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Abdul-Nabi SS, Tamim H, Hitti E. Waterpipe vs non-Waterpipe carbon monoxide poisoning: Comparison of patient characteristics, clinical presentation and outcomes. Am J Emerg Med 2024; 79:70-74. [PMID: 38382236 DOI: 10.1016/j.ajem.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The aim of this study is to describe the difference between carboxyhemoglobin (CO-Hb) acute poisoning caused by waterpipe vs non-waterpipe exposures as they relate to demographics, clinical presentations and outcome of patients. DESIGN Retrospective cohort study conducted in the Emergency Department (ED) at the Lebanon. PATIENTS All adult patients presenting with a CO-Hb level ≥ 10 between January 2019 and August 2023 with exposure types stratified as waterpipe or non-waterpipe. MEASUREMENTS AND MAIN RESULTS 111 ED visits were identified. Among these, 73.9% were attributed to waterpipe exposure, while 26.1% were non-waterpipe sources. These included cigarette smoking (17.2%), burning coal (24.1%), fire incidents (3.6%), gas leaks (6.9%), heating device use (10.3%), and undocumented sources (37.9%). Patients with waterpipe-related carbon monoxide exposure were younger (41 vs 50 years, p = 0.015) women (63.4 vs 41.4%, p = 0.039) with less comorbidities compared to non-waterpipe exposures (22.2 vs 41.4%, p = 0.047). Waterpipe smokers were more likely to present during the summer (42.7 vs 13.8%, p = 0.002) and have shorter ED length of stays (3.9 vs 4.5 h, p = 0.03). A higher percentage of waterpipe smokers presented with syncope (52.4 vs 17.2%, p = 0.001) whereas cough/dyspnea were more common in non-waterpipe exposures (31 vs 9.8%, p = 0.006). The initial CO-Hb level was found to be significantly higher in waterpipe exposure as compared to non-waterpipe (19.7 vs 13.7, p = 0.004). Non-waterpipe exposures were more likely to be admitted to the hospital (24.1 vs 4.9%, p = 0.015). Waterpipe smokers had significantly higher odds of experiencing syncope, with a 5.74-fold increase in risk compared to those exposed to non-waterpipe sources (p = 0.004) irrespective of their CO-Hb level. Furthermore, males had significantly lower odds of syncope as compared to females, following carbon monoxide exposure (aOR 0.31, 95% CI 0.13-0.74). CONCLUSION CO-Hb poisoning related to waterpipe smoking has distinctive features. Syncope is a commonly associated presentation that should solicit a focused social history in communities where waterpipe smoking is common. Furthermore, CO-Hb poisoning should remain on the differential in patients presenting with headache, syncope, dizziness, vomiting or shortness of breath, even outside of the non-waterpipe exposure peaks of winter season.
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Affiliation(s)
- Sarah S Abdul-Nabi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Farhat T, Moussally K, Nahouli H, Hamad SA, Qaraya KA, Abdul-Sater Z, El Sheikh WG, Jawad N, Al Sedawi K, Obaid M, AbuKhoussa H, Nyaruhirira I, Tamim H, Hettiaratchy S, Bull AMJ, Abu-Sittah G. The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip. Confl Health 2024; 18:35. [PMID: 38658929 DOI: 10.1186/s13031-024-00596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Limb salvage by ortho-plastic teams is the standard protocol for treating open tibial fractures in high-income countries, but there's limited research on this in conflict settings like the Gaza Strip. This study assessed the clinical impact of gunshot-related open tibial fractures, compared patient management by orthopedic and ortho-plastic teams, and identified the risk factors for bone non-union in this context. METHODS A retrospective review of medical records was conducted on Gaza Strip patients with gunshot-induced-open tibial fractures from March 2018 to October 2020. Data included patient demographics, treatments, and outcomes, with at least one year of follow-up. Primary outcomes were union, non-union, infection, and amputation. RESULTS The study included 244 injured individuals, predominantly young adult males (99.2%) with nearly half (48.9%) having Gustilo-Anderson type IIIB fractures and more than half (66.8%) with over 1 cm of bone loss. Most patients required surgery, including rotational flaps and bone grafts with a median of 3 admissions and 9 surgeries. Ortho-plastic teams managed more severe muscle and skin injuries, cases with bone loss > 1 cm, and performed less debridement compared to other groups, though these differences were not statistically significant. Non-union occurred in 53% of the cases, with the ortho-plastic team having the highest rate at 63.6%. Infection rates were high (92.5%), but no significant differences in bone or infection outcomes were observed among the different groups. Logistic regression analysis identified bone loss > 1 cm, vascular injury, and the use of a definitive fixator at the first application as predictors of non-union. CONCLUSIONS This study highlights the severity and complexity of such injuries, emphasizing their significant impact on patients and the healthcare system. Ortho-plastic teams appeared to play a crucial role in managing severe cases. However, further research is still needed to enhance our understanding of how to effectively manage these injuries.
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Affiliation(s)
- Theresa Farhat
- Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Krystel Moussally
- Médecins Sans Frontières, Lebanon Branch Office, Middle East Medical Unit, Beirut, Lebanon
| | - Hasan Nahouli
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Shahd Abu Hamad
- Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Khulood Abul Qaraya
- Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Walaa G El Sheikh
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Jawad
- Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Khouloud Al Sedawi
- Operational Centre Brussels, Gaza mission, Médecins Sans Frontières, Gaza, Palestine
| | - Mohammed Obaid
- Operational Centre Brussels, Gaza mission, Médecins Sans Frontières, Gaza, Palestine
| | - Hafez AbuKhoussa
- Operational Centre Brussels, Gaza mission, Médecins Sans Frontières, Gaza, Palestine
| | - Innocent Nyaruhirira
- Operational Centre Brussels, Medical Department, Médecins Sans Frontières, Brussels, Belgium
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Shehan Hettiaratchy
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | - Ghassan Abu-Sittah
- Global Health Institute, American University of Beirut, Gefinor Center Block D, 3rd floor, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
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Abou-Abbass H, El Sheikh WG, Bizri M, Tamim H, Al-Hajj S, Karout L, Allouch F, Chehade R, Ghannam M, Fares Y, Nasser Z, Harati H, Kobeissy F. Cultural assimilation of adult Syrian refugees in Lebanon: Effect modification by religiosity and sex on the relation between cultural adversities and common mental health disorders. Psychol Trauma 2024:2024-74488-001. [PMID: 38635208 DOI: 10.1037/tra0001671] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE In this study, we aimed to explore the prevalence and determinants of common mental health disorders (CMHDs, posttraumatic stress disorder [PTSD], depression, and anxiety) in Syrian refugees in Lebanon. Specifically, we examined how the associations between cultural adversities (discrimination, unemployment, and separation from family) and CMHDs are modified by levels of religiosity and sex. METHOD Between March and June 2017, a cross-sectional study was conducted targeting adult Arab Syrian refugees residing in Beirut and Southern Lebanon. Eligibility criteria comprised being a United Nations High Commissioner for Refugees-registered Syrian refugee residing in Lebanon, 18 years and older, and having no history of mental disorder or physical disability. A total of 191 refugees agreed to participate and complete a battery of six questionnaires. Exposures were measured using a sociodemographic questionnaire, the Postmigration Living Difficulties Checklist, the Harvard Trauma Questionnaire, and the Belief into Action Scale, while outcomes were measured using the Posttraumatic Stress Disorder Checklist for DSM-5 and the Depression and Anxiety Scale-21 Items. RESULTS Half (50.3%) of our sample had high PTSD risk, 73.8% had high depression risk, and 73.8% had high anxiety risk. Stratified analysis revealed religiosity and sex to be effect modifiers of the associations between cultural adversities and CMHDs. Specifically, cultural adversities were only significantly associated with CMHDs in the low religiosity stratum and males. Only unemployment was a significant risk factor for PTSD in both males (OR = 4.53, 95% CI [1.44, 14.27]) and females (OR = 2.77, 95% CI [1.14, 6.74]). CONCLUSIONS Religiosity and sex are effect modifiers of the associations between cultural adversities and CMHDs. Religious and spiritual interventions in mental health care should be adopted in refugee settings. Moreover, there is an urgent need for capacity-building initiatives addressing social determinants of mental health among Syrian refugees in Lebanon. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Hussein Abou-Abbass
- Department of Biochemistry and Molecular Genetics, American University of Beirut
| | - Walaa G El Sheikh
- Department of Biochemistry and Molecular Genetics, American University of Beirut
| | - Maya Bizri
- Department of Psychiatry, American University of Beirut Medical Center
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center
| | - Samar Al-Hajj
- Department of Epidemiology and Population Health, American University of Beirut
| | - Lina Karout
- Department of Diagnostic Radiology, American University of Beirut Medical Center
| | - Farah Allouch
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine
| | | | | | | | - Zeina Nasser
- Neuroscience Research Center, Lebanese University
| | - Hayat Harati
- Neuroscience Research Center, Lebanese University
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut
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Kaddoura R, Elbejjani M, Tamim H, Mahfoud ZR, Salameh P, Mirza F, Charafeddine L. Building a maternal and child cohort amidst Lebanon's socioeconomic collapse: preliminary results and navigating research challenges. Popul Health Metr 2024; 22:5. [PMID: 38528603 DOI: 10.1186/s12963-024-00325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
The impact of conflict and crisis on maternal and child health underscores the need for reliable research in vulnerable populations. Lebanon, amidst ongoing economic collapse, political instability, and healthcare system strain, offers a case study for exploring these impacts, particularly on preterm babies and their development. This study aims to assess the feasibility of establishing a prospective cohort of mothers and their full-term and preterm babies in Lebanon, examining the association between social determinants, preterm birth, and developmental outcomes amidst the nation's multifaceted crises. The planned cohort involves 50 full-term and 50 preterm mother-baby pairs recruited at birth and followed up to 9-12 months post-birth. Data collection spans social determinants, perceived stress, social support, quality of life, and developmental assessments. Challenges in recruitment, follow-up, and data collection in the context of Lebanon's socio-political and economic turmoil are evaluated, alongside ethical considerations for research in vulnerable populations. Preliminary findings highlight substantial recruitment and follow-up challenges, notably due to population mobility, economic instability, and healthcare access issues. Despite these obstacles, 113 mother-baby pairs have been recruited. Early analysis reveals significant stress and reduced quality of life among mothers, particularly those with preterm infants, against a backdrop of declining birth rates and healthcare worker exodus. Conducting research in crisis settings like Lebanon presents unique methodological and ethical challenges but remains crucial for understanding and improving health outcomes in vulnerable populations. The study underscores the importance of adaptable research designs and ethical diligence in crisis research, highlighting the need for interventions tailored to these contexts. Establishing a mother and child cohort in Lebanon's crisis-ridden setting is faced with many challenges but is essential for guiding future interventions. Research in such contexts is needed to address health disparities and supporting vulnerable populations, emphasizing the need for dedicated funding and innovative research approaches in times of crisis.
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Affiliation(s)
- Rima Kaddoura
- American University of Beirut (AUB), Beirut, Lebanon
| | | | - Hani Tamim
- American University of Beirut (AUB), Beirut, Lebanon
- Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus
| | - Fadi Mirza
- Latifa Hospital & Private Practice, Dubai, United Arab Emirates
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Fakhoury HMA, Arabi TZ, Tamim H, Chun RF, Grant WB, Hewison M, AlAnouti F, Pilz S, Annweiler C, Tzimagiorgis G, Haitoglou C, Karras SN. Associations of free, bioavailable and total 25-hydroxyvitamin D with neonatal birth anthropometry and calcium homoeostasis in mother-child pairs in a sunny Mediterranean region. Br J Nutr 2024; 131:801-808. [PMID: 37880994 PMCID: PMC10864994 DOI: 10.1017/s000711452300243x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
Sufficient vitamin D status is crucial for successful pregnancy and fetal development. The assessment of 25-hydroxyvitamin D (25(OH)D) concentrations is commonly used to evaluate vitamin D status. Our objective was to examine the interrelated biodynamics of maternal and neonatal total, free and bioavailable 25(OH)D in maternal-neonatal dyads at birth and their associations with homeostasis and neonatal birth anthropometry. We analysed a cohort of seventy full-term mother-child pairs. We found positive associations between all neonatal measures of vitamin D status. Maternal forms exhibited a similar pattern of association, except for the bioavailable maternal form. In multivariate analysis, both total and free maternal 25(OH)D concentrations were correlated with all neonatal forms (neonatal total 25(OH)D: 1·29 (95 % CI, 1·12, 1·46) for maternal total 25(OH)D, 10·89 (8·16, 13·63) for maternal free 25(OH)D), (neonatal free 25(OH)D: 0·15 for maternal total 25(OH)D, 1·28 (95 % CI, 0·89, 1·68) for maternal free 25(OH)D) and (0·13 (95 % CI, 0·10, 0·16), 1·06 (95 % CI, 0·68, 1·43) for maternal free 25(OH)D), respectively, with the exclusion of the bioavailable maternal form. We observed no significant interactions within or between groups regarding maternal and neonatal vitamin D parameters and maternal calcium and parathyroid hormone concentrations, and neonatal birth anthropometry. Our study indicates that bioavailable maternal and neonatal 25(OH)D have no significant effects on vitamin D equilibrium, Ca homeostasis and neonatal anthropometry at birth. However, we observed an interaction between maternal and neonatal total and free 25(OH)D concentrations at the maternal-neonatal interface, with no associations observed with other calciotropic or anthropometric outcomes.
