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Mitchell DN, Beams DR, Chorney SR, Kou YF, Liu P, Dabbous H, Johnson RF. Neighborhood Socioeconomic Disadvantage and Long-Term Outcomes After Pediatric Tracheostomy. Laryngoscope 2024; 134:2415-2421. [PMID: 37850858 DOI: 10.1002/lary.31117] [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: 06/06/2023] [Revised: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES To determine whether long-term outcomes after pediatric tracheostomy are impacted by neighborhood socioeconomic disadvantage. METHODS A prospective cohort of children with tracheostomies was followed at an academic pediatric hospital between 2015 and 2020. Patients were grouped into low or high socioeconomic disadvantage using their neighborhood area deprivation index (ADI). Survival and logistic regression analyses determined the relationship between ADI group, decannulation, and mortality. RESULTS A total of 260 children were included with a median age at tracheostomy of 6.6 months (interquartile range [IQR], 3.9-42.3). The cohort was 53% male (N = 138), 55% White race (N = 143), and 35% Black or African American (N = 90). Tracheostomy was most frequently indicated for respiratory failure (N = 189, 73%). High neighborhood socioeconomic disadvantage was noted for 66% of children (N = 172) and 61% (N = 158) had severe neurocognitive disability. ADI was not associated with time to decannulation (HR = 0.90, 95% confidence interval [95% CI]: 0.53-1.53) or time to death (HR = 0.92, 95% CI: 0.49-1.72). CONCLUSIONS Neighborhood socioeconomic disadvantage was not associated with decannulation or mortality among children with a tracheostomy. These findings suggest that long-term outcomes after pediatric tracheostomy are less dependent on socioeconomic factors in an individual community. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2415-2421, 2024.
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Affiliation(s)
- Dalia N Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Dylan R Beams
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Pamila Liu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Helene Dabbous
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A
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Sheen D, Houser TK, Olsson SE, Dabbous H, Kou Y, Johnson RF, Chorney SR. Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery. OTO Open 2024; 8:e142. [PMID: 38689853 PMCID: PMC11058695 DOI: 10.1002/oto2.142] [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: 11/08/2023] [Revised: 03/16/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Objective To determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery. Study Design Retrospective case-control. Setting Tertiary children's hospital. Methods Consecutive children (<5 years) between 2012 and 2022 with UVCP after cardiac surgery were included. Resolution of thin liquid aspiration after IL versus observation was determined for children obtaining videofluoroscopic swallow studies (VFSS). Results A total of 32 children with left UVCP after cardiac surgery met inclusion. Initial surgeries were N = 9 (28%) patent ductus arteriosus ligations, N = 7 (22%) aortic arch surgeries, N = 9 (28%) surgeries for hypoplastic left heart syndrome, and N = 7 (22%) other cardiac surgeries. The mean age at initial surgery was 1.8 months (SD: 3.7). All children had a VFSS obtained after surgery that confirmed aspiration. There were 17 children that obtained an IL at 33.6 months (SD: 20.9) after cardiac surgery and 15 children observed without IL procedure. No surgical complications after IL were noted. The rate of aspiration resolution based on postoperative VFSS was N = 14 (82%) for the IL group and N = 9 (60%) for the control group P = .24. Documented VFSS aspiration resolution after cardiac surgery occurred by 9.6 months (SD: 10.0) in the observation group and 47.4 months (SD: 24.1) in the IL group (P < .001). Conclusion IL can help treat aspiration in children with UVCP after cardiac surgery but the benefit beyond observation remains unclear. Future studies should continue to explore the utility for IL in managing dysphagia in this pediatric population.
