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Najem E, Marin T, Zhuo Y, Lahoud RM, Tian F, Beddok A, Rozenblum L, Xing F, Moteabbed M, Lim R, Liu X, Woo J, Lostetter SJ, Lamane A, Chen YLE, Ma C, El Fakhri G. The role of 18F-FDG PET in minimizing variability in gross tumor volume delineation of soft tissue sarcomas. Radiother Oncol 2024; 194:110186. [PMID: 38412906 PMCID: PMC11042980 DOI: 10.1016/j.radonc.2024.110186] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Accurate gross tumor volume (GTV) delineation is a critical step in radiation therapy treatment planning. However, it is reader dependent and thus susceptible to intra- and inter-reader variability. GTV delineation of soft tissue sarcoma (STS) often relies on CT and MR images. PURPOSE This study investigates the potential role of 18F-FDG PET in reducing intra- and inter-reader variability thereby improving reproducibility of GTV delineation in STS, without incurring additional costs or radiation exposure. MATERIALS AND METHODS Three readers performed independent GTV delineation of 61 patients with STS using first CT and MR followed by CT, MR, and 18F-FDG PET images. Each reader performed a total of six delineation trials, three trials per imaging modality group. Dice Similarity Coefficient (DSC) score and Hausdorff distance (HD) were used to assess both intra- and inter-reader variability using generated simultaneous truth and performance level estimation (STAPLE) GTVs as ground truth. Statistical analysis was performed using a Wilcoxon signed-ranked test. RESULTS There was a statistically significant decrease in both intra- and inter-reader variability in GTV delineation using CT, MR 18F-FDG PET images vs. CT and MR images. This was translated by an increase in the DSC score and a decrease in the HD for GTVs drawn from CT, MR and 18F-FDG PET images vs. GTVs drawn from CT and MR for all readers and across all three trials. CONCLUSION Incorporation of 18F-FDG PET into CT and MR images decreased intra- and inter-reader variability and subsequently increased reproducibility of GTV delineation in STS.
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Affiliation(s)
- Elie Najem
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Thibault Marin
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Yue Zhuo
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Rita Maria Lahoud
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Fei Tian
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Arnaud Beddok
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Laura Rozenblum
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Fangxu Xing
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Maryam Moteabbed
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA; Radiation Oncology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Ruth Lim
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Xiaofeng Liu
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Jonghye Woo
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Stephen John Lostetter
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Abdallah Lamane
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Yen-Lin Evelyn Chen
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA; Radiation Oncology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Chao Ma
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Georges El Fakhri
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA.
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Nassar AH, El Zarif T, Khalid AB, Rahme S, Zhong C, Kwak L, Salame M, Farhat EB, Freeman D, El-Am E, Ravishankar A, Ahmad B, Nana FA, Kaldas D, Naqash AR, Sharon E, LeBoeuf NR, Cortellini A, Malgeri A, Gupta S, Al-Hader A, Sparks JA, Linnoila J, Hamnvik OPR, Mouhieddine TH, Marron T, Parikh K, McKay RR, Dilling T, Choueiri TK, Adib E, Najem E, Kim SY, Sonpavde G. Clinical outcomes and safety of immune checkpoint inhibitors in patients with solid tumors and paraneoplastic syndromes. J Immunother Cancer 2024; 12:e008724. [PMID: 38448038 PMCID: PMC10916116 DOI: 10.1136/jitc-2023-008724] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Patients with paraneoplastic syndromes (PNS) are excluded from clinical trials involving immune checkpoint inhibitors (ICIs) due to safety concerns. Moreover, real-world data on efficacy and safety is scarce. METHODS In this retrospective study, data were collected on patients with PNS and solid tumors receiving ICI between 2015 and 2022 at nine institutions. Patients were classified into: Cohort 1 (pre-existing PNS before ICI initiation), cohort 2 (PNS during ICI treatment), and cohort 3 (PNS after ICI discontinuation). Patients with metastatic non-small cell lung cancer (NSCLC) (mNSCLC) from cohort 1 were matched to patients who were PNS-free at each institution up to a 1:3 ratio for age, sex, type of ICI, use of concurrent chemotherapy, and number of lines of systemic therapy prior to ICI initiation. Kaplan-Meier method was used to assess overall survival (OS) and time-to-next treatment (TTNT). RESULTS Among 109 patients with PNS treated with ICIs, median age at ICI initiation was 67 years (IQR: 58-74). The most represented cancer type was NSCLC (n=39, 36%). In cohort 1 (n=55), PNS exacerbations occurred in 16 (29%) patients with median time to exacerbation after ICI of 1.1 months (IQR: 0.7-3.3). Exacerbation or de novo PNS prompted temporary/permanent interruption of ICIs in 14 (13%) patients. For cohort 2 (n=16), median time between ICI initiation and de novo PNS was 1.2 months (IQR: 0.4-3.5). Treatment-related adverse events (trAEs) occurred in 43 (39%) patients. Grade ≥3 trAEs occurred in 18 (17%) patients. PNS-directed immunosuppressive therapy was required in 55 (50%) patients. We matched 18 patients with mNSCLC and PNS (cohort 1) to 40 without PNS, treated with ICIs. There was no significant difference in OS or TTNT between patients with mNSCLC with and without PNS, although a trend was seen towards worse outcomes in patients with PNS. TrAEs occurred in 6/18 (33%) and 14/40 (35%), respectively. Grade ≥3 trAEs occurred in 4 (22%) patients with PNS and 7 (18%) patients without PNS. CONCLUSIONS Exacerbations of pre-existing PNS occurred in 29% of patients treated with ICIs and both exacerbations and de novo PNS occur early in the ICI course. TrAE from ICIs were similar between patients with and without PNS. Our data suggest that pre-existing PNS should not preclude consideration of ICI therapy although patients may not derive the same clinical benefit compared with patients without PNS.
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Affiliation(s)
| | - Talal El Zarif
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ahmed Bilal Khalid
- Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Serena Rahme
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA
| | - Caiwei Zhong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lucia Kwak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Elias Bou Farhat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dory Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Arjun Ravishankar
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bachar Ahmad
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frank Aboubakar Nana
- Division of Pneumology, CHU UCL Namur, Yvoir, Namur, Belgium
- Division of Pneumology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Kaldas
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
- Department of Clinical Oncology, Cairo University, Giza, Egypt
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, Maryland, USA
| | | | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Malgeri
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Shruti Gupta
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ahmad Al-Hader
- Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | | | - Jenny Linnoila
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Thomas Marron
- Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Rana R McKay
- Division of Medical Oncology, University of California San Diego, La Jolla, California, USA
| | - Thomas Dilling
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Toni K Choueiri
- Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, UK
| | - Elio Adib
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elie Najem
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - So Yeon Kim
- Yale University, New Haven, Connecticut, USA
| | - Guru Sonpavde
- Medical Oncology, AdventHealth Central Florida, Orlando, Florida, USA
- AdventHealth Cancer Institute, AdventHealth, Altamonte Springs, Florida, USA
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Hanania N, Najem E, Tamim H, Assaf N, Majari G, Younes W, Abbas F, Berjawi G, Mahfouz R. Comparison between the accuracy of chest computerized tomography vs. reverse transcriptase polymerase chain reaction in a tertiary care center in Lebanon; along with their correlation to mortality, morbidity and symptoms in COVID-19 patients. Human Gene 2023:201150. [PMID: 37521007 PMCID: PMC9891785 DOI: 10.1016/j.humgen.2023.201150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives Chest Computerized Tomography has been widely used in COVID patients' assessment. Hence the question arises as to whether there is any correlation between the Ct value and findings on Chest CT scan or clinical presentation of the patient. We wanted to test the hypothesis of whether low Ct values (≤30) in RT-PCR were associated with a high mortality rate, CT scan findings, or with comorbidities such as immunosuppression and lung disease. Methods The radiographic records and RT-PCR Ct values of 371 COVID patents diagnosed at the American University of Beirut Medical Center were reviewed. Results We found out that the sensitivity of chest CT scan compared to RT-PCR, the gold standard, turned out to be 74% (95% CI 69–79%). Specificity, on the other hand was 33% (95% CI 16–55%). The positive predictive value of CT was 94% (95% CI 91–97%) and the negative predictive value was 8% (95% CI 4–16%). low Ct values in RT-PCR were not associated with a higher mortality rate (p-value = 0.416). There was no significant positive association between low Ct value and suspicious CT scan findings (typical and indeterminate for COVID-19), with a p-value of 0.078. There was also no significant association between low Ct value and immunosuppression (p-value = 0.511), or lung disease (p-value =0.06). CT scan findings whether suspicious or not for COVID-19 infection, were not shown to be significantly associated with respiratory symptoms of any kind. No association was found between a history of lung disease, immunosuppression and suspicious CT scan findings for COVID-19. Conclusion As long as this pandemic exists, nucleic acid testing was and remains the gold standard of COVID-19 diagnosis worldwide and in our community as it has a superior diagnostic accuracy to CT scan and higher sensitivity (94% vs 74%).
