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Aoun F, Helou E, Albisinni S. Shifting the paradigm in high-risk prostate cancer: how good is TNM alone? Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00748-1. [PMID: 37884614 DOI: 10.1038/s41391-023-00748-1] [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: 10/09/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Fouad Aoun
- Urology Unit, Department of Urology, Saint Joseph University, Hotel Dieu de France, Beirut, Lebanon.
| | - Elie Helou
- Urology Unit, Department of Urology, Saint Joseph University, Hotel Dieu de France, Beirut, Lebanon
| | - Simone Albisinni
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
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Zhao A, Wegener M, Brooks R, Mininberg L, Helou E, Maughan A, Villanueva M. Characterizing Persons With HIV/HCV Coinfection Who Remain Untreated for Hepatitis C at Four HIV Clinics in Connecticut (CT): Role of Multiple Overlapping Barriers at the Individual and Clinic System Levels. Health Promot Pract 2023; 24:1029-1038. [PMID: 37439687 DOI: 10.1177/15248399231169793] [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] [Indexed: 07/14/2023]
Abstract
Introduction. Direct-acting antiviral medications have made hepatitis C virus (HCV) cure possible for >95% of persons with chronic HCV infection, including those coinfected with HIV. Achieving strategic HCV elimination targets requires an understanding of system, provider, and patient-level barriers to treatment. We explored such barriers among persons with HIV/HCV coinfection who remained untreated for HCV. Methods. Among four primary care HIV clinics in CT with high rates of HCV cure, 25 patients with HIV/HCV coinfection were eligible (no HCV treatment as of March 31, 2021). We conducted retrospective chart reviews of demographics, clinical practice patterns, patient-specific issues such as housing, transportation, food security, and presence of mental health and substance use problems. Results. Among untreated patients, 13 (51%) were female; 17 (68%) were Black; median age was 62 years old. The majority (84%) had injecting drug use (IDU) as HIV transmission risk factor; 14 (56%) were prescribed medication-assisted treatment. Median time since HIV and HCV diagnosis was 25 and 19 years, respectively. Clinic-level barriers were noted in 19 (76%) and included lack of evaluation, treatment not recommended or implemented. Concomitant structural barriers included unstable housing for 11 (44%) and lack of transportation for eight (32%). Most patients had history of illicit substance use (84%) and mental health issues (68%). Many (76%) had multiple potential barriers. Conclusions. Multiple overlapping barriers spanning clinic and patient level domains including social determinants of health were the norm in persons with long-standing HIV/HCV coinfection who have not received HCV treatment. Interventions will require innovative, multi-disciplinary and personalized approaches.
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Affiliation(s)
| | | | | | | | - Elie Helou
- StayWell Health Care, Waterbury, CT, USA
| | - Ashly Maughan
- Cornell Scott-Hill Health Center, New Haven, CT, USA
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3
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Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Correction: Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res 2022; 22:765. [PMID: 35689220 PMCID: PMC9188222 DOI: 10.1186/s12913-022-08159-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon. .,Department of Nephrology, Saint-George Hospital, Ajaltoun, Lebanon.