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Affiliation(s)
- Hana M. A. Fakhoury
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek Ziad Arabi
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hani Tamim
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rene F. Chun
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA94164-1603, USA
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Fatme AlAnouti
- Department of Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
- ASPIRE Precision Medicine Research InstituteAbu Dhabi, United Arab Emirates
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cedric Annweiler
- UNIV ANGERS, UPRES EA 4638, University of Angers, Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
| | - Georgios Tzimagiorgis
- Laboratory of Biological Chemistry, Medical School, Aristotle University, 54636 Thessaloniki, Greece
| | - Costas Haitoglou
- Laboratory of Biological Chemistry, Medical School, Aristotle University, 54636 Thessaloniki, Greece
| | - Spyridon N. Karras
- Laboratory of Biological Chemistry, Medical School, Aristotle University, 54636 Thessaloniki, Greece
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Li B, Verma R, Beaton D, Tamim H, Hussain MA, Hoballah JJ, Lee DS, Wijeysundera DN, de Mestral C, Mamdani M, Al-Omran M. Predicting Outcomes Following Endovascular Abdominal Aortic Aneurysm Repair Using Machine Learning. Ann Surg 2024; 279:521-527. [PMID: 37389890 DOI: 10.1097/sla.0000000000005978] [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: 07/01/2023]
Abstract
OBJECTIVE To develop machine learning (ML) models that predict outcomes following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). BACKGROUND EVAR carries non-negligible perioperative risks; however, there are no widely used outcome prediction tools. METHODS The National Surgical Quality Improvement Program targeted database was used to identify patients who underwent EVAR for infrarenal AAA between 2011 and 2021. Input features included 36 preoperative variables. The primary outcome was 30-day major adverse cardiovascular event (composite of myocardial infarction, stroke, or death). Data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, 6 ML models were trained using preoperative features. The primary model evaluation metric was area under the receiver operating characteristic curve. Model robustness was evaluated with calibration plot and Brier score. Subgroup analysis was performed to assess model performance based on age, sex, race, ethnicity, and prior AAA repair. RESULTS Overall, 16,282 patients were included. The primary outcome of 30-day major adverse cardiovascular event occurred in 390 (2.4%) patients. Our best-performing prediction model was XGBoost, achieving an area under the receiver operating characteristic curve (95% CI) of 0.95 (0.94-0.96) compared with logistic regression [0.72 [0.70-0.74)]. The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.06. Model performance remained robust on all subgroup analyses. CONCLUSIONS Our newer ML models accurately predict 30-day outcomes following EVAR using preoperative data and perform better than logistic regression. Our automated algorithms can guide risk mitigation strategies for patients being considered for EVAR.
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Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada
| | - Raj Verma
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Derek Beaton
- Data Science and Advanced Analytics, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Hani Tamim
- Faculty of Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jamal J Hoballah
- Department of Surgery, Division of Vascular and Endovascular Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Douglas S Lee
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Charles de Mestral
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada
- Data Science and Advanced Analytics, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Faris N, Saliba M, Tamim H, Jabbour R, Fakih A, Sadek Z, Antoun R, El Sayed M, Hitti E. Electronic medical record implementation in the emergency department in a low-resource country: Lessons learned. PLoS One 2024; 19:e0298027. [PMID: 38427653 PMCID: PMC10906867 DOI: 10.1371/journal.pone.0298027] [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] [Received: 11/14/2022] [Accepted: 01/17/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE There is paucity of information regarding electronic medical record (EMR) implementation in emergency departments in countries outside the United States especially in low-resource settings. The objective of this study is to describe strategies for a successful implementation of an EMR in the emergency department and to examine the impact of this implementation on the department's operations and patient-related metrics. METHODS We performed an observational retrospective study at the emergency department of a tertiary care center in Beirut, Lebanon. We assessed the effect of EMR implementation by tracking emergency departments' quality metrics during a one-year baseline period and one year after implementation. End-user satisfaction and patient satisfaction were also assessed. RESULTS Our evaluation of the implementation of EMR in a low resource setting showed a transient increase in LOS and visit-to-admission decision, however this returned to baseline after around 6 months. The bounce-back rate also increased. End-users were satisfied with the new EMR and patient satisfaction did not show a significant change. CONCLUSIONS Lessons learned from this successful EMR implementation include a mix of strategies recommended by the EMR vendor as well as specific strategies used at our institution. These can be used in future implementation projects in low-resource settings to avoid disruption of workflows.
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Affiliation(s)
- Nagham Faris
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miriam Saliba
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rima Jabbour
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Fakih
- Department of Information Technology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zouhair Sadek
- Department of Information Technology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rula Antoun
- Department of Information Technology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
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Almutairi A, Alenezi F, Tamim H, Sadat M, Humaid FB, AlMatrood A, Syed Y, Arabi Y. The prevalence of acute kidney injury in patients with community-acquired pneumonia who required mechanical ventilation. Ann Saudi Med 2024; 44:104-110. [PMID: 38615183 PMCID: PMC11016152 DOI: 10.5144/0256-4947.2024.104] [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] [Received: 11/03/2011] [Accepted: 12/08/2023] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a common reason for intensive care unit (ICU) admission and sepsis. Acute kidney injury (AKI) is a frequent complication of community-acquired pneumonia and is associated with increased short- and long-term morbidity and mortality and healthcare costs. OBJECTIVE Describe the prevalence of AKI in patients with CAP requiring mechanical ventilation and evaluate its association with inhospital mortality. DESIGN Retrospective cohort. SETTING Intensive care unit. PATIENTS AND METHODS We included patients with CAP on mechanical ventilation. Patients were categorized according to the development of AKI in the first 24 hours of ICU admission using the Kidney Disease Improving Global Outcomes (KDIGO) classification from no AKI, stage 1 AKI, stage 2 AKI, and stage 3 AKI. MAIN OUTCOME MEASURES The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, hospital and ICU length of stay, ventilation duration, tracheostomy, and renal replacement therapy requirement. RESULTS Of 1536 patients included in the study, 829 patients (54%) had no AKI while 707 (46%) developed AKI. In-hospital mortality was 288/829 (34.8%) for patients with no AKI, 43/111 (38.7%) for stage 1 AKI, 86/216 (40%) for stage 2 AKI, and 196/380 (51.7%) for stage 3 AKI (P<.0001). Multivariate analysis revealed that stages 1, 2, or 3 AKI compared to no AKI were not independently associated with in-hospital mortality. Older age, vasopressor use; decreased Glasgow coma scale, PaO2/Fio2 ratio and platelet count, increased bilirubin, lactic acid and INR were associated with increased mortality while female sex was associated with reduced mortality. CONCLUSION Among mechanically ventilated patients with CAP, AKI was common and was associated with higher crude mortality. The higher mortality could not be attributed alone to AKI, but rather appeared to be related to multi-organ dysfunction. LIMITATIONS Single-center retrospective study with no data on baseline serum creatinine and the use of estimated baseline creatinine distributions based on the MDRD (Modification of Diet in Renal Disease)equation which may lead to an overestimation of AKI. Second, we did not have data on the microbiology of pneumonia, appropriateness of antibiotic therapy or the administration of other medications that have been demonstrated to be associated with AKI.
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Affiliation(s)
- Abdulmajed Almutairi
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Farhan Alenezi
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Musharaf Sadat
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Felwa Bin Humaid
- Intensive Care Unit, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Amal AlMatrood
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yadullah Syed
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Sbaity E, Tamim H, Zalaquett NG, Zein O, Dakik HA. Comparison of the performance of the AUB-HAS2 Cardiovascular Risk Index in emergency vs elective surgeries. J Cardiol 2024:S0914-5087(24)00025-X. [PMID: 38382579 DOI: 10.1016/j.jjcc.2024.02.007] [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] [Received: 10/10/2023] [Revised: 12/29/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The AUB-HAS2 Cardiovascular Risk Index is a newly derived tool for preoperative cardiovascular evaluation. It is based on six data elements: history of heart disease, symptoms of angina or dyspnea, age ≥ 75 years, hemoglobin < 12 g/dl, vascular surgery, and emergency surgery. This study compares the performance of this new index among emergency and elective surgeries. METHODS AND RESULTS The study population consisted of 1,167,414 non-cardiac surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database (153,715 were emergency and 1,013,699 were elective). Each patient was given an AUB-HAS2 score of 0, 1, 2, 3, or >3 depending on the number of data elements s/he has. The outcome measure (death, myocardial infarction, or stroke at 30 days after surgery) was higher in emergency than elective surgeries (7.0 % vs 1.4 %, p < 0.0001). The AUB-HAS2 index was able to stratify risk in both types of surgeries with a gradual increase in risk as the score increased (p < 0.0001). The discriminatory power of the AUB-HAS2 index, measured by the area under the receiver operator characteristic curves, was good and similar in the two types of surgeries (0.804 for emergency vs 0.791 for elective surgeries). CONCLUSION The AUB-HAS2 index is a versatile tool that can effectively and equally stratify risk in both emergency and elective surgeries with a good discriminatory power.
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Affiliation(s)
- Eman Sbaity
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Omar Zein
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Habib A Dakik
- American University of Beirut Medical Center, Beirut, Lebanon.
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10
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Li B, Verma R, Beaton D, Tamim H, Hussain MA, Hoballah JJ, Lee DS, Wijeysundera DN, de Mestral C, Mamdani M, Al-Omran M. Predicting outcomes following lower extremity open revascularization using machine learning. Sci Rep 2024; 14:2899. [PMID: 38316811 PMCID: PMC10844206 DOI: 10.1038/s41598-024-52944-1] [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: 04/11/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
Lower extremity open revascularization is a treatment option for peripheral artery disease that carries significant peri-operative risks; however, outcome prediction tools remain limited. Using machine learning (ML), we developed automated algorithms that predict 30-day outcomes following lower extremity open revascularization. The National Surgical Quality Improvement Program targeted vascular database was used to identify patients who underwent lower extremity open revascularization for chronic atherosclerotic disease between 2011 and 2021. Input features included 37 pre-operative demographic/clinical variables. The primary outcome was 30-day major adverse limb event (MALE; composite of untreated loss of patency, major reintervention, or major amputation) or death. Our data were split into training (70%) and test (30%) sets. Using tenfold cross-validation, we trained 6 ML models. Overall, 24,309 patients were included. The primary outcome of 30-day MALE or death occurred in 2349 (9.3%) patients. Our best performing prediction model was XGBoost, achieving an area under the receiver operating characteristic curve (95% CI) of 0.93 (0.92-0.94). The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.08. Our ML algorithm has potential for important utility in guiding risk mitigation strategies for patients being considered for lower extremity open revascularization to improve outcomes.
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Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, Canada
| | - Raj Verma
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Derek Beaton
- Data Science & Advanced Analytics, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Hani Tamim
- Faculty of Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jamal J Hoballah
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Douglas S Lee
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, University of Toronto, Toronto, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Charles de Mestral
- Department of Surgery, University of Toronto, Toronto, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, Canada
- Data Science & Advanced Analytics, Unity Health Toronto, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Mohammed Al-Omran
- Department of Surgery, University of Toronto, Toronto, Canada.
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, Canada.
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
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11
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Ridany I, Akika R, Saliba NA, Tamim H, Badr K, Zgheib NK. Aromatic Hydrocarbon Receptor Repressor (AHRR) is a biomarker of ambient air pollution exposure and Coronary Artery Disease (CAD). Environ Toxicol Pharmacol 2024; 105:104344. [PMID: 38103810 DOI: 10.1016/j.etap.2023.104344] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Two hundred and twenty subjects were recruited while undergoing cardiac catheterization. AHRR cg05575921 methylation was shown to be significantly decreased in ever smokers compared to never smokers (Mean± SD = 64.2 ± 17.2 vs 80.1 ± 11.1 respectively; P < 0.0001). In addition, higher urinary levels of 2-OHNAP and 2-OHFLU were significantly associated with more AHRR cg05575921 hypomethylation, even after correcting for smoking (β[95%CI]= -4.161[-7.553, -0.769]; P = 0.016 and -5.190[-9.761, -0.618]; P = 0.026, respectively) but not 1-OHPYR (β[95%CI]= -3.545 [-10.935, 3.845]; P = 0.345). Additionally, hypomethylation of AHRR ROI was significantly associated with obstructive coronary artery disease (CAD) after adjusting for smoking, age, sex, diabetes and dyslipidemia (OR [95%CI] = 1.024[1.000 - 1.048]; P = 0.046). Results of this study necessitate further validation to potentially consider clinical incorporation of AHRR methylation status as an early predictive biomarker for the potential association between ambient air pollution and CAD.
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Affiliation(s)
- Ibrahim Ridany
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Reem Akika
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Najat Aoun Saliba
- Department of Chemistry, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon; Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Kamal Badr
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon; Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nathalie Khoueiry Zgheib
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Vascular Medicine Program, American University of Beirut, Beirut, Lebanon.
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12
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Mushtaq AH, Rasheed AW, Jamil MG, Maghrabi K, Khoja O, Sajid MR, Tamim H, Hijazi M, Owaidah T. A retrospective analysis of the frequency of heparin-induced thrombocytopenia in the intensive care unit at a tertiary care center in Riyadh, Saudi Arabia. Am J Blood Res 2023; 13:198-206. [PMID: 38223315 PMCID: PMC10784120] [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] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is an extremely serious and potentially fatal condition that can develop in patients taking heparin-based medications, such as unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). The incidence and risk factors for HIT in critically ill patients, however, are not well defined. METHODS We retrospectively collected data on HIT test results, route of heparin administration, age, sex, heparin type (UFH or LMWH), and date of illness from patients admitted to the intensive care unit (ICU) and regular nursing floor (non-ICU) at our hospital between January 2011 and December 2014. We screened patients for HIT using the 4T score and confirmed the diagnosis through laboratory testing (direct enzyme immunoassay immunoglobulin G [IgG] or a platelet-activating antibody). RESULTS We screened a total of 946 patients, 56 (5.9%) of whom were positive for HIT. Among 776 patients receiving UFH and 180 receiving LMWH, 2.8 and 6.6% developed HIT, respectively (P = 0.051). We then classified our patients into two groups: ICU, and non-ICU. In the non-ICU group (n = 317), 4 (2.7%) patients receiving LMWH and 25 (5.1%) receiving UFH were positive for HIT (P = 0.221). In the ICU group (n = 639), 1 (3.1%) patient receiving LMWH and 26 (9.1%) receiving UFH were positive for HIT (P = 0.249). The ICU group, therefore, had a higher cumulative incidence rate of HIT than the non-ICU group (8.5 vs. 4.5%). CONCLUSION HIT was more common in ICU patients than non-ICU patients and in more patients receiving UFH than LMWH, although the differences were not statistically significant. Early diagnosis and appropriate treatment are essential to prevent adverse outcomes in patients with HIT.
