An inverse correlation was found between 1-hour plasma glucose value during OGTT and insulin secretion-sensitivity index-2 (ISSI-2) (r: -0.3298; p: 0.025), between ISSI-2 and ALT (r: -0.3262; p: 0.027), and between 1-hour plasma glucose value and ISSI-2 (r: -0.537; p: 0.005) in the whole group of β-TDT patients enrolled in our study. CONCLUSIONS This retrospective study displayed that finding an isolated high 1-hour post-load glucose level (≥155 mg/dL; H-NGT) during the OGTT may serve as a simple biomarker to detect high-risk patients, with chronic liver disease and/or iron overload, who need periodic glycemic surveillance. Measuring the ISSI 2 represented another valuable predictive marker in the assessment of glycemia in these patients.
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt.
| | - Ploutarchos Tzoulis
- Department of Diabetes & Endocrinology, Whittington Hospital, University College London, London, UK.
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman.
| | | | - Christos Kattamis
- First Department of Paediatrics, National Kapodistrian University of Athens, Greece..
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35
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Affiliation(s)
- Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Ad Dawhah, Qatar
| | - Ashraf Soliman
- Alexandria University, Department of Pediatrics, Division of Endocrinology, Alexandria, Egypt
| | - Alan D Rogol
- University of Virginia, Department of Pediatrics, Charlottesville, VA, USA
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36
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Ali E, Soliman A, De Sanctis V, Nussbaumer D, Yassin M. Priapism in Patients with Chronic Myeloid Leukemia (CML): A Systematic Review. Acta Biomed 2021; 92:e2021193. [PMID: 34212918 PMCID: PMC8343736 DOI: 10.23750/abm.v92i3.10796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Background: Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. In patients with leukemia, 50% of cases of priapism are due to Chronic Myeloid Leukemia (CML). We present a systematic review of priapism in CML. Acquisition of evidence: An extensive literature research was carried out in PubMed, Google Scholar, SCOPUS, and Science Citation Index databases. The search included cases up to 4th August 2020. Synthesis of evidence: A total of 68 articles were found and included in our review, including 3 reviews from three different centers. We found 68 articles (102 patients; figure 1) and several case reports on priapism in CML. Priapism was noticed in some patients at the first presentation of CML. However, it was infrequently reported during the start of treatment, following the stop of medication and post-splenectomy. The mean age at presentation was 27.4 years, and the mean time from onset of priapism to the time to get medical attention (presentation) was 78.2 hours. The mean white blood cell count associated with priapism was 321.29x109/L, and the mean platelet count was 569 x10 9/L. The chronic phase of CML was the most common phase where priapism occurred. Most patients were Asian (>50%). Nearly a quarter of patients (27.4%) developed permanent erectile dysfunction. Conclusions: Priapism is a urological emergency requiring urgent multidisciplinary management to prevent erectile dysfunction. Because of the relatively rare occurrence of priapism in CML patients, there is no standard treatment protocol. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Vincenzo De Sanctis
- Coordinator of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A), Ferrara, Italy.
| | | | - Mohamed Yassin
- Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
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De Sanctis V, Soliman A, Tzoulis P, Daar S, Fiscina B, Kattamis C. The Pancreatic changes affecting glucose homeostasis in transfusion dependent β- thalassemia (TDT): a short review. Acta Biomed 2021; 92:e2021232. [PMID: 34212898 PMCID: PMC8343719 DOI: 10.23750/abm.v92i3.11685] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
Background : The natural history of the glycometabolic state in transfusion-dependent β-thalassemia (TDT) patients is characterized by a deterioration of glucose tolerance over time. Aims: This review depicts our current knowledges on the complex and multifacet pathophysiologic mechanisms implicated in the development of alteration of glucose homeostasis in patients with TDT. Search strategy: A systematic search was done on December 2020 including Web of Science (ISI), Scopus, PubMed, Embase, and Scholar for papers published in the last 20 years. Moreover, we checked the reference lists of the relevant articles and previously performed reviews for additional pertinent studies. The personal experience on the care of patients with thalassemias is also reported. Conclusion: A regular packed red blood cells (PRBCs) transfusion program, optimization of chelation therapy, and prevention and treatment of liver infections are critical to achieve adequate glucometabolic control in TDT patients. Many exciting opportunities remain for further research and therapeutic development. (www.actabiomedica.it)
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt.
| | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, N19 5NF UK.
