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Mohanna M, Herrán M, Dominguez B, Sabbagh S, Msheik A, Itani M, Saba L, Iska S, Liang H, Diaz CM, Nahleh Z. "You matter": patients perceptions and disparities about cancer care and telehealth during and after COVID-19 pandemic. Support Care Cancer 2024; 32:236. [PMID: 38506939 PMCID: PMC10954847 DOI: 10.1007/s00520-024-08433-2] [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: 10/12/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Disparities in cancer care have been exacerbated by the COVID-19 pandemic. The aim of this study is to establish how telehealth mitigated the effect of COVID-19 on the healthcare sector and to identify potential disparities in perception and experience with telehealth in cancer care during and after the pandemic. METHODS We identified individuals with an established cancer diagnosis who received treatment at a comprehensive academic cancer center with a diverse patient population between 2019 and 2021, during the COVID-19 pandemic. Participants were asked to complete a self-administrated survey intended to collect patient-reported outcomes on socioeconomic and mental health challenges incurred during the pandemic as well as participants' experience with telehealth. The assessment was adapted from a 21-question-based survey applied for mental health. Descriptive statistics were used to summarize participant characteristics and the response to the survey items. Multivariable logistic regression was performed to assess and analyze the contributing factors to the survey responses. RESULTS A total of N = 136 participants were included in this analysis. The majority of participants (60.6%) reported increased anxiety, stress, or experience of distress as a direct result of COVID-19. However, among 54.1% of survey responders participated in a telehealth appointment and 84.4% agreed it was an easy and effective experience. CONCLUSION Elderly, male, and black participants reported the worst impact related to the pandemic. The majority of patients had a positive experience with telehealth. The results of the study suggest that telehealth services can serve as a tool for patients with cancer during and beyond active treatment to access supportive services.
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Affiliation(s)
- Mohamed Mohanna
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | - María Herrán
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Barbara Dominguez
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Saad Sabbagh
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Ali Msheik
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mira Itani
- Department of Family Medicine, Emory, Atlanta, Ga, USA
| | - Ludovic Saba
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Sindu Iska
- Department of Hematology and Oncology, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Hong Liang
- Department of Research, Cleveland Clinic Florida, Weston, USA
| | - Caroline Metzel Diaz
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Zeina Nahleh
- Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
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Fahed E, Msheik A, Yazbeck M, Rahal M, Antoun S, Geagea C, Younes P. Unveiling Dandy-Walker syndrome: A surprising twist in the tale of acute hydrocephalus and Down syndrome child. eNeurologicalSci 2023; 33:100480. [PMID: 37928178 PMCID: PMC10624568 DOI: 10.1016/j.ensci.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/13/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023] Open
Abstract
The correlation between Down syndrome and Dandy-Walker syndrome is an exceptionally uncommon occurrence. To date, only four cases have been documented. All previously reported cases involved individuals under the age of 37 months, with prenatal or birth diagnoses. Additionally, most of these cases displayed a limited life expectancy and experienced poor developmental outcomes. In this report, we present the first-ever instance of an 11-year-old male patient, previously undiagnosed with Dandy-Walker syndrome, who presented with acute intracranial hypertension. Magnetic Resonance Imaging revealed an active hydrocephalus caused by a Dandy-Walker malformation. The patient's condition was effectively managed through the implementation of a ventriculo-cysto-peritoneal shunt. This case highlights the coexistence of Dandy-Walker syndrome and Down syndrome in an asymptomatic young patient. Furthermore, it demonstrates that active hydrocephalus in such cases can be successfully addressed through either endoscopic third ventriculostomy or ventriculo-cysto-peritoneal shunt procedures.
