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Levine DA, Uy V, Krief W, Bornstein C, Daswani D, Patel D, Kriegel M, Jamal N, Patel K, Liang T, Arroyo A, Strother C, Lim CA, Langhan ML, Hassoun A, Chamdawala H, Kaplan CP, Waseem M, Tay ET, Mortel D, Sivitz AB, Kelly C, Lee HJ, Qiu Y, Gorelik M, Platt SL, Dayan P. Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region. Pediatr Emerg Care 2023; 39:555-561. [PMID: 36811547 DOI: 10.1097/pec.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock. METHODS We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors. RESULTS Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]). CONCLUSIONS Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.
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Affiliation(s)
- Deborah A Levine
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Vincent Uy
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - William Krief
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Cara Bornstein
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Dina Daswani
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Darshan Patel
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Marni Kriegel
- Department of Emergency Medicine and Pediatrics, Hackensack University Medical Center/Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nazreen Jamal
- Department of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons
| | - Kavita Patel
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Tian Liang
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Alexander Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn
| | - Christopher Strother
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Czer Anthoney Lim
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa L Langhan
- Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven CT
| | - Ameer Hassoun
- Department of Emergency Medicine, NewYork-Presbyterian Queens/Weill Cornell Medicine, Flushing
| | - Haamid Chamdawala
- Department of Pediatrics, Jacobi Hospital Center/North Central Bronx Hospital, The Bronx
| | - Carl Philip Kaplan
- Departments of Pediatrics and Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook
| | - Muhammad Waseem
- Departments of Emergency Medicine and Pediatrics, Lincoln Medical Center/Weill Cornell Medicine, The Bronx
| | - Ee Tein Tay
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine/Bellevue Hospital Center
| | - David Mortel
- Departments of Emergency Medicine and Pediatrics, Harlem Hospital Center, New York
| | - Adam B Sivitz
- Departments of Emergency Medicine and Pediatrics, Newark Beth Israel Medical Center/Children's Hospital of New Jersey, New Jersey Medical School, Rutgers University, Newark
| | - Christopher Kelly
- Department of Emergency Medicine, NewYork-Presbyterian/Brooklyn Methodist Hospital, Brooklyn
| | | | | | | | - Shari L Platt
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Peter Dayan
- Emergency Medicine, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons, New York, NY
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Smith B, Hassoun A. Peeling fingernails in a 5-year-old. J Am Coll Emerg Physicians Open 2023; 4:e12945. [PMID: 37056717 PMCID: PMC10086314 DOI: 10.1002/emp2.12945] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/17/2023] [Indexed: 04/15/2023] Open
Affiliation(s)
- Brian Smith
- Department of Emergency MedicineNew York Presbyterian/QueensFlushingNew YorkUSA
| | - Ameer Hassoun
- Division of Pediatric Emergency Medicine, Department of Emergency MedicineNew York Presbyterian/QueensFlushingNew YorkUSA
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Patel NH, Hassoun A, Chao JH. The Practice of Obtaining a Chest Radiograph in Pediatric Patients Presenting With Their First Episode of Wheezing: A Survey of Resident Physicians. Clin Pediatr (Phila) 2021; 60:465-473. [PMID: 34486411 DOI: 10.1177/00099228211044296] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A chest radiograph (CXR) is not routinely indicated in children presenting with their first episode of wheezing; however, it continues to be overused. A survey was distributed electronically to determine what trainees are taught and their current practice of obtaining a CXR in children presenting with their first episode of wheezing and the factors that influence this practice. Of the 1513 trainees who completed surveys, 35.3% (535/1513) reported that they were taught that pediatric patients presenting with their first episode of wheezing should be evaluated with a CXR. In all, 22.01% (333/1513) indicated that they would always obtain a CXR in these patients, and 13.75% (208/1513) would always obtain a CXR under a certain age (4 weeks to 12 years, median of 2 years). Our study identifies a target audience that would benefit from education to decrease the overuse of CXRs in children.
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Affiliation(s)
| | - Ameer Hassoun
- New York Presbyterian-Queens Hospital, Flushing, NY, USA
| | - Jennifer H Chao
- SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY, USA
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Hassoun A, Dahan N, Kelly C. A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments. Clin Pediatr (Phila) 2021; 60:247-251. [PMID: 33853371 DOI: 10.1177/00099228211006688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.
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Affiliation(s)
- Ameer Hassoun
- New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, NY, USA
| | - Nessy Dahan
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Christopher Kelly
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Hassoun A, Pugh S, Merced I, Sharma M. Expanding Pediatric Emergency Physician's Scope of Practice in Response to the COVID-19 Pandemic. J Emerg Med 2021; 60:567-568. [PMID: 33902884 PMCID: PMC8064629 DOI: 10.1016/j.jemermed.2020.10.057] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/25/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ameer Hassoun
- Division of Pediatric Emergency Medicine,Department of Emergency Medicine, New York-Presbyterian Queens Hospital, Weill Cornell Medicine, Flushing, New York
| | - Suzanne Pugh
- Department of Emergency Medicine, New York-Presbyterian Queens Hospital, Flushing, New York
| | - Indira Merced
- Department of Emergency Medicine, New York-Presbyterian Queens Hospital, Flushing, New York
| | - Manish Sharma
- Department of Emergency Medicine, New York-Presbyterian Queens Hospital, Flushing, New York
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Affiliation(s)
- Ameer Hassoun
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Flushing, Queens, NY, USA.
| | - Angela Kadenhe-Chiweshe
- NewYork-Presbyterian Queens Hospital, Department of Surgery, Division of Pediatric Surgery, Flushing, Queens, NY, USA
| | - Manish Sharma
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Flushing, Queens, NY, USA
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Hassoun A, Brady K, Arefi R, Trifonova I, Tsirilakis K. Vaping-Associated Lung Injury During COVID-19 Multisystem Inflammatory Syndrome Outbreak. J Emerg Med 2020; 60:524-530. [PMID: 33483200 PMCID: PMC7732222 DOI: 10.1016/j.jemermed.2020.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/22/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
Background E-cigarette or vaping product use–associated lung injury (EVALI) is a complex inflammatory syndrome predominantly seen in adolescents and young adults. The clinical and laboratory profile can easily mimic infectious and noninfectious conditions. The exclusion of these conditions is essential to establish the diagnosis. Recently, the novel coronavirus disease 2019 (COVID-19) pandemic introduced the multisystem inflammatory syndrome in children (MIS-C). MIS-C knowledge is evolving. The current criteria to establish the diagnosis are not specific and have overlapping features with EVALI, making the accurate diagnosis a clinical challenge during continued COVID-19 transmission within the community. Case Report Three young adults evaluated at our emergency department for prolonged fever and gastrointestinal and respiratory symptoms were initially assessed for possible MIS-C due to epidemiologic links to COVID-19 and were eventually diagnosed with EVALI. The clinical, laboratory, and radiologic characteristics of both entities are explored, as well as the appropriate medical management. Why Should an Emergency Physician Be Aware of This? Physician awareness of overlapping and differentiating EVALI and MIS-C features is essential to direct appropriate diagnostic evaluation and medical management of adolescents and young adults presenting with systemic inflammatory response during the unfolding pandemic of COVID-19.