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Affiliation(s)
- Ali H Mushtaq
- Al Faisal UniversityRiyadh, Saudi Arabia
- Department of Internal Medicine, Cleveland Clinic FoundationCleveland, Ohio, The United States of America
| | - Abdulrahman W Rasheed
- Department of Internal Medicine, Cleveland Clinic FoundationCleveland, Ohio, The United States of America
| | - Mouhamad G Jamil
- Department of Hematology, King Faisal Specialist Hospital and Research CenterRiyadh, Saudi Arabia
| | - Khalid Maghrabi
- Department of Hematology, King Faisal Specialist Hospital and Research CenterRiyadh, Saudi Arabia
| | - Osama Khoja
- Department of Hematology, King Faisal Specialist Hospital and Research CenterRiyadh, Saudi Arabia
| | | | - Hani Tamim
- Al Faisal UniversityRiyadh, Saudi Arabia
| | - Mohammad Hijazi
- Department of Hematology, King Faisal Specialist Hospital and Research CenterRiyadh, Saudi Arabia
| | - Tarek Owaidah
- Al Faisal UniversityRiyadh, Saudi Arabia
- Department of Hematology, King Faisal Specialist Hospital and Research CenterRiyadh, Saudi Arabia
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13
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Zakhour R, Tamim H, Faytrouni F, Makki M, Hojeij R, Charafeddine L. Determinants of human papillomavirus vaccine hesitancy among Lebanese parents. PLoS One 2023; 18:e0295644. [PMID: 38091310 PMCID: PMC10718448 DOI: 10.1371/journal.pone.0295644] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is responsible for cancer of cervix uteri. Despite its safety and immunogenicity, HPV vaccine hesitancy is one of the most challenging topics that pediatricians face. METHODS We aimed to describe the impact of knowledge, attitude, and practice towards vaccines in general, on practice related to HPV vaccination in Lebanon. A questionnaire addressed to parents of students (3-18 years of age) was distributed in 2 public and 2 private schools randomly selected from the greater Beirut area during the school year 2017-2018. Questionnaires covered knowledge, attitude, and practices of vaccination in general and HPV vaccine in particular. RESULTS Out of 400 distributed questionnaires, 306 (76.5%) were returned. Of the 185 parents aware of HPV vaccine, 60% hadn't given or were not planning to give the HPV vaccine to their children. Of parents not in favor of HPV vaccine, 7.5 thought that vaccines aren't necessary versus none among those in favor of HPV vaccine(p = 0.02). Thirteen percent of those not in favor of HPV vaccine thought that vaccines are not safe versus 2.7% in the group in favor (p = 0.02). An effect of gender on vaccine acceptance was noted: mothers vs fathers and daughters vs sons. Lack of recommendation by pediatricians and the thought that too little is known about the vaccine were the most selected reasons for parents not wanting to vaccinate their children against HPV, whereas cost and religious and cultural beliefs seemed to have no impact. CONCLUSION Most parents in our study did not vaccinate or weren't willing to vaccinate their children against HPV even when they were in favor of vaccines in general. Physician recommendation was shown to be one of the most important predictors of vaccination. Effort should be put into educating parents about the importance of the vaccine and its well-established safety and efficacy regardless of gender. Lebanese physicians should also be educated and empowered to recommend HPV vaccine more strongly and consistently.
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Affiliation(s)
- Ramia Zakhour
- Division of Pediatric Infectious Diseases, McGovern Medical School Houston, University of Texas, Austin, Texas, United States of America
| | - Hani Tamim
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Farah Faytrouni
- Department of Pediatrics, Medcare Medical Centers, Dr Sulaiman Al Habib Medical Group, United Arab Emirates
| | - Maha Makki
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Hojeij
- Division of Pediatric Infectious Diseases, McGovern Medical School Houston, University of Texas, Austin, Texas, United States of America
| | - Lama Charafeddine
- Division of Pediatric Infectious Diseases, McGovern Medical School Houston, University of Texas, Austin, Texas, United States of America
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Bulbul Z, El Rassi I, Hamade R, Tamim H, Bitar F. Three-dimensional printing of mitral valve models using echocardiographic data improves the knowledge of cardiology fellow physicians in training. Front Cardiovasc Med 2023; 10:1307994. [PMID: 38124899 PMCID: PMC10731368 DOI: 10.3389/fcvm.2023.1307994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Background High fidelity three-dimensional Mitral valve models (3D MVM) printed from echocardiography are currently being used in preparation for surgical repair. Aim We hypothesize that printed 3DMVM could have relevance to cardiologists in training by improving their understanding of normal anatomy and pathology. Methods Sixteen fellow physicians in pediatric and adult cardiology training were recruited. 3D echocardiography (3DE) video clips of six mitral valves (one normal and five pathological) were displayed and the fellows were asked to name the prolapsing segments in each. Following that, three still images of 3D MVMs in different projections: enface, profile and tilted corresponding to the same MVs seen in the clip were presented on a screen. Participating physicians were presented with a comprehensive questionnaire aimed at assessing whether the 3D MVM has improved their understanding of valvular anatomy. Finally, a printed 3D MVM of each of the valves was handed out, and the same questionnaire was re-administered to identify any further improvement in the participants' perception of the anatomy. Results The correct diagnosis using the echocardiography video clip of the Mitral valve was attained by 45% of the study participants. Both pediatric and adult trainees, regardless of the year of training demonstrated improved understanding of the anatomy of MV after observing the corresponding model image. Significant improvement in their understanding was noted after participants had seen and physically examined the printed model. Conclusion Printed 3D MVM has a beneficial impact on the cardiology trainees' understanding of MV anatomy and pathology compared to 3DE images.
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Affiliation(s)
- Ziad Bulbul
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Issam El Rassi
- Pediatric Cardiac Surgery, Al Jalila Hospital, Dubai, United Arab Emirates
| | - Ramsey Hamade
- Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Biostatistics, American University of Beirut, Beirut, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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Awada Z, Cahais V, Cuenin C, Akika R, Silva Almeida Vicente AL, Makki M, Tamim H, Herceg Z, Khoueiry Zgheib N, Ghantous A. Waterpipe and cigarette epigenome analysis reveals markers implicated in addiction and smoking type inference. Environ Int 2023; 182:108260. [PMID: 38006773 PMCID: PMC10716859 DOI: 10.1016/j.envint.2023.108260] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 11/27/2023]
Abstract
Waterpipe smoking is frequent in the Middle East and Africa with emerging prevalence worldwide. The epigenome acts as a molecular sensor to exposures and a crucial driver in several diseases. With the widespread use of waterpipe smoking, it is timely to investigate its epigenomic markers and their role in addiction, as a central player in disease prevention and therapeutic strategies. DNA methylome-wide profiling was performed on an exposure-rich population from the Middle East, constituting of 216 blood samples split equally between never, cigarette-only and waterpipe-only smokers. Waterpipe smokers showed predominantly distinct epigenetic markers from cigarette smokers, even though both smoking forms are tobacco-based. Moreover, each smoking form could be accurately (∼90 %) inferred from the DNA methylome using machine learning. Top markers showed dose-response relationship with extent of smoking and were validated using independent technologies and additional samples (total N = 284). Smoking markers were enriched in regulatory regions and several biological pathways, primarily addiction. The epigenetically altered genes were not associated with genetic etiology of tobacco use, and the methylation levels of addiction genes, in particular, were more likely to reverse after smoking cessation. In contrast, other epigenetic markers continued to feature smoking exposure after cessation, which may explain long-term health effects observed in former smokers. This study reports, for the first time, blood epigenome-wide markers of waterpipe smokers and reveals new markers of cigarette smoking, with implications in mechanisms of addiction and the capacity to discriminate between different smoking types. These markers may offer actionable targets to reverse the epigenetic memory of addiction and can guide future prevention strategies for tobacco smoking as the most preventable cause of illnesses worldwide.
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Affiliation(s)
- Zainab Awada
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Vincent Cahais
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Cyrille Cuenin
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Reem Akika
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Anna Luiza Silva Almeida Vicente
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Maha Makki
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zdenko Herceg
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Nathalie Khoueiry Zgheib
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Akram Ghantous
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France.
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16
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Azzi C, Hussain HK, Jabbour Y, Tamim H, Zeid FA, Akkari C, Khdhir M, Khoury N, Moukaddam H, Hourani R. Imaging findings of the injured in the massive Beirut blast. Emerg Radiol 2023; 30:699-709. [PMID: 37851147 DOI: 10.1007/s10140-023-02175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE (1) Describe imaging utilization and findings within two weeks of the 2020 Beirut blast according to the mechanism of injury, (2) determine the appropriate imaging modality per organ/system, and (3) describe changes in the workflow of a radiology department to deal with massive crises. MATERIALS AND METHODS Two hundred sixty patients presented to the largest emergency department in Beirut and underwent imaging within 2 weeks of the blast. In this retrospective study, patients were divided into early (1) and late (2) imaging groups. Patients' demographic, outcome, type and time of imaging studies, body parts imaged, and mechanism and types of injuries were documented. RESULTS Two hundred five patients in group 1 underwent 502 and 55 patients in group 2 underwent 145 imaging studies. Tertiary blast injuries from direct impact and falling objects were the most common type of injuries followed by secondary (shrapnel) injuries. Both types of injuries affected mostly the head and neck and upper extremities. Plain radiographs were adequate for the extremities and CT for the head and neck. A regularly updated and practiced emergency plan is essential to mobilize staff and equipment and efficiently deliver radiology services during crises. CONCLUSION Because the powerful Beirut blast occurred at the port located in the periphery of the city, most injuries seen on imaging were of the upper extremities and head and neck caused by the severe blast wind or penetrating shrapnel and resulted from people using their arms to protect their heads and bodies from direct impact and falling objects.
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Affiliation(s)
- Caline Azzi
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hero K Hussain
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Radiology, University of Michigan and Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Yara Jabbour
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Farah Abou Zeid
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Chantal Akkari
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mihran Khdhir
- Department of Radiology, Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Nabil Khoury
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hicham Moukaddam
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Hourani
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
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Mahevish R, Khan A, Mahmood HR, Qazi S, Fakhoury HMA, Tamim H. The Impact of Social Media on the Physical and Mental Well-Being of Medical Students During the COVID-19 Pandemic. J Epidemiol Glob Health 2023; 13:902-910. [PMID: 37955808 PMCID: PMC10686904 DOI: 10.1007/s44197-023-00164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
COVID-19 pandemic has increased social media engagement globally. This study examined the correlation between social media use and physical/mental health among university students, considering gender and academic year. Out of 146 responses, 119 were analyzed after excluding participants with pre-existing psychological conditions. Results showed a significant correlation between social media use and mental health for all participants (correlation coefficient = 0.30, p < 0.001), indicating a negative impact on mental health with increased use. Gender-specific analysis revealed a non-significant correlation among males (p = 0.21), while females exhibited a significant correlation (correlation coefficient = 0.32, p = 0.01), suggesting an adverse effect on their mental health. Regarding physical health, females displayed an even higher correlation (correlation coefficient = 0.40, p < 0.001), highlighting the negative influence of social media on their physical well-being. Conversely, no significant correlation was observed among males. Analyzing by academic year, both pre-clerkship and clerkship students showed a significant correlation between social media use and mental health (correlation coefficients of 0.26, p = 0.01, and 0.42, p = 0.03, respectively). Similarly, a significant correlation was found between social media use and physical health among pre-clerkship students (correlation coefficient = 0.34, p = 0.001), but not among clerkship students. In conclusion, this study provides evidence of the adverse impact of social media use on physical and mental health among university students, particularly among females and across different academic years. These findings underscore the importance of promoting healthy social media habits and raising awareness about the potential negative effects on well-being.
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Affiliation(s)
- Raaina Mahevish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Aisha Khan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Sadia Qazi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Li B, Verma R, Beaton D, Tamim H, Hussain MA, Hoballah JJ, Lee DS, Wijeysundera DN, de Mestral C, Mamdani M, Al-Omran M. Predicting outcomes following open revascularization for aortoiliac occlusive disease using machine learning. J Vasc Surg 2023; 78:1449-1460.e7. [PMID: 37454952 DOI: 10.1016/j.jvs.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/12/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Open surgical treatment options for aortoiliac occlusive disease carry significant perioperative risks; however, outcome prediction tools remain limited. Using machine learning (ML), we developed automated algorithms that predict 30-day outcomes following open aortoiliac revascularization. METHODS The National Surgical Quality Improvement Program (NSQIP) targeted vascular database was used to identify patients who underwent open aortoiliac revascularization for atherosclerotic disease between 2011 and 2021. Input features included 38 preoperative demographic/clinical variables. The primary outcome was 30-day major adverse limb event (MALE; composite of untreated loss of patency, major reintervention, or major amputation) or death. The 30-day secondary outcomes were individual components of the primary outcome, major adverse cardiovascular event (MACE; composite of myocardial infarction, stroke, or death), individual components of MACE, wound complication, bleeding, other morbidity, non-home discharge, and unplanned readmission. Our data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, we trained six ML models using preoperative features. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). Model robustness was evaluated with calibration plot and Brier score. Variable importance scores were calculated to determine the top 10 predictive features. Performance was assessed on subgroups based on age, sex, race, ethnicity, symptom status, procedure type, and urgency. RESULTS Overall, 9649 patients were included. The primary outcome of 30-day MALE or death occurred in 1021 patients (10.6%). Our best performing prediction model for 30-day MALE or death was XGBoost, achieving an AUROC of 0.95 (95% confidence interval [CI], 0.94-0.96). In comparison, logistic regression had an AUROC of 0.79 (95% CI, 0.77-0.81). For 30-day secondary outcomes, XGBoost achieved AUROCs between 0.87 and 0.97 (untreated loss of patency [0.95], major reintervention [0.88], major amputation [0.96], death [0.97], MACE [0.95], myocardial infarction [0.88], stroke [0.93], wound complication [0.94], bleeding [0.87], other morbidity [0.96], non-home discharge [0.90], and unplanned readmission [0.91]). The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.05. The strongest predictive feature in our algorithm was chronic limb-threatening ischemia. Model performance remained robust on all subgroup analyses of specific demographic/clinical populations. CONCLUSIONS Our ML models accurately predict 30-day outcomes following open aortoiliac revascularization using preoperative data, performing better than logistic regression. They have potential for important utility in guiding risk-mitigation strategies for patients being considered for open aortoiliac revascularization to improve outcomes.