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Affiliation(s)
- Elie Fahed
- Neurosurgery department, Bellevue Medical Center, Beirut, Lebanon
| | - Ali Msheik
- Neurosurgery, Faculty of medical sciences, Lebanese University, Lebanon
| | - Mohamad Yazbeck
- Neurosurgery Department, Clemenceau Medical Center, Beirut, Lebanon
| | - Maya Rahal
- Pediatrics department, Bellevue Medical Center, Beirut, Lebanon
| | | | - Caroline Geagea
- Pediatrics department, Bellevue Medical Center, Beirut, Lebanon
| | - Philippe Younes
- Neurosurgery department, Bellevue Medical Center, Beirut, Lebanon
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Yazbeck M, Msheik A, Berjaoui C, Dabboucy B, Comair Y. Severe hyponatremia and bilateral sequential facial palsy: A case report. Radiol Case Rep 2023; 18:4062-4065. [PMID: 37701361 PMCID: PMC10493881 DOI: 10.1016/j.radcr.2023.08.060] [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: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023] Open
Abstract
Facial palsy (FP) is a known consequence of head trauma, manifesting either immediately at the time of injury or with delayed onset, typically occurring 2 days or more post-trauma. Unilateral FP is the more common presentation and is often attributed to partial or complete transection of facial nerves or delayed onset edema. Conversely, bilateral facial palsy is a rare occurrence, reported in only a small number of cases, accounting for approximately 3% of patients presenting with bilateral weakness. In this report, we present the case of a previously healthy 28-year-old female who suffered a closed head injury during the Beirut Port Blast. Four days following the incident, the patient exhibited right-sided peripheral FP, which was consistent with a right temporal bone fracture. Subsequently, on the fifth day, the right-sided FP worsened, accompanied by the development of new FP on the left side, characterized by sparing of the frontal region, indicating a central origin for the left-sided FP. Laboratory investigations revealed severe hypovolemic hyponatremia with a sodium level of 105 mmol/L. As isotonic saline fluid replacement was initiated, there was progressive improvement in the left-sided FP. The right-sided palsy also resolved gradually with the implementation of facial rehabilitation therapy. It is important to note that severe head trauma, particularly with a concussive injury, can lead to facial paralysis through various mechanisms. Furthermore, severe hyponatremia should be considered a potential cause of central facial palsy, particularly in the presence of bilateral facial involvement. A thorough evaluation is encompassing assessment of palsy patterns, comprehensive imaging studies, and metabolic investigations is crucial for accurate diagnosis and timely intervention, resulting in successful treatment.
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Affiliation(s)
- Mohamad Yazbeck
- Department of Neurosurgery, Clemenceau Medical Center, Beirut, Lebanon
| | - Ali Msheik
- Department of Neurosurgery, Lebanese University Faculty of Medical Sciences, Beirut, Lebanon
| | | | - Baraa Dabboucy
- Department of Neurosurgery, Lebanese University Faculty of Medical Sciences, Beirut, Lebanon
| | - Youssef Comair
- Department of Neurosurgery, Clemenceau Medical Center, Beirut, Lebanon
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Msheik A, Assi F, Hamed F, Jibbawi A, Nakhl AM, Khoury A, Mohanna R, Gerges T, Atat R. Stem Cell Transplantation for Multiple Sclerosis: A 2023 Review of Published Studies. Cureus 2023; 15:e47972. [PMID: 38034162 PMCID: PMC10686127 DOI: 10.7759/cureus.47972] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
This comprehensive literature review underscores the potential of stem cell transplantation (SCT) as a therapeutic intervention for multiple sclerosis (MS). By amalgamating evidence from various sources, including randomized controlled trials (RCTs), observational, retrospective, and comparative studies, this review offers a holistic understanding of SCT's effectiveness, safety, and feasibility in diverse contexts of MS management. SCT has shown promise in mitigating disease activity and progression, particularly in relapsing-remitting MS (RRMS). RCTs like the high dose immunoablation and autologous hematopoietic stem cell transplantation in MS (ASTIMS) versus mitoxantrone therapy in severe multiple sclerosis and multiple sclerosis international stem cell transplant (MIST) trials reveal SCT's capacity to reduce new lesion occurrences and inflammatory activity. However, variability exists in disability score improvements among these studies. Observational and retrospective investigations further affirm SCT's potential, highlighting decreased relapse rates, enhanced expanded disability status scale (EDSS) scores, and a noteworthy proportion of patients achieving no evidence of disease activity (NEDA). The initial literature search using all of the search items produced a total of 3,636 articles. After title, abstract, and article type screening and article retrieving, 147 articles were assessed for eligibility using the inclusion criteria. At the end of the literature search, 37 articles met the eligibility criteria. They were included in our review according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Patients treated with hematopoietic stem cell transplantation (HSCT) present lower progression and relapse rates, suppression of inflammatory activity, and a greater reduction in T2 lesions on MRI than those treated with disease-modifying therapies (DMTs). In summary, while SCT presents promise as a therapeutic option for MS, its deployment should be tailored to individual patient characteristics, disease stages, and responses.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Faculty of Medicine Lebanese University, Hadath, LBN