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Key Words
- covid
- rt-pcr
- ct scan
- ct value
- sensitivity
- aubmc, american university of beirut medical center
- cad, coronary artery disease
- copd, chronic obstructive pulmonary disease
- covid, coronavirus disease
- ct, cycle threshold
- ct, computed tomography
- ed, emergency department
- kvp, kilovolt power
- mas, milliamperes
- mm, millimeters
- pcr, polymerase chain reaction
- rt-pcr, reverse transcriptase polymerase chain reaction
- rrt-pcr, real-time reverse transcriptase polymerase chain reaction
- who, world health organization
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Affiliation(s)
- Noor Hanania
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Najem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Assaf
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghaidaa Majari
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael Younes
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatmeh Abbas
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Berjawi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Corresponding author at: Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon
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Zadeh C, Khoury N, Najem E, Moukaddam H. Snapping of bilateral biceps femoris tendons: A case report and brief review. Radiol Case Rep 2022; 17:1293-1299. [PMID: 35242255 PMCID: PMC8857580 DOI: 10.1016/j.radcr.2021.12.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/19/2021] [Accepted: 12/30/2021] [Indexed: 12/03/2022] Open
Abstract
Snapping of the biceps femoris tendon is a rare cause of lateral knee pain often due to multiple factors including fibular head deformity and thickening of the anterior band of the biceps femoris tendon inserting on the tibia. Understanding the complex and poorly understood anatomy of the biceps femoris tendon is crucial and essential for proper diagnosis of its snapping. In this report, we describe the rare entity of bilateral biceps femoris tendon snapping in a young man using a multimodality diagnostic approach.
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Amine A, Habashy KJ, Najem E, Abbas R, Moussalem C, Bsat S, Hourany R, Darwish H. Frontal Sinus Morphometry in Relation to Surgically Relevant Landmarks in the Middle East Population: Can We Globalize? World Neurosurg 2020; 148:e87-e93. [PMID: 33309894 DOI: 10.1016/j.wneu.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The frontal bone is frequently approached during neurosurgical procedures. Feared complications of such surgeries include cerebrospinal fluid leak, among others, and frequently result from a breach of the frontal sinus. For this reason, the sinus should be avoided when possible. The supraorbital notch (SON) is a reliable and easily identifiable surgical landmark and its relation to the frontal sinus has been previously studied. However, the frontal sinus shows significant variability in size and shape between populations. METHODS In the present study, we investigate the frontal sinus dimension and its relation to the SON in the Middle Eastern population. RESULTS The analysis of a set of computed tomography scans reveals a significant variation in size between genders, and we subsequently provide neurosurgeons in the region with population-targeted, gender-specific risk maps. CONCLUSIONS We finally conclude that a 2-cm margin rostral and lateral to the SON is safest.