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Affiliation(s)
- Derek Sheen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Thomas K. Houser
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sofia E. Olsson
- Burnett School of Medicine at Texas Christian UniversityFort WorthTexasUSA
| | - Helene Dabbous
- Department of Otolaryngology–Head and Neck SurgeryWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Yann‐Fuu Kou
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's HealthDallasTexasUSA
| | - Romaine F. Johnson
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's HealthDallasTexasUSA
| | - Stephen R. Chorney
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's HealthDallasTexasUSA
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Suresh R, Dabbous H, Alahari S, Kou Y, Johnson RF, Chorney SR. Tracheal A-frame deformity and suprastomal collapse after pediatric tracheostomy. Laryngoscope Investig Otolaryngol 2024; 9:e1202. [PMID: 38362191 PMCID: PMC10866584 DOI: 10.1002/lio2.1202] [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: 08/16/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024] Open
Abstract
Objectives To determine the incidence of A-frame deformity and suprastomal collapse after pediatric tracheostomy. Study design Retrospective cohort. Methods All patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children without a surveillance bronchoscopy at least 6 months after tracheostomy were excluded. Operative reports identified tracheal A-frame deformity or suprastomal collapse. Results A total of 175 children met inclusion with 18% (N = 32) developing A-frame deformity within a mean of 35.8 months (SD: 19.4) after tracheostomy. For 18 children (18/32, 56%), A-frame developed within a mean of 11.3 months (SD: 15.7) after decannulation. There were 96 children developing suprastomal collapse (55%) by a mean of 17.7 months (SD: 14.2) after tracheostomy. All suprastomal collapse was identified prior to decannulation. Older age at tracheostomy was associated with a lower likelihood of collapse (OR: 0.92, 95% CI: 0.86-0.99, p = .03). The estimated 5-year incidence of A-frame deformity after tracheostomy was 32.8% (95% CI: 23.0-45.3) and the 3-year incidence after decannulation was 36.1% (95% CI: 24.0-51.8). Highly complex children had an earlier time to A-frame development (p = .04). At 5 years after tracheostomy, the estimated rate of suprastomal collapse was 73.7% (95% CI: 63.8-82.8). Conclusions Tracheal A-frame deformity is estimated to occur in 36% of children within 3 years after tracheostomy decannulation. Suprastomal collapse, which approaches 74% at 5 years after tracheostomy, is more common when tracheostomy is placed at a younger age. Surgeons caring for tracheostomy-dependent children should recognize acquired airway obstruction and appropriately monitor these outcomes. Level of evidence 3.
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Affiliation(s)
- Rishi Suresh
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Helene Dabbous
- Department of Otolaryngology‐Head and Neck SurgeryWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Swapnika Alahari
- University of Texas Southwestern School of MedicineDallasTexasUSA
| | - Yann‐Fuu Kou
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Children's Medical Center Dallas, Department of Pediatric OtolaryngologyDallasTexasUSA
| | - Romaine F. Johnson
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Children's Medical Center Dallas, Department of Pediatric OtolaryngologyDallasTexasUSA
| | - Stephen R. Chorney
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Children's Medical Center Dallas, Department of Pediatric OtolaryngologyDallasTexasUSA
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Dabbous H, Chorney SR, Johnson RF, Kou YF. Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty. Laryngoscope 2024; 134:963-967. [PMID: 37458330 DOI: 10.1002/lary.30875] [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: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double-staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation and number of endoscopic interventions needed after dsLTP. METHODS A case series with chart review included children who underwent dsLTP at a tertiary children's hospital between 2008 and 2021. Rates of decannulation, time to decannulation, and number of interventions after dsLTP were recorded for children with high- or low-grade stenosis at the first bronchoscopy after stent removal. RESULTS Of the 65 children who were included, 88% had high-grade stenosis and 98% had a preoperative tracheostomy. Successful decannulation happened in 74% of the children, and 44% of the children were decannulated within 12 months of surgery. For children with low-grade stenosis at the first endoscopy after stent removal, 84% were successfully decannulated compared with 36% of the children with high-grade stenosis (p = 0.001). After dsLTP, children with high-grade stenosis required 7.5 interventions (SD: 3.3) compared with 4.0 interventions (SD: 3.0) for children with low-grade stenosis (p < 0.001). Decannulated children with high-grade stenosis necessitated more endoscopic procedures (7.0 vs. 3.7, p = 0.02). Time to decannulation was similar between children with high- and low-grade early postoperative stenosis (21.9 vs. 17.8 months, p = 0.63). CONCLUSIONS Higher grade stenosis identified on the first airway endoscopy after suprastomal stent removal is correlated with lower decannulation rates and more postoperative endoscopic interventions. Although time to decannulation was not impacted by early stenosis grade, surgeons might utilize these early airway findings to counsel families and prognosticate possible surgical success. LEVEL OF EVIDENCE 4 Laryngoscope, 134:963-967, 2024.