| | - Farah Assi
- Infectious Diseases, Faculty of Medicine Lebanese University, Beirut, LBN
| | - Faten Hamed
- Pharmacology, Lebanese International University, Beirut, LBN
| | - Ali Jibbawi
- Pediatric Medicine, Saint Georges Hospital, Beirut, LBN
| | - Anna-Marina Nakhl
- Medicine and Surgery, Faculty of Medicine Lebanese University, Beirut, LBN
| | - Anthony Khoury
- Medicine and Surgery, Faculty of Medicine Lebanese University, Beirut, LBN
| | - Rami Mohanna
- Medicine and Surgery, Faculty of Medicine Saint-Joseph University, Beirut, LBN
| | - Teddy Gerges
- Anesthesia, Winchester Anesthesia Associates, Boston, USA
| | - Rami Atat
- Neurology, Faculty of Medical Sciences Lebanese University, Beirut, LBN
- Neurology, Al Zahraa University Medical Center, Beirut, LBN
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5
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Msheik A, Saad F, Saad WA, Al Mokdad Z, Tarhini C, Bayram M. Navigating treatment options for sacral spine lymphoma: A medical journey. Int J Surg Case Rep 2023; 107:108327. [PMID: 37210801 DOI: 10.1016/j.ijscr.2023.108327] [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: 04/14/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Early clinical presentations of spinal processes involving the epidural space are often vague and can mimic other spinal nerve impingements. Patients with NHLs frequently experience neurological problems due to metastatic spinal cord compression (MSCC). CASE PRESENTATION In this case report, we present a 66-year-old female patient who was diagnosed with diffuse large B-cell lymphoma (DLCBL) of the sacral spine after a recurrence of cauda equine syndrome. The patient initially presented with back discomfort, radicular pain, and muscle weakness, which progressed to weakness in the lower extremities and bladder dysfunction over a few weeks. The patient was treated by surgical decompression and the biopsy result revealed a diagnosis of DLBCL. Further workup proved the tumor is primary and the patient as treated with radio- and chemotherapy. CLINICAL DISCUSSION The varied distribution of symptoms based on the spinal level of the lesion makes early clinical diagnosis of spinal NHL challenging. In this case, the patient's initial symptoms closely resembled intervertebral disc herniation or other spinal nerve impingements, which delayed the diagnosis of NHL. The abrupt onset and progression of neurological symptoms in the lower extremities and bladder dysfunction raised the suspicion of MSCC. CONCLUSION NHLs can present as metastatic spinal cord compression, which can cause neurological problems. Early clinical diagnosis of spinal NHLs is challenging due to the vague and varied presentations. A high index of suspicion for MSCC should be maintained in patients with NHLs who present with neurological symptoms.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Lebanese University Faculty of Medicine, Hadath, Lebanon.
| | - Firas Saad
- Oncology, St. George's University School of Medicine, New York, USA
| | - Wajih A Saad
- Oncology, Lebanese University Faculty of Medicine, Beirut, Lebanon
| | - Zeinab Al Mokdad
- Registered Nurse, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Charif Tarhini
- Hematology-oncology Fellow, University of Balamand, Beirut, Lebanon
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, Lebanon
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6
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Msheik A, Al Mokdad Z, Gerges T, Aoude A. Spinal Dural Arteriovenous Fistula: Insights Into Operative Management. Cureus 2023; 15:e38448. [PMID: 37273323 PMCID: PMC10234455 DOI: 10.7759/cureus.38448] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Spinal Dural Arteriovenous Fistula (SDAVF) is a rare and complex vascular condition with significant neurological consequences if left untreated. We present a case of SDAVF in a 46-year-old male who presented with progressive myelopathy. The patient presented with a three-month history of progressive lower extremity weakness, numbness, urinary retention, constipation, and gait disturbance. The spine's magnetic resonance imaging (MRI) showed diffuse T2 hyperintensity and contrast enhancement from T11 to L1, raising the suspicion of an intradural spinal cord lesion. Further evaluation with spinal angiography revealed an SDAVF at the level of T11-T12. The patient underwent surgical resection of the fistula, His lower extremity weakness and numbness improved significantly after surgery, and he was discharged with a plan for close follow-up. Early diagnosis and appropriate treatment prevent neurological deficits and improve patient outcomes. Surgical resection of the fistula can significantly improve neurological symptoms and should be considered a treatment option for SDAVF.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Zeinab Al Mokdad
- Public Health, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Teddy Gerges
- Anesthesiology, Winchester Anesthesia Associates Inc., Winchester, USA
| | - Ahmad Aoude
- Neurological Surgery, Al Rassoul Al Azam Hospital, Beirut, LBN
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7