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Affiliation(s)
- Ameer Hassoun
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, New York
| | - KeriAnne Brady
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, New York
| | - Rojin Arefi
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, New York
| | - Irina Trifonova
- Department of Pediatrics, New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, New York
| | - Kalliope Tsirilakis
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, New York
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Affiliation(s)
- Ameer Hassoun
- Division of Pediatric Emergency Medicine Department of Emergency Medicine New York‐Presbyterian Queens Hospital Flushing NYUSA
| | - Suzanne Pugh
- Division of Pediatric Emergency Medicine Department of Emergency Medicine New York‐Presbyterian Queens Hospital Flushing NYUSA
| | - Indira Merced
- Division of Pediatric Emergency Medicine Department of Emergency Medicine New York‐Presbyterian Queens Hospital Flushing NYUSA
| | - Manish Sharma
- Division of Pediatric Emergency Medicine Department of Emergency Medicine New York‐Presbyterian Queens Hospital Flushing NYUSA
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Hassoun A, Prasad N, Pugh S, Merced I, Abularrage J, Sharma M. Parental Coronavirus Disease 2019 Testing of Hospitalized Children: Rethinking Infection Control in a Pandemic. J Pediatric Infect Dis Soc 2020; 9:564-565. [PMID: 32856705 PMCID: PMC7499684 DOI: 10.1093/jpids/piaa103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Novel coronavirus disease 2019 (COVID-19) poses a challenge to infection control within hospital systems. Asymptomatic children and their caretakers carry the risk of silently spreading infection in pediatric emergency departments and hospital units. Our current knowledge is evolving, and infection control measures are frequently changing depending on new emerging data. METHODS We conducted a point-prevalence study to assess SARS-CoV-2 Real-Time Polymerase Chain Reaction (SARS-CoV-2 RT-PCR) results of hospitalized children, their asymptomatic caretakers, and caretaker-child test concordance at a major community hospital in New York City. We screened Children and caretakers with temperature measurements and the presence of COVID-19 symptoms before pediatric emergency department evaluation. Children requiring hospitalization and their caretakers had nasopharyngeal swabs for SARS-CoV-2 RT-PCR. The paired results are used to identify the infection control level at the appropriate pediatric unit. RESULTS Forty consecutive asymptomatic caretaker-child pairs had SARS-CoV-2 RT-PCR testing between May 28th to June 22nd, 2020. The rate of asymptomatic COVID-19 was 2.5% in hospitalized children and 7.5% in caretakers. The caretaker-child SARS-CoV-2 RT-PCR test concordance was evident in 95% of the cohort. CONCLUSION This cohort had a low asymptomatic SARS-CoV-2 PCR positive rate in children and their caretakers with a high concordance rate of paired test results. It suggests that children's SARS-CoV-2 PCR test result will likely correspond to their accompanying caretaker at healthcare facilities where admission screening is performed.
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Affiliation(s)
- Ameer Hassoun
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine. Flushing, New York,Address correspondence to: Ameer Hassoun, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Queens, 5645 Main Street, Flushing NY, 11355, [], 917-257-7157
| | - Nishant Prasad
- New York-Presbyterian Queens Hospital, Department of Medicine, The Dr. James J. Rahal Jr. Division of Infectious Diseases. Flushing, New York
| | - Suzanne Pugh
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine. Flushing, New York
| | - Indira Merced
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine. Flushing, New York
| | - Joseph Abularrage
- New York-Presbyterian Queens Hospital, Department of Pediatrics. Flushing, New York
| | - Manish Sharma
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine. Flushing, New York
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10
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Subramaniam S, Hassoun A. Child With Swollen Face. Ann Emerg Med 2017; 67:678-92. [PMID: 27106375 DOI: 10.1016/j.annemergmed.2015.10.010] [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] [Received: 05/04/2015] [Indexed: 10/21/2022]
Affiliation(s)
- Sathyaseelan Subramaniam
- Pediatric Emergency Department of SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
| | - Ameer Hassoun
- Pediatric Emergency Department of SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
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Hassoun A, Huff MD, Asis E, Chahal K, Azarbal A, Lu S. Effect of target-enriched multiplex polymerase chain reaction on patient outcomes and costs during the 2013-14 influenza season. J Hosp Infect 2017; 96:366-370. [PMID: 28571763 DOI: 10.1016/j.jhin.2017.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/05/2017] [Accepted: 04/09/2017] [Indexed: 11/20/2022]
Abstract
The US Centers for Disease Control and Prevention recommends the initial use of rapid antigen influenza diagnostic test (RIDT) for the detection of influenza A (H1N1-09). Nasopharyngeal samples were tested from 246 patients for H1N1-09 using target-enriched multiplex polymerase chain reaction (TEM-PCR), of which 163 were additionally tested via RIDT. RIDTs had a sensitivity of 18.7% compared with TEM-PCR as the reference standard. Patients with false-negative RIDTs were withheld from 111 days of oseltamivir and 65 days of isolation. Patients negative for H1N1 via TEM-PCR had antiviral therapy immediately stopped, thereby evading 408 days of oseltamivir and 315 days of unnecessary isolation. This cost avoidance saved US$208,982.
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Affiliation(s)
- A Hassoun
- Alabama Infectious Disease Center, Huntsville, AL, USA
| | - M D Huff
- Diatherix Laboratories, LLC, Huntsville, AL, USA.
| | - E Asis
- University of Alabama Birmingham School of Medicine - Huntsville Campus, Huntsville, AL, USA
| | - K Chahal
- University of Alabama Birmingham School of Medicine - Huntsville Campus, Huntsville, AL, USA
| | - A Azarbal
- University of Alabama Birmingham School of Medicine - Huntsville Campus, Huntsville, AL, USA
| | - S Lu
- Diatherix Laboratories, LLC, Huntsville, AL, USA
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12
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Hassoun A, Thottacherry ED, Raja M, Scully M, Azarbal A. Retrospective comparative analysis of cardiovascular implantable electronic device infections with and without the use of antibacterial envelopes. J Hosp Infect 2016; 95:286-291. [PMID: 28131641 DOI: 10.1016/j.jhin.2016.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/01/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) infections are associated with morbidity and mortality. Peri-operative systemic intravenous antibiotic prophylaxis reduces the rate of CIED infections. AIGISRx, a polymer envelope implanted with the CIED, releases minocycline and rifampin, and has been introduced to reduce infections. METHODS Retrospective review of 184 patients who underwent CIED implantation was conducted. Ninety-two patients were implanted with an AIGISRx envelope (AIGISRx group) and 92 patients were not implanted with an AIGISRx envelope (control group). Data were collected on demographics and risk factors for CIED infections (i.e. congestive heart failure, renal insufficiency, chronic kidney disease, oral anticoagulant use, chronic steroid use, need for lead replacement or revision, temporary pacing, early re-intervention, and having more than two leads in place). Rates of implantation success, major infections and mortality were compared between the AIGISRx group and the control group. RESULTS The AIGISRx group had longer hospitalizations (6.8±10.7 days vs 3.1±5.2 days; P=0.001), higher chronic corticosteroid use, higher rates of replacement or revision (51.1% vs 8.7%; P=0.001), and a greater proportion of devices with more than two intracardiac leads (42.4% vs 29.3%; P=0.03) than the control group. Successful implantation occurred in 97% of patients in both groups. Major infection was seen in 5.4% of cases in the AIGISRx group and 1.1% of cases in the control group (P=0.048). Device removal was conducted in 3.3% of cases in the AIGISRx group compared with 1.1% of cases in the control group (P=0.16). There were two deaths in the AIGISRx group. Organisms cultured were meticillin-resistant Staphylococcus aureus, meticillin-susceptible S. aureus and Enterococcus faecalis. CONCLUSION The AIGISRx group had higher rates of major infection but also higher risk factors compared with the control group. The rate of device extraction and CIED-related mortality was higher in the AIGISRx group than in the control group.
