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Guha-Sapir D, Rodriguez-Llanes JM, Hicks MH, Donneau AF, Coutts A, Lillywhite L, Fouad FM. Civilian deaths from weapons used in the Syrian conflict. BMJ 2015; 351:h4736. [PMID: 26419494 DOI: 10.1136/bmj.h4736] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Coutts A, Fouad FM, Abbara A, Sibai AM, Sahloul Z, Blanchet K. Responding to the Syrian health crisis: the need for data and research. THE LANCET RESPIRATORY MEDICINE 2015; 3:e8-9. [DOI: 10.1016/s2213-2600(15)00041-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 12/18/2022]
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Ben Taleb Z, Bahelah R, Fouad FM, Coutts A, Wilcox M, Maziak W. Syria: health in a country undergoing tragic transition. Int J Public Health 2014; 60 Suppl 1:S63-72. [PMID: 25023995 DOI: 10.1007/s00038-014-0586-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To document the ongoing destruction as a result of the tragic events in Syria, to understand the changing health care needs and priorities of Syrians. METHODS A directed examination of the scientific literature and reports about Syria before and during the Syrian conflict, in addition to analyzing literature devoted to the relief and rebuilding efforts in crisis situations. RESULTS The ongoing war has had high direct war casualty, but even higher suffering due to the destruction of health system, displacement, and the breakdown of livelihood and social fabric. Millions of Syrians either became refugees or internally displaced, and about half of the population is in urgent need for help. Access to local and international aid organizations for war-affected populations is an urgent and top priority. CONCLUSIONS Syrians continue to endure one of the biggest human tragedies in modern times. The extent of the crisis has affected all aspects of Syrians' life. Understanding the multi-faceted transition of the Syrian population and how it reflects on their health profile can guide relief and rebuilding efforts' scope and priorities.
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Dewachi O, Skelton M, Nguyen VK, Fouad FM, Sitta GA, Maasri Z, Giacaman R. Changing therapeutic geographies of the Iraqi and Syrian wars. Lancet 2014; 383:449-57. [PMID: 24452046 DOI: 10.1016/s0140-6736(13)62299-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The health consequences of the ongoing US-led war on terror and civil armed conflicts in the Arab world are much more than the collateral damage inflicted on civilians, infrastructure, environment, and health systems. Protracted war and armed conflicts have displaced populations and led to lasting transformations in health and health care. In this report, we analyse the effects of conflicts in Iraq and Syria to show how wars and conflicts have resulted in both the militarisation and regionalisation of health care, conditions that complicate the rebuilding of previously robust national health-care systems. Moreover, we show how historical and transnational frameworks can be used to show the long-term consequences of war and conflict on health and health care. We introduce the concept of therapeutic geographies--defined as the geographic reorganisation of health care within and across borders under conditions of war.
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Sahloul Z, Coutts A, Fouad FM, Jabri S, Hallam R, Azrak F, Maziak W. Health response system for Syria: beyond official narrative. Lancet 2014; 383:407. [PMID: 24457206 DOI: 10.1016/s0140-6736(13)62558-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wilcox M, Mason H, Fouad FM, Rastam S, Ali RA, Capwell S, O’Flaherty M, Page TF, Maziak W. OP14 Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Syria. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Al Ali R, Mzayek F, Rastam S, M Fouad F, O'Flaherty M, Capewell S, Maziak W. Forecasting future prevalence of type 2 diabetes mellitus in Syria. BMC Public Health 2013; 13:507. [PMID: 23705638 PMCID: PMC3673829 DOI: 10.1186/1471-2458-13-507] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 05/19/2013] [Indexed: 11/24/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is increasingly becoming a major public health problem worldwide. Estimating the future burden of diabetes is instrumental to guide the public health response to the epidemic. This study aims to project the prevalence of T2DM among adults in Syria over the period 2003–2022 by applying a modelling approach to the country’s own data. Methods Future prevalence of T2DM in Syria was estimated among adults aged 25 years and older for the period 2003–2022 using the IMPACT Diabetes Model (a discrete-state Markov model). Results According to our model, the prevalence of T2DM in Syria is projected to double in the period between 2003 and 2022 (from 10% to 21%). The projected increase in T2DM prevalence is higher in men (148%) than in women (93%). The increase in prevalence of T2DM is expected to be most marked in people younger than 55 years especially the 25–34 years age group. Conclusions The future projections of T2DM in Syria put it amongst countries with the highest levels of T2DM worldwide. It is estimated that by 2022 approximately a fifth of the Syrian population aged 25 years and older will have T2DM.