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
| | | | - Christos Kattamis
- First Department of Paediatrics, National Kapodistrian University of Athens 11527, Greece.
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De Sanctis V, Soliman A, Tzoulis P, Daar S, Kattamis A, Delaporta P, Yassin MA, Karimi M, Canatan D, Al Jaouni S, Galati MC, Raiola G, Messina G, Campisi S, Saki F, Kottahachchi D, Kaleva V, Petrova K, Banchev A, Kattamis C. The Prevalence of glucose dysregulations (GDs) in patients with β-thalassemias in different countries: A preliminary ICET-A survey. Acta Biomed 2021; 92:e2021240. [PMID: 34212897 PMCID: PMC8343724 DOI: 10.23750/abm.v92i3.11733] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt.
| | - Ploutarchos Tzoulis
- Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK.
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman.
| | - Antonis Kattamis
- Thalassemia Unit, Division of Pediatric Hematology-Oncology, First Department of Pediatrics, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece.
| | - Polyxeni Delaporta
- Thalassemia Unit, Division of Pediatric Hematology-Oncology, First Department of Pediatrics, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece.
| | - Mohamed A Yassin
- National Center for Cancer Care and Research, Medical Oncology Hematology Section HMC, Doha, Qatar.
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Duran Canatan
- Medical Director of Antalya Genetic Diseases Center, Antalya, Turkey.
| | - Soad Al Jaouni
- Head Division of Pediatric Hematology Oncology, Department of Hematology Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Maria Concetta Galati
- Department of Pediatric Haematoncology, Thalassaemia and Prenatal Diagnosis Regional Center, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
| | - Giuseppe Raiola
- Department of Paediatrics, Pugliese-Ciaccio Hospital,Catanzaro, Italy.
| | - Giuseppe Messina
- UOSD Microcitemie, Grande Ospedale Metropolitano "Bianchi- Melacrino- Morelli", Reggio Calabria, Italy.
| | | | - Forough Saki
- Shiraz Endocrinology and Metabolism Research Center, Shiraz, Iran.
| | | | - Valeria Kaleva
- Varna Expert Center for Coagulopathies and Rare Anemias, Sofia, Bulgaria.
| | - Kristina Petrova
- Varna Expert Center for Coagulopathies and Rare Anemias, Sofia, Bulgaria.
| | - Atanas Banchev
- Pediatric Hematology-Oncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria.
| | - Christos Kattamis
- First Department of Paediatrics, National Kapodistrian University of Athens, Greece.
