1
|
Alameh A, Anaya F, Jabri A, Sukhon F, Alhuneafat L, Khader S, Villablanca P, Aggrawal V, Siraj A, Balakumaran K, Alqarqaz M. Hypertrophic cardiomyopathy in pregnancy: Nationwide analysis of patients characteristics and outcomes. Curr Probl Cardiol 2024; 49:102638. [PMID: 38734121 DOI: 10.1016/j.cpcardiol.2024.102638] [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: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) poses unique challenges in the management of pregnant patients due to the complex interplay of physiological changes of pregnancy. Despite its relatively low prevalence among pregnant women, HCM can significantly impact maternal and fetal outcomes. This study aims to enhance understanding of pregnant patients with HCM and the associated outcomes through a nationwide analysis of patient characteristics and outcomes. METHODS A retrospective analysis was conducted using data obtained from the Agency for Healthcare Research in Quality (AHRQ) Nationwide Inpatient Sample (NIS) database from January 2016 to December 2020. 3,599,855 pregnant patients without HCM and 187 pregnant patients with HCM were identified using International Classification of Disease (ICD) codes, and baseline characteristics, medical comorbidities, and outcomes were compared between the two groups. RESULTS Significant differences were observed in baseline characteristics, including age distribution, racial composition, and prevalence of systemic organ disease, between pregnant women with and without HCM. Women with HCM had higher odds of experiencing maternal complications, such as acute heart failure and peripartum cardiomyopathy, as well as higher rates of fetal distress and obstetric interventions, including preterm delivery and caesarean section. CONCLUSION Comprehensive cardiovascular assessment and risk stratification are essential in pregnant women with HCM to optimize maternal and fetal outcomes. Moreover, disparities in baseline characteristics and outcomes among black pregnant women with HCM highlight the need for a multifactorial approach to addressing pregnancy-related complications.
Collapse
Affiliation(s)
- Anas Alameh
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Firas Anaya
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Laith Alhuneafat
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Safwan Khader
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Vikas Aggrawal
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kathir Balakumaran
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mohammad Alqarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
2
|
Sukhon F, Jabri A, Al-Abdouh A, Alameh A, Alhuneafat L, Jebaje ZA, Khader S, Mhanna M, Koenig G, Alaswad K, Villablanca P, AlQarqaz M. Liberal versus conservative transfusion strategy for patients with acute myocardial infarction and anemia: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102247. [PMID: 38040217 DOI: 10.1016/j.cpcardiol.2023.102247] [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: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND A hemoglobin (Hb) level goal of 7-8 g/dL is a standard care threshold, prompting blood transfusion. The debate over whether acute myocardial infarction (MI) patients benefit from a more liberal transfusion strategy prompted a meta-analysis of relevant trials. METHODS We performed a meta-analysis of randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in anemic MI patients. Primary outcomes were recurrent MI and death/MI, while secondary outcomes included stroke, revascularization, heart failure, and all-cause mortality. Due to the limited trials, we utilized the Paul-Mendele method with Hartung Knapp adjustment. RESULTS Involving 2155 patients with liberal transfusion and 2170 with conservative transfusion across four RCTs, liberal transfusion did not significantly reduce MI (relative risk [RR] 0.85; 95 % CI 0.72 - 1.02, p = 0.07) or death/MI (RR 0.88; 95 % CI 0.45 - 1.71, p = 0.57). No significant differences were observed in all-cause mortality (RR 0.82; 95 % CI 0.25 - 2.68, p = 0.63), stroke (RR 0.89; 95 % CI 0.48 - 1.64, p = 0.50), revascularization (RR 0.93; 95 % CI 0.48 - 1.80, p = 0.68), or heart failure (RR 1.14; 95 % CI 0.04 - 28.84, p = 0.88). CONCLUSION Our meta-analysis supports current medical guidelines, reinforcing the practice of limiting transfusions in acute MI patients to those with an Hb level of 7 or 8 g/dL. Liberal transfusion strategies did not show improved clinical outcomes.