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Msheik A, Gerges T, Al Mokdad Z, Abbass D, Mohanna A, Aoude A. Revolutionizing Treatment for Chronic Subdural Hematoma: Promising Outcomes With Middle Meningeal Artery Embolization. Cureus 2023; 15:e39733. [PMID: 37398745 PMCID: PMC10310347 DOI: 10.7759/cureus.39733] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Chronic subdural hematoma (cSDH) is a common condition that typically requires surgical intervention. Middle meningeal artery embolization (MMAE) has emerged as a potential alternative treatment option, although the choice of embolization material remains a topic of debate. In this case series, we report on the outcomes of 10 patients with cSDH who underwent MMAE. Most patients experienced symptom relief and a significant reduction in cSDH size post-procedure. Despite the presence of comorbidities and risk factors, most patients had positive outcomes following MMAE treatment. Only one patient required surgical intervention after the MMAE procedure due to the progression of symptoms, while MMAE successfully prevented recurrence in most patients. Our findings suggest that MMAE can be a promising treatment option for selected patients with cSDH. However, further studies are needed to compare the efficacy and safety of different embolization materials in MMAE procedures for cSDHs.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Lebanese University Faculty of Medicine, Hadath, LBN
| | - Teddy Gerges
- Anesthesia, Winchester Anesthesia Associates, Boston, USA
| | - Zeinab Al Mokdad
- Public Health, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Daniel Abbass
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | | | - Ahmad Aoude
- Neurosurgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
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Khatoun MA, Kanso H, Gerges T, Chammas E, Msheik A. Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation. Cureus 2023; 15:e39732. [PMID: 37398782 PMCID: PMC10310348 DOI: 10.7759/cureus.39732] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Incidentaloma, a term that embodies the detection of certain problems during the performance of unreasonable investigations, resonates in the medical field. Retroaortic coronary sign is a recently recognized echocardiographic feature of the anomalous coronary artery. It is typically associated with anomalies of the left coronary artery, especially the left circumflex artery. As far as has been monitored, few echocardiographic signs that correlate with this feature have been identified. This feature often remains underdiagnosed on transthoracic echocardiograms due to confusion with artifacts, calcifications, and other cardiac structures. A 45-year-old male patient underwent regular cardiac routine assessment. Retroaortic anomalous coronary (RAC) sign was incidentally detected by transthoracic thoracic echocardiogram; consequently, the retroaortic route of the coronary artery was suspected. Coronary computed tomography angiography was requested to confirm the seen echocardiographic signs. After a 3D reconstruction imaging, the left circumflex retroaortic course was identified with right coronary sinus origin. This case ensures the importance of transthoracic echocardiography as a noninvasive tool in diagnosing anomalous coronary arteries. These anomalies are usually diagnosed by coronary computed tomography angiography and coronary angiography, mainly in the presence of retroaortic coronary sign or "crossed aorta sign."
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Affiliation(s)
| | - Hassan Kanso
- Radiology, Clémenceau Medical Center, Beirut, LBN
| | - Teddy Gerges
- Anesthesia, Winchester Anesthesia Associates, Winchester, USA
| | - Elie Chammas
- Cardiology, Clémenceau Medical Center, Beirut, LBN
| | - Ali Msheik
- Neurological Surgery, Lebanese University Faculty of Medicine, Beirut, LBN
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Dakroub F, Yassine M, Fakhredine S, Msheik A, Rahal H, Hayek G, Akl A, Zaarour R, Akl H. Observational cohort study of the clinical outcomes associated with B.1.1.7/SGTF among hospitalized COVID-19 patients in Lebanon. East Mediterr Health J 2023; 29:262-270. [PMID: 37246437 DOI: 10.26719/emhj.23.052] [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] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/08/2022] [Indexed: 05/30/2023]
Abstract
Background The B.1.1.7 SARS-CoV-2 variant results in spike gene target failure (SGTF) in reverse transcription-quantitative polymerase chain reaction (RT-PCR) assays. Few studies have been published on the clinical impact of B.1.1.7/SGTF. Aims To assess the incidence of B.1.1.7/SGTF and its associated clinical characteristics among hospitalized COVID-19 patients. Methods This observational, single-centre, cohort study was conducted between December 2020 and February 2021 and included 387 hospitalized COVID-19 patients. The Kaplan-Meier method was used for survival analysis, and logistic regression to identify risk factors associated with B.1.1.7/SGTF. Results By February 2021, B.1.1.7/SGTF (88%) dominated the SARS-CoV-2 PCR results in a Lebanese hospital. Of the 387 eligible COVID-19 patients confirmed by SARS-CoV-2 RT-PCR, 154 (40%) were non-SGTF and 233 (60%) were B.1.1.1.7/SGTF; this was associated with a higher mortality rate among female patients [22/51 (43%) vs 7/37 (19%); P = 0.0170]. Among patients in the B.1.1.7/SGTF group, most were aged ≥ 65 years [162/233 (70%) vs 74/154 (48%); P < 0.0001]. Independent predictors of B.1.1.7/SGTF infection were hypertension (OR = 0.415; CI: 0.242-0.711; P = 0.0010), age ≥ 65 years (OR = 0.379; CI: 0.231-0.622; P < 0.0001), smoking (OR = 1.698; CI: 1.023-2.819; P = 0.0410), and cardiovascular disease (OR = 3.812; CI: 2.215-6.389; P < 0.0001). Only non-SGTF patients experienced multi-organ failure [5/154 (4%) vs 0/233 (0%); P = 0.0096]. Conclusion There was a clear difference between the clinical features associated with B.1.1.7/SGTF and non-SGTF lineages. Tracking viral evolution and its clinical impact is crucial for proper understanding and management of the COVID-19 pandemic.