| | - Elie Helou
- Department of Urology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Unit of biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rony M Zeenny
- Pharmacy Director, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dania Chelala
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,Department of Nephrology at Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res 2022; 22:586. [PMID: 35501814 PMCID: PMC9063193 DOI: 10.1186/s12913-022-07936-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/10/2023] Open
Abstract
Background Chronic kidney disease (CKD) is the 12th leading cause of death worldwide. Cost-of-illness studies of CKD are scarce in developing countries. This study aims to estimate the cost of illness of all stages of CKD in Lebanon, from early stages until dialysis and kidney transplantation. The secondary objective is to identify factors related to the highest financial burden. Methods This is a cross-sectional study of CKD patients who presented to two nephrology clinics during November 2020. Their medical and administrative records were reviewed for collection of demographics, CKD characteristics, direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. Logistic regression analysis was used to evaluate risk factors associated with costs. Results The sample included 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 transplant patients. Their mean age was 66.74 ± 15.36 years, 57.5% were males and 42.5% diabetics. The total median cost per year of CKD across all categories was assessed to be 7,217,500 Lebanese Pounds (3,750,000–35,535,250; 1 $USD = 1515 LBP in 2019) from the societal perspective and 5,685,500 LBP (2,281,750- 32,386,500) from the third-party payer perspective. Statistical analysis showed a higher total cost in hemodialysis (p < 0.001), higher cost of medications in transplant (p < 0.001) and higher cost in technique modality in peritoneal dialysis (p < 0.001). In a sub-analysis of hemodialysis patients, dialysis vintage negatively correlated with total societal cost (r = -0.391, p = 0.013); the regression analysis found diabetes as a risk factor for higher cost (OR = 2.3; 95%CI: 0.638,8.538; p = 0.201). In the subcategory of CKD-ND patients, age correlated with total societal cost (r = 0.323, p = 0.001); diabetes and coronary artery disease were significantly associated with higher total cost (OR = 2.4; 95%CI: 1.083,5.396; p = 0.031; OR = 3.7; 95%CI: 1.535,8.938; p = 0.004). Conclusions This cost of illness study showed a high burden of hemodialysis and peritoneal dialysis cost compared to transplant and non-dialysis CKD patients. It revealed a significantly higher cost of medications in transplant patients. Health policies should target interventions that prevent end-stage kidney disease and encourage kidney transplantation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07936-0.
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon. .,Department of Nephrology, Saint-George Hospital, Ajaltoun, Lebanon.
| | - Elie Helou
- Department of Urology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Unit of biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rony M Zeenny
- Pharmacy Director, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dania Chelala
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,Department of Nephrology at Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Aoun M, Helou E, Sleilaty G, Nehme Chelala D. MO889COST OF ILLNESS OF CHRONIC KIDNEY DISEASE IN LEBANON: FROM THE SOCIETAL PERSPECTIVE. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab100.0014] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Chronic Kidney Disease (CKD) is the 12th leading cause of death worldwide and a high societal burden. Cost-of-illness studies of CKD are scarce in developing countries. Identifying factors associated with the highest cost can help decision makers adapt health policies and sustain kidney health services, especially in limited resources' settings. This study aims to estimate the cost of illness of CKD in Lebanon, from the early stages of CKD until dialysis and kidney transplant and identify cost components related to the highest financial burden.
Method
This is a cross-sectional study of all CKD patients who presented to two nephrology clinics during the first two weeks of November 2020. The sample size required for the study to be representative was 154 patients. The medical and administrative records were reviewed to collect the demographics and CKD characteristics of patients as well as the direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year between 1st June 2019 and 1st June 2020. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. The study got the approval of the ethics committee of Saint-Joseph University.
Results
The sample included a total of 160 patients: 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 kidney transplant patients. Their mean age was 66.74 ±15.36 years, 57.5% were males and 42.5% diabetics. The mean number of daily medications was 8.75 ±3.38, mean frequency of blood tests per year 6.86 ±6.4 and mean number of hospital admissions per year 0.79 ±1.43. The mean total annual cost of CKD per patient across all categories was assessed at 19,900,164 ±27,893,591 Lebanese Pounds (1 $USD= 1515 LP in 2019). Statistical analysis showed a higher total cost among dialysis patients compared to other categories of CKD (p<0.001), higher cost of medications in transplant patients (p<0.001) and higher cost of technique modality in peritoneal dialysis patients (p<0.001). These differences are summarized in Figure 1.
Conclusion
Similar to previous studies from other countries, this cost of illness analysis showed a high burden of dialysis annual costs compared to non-dialysis CKD and transplant patients. It revealed as well a great burden of medications' costs at the level of dialysis and transplantation. It is thus crucial that governments and health policies in low- and middle-income countries target interventions that prevent end-stage kidney disease, reduce medications' costs and most of all create programs that encourage kidney transplantation.
