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Makki M, Bentaleb M, Abdulrahman M, Suhool AA, Al Harthi S, Ribeiro Jr MAF. Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma. World J Clin Oncol 2024; 15:381-390. [PMID: 38576598 PMCID: PMC10989261 DOI: 10.5306/wjco.v15.i3.381] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
Primary biliary tract tumors are malignancies that originate in the liver, bile ducts, or gallbladder. These tumors often present with jaundice of unknown etiology, leading to delayed diagnosis and advanced disease. Currently, several palliative treatment options are available for primary biliary tract tumors. They include percutaneous transhepatic biliary drainage (PTBD), biliary stenting, and surgical interventions such as biliary diversion. Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors. It involves the administration of chemotherapy drugs, such as gemcitabine and cisplatin, which have shown promising results in improving overall survival in patients with advanced biliary tract tumors. PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction. Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction. Surgical interventions, such as biliary diversion, have traditionally been used as palliative options for primary biliary tract tumors. However, biliary diversion only provides temporary relief and does not remove the tumor. Primary biliary tract tumors often present in advanced stages, making palliative treatment the primary option for improving the quality of life of patients.
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Affiliation(s)
- Maryam Makki
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates
| | - Malak Bentaleb
- Department of Surgery, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 11001, United Arab Emirates
| | - Mohammed Abdulrahman
- Department of Surgery, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 11001, United Arab Emirates
| | - Amal Abdulla Suhool
- Department of Surgery, Division of Hepato-Pancreato-Biliary (HPB) Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 91888, United Arab Emirates
| | - Salem Al Harthi
- Department of Surgery, Division of Hepato-Pancreato-Biliary (HPB) Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 91888, United Arab Emirates
| | - Marcelo AF Ribeiro Jr
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates
- Department of Surgery, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 11001, United Arab Emirates
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Al-Marzouqi O, Makki M, Osman R, Hussein B, Issa W. A huge mesenteric cyst: A case report and literature review. Hamdan Med J 2022. [DOI: 10.4103/hmj.hmj_39_22] [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: 12/24/2022] Open
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Hamed DM, Belhoul KM, Al Maazmi NA, Ghayoor F, Moin M, Al Suwaidi M, Narainen M, Makki M, AbdulRahman M. Intravenous methylprednisolone with or without tocilizumab in patients with severe COVID-19 pneumonia requiring oxygen support: A prospective comparison. J Infect Public Health 2021; 14:985-989. [PMID: 34153729 PMCID: PMC8191304 DOI: 10.1016/j.jiph.2021.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cytokine storm is a marker of severity and severe mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia. Immunomodulatory treatments may reduce morbidity and mortality. OBJECTIVES To determine whether a 7-day course of methylprednisolone (MP) administered with and without tocilizumab improves outcomes in patients with severe COVID-19 (SARS-CoV-2) pneumonia requiring oxygen therapy, relative to historical controls. STUDY DESIGN AND METHOD In this randomized controlled study, patients hospitalized with severe COVID-19 at Rashid Hospital, Dubai, in June 2020 were randomized 1:1 to receive intravenous MP (40 mg twice daily for 7 days) with or without a single dose of intravenous tocilizumab (400 mg). While data from the control arm, consisting of patients administered usual care, were obtained through retrospective review of their electronic medical records. The patients in the three arms were matched by disease severity and inclusion and exclusion criteria. The primary outcomes were day 45 all-cause mortality after randomization, rate of admission to the intensive care unit (ICU), length of ICU stay, days on ventilators, and length of hospital stay. RESULTS In total, 76 patients were recruited, including 23 treated with MP, 26 with MP plus tocilizumab, and 27 historical controls. The rates of admission to the ICU and invasive mechanical ventilation were lowest in patients treated with MP alone, with the rates in this group being significantly lower than the rates in the control group (p = 0.04). Time on a ventilator was lowest in the MP group (1.09 ± 3.68 days) and highest in the control group (7.93 ± 14.86 days). The number of days in the ICU was significantly lower in the MP group than in the control and MP plus tocilizumab groups (p = 0.043). One patient (4.3%) in the MP group and five (18.5%) in the control arm died within 45 days. Survival was highest in patients treated with MP alone, with the addition of tocilizumab not improving survival or any of the other outcomes significantly. INTERPRETATION/CONCLUSION In patients with severe COVID-19 pneumonia on oxygen support, administration of MP daily for 7 days had reduced mortality at 45 days and was associated with significantly lower ICU admission and ventilation rates compared with usual. Adding tocilizumab to MP did not improve any of the studied outcomes significantly.