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Khalil J, Afifi R, Fouad FM, Hammal F, Jarallah Y, Mohamed M, Nakkash R. Women and Waterpipe Tobacco Smoking in the Eastern Mediterranean Region: Allure or Offensiveness. Women Health 2013; 53:100-16. [DOI: 10.1080/03630242.2012.753978] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Rastam S, Al Ali R, Maziak W, Mzayek F, Fouad FM, O'Flaherty M, Capewell S. Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006. BMC Public Health 2012; 12:754. [PMID: 22958443 PMCID: PMC3485167 DOI: 10.1186/1471-2458-12-754] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 08/29/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them. METHODS The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses. RESULTS Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD. CONCLUSION Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.
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Al Ali R, Rastam S, Fouad FM, Mzayek F, Maziak W. Modifiable cardiovascular risk factors among adults in Aleppo, Syria. Int J Public Health 2011; 56:653-62. [PMID: 21814848 DOI: 10.1007/s00038-011-0278-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 06/28/2011] [Accepted: 07/12/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This report provides the first comprehensive and standardized assessment of the distribution of cardiovascular disease (CVD) risk factors in Syria, where such data are still scarce. METHODS A population-based household survey was conducted in Aleppo (population >2.5 million), involving 1,168 subjects ≥25 years old (47.7% men; mean age 44.7 ± 12.7 years). Information about socio-demographics, personal behavior, and other CVD risk factors was collected. Anthropometric measurements and fasting blood samples were obtained. RESULTS The prevalence of clinical risk factors of CVD (ClinRFs) was 45.6% for hypertension, 43.2% for obesity, 21.9% for hypercholesterolemia and 15.6% for diabetes. The prevalence of behavioral risk factors (BehRFs) was 82.3% for physical inactivity, 39.0% for smoking, and 33.4% for unhealthy diet. All ClinRFs increased with age, while gender was associated only with obesity and smoking. Education was associated with obesity and diabetes (P < 0.05 for all). CONCLUSIONS Adults in Syria have some of the world's highest prevalence of CVD risk factors. Unhealthy behaviors and social norms unfavorable to women may explain some of such risk profiles.
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Al Moustafa AE, Fouad FM, Rastam S. Reply to the letter to the editor by Chaouachi and Sajid: cancer risks of hookah (shisha, narghile) tobacco use require further independent sound studies. Int J Cancer 2010. [DOI: 10.1002/ijc.25185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fouad FM, Rastam S, Al Moustafa AE. Involvement of water pipe smoking in the development of human pancreatic cancer. Int J Cancer 2010; 127:497-8. [PMID: 19937792 DOI: 10.1002/ijc.25061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is considerable public health problem, but data on the prevalence and correlates of T2DM in Syria are scarce. The aim of the present study was to establish reliable estimates of the prevalence of T2DM in Syria. METHODS A cross-sectional, population-based survey was conducted in Aleppo, Syria (population 2.5 million), in 2006. The study was conducted on a random sample of 1168 subjects ≥25 years of age (47.7% men; mean age 44.7 ± 12.7 years). Information regarding a personal history of diabetes and other risk factors was collected, followed by measurement of weight, height, and the waist:hip ratio (WHR). Of the 1168 participants, 806 provided fasting blood samples that were analyzed for fasting plasma glucose (FPG) and HbA1c. RESULTS The prevalence of T2DM based on FPG ≥126 mg/dL and HbA1c ≥6.5% was 15.6% (11.2% self-reported; 5.0% diagnosed) and 14.8%, respectively. The prevalence of impaired fasting glucose (FPG ≥110 and <126 mg/dL) was 8.6%. There was a significant positive association between T2DM and age, WHR, a family history of T2DM, and body mass index (BMI) and an inverse association between T2DM and physical activity (P < 0.01 for all). Multivariate analysis showed that age, BMI, WHR, and a family history of T2DM were the most important factors associated with T2DM. Only 16.7% of treated cases of T2DM were under control (i.e. HbA1c <7%). CONCLUSIONS Based on the results obtained in our sample, T2DM is widespread in Syria. Many of those with T2DM are unaware of their disease and most have unsatisfactory control of their disease.