Collapse
Affiliation(s)
- Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Anas Alameh
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Laith Alhuneafat
- Cardiovascular Disease Insititute, University of Minnesota, Minneapolis, MN, USA
| | - Zaid Al Jebaje
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Safwan Khader
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Mohammed Mhanna
- Division of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Gerald Koenig
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Khaldoon Alaswad
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Mohammad AlQarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA.
| |
Collapse
|
3
|
Di Vincenzo L, Jabri A, Alameh A, Sukhon F, Kondapaneni MD. A VERY RARE CORONARY ARTERY ANOMALY, INTERCORONARY COMMUNICATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04421-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
4
|
Alrifai N, Alhuneafat L, Jabri A, Khalid MU, Tieliwaerdi X, Sukhon F, Hammad N, Al-Abdouh A, Mhanna M, Siraj A, Sharma T. Pregnancy and Fetal Outcomes in Patients with Ehlers-Danlos Syndrome: A Nationally Representative Analysis. Curr Probl Cardiol 2023; 48:101634. [PMID: 36806636 DOI: 10.1016/j.cpcardiol.2023.101634] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Cardiovascular (CV) disease remains one of the leading causes of maternal morbidity and mortality globally. CV complications occur frequently in Ehlers-Danlos Syndrome (EDS). Pregnancy outcomes, however, are not well established in patients with EDS. We aim to evaluate pregnancy outcomes in this population compared to patients without EDS. METHODS We conducted a population-based, retrospective, cohort study using the national inpatient data sample to evaluate and compare pregnancy and fetal outcomes in patients with and without EDS, delivering between 2016 and 2019. Regression analysis was performed and adjusted for maternal age and race to compare maternal and fetal outcomes. RESULTS Of the total 5,887,050 births in our cohort, 1,016 were to patients with EDS. The EDS cohort was more likely to be older and white with multiple gestations and comorbidities, such as smoking, mitral valve prolapse, and chronic hypertension. When we adjusted for age and race, patients with EDS were more likely than those without EDS to require Cesarean-section, develop postpartum hemorrhage, experience intrauterine growth restriction, and deliver preterm. CONCLUSION In this nationally representative study, patients with EDS experienced higher rates of maternal complications, however, aortic aneurysmal rupture was not among them. Further studies regarding each type of EDS and its obstetric complications may aid in pre-pregnancy counseling, antenatal care, and formulating a multidisciplinary obstetric approach for this patient population. SHORT ABSTRACT Cardiovascular complications occur frequently in Ehlers-Danlos Syndrome (EDS). Pregnancy outcomes, however, are not well established in patients with EDS. We conducted a population-based, retrospective, cohort study using the national inpatient sample to compare pregnancy and fetal outcomes in patients with and without EDS, delivering between 2016 and 2019. Regression analysis was performed and adjusted for maternal age and race to compare both groups. Of the total 5,887,050 births in our cohort, 1,016 were to patients with EDS. The EDS cohort was more likely to be older, white and have multiple comorbidities, such as smoking, mitral valve prolapse, and chronic hypertension. When we adjusted for age and race, patients with EDS were more likely than those without EDS to require Cesarean-section, develop postpartum hemorrhage, experience intrauterine growth restriction, and deliver preterm. In this study, patients with EDS experienced higher rates of maternal complications, however, aortic aneurysmal rupture was not among them.
Collapse
Affiliation(s)
- Nada Alrifai
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA.
| | | | | | - Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Nour Hammad
- Department of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, OH USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohammed Mhanna
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Tarun Sharma
- Department of Rheumatology, Allegheny Health Network, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Assi HI, Alameh IA, Khoury J, Bou Zerdan M, Akiki V, Charafeddine M, El Saheb GI, Sukhon F, Sbaity E, Baydoun S, Shabb N, Berjawi G, Haidar MB. Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients. Front Oncol 2021; 11:740336. [PMID: 34660301 PMCID: PMC8518554 DOI: 10.3389/fonc.2021.740336] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to evaluate the diagnostic ability of 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) PET/non-contrast CT compared with those of ultrasound (US)-guided fine needle aspiration (FNA) for axillary lymph node (ALN) staging in breast cancer patients. Patients and Methods Preoperative 18F-FDG PET/non-contrast CT was performed in 268 women with breast cancer, as well as ALN dissection or sentinel lymph node (SLN) biopsy. One hundred sixty-four patients underwent US-guided FNA in combination with 18F-FDG PET/CT. The diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. The receiver operating characteristic (ROC) curves were compared to evaluate the diagnostic ability of several imaging modalities. Results Axillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by ALN dissection and/or SLN dissection. Of the patients with positive 18F-FDG uptake in the axilla, 21% had false-positive results, whereas 79% were truly positive. Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-PET/CT had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided FNA had a sensitivity of 91.67% and a specificity of 87.50%. The mean primary cancer size (p = 0.04) and tumor grade (p = 0.04) in combination were the only factors associated with the accuracy of 18F-FDG PET/CT for detecting metastatic ALNs. Conclusion The diagnostic performance of 18F-FDG PET/CT for the detection of axillary node metastasis in breast cancer patients was not significantly different from that of US-guided FNA. Combining 18F-FDG PET/CT with US-guided FNA or SLN biopsy could improve the diagnostic performance compared to 18F-FDG PET/CT alone.