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Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada
| | - Raj Verma
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Derek Beaton
- Department of Data Science and Advanced Analytics, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Hani Tamim
- Faculty of Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jamal J Hoballah
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Douglas S Lee
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Charles de Mestral
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada; Department of Data Science and Advanced Analytics, Unity Health Toronto, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada; College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
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Basbous M, Yehya N, Salti N, Tamim H, Nabulsi M. Cost-benefit analysis of a multicomponent breastfeeding promotion and support intervention in a developing country. medRxiv 2023:2023.11.17.23298704. [PMID: 38014286 PMCID: PMC10680883 DOI: 10.1101/2023.11.17.23298704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life. Methods This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models investigated the effect of the multicomponent intervention (independent variable) on the overall infant nutrition cost and the overall mother-infant health costs (as dependent variables), adjusting for monthly income and number of children (confounders) at different time points in the first two years. Similar regression models investigated the association between infant nutrition type (exclusive breastfeeding, mixed feeding, artificial milk) and infant nutrition costs and infant-mother health costs. Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p -value below 0.05. Results The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient by the end of the first year (incremental net benefits of 374 USD; BCR=2.44), and by the end of the second year (incremental net benefits of 472 USD; BCR=2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year ( p =0.045). Stratified analyses by the type of infant nutrition revealed that infants who were on Exclusive/Predominant , or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years ( p <0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years ( p <0.05), but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants ( p =0.001), they were similar in infants on Mixed Feeding or Artificial Milk . Conclusions Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.
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Ghulmiyyah LM, El-Husheimi A, Usta IM, Colon-Aponte C, Ghazeeri G, Hobeika E, Mirza FG, Tamim H, Hamadeh C, Nassar AH. Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial. Am J Perinatol 2023; 40:1644-1650. [PMID: 34775581 DOI: 10.1055/s-0041-1739409] [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: 10/19/2022]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. STUDY DESIGN This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. RESULTS A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). CONCLUSION There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. KEY POINTS · Transabdominal uterine compression and uterine massage are appropriate to prevent postpartum hemorrhage.. · No significant difference in blood loss or maternal discomfort observed between the two techniques.. · Both methods are equally effective and either one can be used based on provider preference..
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Affiliation(s)
- Labib M Ghulmiyyah
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida
| | - Alaa El-Husheimi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ihab M Usta
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cristina Colon-Aponte
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida
| | - Ghina Ghazeeri
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Hobeika
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi G Mirza
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Caroline Hamadeh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Saberi B, Gurakar A, Tamim H, Schneider CV, Sims OT, Bonder A, Fricker Z, Alqahtani SA. Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change. JAMA Netw Open 2023; 6:e2341096. [PMID: 37917059 PMCID: PMC10623194 DOI: 10.1001/jamanetworkopen.2023.41096] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Importance Racial disparities in liver transplant (LT) for hepatocellular carcinoma (HCC) may be associated with unequal access to life-saving treatment. Objective To quantify racial disparities in LT for HCC and mortality after LT, adjusting for demographic, clinical, and socioeconomic factors. Design, Setting, and Participants This cohort study was a retrospective analysis of United Network Organ Sharing/Organ Procurement Transplant Network (OPTN) data from 2003 to 2021. Participants were adult patients with HCC on the LT waiting list and those who received LT. Data were analyzed from March 2022 to September 2023. Exposures Race and time before and after the 2015 OPTN policy change. Main Outcomes and Measures Proportion of LT from wait-listed candidates, the proportion of waiting list removals, and mortality after LT. Results Among 12 031 patients wait-listed for LT with HCC (mean [SD] age, 60.8 [7.4] years; 9054 [75.3%] male; 7234 [60.1%] White, 2590 [21.5%] Latinx/o/a, and 1172 [9.7%] Black or African American), this study found that after the 2015 model of end-stage liver disease (MELD) exception policy changes for HCC (era 2), the overall proportion of LT for HCC across all races decreased while the proportion of dropouts on the LT waiting list remained steady compared with patients who did not have HCC. In Kaplan-Meier analysis, Asian patients demonstrated the lowest dropout rates in both era 1 and era 2 (1-year dropout, 16% and 17%, respectively; P < .001). In contrast, Black or African American patients had the highest dropout rates in era 1 (1-year dropout, 24%), but comparable dropout rates (23%) with White patients (23%) and Latinx/o/a patients in era 2 (23%). In both eras, Asian patients had the highest survival after LT (5-year survival, 82% for era 1 and 86% for era 2), while Black or African American patients had the worst survival after LT (5-year survival, 71% for era 1 and 79% for era 2). In the multivariable analysis for HCC LT recipients, Black or African American race was associated with increased risk of mortality in both eras, compared with White race (HR for era 1, 1.17; 95% CI, 1.05-1.35; and HR for era 2, 1.31; 95% CI, 1.10-1.56). Conclusions and Relevance This cohort study of LT candidates in the US found that after the 2015 MELD exception policy change for HCC, the proportion of LT for HCC had decreased for all races. Black or African American patients had worse outcomes after LT than other races. Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC LT candidates.
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Affiliation(s)
- Behnam Saberi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ahmet Gurakar
- Johns Hopkins University, Division of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Carolin V. Schneider
- Department of Internal Medicine III, Rheinisch Westfälisch Technische Hochschule Aachen University, Aachen, Germany
| | - Omar T. Sims
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alan Bonder
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Zachary Fricker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Saleh A. Alqahtani
- Johns Hopkins University, Division of Gastroenterology and Hepatology, Baltimore, Maryland
- Liver Transplant Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
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Messerlian N, Zgheib N, Chokor FAZ, Nasrallah M, Tamim H, Nasreddine L. Fructose intake and its association with relative telomere length: an exploratory study among healthy Lebanese adults. Front Nutr 2023; 10:1270124. [PMID: 38024356 PMCID: PMC10643745 DOI: 10.3389/fnut.2023.1270124] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Shorter relative telomere length (RTL) has been associated with increased incidence of morbidity. Although still disputed, available evidence suggests that dietary factors, including sugar-sweetened beverages (SSB) may be linked with shorter RTL. It was argued that the link between SSB and RTL may be explained by the sugar content of these beverages, and specifically fructose given its impact on oxidative stress and the inflammatory response. However, none of the existing studies have examined the specific link between fructose intake and RTL. This exploratory study aimed at (1) assessing the intake of dietary fructose (total, added and natural) in Lebanese healthy adults and (2) examining dietary fructose as a predictor of short telomere length. Methods Following a cross-sectional design (n = 282), anthropometric and biochemical data were collected. RTL was assessed by utilizing real-time polymerase chain reaction (RT-qPCR) to amplify both telomere and single-copy gene segments. Dietary intake was evaluated using a culture-specific food frequency questionnaire (FFQ). Intakes of added fructose, naturally-occurring fructose, and total fructose were estimated. Results Mean intakes of added and natural fructose were of 39.03 ± 34.12 and 12.28 ± 8.59 g/day, respectively, representing 4.80 ± 3.56 and 1.78 ± 1.41% of total energy intake (EI). Mean total fructose intake was of 51.31 ± 35.55 g/day, contributing 6.58 ± 3.71% EI. Higher intakes of total and added fructose were significantly associated with shorter RTL 2nd RTL tertile as compared to the 3rd RTL tertile; relative risk ratio (RRR) = 3.10 [95% confidence interval (CI): 1.38, 6.94] and RRR = 2.33 (95% CI: 1.02, 5.36), respectively after adjustment for confounders identified using a directed acyclic graph (DAG). Conclusion In conclusion, although we could not observe a dose-dependent relation between fructose intakes and RTL shortening and although the study is limited by its small sample size, the findings suggest that total and added dietary fructose intakes may be associated with shorter RTL. Larger studies, of longitudinal nature, are needed to further confirm the study findings.
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Affiliation(s)
- Nairie Messerlian
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nathalie Zgheib
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatima Al Zahraa Chokor
- Department of Public Health, College of Health Sciences, Qatar University Health, Qatar University, Doha, Qatar
| | - Mona Nasrallah
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon
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Li B, Verma R, Beaton D, Tamim H, Hussain MA, Hoballah JJ, Lee DS, Wijeysundera DN, de Mestral C, Mamdani M, Al‐Omran M. Predicting Major Adverse Cardiovascular Events Following Carotid Endarterectomy Using Machine Learning. J Am Heart Assoc 2023; 12:e030508. [PMID: 37804197 PMCID: PMC10757546 DOI: 10.1161/jaha.123.030508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023]
Abstract
Background Carotid endarterectomy (CEA) is a major vascular operation for stroke prevention that carries significant perioperative risks; however, outcome prediction tools remain limited. The authors developed machine learning algorithms to predict outcomes following CEA. Methods and Results The National Surgical Quality Improvement Program targeted vascular database was used to identify patients who underwent CEA between 2011 and 2021. Input features included 36 preoperative demographic/clinical variables. The primary outcome was 30-day major adverse cardiovascular events (composite of stroke, myocardial infarction, or death). The data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, 6 machine learning models were trained using preoperative features. The primary metric for evaluating model performance was area under the receiver operating characteristic curve. Model robustness was evaluated with calibration plot and Brier score. Overall, 38 853 patients underwent CEA during the study period. Thirty-day major adverse cardiovascular events occurred in 1683 (4.3%) patients. The best performing prediction model was XGBoost, achieving an area under the receiver operating characteristic curve of 0.91 (95% CI, 0.90-0.92). In comparison, logistic regression had an area under the receiver operating characteristic curve of 0.62 (95% CI, 0.60-0.64), and existing tools in the literature demonstrate area under the receiver operating characteristic curve values ranging from 0.58 to 0.74. The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.02. The strongest predictive feature in our algorithm was carotid symptom status. Conclusions The machine learning models accurately predicted 30-day outcomes following CEA using preoperative data and performed better than existing tools. They have potential for important utility in guiding risk-mitigation strategies to improve outcomes for patients being considered for CEA.