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Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Nephrology, Beirut, Lebanon
| | - Elie Helou
- Faculty of Medicine, Saint-Joseph University, Urology , Beirut, Lebanon
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Kechichian E, Helou E, Sarkis J, Hayek C, Labaki C, Nemr E, Tomb R. The place of 5-aminolaevulinic acid-photodynamic therapy in the treatment landscape of urethral warts: A systematic review. Photodiagnosis Photodyn Ther 2021; 33:102204. [PMID: 33529745 DOI: 10.1016/j.pdpdt.2021.102204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/10/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human papilloma virus (HPV) infection is the most common sexually transmitted disease worldwide and the main cause of genital warts. Clear recommendations for the management of urethral warts, which are often hard to detect and difficult to treat, are still lacking. OBJECTIVE To summarize all available data describing treatment modalities of urethral warts, compare their efficacy and side effects, and provide physicians a treatment strategy outline. MATERIAL AND METHODS Till June 2020, we conducted a systematic review of articles studying the different treatment modalities of urethral condylomas. A chi-square test was used to compare the recurrence rates between treatment modalities, the complete clearance rates at first follow-up and the rates of adverse events. RESULTS A total of 26 articles with 1730 patients were included in our review. 61 % of patients were deemed completely cured on the first follow-up while 21 % recurred. 5-aminolevulinic acid (ALA) mediated photodynamic therapy (PDT) was the most common treatment and yielded the lowest recurrence rate (7.5 %) followed by laser therapy (24 %) and topical therapy (31 %) (p < 0.01). ALA-PDT resulted in a higher rate of clearance on follow up (96 %) compared to laser therapy (69 %) and topical therapy (14 %) (p < 0.01). Adverse events were more frequent in the ALA-PDT group (69 %) compared to laser therapy (28 %) and topical treatment (30 %) (p < 0.01). CONCLUSION ALA-PDT appears to be the most effective treatment of urethral condylomas in term of clearance and recurrence rate, but with a higher risk of adverse events. Management should be tailored to the type of lesion found at presentation.
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Affiliation(s)
- Elio Kechichian
- Department of Dermatology, Saint-Joseph University, Beirut, Lebanon.
| | - Elie Helou
- Department of Urology, Saint-Joseph University, Beirut, Lebanon
| | - Julien Sarkis
- Department of Urology, Saint-Joseph University, Beirut, Lebanon
| | - Claude Hayek
- Department of Dermatology, Saint-Joseph University, Beirut, Lebanon
| | - Chris Labaki
- Department of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Elie Nemr
- Department of Urology, Saint-Joseph University, Beirut, Lebanon
| | - Roland Tomb
- Department of Dermatology, Saint-Joseph University, Beirut, Lebanon
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Helou E, Grant M, Landry M, Wu X, Morrow JS, Malinis MF. Fatal case of cutaneous-sparing orolaryngeal zoster in a renal transplant recipient. Transpl Infect Dis 2017; 19. [PMID: 28401625 DOI: 10.1111/tid.12704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/02/2016] [Revised: 10/08/2016] [Accepted: 01/09/2017] [Indexed: 01/04/2023]
Abstract
Herpesvirus infections in solid organ transplant (SOT) recipients are a significant cause of morbidity and mortality. We report a case of herpes zoster (HZ) in a kidney transplant recipient while receiving belatacept, a CTLA-4 inhibitor that prevents acute rejection. The patient presented with oropharyngolaryngeal mucosal lesions that subsequently disseminated resulting in pneumonitis and meningo-encephalitis. Very late-onset HZ can occur and can present atypically in SOT recipients. Delayed recognition and treatment may result in poor outcomes, as illustrated by this case.