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Iqbal M, Elmassry A, Mounir A, Ibrahim O, Soliman A. A novel Q-value-based nomogram for single intracorneal ring segment implantation versus standard manufacturer's nomogram combined with accelerated cross-linking for treatment of keratoconus: a randomized controlled trial. Acta Ophthalmol 2021; 99:e501-e511. [PMID: 32930519 PMCID: PMC8359282 DOI: 10.1111/aos.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
Purpose To compare the efficacy of implanting a single Keraring segment according to a novel Q‐value‐based nomogram (QN) to that of segment implantation according to the manufacturer's standard nomogram (SN), for keratoconus treatment. Methods This was a prospective, randomized controlled trial of 104 patients (104 eyes) with Amsler‐Krumeich grade 1 or 2 keratoconus, and type 1 or 2 cone asymmetry determined according to manufacturer's classification. They were randomly distributed into two groups: group A patients (n = 52) underwent Keraring implantation according to the SN, and group B patients (n = 52) underwent implantation of a single (210° arc‐length) Keraring segment according to the QN. Both treatments were combined with accelerated transepithelial cross‐linking, and follow‐up was 6 months. Main outcome measures were preoperative and postoperative visual acuity, subjective refraction and corneal topography. Results At postoperative month 6, group B exhibited statistically significantly higher values of mean uncorrected distance visual acuity (UDVA), sphere, K2, K‐average, K‐max and Q‐anterior (p = 0.02, 0.01, 0.002, 0.001, 0.0001 and 0.03, respectively) compared to that of group A. However, group A exhibited better refractive cylindrical improvements (p = 0.04). In group A, we documented spontaneous extrusion of one Keraring segment. Conclusion Single 210° arc‐length segment implantation using our objective QN was more efficacious for keratoconus treatment than using the subjective SN. The nomograms were comparable when the Q‐anterior value was >−1.00; however, the QN was superior to the SN when the Q‐anterior value was ≤−1.00. The QN yielded greater postoperative UDVA and smoother corneal remodelling than did the SN for treatment of grade 1 and 2 keratoconic eyes.
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology Faculty of Medicine Sohag University Sohag Egypt
| | - Ahmed Elmassry
- Department of Ophthalmology Faculty of Medicine Alexandria University Alexandria Egypt
| | - Amr Mounir
- Department of Ophthalmology Faculty of Medicine Sohag University Sohag Egypt
| | - Ola Ibrahim
- Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo Egypt
| | - Ashraf Soliman
- Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo Egypt
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Ahmed S, Soliman A, De Sanctis V, Alyafie F, Alaaraj N, Hamed N, Ali HA, Kamal A. Defective Cortisol Secretion in Response to Spontaneous Hypoglycemia but Normal Cortisol Response to ACTH stimulation in neonates with Hyperinsulinemic Hypoglycemia (HH). Acta Biomed 2021; 92:e2021182. [PMID: 33988135 PMCID: PMC8182578 DOI: 10.23750/abm.v92i2.11396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/04/2022]
Abstract
Introduction: Hyperinsulinemic Hypoglycaemia (HH) is the most common cause of recurrent and persistent hypoglycemia in the neonatal period. Cortisol and GH play an important role as a counterregulatory hormone during hypoglycemia. Both antagonize the peripheral effects of insulin and directly influence glucose metabolism Patients and Methods: We studied cortisol and GH secretion in newborn infants with HH during spontaneous hypoglycemia. In addition, their basal ACTH level was measured and cortisol response to a standard dose ACTH test was performed. Results: Nine newborns with HH were studied during the first 2 weeks of life. During HH, their mean glucose concentration was 1.42 ± 0.7 mmol/L, mean beta hydroxybutyrate level was 0.08 ± 0.04 mmol/L, and mean serum insulin level was 17.78 ± 9.7 μU/mL. Their cortisol and GH levels at the time of spontaneous hypoglycemia were 94.7 ± 83.1 nmol/L and 82.4 ± 29 m IU/L respectively. They had relatively low level of ACTH (range: 14 :72 pg/ml, mean: 39.4 ± 20 pg/mL) during hypoglycemia. All infants had GH concentration > 20 mIU/L at the time of hypoglycemia. All infants underwent ACTH test. Their basal serum cortisol levels did not differ compared to cortisol levels during hypoglycemia, and all had a normal peak cortisol response (> 500 nmol/L) in response to i.v. ACTH stimulation test. Conclusion: Infants with HH have low cortisol response to spontaneous hypoglycemia with normal response to exogenous standard-dose ACTH. Checking hypothalamic-pituitary axis (HPA) axis later in infancy using low dose ACTH may be useful to diagnose persistent HPA abnormalities in these infants. All HH infants had appropriate elevation of GH during hypoglycemia. (www.actabiomedica.it)
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Affiliation(s)
- Shayma Ahmed
- Departments of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Ashraf Soliman
- Departments of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | | | - Fawzia Alyafie
- Departments of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Nada Alaaraj
- Departments of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Departments of Pediatrics, Hamad General Hospital, Doha, Qatar.
| | - Hamdy A Ali
- Departments of Neonatology, Hamad General Hospital, Doha, Qatar.
| | - Abdulla Kamal
- Departments of Pharmacology, Hamad General Hospital, Doha, Qatar.