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Affiliation(s)
- Ben Li
- Department of SurgeryUniversity of TorontoCanada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health TorontoUniversity of TorontoCanada
- Institute of Medical ScienceUniversity of TorontoCanada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T‐CAIREM)University of TorontoCanada
| | - Raj Verma
- School of Medicine, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Derek Beaton
- Data Science & Advanced Analytics, Unity Health TorontoUniversity of TorontoCanada
| | - Hani Tamim
- Faculty of Medicine, Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
- College of MedicineAlfaisal UniversityRiyadhKingdom of Saudi Arabia
| | - Mohamad A. Hussain
- Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Brigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Jamal J. Hoballah
- Division of Vascular and Endovascular Surgery, Department of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Douglas S. Lee
- Division of Cardiology, Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
| | - Duminda N. Wijeysundera
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
- Department of AnesthesiaSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
| | - Charles de Mestral
- Department of SurgeryUniversity of TorontoCanada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health TorontoUniversity of TorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
| | - Muhammad Mamdani
- Institute of Medical ScienceUniversity of TorontoCanada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T‐CAIREM)University of TorontoCanada
- Data Science & Advanced Analytics, Unity Health TorontoUniversity of TorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESUniversity of TorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
- Leslie Dan Faculty of PharmacyUniversity of TorontoCanada
| | - Mohammed Al‐Omran
- Department of SurgeryUniversity of TorontoCanada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health TorontoUniversity of TorontoCanada
- Institute of Medical ScienceUniversity of TorontoCanada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T‐CAIREM)University of TorontoCanada
- College of MedicineAlfaisal UniversityRiyadhKingdom of Saudi Arabia
- Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, Unity Health TorontoTorontoCanada
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia
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Zahran TE, Al Hassan S, Al Karaki V, Hammoud L, Helou CE, Khalifeh M, Al Hariri M, Tamim H, Majzoub IE. Outcomes of critically ill COVID-19 patients boarding in the emergency department of a tertiary care center in a developing country: a retrospective cohort study. Int J Emerg Med 2023; 16:73. [PMID: 37833683 PMCID: PMC10576402 DOI: 10.1186/s12245-023-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Boarding of critically ill patients in the emergency department (ED) has long been known to compromise patient care and affect outcomes. During the COVID-19 pandemic, multiple hospitals worldwide experienced overcrowded emergency rooms. Large influx of patients outnumbered hospital beds and required prolonged length of stay (LOS) in the ED. Our aim was to assess the ED LOS effect on mortality and morbidity, in addition to the predictors of in-hospital mortality, intubation, and complications of critically ill COVID-19 ED boarder patients. METHODS This was a retrospective cohort study, investigating 145 COVID-19-positive adult patients who were critically ill, required intensive care unit (ICU), and boarded in the ED of a tertiary care center in Lebanon. Data on patients who boarded in the emergency from January 1, 2020, till January 31, 2021, was gathered and studied. RESULTS Overall, 66% of patients died, 60% required intubation, and 88% developed complications. Multiple risk factors were associated with mortality naming age above 65 years, vasopressor use, severe COVID pneumonia findings on CT chest, chemotherapy treatment in the previous year, cardiovascular diseases, chronic kidney diseases, prolonged ED LOS, and low SaO2 < 95% on triage. In addition, our study showed that staying long hours in the ED increased the risk of developing complications. CONCLUSION To conclude, all efforts need to be drawn to re-establish mitigation strategies and models of critical care delivery in the ED to alleviate the burden of critical boarders during pandemics, thus decreasing morbidity and mortality rates. Lessons from this pandemic should raise concern for complications seen in ED ICU boarders and allow the promotion of health measures optimizing resource allocation in future pandemic crises.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Sally Al Hassan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Victoria Al Karaki
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Hammoud
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle El Helou
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Khalifeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- QU Health, Qatar University, Doha, Qatar
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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25
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Carrillo-Larco RM, Guzman-Vilca WC, Alvizuri-Gómez C, Tamim H, Alqahtani SA, García-Larsen V. Sensitivity and specificity of three diabetes diagnostic criteria in people with non-alcoholic fatty liver disease (NAFLD) and otherwise healthy people: Analysis of NHANES III. Prim Care Diabetes 2023; 17:506-512. [PMID: 37321876 DOI: 10.1016/j.pcd.2023.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
AIMS Establishing whether fasting plasma glucose (FPG), postprandial glucose (PPG), and HbA1c have the same diagnostic accuracy in NAFLD versus otherwise healthy people could inform T2DM screening recommendations for those with NAFLD. METHODS Cross-sectional analysis of the Third National Health and Nutrition Examination Survey (NHANES III) 1989-1994. T2DM was defined as PPG ≥ 200 mg/dL, FPG ≥ 126 mg/dL, or HbA1c ≥ 6.5 %. We estimated sensitivity and specificity between the six pairwise combinations between the three T2DM definitions in people with and without NAFLD. With Poisson regressions, we investigated if people with NAFLD were more likely to have T2DM with two diagnostic criteria yet not with the third one. RESULTS There were 3652 people with mean age 55.6 years and 49.4 % were men; 673 (18.4 %) people had NAFLD. Compared to NAFLD-free individuals, those with NAFLD had lower specificity in all pairwise comparisons except when PPG was the reference vs HbA1c [98.28 % (95 % CI: 97.73 %-98.72 %) in people without NAFLD vs 96.15 % (95 % CI: 94.28 %-97.54 %)]. The sensitivity of FPG was slightly superior to PPG and HbA1c in people without NAFLD; for example, 64.62 % (95 % CI: 55.75 %-72.80 %) for FPG vs 56.58 % (95 % CI: 44.71 %-67.92 %) for HbA1c. People with NAFLD were more likely to be diagnosed with FPG and PPG yet not with HbA1c (PR=2.15; p = 0.020). CONCLUSIONS While these T2DM diagnostic criteria may capture different patients both in people with and without NAFLD, in the NAFLD population FPG appears to have the best sensitivity and there were no differences between PPG and HbA1c in terms of specificity.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Hani Tamim
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saleh A Alqahtani
- King Faisal Specialist Hospital & Research Centre, Riyadh 11564, Saudi Arabia; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Vanessa García-Larsen
- Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Huang DC, Yu RL, Alqahtani S, Tamim H, Saberi B, Bonder A. Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma. Ann Hepatol 2023; 28:101127. [PMID: 37286167 DOI: 10.1016/j.aohep.2023.101127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable access to organ transplants; however, their impacts are unclear. We aimed to characterize differences in post-liver transplant (LT) survival among patients with HCC, when considering race and ethnicity, income, and insurance type, and understand if these associations were impacted by Share 35. MATERIALS AND METHODS We conducted a retrospective cohort study of 30,610 adult LT recipients with HCC. Data were obtained from the UNOS database. Survival analysis was carried out using Kaplan-Meier curves, and multivariate Cox regression analysis was used to calculate hazard ratios. RESULTS Men (HR: 0.90 (95% CI: 0.85-0.95)), private insurance (HR: 0.91 (95% CI: 0.87-0.92)), and income (HR: 0.87 (95% CI: 0.83-0.92)) corresponded with higher post-LT survival, when adjusted for over 20 demographic and clinical characteristics (Table 2). African American or Black individuals were associated with lower post-LT survival (HR: 1.20 (95% CI: 1.12-1.28)), whereas. Asian (HR: 0.79 (95% CI: 0.71-0.88)) or Hispanic (HR: 0.86 (95% CI: 0.81-0.92)) individuals were associated with higher survival as compared with White individuals (Table 2). Many of these patterns held in the pre-Share 35 and Share 35 periods. CONCLUSIONS Racial, ethnic, and socioeconomic disparities at time of transplant, such as private insurance and income, influence post-LT survival in patients with HCC. These patterns persist despite the passage of equitable access policies, such as Share 35.
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Affiliation(s)
- Dora C Huang
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Rosa L Yu
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Saleh Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, United States; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alan Bonder
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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Nammour T, El Jamal L, Hosni MN, Tamim H, Kerbage A, Hashash JG, Shaib YH, Daniel F, Francis F, Mourad FH, Soweid A, Sharara AI, Makki M, Rockey DC, Barada K. Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients With Overt Gastrointestinal Bleeding. J Clin Gastroenterol 2023; 57:700-706. [PMID: 35921332 DOI: 10.1097/mcg.0000000000001736] [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] [Received: 01/03/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022]
Abstract
GOALS AND BACKGROUND We aimed to develop a novel 1-year mortality risk-scoring system that includes use of antithrombotic (AT) drugs and to validate it against other scoring systems in patients with acute gastrointestinal bleeding (GIB). STUDY We developed a risk-scoring system from prospectively collected data on patients admitted with GIB between January 2013 and August 2020, who had at least 1- year of follow-up. Independent predictors of 1-year mortality were determined after adjusting for the following confounders: the age-adjusted Charlson Comorbidity Index (CCI) (divided into 4 groups: CCI-0=0, CCI-1=1 to 3, CCI-2=4 to 6, CCI-3 ≥7), need for blood transfusion, GIB severity, need for endoscopic therapy, and type of AT. The risk score was based on independent predictors. RESULTS Five hundred seventy-six patients were included and 123 (21%) died at 1-year follow-up. Our risk -score was based on the following: CCI-2 (2 points), CCI-3 (4 points), need for blood transfusion (1 point), and no use of aspirin (1 point), as aspirin use was protective (maximum score=6). Patients with higher risk scores had higher mortality. The model had a better predictive accuracy [AUC=0.82, 95% confidence interval (0.78-0.86), P <0.0001] than the Rockall score for upper GIB (Area Under the Curve (AUC)=0.68, P <<0.0001), the Oakland score for lower GIB (AUC=0.69, p =0.004), or the Shock Index for all (AUC=0.54, P <0.0001). CONCLUSION A simple and novel score that includes use of AT upon admission accurately predicts 1-year mortality in patients with GIB. This scoring system may help guide follow-up decisions and inform the prognosis of patients with GIB.
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Affiliation(s)
| | | | | | - Hani Tamim
- Biostatistics Support Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | | | | | | | | | | | - Maha Makki
- Biostatistics Support Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC
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El Zakhem A, Mahmoud O, Zakhour J, Nahhal SB, El Ghawi N, Omran N, El Sheikh WG, Tamim H, Kanj SS. The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon. J Fungi (Basel) 2023; 9:769. [PMID: 37504757 PMCID: PMC10381108 DOI: 10.3390/jof9070769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
Invasive fungal infections, notably candidemia, have been associated with COVID-19. The epidemiology of candidemia has significantly changed during the COVID-19 pandemic. We aim to identify the microbiological profile, resistance rates, and outcomes of COVID-19-associated candidemia (CAC) compared to patients with candidemia not associated with COVID-19. We retrospectively collected data on patients with candidemia admitted to the American University of Beirut Medical Center between 2004 and 2022. We compared the epidemiology of candidemia during and prior to the COVID-19 pandemic. Additionally, we compared the outcomes of critically ill patients with CAC to those with candidemia without COVID-19 from March 2020 till March 2022. Among 245 candidemia episodes, 156 occurred prior to the pandemic and 89 during the pandemic. Of the latter, 39 (43.8%) were CAC, most of which (82%) were reported from intensive care units (ICU). Non-albicans Candida (NAC) spp. were predominant throughout the study period (67.7%). Candida auris infection was the most common cause of NAC spp. in CAC. C. glabrata had decreased susceptibility rates to fluconazole and caspofungin during the pandemic period (46.1% and 38.4%, respectively). The mortality rate in the overall ICU population during the pandemic was 76.6%, much higher than the previously reported candidemia mortality rate observed in studies involving ICU patients. There was no significant difference in 30-day mortality between CAC and non-CAC (75.0% vs. 78.1%; p = 0.76). Performing ophthalmic examination (p = 0.002), CVC removal during the 48 h following the candidemia (p = 0.008) and speciation (p = 0.028) were significantly associated with a lower case-fatality rate. The epidemiology of candidemia has been significantly affected by the COVID-19 pandemic at our center. Rigorous infection control measures and proper antifungal stewardship are essential to combat highly resistant species such as C. auris.
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Affiliation(s)
- Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Omar Mahmoud
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Johnny Zakhour
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Sarah B Nahhal
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Nour El Ghawi
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Nadine Omran
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Walaa G El Sheikh
- Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut 110236, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut 110236, Lebanon
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut 110236, Lebanon
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Massouh N, Jaffa AA, Tamim H, Jaffa MA. Social and racial inequalities in diabetes and cancer in the United States. Front Public Health 2023; 11:1178979. [PMID: 37538273 PMCID: PMC10395076 DOI: 10.3389/fpubh.2023.1178979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Background Cancer and diabetes are among the leading causes of morbidity and mortality worldwide. Several studies have reported diabetes as a risk factor for developing cancer, a relationship that may be explained by associated factors shared with both diseases such as age, sex, body weight, smoking, and alcohol consumption. Social factors referred to as social determinants of health (SDOH) were shown to be associated with the risk of developing cancer and diabetes. Despite that diabetes and social factors were identified as significant determinants of cancer, no studies examined their combined effect on the risk of developing cancer. In this study, we aim at filling this gap in the literature by triangulating the association between diabetes, indices of SDOH, and the risk of developing cancer. Methods We have conducted a quantitative study using data from the Behavioral Risk Factor Surveillance System (BRFSS), whereby information was collected nationally from residents in the United States (US) with respect to their health-related risk behaviors, chronic health conditions, and the use of preventive services. Data analysis using weighted regressions was conducted on 389,158 study participants. Results Our findings indicated that diabetes is a risk factor that increases the likelihood of cancer by 13% (OR 1.13; 95%CI: 1.05-1.21). People of White race had higher odds for cancer compared to African Americans (OR 0.44; 95%CI: 0.39-0.49), Asians (OR 0.27; 95%CI: 0.20-0.38), and other races (OR 0.56; 95%CI: 0.46-0.69). The indices of SDOH that were positively associated with having cancer encompassed unemployment (OR 1.78; 95%CI: 1.59-1.99), retirement (OR 1.54; 95%CI: 1.43-1.67), higher income levels with ORs ranging between 1.16-1.38, college education (OR 1.10; 95%CI: 1.02-1.18), college graduates (OR 1.31; 95%CI: 1.21-1.40), and healthcare coverage (OR 1.44; 95%CI: 1.22-1.71). On the other hand, the indices of SDOH that were protective against having cancer were comprised of renting a home (OR 0.86; 95%CI: 0.79-0.93) and never married (OR 0.73; 95%CI: 0.65-0.81). Conclusion This study offers a novel social dimension for the association between diabetes and cancer that could guide setting strategies for addressing social inequities in disease prevention and access to healthcare.
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Affiliation(s)
- Nour Massouh
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayad A. Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Hani Tamim
- Biostatistics Unit, Faculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Miran A. Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Chase RC, Tamim H, Sheikh WGE, Clift K, Bruining D, Ha C, Farraye FA, Hashash JG. Association of serum IgG4 and disease outcomes in patients with inflammatory bowel disease. Ann Gastroenterol 2023; 36:423-429. [PMID: 37396005 PMCID: PMC10304528 DOI: 10.20524/aog.2023.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/04/2023] [Indexed: 07/04/2023] Open
Abstract
Background The etiology of inflammatory bowel disease (IBD) is multifactorial and thought to be influenced by inappropriate activation of the gut mucosal immune system. As the only immunoglobulin G (IgG) subclass unable to activate the classical complement cascade, the role of IgG4 in IBD pathophysiology as an immunomodulator is controversial. This study aimed to determine the association of low, normal and high IgG4 levels with the outcomes of IBD patients. Methods This was a retrospective study of a multisite tertiary care center database evaluating patients with IBD who had an IgG4 level drawn between 2014 and 2021. Subjects were divided into low, normal, and high IgG4 level groups for evaluation of demographic and clinical indicators of IBD activity and severity. Results Of 284 patients with IBD, 22 had low (7.7%), 16 high (5.6%), and 246 (86.6%) normal IgG4 levels. There was no difference in IBD subtype, mean age, age at IBD diagnosis, or smoking between the 3 groups. There was no difference in number of hospitalizations (P=0.20), C-reactive protein levels, need for intestinal resection (P=0.85), or presence of primary sclerosing cholangitis (P=0.15), pancreatitis (P=0.70), or perianal disease (P=0.68) between the groups. Significantly more patients in the low IgG4 group had previous exposure to vedolizumab compared to the other groups and more patients in the low IgG4 group received vedolizumab (P=0.04), azathioprine (P=0.04) and prednisone (P=0.03) during the 5-year follow up. Conclusion In this study, a low serum IgG4 level was associated with higher rates of vedolizumab, azathioprine, and steroid use.