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Affiliation(s)
- A Hassoun
- Department of Infectious Disease, Alabama Infectious Diseases Center, Huntsville, AL, USA.
| | - E D Thottacherry
- Department of Infectious Disease, Alabama Infectious Diseases Center, Huntsville, AL, USA
| | - M Raja
- Department of Infectious Disease, Alabama Infectious Diseases Center, Huntsville, AL, USA
| | - M Scully
- Department of Infectious Disease, Alabama Infectious Diseases Center, Huntsville, AL, USA
| | - A Azarbal
- Department of Infectious Disease, Alabama Infectious Diseases Center, Huntsville, AL, USA
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Mahajan P, Batra P, Shah BR, Saha A, Galwankar S, Aggrawal P, Hassoun A, Batra B, Bhoi S, Kalra OP, Shah D. The 2015 Academic College of Emergency Experts in India's INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India. Int J Crit Illn Inj Sci 2016; 5:247-55. [PMID: 26807394 PMCID: PMC4705571 DOI: 10.4103/2229-5151.170839] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally, organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3-year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program - DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.
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Affiliation(s)
- Prashant Mahajan
- Department of Pediatrics and Emergency Medicine, Wayne State School of Medicine, Michigan, USA
| | - Prerna Batra
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India
| | - Binita R Shah
- Department of Emergency Medicine, SUNY Downstate Medical Center, New York, USA
| | - Abhijeet Saha
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research and Ram Manohar Lohia Hospital, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| | - Praveen Aggrawal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ameer Hassoun
- Department of Emergency Medicine, SUNY Downstate Medical Center, New York, USA
| | - Bipin Batra
- National Board of Examinations, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Om Prakash Kalra
- Department of Medicine, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India
| | - Dheeraj Shah
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India
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Mueller NT, Whyatt R, Hoepner L, Oberfield S, Dominguez-Bello MG, Widen EM, Hassoun A, Perera F, Rundle A. Prenatal exposure to antibiotics, cesarean section and risk of childhood obesity. Int J Obes (Lond) 2014; 39:665-70. [PMID: 25298276 DOI: 10.1038/ijo.2014.180] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/18/2014] [Accepted: 09/26/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES Cesarean section (CS) and antibiotic use during pregnancy may alter normal maternal-offspring microbiota exchange, thereby contributing to aberrant microbial colonization of the infant gut and increased susceptibility to obesity later in life. We hypothesized that (i) maternal use of antibiotics in the second or third trimester of pregnancy and (ii) CS are independently associated with higher risk of childhood obesity in the offspring. SUBJECTS/METHODS Of the 727 mothers enrolled in the Northern Manhattan Mothers and Children Study, we analyzed the 436 mother-child dyads followed until 7 years of age with complete data. We ascertained prenatal antibiotic use by a questionnaire administered late in the third trimester, and delivery mode by medical record. We derived age- and sex-specific body mass index (BMI) z-scores using the CDC SAS Macro, and defined obesity as BMI z⩾95th percentile. We used binary regression with robust variance and linear regression models adjusted for maternal age, ethnicity, pre-gravid BMI, maternal receipt of public assistance, birth weight, sex, breastfeeding in the first year and gestational antibiotics or delivery mode. RESULTS Compared with children not exposed to antibiotics during the second or third trimester, those exposed had 84% (33-154%) higher risk of obesity, after multivariable adjustment. Second or third trimester antibiotic exposure was also positively associated with BMI z-scores, waist circumference and % body fat (all P<0.05). Independent of prenatal antibiotic usage, CS was associated with 46% (8-98%) higher offspring risk of childhood obesity. Associations were similar for elective and non-elective CS. CONCLUSIONS In our cohort, CS and exposure to antibiotics in the second or third trimester were associated with higher offspring risk of childhood obesity. Future studies that address the limitations of our study are warranted to determine if prenatal antibiotic use is associated with offspring obesity. Research is also needed to determine if alterations in neonatal gut microbiota underlie the observed associations.
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Affiliation(s)
- N T Mueller
- 1] Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA [2] Institute of Human Nutrition and Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - R Whyatt
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - L Hoepner
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - S Oberfield
- Department of Pediatrics, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - M G Dominguez-Bello
- Division of Translational Medicine, New York University School of Medicine, New York, NY, USA
| | - E M Widen
- 1] Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA [2] Institute of Human Nutrition and Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - A Hassoun
- Department of Pediatrics, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - F Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - A Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
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Abstract
Cerebral venous sinus thrombosis (CVST) is a rare and potentially life-threatening cause of stroke. In the past few decades, the incidence and patient demographics have changed because of many factors, including the widespread use of oral contraceptives, improved detection of prothrombotic conditions, and advancement of imaging technology. The presentation of CVST is varied and can include ocular signs and symptoms. We present 2 cases of oral contraceptive-induced CVST in 18-year-old women, whose main presenting findings were ophthalmologic.
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Hassoun A, Stankovic C, Rogers A, Duffy E, Zidan M, Levijoki C, Stanley R, Mahajan P. Listeria and enterococcal infections in neonates 28 days of age and younger: is empiric parenteral ampicillin still indicated? Pediatr Emerg Care 2014; 30:240-3. [PMID: 24651213 DOI: 10.1097/pec.0000000000000104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Empiric parenteral ampicillin has traditionally been used to treat listeria and enterococcal serious bacterial infections (SBI) in neonates 28 days of age or younger. Anecdotal experience suggests that these infections are rare. Existing data suggest an increasing resistance to ampicillin. Guidelines advocating the routine use of empiric ampicillin may need to be revisited. OBJECTIVE This study aimed to describe the epidemiology and ampicillin sensitivity of listeria and enterococcal infections in neonates 28 days of age and younger who presented to 2 pediatric emergency departments (ED) in Michigan. METHODS We conducted a 2-center, retrospective chart review (2006-2010) of neonates 28 days of age or younger who were evaluated for SBI in the ED. We abstracted and compared relevant demographic, historical and physical details, laboratory test results, and antibiotic sensitivity patterns to ampicillin from the eligible patient records. RESULTS We identified SBI in 6% (72/1192) of neonates 28 days of age or younger who were evaluated for SBI, of which 0.08% (1/1192) neonates had enterococcal bacteremia and 0.08% (1/1192) neonates had listeria bacteremia. A total of 1.4% (15/1192) of patients had enterococcal urinary tract infection (UTI). Urinalysis is less helpful as a screening tool for enterococcal UTI when compared with Escherichia coli UTI (P < 0.001). Seventy-three percent (11/15) of urine isolates had an increase of minimal inhibitory concentrations, which indicate gradual development of resistance to ampicillin. CONCLUSIONS Listeria is an uncommon cause of neonatal SBI in febrile neonates who presented to the ED. Empiric use of ampicillin may need to be reconsidered if national data confirm very low listeria and enterococcal prevalence and high ampicillin resistance patterns.