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Affiliation(s)
- Dujana Mostafa Hamed
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
| | | | | | - Farah Ghayoor
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
| | - Muneeba Moin
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
| | - Mahra Al Suwaidi
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
| | - Meeruna Narainen
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
| | - Maryam Makki
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
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El Merhi F, Ghieh D, Taleb H, Abchee A, Karout L, Tamim H, Makki M, Saade C. Author response to letter to editor. Re: Quantification of epi- and pericardial adipose tissue deposits between males and females during cardiac CT may potentially help categorize coronary artery disease risk with thoracic circumference. Radiography (Lond) 2021; 27:989. [PMID: 34074599 DOI: 10.1016/j.radi.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- F El Merhi
- Diagnostic Radiology Department, Brigham and Women's Hospital, Boston, MA, USA; Dana Farber Hospital, USA; Diagnostic Radiology Department, American University of Beirut, USA.
| | - D Ghieh
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - H Taleb
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - A Abchee
- Non-invasive Cardiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - L Karout
- Faculty of Health Sciences, Medical Imaging Sciences, American University of Beirut Medical Center, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - H Tamim
- Biostatistics Unit, Faculty of Medicine, American University of Beirut, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - M Makki
- Biostatistics Department, Faculty of Medicine, American University of Beiru, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - C Saade
- Faculty of Health Sciences, Medical Imaging Sciences, American University of Beirut Medical Center, P.O.Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Sawaya RD, El Zahran T, Mrad S, Abdul Massih C, Shaya S, Makki M, Tamim H, Majdalani M. Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study. BMC Pediatr 2020; 20:117. [PMID: 32164611 PMCID: PMC7069000 DOI: 10.1186/s12887-020-2007-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 11/15/2022] Open
Abstract
Background It is not yet known how antibiotics may affect Serious Bacterial Infections (SBI). Our aim is to describe the presentation, management, and serious bacterial infections (SBI) of febrile children on or off antibiotics. Methods Retrospective, cohort study of febrile Emergency Department patients, 0–36 months of age, at a single institution, between 2009and 2012. Results Seven hundred fifty-three patients were included: 584 in the No-Antibiotics group and 169 (22%) in the Antibiotics group. Age and abnormal lung sounds were predictors for being on antibiotics (OR 2.00 [95% CI 1.23–3.25] and OR 1.04 [95% CI 1.02–1.06] respectively) while female gender, and lower temperatures were negative predictors (OR 0.68 [95%0.47–0.98] and OR 0.47 [95% CI 0.32–0.67] respectively). Antibiotics were prescribed by a physician 89% of the time; the most common one being Amoxicillin/Clavulanic Acid (39%). The antibiotic group got more blood tests (57% vs 45%) and Chest X-Rays (37% vs 25%). Overall, the percent of SBIs (and pneumonias) was statistically the same in both groups (6.5% in the No-antibiotic group VS 3.6%). Conclusions Children presenting on antibiotics and off antibiotics were significantly different in their presentation and management, although the overall percentages of SBI were similar in each group. Further investigations into this subgroup of febrile children are needed.
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Affiliation(s)
- R D Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - T El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Mrad
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - C Abdul Massih
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Shaya
- Department of Emergency Medicine, Henry Ford University, Detroit, MI, USA
| | - M Makki
- Clinical Research Institute, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh/ Beirut, 1107 2020, Lebanon
| | - H Tamim
- Clinical Research Institute, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh/ Beirut, 1107 2020, Lebanon.
| | - M Majdalani
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon.