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Affiliation(s)
- R. Christopher Chase
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida USA (R. Christopher Chase)
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon (Hani Tamim, Walaa G. El Sheikh)
- Alfaisal University, Riyadh, Saudi Arabia (Hani Tamim)
| | - Walaa G. El Sheikh
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon (Hani Tamim, Walaa G. El Sheikh)
| | - Kristin Clift
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA (Kristin Clift, Francis A. Farraye, Jana G. Hashash)
| | - David Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota USA (David Bruining)
| | - Christina Ha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona USA (Christina Ha)
| | - Francis A. Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA (Kristin Clift, Francis A. Farraye, Jana G. Hashash)
| | - Jana G. Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA (Kristin Clift, Francis A. Farraye, Jana G. Hashash)
- Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon (Jana G. Hashash)
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Ayoub CH, El-Asmar JM, El-Achkar A, Dakroub A, Abou Chawareb E, El-Khoury L, Tamim H, Chalhoub V, El Hajj A. A novel nephrectomy-specific respiratory failure index using the ACS-NSQIP dataset. Int Urol Nephrol 2023; 55:813-822. [PMID: 36787087 DOI: 10.1007/s11255-023-03507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Post-operative pulmonary failure is a major complication of nephrectomy that may lead to severe morbidity and mortality. Hence, we aimed to derive a nephrectomy-specific post-operative respiratory failure index. METHODS Our cohort was derived from The American College of Surgeons-National Surgical Quality Improvement Program database between 2005 and 2019. The outcome of interest was post-operative respiratory failure (PRF) defined as any incidence of unplanned intubation post-operatively or requiring mechanical ventilation post-operatively for a period > 48 h. A multivariable logistic regression model was constructed, and model calibration and performance were assessed using a ROC analysis and the Hosmer-Lemeshow test. Finally, we derived the nephrectomy-specific respiratory failure (NSRF) index and compared it to Gupta's index. RESULTS Seventy-nine thousand five hundred and twenty-three patients underwent nephrectomy between the years 2005 and 2019 of which nine hundred and sixty-two patients developed PRF. The final NSRF model encompassed ten variables: age, smoking status, American society of anesthesiology class, abnormal creatinine (≥ 1.5 mg/dL), anemia (< 36%), functional health status, chronic obstructive pulmonary disease, surgical approach, emergency case, and obesity (≥ 40 kg/m2). The NSRF ROC analysis provided C-statistic = 0.78, calibration R2 = 0.99, and proper goodness of fit. In comparison, the C-statistics of Gupta's index was found to be 0.71 (p value < 0.001). CONCLUSION The NSRF is a procedure tailored index for predicting post-operative respiratory failure. It is a valuable tool in the pre-operative evaluation setting that can help identify high-risk patients who will require additional respiratory evaluation and preparation for their surgery.
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Affiliation(s)
- Christian H Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Adnan El-Achkar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Ali Dakroub
- Medical School, American University of Beirut, American University of Beirut, Beirut, Lebanon
| | - Elia Abou Chawareb
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Layane El-Khoury
- Medical School, American University of Beirut, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Viviane Chalhoub
- Department of Anesthesia and Intensive Care, Saint-Joseph University Medical School, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Albert El Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon.
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Nahouli H, Bassil D, Mailhac A, Der-Boghossian A, Tamim H, Al Taki M. Association of Hip Fracture With the Use of Walking Assistance Devices Post-surgery: A Retrospective Study Comparing Intertrochanteric and Subtrochanteric Hip Fractures. Cureus 2023; 15:e36706. [PMID: 37113370 PMCID: PMC10129033 DOI: 10.7759/cureus.36706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Background Hip fractures, including intertrochanteric and subtrochanteric fractures, are among the most common types of fractures. The dynamic hip screw (DHS) and the cephalomedullary hip nail (CHN) are the two main techniques used for the fixation of these types of fractures. This study aims to explore the association of the fracture type with the use of walking assistance devices post-surgery, regardless of the fixation technique. Methodology This study is a retrospective study based on the review of de-identified patient data from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged 65 years old or above who underwent fixation procedures for intertrochanteric or subtrochanteric fractures using CHN or DHS techniques were included in this study. Results A total of 8,881 patients were included and divided into the following two groups: 876 (9.9%) patients treated for subtrochanteric fracture, and 8,005 (90.1%) patients treated for intertrochanteric fracture. No statistical significance was detected in the use of mobility aid postoperatively between the two groups. When compared to CHN, DHS was noted to be the most employed fixation technique among patients with intertrochanteric fractures. One main finding was that patients who underwent surgery using DHS for intertrochanteric fractures were more likely to use walking assistance devices postoperatively compared to those with subtrochanteric fractures treated with the same fixation technique. Conclusions Findings suggest that the use of walking assistance devices post-surgery is independent of the type of fracture and potentially dependent on the fixation technique employed. Future studies focused on the difference in the use of walking assistance devices based on fixation techniques for patients with distinctive sub-types of trochanteric fractures are highly encouraged.
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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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Hassan B, Abou Koura A, Makarem A, Abi Mosleh K, Dimassi H, Tamim H, Ibrahim A. Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients. Front Surg 2023; 10:1080143. [PMID: 36793316 PMCID: PMC9923723 DOI: 10.3389/fsurg.2023.1080143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose Rates of surgical site infection (SSI) following reconstructive flap surgeries (RFS) vary according to flap recipient site, potentially leading to flap failure. This is the largest study to determine predictors of SSI following RFS across recipient sites. Methods The National Surgical Quality Improvement Program database was queried for patients undergoing any flap procedure from years 2005 to 2020. RFS involving grafts, skin flaps, or flaps with unknown recipient site were excluded. Patients were stratified according to recipient site: breast, trunk, head and neck (H&N), upper and lower extremities (UE&LE). The primary outcome was the incidence of SSI within 30 days following surgery. Descriptive statistics were calculated. Bivariate analysis and multivariate logistic regression were performed to determine predictors of SSI following RFS. Results 37,177 patients underwent RFS, of whom 7.5% (n = 2,776) developed SSI. A significantly greater proportion of patients who underwent LE (n = 318, 10.7%) and trunk (n = 1,091, 10.4%) reconstruction developed SSI compared to those who underwent breast (n = 1,201, 6.3%), UE (n = 32, 4.4%), and H&N (n = 100, 4.2%) reconstruction (p < .001). Longer operating times were significant predictors of SSI following RFS across all sites. The strongest predictors of SSI were presence of open wound following trunk and H&N reconstruction [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.82 (1.57-2.11) and 1.75 (1.57-1.95)], disseminated cancer following LE reconstruction [aOR (CI) 3.58 (2.324-5.53)], and history of cardiovascular accident or stroke following breast reconstruction [aOR (CI) 16.97 (2.72-105.82)]. Conclusion Longer operating time was a significant predictor of SSI regardless of reconstruction site. Reducing operating times through proper surgical planning might help mitigate the risk of SSI following RFS. Our findings should be used to guide patient selection, counseling, and surgical planning prior to RFS.
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Affiliation(s)
- Bashar Hassan
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Adham Makarem
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Kamal Abi Mosleh
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Amir Ibrahim
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon,Correspondence: Amir Ibrahim
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Ayoub CH, Chalhoub V, El-Achkar A, Abou Heidar N, Tamim H, Maroun-Aouad M, El Hajj A. Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate. Ther Adv Urol 2023; 15:17562872221150217. [PMID: 36699641 PMCID: PMC9869224 DOI: 10.1177/17562872221150217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023] Open
Abstract
Background Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients. Objectives The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques. Design and methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score-matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis. Results A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP (p < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP (p = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP (p = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP. Conclusion MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques.
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Affiliation(s)
| | | | - Adnan El-Achkar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Marie Maroun-Aouad
- Department of Anesthesiology, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
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Chami HA, Zaouk N, Makki M, Tamim H, Shaya M, Talih F. Varenicline Treatment for Waterpipe Smoking Cessation. Nicotine Tob Res 2023; 25:111-119. [PMID: 35789389 DOI: 10.1093/ntr/ntac162] [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] [Received: 12/30/2021] [Revised: 04/19/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Waterpipe smoking is increasing worldwide with no proven interventions for cessation. We compared abstinence rates with 12-week varenicline therapy versus placebo among habitual waterpipe smokers willing to quit. METHODS This double-blind placebo-controlled single-center trial, randomized waterpipe smokers from Lebanon who did not smoke other tobacco products to receive varenicline or placebo for 12 weeks. All participants also received three structured 30-minute individual behavioral intervention sessions. The primary outcome was repeated point prevalence abstinence assessed by self-report and verified by exhaled carbon monoxide three times during 12 weeks and analyzed with the intention to treat. End of treatment urine cotinine, weight, blood pressure, anxiety, depression, withdrawal, and adverse symptoms were also assessed. RESULTS In total, 152 waterpipe smokers (mean age 38 years [SD = 13], 39% females) willing to quit, who smoked waterpipe exclusively (average 2.3 per day [SD = 1.6] for 16.8 years [SD = 10.8]) were randomized. Seventy-nine participants (52%) with any missing abstinence assessment were considered to have relapsed. Repeat point prevalence abstinence rate was numerically higher among the varenicline group compared to placebo, but the difference did not reach statistical significance when assessed by self-report (16.9 vs. 13.6%, respectively, p = .6) and when further verified by exhaled carbon monoxide (14.1% vs. 9.9%, respectively, p = .4). Abstinence rates were similar in both groups when further verified by urine cotinine at end of treatment. No serious adverse events were reported, adverse symptoms and other outcomes were similar in the varenicline and placebo arms. CONCLUSIONS Varenicline for 12 weeks was not more effective than placebo to achieve abstinence among daily waterpipe smokers. IMPLICATIONS Varenicline in combination with a behavioral intervention did not significantly enhance the quit rate among exclusive waterpipe smokers compared to behavioral intervention plus placebo. We experienced difficulty enrolling exclusive waterpipe smokers willing to quit and observed high dropout rates among participants demonstrating the difficulties of waterpipe smoking cessation.
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Affiliation(s)
- Hassan A Chami
- School of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nour Zaouk
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Monique Shaya
- School of Public Health, American University of Beirut, Beirut, Lebanon
| | - Farid Talih
- School of Medicine, American University of Beirut, Beirut, Lebanon
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Abou Heidar NF, Ayoub CH, Abou Mrad A, Abdul Khalek J, Tamim H, El-Hajj A. Robotic-assisted radical prostatectomy is pushing the boundaries: a national survey of frailty using the national surgical quality improvement program. Ther Adv Urol 2023; 15:17562872231177780. [PMID: 37325291 PMCID: PMC10265338 DOI: 10.1177/17562872231177780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Background Robotic-assisted radical prostatectomy (RARP) has been found to be comparable and, in some cases, favorable to open surgical approaches, while being used in a frailer population. Objectives We aimed to illustrate the trend in population frailty and compare morbidity and mortality postoperatively in patients who underwent RARP. Design and Methods The National Surgical Quality Improvement Program data set was used to select patients who underwent RARP between the years 2011-2019. Age, frailty indicators, surgical characteristics, and perioperative morbidity and mortality were compared between the years 2011-2019 using the chi-square test (χ2) for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables. Results Our patient population consisted of 66,683 patients who underwent RARP. There was an increase in mean age and frailty indicated by an increase in 5-item frailty score ⩾2, metabolic syndrome index = 3, and American Society of Anesthesiologists' (ASA) class ⩾3 between the years 2011-2019 (p < 0.001). Whereas the rate of mortality and morbidity, indicated by postoperative Clavien-Dindo grade ⩾4 and major morbidity, remained the same over the same period (p > 0.264). Furthermore, operative time and length of stay decreased over the same period (p < 0.001). Conclusion RARP is being performed on more frail patients, with no added morbidity or mortality.
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Affiliation(s)
| | | | | | | | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Chami HA, Houjeij N, Makki M, Itani L, Tamim H, Al Mulla A, Celli B, Zeineldine S. Increased airway resistance among exclusive waterpipe smokers detected using impulse oscillometry. Ann Thorac Med 2023; 18:23-30. [PMID: 36968332 PMCID: PMC10034824 DOI: 10.4103/atm.atm_165_22] [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] [Received: 04/25/2022] [Accepted: 11/05/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Waterpipe smoking is increasing in popularity, yet the evidence implicating waterpipe smoking in lung disease is limited. We hypothesized that impulse oscillometry (IOS) would detect airway abnormalities in waterpipe smokers (WPS). METHODS We studied 210 participants, 40 years or older, from the community, of whom 92 were exclusive WPS and 118 were never-smokers. Waterpipe smoking history was assessed using a validated questionnaire. All participants underwent spirometry, and IOS and absolute and percentage predicted results (for age, sex, height, and weight) were compared between WPS and nonsmokers. The association of IOS parameters with waterpipe smoking duration and extent (waterpipe smoked/day * smoking duration) was evaluated using linear regression. RESULTS WPS smoked on average 1.8 ± 1.2 waterpipes/day, over an average duration of 23.3 ± 39.8 years. WPS and nonsmokers were largely asymptomatic and had similar age, body mass index, sex distribution, and spirometric values. Nevertheless, WPS had higher IOS measured resistance at 5Hz compared to nonsmokers, (0.53 ± 0.2 vs. 0.48 ± 0.2 kPa/L/s, P = 0.03) and higher percentage-predicted resistance (124.5 ± 36.3 vs. 115.7% ± 35.6%, P = 0.04). Waterpipe smoking duration was also associated with resistance (β = 0.04 kPa/L/s/year, P = 0.01) and with percentage-predicted resistance (β = 0.05/year, P = 0.02). Waterpipe smoking extent was associated with resistance (β = 0.009 kPa/L/s/waterpipe-year, P = 0.04), while the association with percentage-predicted resistance was near significance (β = 0.009/waterpipe-year, P = 0.07). CONCLUSIONS Waterpipe smoking is associated with increased airway resistance assessed by IOS but not by spirometry in largely asymptomatic individuals from the community.