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Rastam S, Li FM, Fouad FM, Kamal HMA, Akil N, Moustafa AEA. Water pipe smoking and human oral cancers. Med Hypotheses 2010; 74:457-9. [DOI: 10.1016/j.mehy.2009.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 10/04/2009] [Indexed: 10/20/2022]
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Albache N, Al Ali R, Rastam S, Fouad FM, Mzayek F, Maziak W. Epidemiology of Type 2 diabetes mellitus in Aleppo, Syria. J Diabetes 2009. [PMID: 20923489 DOI: 10.1111/j.1753-0407.2009.00063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is considerable public health problem, but data on the prevalence and correlates of T2DM in Syria are scarce. The aim of the present study was to establish reliable estimates of the prevalence of T2DM in Syria. METHODS A cross-sectional, population-based survey was conducted in Aleppo, Syria (population 2.5 million), in 2006. The study was conducted on a random sample of 1168 subjects ≥25 years of age (47.7% men; mean age 44.7 ± 12.7 years). Information regarding a personal history of diabetes and other risk factors was collected, followed by measurement of weight, height, and the waist:hip ratio (WHR). Of the 1168 participants, 806 provided fasting blood samples that were analyzed for fasting plasma glucose (FPG) and HbA1c. RESULTS The prevalence of T2DM based on FPG ≥126 mg/dL and HbA1c ≥6.5% was 15.6% (11.2% self-reported; 5.0% diagnosed) and 14.8%, respectively. The prevalence of impaired fasting glucose (FPG ≥110 and <126 mg/dL) was 8.6%. There was a significant positive association between T2DM and age, WHR, a family history of T2DM, and body mass index (BMI) and an inverse association between T2DM and physical activity (P < 0.01 for all). Multivariate analysis showed that age, BMI, WHR, and a family history of T2DM were the most important factors associated with T2DM. Only 16.7% of treated cases of T2DM were under control (i.e. HbA1c <7%). CONCLUSIONS Based on the results obtained in our sample, T2DM is widespread in Syria. Many of those with T2DM are unaware of their disease and most have unsatisfactory control of their disease.
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Maziak W, Fouad FM, Asfar T, Hammal F, Bachir EM, Rastam S, Eissenberg T, Ward KD. Prevalence and characteristics of narghile smoking among university students in Syria. Int J Tuberc Lung Dis 2004; 8:882-9. [PMID: 15260281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
SETTING Narghile (waterpipe) smoking is increasing in all Arab societies, but little is known about its pattern of use. METHODS In 2003, a cross-sectional survey was conducted among students at Aleppo University using an interviewer-administered questionnaire. A representative sample of 587 students participated (278 males, 309 females; mean age 21.8 +/- 2.1 years; response rate 98.8%). RESULTS Ever narghile smoking was seen among 62.6% of men and 29.8% of women, while current smoking was seen among 25.5% of men and 4.9% of women. Only 7.0% of the men used narghile daily. Age of initiation was 19.2 +/- 2.2 and 21.7 +/- 3.2 years for men and women, respectively (P < 0.001). The salient feature of narghile smoking was its social pattern, where most users initiated and currently smoked narghile with friends. Narghile and cigarette smoking were related among students, with narghile smoking most prevalent among daily cigarette smokers. Multivariate correlates of narghile smoking were being older, male, originating from the city, smoking cigarettes, having friends who smoke narghile, and coming from a household where a greater number of narghiles were smoked daily. CONCLUSIONS Narghile smoking is prevalent among university students in Syria, where it is mainly practiced by men, intermittently, and in the context of social activities with friends.
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Fouad FM, Mamer O, Sauriol F, Khayyal M, Lesimple A, Ruhenstroth-Bauer G. Cardiac heart disease in the era of sucrose polyester, Helicobacter pylori and Chlamydia pneumoniae. Med Hypotheses 2004; 62:257-67. [PMID: 14962637 DOI: 10.1016/s0306-9877(03)00301-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2003] [Accepted: 10/24/2003] [Indexed: 01/14/2023]
Abstract
Recent evidence associates inflammatory mediators with coronary heart disease. Elevation of acute-phase reaction (APR) proteins such as serum amyloid A, fibrinogen, CRP and haptoglobin in response to Helicobacter pylori (H. pylori) infection was shown to initiate gastritis and ischemic heart disease. Positive Chlamydia pneumoniae (C. pneumoniae) serology is associated with increased levels of inflammatory cytokines and tumor necrosis factor-alpha (TNF-alpha), which stimulates endothelial cell activation, procoagulant activity and angiogenesis in patients with coronary heart disease. As a final example, interleukin-6 (IL-6) has been proposed to mediate cardiovascular disorders. Public awareness of risks of excessive body weight and high levels of serum cholesterol propelled the development of synthetic dietary components such as sucrose polyester (SPE) to substitute for natural lipids. SPE is a synthetic lipid whose physical properties are similar to a natural triacylglycerol with a similar assortment of fatty acids and is resistant to lipolysis by gastric and pancreatic enzymes. Intake of SPE in lieu of natural lipids is expected to decrease absorption of essential fatty acids (EFA) and fat-soluble vitamins among other essentials. Deficiency of EFA leads to the formation of faulty cellular membranes, which is manifested as skin lesions, growth failure, erythrocyte fragility, impairment of fertility and uncoupling of oxidation and phosphorylation. Possibilities of absorption of these synthetic lipids into the circulation may represent an unexpected health hazard. We have shown that subcutaneous (sc) administration to rabbits of a range of lipolysis-resistant lipid-like sorbitol, mannitol and arabitol esters of palmitic (P) and lauric (L) acids was found to evoke a mild APR, which in humans could contribute to CHD incidence. We suggest a reversal in the commonly accepted role of SPE as a sequestor of dietary lipid: SPE may be the lipophilic solute contained within the dietary lipid solvent micelle. An alternative conclusion regarding the biological effects of excessive dose of SPE in human and pig for a short time span should be considered.