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Salah F, Tabbarah A, ALArab y N, Asmar K, Tamim H, Makki M, Sibahi A, Hourani R. Can CT and MRI features differentiate benign from malignant meningiomas? Clin Radiol 2019; 74:898.e15-898.e23. [DOI: 10.1016/j.crad.2019.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/25/2019] [Indexed: 12/01/2022]
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Abstract
INTRODUCTION Systemic lupus erythematosus affects 4.8-78.5 people per 100,000 worldwide, 90% of whom are females. Geography and ethnicity have been shown to significantly affect the prevalence and natural history of the disease. Lupus nephritis affects around half of patients with systemic lupus erythematosus. Data about systemic lupus erythematosus and lupus nephritis in the Middle East are still scarce. In this study, we aimed to describe the characteristics of systemic lupus erythematosus and lupus nephritis at a tertiary care center in Lebanon. METHODS This is a retrospective chart review of all biopsy-proven lupus nephritis patients admitted to the American University of Beirut medical center between January 2000 and December 2018. Patients above 12 years of age who had any International Society of Nephrology/Renal Pathology Society (ISN/RPS) class of lupus nephritis on their renal biopsy were included in the study. RESULTS The study included 55 patients with lupus nephritis. Upon presentation of systemic lupus erythematosus, the most common clinical feature was arthritis, seen in 83% of patients, followed by anemia (82%) and malar rash (48%). In total 93% had positive ANA, 89% had positive anti-dsDNA and 98% of patients had proteinuria. The most common ISN/RPS class of lupus nephritis in our series was IV (49%). At the time of the biopsy 15% of patients underwent dialysis. At 6 months, 11/27 had complete remission, 6/27 had partial remission and 10/27 had no remission. At 1 year, 8/23 had complete remission, 4/23 had partial remission and 11/23 had no remission. During the study period, 15 out of 35 patients available for analysis had chronic kidney disease (CKD) and six out of 34 patients developed end-stage kidney disease requiring renal replacement therapy. In comparison to other series in the region, our series had more males affected, higher creatinine at the time of biopsy and greater degree of proteinuria. CONCLUSION Our study provided insight on the demographics, characteristics, and outcomes of lupus nephritis in Lebanon. Interestingly, male gender was present in a quarter of patients. This warrants further investigation and confirmation. We are hoping to expand this experience into a national prospective registry to further characterize this entity in our region.
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Affiliation(s)
- S H Koubar
- Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
| | - J Kort
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Kawtharani
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - M Makki
- Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - I Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
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Abdulrahman M, Makki M, Shaaban S, Al Shamsi M, Venkatramana M, Sulaiman N, Sami MM, Abdelmannan DK, Salih AMA, AlShaer L. Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools. Educ Health (Abingdon) 2017; 29:231-243. [PMID: 28406108 DOI: 10.4103/1357-6283.204225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE). METHODS A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools. The questionnaire consisted of five sections. Chi-squared tests, regression analysis, and stepwise logistic regression were performed. RESULTS The overall response rate was 46% (956/2079). Factors that students reported to be extremely important when considering their future career preferences were intellectual satisfaction (87%), work-life balance (71%), having the required talent (70%), and having a stable and secure future (69%). The majority of students (60%) preferred internal medicine, surgery, emergency medicine, or family Medicine. The most common reason given for choosing a particular specialty was personal interest (21%), followed by flexibility of working hours (17%). DISCUSSION The data show that a variety of factors inspires medical students in the UAE in their choice of a future medical specialty. These factors can be used by health policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.
