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Moghnieh R, Husni R, Helou M, Abdallah D, Sinno L, Jadayel M, Diab K, Chami C, Al Rachid M, Awad DC, Zaiter A, Sayegh MH. The Prevalence and Risk Factors of Acute Kidney Injury during Colistin Therapy: A Retrospective Cohort Study from Lebanon. Antibiotics (Basel) 2023; 12:1183. [PMID: 37508279 PMCID: PMC10376607 DOI: 10.3390/antibiotics12071183] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The current study aimed to determine the prevalence, risk factors, and stages of severity of acute kidney injury (AKI) caused by colistimethate sodium (CMS) treatment in patients diagnosed with systemic antibiotic-resistant Gram-negative bacterial infections. The predictors of all-cause mortality in this patient population were also examined. METHODS This retrospective cohort study included patients who were admitted to a university-affiliated hospital and acute tertiary care referral center in Beirut, Lebanon between January 2015 and December 2018 and underwent CMS treatment for a period of 48 h or more. RESULTS The study sample included 298 adult patients, of which 46.3% (n = 138/298) developed AKI (assessed using the Kidney Disease Improving Global Outcomes (KDIGO) criteria). Of these, 37.7% (n = 51/138) were diagnosed with stage 1 AKI, 23.9% with stage 2 (n = 33/138), and 38.4% with stage 3 (n = 53/138). Nephrotoxicity was reversed in 87.5% of AKI patients who survived until hospital discharge. Independent risk factors for AKI included patient age ≥ 75 years (aOR = 1.854; 95% CI: 1.060-3.241; p-value = 0.03); underlying chronic kidney disease (aOR = 4.849; 95% CI: 2.618-9.264; p-value < 0.0001); and concomitant use of vasopressors (aOR = 4.305; 95% CI: 2.517-7.456; p-value < 0.0001). Multivariate analysis showed that the predictors of severe AKI (stage 2 or 3) included baseline hypoalbuminemia (aOR = 2.542; 95% CI: 1.000-6.564; p-value = 0.05); concomitant use of vasopressors (aOR = 6.396; 95% CI: 2.741-15.87; p-value < 0.0001); and CMS days of therapy (DOT) prior to development of AKI ≥ 7 days (aOR = 4.728; 95% CI: 2.069-11.60; p-value < 0.0001). All-cause mortality was recorded in 51.3% of patients (n = 153/298), and this was significantly higher in patients with AKI (76.8%; n = 106/138) compared to those without (29.4%; n = 47/160; OR = 7.964; 95% CI: 4.727-13.417; p-value < 0.0001). Independent predictors of all-cause mortality included a baseline Charlson comorbidity index score ≥5 (aOR = 4.514; 95% CI: 2.443-8.530; p-value < 0.0001); concomitant use of vasopressors (aOR = 7.76; 95% CI: 4.238-14.56; p-value < 0.0001); and CMS-induced AKI (aOR = 4.117; 95% CI: 2.231-7.695; p-value < 0.0001). CONCLUSIONS The findings of this study suggest that old age, history of chronic kidney disease, and concomitant vasopressor treatment are all independent predictors of CMS-induced AKI. The risk of developing severe AKI significantly increases with CMS DOT. Understanding the risk factors of nephrotoxicity is essential for improving prognosis and treatment outcomes.