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Affiliation(s)
- Hassan A. Chami
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America, Beirut, Lebanon
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Nourhan Houjeij
- Department of Nephrology, Saint Louis University, St Louis, Missouri, United States of America
| | - Maha Makki
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Itani
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Al Mulla
- Tobacco Control Center, WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bartolome Celli
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Salah Zeineldine
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
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Arishi H, AlQahtani S, Tamim H, Sadat M, Alenezi FZ, Bin Humaid F, AlWehaibi W, Arabi YM. Combination of norepinephrine with phenylephrine versus norepinephrine with vasopressin in critically ill patients with septic shock: A retrospective study. J Crit Care 2022; 72:154121. [PMID: 35908329 DOI: 10.1016/j.jcrc.2022.154121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the outcomes of patients with septic shock treated with a combination of norepinephrine with phenylephrine compared to norepinephrine with vasopressin. MATERIALS AND METHODS This was a retrospective cohort study including adults admitted between 2002 and 2017 with septic shock according to the Sepsis 3 criteria. We compared outcomes of patients treated with norepinephrine with phenylephrine to those treated with norepinephrine with vasopressin. Multivariate analysis was carried out to evaluate the association of norepinephrine with phenylephrine compared to norepinephrine with vasopressin with in-hospital mortality. RESULTS During the study period, 158 patients with septic shock were treated with norepinephrine with phenylephrine and 129 with norepinephrine with vasopressin. Crude in-hospital mortality was not different between the two groups [91/158 (57.6%) versus 80/129 (62.5%), p = 0.40]. There was also no difference in ICU length of stay or hospital length of stay. Multivariate analysis demonstrated no significant association of norepinephrine with phenylephrine with in-hospital mortality compared to norepinephrine with vasopressin (OR 0.62 (95% confidence interval 0.31, 1.23, p = 0.17). CONCLUSION Phenylephrine used as a second-line vasoactive agent combined with norepinephrine may be a reasonable option compared to vasopressin. However, this finding needs to be validated in a randomized controlled trial.
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Affiliation(s)
- Hatim Arishi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Samah AlQahtani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hani Tamim
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon; AlFaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Farhan Zayed Alenezi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Felwa Bin Humaid
- King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Wedyan AlWehaibi
- King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
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Geagea L, Ghanimé PM, El Hayek S, Kobeissy F, Tamim H, Elbejjani M, Talih F. Assessing cognitive behavioral therapy for insomnia in individuals with cannabis use disorder utilizing actigraphy and serum biomarkers: A pilot study. Sleep Med 2022; 100:434-441. [PMID: 36244318 DOI: 10.1016/j.sleep.2022.09.017] [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] [Received: 03/21/2022] [Revised: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/BACKGROUND This pilot study aims to assess the effect of Cognitive Behavioral Therapy for insomnia (CBTi) in individuals with cannabis use disorder and insomnia. It also aims to investigate the effect of CBTi on levels of serum inflammatory markers in relation to insomnia symptoms. METHODS/PATIENTS Individuals with cannabis use disorder and insomnia symptoms were recruited over 18 months. Data collected included demographics, self-reported sleep parameters, and cannabis use. Blood samples were drawn to measure IL-2, IL-6, CRP, and cortisol. Participants completed the Insomnia Severity Index questionnaire (ISI) and the Patient Health Questionnaire-4 (PHQ-4), and they were provided with an actigraphy (wrist) device for 1 week before CBTi and a subsequent week after completing the 4 CBTi sessions. RESULTS Nineteen participants were enrolled in the study. The mean ISI score decreased from moderately severe insomnia at baseline to no clinically significant insomnia after CBTi with a sustained decrease at 3- and 6-months follow-up. Actigraphy showed a significant decrease in sleep onset latency (SOL) after CBTi. Three months after CBTi, 80% of participants reported a decrease in their cannabis use. There was also a significant and sustained decrease in mean PHQ-4 scores after CBTi. Although only trending towards significance, the levels of three out of four biomarkers (IL-2, IL-6, CRP) were decreased 6 months after CBTi. CONCLUSIONS CBTi is effective as a short- and long-term treatment of insomnia and comorbid anxiety/depression in individuals who regularly use cannabis. A potential added benefit is a reduction in cannabis consumption and inflammatory serum biomarkers.
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Affiliation(s)
- Luna Geagea
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Pia Maria Ghanimé
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, United States
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute and Department of Internal Medicine, American University of Beirut, Lebanon
| | - Martine Elbejjani
- Clinical Research Institute and Department of Internal Medicine, American University of Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
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Ghossoub E, Hayek SE, Trad K, Maalouf FT, Tamim H. Association between Cannabis Use Disorder and Self- and Other-Directed Aggression. J Am Acad Psychiatry Law 2022; 50:590-599. [PMID: 36180127 DOI: 10.29158/jaapl.220002-21] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Cannabis is the most widely used drug worldwide. Data about the association of cannabis use with aggression is heterogeneous. The objective of the current study was to assess the nature of the association between cannabis use disorder (CUD) and self-directed, other-directed, and combined aggression. We used data from the National Survey on Drug Use and Health across 2008 to -2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios (ORs) for those having CUD perpetrating each form of aggression compared with no aggression and other-directed compared with self-directed aggression. CUD was associated with significantly increased odds of committing other-directed (adjusted OR [aOR] = 1.42, 95 percent CI = 1.26-1.60) and combined aggression (aOR = 2.11, 95 percent CI = 1.36-3.26) compared with no aggression. CUD was associated with a nonstatistically significant risk of other-directed compared with self-directed aggression (aOR = 1.29, 95 percent CI = .97-1.69). In those 18 to 25 years old, CUD was significantly associated with an increased differential risk of other-directed versus self-directed aggression (aOR = 1.29, 95 percent CI = 1.03-1.62). Cannabis use disorder seems to increase the risk of other-directed aggression compared with self-directed aggression, especially among youths.
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Affiliation(s)
- Elias Ghossoub
- Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Hayek is Addiction Psychiatry Fellow at the University of Miami Jackson Health System, Miami, FL. Mr. Trad is a Medical Student, Lebanese American University, Byblos, Lebanon. Dr. Maalouf is Associate Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Tamim is Professor, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
| | - Samer El Hayek
- Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Hayek is Addiction Psychiatry Fellow at the University of Miami Jackson Health System, Miami, FL. Mr. Trad is a Medical Student, Lebanese American University, Byblos, Lebanon. Dr. Maalouf is Associate Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Tamim is Professor, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalid Trad
- Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Hayek is Addiction Psychiatry Fellow at the University of Miami Jackson Health System, Miami, FL. Mr. Trad is a Medical Student, Lebanese American University, Byblos, Lebanon. Dr. Maalouf is Associate Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Tamim is Professor, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Fadi T Maalouf
- Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Hayek is Addiction Psychiatry Fellow at the University of Miami Jackson Health System, Miami, FL. Mr. Trad is a Medical Student, Lebanese American University, Byblos, Lebanon. Dr. Maalouf is Associate Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Tamim is Professor, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Hayek is Addiction Psychiatry Fellow at the University of Miami Jackson Health System, Miami, FL. Mr. Trad is a Medical Student, Lebanese American University, Byblos, Lebanon. Dr. Maalouf is Associate Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Tamim is Professor, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Alqahtani SA, Gurakar A, Tamim H, Schiano TD, Bonder A, Fricker Z, Kazimi M, Eckhoff DE, Curry MP, Saberi B. Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades. J Clin Transl Hepatol 2022; 10:814-824. [PMID: 36304492 PMCID: PMC9547266 DOI: 10.14218/jcth.2021.00538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Liver organ shortage remains a major health burden in the US, with more patients being waitlisted than the number of liver transplants (LTs) performed. This study investigated US national and regional trends in living donor LT (LDLT) and identified factors associated with recipient survival. METHODS We retrospectively analyzed LDLT recipients and donors from the United Network Organ Sharing/Organ Procurement Transplant Network database from 1998 until 2019 for clinical characteristics, demographic differences, and survival rate. National and regional trends in LDLT, recipient outcomes, and predictors of survival were analyzed. RESULTS Of the 223,571 candidates listed for an LT, 57.5% received an organ, of which only 4.2% were LDLTs. Annual adult LDLTs first peaked at 412 in 2001 but experienced a significant decline to 168 by 2009. LDLTs then gradually increased to 445 in 2019. Region 2 had the highest LDLT numbers (n=919), while region 1 had the highest proportion (11.1%). Overall, post-LT mortality was 21.4% among LDLT recipients. Post-LDLT survival rates after 1-, 5-, and 10-years were 92%, 87%, and 70%, respectively. Interval analysis (2004-2019) showed that patients undergoing LDLT in recent years had lower mortality than in earlier years (hazard ratio=0.81, 95% confidence interval=0.75-0.88). CONCLUSIONS Following a substantial decline after a peak in 2001, the number of adult LDLTs steadily increased from 2011 to 2019. However, LDLTs still constitute the minority of the transplant pool in the US. Life-saving policies to increase the use of LDLTs, particularly in regions of high organ demand, should be implemented.
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Affiliation(s)
- Saleh A. Alqahtani
- Johns Hopkins University, Division of Gastroenterology and Hepatology, Baltimore, MD, USA
| | - Ahmet Gurakar
- Johns Hopkins University, Division of Gastroenterology and Hepatology, Baltimore, MD, USA
| | - Hani Tamim
- American University of Beirut, Department of Internal Medicine, Beirut, Lebanon
| | - Thomas D. Schiano
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, NY, USA
| | - Alan Bonder
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zachary Fricker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marwan Kazimi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Devin E. Eckhoff
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael P. Curry
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Behnam Saberi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Correspondence to: Behnam Saberi, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center. Harvard Medical School, 375 Longwood Ave, Room 425, Boston, MA 02215, USA. ORCID: https://orcid.org/0000-0002-7157-5827. E-mail:
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Tfaily MA, Tamim H, El Hajj A, Mukherji D. Muscle invasive bladder cancer and radical cystectomy: a risk predictive model. Ecancermedicalscience 2022; 16:1456. [PMID: 36405942 PMCID: PMC9666275 DOI: 10.3332/ecancer.2022.1456] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Radical cystectomy (RC) for muscle invasive bladder cancer (MIBC) remains the historical gold standard for treatment despite significant perioperative morbidity and subsequent quality of life concerns. Trimodal therapy (TMT) is gaining acceptance as an alternative bladder preserving approach. We aim to identify patients for whom TMT may be the optimal approach by constructing risk calculators of morbidity and mortality associated with RC. Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, we selected patients diagnosed with MIBC undergoing RC, with a total of 10,642 patients identified. The primary outcome was mortality and secondary outcome was morbidity within 30 days of the procedure. We conducted multivariate logistic regression to obtain the best fit model for each outcome on 70% of the sample. Validation of the models was then performed on the remaining 30% of the sample. Model performance was assessed using discrimination and calibration abilities and a risk calculator was constructed for pre-operative counselling. Results Of the full cohort, 199 patients (1.9%) died and 2,328 patients (21.9%) experienced morbidity. Variables selected for the model predicting mortality included age, frailty, the American Society of Anesthesiologists status and preoperative creatinine. For the mortality model, the area under the curve was 72% with a Hosmer–Lemeshow statistic of 0.722. For the morbidity model, the area under the curve was 60% with a Hosmer–Lemeshow statistic of 0.287. Variables significant in the model included continent diversion, smoking and frailty. Conclusion We have constructed statistically significant and clinically relevant models using readily available health indicators to be used in multi-disciplinary discussion to provide high-risk patients with individualised risks of morbidity and mortality from RC, allowing for counselling for alternative treatments such as TMT.
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Affiliation(s)
- Mohamad Ali Tfaily
- Department of Internal Medicine, Emory University, Atlanta, GA 30322, USA
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Wazir A, Tamim H, Wakil C, Sawaya RD. Misdiagnosis of Pediatric Concussions in the Emergency Department: A Retrospective Study. Pediatr Emerg Care 2022; 38:e1641-e1645. [PMID: 35477571 DOI: 10.1097/pec.0000000000002714] [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: 11/26/2022]
Abstract
OBJECTIVE We aimed to determine the rate and predictors of correctly diagnosed concussions in the pediatric emergency department and to describe the characteristics, presentation, and management of concussions in children presenting for minor head injury. METHODS We included 186 patients aged 5 to 18 years presenting within 24 hours of minor head injuries and met our diagnostic criteria for concussion. We compared patients correctly diagnosed with a concussion with those who were not. Our main outcome was the rate and predictors of misdiagnoses. RESULTS Of the patients, 5.4% were correctly diagnosed. Amnesia was the only variable associated with correct diagnoses (40.0% vs 10.2%, P = 0.02). The most common mechanism of injury was fall (8.4%); the most frequent symptoms were nausea/vomiting (42.5%), and 48.4% had a brain computed tomography scan done. CONCLUSIONS The high rate of concussion misdiagnosis puts into question the usability of current concussion guidelines, their accuracy, and barriers to translation into clinical practice.
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Affiliation(s)
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Dakik L, Basbous M, Tamim H, Moubarak Y, Tarek N, Hamideh D, Muwakkit S, Abboud M, Saab R. Vincristine-induced neurotoxicity in pediatric patients with rhabdomyosarcoma: A retrospective analysis of clinical features and outcome. Pediatr Hematol Oncol 2022; 39:644-649. [PMID: 35262458 DOI: 10.1080/08880018.2022.2047849] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vincristine is an essential component of rhabdomyosarcoma treatment. However, it can cause motor neurotoxicity, necessitating dose reductions. We retrospectively reviewed the rates and patterns of vincristine-induced motor neuropathy in children treated for rhabdomyosarcoma, and investigated effects on outcome. Fifteen of 43 patients (35%) developed motor neuropathies necessitating dose reductions, which ranged from 1.7% to 58% of planned cumulative dose. Older age was the only significant clinical risk factor. Almost half (47%) recovered during treatment with subsequent dose escalation. Most patients had complete resolution of symptoms upon follow-up. There was no discernible effect of treatment reduction on survival or relapse rates.