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Affiliation(s)
- Helene Dabbous
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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Narayanan AM, Dabbous H, St John R, Kou YF, Johnson RF, Chorney SR. Pediatric tracheostomy audiometric outcomes - A quality improvement initiative. Int J Pediatr Otorhinolaryngol 2023; 173:111694. [PMID: 37625278 DOI: 10.1016/j.ijporl.2023.111694] [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: 05/05/2023] [Revised: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Pediatric tracheostomy patients disproportionately experience hearing loss and are at risk for delayed identification due to their medical complexity. Nonetheless, protocols to monitor hearing in these children are lacking. This quality improvement (QI) initiative aimed to increase the rates of audiometric testing within 12 months of pediatric tracheostomy placement. METHODS A retrospective cohort study included children who underwent tracheostomy under 18 months of age between 2012 and 2020. Rates of audiometric assessments before and after QI project implementation (2015) were reported along with hearing loss characteristics. RESULTS A total of 253 children met inclusion. Before project initiation (2012-2014), 32% of children (28/87) obtained audiometric testing within 12 months after tracheostomy. During the first three years of implementation (2015-2017), 39% (38/97) were tested, while 55% (38/69) were tested during the subsequent three years (2018-2020) (P = .01). A passing newborn hearing screen was obtained for 70% of the 210 children with a recorded result, and 198 survived at least 12 months to receive audiometric testing at a median of 11.3 months (IQR: 6.2-22.8) after tracheostomy. Hearing loss was identified for 44% of children (N = 88), of which 42 children initially passed newborn hearing screen. A second assessment was obtained for 62% of children (123/198) at a median of 11.3 months (IQR: 4.5-17.5) after the initial test. In this group, 23% with a previously normal audiometric exam were found to have hearing loss (15/66). CONCLUSIONS QI initiatives designed to monitor hearing loss in children with a tracheostomy can result in improved rates of audiometric assessments. This population has disproportionately high rates of hearing loss, including delayed onset hearing loss making audiometric protocols valuable to address speech and language development delays.
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Affiliation(s)
- Ajay M Narayanan
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Helene Dabbous
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rachel St John
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Romaine F Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Stephen R Chorney
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA.
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6
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Kim J, Chorney SR, Kou YF, Dabbous H, Johnson RF. A Pediatric Tracheostomy Scorecard: A Quality Improvement Tool for Comparative Analysis. Laryngoscope 2023. [PMID: 37166149 DOI: 10.1002/lary.30746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Jenny Kim
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Helene Dabbous
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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Villalobos A, Xing M, Dabbous H, Aslanyan L, Bode A, Lilly M, Bercu Z, Kokabi N. Abstract No. 8 Comparative Effectiveness and Safety of Percutaneous Cryoablation and Microwave Ablation for T1a Renal Cell Carcinomas. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Montasser I, Ebada H, Faheem H, Dabbous H, Massoud Y, Salah M, Sakr M, Bahaa M, Monayeri ME, Meteini M. Plasma cell-rich acute rejection after living donor liver transplantation: Unusual or underestimated diagnosis? Journal of Liver Transplantation 2022. [DOI: 10.1016/j.liver.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hamdan AL, Dabbous H. Vocal Fold Paralysis Secondary to Subclavian Venous Thrombosis. J Voice 2020; 35:809.e11-809.e13. [PMID: 32089419 DOI: 10.1016/j.jvoice.2019.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
The etiology of vocal fold paralysis is multifaceted. One of the rare causes is internal jugular vein thrombosis secondary to central venous catheterization. The palsy is usually ipsilateral to the site of indwelled catheterization, self-limited and reversible. The authors of this manuscript report a rare case of contralateral recurrent laryngeal nerve palsy induced by subclavian vein thrombosis following central venous catheterization. The patient developed irreversible vocal fold paralysis that necessitated office-based injection laryngoplasty.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Helene Dabbous