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Affiliation(s)
- Ameer Hassoun
- From the *Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Wayne State University, Detroit; and †Departments of Emergency Medicine and ‡Pediatrics, University of Michigan, Ann Arbor, MI
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17
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Smeltzer S, Hassoun A. Successful use of fidaxomicin in recurrent Clostridium difficile infection in a child. J Antimicrob Chemother 2013; 68:1688-9. [DOI: 10.1093/jac/dkt079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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18
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Kaushal R, Hassoun A. Successful treatment of methicillin-resistant Staphylococcus epidermidis prosthetic joint infection with telavancin. J Antimicrob Chemother 2012; 67:2052-3. [DOI: 10.1093/jac/dks165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Hassoun A, Kannikeswaran N, Tigchelaar H, Wood KE, Boneparth A, Opio G, Kaplan MR, Silverblatt K. Index of suspicion. Case 1: pallor, screaming, sweating, and breathing difficulty associated with feeding in a 2-month-old infant. Case 2: Swelling, redness, warmth, tenderness, and purulent drainage under the nail in an adolescent girl. Case 3: urticarial rash, fatigue, achiness, and dark urine in an adolescent girl. Pediatr Rev 2011; 32:543-8. [PMID: 22135425 DOI: 10.1542/pir.32-12-543] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ameer Hassoun
- Carman and Ann Adam Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
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20
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Berntorp E, Keeling D, Makris M, Tagliaferri A, Male C, Mauser-Bunschoten EP, Musso R, Roca CA, Hassoun A, Kollmer C, Charnigo R, Baumann J, Rendo P. A prospective registry of European haemophilia B patients receiving nonacog alfa, recombinant human factor IX, for usual use. Haemophilia 2011; 18:503-9. [PMID: 22044794 DOI: 10.1111/j.1365-2516.2011.02685.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nonacog alfa, a recombinant factor IX (FIX) used for the treatment of haemophilia B, was approved in Europe in 1998. In accordance with European Medicines Agency requirements, a registry study was conducted from 2002 to 2009. A reformulated iso-osmotic version was approved for European use in 2007. This study was conducted to evaluate the safety of nonacog alfa in a usual care setting, and provide clinical trial and postmarketing surveillance data support. This open-label, non-interventional, prospective observational cohort study (registry) comprised 52 sites in nine European countries. Patients with haemophilia B receiving nonacog alfa in either formulation for prevention or treatment were followed on a usual care schedule. A total of 218 patients were enrolled, of whom 66 (30.3%) were <18 years of age. Haemophilia severity was evenly distributed, with baseline FIX activity of <1%, 1-5% and >5% in 33.3%, 36.6% and 30.1% of patients, respectively. One hundred thirty-eight patients received the original formulation alone; 80 switched to or received only the new formulation. There was a low incidence of events of special interest (ESIs), with less-than-expected therapeutic effect in five patients (2.2%), inhibitor development in two (0.9%), thrombosis in one (0.5%) and allergic events in eight (3.7%). These accounted for the majority of the 15 serious AEs reported in six patients. Six patients discontinued because of AEs, primarily related to hypersensitivity. Nonacog alfa was shown to be safe for the treatment of haemophilia B, with a low incidence of serious AEs and ESIs.
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Affiliation(s)
- E Berntorp
- Malmö Centre for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
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21
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Jambart S, Ammache Z, Haddad F, Younes A, Hassoun A, Abdalla K, Selwan CA, Sunna N, Wajsbrot D, Youseif E. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res 2011; 39:366-77. [PMID: 21672340 DOI: 10.1177/147323001103900204] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The prevalence of painful diabetic peripheral neuropathy (DPN) was evaluated in type 1 or type 2 diabetes mellitus patients (n = 4097) attending outpatient clinics across the Middle East. Overall, 53.7% of 3989 patients with DN4 data met the criteria for painful DPN (Douleur Neuropathique-4 [DN4] scores ≥ 4). Significant predictors of painful DPN included long history (≥ 10 years) of diabetes (odds ratio [OR] 2.43), age ≥ 65 years (OR 2.13), age 50 - 64 years (OR 1.75), presence of type 1 versus type 2 diabetes (OR 1.59), body mass index > 30 kg/m(2) (OR 1.35) and female gender (OR 1.27). Living in one of the Gulf States was associated with the lowest odds of having painful DPN (OR 0.44). The odds of painful DPN were highest among patients with peripheral vascular disease (OR 4.98), diabetic retinopathy (OR 3.90) and diabetic nephropathy (OR 3.23). Because of the high prevalence and associated suffering, disability and economic burden of painful DPN, it is important that diabetic patients are periodically screened, using a simple instrument such as the DN4, and receive appropriate treatment if symptoms develop.
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Affiliation(s)
- S Jambart
- Division of Endocrinology and Metabolism, Saint-Joseph University and Hôtel-Dieu de France Hospital, Beirut, Lebanon.
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22
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Tsay J, Pomeranz C, Hassoun A, Zandieh SO, Rutledge J, Vogiatzi MG, Oberfield SE, Motaghedi R. Screening markers of impaired glucose tolerance in the obese pediatric population. Horm Res Paediatr 2010; 73:102-7. [PMID: 20190546 DOI: 10.1159/000277625] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 02/11/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the epidemic of childhood obesity, it is crucial to devise a simple screening protocol to predict impaired glucose tolerance (IGT) or pre-diabetes. The oral glucose tolerance test (OGTT), which is the gold standard for the diagnosis of IGT, is impractical for screening purposes. This pilot study was designed to formulate a simple, sensitive algorithm to predict IGT using clinical and laboratory parameters. METHODS Ethnicity, family history of diabetes, pubertal status, BMI z-score, blood pressure, lipids, hemoglobin A1c (HbA1c) and OGTT data were retrospectively collected from 209 overweight multi-ethnic subjects aged 3-21 years. Multivariate logistic regression was used to determine independent predictors of IGT. RESULTS HbA1c was the only significant predictor of IGT (p = 0.001), whereas fasting glucose was not. A cut-off of 5.5% had the best combined sensitivity (85.7%) and specificity (56.9%) with an odds ratio of 7.9 of having IGT when HbA1c is > or =5.5%. The remaining clinical parameters were not significant predictors of IGT. CONCLUSION While fasting blood glucose does not seem to be a predictor of IGT, we propose that HbA1c > or =5.5% can be used as a screening test to assess the risk of IGT and to determine who should undergo diagnostic OGTT. Large prospective studies validating our findings are warranted.
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Affiliation(s)
- J Tsay
- Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA
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23
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Lambert T, Guérois C, Gay V, Stieltjes N, Bertrand MA, Derlon A, Sigaud M, Hassoun A, Négrier C, Coatmelec B, Dreyfus M, Dubanchet A. Factor VIII recovery after a single infusion of recalibrated ReFacto�in 14 severe haemophilia A patients. Haemophilia 2007; 13:357-60. [PMID: 17610548 DOI: 10.1111/j.1365-2516.2007.01482.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A recent multicentre collaborative study showed higher estimates of ReFacto potency when assayed with ReFacto Laboratory Standard(TM) (RLS) in comparison when standards consisting of full-length factor VIII (FVIII) were used. The RLS was hence recalibrated, leading to a 20% increase in the amount of ReFacto per vial without change in the labelled potency. The primary objective of this study was to determine the incremental and in vivo recovery of the recalibrated ReFacto in patients with severe haemophilia A. Fourteen male severe haemophilia A patients (FVIII < 1 IU dL(-1)) with a cumulative previous exposure days to any FVIII product >150 were administered an intravenous infusion 50 +/- 5 IU kg(-1) of ReFacto over a 5-min period. Blood samples were collected before infusion and after 15, 30 and 60 min. FVIII clotting activity (FVIII:C) was assessed in a central laboratory by the chromogenic substrate assay. After ReFacto infusion, peak FVIII:C was obtained within 15 min for 10 patients and within 30 min for the remaining four. Mean FVIII:C at peak was 117.7 +/- 17.3 IU dL(-1). Mean incremental recovery was 2.22 +/- 0.27 IU dL(-1) per IU kg(-1) while mean in vivo recovery was 105.9 +/- 14.6%. One patient reported three mild adverse events rated as 'unrelated' to the study drug. FVIII recovery after recalibrated ReFacto infusion falls within the expected range and is similar to the values reported for other FVIII concentrates.
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Affiliation(s)
- T Lambert
- CHU Bicêtre AP-HP, Le Kremlin Bicêtre, France.