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Affiliation(s)
- Elie Helou
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grant
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Marie Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Xinyu Wu
- Department of Surgical Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Jon S Morrow
- Department of Surgical Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Maricar F Malinis
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.,Department of Surgery (Transplant), Yale University School of Medicine, New Haven, CT, USA
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Helou E, Shenoi S, Kyriakides T, Landry ML, Kozal M, Barakat LA. Characterizing Patients with Very-Low-Level HIV Viremia: A Community-Based Study. J Int Assoc Provid AIDS Care 2016; 16:261-266. [PMID: 27903948 DOI: 10.1177/2325957416680028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Very-low-level viremia (VLLV) is a relatively new concept in the realm of human immunodeficiency virus (HIV) care. Newer generation assays are now able to detect plasma HIV RNA Viral Load (VL) levels as low as 20 copies/mL. The authors characterized patients with VLLV (VL between 20 and 50 copies/mL) in order to identify possible risk factors associated with virologic failure and poor clinical outcomes. METHODS The authors reviewed 119 consecutive charts of patients with VLLV. Sociodemographic data were extracted and viral load and CD4 counts were trended over a 12 month period (February 2013-February 2014). Regression analysis was used to assess the role of different factors on virologic failure at 1 year. RESULTS Of the study participants with evaluable data (n = 100), the median age was 53 years (interquartile range: 43-57.5), 67% were nonwhite, 34% were women, 58% were smokers, 47% were alcoholics, 58% had a history of intravenous drug use, and 40% were coinfected with hepatitis C virus. More than half of the participants had 3 or more comorbidities and their HIV pill burden was high (more than 2 pills daily). After 12 months, 65 participants achieved undetectable viral load levels, whereas 15 experienced virologic failure (2 consecutive viral loads > 50 copies/mL) and the remaining 20 had persistent VLLV. In the virologic failure group, there was a predominance of white males (66%) with a significant number of comorbidities and pill burden. Univariate logistic regression suggested that there was a difference between the failure versus nonfailure groups in terms of race, ethnicity, and alcohol use. Multivariate regression with virological failure as the outcome suggested a trend only in terms of participant's alcohol use. CONCLUSION Most patients with initial VLLV (70%) achieved virologic suppression at 1 year with no antiretroviral therapy changes. Thus, VLLV does not necessarily predict virologic failure and should not prompt more frequent clinic visits or antiretroviral regimen changes. Further research is needed in order to determine the predictors of virologic failure in this subset of patients and the clinicians' attitude toward VLLV.
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Affiliation(s)
- Elie Helou
- 1 Yale-New Haven Hospital, Section of Infectious Disease, New Haven, CT, USA
| | - Sheela Shenoi
- 2 Yale University School of Medicine, Department of Medicine, Section of Infectious Disease, New Haven, CT, USA
| | | | - Marie-Louise Landry
- 1 Yale-New Haven Hospital, Section of Infectious Disease, New Haven, CT, USA.,2 Yale University School of Medicine, Department of Medicine, Section of Infectious Disease, New Haven, CT, USA
| | - Michael Kozal
- 2 Yale University School of Medicine, Department of Medicine, Section of Infectious Disease, New Haven, CT, USA.,4 Veterans Affairs Connecticut Healthcare Systems, West Haven, CT, USA
| | - Lydia Aoun Barakat
- 2 Yale University School of Medicine, Department of Medicine, Section of Infectious Disease, New Haven, CT, USA
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Helou E, Buse J, Camara O. Vergleichende Untersuchung des Mammakarzinoms seit Einführung des Mammografie-Screening im Mittelthüringen (Eine retrospektive Analyse 2006 – 2014). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Helou E, Camara O. Vergleichende Untersuchung des Mammakarzinoms seit Einführung des Mammografie-Screening im Mittelthüringen (Eine retrospektive Analyse 2008 – 2011). Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gannagé-Yared MH, Helou E, Zaraket V, Abi Akl S, Antonios L, Moussalli ML, Wakim S. Serum 25 hydroxyvitamin D in employees of a Middle Eastern university hospital. J Endocrinol Invest 2014; 37:541-6. [PMID: 24658790 DOI: 10.1007/s40618-014-0061-1] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/06/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Middle East registers the highest rate of vitamin D deficiency worldwide. In Lebanon, previous studies looked at this deficiency in schoolchildren, university students, young adults and postmenopausal women. However, no previous study was performed in hospital workers. The objective of our study was to evaluate vitamin D status in a Beirut hospital center and to look at the potential factors influencing these measurements. METHODS This cross-sectional study was performed on hospital employees who came for a regular checkup at the primary health-care department. 