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Hammouda K, Khalifa F, Soliman A, Ghazal M, El-Ghar MA, Badawy MA, Darwish HE, Khelifi A, El-Baz A. A multiparametric MRI-based CAD system for accurate diagnosis of bladder cancer staging. Comput Med Imaging Graph 2021; 90:101911. [PMID: 33848756 DOI: 10.1016/j.compmedimag.2021.101911] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022]
Abstract
Appropriate treatment of bladder cancer (BC) is widely based on accurate and early BC staging. In this paper, a multiparametric computer-aided diagnostic (MP-CAD) system is developed to differentiate between BC staging, especially T1 and T2 stages, using T2-weighted (T2W) magnetic resonance imaging (MRI) and diffusion-weighted (DW) MRI. Our framework starts with the segmentation of the bladder wall (BW) and localization of the whole BC volume (Vt) and its extent inside the wall (Vw). Our segmentation framework is based on a fully connected convolution neural network (CNN) and utilized an adaptive shape model followed by estimating a set of functional, texture, and morphological features. The functional features are derived from the cumulative distribution function (CDF) of the apparent diffusion coefficient. Texture features are radiomic features estimated from T2W-MRI, and morphological features are used to describe the tumors' geometric. Due to the significant texture difference between the wall and bladder lumen cells, Vt is parcelled into a set of nested equidistance surfaces (i.e., iso-surfaces). Finally, features are estimated for individual iso-surfaces, which are then augmented and used to train and test machine learning (ML) classifier based on neural networks. The system has been evaluated using 42 data sets, and a leave-one-subject-out approach is employed. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve (AUC) are 95.24%, 95.24%, 95.24%, and 0.9864, respectively. The advantage of fusion multiparametric iso-features is highlighted by comparing the diagnostic accuracy of individual MRI modality, which is confirmed by the ROC analysis. Moreover, the accuracy of our pipeline is compared against other statistical ML classifiers (i.e., random forest (RF) and support vector machine (SVM)). Our CAD system is also compared with other techniques (e.g., end-to-end convolution neural networks (i.e., ResNet50).
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Affiliation(s)
- K Hammouda
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - F Khalifa
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - A Soliman
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - M Ghazal
- Electrical and Computer Engineering Department, Abu Dhabi University, UAE
| | - M Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - M A Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - H E Darwish
- Mathematics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - A Khelifi
- Computer Science and Information Technology Department, Abu Dhabi University, UAE
| | - A El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY, USA.
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Alaaraj N, Soliman A, Hamed N, Alyafei F, De Sanctis V. Understanding the complex role of mTORC as an intracellular critical mediator of whole-body metabolism in anorexia nervosa: A mini review. Acta Biomed 2021; 92:e2021170. [PMID: 33682848 PMCID: PMC7975969 DOI: 10.23750/abm.v92i1.11342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/02/2022]
Abstract
Anorexia nervosa (AN) is a kind of malnutrition resulting from chronic self-induced starvation. The reported associated endocrine changes (adaptive and non-adaptive) include hypothalamic amenorrhea, a nutritionally acquired growth hormone resistance with low insulin like growth factor-1 (IGF-1) secretion, relative hypercortisolemia, decreased leptin and insulin concentrations, and increased ghrelin, Peptide YY (PYY) and adiponectin secretion. The combined effect of malnutrition and endocrinopathy may have deleterious effects on multi-organs including bone, gonads, thyroid gland, and brain (neurocognition, anxiety, depression, and other psychopathologies). The mammalian target of rapamycin (mTOR) is a kinase that in humans is encoded by the mTOR gene. Recent studies suggest an important role of mTOR complex in integration of nutrient and hormone signals to adjust energy homeostasis. In this review, we tried to elucidate the role/s of mTOR as critical mediator of the cellular response in anorexia nervosa. (www.actabiomedica.it)
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Affiliation(s)
- Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Fawziya Alyafei
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
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De Sanctis V, Soliman A, Alaaraj N, Ahmed S, Alyafei F, Hamed N. Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Biomed 2021; 92:e2021168. [PMID: 33682846 PMCID: PMC7975963 DOI: 10.23750/abm.v92i1.11346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 01/30/2023]
Abstract
Linear growth failure (stunting) in childhood is the most prevalent form of undernutrition globally. The debate continues as to whether children who become stunted before age 24 months can catch up in growth and cognitive functions later in their lives. The potentially irreparable physical and neurocognitive damage that accompanies stunted growth is a major obstacle to human development. This review aims at evaluation and summarizing the published research covering the different aspects of stunting from childhood to adulthood.