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24
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Abstract
Bile is, in certain cases, collected together with blood from different sites (heart, brain, femoral), urine and other organs or matrices. This study reports comparative results obtained from the analysis of blood and bile for different drugs found: acetaminophen, amphetamine and related compounds, several antidepressants, several benzodiazepines, cocaine and its metabolites, dextropropoxyphene and its metabolite, hydroxyzine, methadone and metabolite, morphine and codeine, levomepromazine, thioridazine, propranolol, tramadol and its metabolite. Several findings are presented: (1) There were no significant differences in the levels of the compounds among the samples of blood obtained from different sites. (2) Levels in bile are generally several fold higher than those in blood. The mean bile to blood ratios vary from about 1 (for acetaminophen, amphetamine) to about 2000 (for desmethylclobazam). (3) In certain cases (16 over 44), although the drug or its metabolite was not detected in blood from different sites, it was detected in bile. As other authors had advocated, it is very useful to ask the pathologist to take the gall bladder with its contents together with the other samples, in order that the sample of bile can be used in the comprehensive toxicological analysis and therefore be complementary to the other fluids or matrices. An additional advantage for using bile is that the concentrations of drugs or their metabolites are generally several fold higher than their blood concentrations.
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Affiliation(s)
- R Vanbinst
- Laboratory of Toxicology, St-Luc Hospital, Université catholique de Louvain, Hippocrate Avenue 10, 1200, Brussels, Belgium
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25
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Maruno M, Furuyama K, Akagi R, Horie Y, Meguro K, Garbaczewski L, Chiorazzi N, Doss MO, Hassoun A, Mercelis R, Verstraeten L, Harper P, Floderus Y, Thunell S, Sassa S. Highly heterogeneous nature of delta-aminolevulinate dehydratase (ALAD) deficiencies in ALAD porphyria. Blood 2001; 97:2972-8. [PMID: 11342419 DOI: 10.1182/blood.v97.10.2972] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The properties of 9 delta-aminolevulinate dehydratase (ALAD) mutants from patients with ALAD porphyria (ADP) were examined by bacterial expression of their complementary DNAs and by enzymologic and immunologic assays. ALADs were expressed as glutathione-S-transferase (GST) fusion proteins in Escherichia coli and purified by glutathione-affinity column chromatography. The GST-ALAD fusion proteins were recognized by anti-ALAD antibodies and were enzymatically active as ALAD. The enzymatic activities of 3 ALAD mutants, K59N, A274T, and V153M, were 69.9%, 19.3%, and 41.0% of that of the wild-type ALAD, respectively, whereas 6 mutants, G133R, K59N/G133R, F12L, R240W, V275M, and delTC, showed little activity (< 8%). These variations generally reflect the phenotype of ALAD in vivo in patients with ADP and indicate that GST-ALAD fusion protein is indeed useful for predicting of the phenotype of ALAD mutants. The location of F12L mutation in the enzyme's molecular structure indicates that its disturbance of the quaternary contact of the ALAD dimer appears to have a significant influence on the enzymatic activity. Mouse monoclonal antibodies to human ALAD were developed that specifically recognized a carboxy terminal portion of ALAD, or other regions in the enzyme. This study represents the first complete analysis of 9 mutants of ALAD identified in ADP and indicates the highly heterogeneous nature of mutations in this disorder.
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Affiliation(s)
- M Maruno
- Rockefeller University, New York, NY; Okayama Prefectural University, Okayama, Japan
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26
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Akagi R, Nishitani C, Harigae H, Horie Y, Garbaczewski L, Hassoun A, Mercelis R, Verstraeten L, Sassa S. Molecular analysis of delta-aminolevulinate dehydratase deficiency in a patient with an unusual late-onset porphyria. Blood 2000; 96:3618-23. [PMID: 11071662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Cloning, expression, and genotype studies of the defective gene for delta-aminolevulinate dehydratase (ALAD) in a patient with an unusual late onset of ALAD deficiency porphyria (ADP) were carried out. This patient was unique in that he developed the inherited disease, together with polycythemia, at the age of 63. ALAD activity in erythrocytes of the patient was less than 1% of the normal control level. ALAD complementary DNA (cDNA) isolated from the patient's Epstein-Barr virus (EBV)-transformed lymphoblastoid cells had 2 base transitions in the same allele, G(177) to C and G(397) to A, resulting in amino acid substitutions K59N and G133R, respectively. It has been verified that the patient had no other ALAD mutations in this and in the other allele. By restriction fragment length polymorphism (RFLP) analysis, all family members of the proband who had one-half ALAD activity compared with the ALAD activity of the healthy control were shown to have the same set of base transitions. Expression of ALAD cDNA in CHO cells revealed that K59N cDNA produced a protein with normal ALAD activity, while G133R and K59N/G133R cDNA produced proteins with 8% and 16% ALAD activity, respectively, compared with that expressed by the wild type cDNA. These findings indicate that while the proband was heterozygous for ALAD deficiency, the G(397) to A transition resulting in the G133R substitution is responsible for ADP, and the clinical porphyria developed presumably due to an expansion of the polycythemic clone in erythrocytes that carried the mutant alad allele.
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Affiliation(s)
- R Akagi
- The Rockefeller University, New York, NY; Okayama Prefectural University, Soja, Japan
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27
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Abstract
BACKGROUND Both antigen-dependent (immunologic) and non-antigen-dependent (nonimmunologic) factors have been implicated in long-term renal allograft loss. Differentiating between these two factors is important because prevention strategies differ. METHODS To isolate the importance of these 2 factors, we studied long-term actuarial graft survival in a cohort of adult kidney recipients who underwent transplants at a single institution between January 1, 1984 and October 31, 1998. Excluded were recipients with graft loss as a result of death with function, technical failure, primary nonfunction, and recurrent disease, leaving 1587 recipients (757 cadaver [CAD], 830 living donor [LD]) who would be at risk for graft loss secondary to both immunologic and nonimmunologic factors. These recipients were analyzed in the following 2 groups: those treated for a previous episode of acute rejection (AR) (Group1; n = 588; 328 CAD, 260 LD) and those with no AR (Group 2: n = 999; 429 CAD, 570 LD). Actuarial graft survival and causes of graft loss were determined for each group. Presumably, graft loss in Group 1 would be caused by immunologic and nonimmunologic factors; graft loss in Group 2 would be caused primarily by nonimmunologic factors. RESULTS The 10-year graft survival rate (censored for death with function, technical failure, primary nonfunction, and recurrent disease) in Group 2 was 91%. In contrast, the 10-year graft survival rate in Group 1 was 45% (P<0.001 vs. Group 2). Causes of graft loss in Group 2 were chronic rejection in 1.8% (3.0% CAD, 0.9% LD), de novo disease, 0.4%; sepsis, 0.2%; discontinuation of immunosuppressive therapy, 0.3%; and unknown, 0.6%. In contrast, 23.8% (29.9% CAD, 16.2% LD) of recipients in Group 1 had graft loss caused by chronic rejection (P = 0.001 vs. Group 2). CONCLUSIONS This very low incidence of chronic rejection in recipients without previous AR suggests that immunologic factors are the main determinants of long-term kidney transplant outcome; nonimmunologic factors in isolation may have only a minimal impact on long-term graft survival.