25(OH)D measurements were performed using the Dia-Sorin chemiluminescent assay. RESULTS 392 subjects (318 women and 74 men) were included in the study. The mean age of the participants was 41.02 ± 11.3 years. The mean 25(OH)D level was 15.61 ± 7.91 ng/ml, with no significant difference according to gender. There were no significant correlations between 25(OH)D and both BMI and age, but 25(OH)D was significantly associated with educational level (p = 0.03). There was a significant difference in 25(OH)D levels according to season (p < 0.001) and a significant association between 25(OH)D and the reported weekly hours of sun exposure (r = 0.1, p = 0.032), but not with the reported sunscreen use. Fish consumption was positively associated with 25(OH)D levels (p = 0.018), while milk, dairy product or egg consumption did not achieve any significant relationship. In a stepwise linear regression analysis, fish consumption and season were the only independent predictors of 25(OH)D levels (p = 0.007 and p = 0.0001 respectively). CONCLUSION Vitamin D deficiency is common among hospital workers. This finding reinforces the need for vitamin D supplementation in these high-risk populations.
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Affiliation(s)
- M-H Gannagé-Yared
- Department of Endocrinology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon,
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12
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Rey D, Helou E, Oderda M, Robbiani J, Lopez L, Piechaud PT. Laparoscopic and robot-assisted continent urinary diversions (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 15 adult patients: the Saint Augustin technique. BJU Int 2013; 112:953-8. [PMID: 23937141 DOI: 10.1111/bju.12257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches. PATIENTS AND METHODS Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4). The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire. RESULTS All surgeries were successfully completed with no conversions. Operating time was always <5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months. Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure. Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient. Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery. CONCLUSIONS While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.
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Affiliation(s)
- Denis Rey
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
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13
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Abboud B, Sleilaty G, Helou E, Safa N, Armache K. [Unusual cause of hypogastric mass in men]. Presse Med 2007; 36:1329-30. [PMID: 17553657 DOI: 10.1016/j.lpm.2006.12.039] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 12/31/2006] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bassam Abboud
- Département de chirurgie générale, Hôtel-Dieu de France, Faculté de Médecine, Université Saint-Josep, Beyrouth, Liban.
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Abstract
BACKGROUND Double parathyroid adenomas occur in 2% to 15% of primary hyperparathyroidism cases, but the very existence of double adenomas has been controversial. This study was conducted to evaluate the clinical significance and anatomic distribution of parathyroid double adenomas. STUDY DESIGN Mono-institutional retrospective study of the medical records of 183 unselected consecutive patients who underwent intervention for primary hyperparathyroidism between 1996 and 2003. RESULTS A total of 14 (7.65%) patients were found to have double parathyroid adenomas. Intraoperative parathyroid hormone (PTH) levels were measured in every case. Two enlarged parathyroid glands were identified in four possible configurations: two both superior, one both inferior, two both right, three both left, two right superior and left inferior, and three left superior and right inferior. There was a preferential crossed bilateral distribution of double adenomas. In all patients, intraoperative PTH levels dropped by at least 50% from baseline after removal of both abnormal parathyroid glands. In this series, no patient developed persistent hypoparathyroidism or had recurrent laryngeal nerve injuries or neck hematoma. All patients remained normocalcemic 9 to 96 months postoperatively. One patient had persistently elevated PTH values with normal serum calcium levels. CONCLUSION The drop in intraoperative PTH levels and maintenance of normocalcemia postoperatively confirm previous reports that double adenomas do exist and are not simply missed cases of four-gland hyperplasia. There was a preferential crossed bilateral distribution of double adenomas in this series.
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Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
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15
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Helou E, Farah M, Nasr W. [Congenital dilatation of the intrahepatic bile ducts (C.D.I.B.D) associated with intrahepatic lithiasis]. Bull Soc Int Chir 1966; 25:3-11. [PMID: 5932553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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