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Maroun CA, Al Feghali K, Traboulsi H, Dabbous H, Abbas F, Dunya G, Ziade G, Mahfouz R, Youssef B, Tamim H, Geara F, Khalifeh I, Moukarbel RV. HPV-related oropharyngeal cancer prevalence in a middle eastern population using E6/E7 PCR. Infect Agent Cancer 2020; 15:1. [PMID: 31921331 PMCID: PMC6945694 DOI: 10.1186/s13027-019-0268-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background Given the paucity of data and widely variable rates that have been reported, the main objective of this study was to examine the prevalence of HPV-positivity in oropharyngeal squamous cell carcinoma (OPSCC) in Middle Eastern patients presenting to one of the region's largest tertiary care centers using polymerase chain reaction (PCR) amplification of the HPV E6/E7 oncogenes, a highly sensitive and specific method of detection. Methods Medical charts and archived pathological specimens were obtained for patients diagnosed with biopsy proven oropharyngeal cancer who presented to the American University of Beirut Medical Center between 1972 and 2017. DNA was extracted from paraffin-embedded specimens and tested for 30 high-risk and low-risk papilloma viruses using the PCR-based EUROarray HPV kit (EuroImmun). Results A total of 57 patients with oropharyngeal cancer were initially identified; only 34 met inclusion/exclusion criteria and were included in the present study. Most patients were males (73.5%) from Lebanon (79.4%). The most common primary tumor site was in the base of tongue (50%), followed by the tonsil (41.2%). The majority of patients (85.3%) tested positive for HPV DNA. Conclusion The prevalence of HPV-positivity amongst Middle Eastern OPSCC patients, specifically those from Lebanon, may be far greater than previously thought. The Lebanese population and other neighboring Middle Eastern countries may require a more vigilant approach towards HPV detection and awareness. On an international level, further research is required to better elucidate non-classical mechanisms of HPV exposure and transmission.
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Affiliation(s)
- Christopher A Maroun
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Karine Al Feghali
- 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Henri Traboulsi
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Helene Dabbous
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Fatmeh Abbas
- 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, 2nd Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Gabriel Dunya
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Georges Ziade
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Rami Mahfouz
- 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, 2nd Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Bassem Youssef
- 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- 4Biostatistics Unit, Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fady Geara
- 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Khalifeh
- 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, 2nd Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Roger V Moukarbel
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
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El-Meteini M, Sakr M, Eldorry A, Mohran Z, Abdelkader NA, Dabbous H, Montasser I, Refaie R, Salah M, Aly M. Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy? Transplant Proc 2019; 51:2451-2456. [PMID: 31358454 DOI: 10.1016/j.transproceed.2019.01.197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
Non-invasive methods have evolved as a surrogate for liver biopsy such as indirect markers (aspartate transaminase to platelet ratio index, fibro-α score), transient elastography (TE), and magnetic resonance elastography (MRE). The aim of this study is to prospectively compare the value of MRE, TE, and indirect markers in detecting and staging allograft fibrosis compared to liver biopsies in patients who have undergone living donor liver transplantation for complications related to hepatitis C virus. A total of 31 living donor liver transplantation recipients with hepatitis C virus recurrence underwent a liver biopsy, TE, and MRE within 3 months of a liver biopsy. Fibrosis was assessed according to the biopsy and staged according to Metavir criteria. There was a significant correlation between both MRE and fibro-α scores, as well as histologic classification by liver biopsy (P = .02, .002). The diagnostic accuracy of MRE and fibro-α scores in diagnosing significant fibrosis (F ≥ 3) was measured as the area under the curve (.708 and .833, respectively). Both methods showed good diagnostic performance. TE and aspartate transaminase to platelet ratio index were insignificantly correlated with the degree of fibrosis in liver biopsy (P value of .134, .535). At a cutoff value of 5.5 kPa, MRE predicted graft fibrosis (Metavir stage ≥ 3) with 71.43% sensitivity, 75% specificity, 45.5% positive predictive value, and 90% negative predictive value; at a cutoff value > 1.47, fibro-α scores predicted significant graft fibrosis (Metavir stage ≥ 3) with 85.7% sensitivity and 70.83% specificity, with a positive predictive value of 46.2% and a negative predictive value of 94.4%. These data suggest that non-invasive methods could be considered a reliable tool in assessing significant graft fibrosis post-living donor liver transplantation.