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Affiliation(s)
- A Humar
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
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28
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Kandaswamy R, Hassoun A, Parr L, Zhang K, Gruessner A, Sutherland DER, Humar A. PROLONGED PRESERVATION TIME INCREASES THE INCIDENCE OF SURGICAL COMPLICATIONS AFTER PANCREAS TRANSPLANT. Transplantation 1999. [DOI: 10.1097/00007890-199905150-00119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brau M, Vanbinst R, Hassoun A, Wallemacq PE. Simultaneous detection and quantification of acidic and basic drugs in serum toxicological screening: use of ion-pairing technique in liquid-liquid extraction. Acta Clin Belg 1999; 53 Suppl 1:74-8. [PMID: 10216988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The toxicological screening, using the combination of high performance liquid chromatography with diode array ultraviolet detector and ion-pairing technique in liquid-liquid extraction, is an effective tool in the identification and quantification of the acidic and basic substances in a single run. The use of an ion-pairing technique in the conventional extraction shows the co-extraction of the uncharged and charged form of the analytes present in a serum sample. The stationary phase used is C-18-bonded phase. The mobile phase is acetonitrile--phosphate buffer (pH 3; 25 mM) containing 25 mM triethylammonium as ion-pairing agent. The analytical validation shows reproducible recoveries, good day-to-day repeatability and sensible results compatible with clinical and forensic use.
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Affiliation(s)
- M Brau
- Laboratoire de Toxicologie et Monitoring Thérapeutique, Cliniques Universitaires Saint-Luc, Bruxelles
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30
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Humar A, Kerr S, Hassoun A, Granger D, Suhr B, Matas A. The association between acute rejection and chronic rejection in kidney transplantation. Transplant Proc 1999; 31:1302-3. [PMID: 10083581 DOI: 10.1016/s0041-1345(98)02006-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Humar
- Department of Surgery, University of Minnesota, Minneapolis, USA
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31
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Anastasescou M, Cornu O, Banse X, König J, Hassoun A, Delloye C. Ethanol treatment of tendon allografts: a potential HIV inactivating procedure. Int Orthop 1998; 22:252-4. [PMID: 9795814 PMCID: PMC3619604 DOI: 10.1007/s002640050253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The penetration rate of ethanol in human tendons was studied to in order to define the conditions which were necessary to achieve an inactivating concentration against the Human Immunodeficiency Virus (HIV) within the tendon. The rate of alcohol penetration was found to be slow and did not differ with different types of tendons. An average ethanol concentration of 14% (v/v) was measured in human tendons after they had been immersed for 2 h in 70% (v/v) ethanol, and a concentration of 19% (v/v) was reached after 3 h. Ethanol immersion of human tendons may represent an additional safety procedure in inactivating the HIV virus provided the duration is at least 3 h.
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Affiliation(s)
- M Anastasescou
- Orthopaedic Research Laboratory, Catholic University of Louvain, Brussels, Belgium
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32
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Abstract
A 19-year-old woman was admitted 45 min after ethylene glycol (EG) ingestion. The initial serum EG concentration was 1.34 g/l (21.6 mmol/l), the anion gap 14.5, and the osmolal gap 24. Renal function was preserved (serum creatinine 75.1 micromol/l). As the patient was seen soon after poisoning, before the development of metabolic acidosis, therapy with 4-methylpyrazole (4-MP) was proposed as an antidote. 4-MP was administered via the intravenous route (7 mg/kg as loading dose, followed by 3.6, 1.2, 0.6, and 0.6 mg/kg at intervals of 12 h). 4-MP alone was effective in preventing EG biotransformation to toxic metabolites (absence of metabolic acidosis and renal injury). Ethanol therapy, hemodialysis, and sodium bicarbonate administration were not required. The half-life of EG during 4-MP therapy was 11 h, with a mean EG renal clearance of 26.9 ml/min, and a total of 65.3 g EG was eliminated unchanged in the urine. 4-MP therapy was also well tolerated.
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Affiliation(s)
- P Hantson
- Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium.
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Wallemacq PE, Leal T, Besse T, Squifflet JP, Reding R, Otte JB, Lerut J, Hassoun A. IMx tacrolimus II vs IMx tacrolimus microparticle enzyme immunoassay evaluated in renal and hepatic transplant patients. Clin Chem 1997; 43:1989-91. [PMID: 9342026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P E Wallemacq
- Dept. of Clin. Chem., University Hosp. St Luc, Univ. of Louvain, Brussels, Belgium.
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34
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Abstract
Tacrolimus is extensively metabolized by the cytochrome P-450 system. Hepatic metabolic phase I reactions of tacrolimus include mainly demethylation and/or hydroxylation. No valid data have been published on phase II pathways (glucuronide- or sulfo-conjugation). In order to investigate these pathways, different beta-glucuronidase/sulfatase enzyme preparations were used to hydrolyse the conjugates potentially present in human bile extracts. Two analytical methods were used: a non-specific method, MEIA, and a specific combined HPLC/MEIA method. The influence of the extraction pH was investigated. After beta-glucuronidase hydrolysis and extraction at pH 5, tacrolimus concentrations, obtained either from HPLC-MEIA or MEIA, always appeared significantly higher, suggesting the presence of glucuronides in the bile. When the extraction was performed at pH 1.5, only the HPLC-MEIA concentrations appeared higher after hydrolysis. MEIA concentrations obtained before and after hydrolysis were similar. These data are consistent with the fact that glucuronides are extracted at pH 1.5 but not at pH 5 and suggest first that, without hydrolysis, the extracted glucuronides are separated from the tacrolimus fraction in the HPLC-MEIA procedure, and second, that the glucuronides are cross-detected by the monoclonal antibody in the immunoassay. From these data, it is concluded that clues have been found, suggesting the presence in human bile of tacrolimus glucuronides, which cross-react with the monoclonal antibody, provided they are extracted in the sample tested.
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Affiliation(s)
- I Firdaous
- Department of Clinical Chemistry, University Hospital St Luc, Catholic University of Louvain, Brussels, Belgium
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35
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Leal T, Dupret P, Hassoun A, Wallemacq PE. Topical application of eosin to burns produces interference in measurement of serum vancomycin by fluorescence polarization immunoassay. Clin Chem 1997; 43:1238-40. [PMID: 9216463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T Leal
- Dept. of Clin. Chem., University Hospital St. Luc, University of Louvain, Brussels Belgium
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36
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Sumrani N, Hong JH, Georgi B, Maursky V, Hassoun A, Markell MS, Distant DA, Sommer BG. Impact of early acute rejection on outcome of HLA-mismatched living related donor kidney transplants. Transplant Proc 1996; 28:1451-2. [PMID: 8658736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- N Sumrani
- Department of Surgery, State University of New York Health Science Center at Brooklyn 11203, USA
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37
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Georgi B, Sumrani N, Maursky V, Hassoun A, Hong JH, Yu L, JeanBaptiste F, Distant DA, Mocerino M, Sommer BG. Racial differences in long-term renal allograft outcome. Transplant Proc 1996; 28:1623-5. [PMID: 8658812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- B Georgi
- Department of Surgery, State University of New York Health Science Center at Brooklyn, USA
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38
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Firdaous I, Hassoun A, Otte JB, Reding R, Squifflet JP, Besse T, Wallemacq PE. HPLC-microparticle enzyme immunoassay specific for tacrolimus in whole blood of hepatic and renal transplant patients. Clin Chem 1995; 41:1292-6. [PMID: 7544705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tacrolimus is a relatively new immunosuppressant used in organ transplantation to prevent graft rejection. However, its use is not devoid of side effects, making it important to maintain blood concentrations within therapeutic ranges. Several analytical methods are currently available for routine drug monitoring. However, these methods are based on use of the same monoclonal antibody, which also cross-reacts with some metabolites, resulting in overestimation of some blood concentrations. Even though this antibody appears appropriate for therapeutic drug monitoring, no reference method measures only the parent drug, mainly because of the poor absorptivity of tacrolimus in ultraviolet light. We have developed a method displaying an increased specificity towards the unchanged drug, using conventional equipment available in most clinical laboratories. After chromatographic separation of the blood extract, the tacrolimus fraction is analyzed by an automated microparticle enzyme immunoassay (MEIA) performed on the IMx analyzer (Abbott Labs.). This method is linear from 0 to 40 micrograms/L, yields CVs from 8.5% to 18.2%, and has a detection limit of 5 micrograms/L. Tacrolimus concentrations obtained by HPLC-MEIA in hepatic and renal transplant patients are from 47.5% to 18.8% lower than those obtained by MEIA, according to liver function tests and metabolite accumulation, even though no significant differences were observed between the methods for drug-free blood samples supplemented with known amounts of tacrolimus.