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Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Lebanese American University Medical Center, 13-5053 Beirut, Lebanon
- Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital, 11-6301 Beirut, Lebanon
| | - Rola Husni
- Department of Internal Medicine, Lebanese American University Medical Center, 13-5053 Beirut, Lebanon
| | - Mariana Helou
- Department of Internal Medicine, Lebanese American University Medical Center, 13-5053 Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, 11-6301 Beirut, Lebanon
| | - Loubna Sinno
- Department of Medical Research, Makassed General Hospital, 11-6301 Beirut, Lebanon
| | - Marwa Jadayel
- Faculty of Pharmacy, Lebanese University, 6573/14 Beirut, Lebanon
| | - Kawsar Diab
- Department of Obstetrics and Gynecology, Al-Zahraa Hospital-University Medical Center, VF7P+JVR Beirut, Lebanon
- Faculty of Medicine, Lebanese University, 6573/14 Beirut, Lebanon
| | - Carmen Chami
- Faculty of Medicine, Lebanese University, 6573/14 Beirut, Lebanon
| | - Marah Al Rachid
- Faculty of Medicine, Lebanese University, 6573/14 Beirut, Lebanon
| | | | - Aline Zaiter
- Faculty of Medicine, Lebanese University, 6573/14 Beirut, Lebanon
| | - Mohamed H Sayegh
- Faculty of Medicine, American University of Beirut, 11-0236 Beirut, Lebanon
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Smolej E, Malozewski M, McKendry S, Diab K, Daubert C, Farnum A, Orianna S, Reel K, Cameron JI. A qualitative study exploring family caregivers' support needs in the context of medical assistance in dying. Palliat Support Care 2022; 21:1-7. [PMID: 35642744 DOI: 10.1017/s1478951522000116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/06/2022]
Abstract
OBJECTIVES Family members are often involved in the provision of care to a relative at some point in their life. Their role becomes inherently complex when their care recipient is interested in seeking medical assistance in dying (MAID). As assisted death for "grievous and irremediable conditions" was legalized in Canada in 2016, the perspectives of family caregivers have received little attention. To best support caregivers to individuals seeking assisted dying, healthcare practitioners must first understand the perspectives of family caregivers in this context. The objective of this qualitative study was to explore the experiences and support needs of family caregivers who are or who have provided care to individuals who are seeking or have sought MAID. METHODS This study employed a qualitative descriptive design. Family caregivers supporting individuals living with grievous and irremediable conditions were recruited through social media outlets and support organizations. Data were collected through semi-structured telephone interviews and online surveys. Data were transcribed and analyzed using thematic analysis. RESULTS The study included 11 participants, comprising spouses, parents, and adult children. The research identified three prevalent themes: the caregiver experience including roles and responsibilities and the impact of their role; the MAID experience including the process and their thoughts and feelings about MAID; and caregiver insight into supports and services viewed as valuable or needed for the MAID process. SIGNIFICANCE OF RESULTS Study findings may assist in the provision and development of best practice resources and guidelines to support healthcare professionals involved in the delivery of MAID. Specifically, caregivers need to be supported in the context of their caregiving responsibilities to minimize the impact on their own lives and optimize their MAID experience.
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Affiliation(s)
- E Smolej
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - M Malozewski
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - S McKendry
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - K Diab
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - C Daubert
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - A Farnum
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Scali Orianna
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - K Reel
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Canada
- Health Ethics Alliance, Sunnybrook Health Sciences Centre, Toronto, Canada
- Global Institute for Psychosocial, Palliative and End-of-Life Care, Toronto, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Madan S, Patel S, Diab K, Saeed O, Sims D, Forest S, Goldstein D, Jorde U. Association of Race/Ethnicity, Inactivation on Waitlist for Socioeconomic Reasons, and Outcomes in Heart-Transplantation (HT). J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sallam I, Amira G, Sherif A, Jalal S, Sherif M, Diab K. Long term outcomes of single breast incision for breast and axillary surgery on the axillary pain and range of movement. Breast 2019. [DOI: 10.1016/s0960-9776(19)30397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sallam I, Amira G, Sherif A, Sherif M, Yousri A, Diab K. Resecting the unresectable primary locally advanced colorectal cancer. Does it make difference in survival and quality of life? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kong F, Zhang H, LIU Y, Yao H, Cerra-Franco A, Shiue K, Vile D, Wang W, Langer M, Watson G, Bartlett G, Diab K, Birdas T, Timmerman R, Lautenschlaeger T, Jin J. Radiation to the Immune System May be an Important Risk Factor for Long-term Survival after SBRT in Early Stage Non-small Cell Lung Cancer: A Role of RT Plan Optimization. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sallam I, Amira G, Sherif A, Youssri A, Sherif M, Diab K. The efficacy of single breast incision for both breast and axillary surgery on the postoperative pain and range of movement: A comparative study experience at MISR cancer center. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kong F, Liu Y, Zhang H, Yao H, Cerra-Franco A, Shiue K, Vile D, Wang W, Langer M, Watson G, Bartlett G, Diab K, Birdas T, Lautenschlaeger T, Jin J. MA 13.06 New Risk Factors for Overall Survival After SBRT in Early Stage NSCLC: A Role of RT Plan Optimization. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kong F, LIU Y, Cerra-Franco A, Shiue K, Vile D, Yao H, Wang W, Langer M, Watson G, Bartlett G, Diab K, Birdas T, Timmerman R, Lautenschlaeger T, Jin J. Radiation to the Normal Lung May be an Important Risk Factor for Survival after Stereotactic Body Radiation Therapy in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Amira G, Sherif A, Sallam I, Sherif M, Youssif M, Diab K, Taher W. Breast reconstruction using modified inferior dermal flap, implant, and nipple areola complex repositioning technique. Experience at MISR Cancer Center. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Amira G, Sherif A, Sallam I, Sherif M, Diab K, Youssif M, Elgohary A, Noaman A, Zaid A, Moataz M, Hefny M. 246. What type of oncoplastic surgical techniques do Egyptian patients prefer for breast cancer, contralateral symmetry or ipsilateral contour? Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amira G, Sherif A, Sallam I, Noaman A, Diab K, Sherif M, Elgohary A, Youssif M. 249. Oncoplastic breast surgery in Egypt: The impact on the breast multidisciplinary team service and on the patients' pre- and postoperative peace of mind as a multicenter experience. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Amira G, Sherif A, Sallam I, Sherif M, Diab K, Noaman A. 912 Contralateral symmetry as a part of oncoplastic breast surgery indication and timing: Impact on esthetic look and patient satisfaction. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Petrache I, Diab K, Knox KS, Twigg HL, Stephens RS, Flores S, Tuder RM. HIV associated pulmonary emphysema: a review of the literature and inquiry into its mechanism. Thorax 2008; 63:463-9. [PMID: 18443163 DOI: 10.1136/thx.2007.079111] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chronic lung diseases are increasingly recognised complications of the human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). Of these, pulmonary emphysema, characterised by permanent destruction of the lung parenchyma distal to the terminal bronchioles accompanied by various degrees of inflammation, is emerging as a distinct source of morbidity for patients infected with HIV. Similarly, HIV is now frequently cited as a susceptibility factor for the development of emphysema, independent of cigarette smoking status. The presence of common coexistent confounding factors that may predispose patients to chronic lung injury such as drugs, opportunistic infections and malnutrition, limits the scope of studies of direct mechanisms involved in HIV associated emphysematous lung disease. We review the clinical studies supporting a direct association between HIV infection and emphysema. Recent developments in the basic understanding of HIV infection and emphysema are also reviewed, since they may aid in understanding the pathobiology of HIV associated emphysema. The authors emphasise how HIV infection may affect cytotoxic lymphocyte activation, lung capillary endothelial cell injury and apoptosis, sphingolipid imbalance and oxidative stress in the lung. A better understanding of the pathogenesis of HIV associated pulmonary emphysema may provide clues and therapeutic targets that have broader application in this disease, including cigarette smoke induced emphysema.
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Affiliation(s)
- I Petrache
- Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University, Van Nuys Medical Science Building, 635 Barnhill Drive, MS224, Indianapolis, IN 46202-5120, USA.
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El Hassan N, Dbaibo G, Diab K, Musallam S, Haidar R, Obeid M, Bitar F. Pseudomonas pericarditis in an immunocompetent newborn: unusual presentation with review of the literature. J Infect 2002; 44:49-51. [PMID: 11972421 DOI: 10.1053/jinf.2001.0894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute purulent pericarditis is a rare entity in the neonatal age group. The most common isolated organisms are Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Other organisms, like Pseudomonas aeruginosa, have been seldom implicated with only one case of Pseudomonas pericarditis reported in the neonatal period. The prognosis is often considered very poor in this age group. This article describes Pseudomonas pericarditis in a 1-week-old immunocompetent female newborn who was successfully managed with combined medical and surgical therapy.
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Affiliation(s)
- N El Hassan
- Department of Paediatrics, American University of Beirut, Medical Center, Lebanon
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Abstract
A case is presented in which the insertion of a pulmonary artery catheter was complicated by the formation of a knot around the chordae tendineae of the tricuspid valve. The catheter was pulled out under fluoroscopic guidance using a guidewire inserted through the femoral vein.
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Affiliation(s)
- S Arnaout
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
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Dbaibo GS, El-Assaad W, Krikorian A, Liu B, Diab K, Idriss NZ, El-Sabban M, Driscoll TA, Perry DK, Hannun YA. Ceramide generation by two distinct pathways in tumor necrosis factor alpha-induced cell death. FEBS Lett 2001; 503:7-12. [PMID: 11513845 DOI: 10.1016/s0014-5793(01)02625-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ceramide accumulation in the cell can occur from either hydrolysis of sphingomyelin or by de novo synthesis. In this study, we found that blocking de novo ceramide synthesis significantly inhibits ceramide accumulation and subsequent cell death in response to tumor necrosis factor alpha. When cells were pre-treated with glutathione, a proposed cellular regulator of neutral sphingomyelinase, inhibition of ceramide accumulation at early time points was achieved with attenuation of cell death. Inhibition of both pathways achieved near-complete inhibition of ceramide accumulation and cell death indicating that both pathways of ceramide generation are stimulated. This illustrates the complexity of ceramide generation in cytokine action.
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Affiliation(s)
- G S Dbaibo
- Department of Pediatrics, American University of Beirut, Lebanon.
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