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Affiliation(s)
- M El-Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Sakr
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Eldorry
- Interventional Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Z Mohran
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N A Abdelkader
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H Dabbous
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - I Montasser
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R Refaie
- Internal Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - M Salah
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M Aly
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ibrahim D, Dabbous H, Abi Aad Y, Araj GF, Rizk NA. Simultaneous Brucella breast and pacemaker infection. IDCases 2019; 15:e00485. [PMID: 30701157 PMCID: PMC6348196 DOI: 10.1016/j.idcr.2019.e00485] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/26/2022] Open
Abstract
Infection with Brucella spp. is endemic to the Middle East and the eastern Mediterranean basin. Brucellosis can mimic infectious and non-infectious febrile illnesses and therefore it can pose a diagnostic challenge. A wide range of deep-seated infections have been ascribed to brucellosis including breast abscesses and infections of prosthetic endovascular devices. The latter are usually rare but difficult to treat short of excision of the infected device. Here, we present the case of a middle-aged Lebanese woman who presented with simultaneous breast abscesses and a pacemaker infection due to brucellosis. To our knowledge, a similar manifestation has not been reported in the literature.
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Affiliation(s)
- Dima Ibrahim
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Helene Dabbous
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yasmine Abi Aad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - George F Araj
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Pathology And Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Nesrine A Rizk
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Sabri A, Dabbous H, Dowli A, Barazi R. The airway in inhalational injury: diagnosis and management. Ann Burns Fire Disasters 2017; 30:24-29. [PMID: 28592930 PMCID: PMC5446904] [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: 10/05/2016] [Accepted: 12/15/2016] [Indexed: 06/07/2023]
Abstract
It is estimated that 13.000 to 22.000 individuals suffer from inhalational burns each year in the United States alone. Despite these high numbers, inhalational burns remain a major challenge to otolaryngologists. In this paper, a review of literature is presented in order to provide otolaryngologists with a systematic approach to patients with inhalational burns to optimize treatment, cost, morbidity and, most importantly, mortality. For this purpose, a broad PubMed search was conducted. The available literature was found to highlight the importance of airway management in terms of the timing of intubation, method of intubation, trachea-esophageal (TE) fistula formation and TE rupture. It also emphasizes the importance of carbon monoxide intoxication and prompt correction. Drugs such as heparin sulfate, N-acetylcysteine and albuterol have been proven to help in the treatment of patients with inhalational burns, and more research is currently underway with the purpose of developing chelating drugs that scavenge the toxic substances in the smoke before they can damage the airway.
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Affiliation(s)
- A. Sabri
- Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - H. Dabbous
- Medical School, American University of Beirut, Beirut, Lebanon
| | - A. Dowli
- Department of Surgery, Maine Medical Center, Portland, USA
| | - R. Barazi
- Department of Otolaryngology - Head and Neck Surgery, American University of Beirut, Beirut, Lebanon
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Mukhtar A, Dabbous H, El Sayed R, Aboulfetouh F, Bahaa M, Abdelaal A, Fathy M, El-Meteini M. A novel mutation of the ornithine transcarbamylase gene leading to fatal hyperammonemia in a liver transplant recipient. Am J Transplant 2013; 13:1084-1087. [PMID: 23551631 DOI: 10.1111/ajt.12146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 11/22/2012] [Accepted: 12/10/2012] [Indexed: 02/06/2023]
Abstract
Ornithine transcarbamylase (OTC) deficiency (OTCD) is an X-linked urea cycle disorder. Being an X-linked disease, the onset and severity of the disease may vary among female carriers. Some of them start to develop the disease early in life, whereas others remain asymptomatic throughout their lives. Our patient was a 42-year-old man who developed severe hyperammonemia and fatal brain edema after receiving a right lobe graft from an asymptomatic female living donor with unrecognized OTCD. The donor developed hyperammonemia and disturbed level of consciousness that was managed successfully by hemodialysis. Molecular testing of the OTC gene in the donor revealed a heterozygous nonsense mutation (c.429T>A) in exon 5.