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Affiliation(s)
- Fatima Dakroub
- Biology Department, Faculty of Science, Lebanese University, Beirut, Lebanon
- Research Unit, Lebanese University, Beirut, Lebanon
| | - Mohammad Yassine
- Research Unit, Lebanese University, Beirut, Lebanon
- Pharmacy Department, Lebanese University, Beirut, Lebanon
| | - Soha Fakhredine
- Research Unit, Lebanese University, Beirut, Lebanon
- Infectious Diseases Division, Lebanese University, Beirut, Lebanon
| | - Ali Msheik
- Pulmonary Department, Lebanese University, Beirut, Lebanon
| | - Hassan Rahal
- Infectious Diseases Division, Lebanese University, Beirut, Lebanon
| | - Ghadir Hayek
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Ali Akl
- Molecular Laboratory Department, Saint George Hospital, Beirut, Lebanon
| | - Rana Zaarour
- Pulmonary Department, Lebanese University, Beirut, Lebanon
| | - Haidar Akl
- Biology Department, Faculty of Science, Lebanese University, Beirut, Lebanon
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Msheik A, Fares Y, Hamoud M, Atat R. Unraveling the Complexity of Multicentric Gliomas: Insights Into Chronicity and Genetic Aberrations. Cureus 2023; 15:e37284. [PMID: 37168179 PMCID: PMC10165940 DOI: 10.7759/cureus.37284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Gliomas are among the most common primary tumors of the brain. Discrimination among tumors of more than one focus has segregated the latter into two groups: multifocal gliomas and multicentric gliomas (MCGs). In this case series, outcomes among three patients are described and discussed in light of the findings present in the literature. Ideally, it is crucial to consider genetic testing for categorizing each tumor. This can help determine the original genetic mutations of MCGs and allow to establish necessary screening testing for early detection. We present the cases of three patients diagnosed with cranial gliomas. The first case showed two synchronous gliomas at different loci in the right hemisphere. The second patient showed synchronous lesions on cranial magnetic resonance imaging in each hemisphere. The third case was of a patient with metachronous lesions appearing at different times with similar radiological findings at different loci of the same hemisphere. Discrimination among multifocal and multicentric gliomas requires genetic workup because radiological and temporal findings may fail to allow adequate discrimination.
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Affiliation(s)
- Ali Msheik
- Neurosurgery, Al Zahraa Hospital University Medical Center, Beirut, LBN
| | - Youssef Fares
- Neurosurgery, Al Zahraa Hospital University Medical Center, Beirut, LBN
| | - Maarouf Hamoud
- Neurosurgery, Al Zahraa Hospital University Medical Center, Beirut, LBN
| | - Rami Atat
- Neurology Division, Faculty of Medicine, Lebanese University, Al Zahraa Hospital University Medical Center, Beirut, LBN
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11
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Msheik A, Abbass D, Bayram M, Awde A, Al Mokdad Z. Cervical Myelocystocele: A One-in-50,000 Congenital Abnormality of the Spinal Cord. Cureus 2023; 15:e37278. [PMID: 37168187 PMCID: PMC10165719 DOI: 10.7759/cureus.37278] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Neural tube defects are a group of birth defects that affect the development of the spinal cord and brain. Myelomeningocele is a type of neural tube defect that results in the protrusion of the spinal cord and meninges through a defect in the vertebral column. While myelomeningocele is a relatively rare condition, cervical myelomeningocele is extremely uncommon. The condition can lead to various neurological problems and atrophies and is typically diagnosed in the first trimester of pregnancy using an ultrasound examination. Surgical intervention is typically recommended to repair the affected vertebral column. In this report, we describe the case of a four-month-old baby boy who was diagnosed with a cervical myelocystocele and successfully treated surgically. The patient had an excellent postoperative status, and this case highlights the importance of early diagnosis and intervention in the management of this rare condition.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Zahraa Hospital University Medical Center, Beirut, LBN
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Daniel Abbass
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Ahmad Awde
- Neurosurgery, Endovascular Neurosurgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Zeinab Al Mokdad