Collapse
Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim A Alameh
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vanessa Akiki
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghida I El Saheb
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Sbaity
- Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Serine Baydoun
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nina Shabb
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Berjawi
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad B Haidar
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
6
|
Assi HI, Hilal L, Abu-Gheida I, Berro J, Sukhon F, Skaf G, Geara F, Boulos F, Charafeddine M, Tabbarah A, Khoury J, Najjar M. Corrigendum to "Demographics and outcomes of meningioma patients treated at a tertiary care center in the Middle East" [Clin. Neurol. Neurosurg. 195 (2020) 105846]. Clin Neurol Neurosurg 2020; 197:105926. [PMID: 32499059 DOI: 10.1016/j.clineuro.2020.105926] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - Lara Hilal
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Ibrahim Abu-Gheida
- Department of Radiation Oncology, Burjeel Medical City, United Arab Emirates
| | - Juliett Berro
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Ghassan Skaf
- Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Abeer Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Marwan Najjar
- Department of Surgery, American University of Beirut Medical Center, Lebanon.
| |
Collapse
|
7
|
Assi HI, Hilal L, Abu-Gheida I, Berro J, Sukhon F, Skaf G, Geara F, Boulos F, Charafeddine M, Tabbarah A, Khoury J, Najjar M. Demographics and outcomes of meningioma patients treated at a tertiary care center in the Middle East. Clin Neurol Neurosurg 2020; 195:105846. [PMID: 32334046 DOI: 10.1016/j.clineuro.2020.105846] [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: 01/21/2020] [Revised: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Meningioma is the most common intracranial primary brain tumor. Risk factors such as age and exposure to radiation as well as prognostic factors such as grade, location, and extent of surgical resection have been reported in the literature worldwide; however, to our knowledge, data from the Middle East is still warranted. In this study, we aim to identify the characteristics, risk factors and outcomes of meningioma patients treated at a multidisciplinary regional referral center in the Middle East. PATIENTS AND METHODS This is a retrospective chart review with a prospective follow up of outcomes. It included patients diagnosed with meningioma between January 2005 and December 2015 at the American University of Beirut Medical Center. Patient's demographics, risk factors and outcomes were first retrospectively collected. Then, we conducted phone calls to all included alive patients to update their disease status and outcomes. RESULTS One-hundred and ninety-five patients were included. 69 % had grade I tumors and around 31 % with grades II and III meningiomas. The means of the overall survival and progression free survival (PFS) were 198 and 126 months, respectively. The residence area (city vs. countryside), occupation, alcohol use, oral contraceptive use, family history of meningioma, previous head trauma, radiation exposure for head/brain imaging, cell phone use, and finally, the tumor Ki-67 protein level did not correlate with the survival outcomes. The meningioma grade and extent of resection were significant predictors of the PFS on the univariate analysis, whereas, in the multivariate analysis only previous radiotherapy was significant in prolonging PFS. CONCLUSION In our study cohort, that included around 30 % grades II and III tumors, previous radiotherapy use was the only significant prognostic factor for longer PFS in patients diagnosed with meningioma. Future prospective studies should be conducted to evaluate genetic and molecular factors that could possibly be linked to meningioma grade and prognosis in our population of Middle Eastern patients.
Collapse
Affiliation(s)
- Hazem I Assi
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - Lara Hilal
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Ibrahim Abu-Gheida
- Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Juliett Berro
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Fares Sukhon
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Ghassan Skaf
- Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Abeer Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Lebanon
| | - Jessica Khoury
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | - Marwan Najjar
- Department of Surgery, American University of Beirut Medical Center, Lebanon.
| |
Collapse
|
8
|
Assi H, Salem R, Sukhon F, Abbas J, Boulos F, Saghir NE. Phyllodes tumors of the breast treated in a tertiary health care center: case series and literature review. J Int Med Res 2018; 48:300060518803530. [PMID: 30318976 PMCID: PMC7113489 DOI: 10.1177/0300060518803530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/29/2022] Open
Abstract
Objective This study was performed to determine the subtypes of phyllodes tumor (PT) in
patients at a single tertiary healthcare center in Lebanon and to describe
their characteristics along with a review of the literature. Methods This single-institution retrospective cohort study included all cases of PT
of the breast treated at the American University of Beirut Medical Center
from 1 January 2010 to 31 December 2014. The patients’ demographic data,
tumor characteristics, treatment data, and pathology reports were
analyzed. Results Thirty patients were enrolled. Their median age was 42 years. In total, 66.7%
had benign disease and 22.3% had malignant disease. Twenty-seven patients
underwent surgery, four received radiotherapy, and one received systemic
chemotherapy after PT progression. Twenty-seven patients had no recurrence
at the last follow-up, two had local recurrence, and one had metastatic
disease. All three patients with recurrence had an adequate negative
surgical margin at the first excision. Conclusion This is the first cohort of patients with PT described in Lebanon and one of
few in the Middle East. Our findings provide insight into the epidemiology,
treatment modalities, and prognosis of PT in this geographical region.