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Affiliation(s)
- Mahera Abdulrahman
- Department of Medical Education, Dubai Health Authority, United Arab Emirates
| | - Maryam Makki
- Department of Surgery, Dubai Health Authority, United Arab Emirates
| | - Sami Shaaban
- Department of Medical Education, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Maryam Al Shamsi
- Department of Medical Education, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Manda Venkatramana
- Department of Surgery, Gulf Medical University, Ajman, United Arab Emirates
| | - Nabil Sulaiman
- Department of Family and Community Medicine and Behavioral Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Manal M Sami
- Department of Pathology, Ras al-Khaimah Medical and Health Sciences University, Ras al-Khaimah, United Arab Emirates
| | - Dima K Abdelmannan
- Department of Internal Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | | | - Laila AlShaer
- Department of Hematology, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Makki M, Ayoub G, Abdul-Hameed H, Zaïri F, Mansoor B, Naït-Abdelaziz M, Ouederni M. Mullins effect in polyethylene and its dependency on crystal content: A network alteration model. J Mech Behav Biomed Mater 2017; 75:442-454. [PMID: 28822341 DOI: 10.1016/j.jmbbm.2017.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 12/15/2016] [Revised: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 11/17/2022]
Abstract
This contribution is focused on the Mullins effect in polyethylene. An ultra-low-density polyethylene with 0.15 crystal content, a low-density polyethylene with 0.3 crystal content and a high-density polyethylene with 0.72 crystal content are subjected to cyclic stretching over a large strain range. Experimental observations are first reported to examine how the crystal content influences the Mullins effect in polyethylene. It is found that the cyclic stretching is characterized by a stress-softening, a hysteresis and a residual strain, whose amounts depends on the crystal content and the applied strain. A unified viscohyperelastic-viscoelastic-viscoplastic constitutive model is proposed to capture the polyethylene response over a large strain range and its crystal-dependency. The macro-scale polyethylene response is decomposed into two physically distinct sources, a viscoelastic-viscoplastic intermolecular part and a viscohyperelastic network part. The local inelastic deformations of the rubbery amorphous and crystalline phases are considered by means of a micromechanical treatment using the volume fraction concept. Experimentally-based material kinetics are designed by considering the Mullins effect crystal-dependency and are introduced into the constitutive equations to capture the experimental observations. It is shown that the model is able to accurately reproduce the Mullins effect in polyethylene over a large strain range. The inherent deformation mechanisms are finally presented guided by the proposed constitutive model.
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Affiliation(s)
- M Makki
- Mechanical Engineering Department, American University of Beirut, PO Box 11-0236, Beirut, Lebanon
| | - G Ayoub
- Mechanical Engineering Program, Texas A&M University at Qatar, Doha, Qatar; Industrial and Manufacturing Systems Engineering department, University of Michigan Dearborn, MI 48128, USA.
| | - H Abdul-Hameed
- Univ. Lille, FRE 3723 - LML - Laboratoire de Mécanique de Lille, F-59000 Lille, France
| | - F Zaïri
- Univ. Lille, FRE 3723 - LML - Laboratoire de Mécanique de Lille, F-59000 Lille, France; CHRU Lille, Département de Neurochirurgie, Hôpital Roger Salengro, F-59000 Lille, France.
| | - B Mansoor
- Mechanical Engineering Program, Texas A&M University at Qatar, Doha, Qatar
| | - M Naït-Abdelaziz
- Univ. Lille, FRE 3723 - LML - Laboratoire de Mécanique de Lille, F-59000 Lille, France
| | - M Ouederni
- Research and Development, Qatar Petrochemical Co. (QAPCO), Qatar
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Ammar S, Belhassen S, Laamiri R, Sahnoun L, Ksia A, Ezzi A, Makki M, Aloui S, Krichene I, Belghith M, Nouri A. P-025 – Prise en charge diagnostique et chirurgicale des doubles arcs aortiques. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30210-4] [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]