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Affiliation(s)
- A Mukhtar
- Department of Anesthesia and Critical Care, Cairo University, Egypt
| | - H Dabbous
- Ain-Shams Center for Organ Transplant (ASCOT), Ain Shams University, Cairo, Egypt
| | - R El Sayed
- Department of Clinical and Chemical Pathology, Cairo University, Egypt
| | - F Aboulfetouh
- Department of Anesthesia and Critical Care, Cairo University, Egypt
| | - M Bahaa
- Ain-Shams Center for Organ Transplant (ASCOT), Ain Shams University, Cairo, Egypt
| | - A Abdelaal
- Ain-Shams Center for Organ Transplant (ASCOT), Ain Shams University, Cairo, Egypt
| | - M Fathy
- Ain-Shams Center for Organ Transplant (ASCOT), Ain Shams University, Cairo, Egypt
| | - M El-Meteini
- Ain-Shams Center for Organ Transplant (ASCOT), Ain Shams University, Cairo, Egypt
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el-Zayadi AR, Selim OE, Hamdy H, Dabbous H, Ahdy A, Moniem SA. Association of chronic hepatitis C infection and diabetes mellitus. Trop Gastroenterol 1998; 19:141-4. [PMID: 10228436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The aim of the study was to detect a possible aetiological association between chronic hepatitis C virus (HCV) infection and diabetes mellitus (DM). Among the 591 HCV seropositive chronic liver disease (CLD) patients, 150 (25.4%) had associated diabetes mellitus while only 25 of 223 HCV seronegatives (11.2%) were diabetics. The HCV seropositive patients were three times more likely to suffer from diabetes mellitus than those who were HCV seronegative and the results were highly significant (odds ratio = 2.7, CI = 1.7-4.4, P < 0.0001). Liver biopsy showed cirrhosis in 24 out of 53 (45.3%) HCV seropositive diabetics and 9/20 (45%) of the HCV seronegative diabetics. The association between the degree of liver disease and the development of diabetes mellitus did not differ statistically between the two groups. Islet cell antibody (ICA) was present in 44.4% of HCV seropositives compared to 73.3% of seronegative diabetics, while NIDDM showed 40% ICA positivity. Although ICA level was highest in HCV seronegative diabetics, the difference between the various groups was not significant statistically. About 29% of HCV seropositive diabetics were on insulin therapy while only 16% of HCV seronegative diabetics received insulin therapy. HCV seropositives were about 2 times more prone to require insulin therapy than HCV seronegatives (odds ratio = 2.0, CI = 1.2-5.7, P = 0.010). We conclude that chronic hepatitis C patients in Egypt are three times more likely to develop DM than HCV seronegative patients. Pancreatic beta -cells might be an extrahepatic target of HCV.
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Affiliation(s)
- A R el-Zayadi
- H. Dabbous Department of Tropical Medicine, Ain Shams University, Cairo, Egypt
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el-Zayadi AR, Selim O, Ibrahim EH, Hamdy H, Dabbous H, Ahdy A, Moneim SA. Does schistosomiasis play a role in the high sero prevalence of HCV antibody among Egyptians? Trop Gastroenterol 1997; 18:98-100. [PMID: 9385849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many studies have demonstrated a very high prevalence of HCV antibodies among blood donors (BD) and chronic liver disease (CLD) patients in Egypt. This high prevalence might be attributed to cross reactivity between HCV antibodies and schistosome antibodies. We decided to study the association and cross serology between the presence of anti-HCV and Schistosomal infection among BD and CLD patients. Sera of blood donors and CLD patients were tested for anti-HCV by second generation ELISA. Antibodies to Schistosoma species were quantified by IHA test. Two tailed z score was used to detect significant difference. To test for cross reactivity between the two antibodies 20 BD and 20 CLD patients positive for both HCV-antibody and schistosome antibody were taken as controls. Another 20 samples also served as a control group; 10 of them seropositive for HCV only and 10 positive for IHA for schistosomiasis alone. All were subjected to: 1) RIBA-2 confirmatory test 2) Adsorption of schistosome antibodies using 100 microgram schistosome antigens per 100 microliters serum 3) Both HCV-ELISA-2 and RIBA-2 were checked after adsorption. The titre of schistosome antibodies in positive sera ranged from 1:128 to 1:1536. HCV seroprevalence was more pronounced among antischistosomal positive sera. This was seen in both BD and CLD patients where antischistosomal positive sera were at double risk to show positive HCV antibody. After adsorption of schistosome antibody, there was no change in reactivity of both ELISA-2 and RIBA-2. We conclude that HCV antibodies were significantly higher in schistosomal antibody positive Egyptians, there was no cross reactivity between the two antibodies and the high prevalence could be due to HCV transmission during anti-bilharzial parenteral therapy or due to depressed cell mediated immunity associated with schistosomal infection.