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Affiliation(s)
- I Firdaous
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
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39
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Firdaous I, Hassoun A, Otte JB, Reding R, Squifflet JP, Besse T, Wallemacq PE. HPLC-microparticle enzyme immunoassay specific for tacrolimus in whole blood of hepatic and renal transplant patients. Clin Chem 1995. [DOI: 10.1093/clinchem/41.9.1292] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Tacrolimus is a relatively new immunosuppressant used in organ transplantation to prevent graft rejection. However, its use is not devoid of side effects, making it important to maintain blood concentrations within therapeutic ranges. Several analytical methods are currently available for routine drug monitoring. However, these methods are based on use of the same monoclonal antibody, which also cross-reacts with some metabolites, resulting in overestimation of some blood concentrations. Even though this antibody appears appropriate for therapeutic drug monitoring, no reference method measures only the parent drug, mainly because of the poor absorptivity of tacrolimus in ultraviolet light. We have developed a method displaying an increased specificity towards the unchanged drug, using conventional equipment available in most clinical laboratories. After chromatographic separation of the blood extract, the tacrolimus fraction is analyzed by an automated microparticle enzyme immunoassay (MEIA) performed on the IMx analyzer (Abbott Labs.). This method is linear from 0 to 40 micrograms/L, yields CVs from 8.5% to 18.2%, and has a detection limit of 5 micrograms/L. Tacrolimus concentrations obtained by HPLC-MEIA in hepatic and renal transplant patients are from 47.5% to 18.8% lower than those obtained by MEIA, according to liver function tests and metabolite accumulation, even though no significant differences were observed between the methods for drug-free blood samples supplemented with known amounts of tacrolimus.
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Affiliation(s)
- I Firdaous
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
| | - A Hassoun
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
| | - J B Otte
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
| | - R Reding
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
| | - J P Squifflet
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
| | - T Besse
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
| | - P E Wallemacq
- Department of Clinical Chemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
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40
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Roels S, Hassoun A, Hoorens J. Accumulation of protoporphyrin isomers I and III, and multiple decarboxylation products of uroporphyrin in a case of porphyria in a slaughtered pig. Zentralbl Veterinarmed A 1995; 42:145-51. [PMID: 8592889 DOI: 10.1111/j.1439-0442.1995.tb00366.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pathological and biochemical examinations were made on tissues from a case of porphyria in a slaughtered pig. Bones, kidneys, teeth and lymph nodes showed a mahogany discoloration. Histologically, the pigment was negative on staining for iron (Gomori) and showed a strong red-orange fluorescence under UV light proving it to be porphyrin. Biochemical studies on the kidney, lymph nodes, bone and bone marrow revealed a 'mixed' erythropoietic protoporphyria-coproporphyria. This indicates that the case presented probably represented both a uroporphyrinogen decarboxylase and uroporphyrinogen-III-cosynthase dysfunction.
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Affiliation(s)
- S Roels
- Department of Pathology, Faculty of Veterinary Medicine, University of Gent, Belgium
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41
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Abstract
Dextropropoxyphene overdose may be complicated by serious cardiovascular manifestations, including conduction abnormalities and collapse. We report two patients in whom cardiac toxicity developed. Cardiovascular depression seemed to be improved after naloxone infusion in these two cases. Possible mechanisms are briefly discussed.
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Affiliation(s)
- P Hantson
- Department of Emergency and Intensive Medicine, Cliniques Universitaires St-Luc, Brussels, Belgium
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42
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Hantson P, Mahieu P, Hassoun A, Otte JB. Outcome following organ removal from poisoned donors in brain death status: a report of 12 cases and review of the literature. J Toxicol Clin Toxicol 1995; 33:709-12. [PMID: 8523498 DOI: 10.3109/15563659509010634] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Experience with organ procurement from poisoned donors in brain death status is still limited in comparison with other etiologies. From 1963 to 1993, 2769 grafts (heart 141, kidney 1922, liver 623, pancreas 43) were performed in our University Hospital. Since 1975, among 1174 patients admitted to the ICU for acute poisoning, 12 patients who developed brain death status were considered for organ donation. The toxics involved were: methaqualone (1), benzodiazepines (1), benzodiazepines plus tricyclic antidepressants (2), barbiturates (2), insulin (2), carbon monoxide (1), cyanide (1), methanol (1), and acetaminophen (1). Exclusion criteria for organ removal were applied according to the nature of the toxin and the general criteria used for organ donation. The organs removed were: heart 5, heart valves for graft bank 2, kidneys 22, liver 4, pancreas 2, pancrease islet cells 2. Pertinent follow-up was obtained in 23 of 32 recipients. Immediate outcome was favorable in 20/23 patients (85%). Three patients died either from stroke, heart failure or preexisting encephalopathy. Two patients died from either chronic hepatic or renal graft rejection. None of these events could be directly related to a toxic origin. The one year survival rate of 75% is similar to that observed in the population who received organs from nonpoisoned donors. Organ procurement can be considered in few selected cases of acute poisoning. The accuracy of the diagnosis of irreversible brain damage is essential in this setting.
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Affiliation(s)
- P Hantson
- Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium
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43
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Nickmilder MJ, Latinne D, Hassoun A, Wallemacq PE. Inhibitory effects of solvent and solid-phase extraction residues on mixed lymphocyte cultures. J Pharmacol Toxicol Methods 1994; 32:31-3. [PMID: 7833504 DOI: 10.1016/1056-8719(94)90014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Residues from eight solvents/solvent mixtures before and after their passage through C18- bonded phase columns were assayed for cytostatic activity using mixed lymphocyte cultures (MLC). All residues, except those from acetonitrile, exhibited cytostatic activity (15%-35% MLC inhibition as measured by 3H-thymidine incorporation). Passage of solvents through bonded phase columns contributed an additional and significant cytostatic effect (19%-69% MLC inhibition). Pretreatment of columns with methanol led to further increases in the release of cytostatic residues from the columns, only when followed by less polar solvents (hexane, ethylacetate, etc.). It is concluded that residues from solid-phase extraction columns may interfere with subsequent cell culture-based assays for proliferative/antiproliferative activity.
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Affiliation(s)
- M J Nickmilder
- Department of Clinical Biochemistry, University Hospital St Luc, Catholic University of Louvain, Brussels, Belgium
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44
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Firdaous I, Hassoun A, Otte JB, Reding R, de Clety SC, Wallemacq PE. Pediatric intravenous FK506--how much are we really infusing? Transplantation 1994; 57:1821-3. [PMID: 7517079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- I Firdaous
- Department of Clinical Biochemistry, University Hospital St. Luc, University of Louvain, Brussels, Belgium
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45
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Abstract
We report a case of organophosphate poisoning with a commercial preparation of malathion (deliberate ingestion of Malathane Garden Spray: malathion 15% in isopropyl alcohol) in which the initial cholinergic crisis was followed by cardiac, pulmonary, neurological and renal manifestations. They occurred when erythrocyte and plasma cholinesterases were reactivating. A chemical analysis of the pesticide preparation revealed, apart from malathion itself, the presence of isopropylmalathion and O,O,S-trimethylphosphorothioate. Although pure malathion is regarded as one of the safest organophosphate insecticides, this observation underlines the possibility of severe complications after exposure to a preparation which has been stored for a long period of time.