- Medical Sciences, Public Health, Lebanese University Faculty of Medical Sciences, Hadath, LBN
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12
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Chemeisani A, Hamade A, Kawtharani AA, Tarhini H, Hamze N, Msheik A. The Benefit of Early Epidural Corticosteroid Injections for Acute Sciatica-Associated Lower Back Pain: A Four-Year Case Series in Lebanon. Cureus 2023; 15:e34847. [PMID: 36923167 PMCID: PMC10009298 DOI: 10.7759/cureus.34847] [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] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Background Early epidural steroid injections are currently widely used for patients experiencing lumbago. However, there is uncertainty about their efficacy, such as the limitation of continuous drug infusion and the need for well-trained physicians on this technique. The main objective of this study was to evaluate the effectiveness of early epidural steroid injections in treating patients with acute sciatica in the lower back in terms of symptom relief and recurrence rate. Methods A case series was conducted in Lebanon from 2015 to 2019. We recruited 98 patients suffering from sciatica due to disc disease over three-time intervals: two weeks, one, and three months. The immediate results accounted for the intensity of various symptoms (numerical rating scale (NRS) for pain) and the assessment of patient satisfaction (Macnab criteria). Results The clinical results showed at least a three-point pain relief according to Numerical Rating Scale (NRS) and a good grade according to MacNab (P <0.001), with only 10.4% of the total population having a positive leg raise test post-injection. The maximum benefit was noted after two weeks from the injection with a 5.7 mean change in NRS (p<0.001) with a good/excellent response in MacNab and a 4.9 change with only a good response after one month. This study noticed a rebound phenomenon where around half of the patients needed two steroid injections after three months (39.6 % after three months and 17.9 % after six months). Conclusion Even though current guidelines worldwide may suggest the use of conservative treatment for low back pain with acute sciatica, our study has demonstrated the effectiveness of epidural steroid injections in the Lebanese population with a significant outcome.
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Affiliation(s)
- Ammar Chemeisani
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Ali Hamade
- Internal Medicine, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | | | - Hasan Tarhini
- Emergency Medicine, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Nour Hamze
- General Practice, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Ali Msheik
- Neurological Surgery, Zahraa Hospital University Medical Center (UMC), Beirut, LBN.,Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
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Msheik A, Fares Y, Mohanna M, Aoude A, Shkeir M, Chehade F, Kanj A, Mohanna A. Middle meningeal artery embolisation: The review of a new treatment for chronic subdural hematomas. Surg Neurol Int 2023; 14:66. [PMID: 36895214 PMCID: PMC9990792 DOI: 10.25259/sni_1096_2022] [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: 12/07/2022] [Accepted: 02/03/2023] [Indexed: 02/26/2023] Open
Abstract
Background This is a literature review aiming to provide an update about the recent findings related to the efficacy of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematomas (cSDHs), comparison with conventional therapy and deduction of the current recommendations and indications. Methods The literature is reviewed using a search through the PubMed index using keywords. Studies are then screened, skimmed, and thoroughly read. 32 studies fulfilled the inclusion criteria and are included in the study. Results Five indications for the application of MMA embolization (MMAE) are deducted from the literature. The usage as a preventive measure after surgical treatment of symptomatic cSDHs in patients with a high risk of recurrence and the usage as a standalone procedure has been the most common reasons for indication of this procedure. Rates of failures for the aforementioned indications have been 6.8% and 3.8%, respectively. Conclusion The safety of MMAE as a procedure is regarded as a general theme in the literature and can be considered for future applications. Usage of this procedure in clinical trials with more patient segregation and timeframe assessment relative to surgical intervention are recommendations of this literature review.