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Maziak W, Asfar T, Mzayek F, Fouad FM, Kilzieh N. Socio-demographic correlates of psychiatric morbidity among low-income women in Aleppo, Syria. Soc Sci Med 2002; 54:1419-27. [PMID: 12058857 DOI: 10.1016/s0277-9536(01)00123-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interest in mental morbidity as an important component of health is increasing worldwide. Women generally suffer more than men from common mental disorders, and discrimination against women adds to their mental sufferings. Studies looking into the socio-demographic correlates of women's mental morbidity are lacking in most Arab countries. In this study we wanted to determine the spread and socio-demographic correlates of mental distress among low-income women in Aleppo, Syria. A sample of 412 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97.2%, mean age of participants 28 + 8.4 years, where married women constituted 87.9%. A special questionnaire was prepared for the study purpose, utilizing the SRQ-20 non-psychotic items and questions about background information considered relevant to the mental health of women in the studied population. Interviews were conducted in an anonymous one-to-one fashion. The prevalence of psychiatric distress in our sample was 55.6%. Predictors of women's mental health in the logistic regression analysis were; physical abuse, women's education, polygamy, residence, age and age of marriage. Among these predictors, women's illiteracy, polygamy and physical abuse were the strongest determinants of mental distress leading to the worse outcomes. Our data show that mental distress is common in the studied population and that it is strongly associated with few, possibly modifiable, factors.
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Fouad FM, Mamer OA, Sauriol F, Ruhenstroth-Bauer G. Kinetics and mechanisms of hepatic acute phase response to subtotal partial hepatectomy and cultural impact on environmental hepatic end-stage liver injury in the homeless. Med Hypotheses 2001; 56:709-23. [PMID: 11399123 DOI: 10.1054/mehy.2001.1354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intoxication and liver damage induced by carbon tetrachloride (CCl(4)), aflatoxin B1, diabetes, and subtotal partial hepatectomy (PH(90)) in rats in which approximately 90% of the total hepatic tissue mass is surgically removed produces an acute-phase response (APR) whose initial stage prior to regression closely mimics the APRs associated with the life-threatening hepatic failure seen in the homeless. Rats treated by PH(90)were either healthy, CCl(4)-intoxicated, diabetic, or alflatoxin B1 (AFB1) intoxicated to the point of 75% liver insufficiency. It is well documented that high rates of mortality following PH(90)in aseptic rats could be minimized by supplementing drinking water with 20% glucose, organic components of L-15 medium and housing animals in cages maintained at 33-35;C. Aseptic rats showed a mild 20-30% decrease in APR proteins during the first 4-5 days following PH(90), while a maximal APR was noted 9-12 days post PH(90)and lasted for ~30 days when it returned to values close to those of healthy controls. This delay in hepatic APR of the remnant caudate lobe favoured replacement of lost basophilic clumps and ribosomes. The newly synthesized ribosomes of the nascent hepatocytes quantitatively maintained the APR signals of the injured caudate hepatocytes, and biosynthesized and released a typical spectrum of APR proteins. We suggest that massively injured liver has decoded an already stored and irreversible DNA-biochemical sequence of events in which priority is given to recovery of lost tissues by delaying an APR response to injury. In PH(90)of diabetic and CCl(4)-intoxicated rats, the hepatic dual functions of regeneration and APR processes associated with intoxication-initiated catabolic signals, created a heavy metabolic burden on the remnant caudate lobe leading to higher rates of mortality. APR of healthy rats to AFB1 parallels that of alpha-amanitin-induced intoxication. Similarly, within shorter time scale proportional to the severity of surgery, livers undergoing 75% partially hepatectomy (PH(75)) delayed both the onset and regression of APR. We are therefore led to believe that approaches other than liver transplantation should be considered as viable alternatives in the treatment of various acute and chronic liver diseases to avoid rejection and retransplantation. Scarcity of cadaveric liver has forced the medical community to investigate xenotransplantation with its unknown risks. Concomitantly, it is suggested that in view of the incalculable risks of indifference, the homeless must receive much improved medical care as we have found that two-dimensional immunoelectrophoretic assay of their serum is indicative of acute and chronic liver injury. The scientific and moral interrelationships of related matters are illuminated.