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Shayma Ahmed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Fawziya Alyafei
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
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Abstract
Despite the widespread of coronavirus disease-19 (COVID-19) infection around the world, there are very scarce reported literature about the care of patients with a known diagnosis of hemoglobin disorders such as sickle cell disease (SCD) or thalassemia and confirmed COVID-19 infection. Thalassemia International Federation issued a position statement to include patients with thalassemia and SCD among the high-risk groups of patients. Here, we present an interesting case of a 42-year-old patient know to have SCD presenting with Vaso-occlusive (VOC) pain episode in the absence of COVID-19 signs and symptoms, who tested positive for COVID-19 infection and had a smooth recovery. This case highlights the importance of screening SCD patients presenting with VOC-related events even in the absence of COVID-19 signs and symptoms.
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Affiliation(s)
- Mohammad Ali
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Lina Okar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
- *Lina Okar, Family Medicine Department, Hamad Medical Corporation, PO Box 3050, Al Rayan Street, Doha (Qatar),
| | - Nabil E. Omar
- Department of Pharmacy, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Jabeed Parengal
- Department of Medicine, Infectious Disease Section, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Soliman
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
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Iqbal P, Soliman A, De Sanctis V, Yassin MA. Association of tuberculosis in patients with chronic myeloid leukemia: a treatment proposal based on literature review. Expert Rev Hematol 2021; 14:211-217. [PMID: 33433245 DOI: 10.1080/17474086.2021.1875818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Chronic Myeloid leukemia (CML) is one of the first hematological malignancy linked with genetic alterations and have a targeted therapy with Tyrosine Kinase Inhibitors. However, there are certain unanswered questions and many unmet needs which limit its treatment. Concurrent Mycobacterium Tuberculosis (Mtb) infection is one of those significant factors. Tuberculosis (TB) is a highly prevalent disease in association with diabetes mellitus, malignancy, poor socioeconomic environment, HIV, and other immunosuppressive conditions in developed and developing countries. Anti-TB medications can affect other drug's pharmacokinetics by altering liver enzymes metabolism and poses treatment challenge with CML medications.Areas covered: The authors performed a rigorous literature review between 2000 and 2020 using PubMed and Google Scholar, with the main focus on all articles addressing the topic of TB in CML. Authors highlighted the need to improve clinical diagnosis and to define management strategy for this dilemma.Expert opinion: In the current era, there are no clear guidelines or recommendations in the literature that address this problem. The aim of this review was to collect and carefully analyze the literature to highlight the need for comprehensive guidelines and propose an algorithm for better management of TB in patients with CML.