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Affiliation(s)
- A R el-Zayadi
- Department of Tropical Medicine, Ain Shams University, Egypt
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17
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el-Zayadi A, Tawfik HS, Dabbous H, Abd el-Moneim SA. Microcalculi of the common bile duct: a misdiagnosed problem. Endoscopy 1997; 29:222. [PMID: 9201477 DOI: 10.1055/s-2007-1004169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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El-Zayadi A, Khalifa AA, El-Misiery A, Naser AM, Dabbous H, Aboul-Ezz AA. Evaluation of risk factors for intrafamilial transmission of HCV infection in Egypt. J Egypt Public Health Assoc 1997; 72:33-51. [PMID: 17265624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The objectives of this study were to define the prevalence of intrafamilial transmission of HCV and evaluate the risk factors in this setting. A cross-sectional, family-based seroepidemiological study was performed in Cairo Liver Center and Oncology Diagnostic Unit, Ain Shams University. A total of 102 index patients (72 males and 30 females) with type C chronic liver disease and their 305 family contacts were studied. Only 265 family contacts were eligible for the study as they showed no previous history of exposure to risk factors. Overall, 15 family contacts (5.7%) were positive for anti-HCV, indicating a lower anti-HCV prevalence among family contacts than the general population in Egypt. Spouses were at higher risk of infection (16.7%) than family members (2.6%). Among the repeatedly positive samples for anti-HCV, only 3 samples were HCV-RNA positive (1.1%), all were spouses. Logistic regression analysis revealed that spouses reporting promiscuous sexual relations were at higher risk than those with normal sexual relations. Contacts sharing personal objects were also at higher risk to develop HCV infection. Index cases reporting previous blood transfusion (18.6%), i.v. antibilharzial therapy (33.3%), multiple sex partners (1.0%) or advanced liver diseases were more infective to their family contacts. The contacts of index cases had increasing risk of HCV infection with increase in age and duration of contact. The prevalence rate of intrafamilial spread of HCV infection is low compared to the rate among general population, emphasizing its limited role in transmitting HCV infection. Long duration of sexual contact and promiscuous sexual activities were major risk factors in this setting.
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Abstract
Hepatitis C virus (HCV) genotype 4 is the principal HCV genotype found in Egypt and the Middle East. Little is known concerning its propensity to cause disease and the frequency with which infected individuals respond to interferon-alpha (IFN-alpha). We have investigated the response to treatment in a cohort of 100 chronic hepatitis C patients infected with genotype 4. All patients had biopsy-proven chronic active liver disease. Each was treated with 3 million units (MU) IFN-alpha, thrice weekly. Response was monitored, in 92 patients who completed treatment, by alanine aminotransferase (ALT) measurements and by polymerase chain reaction (PCR) for HCV. ALT levels remained abnormal in 64 patients during treatment (69.6%). Of the 28 patients who showed a biochemical response during treatment (30.4%), 18 maintained this over the 6-month posttreatment period. Amongst the sustained biochemical responders, HCV RNA was cleared from serum in only four of the 18 (22.2%) in this period. Histological improvement was observed in 26/51 (50.9%) of the patients who had a second biopsy. Hence, patients infected with HCV genotype 4 show a poor response to IFN-alpha therapy compared with genotypes 2 and 3, but a similar response to IFN-alpha compared with those infected with type 1b HCV. These findings have major implications for treatment strategies in the Middle East, including Egypt, where HCV genotype 4 is widely distributed.