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Affiliation(s)
- Ali Msheik
- Department of Neurological Surgery, Lebanese University, Faculty of Medical Sciences
| | - Youssef Fares
- Department of Neurological Surgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Lebanon
| | - Mohammad Mohanna
- Department of Oncology, Cleveland Clinic, Weston, Florida, United States
| | - Ahmad Aoude
- Department of Neurological Surgery, Al Rassoul Al-Azam Hospital
| | - Mohamad Shkeir
- Head of Radiology Department, Zahraa Hospital University Medical Center
| | - Feras Chehade
- Department of Nuclear Medicine Radiobiology Radiopathology, Faculty of Medical Sciences, Lebanese University
| | - Ali Kanj
- Radiology Department, Bahman Hospital, Faculty of Medicine, Lebanese University
| | - Assaad Mohanna
- Head of Department of Radiology, Faculty of Medicine, Lebanese University, Bahman Hospital, Centre Hospitalier Vallee de la Maurienne-France, Beirut, Lebanon
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Kawtharani AA, Msheik A, Salman F, Haj Younes A, Chemeisani A. A Survey of Neck Pain among Dentists of the Lebanese Community. Pain Res Manag 2023; 2023:8528028. [PMID: 37007860 PMCID: PMC10063358 DOI: 10.1155/2023/8528028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/01/2023] [Accepted: 02/21/2023] [Indexed: 04/04/2023]
Abstract
Results The majority of participants were between the ages of 25 and 35, and the gender distribution of the demographic distribution was comparable. The prevalence of pain was 86.8% (97/342 dentists). NDI analysis showed that 65.7% had mild disability, 12.8% have a moderate disability, and 1% had severe disability. Bivariate analysis showed that pain was affected by age (p=0.013), orthodontist practices (p=0.031), regular exercise (p < 0.001), using vibrating instruments (p < 0.001), cervical flexion for better vision while working (p < 0.001), knowledge, and experience about ergonomic posture (p < 0.005). Multivariate analysis showed four predictors for pain: age (p=0.017), performing stretching exercises after finishing clinical practice (p=0.022), orthodontist specialty (p=0.029), and performing cervical flexion for better vision while working (p=0.004). Conclusion This study showed that through the application of some strategies such as stretching, exercising, and being careful in using vibrating instruments, the dentist may be able to relieve the pain.
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Affiliation(s)
| | - Ali Msheik
- Neurological Surgery, Lebanese University, Faculty of Medicine, Hadath, Lebanon
- Neurological Surgery, Al Zahraa Hospital UMC, Jnah, Beirut, Lebanon
| | - Fadi Salman
- General Surgery, Lebanese University, Faculty of Medicine, Hadath, Beirut, Lebanon
| | - Ali Haj Younes
- Obstetrics and Gynecology, Lebanese University, Faculty of Medicine, Hadath, Beirut, Lebanon
| | - Ammar Chemeisani
- Neurological Surgery, Lebanese University, Faculty of Medicine, Hadath, Lebanon
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Muacevic A, Adler JR, Haj Ali T, Jibbawi AA, Yehya K, Msheik A. The Benefit of Epidural Transforaminal Injection of Ozone in Comparison With Transforaminal Steroids Injection in the Management of Chronic Low Back Pain in Lebanese Population: One-Year Retrospective Study. Cureus 2023; 15:e34106. [PMID: 36843776 PMCID: PMC9946692 DOI: 10.7759/cureus.34106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Background Chronic low back pain (CLBP) is one of the most common complaints affecting the population worldwide including in Lebanon. Until 15 years ago, surgery was the treatment of choice. However, conservative measures are now preferred because of the large number of post-surgical complications, in addition to the many conditions where surgery cannot be performed. Objective The aim of our study is to determine the effectiveness of transformational epidural injection of ozone (TFEOI) in the management of CLBP among the Lebanese population in the Nabatieh area in comparison with patients who received transformational epidural steroid injection (TFESI). Methods A one-year (2016-2017) retrospective study where 100 patients with CLBP were selected from two hospitals (Alnajdah, and Ragheb Harb hospitals) and divided into two groups. Fifty patients were treated with Ozone injections while the other 50 were treated with steroid injections. For each patient, we recorded the type of pain, irradiation, paresthesia, and the type of injection given (steroid or Ozone). We used the patients' files and contacted them via phone calls. The results of this study were reached based on Vas Score and Mac Nab criteria which are subjective questionnaires. Results The study showed that the TFESI was effective for a short duration (86% of results were excellent and good after one month of injection, but they decreased to 16% after six months). On the other hand, TFEOI was effective over both short and long duration (82% excellent and good after one month, 64% excellent and good after six months). Conclusion Results from this study provide that ozone injection has high benefits in the management of CLBP in the Lebanese population.
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Muacevic A, Adler JR, Salman F, Haj Younes A, Msheik A. Neck and Musculoskeletal Pain Among Dentists: A Review of the Literature. Cureus 2023; 15:e33609. [PMID: 36788815 PMCID: PMC9910811 DOI: 10.7759/cureus.33609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Musculoskeletal disorders (MSD), notably neck pain, are important occupational health issues in the field of dentistry. Many studies were done worldwide to gather data about neck and back pain. They used different characteristics and risk factors. Other studies aimed to determine only the prevalence of neck and back problems among dentists. We aim to review the literature for research about the optimal factors to be assessed and the proper measures to be installed by dentists to prevent cervical pain and to be taught and shared with dental students. Such an aim requires a thorough review of the current condition. This is a brief review of the literature to shed light on the latest news on this topic. Research using keywords such as dentistry, neck pain, neck pain index, occupational pain, and dental specialties were used to skim the literature for related topics. Publications are considered based on their relevance to the topic. Topics related to other professions and pain induced by illnesses other than occupational factors are not included. The final conclusion shows that no final results were conducted regarding the optimal characteristics that the dentists should be using. Therefore, we recommend a study with an aim to determine the optimal factors to be used by dentists to prevent cervical pain and to be taught to dental students.