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Affiliation(s)
- Phool Iqbal
- Department of Internal Medicine, Hamad Medical Corporation, (HMC), Doha, Qatar
| | - Ashraf Soliman
- Pediatrics and Endocrinology Department of Pediatrics, Hamad Medical Center, Doha, Qatar.,Department of Pediatrics, University of Alexandria, Alexandria, Egypt
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mohamed A Yassin
- Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, (HMC), Doha, Qatar
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de Sanctis V, Soliman A, Tzoulis P, Daar S, Karimi M, Yassin MA, Pozzobon G, Kattamis C. The clinical characteristics, biochemical parameters and insulin response to oral glucose tolerance test (OGTT) in 25 transfusion dependent β-thalassemia (TDT) patients recently diagnosed with diabetes mellitus (DM). Acta Biomed 2021; 92:e2021488. [PMID: 35075059 PMCID: PMC8823555 DOI: 10.23750/abm.v92i6.12366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients with transfusion dependent β-thalassemia (TDT) are at high risk for developing, over the time, a form of diabetes distinct from type 1 and type 2 diabetes, but with similarities to both. AIMS OF STUDY The aim of this study is to describe the clinical and laboratory data, and the insulin secretion and sensitivity, in TDT patients , recently diagnosed with diabetes mellitus (DM). MATERIALS AND METHODS The medical records of 25 TDT patients with DM, diagnosed by standardized oral glucose tolerance test (OGTT) and insulin secretion, were analysed; data were compared to TDT patients without diabetes and to a group of healthy subjects. Natural history of glucometabolic status before the diagnosis of DM was also reviewed. RESULTS On average, the TDT patients with DM were younger compared to TDT patients without diabetes. The mean age at diagnosis of DM in female and male TDT patients was 24.0 ± 7.1 years and 31.9 ± 5.6 years, respectively (P: 0.007). Serum alanine aminotransferase values, basal insulin levels and prevalence of hypogonadism were consistently higher in TDT patients with DM compared to those without diabetes. Decreased insulin secretion and increased insulin resistance was observed in patients with DM. CONCLUSION The natural history of glucometabolic status in TDT patients is characterized by a deterioration of glucose tolerance over time. Iron overload and liver dysfuction are the main factors responsible for glucose disturbances (GD) in TDT patients. The therapeutic approach must be individualized and followed by a multidisciplinary team.
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Affiliation(s)
- Vincenzo de Sanctis
- Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine) and Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
| | - Ploutarchos Tzoulis
- Department of Metabolism and Experimental Therapeutics, Division of Medicine, University College London, London, UK
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman, Oman
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamed A. Yassin
- Hematology-Oncology Department, National Centre for Cancer Care and Research, Doha, Qatar
| | | | - Christos Kattamis
- First Department of Pediatrics, National Kapodistrian University of Athens, Greece
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Hassan M, Khalil A, Magboul S, Alomari O, Abdalla T, Alsliman H, Alhothi A, Al Maslamani E, AlAmri M, Soliman A. Neonates and Young Infants With COVID-19 Presented With Sepsis-Like Syndrome: A Retrospective Case Controlled Study. Front Pediatr 2021; 9:634844. [PMID: 33718304 PMCID: PMC7947254 DOI: 10.3389/fped.2021.634844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/02/2021] [Indexed: 01/17/2023] Open
Abstract
Objective: We aimed to describe the presentations and biochemical characteristics of sepsis-like syndrome (SLS) in infants aged <2 months who tested positive for SARS-CoV-2-in comparison to those in the same age group who were SARS-CoV-2-negative. Background: COVID-19 presents with a spectrum of manifestations, and children seem to have a favorable clinical course compared to other age groups. Limited data are available for symptomatic infants. Design: This was a case-controlled single-institution retrospective study on infants aged <2 months admitted with SLS between 1 April 2020 and 1 July 2020. These infants were divided into 2 groups: Group 1 (n = 41), infants with positive nasal/oropharyngeal swab polymerase chain reaction (PCR) results for