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Affiliation(s)
- A Dive
- Centre de toxicologie clinique, U.C.L. Saint-Luc, Bruxelles, Belgium
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46
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Abstract
The clinical monitoring and intensive care of patients who have taken an overdose of a benzodiazepine require rapid and quantitative methods to assess benzodiazepine concentrations in biological fluids. A radioreceptor assay (RRA) permits the simultaneous measurement of the benzodiazepine molecules that bind to the receptor, providing a total estimate of all pharmacologically active forms of the drug(s) (parent drug and active metabolites). This study describes the development of an RRA for the determination of benzodiazepine compounds in serum using a lyophilized bovine brain cerebral cortex receptor preparation. The standard curves and the sensitivity of this RRA are determined for 20 different benzodiazepines and the specific antagonist flumazenil. The sensitivity ranges from 5 ng/mL for clonazepam to 3500 ng/mL for chlordiazepoxide. The IC50 values are significantly correlated (r = 0.81) with the lowest recommended therapeutic concentrations. The advantages and disadvantages of this RRA are discussed and compared with those of other chromatographic and immunological methods.
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Affiliation(s)
- J Bruhwyler
- Laboratory of Toxicology, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
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47
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Wallemacq PE, Firdaous I, Hassoun A. Improvement and assessment of enzyme-linked immunosorbent assay to detect low FK506 concentrations in plasma or whole blood within 6 hours. Clin Chem 1993. [DOI: 10.1093/clinchem/39.6.1045] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
FK506, a promising new immunosuppressant, is currently under clinical investigation. Because dose-dependent toxicity is possible, blood concentrations of FK506 should be monitored. We improved the original ELISA of FK506 by shortening the incubation time. With some modification of materials, results are obtained within 6 h instead of 2 days, with similar or even better precision. Internal and external quality-control programs showed that our results correlated satisfactorily both with values determined by the original method and the theoretical expected values. Either plasma (detection limit 0.1 microgram/L) or whole-blood (detection limit 1 microgram/L) samples can be used. The sensitivity of the method makes it particularly useful for accurate pharmacokinetic studies or measurement of low blood concentrations. Twenty-four drugs and nine biological variables showed no significant interference on the assay. Study of the concentration- and temperature-dependent distribution of FK506 shows that the drug is largely bound to erythrocytes (ratio of blood to plasma concentrations is 10-40); as the erythrocytes become saturated, more of the drug is found in the plasma. Plasma concentrations may vary according to the blood temperature. We conclude that whole blood should be used for FK506 monitoring, as it is for monitoring cyclosporine.
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Affiliation(s)
- P E Wallemacq
- Laboratoire de Toxicologie et de Monitoring Thérapeutique, Cliniques Universitaires St. Luc, Bruxelles, Belgique
| | - I Firdaous
- Laboratoire de Toxicologie et de Monitoring Thérapeutique, Cliniques Universitaires St. Luc, Bruxelles, Belgique
| | - A Hassoun
- Laboratoire de Toxicologie et de Monitoring Thérapeutique, Cliniques Universitaires St. Luc, Bruxelles, Belgique
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48
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Wallemacq PE, Firdaous I, Hassoun A. Improvement and assessment of enzyme-linked immunosorbent assay to detect low FK506 concentrations in plasma or whole blood within 6 hours. Clin Chem 1993; 39:1045-9. [PMID: 7684956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
FK506, a promising new immunosuppressant, is currently under clinical investigation. Because dose-dependent toxicity is possible, blood concentrations of FK506 should be monitored. We improved the original ELISA of FK506 by shortening the incubation time. With some modification of materials, results are obtained within 6 h instead of 2 days, with similar or even better precision. Internal and external quality-control programs showed that our results correlated satisfactorily both with values determined by the original method and the theoretical expected values. Either plasma (detection limit 0.1 microgram/L) or whole-blood (detection limit 1 microgram/L) samples can be used. The sensitivity of the method makes it particularly useful for accurate pharmacokinetic studies or measurement of low blood concentrations. Twenty-four drugs and nine biological variables showed no significant interference on the assay. Study of the concentration- and temperature-dependent distribution of FK506 shows that the drug is largely bound to erythrocytes (ratio of blood to plasma concentrations is 10-40); as the erythrocytes become saturated, more of the drug is found in the plasma. Plasma concentrations may vary according to the blood temperature. We conclude that whole blood should be used for FK506 monitoring, as it is for monitoring cyclosporine.
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Affiliation(s)
- P E Wallemacq
- Laboratoire de Toxicologie et de Monitoring Thérapeutique, Cliniques Universitaires St. Luc, Bruxelles, Belgique
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49
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Verstraeten L, Dewier B, Montjoie C, Hassoun A. [Drug-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Review of literature]. J Pharm Belg 1993; 48:227-232. [PMID: 8410627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is caused by an incapacity of plasmatic hypotonia to inhibit antidiuretic hormone (ADH) secretion. This phenomenon leads to a water retention and an expanded extracellular fluid volume, and secondary to a dilution of plasmatic sodium and also to a renal loss of sodium. The SIADH is a relatively rare syndrome, which may occur in various circumstances: central nervous system diseases, cancers, infections... Sometimes, it may be observed as a drug-related side effect: carbamazepine, chlorpropamide, antidepressors, anticancer drugs are particularly involved.
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Affiliation(s)
- L Verstraeten
- Service de Biochimie Médicale, Cliniques Universitaires St-Luc, Bruxelles, Belgique
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50
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Fiasse R, Pauwels S, Rahier J, Jamar F, Ketelslegers JM, Hassoun A, de Longueville M. Use of octreotide in the treatment of digestive neuroendocrine tumours. Seven year experience in 20 cases including 9 cases of metastatic midgut carcinoid and 5 cases of metastatic gastrinoma. Acta Gastroenterol Belg 1993; 56:279-91. [PMID: 8266771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The authors report their experience with octreotide in 20 patients (median age 57 years, 10 M, 10 F) from 1984 to 1991; 16 had metastatic APUDoma: 1 PPoma with VIPoma, 1 glucagonoma, 5 gastrinoma including 1 associated to PP-oma, 9 mid-gut carcinoid; 3 patients had multiple-endocrine neoplasia type I (MEN-I) with Zollinger-Ellison syndrome (ZES) and 1 patient a non-metastatic VIPoma. Octreotide (200-750 micrograms/day) was administered bid or tid with regular laboratory controls and morphological assessment. There was a striking improvement of symptoms, particularly in the carcinoid group (reduction of flushing in all patients and of diarrhoea in 3/5), in the patient with gastrinoma + acromegaly (regression of congestive heart failure) and in the patient with non-metastatic VIPoma. The hormonal markers were markedly reduced, particularly gastrin, PP (except in the patient with PPoma + VIPoma), VIP, GH and Somatomedin-C and urinary 5HIAA in 4/9 patients with carcinoid. There was only one partial regression of metastases (gastrinoma) and 4 apparent stabilizations of tumour growth, in the 16 metastatic cases. Among them, 4 patients died: 1 glucagonoma, 1 PPoma + VIPoma, 2 mid-gut carcinoids after a treatment of 5, 16, 30, 36 months, respectively. The patient with acromegaly + ZES died after 6 years of treatment at age 81. A patient with prolactinoma, resected insulinoma, hyperparathyroidism and ZES was not improved by a short course of octreotide (hypoglycemia); he died later of recurrent insulinoma. In conclusion, octreotide is a useful drug to control most of the symptoms related to gut endocrine tumours; it may inhibit tumour growth.
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Affiliation(s)
- R Fiasse
- University Clinics St-Luc, UCL, Brussels, Belgique
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