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Affiliation(s)
- Lama Dakik
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maya Basbous
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Yacoub Moubarak
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Tarek
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dima Hamideh
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Muwakkit
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miguel Abboud
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Saab
- Department of Pediatrics, Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Ayoub CH, El-Asmar JM, Abou Heidar NF, Najm N, Nasrallah AA, Tamim H, Dakik HA, El Hajj A. A novel radical prostatectomy specific index (PSI) for the prediction of major cardiovascular events following surgery. Int Urol Nephrol 2022; 54:3069-3078. [PMID: 35982275 DOI: 10.1007/s11255-022-03293-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate cancer patients tend to be older with multiple comorbidities and are thus at increased risk for postoperative cardiovascular events after radical prostatectomy (RP). Thus, proper patient selection strategies are essential to decide for or against a surgical approach. We aimed to derive a prostatectomy specific index (PSI) for patients undergoing RP and compare its performance to universally used indices. METHODS The cohort was derived from National Surgical Quality Improvement Program database between 2005 and 2012. The primary outcome was incidence of major adverse cardiovascular events at 30 days post-surgery including: death, myocardial infarction, or stroke. A multivariable logistic regression model was constructed, performance and calibration were evaluated using a ROC analysis and the Hosmer-Lemeshow test, the PSI index was derived and compared to the RCRI and AUB-HAS2 indices. RESULTS A total of 17,299 patients were included in our cohort, with a mean age of 62 ± 7.4 years. Seventy three patients had a cardiac event post RP. The final PSI index encompassed six variables: history of heart disease, age, anemia, American society of anesthesiology class, surgical approach, and hypertension. The PSI ROC analysis provided C-statistic = 0.72, calibration R2 = 0.99 and proper goodness of fit. In comparison, the C-statistics of RCRI and AUB-HAS2 were found to be 0.57 and 0.65, respectively (p value < 0.001). CONCLUSION The PSI model is a procedure tailored index for prediction of major cardiovascular events post RP. It was calibrated using a large national database aiming to optimize treatment selection strategies for prostate cancer patients.
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Affiliation(s)
- Christian H Ayoub
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Nicolas Najm
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Ali A Nasrallah
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
| | - Habib A Dakik
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
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Nasrallah M, Tamim H, Mailhac A, AlBuhairan F. Lifestyle habits in Saudi adolescents with diagnosed diabetes: An opportunity for health promotion. PLoS One 2022; 17:e0270807. [PMID: 35925967 PMCID: PMC9352005 DOI: 10.1371/journal.pone.0270807] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
Aims This study assessed lifestyle and health behavior habits among a representative sample of Saudi adolescents with self-reported diabetes and compared them to non-diabetic peers. Methods This was a nested case-control study, from the Jeeluna cohort, a nationwide, cross-sectional study of 12,575 Saudi boys and girls aged 10–19 years. Non-diabetic adolescents were matched to those with diabetes on a ratio of 4:1 based on age, gender and region. Retained information from the original study included: socio-demographics, lifestyle behaviors, tobacco/substance use, screen use, anthropometric measurements, and laboratory results. Results The prevalence of diabetes was 0.7% (n = 87). Overall, 65% of diabetic participants were males, and 22.4% aged ≤14 years. Overall, both groups had low rates of healthful habits in their diet and physical activity. Both groups had similar rates of tobacco use, and high digital screen time. Adolescents with diabetes had more consistent sleeping pattern, were more likely to be on a diet, thought they spent enough time with their physician and obtained medical information more often from their health clinic. They were also more likely to feel down and to chat more often. Conclusion Adolescents with diabetes remain far from guideline targets but seem predisposed to better lifestyle and have more access to health as compared to their non-diabetic peers.
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Affiliation(s)
- Mona Nasrallah
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadia AlBuhairan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Health Sector Transformation Program, Riyadh, Saudi Arabia
- * E-mail:
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Chebl RB, Assaf M, Kattouf N, Haidar S, Khamis M, Abdeldaem K, Makki M, Tamim H, Dagher GA. The association between the neutrophil to lymphocyte ratio and in-hospital mortality among sepsis patients: A prospective study. Medicine (Baltimore) 2022; 101:e29343. [PMID: 35905272 PMCID: PMC9333497 DOI: 10.1097/md.0000000000029343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Neutrophil to lymphocyte ratio (NLR) was shown to be associated with disease severity, poor prognosis and increased mortality in sepsis. However, the association between NLR and sepsis prognosis remains controversial. Our study aims to prospectively examine the prognostic ability of NLR in predicting in-hospital mortality among sepsis patients and determine the optimal cutoff of NLR that can most accurately predict in-hospital mortality in sepsis patients. This study was a prospective cohort study that included adult sepsis patients that presented to the emergency department of a tertiary care center between September 2018 and February 2021. Receiver operating characteristic curve was used to determine the optimal cutoff of the neutrophil to lymphocyte ratio that predicts in-hospital mortality. Patients were divided into 2 groups: above and below the optimal cutoff. Stepwise logistic regression was performed to assess the magnitude of the association between NLR and in-hospital mortality. A total of 865 patients were included in the study. The optimal cutoff for the neutrophil to lymphocyte ratio that predicts in-hospital mortality was found to be 14.20 with a sensitivity of 44.8% and a specificity of 65.3% (with PPV = 0.27 and NPV = 0.80). The area under the curve for the ratio was 0.552 with a 95% confidence intervals = [0.504-0.599] with a P value = .03. Patients that have a NLR above the cutoff were less likely to survive with time compared to patients below the cutoff based on the Kaplan-Meier curves. In the stepwise logistic regression, the optimal neutrophil to lymphocyte ratio cutoff was not associated with in-hospital mortality (odds ratios = 1.451, 95% confidence intervals = [0.927-2.270], P = .103). In conclusion the optimal cutoff of the NLR that predicts in-hospital mortality among sepsis patients was 14.20. There was no association between the NLR and in-hospital mortality in sepsis patients after adjusting for confounders. Further studies with a larger sample size should be done to determine the optimal NLR cutoff and its prognostic role in septic patients (in-hospital mortality and other clinically significant outcomes).
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Affiliation(s)
- Ralph Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Assaf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadim Kattouf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Saadeddine Haidar
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamed Khamis
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Karim Abdeldaem
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
- *Correspondence: Gilbert Abou Dagher, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236 Riad El Solh, Beirut 1107 2020, Lebanon (e-mail: )
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Fahs A, Hussein N, Zalzali H, Ramadan F, Ghamloush F, Tamim H, El Homsi M, Badran B, Boulos F, Tawil A, Ghayad SE, Saab R. CD147 Promotes Tumorigenesis via Exosome-Mediated Signaling in Rhabdomyosarcoma. Cells 2022; 11:cells11152267. [PMID: 35892564 PMCID: PMC9331498 DOI: 10.3390/cells11152267] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Rhabdomyosarcoma (RMS) is an aggressive childhood soft-tissue tumor, with propensity for local invasion and distant metastasis. Exosomes are secreted vesicles that mediate paracrine signaling by delivering functional proteins and miRNA to recipient cells. The transmembrane protein CD147, also known as Basigin or EMMPRIN, is enriched in various tumor cells, as well as in tumor-derived exosomes, and has been correlated with poor prognosis in several types of cancer, but has not been previously investigated in RMS. We investigated the effects of CD147 on RMS cell biology and paracrine signaling, specifically its contribution to invasion and metastatic phenotype. CD147 downregulation diminishes RMS cell invasion and inhibits anchorage-independent growth in vitro. While treatment of normal fibroblasts with RMS-derived exosomes results in a significant increase in proliferation, migration, and invasion, these effects are reversed when using exosomes from CD147-downregulated RMS cells. In human RMS tissue, CD147 was expressed exclusively in metastatic tumors. Altogether, our results demonstrate that CD147 contributes to RMS tumor cell aggressiveness, and is involved in modulating the microenvironment through RMS-secreted exosomes. Targeted inhibition of CD147 reduces its expression levels within the isolated exosomes and reduces the capacity of these exosomes to enhance cellular invasive properties.
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Affiliation(s)
- Assil Fahs
- Department of Biology, Faculty of Science II, Lebanese University, Fanar P.O. Box 90656, Lebanon; (A.F.); (F.R.)
- Laboratory of Cancer Biology and Molecular Immunology, Department of Chemistry and Biochemistry, Faculty of Science I, Lebanese University, Hadat 1003, Lebanon; (N.H.); (M.E.H.); (B.B.)
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Nader Hussein
- Laboratory of Cancer Biology and Molecular Immunology, Department of Chemistry and Biochemistry, Faculty of Science I, Lebanese University, Hadat 1003, Lebanon; (N.H.); (M.E.H.); (B.B.)
| | - Hasan Zalzali
- Department of Pediatrics & Adolescent Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (H.Z.); (F.G.)
| | - Farah Ramadan
- Department of Biology, Faculty of Science II, Lebanese University, Fanar P.O. Box 90656, Lebanon; (A.F.); (F.R.)
- Laboratory of Cancer Biology and Molecular Immunology, Department of Chemistry and Biochemistry, Faculty of Science I, Lebanese University, Hadat 1003, Lebanon; (N.H.); (M.E.H.); (B.B.)
| | - Farah Ghamloush
- Department of Pediatrics & Adolescent Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (H.Z.); (F.G.)
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
- College of Medicine, Alfaisal University, Riyadh 11564, Saudi Arabia
| | - Mahmoud El Homsi
- Laboratory of Cancer Biology and Molecular Immunology, Department of Chemistry and Biochemistry, Faculty of Science I, Lebanese University, Hadat 1003, Lebanon; (N.H.); (M.E.H.); (B.B.)
| | - Bassam Badran
- Laboratory of Cancer Biology and Molecular Immunology, Department of Chemistry and Biochemistry, Faculty of Science I, Lebanese University, Hadat 1003, Lebanon; (N.H.); (M.E.H.); (B.B.)
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (F.B.); (A.T.)
| | - Ayman Tawil
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (F.B.); (A.T.)
| | - Sandra E. Ghayad
- Department of Biology, Faculty of Science II, Lebanese University, Fanar P.O. Box 90656, Lebanon; (A.F.); (F.R.)
- C2VN, INSERM 1263, INRAE 1260, Aix-Marseille University, CEDEX 5, 13385 Marseille, France
- Correspondence: (S.E.G.); (R.S.); Tel.: +33-491835601 (S.E.G.); +961-1-350000 (ext. 4780) (R.S.); Fax: +33-491835602 (S.E.G.); +961-1-377384 (R.S.)
| | - Raya Saab
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
- Department of Pediatrics & Adolescent Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (H.Z.); (F.G.)
- Correspondence: (S.E.G.); (R.S.); Tel.: +33-491835601 (S.E.G.); +961-1-350000 (ext. 4780) (R.S.); Fax: +33-491835602 (S.E.G.); +961-1-377384 (R.S.)
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Sagherian BH, Hoballah JJ, Tamim H. Comparing the 30-Day Complications Between Smokers and Nonsmokers Undergoing Surgical Fixation of Ankle Fractures. Foot & Ankle Orthopaedics 2022; 7:24730114221115677. [PMID: 35959141 PMCID: PMC9358578 DOI: 10.1177/24730114221115677] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: There have been conflicting reports regarding the effect of smoking on complications after surgical treatment of ankle fractures. This study aimed at identifying the complications for which smokers and subgroups of smokers are at a higher risk compared to nonsmokers when undergoing surgery for fixation of rotational ankle fractures. Methods: The American College of Surgeons National Surgical Quality Improvement Program data set from 2008 to 2019 was used to compare the 30-day wound, cardiac, renal, and infectious complications, related readmissions, and return to the operating room between the 2 cohorts. Results: Of 33 741 patients included, 25 642 (76.0%) were nonsmokers and 8099 (24.0%) were smokers. Multivariate analysis showed that smokers were at a higher risk for deep wound infection (OR 2.34, 95% CI 1.48-3.69, P < .001), wound dehiscence (OR 2.43, 95% CI 1.56-3.77, P < .001), related return to the operating room (OR 1.69, 95% CI 1.36-2.11, P < .001), and related readmissions (OR 1.67, 95% CI 1.32-2.09, P < .001). Smokers at an increased risk for deep infection included patients between 50 and 59 years (OR 5.75, 95% CI 1.78-18.5, P = .003), who were Black (OR 4.24, 95% CI 1.04-17.23, P = .044), who had body mass index (BMI) 35 to 39.9 (OR 3.73, 95% CI 1.46-9.50, P = .006), or operative times between 60 and 90 minutes (OR 3.64, 95% CI 1.79-7.39, P < .001). Smoker subgroups at a higher risk for wound dehiscence included patients between 50 and 59 years (OR 9.86, 95% CI 3.29-29.53, P < .001), with operative times between 90 and 120 minutes (OR 4.88, 95% CI 1.89-12.58, P < .001), with BMI 30 to 34.9 (OR 3.06, 95% CI 1.45-6.45, P = .003) and who underwent spinal/epidural anesthesia (OR 9.31, 95% CI 2.31-37.58, P = .002). Conclusion: Smokers were at an increased risk for deep wound infection, wound dehiscence, related reoperations, and related readmissions after ankle fracture surgery. Certain subgroups were at an even higher risk for these complications. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Bernard H. Sagherian
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jawad J. Hoballah
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit in the Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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