SARS-CoV-2; and Group 2 (n = 40), infants with negative PCR results for SARS-CoV-2 (control group). Details between both groups were reviewed and analyzed. Outcome: The clinical and laboratory data for SARS-CoV-2 -positive infants who presented with SLS may differ from those for infants with SLS who tested negative for SARS-CoV-2. Results: Overall, 105 infants were admitted with clinical sepsis: 41 were SARS-CoV-2-positive, and 64 were negative. Fever was present in 90% of SARS-CoV-2-positive infants vs. 80% of the negative group. SARS-CoV-2-positive infants had a higher incidence of nasal congestion and cough (39 and 29%, respectively) compared to the SARS-CoV-2-negative group (20 and 3%, respectively) (P < 0.05). Poor feeding and hypoactivity occurred more frequently in the SARS-CoV-2-negative group (58 and 45%, respectively) than in the SARS-CoV-2-positive group (22 and 12%, respectively, P < 0.004). Sepsis workup, including lumbar puncture, was performed in 67% and partial septic workup was performed in 23% of the SARS-CoV-2-positive infants. Full sepsis workup was performed in 92% of the SARS-CoV-2-negative group. Cerebrospinal fluid (CSF) cultures were negative in 26/27SARS-CoV-2-positive infants (an infant had Klebsiella meningitis). All the SARS-CoV-2-negative infants had negative CSF cultures. Blood culture was negative in both groups. Urine culture showed bacterial growth in 9 infants with SARS-CoV-2-negative sepsis. Conclusions: Our study showed that respiratory symptoms (cough and nasal congestion) were more prominent in the SARS-CoV-2-positive group, while poor feeding and hypoactivity were reported more frequently in the negative group. However, the clinical differentiation between COVID-19 disease and sepsis in such age groups is difficult. Therefore, screening young infants with SLS for SARS-CoV-2- is necessary during this pandemic.
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Affiliation(s)
- Manasik Hassan
- Section of Academic General Paediatrics, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Ahmed Khalil
- Department of Clinical Pharmacy of Paediatric, Hamad General Hospital, Doha, Qatar
| | - Samar Magboul
- Section of Academic General Paediatrics, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Ohood Alomari
- Section of Academic General Paediatrics, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Tasneim Abdalla
- Section of Academic General Paediatrics, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Hafez Alsliman
- Section of Paediatric Emergency, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Abdulla Alhothi
- Section of Academic General Paediatrics, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | | | - Mohammed AlAmri
- Section of Paediatric Emergency, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Ashraf Soliman
- Section of Academic General Paediatrics, Department of Paediatrics, Hamad General Hospital, Doha, Qatar
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Abstract
Abstract
Background
Surgery for clitoral reduction has been practised for over half a century. The aim of clitoral surgery is to achieve normal clitoral morphology without compromising sexual function. To achieve these purposes, many techniques were developed since Young first reported reduction clitoroplasty in 1937. As the importance of the neurovascular bundle was realized, attempts were made to preserve this structure aiming at preservation of the sensory supply to the clitoris to achieve sexual satisfaction.
Methods
The study was conducted on six patients with congenital adrenal hyperplasia, who were operated upon with reduction clitoroplasty with neurovascular bundle preservation as a part of the genital reconstruction; surgery was done by single author (first author). Whole surgically removed corporal bodies were processed. Examination of the sections was done for the presence of nerve bundles related to the anatomical location of the neurovascular bundle using S100 immunohistochemical staining.
Results
In four cases, the presence of nerve fibers in the removed part of the corpus stained by S100 was high on the dorsal surface, with the presence of large nerve fibers (score 3–4), and low on the ventral surface with the presence of small nerve fibers (score 1). In the other two cases, it was low on both surfaces (score 1).
Conclusion
Subfacial clitoroplasty technique carries an inevitable risk of nerve injury and should be replaced by the subtunical technique.