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Ammar S, Belhassen S, Ksia A, Laamiri R, Sahnoun L, Makki M, Aloui S, Belghith M, Krichene I, Nouri A. P-027 – Traitement laparoscopique du volvulus gastrique chez le nourrisson. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30212-8] [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]
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Ammar S, Ksia A, Hidouri S, Belhassen S, Aloui S, Mosbehi S, Laamiri R, Hmidi N, Kechiche N, Sahnoun L, Krichene I, Makki M, Belghith M, Nouri A. SFCP P-065 - Invaginations intestinales aigues recidivantes de l’enfant (28cas). Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71780-4] [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: 10/25/2022]
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Makki M, Scheer I, Hagmann C, Liamlahi R, Knirsch W, Dave H, Bernet V, Batinic K, Latal B. Abnormal interhemispheric connectivity in neonates with D-transposition of the great arteries undergoing cardiopulmonary bypass surgery. AJNR Am J Neuroradiol 2013; 34:634-40. [PMID: 23042920 DOI: 10.3174/ajnr.a3256] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neonates with severe CHD require CPB within the first days of life. White matter injury can occur before surgery, and this may impair the long-term neurodevelopmental and psychosocial outcome. The purpose of this study was to assess the microstructural development of the CC in infants with CHD before and after CPB for transposition of the great arteries. MATERIALS AND METHODS Fifteen patients with CHD and 11 age-matched HC were recruited. We separately quantified the parallel (E1) and perpendicular (E23) diffusions, the ADC, and FA of the genu of the CC and splenium of the CC before and after surgery. RESULTS In presurgical measures of the genu of the CC, higher E23 (P = .018), higher ADC (P = .026), and lower FA (P = .033) values were measured compared with those in HC. In the postsurgery scans, the genu of the CC had higher E23 (P = .013), higher ADC (P = .012), and lower FA (P = .033) values compared with those in HC. There was no significant difference in any DTI indices between the pre- and postsurgical groups. CONCLUSIONS We report abnormal microstructural development in the genu of the CC of infants with d-TGA before and after CPB. High E23, high ADC, and low FA values in the genu of the CC may be explained by abnormal axonal pruning, thinner myelin sheaths, smaller axonal diameters, or more oligodendrocytes. It appears that the genu of the CC is more vulnerable than the splenium of the CC in patients with CHD and may serve as a biomarker to identify infants at highest risk for adverse neurodevelopmental outcome.
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Affiliation(s)
- M Makki
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland.
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Bagher-Ebadian H, Nejad-Davarani SP, Ali MM, Brown S, Makki M, Jiang Q, Noll DC, Ewing JR. Magnetic Resonance Imaging Estimation of Longitudinal Relaxation Rate Change (ΔR 1) in Dual Gradient Echo Sequences Using an Adaptive Model. Proc Int Jt Conf Neural Netw 2011; 2011:2501-2506. [PMID: 25285243 PMCID: PMC4181328 DOI: 10.1109/ijcnn.2011.6033544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Magnetic Resonance Imaging (MRI) estimation of contrast agent concentration in fast pulse sequences such as Dual Gradient Echo (DGE) imaging is challenging. An Adaptive Neural Network (ANN) was trained with a map of contrast agent concentration estimated by Look-Locker (LL) technique (modified version of inversion recovery imaging) as a gold standard. Using a set of features extracted from DGE MRI data, an ANN was trained to create a voxel based estimator of the time trace of CA concentration. The ANN was trained and tested with the DGE and LL information of six Fisher rats using a K-Fold Cross-Validation (KFCV) method with 60 folds and 10500 samples. The Area Under the Receiver Operator Characteristic Curve (AUROC) for 60 folds was used for training, testing and optimization of the ANN. After training and optimization, the optimal ANN (4:7:5:1) produced maps of CA concentration which were highly correlated (r =0.89, P < 0.0001) with the CA concentration estimated by the LL technique. The estimation made by the ANN had an excellent overall performance (AUROC = 0.870).