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Fouad FM. [The malaria situation in the Syrian Arab Republic]. MEDITSINSKAIA PARAZITOLOGIIA I PARAZITARNYE BOLEZNI 2000:25. [PMID: 10900915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The problem of malaria in Syria is not large one, and because of good surveillance and management, malaria cases have decreased from 626 cases in 1995 to 68 cases in 1998, of which 14 cases were indigenous ones. Vivax malaria cases are registered in the country only.
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Fouad FM, Mamer OA, Sauriol F, Shahidi F. Chemical and epidemiological aspects of modified butter oil fractions. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 1998; 1:149-179. [PMID: 9650535 DOI: 10.1080/10937409809524549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Butter lipids are an important traditional source of dietary energy intake in the form of fat. Butter lost a sizable portion of its market share due to controversies associated with its cholesterol content and high percentage of long-chain saturated fatty acids. Accordingly, the use of vegetable oils and their chemically manipulated counterparts such as those produced by partial hydrogenation or interestrification increased proportionally. However, beginning in 1940, researchers developed several procedures such as temperature-controlled crystallization, refractionation of crystallized butter oil solids, and supercritical carbon dioxide extraction to improve the acceptance of butter oil. Others proposed preparation of synthetic substitutes such as sucrose polyesters to reduce intestinal absorption of fatty acids, thus reducing caloric intake with concomitant reduction in serum cholesterol. The present review provides a summary of the efforts of several attempts to improve the acceptability of butter together with the anticipated epidemiological consequences of long-term consumption of altered butter oil to mammalian health.
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Sun JP, Pu M, Fouad FM, Christian R, Stewart WJ, Thomas JD. Automated cardiac output measurement by spatiotemporal integration of color Doppler data. In vitro and clinical validation. Circulation 1997; 95:932-9. [PMID: 9054753 DOI: 10.1161/01.cir.95.4.932] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A new Doppler echocardiographic technique has been developed for automated cardiac output measurement (ACOM) that assumes neither a flat flow profile nor collinearity with the scan line, but clinical validation of this method is lacking. METHODS AND RESULTS In 165 subjects (50 intensive care patients, 10 dobutamine echocardiography patients, and 105 normal volunteers; age, 49.4 +/- 19.3 years; 92 men), ACOM was performed in the left ventricular outflow tract (LVOT), with the color baseline shifted to avoid aliasing. ACOM was also tested in a pulsatile in vitro model. Stroke volume was calculated by double integration of Doppler signals in space (across the LVOT) and in time (through the systolic period), assuming hemiaxial symmetry: integral of integral of pi r v(r,t) dr dt, where v(r,t) is the velocity at a distance r from the center of the LVOT at time t during systole. Stroke volume from ACOM was compared with thermodilution (TD), aortic valve pulsed-wave Doppler (PWAO), and left ventricular echocardiographic (two-dimensional [2D]) methods. There was good correlation between ACOM and PWAO (r = .93). TD (r = .86), and 2D (r = .74), with close agreement seen. ACOM had higher correlation and agreement with TD than did either PWAO (P < .02) or 2D (P < .01). ACOM was also able to track accurately the changes in cardiac output with dobutamine infusion in comparison with PWAO (r = .94). In vitro assessment demonstrated excellent correlation (r = .98, y = 1.0x + 1.94) with little impact of pulse repetition frequency or misalignment up to 30 degrees. Gain dependency was noted but could be optimized by visual inspection of the color image. CONCLUSIONS Automatic integration of numerical data within color Doppler flow fields is a feasible new method for quantifying flow. It is simpler and faster, requires fewer assumptions, and uses only one apical view. ACOM is a promising new approach to echocardiographic quantification that deserves further study and refinement.
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