Level of evidence
IV. Type of study: case series with no comparison group.
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Nair AP, Soliman A, Al Masalamani MA, De Sanctis V, Nashwan AJ, Sasi S, Ali EA, Hassan OA, Iqbal FM, Yassin MA. Clinical Outcome of Eosinophilia in Patients with COVID-19: A Controlled Study. Acta Biomed 2020; 91:e2020165. [PMID: 33525219 PMCID: PMC7927494 DOI: 10.23750/abm.v91i4.10564] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 01/21/2023]
Abstract
Background: Eosinophils can be considered as multifunctional leukocytes that contribute to various physiological and pathological processes depending on their location and activation status. There are emerging eosinophil-related considerations concerning COVID-19. Variable eosinophil counts have been reported during COVID-19. Whether these changes are related to the primary disease process or due to immunomodulation induced by the treatment has not yet been elucidated. Aim of the study: To describe changes in the differential leukocyte counts including eosinophils, in a cohort of symptomatic patients with confirmed COVID-19 and to correlate these changes, if any, with the severity of the disease. Patients and methods: We recorded the clinical data, lab findings, including inflammatory markers and leukocyte and differential count, course of the disease and severity score in 314 confirmed symptomatic cases of COVID-19. Results: Laboratory tests revealed that 28.7 % (n =86) had mild eosinophilia (eosinophil count > 500 <1,500/µL). Thirty-four patients (11.3%) had elevated absolute neutrophil count (ANC) (>8,000/µL), and 7 (2.3%) had decreased ANC (< 1,500/µl). Seven patients (2.3%) had lymphopenia (<1,000/µL) and 4 (4.67%) had lymphocytosis (> 4,000/µL). C-reactive protein (CRP) was elevated in 83 patients (27.6%). Chest X-Ray changes included: increased broncho vascular markings (38%), ground-glass opacity (GGO) pneumonitis (19.3%), lobar consolidation (5%), bronchopneumonia (8.3%), nodular opacity (1%), acute respiratory distress syndrome (ARDS) (2.3%), pleural effusion (1.0%) and other atypical findings (6.6%). Patients with eosinophilia had significantly lower CRP, and lower % of GGO, lobar and bronchopneumonia and ARDS in their chest images compared to patients without eosinophilia (p: <0.05). They also had a lower requirement for a hospital stay, ICU admission, mechanical ventilation, and oxygen supplementation versus patients without eosinophilia (p: <0.05). The eosinophils count was correlated negatively with the duration of ICU admission, mechanical ventilation, and oxygen supplementation and with CRP level (r: - 0.34, -0.32, -0.61 and - 0.39, respectively) (p: < 0.01). Conclusions: Our study reports a relatively high prevalence of eosinophilia in symptomatic COVID-19 positive patients. Patients with eosinophilia had a lower level of CRP, milder clinical course and better disease outcomes compared to those without eosinophilia. Our findings indicated a protective role of eosinophils in mitigating the severity of inflammatory diseases through an inhibitory mechanism, as evidenced by lower CRP. This protective role of eosinophils needs to be validated by further prospective studies. (www.actabiomedica.it)
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics. Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Muna A Al Masalamani
- Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | - Abdulqadir J Nashwan
- Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Sreethish Sasi
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Elrazi A Ali
- Department of Internal Medicine, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Ola A Hassan
- Family Medicine, Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Fatima M Iqbal
- Communicable Disease Center (CDC), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Mohamed A Yassin
- Department of Haematology/Oncology, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar.
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Soliman A, De Sanctis V, Alaaraj N, Hamed N. The clinical application of metformin in children and adolescents: A short update. Acta Biomed 2020; 91:e2020086. [PMID: 32921782 PMCID: PMC7717009 DOI: 10.23750/abm.v91i3.10127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022]
Abstract
Metformin is a widely used drug that results in clear benefits in relation to glucose metabolism and diabetes-related complications. The global increase in the prevalence of obesity among children and adolescents is accompanied by the appearance and increasing prevalence of insulin resistance, prediabetes, and type 2 diabetes mellitus (T2DM). In addition, children, and adolescents with premature pubarche and polycystic ovary have considerable degree of insulin resistance. The insulin sensitizing actions of metformin encouraged many investigators and physician to use it as the key drug in these conditions for both prevention and treatment. However, long term-controlled studies are still required to assess the degree and duration of effectiveness and safety of using metformin. This review tries to update physicians about the main and the new therapeutic perspectives of this drug.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | - Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
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