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Affiliation(s)
- Ali Amine
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karl John Habashy
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Najem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawad Abbas
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Moussalem
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Shadi Bsat
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Hourany
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Houssein Darwish
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Ghieh D, Saade C, Najem E, El Zeghondi R, Rawashdeh MA, Berjawi G. Staying abreast of imaging - Current status of breast cancer detection in high density breast. Radiography (Lond) 2020; 27:229-235. [PMID: 32611494 DOI: 10.1016/j.radi.2020.06.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions. KEY FINDINGS Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available. CONCLUSION Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma. IMPLICATIONS FOR PRACTICE It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.
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Affiliation(s)
- D Ghieh
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - C Saade
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - E Najem
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - R El Zeghondi
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - M A Rawashdeh
- Department of Allied Medical Sciences, Jordan University of Science and Technology, P.O.Box: 3030, Irbid 22110, Jordan.
| | - G Berjawi
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Abstract
Intracranial calcifications are frequently encountered in non-contrast computed tomography scan in both adult and pediatric age groups. They refer to calcifications within the brain parenchyma or vasculature and can be classified into several major categories: physiologic/age-related, dystrophic, congenital disorders/phakomatoses, infectious, vascular, neoplastic, metabolic/endocrine, inflammatory and toxic diseases. In this updated review, we present a wide spectrum of intracranial calcifications from both pediatric and adult populations focusing on their pattern, size and location.
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Affiliation(s)
- Charbel Saade
- Department of Medical Imaging Sciences, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Najem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karl Asmar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rida Salman
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassam El Achkar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lena Naffaa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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Dandachi I, Salem Sokhn E, Najem E, Azar E, Daoud Z. Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon. Int J Infect Dis 2016; 45:24-31. [PMID: 26899954 DOI: 10.1016/j.ijid.2016.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 12/15/2015] [Revised: 01/18/2016] [Accepted: 02/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multidrug-resistant (MDR) Enterobacteriaceae can cause severe infections with high morbidity, mortality, and health care costs. Individuals can be fecal carriers of these resistant organisms. Data on the extent of MDR Enterobacteriaceae fecal carriage in the community setting in Lebanon are very scarce. The aim of this study was to investigate the fecal carriage of MDR Enterobacteriaceae among the elderly residents of two nursing homes located in north Lebanon. METHODS Over a period of 4 months, five fecal swab samples were collected from each of 68 elderly persons at regular intervals of 3-4 weeks. Fecal swabs were subcultured on selective media for the screening of resistant organisms. The phenotypic detection of extended-spectrum beta-lactamase (ESBL), AmpC, metallo-beta-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) production was performed using the beta-lactamase inhibitors ethylenediaminetetraacetic acid, phenylboronic acid, and cloxacillin. A temocillin disk was used for OXA-48. Multiplex PCRs were used for the genotypic detection of ESBL and carbapenemase genes, and sequencing was performed to identify CTX-M-15. The medical records of each subject were reviewed on a regular basis in order to assess the risk factors associated with MDR Enterobacteriaceae fecal carriage. RESULTS Over the study period, 76.5% of the recruited elderly persons were at least one-time carriers. A total of 178 isolates were obtained. Phenotypic testing revealed that 91.5% of them were ESBL producers, 4% were AmpC producers, 2.8% were co-producers of ESBL and AmpC, and 1.7% were co-producers of OXA-48 and ESBL. Recent antibiotic intake was found to be the only independent risk factor associated with the fecal carriage of MDR Enterobacteriaceae. CONCLUSIONS The high prevalence of MDR Enterobacteriaceae detected in this study and the emergence of carbapenem resistance is alarming. Efficient infection control measures and antibiotic stewardship programs are urgently needed in these settings in order to limit the spread of resistant strains.
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Affiliation(s)
- Iman Dandachi
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon
| | - Elie Salem Sokhn
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon
| | - Elie Najem
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon
| | - Eid Azar
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon
| | - Ziad Daoud
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, PO Box 33, Amioun, Beirut, Lebanon.
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