Collapse
Affiliation(s)
- Hazem Assi
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Salem
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Sukhon
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaber Abbas
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagi El Saghir
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
9
|
Abstract
Typical hemolytic uremic syndrome (HUS) in adults is an uncommon clinical occurrence and has been rarely reported in the literature. Typical HUS is mainly caused by Shiga toxin-producing Escherichia coli (STEC) and is typically a pediatric disease. Worldwide outbreaks have been reported, one of the largest and most recent being in Germany. We are reporting a case of a 55-year-old male who presented with acute diarrhea. His laboratory parameters were suggestive of HUS and molecular testing was positive for STEC in stools. The patient received supportive therapy, and he recovered clinically with an improvement in his laboratory parameters. We hereby highlight the importance of timely diagnosis of typical HUS in guiding management and avoiding unnecessary testing and treatment. The mainstay of therapy is aggressive and prompt intravenous hydration to help alleviate the acute kidney injury and improve the clinical outcomes.
Collapse
Affiliation(s)
- Ramez Kouzy
- School of Medicine, American University of Beirut Medical Center, Beirut , LBN
| | - Rasha Alawieh
- Internal medicine, American University of Beirut Medical Center, Beirut, LBN
| | - Fares Sukhon
- Internal medicine, American University of Beirut Medical Center, Beirut, LBN
| | - Sally Temraz
- Hematology & Oncology, American University of Beirut Medical, Beirut, LBN
| |
Collapse
|
10
|
Assi H, Nohra V, Sukhon F, Moukalled N, Bou Akl I, Mukherji D, Charafeddine M, Abdul Halim N, El Mouhayyar C, Medlej Y, Bou Khalil P. Outcomes of patients with malignancy admitted to the intensive care units (ICU): A prospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.026] [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: 11/14/2022] Open
|
11
|
Abstract
Degradomics has recently emerged as a subdiscipline in the omics era with a focus on characterizing signature breakdown products implicated in various disease processes. Driven by promising experimental findings in cancer, neuroscience, and metabolomic disorders, degradomics has significantly promoted the notion of disease-specific "degradome." A degradome arises from the activation of several proteases that target specific substrates and generate signature protein fragments. Several proteases such as calpains, caspases, cathepsins, and matrix metalloproteinases (MMPs) are involved in the pathogenesis of numerous diseases that disturb the physiologic balance between protein synthesis and protein degradation. While regulated proteolytic activities are needed for development, growth, and regeneration, uncontrolled proteolysis initiated under pathological conditions ultimately culminates into apoptotic and necrotic processes. In this chapter, we aim to review the protease-substrate repertoires in neural injury concentrating on traumatic brain injury. A striking diversity of protease substrates, essential for neuronal and brain structural and functional integrity, namely, encryptic biomarker neoproteins, have been characterized in brain injury. These include cytoskeletal proteins, transcription factors, cell cycle regulatory proteins, synaptic proteins, and cell junction proteins. As these substrates are subject to proteolytic fragmentation, they are ceaselessly exposed to activated proteases. Characterization of these molecules allows for a surge of "possible" therapeutic approaches of intervention at various levels of the proteolytic cascade.
Collapse
Affiliation(s)
- Hadi Abou-El-Hassan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Fares Sukhon
- Faculty of Medicine, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Edwyn Jeremy Assaf
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hisham Bahmad
- Faculty of Medical, Neuroscience Research Center, Beirut Arab University, Beirut, Lebanon
- Faculty of Medicine, Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussein Abou-Abbass
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Hussam Jourdi
- Faculty of Science¸ Department of Biology, University of Balamand, Souk-el-Gharb Campus, Aley, Lebanon
| | - Firas H Kobeissy
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon.
- Department of Psychiatry, Center for Neuroproteomics and Biomarkers Research, University of Florida, Gainesville, FL, USA.
| |
Collapse
|