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Affiliation(s)
- H Bagher-Ebadian
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - S P Nejad-Davarani
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - M M Ali
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - S Brown
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - M Makki
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - Q Jiang
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - D C Noll
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
| | - J R Ewing
- Physics Dept., Oakland University, Rochester, MI 48309 and Dept. Nuclear Engineering, Shiraz University, Shiraz; Siamak P. Nejad-Davarani - Dept. Neurology, Henry Ford Hospital and Dept. Biomedical Eng. University of Michigan, Ann Arbor; Meser M. Ali - Dept. Radiology, Henry Ford Hospital, Stephen L. Brown - Dept. Radiation Oncology, Henry Ford Hospital, Malek Makki, - Dept. Diagnostic Imaging, University Children Hospital of Zurich, Zurich, Switzerland, Quan Jiang - Dept. Neurology, Henry Ford Hospital; Douglas. C. Noll - Dept. Biomedical Engineering, University of Michigan, Ann Arbor, James R. Ewing Dept. Neurology, Henry Ford Hospital, Dept. Neurology, Wayne State University., and Dept. of Physics, Oakland University
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Juhász C, Haacke EM, Hu J, Xuan Y, Makki M, Behen ME, Maqbool M, Muzik O, Chugani DC, Chugani HT. Multimodality imaging of cortical and white matter abnormalities in Sturge-Weber syndrome. AJNR Am J Neuroradiol 2007; 28:900-6. [PMID: 17494666 PMCID: PMC8134351] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND PURPOSE Impaired cortical venous outflow and abnormal deep venous collaterals are common in Sturge-Weber syndrome (SWS), but their relation to brain metabolism and function is poorly understood. In this study, advanced MR imaging techniques, such as susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI), were applied in conjunction with positron-emission tomography (PET), to assess cortical and white matter structural abnormalities and their relation to cortical glucose metabolism and cognitive functions in children with unilateral SWS. MATERIALS AND METHODS Thirteen children (age, 1.5-10.3 years) with unilateral SWS underwent MR imaging with SWI and DTI, glucose metabolism PET, and comprehensive neuropsychologic assessment prospectively. The MR imaging and PET images were coregistered and cortical regions showing decreased glucose metabolism were compared with locations of SWI signal intensity abnormalities, changes in white matter water diffusion, and cognitive functions. RESULTS SWI detected both cortical abnormalities (n=8) and deep transmedullary veins (n=9), including those in young children with no cortical SWI signal intensity changes. These veins were often located under cortex adjacent to hypometabolic regions. DTI showed abnormal water diffusion both under hypometabolic cortex and in adjacent white matter with collateral veins. Cognitive dysfunction was associated with abnormal water diffusion in the posterior white matter. CONCLUSIONS Transmedullary venous collaterals can be detected early by SWI and persist in white matter adjacent to damaged cortex in children with SWS. Microstructural white matter damage extends beyond cortical abnormalities and may contribute to cognitive impairment. SWI and DTI can be incorporated into clinical MR imaging acquisitions to objectively assess microstructural abnormalities at different stages of SWS.
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Affiliation(s)
- C Juhász
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
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Elabbassi EB, Bach V, Makki M, Delanaud S, Telliez F, Leke A, Libert JP. Assessment of dry heat exchanges in newborns: influence of body position and clothing in SIDS. J Appl Physiol (1985) 2001; 91:51-6. [PMID: 11408412 DOI: 10.1152/jappl.2001.91.1.51] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 12/29/2022] Open
Abstract
A dramatic decrease of sudden infant death syndrome (SIDS) has been noted following the issuance of recommendations to adopt the supine sleeping position for infants. It has been suggested that the increased risk could be related to heat stress associated with body position. In the present study, the dry heat losses of small-for-gestational-age newborns nude or clothed were assessed and compared to see whether there is a difference in the ability to lose heat between the prone and supine positions. An anthropomorphic thermal mannequin was exposed to six environmental temperatures, ranging between 25 and 37 degrees C, in a single-walled, air-heated incubator. The magnitudes of heat losses did not significantly differ between the two body positions for the nude (supine 103.46 +/- 29.67 vs. prone 85.78 +/- 34.91 W/m(2)) and clothed mannequin (supine 59.35 +/- 21.51 vs. prone 63.17 +/- 23.06 W/m(2)). With regard to dry heat exchanges recorded under steady-state conditions, the results show that there is no association between body position and body overheating.
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Affiliation(s)
- E B Elabbassi
- Unité de Recherches sur les Adaptations Physiologiques et Comportementales, Faculté de Médecine, 80036 Amiens Cédex, France.
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Bach V, Telliez F, Makki M, Farges G, Zoccoli G, Krim G, Libert J. Contrôle de l'environnement thermique dans les incubateurs pour nouveau-nés prématurés. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0222-0776(99)80041-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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