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Affiliation(s)
- A el-Zayadi
- Faculty of Medicine, Ain Shams University, Egypt
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El-Zayadi A, Osaima S, Haseeb N, Dabbous H. Controlled trial with human lymphoblastoid interferon among HBeAg and anti-HBe-positive chronic hepatitis B patients in Egypt. J Egypt Public Health Assoc 1995; 70:579-94. [PMID: 17214176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In a randomized controlled trial, sixty chronic hepatitis B liver disease patients (HBsAg +ve and HBV-DNA +ve) were randomly allocated into 2 groups. The first group comprised of 30 patients who were subdivided into 2 subgroups according to the HBeAg/anti-HBe system. One subgroup was HBeAg-positive (12 patients) and the other was anti-HBe-positive (18 patients). All were given human lymphoblastoid IFN alpha (Wellferon-R) at a dosage of 5 MU, thrice weekly for 4 months. The other 30 patients served as a control group, six of whom were lost during the study. The initial response was loss of HBV-DNA in 66.6% of the HBeAg +ve subgroup (8/12 patients), 33% in the anti-HBe subgroup (6/18 patients) and in 8% in the control group (2/24 patients). Patients and controls were followed up for 8 months after the end of IFN therapy. A sustained response (loss of HBV-DNA) 8 months after discontinuation of IFN was attained in 5/12 patients (41.6%) of the HBeAg-positive subgroup compared to none (0/24) in the control group (p < 0.05). In the anti-HBe subgroup, a sustained response in 2/18 patients (11%) compared to none (0/24) in the controls was not significant. We conclude from this study that (Wellferon-R) at a dosage of 5 MU given thrice weekly for 4 months was significantly better (p < 0.05) than no treatment in producing a sustained response among the HBeAg +ve subgroup of patients. On the other hand, in the anti-HBe subgroup the outcome of the previous schedule was not significantly better than in controls due to the small numbers involved although 2 patients did have a sustained response.
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Affiliation(s)
- A El-Zayadi
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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El-Zayadi A, Simmonds P, Dabbous H, Selim O. Hepatitis C virus genotypes among HCV-chronic liver disease patients in Egypt: a leading trial. J Egypt Public Health Assoc 1994; 69:327-34. [PMID: 17212002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED In this trial, we have checked 50 anti-HCV positive, HCV-RNA PCR positive chronic liver disease cases, 44 males, 6 females with a mean age of 51 years. HCV-RNA extraction and genotyping was carried out at the Department of Medical Microbiology, University of Edinburgh, U.K. results showed that 47 (94%) of patients were of genotype 4 and 3 (6%) were of genotype 1. Liver biopsies were performed in 22 only out of the 50 patients studied. The 3 genotype 1 patients were biopsied, 2 had cirrhotic profile and one had CAH. Of 47 genotype 4 patients, 19 were biopsied, 3 were CPH, 2 had CLH, 9 had CAH, 4 had cirrhosis and one patient had HCC. CONCLUSION It appears that Egypt hosts predominantly HCV genotype 4 and less commonly genotype 1. This finding might have important implications concerning the epidemiological aspects, pathogenesis and response to antiviral therapy.
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Affiliation(s)
- A El-Zayadi
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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el-Zayadi A, Mohran Z, Hasseeb N, Nagy N, Dabbous H. Short-term course of corticosteroids in the treatment of resistant ascites complicating schistosomal liver disease. Am J Gastroenterol 1991; 86:53-6. [PMID: 1986555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this work was to evaluate the effect of short-term corticosteroids in resistant ascites complicating schistosomal liver disease after 4 wk or more on standard treatment. Thirty-seven patients were randomly allocated to two groups: Group I (18 patients) was put on 40 mg furosemide and 200 mg spironolactone, in addition to a 15-day, tapering dose of prednisone (15, 10, 5 mg). Group II (19) patients received the same diuretics without steroids, and served as controls. At the end of a 2-wk course of therapy, the mean variations were as follows: body weight in patients in Group I ("cases") decreased by 9.8 kg, compared with 4.3 kg in controls; abdominal girth decreased by 7.4 cm in cases, compared with 3.6 cm in controls; urine output increased by 635.9 ml in cases, compared with 364.6 ml in controls; urinary sodium excretion increased by 16.5 mEq/day in cases, compared with 4.1 mEq/day in controls. These differences between cases and controls were found to be statistically significant (p less than 0.01). On the other hand, there were insignificant differences as regards decrease in blood urea (3.2 g/dl for cases and 2.7 g/dl for controls), decrease in serum creatinine (0.2 mg/dl for both cases and controls), increase in serum albumin (0.3 g/dl in cases and 0.2 g/dl in controls), increase in serum sodium (3.2 mEq/L in cases and 2.7 mEq/L in controls), and increase in serum potassium (0.2 mEq/L in cases and 0.4 mEq/L in controls). We conclude that a short-term course of corticosteroids in conjunction with standard diuretics has proved to be an effective, safe, and economical modality to relieve resistant hepatic ascites. It can be considered a temporary alternative to paracentesis with albumin infusion.
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Affiliation(s)
- A el-Zayadi
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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