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Bazzi N, Dbouk S, Jaber S, Msheik A, Safadi MF, Shaalan Z, Bazzi M. A Retrospective Comparative Study Assessing Patients With Acute Appendicitis During the Pre and Through Lebanese Financial Crisis. Cureus 2022; 14:e28518. [PMID: 36185945 PMCID: PMC9515931 DOI: 10.7759/cureus.28518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction In the past three years, Lebanon, a country located in the Middle East, has faced a severe financial crisis. This crisis had many effects on several sectors in Lebanon, including the healthcare sector. The authors expected an increase in the rate of complicated appendicitis after the crisis due to the shortage of medical supplies. The aim of the study was to compare the rate of complicated acute appendicitis before and after the Lebanese crisis. Methods The study included two groups of patients with acute appendicitis. The first group included patients admitted in the period between November 2018 and November 2019 (before the crisis). The second group included patients admitted between November 2020 and November 2021 (during the crisis). The data were collected retrospectively and analyzed using SPSS software (version 25.00) (SPSS Inc., Chicago, IL). Ethical approval was obtained and the study was registered at Al Zahraa hospital, University Medical Center in Beirut, Lebanon. Results The study included 49 patients in the first group (before the crisis) and 46 patients in the second group (after the crisis). The percentage of complicated appendicitis has increased from 22.4% before the crisis to 28.3% during the crisis. The study showed a statistically significant difference between the two groups in the white blood cell count (10,831 versus 7180 cu.mm, respectively, p=0.006), the operating time (59.9 versus 79.0 minutes, respectively; p=0.004), the need to obtain an intra-peritoneal swab for bacterial culture (83.7% versus 58.7%, respectively; p=0.007), and the need for intra-abdominal abscess drainage (6.1% versus 28.3%, respectively; p=0.004). There were no significant differences in the demographics, the duration of postoperative antibiotic use, the duration of stay in the hospital, and the postoperative complications in the first month following surgery. Conclusion Due to the decreased financial income, the high cost of medical care during the Lebanese crisis, and the delay of patients’ presentation to the hospital, the rate of complicated appendicitis increased during the crisis.
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Msheik A, Mohanna M, Mhanna A, Kanj A, Moussa M, Mohanna A. Predictive value of PSA density in the diagnosis of prostate cancer in lebanese men. Arch Ital Urol Androl 2022; 94:18-24. [PMID: 35352520 DOI: 10.4081/aiua.2022.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Being the second most common cancer in men, prostate cancer detection relies on laboratory tests, imaging, and surgical procedures, although biopsy remains the mainstay in diagnosis of prostate cancer. No clear cut-off of prostate specific antigen density (PSAD) for suspecting prostate cancer has been established in the Lebanese population. Our primary objective was to evaluate the diagnostic strength of the PSAD value versus total prostate specific antigen (tPSA) level in the Lebanese men in correlation with biopsy outcome to avoid unnecessary prostate biopsy. METHODS A retrospective study of 347 patients with history of prostate biopsy done for cancer suspicion included tPSA, prostate volume, and prostate density values and results of prostate biopsy. Data was collected from Bahman hospital and statistical analysis of the mean values of tPSA, prostate volume and PSAD in different age groups was done. Significance of the results was tested using. RESULTS On average, patients with negative biopsies were younger and they had lower tPSA levels, lower PSAD values and larger prostate volume compared to patients with positive biopsies. A PSAD cutoff of 0.185 ng/ml2 revealed the highest predictive strength for prostate cancer (6 times risk) compared with other parameters. These findings were mainly referred to patients with PSA > 10 ng/ml. CONCLUSIONS A multifactorial approach must be conducted including all parameters in order to decide upon the need for prostate biopsy. PSAD proved to be a good marker in favor or against a prostate biopsy with a cut-off of 0.185 ng/ml2, especially in patients with tPSA level higher to 10 ng/ml. A multicenter study was recommended for better and more reliable results and more precise cut-offs.
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Affiliation(s)
- Ali Msheik
- PGY-1 Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Mohamed Mohanna
- PGY-1 Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Ali Mhanna
- PGY-1 General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Ali Kanj
- Radiology Department, Bahman Hospital, Beirut.
| | - Mohamad Moussa
- Chairman of General Surgery and Urology Department, Faculty of Medical Sciences, Lebanese University, Beirut.
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