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Chami HA, Diab M, Zaouk N, Arnaout S, Mitchell GF, Isma'eel H, Shihadeh A. Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use. Chest 2023; 164:1481-1491. [PMID: 37541338 DOI: 10.1016/j.chest.2023.07.070] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Tobacco use via water pipe (commonly referred to as water-pipe smoking [WPS]) is popular among young adults globally and exposes those who smoke to toxicants. RESEARCH QUESTION Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults? STUDY DESIGN AND METHODS We assessed heart rate (HR), brachial and aortic BP, HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 individuals who use water pipes and 34 individuals who have never used a water pipe recruited from the community (mean age, 22.5 ± 3.0 years; 48% female). Measurements were obtained before and after an outdoor session of WPS among participants who use water pipes and among the control group of participants who have never used a water pipe. Measurements were compared after vs before exposure and between those who use and those who do not use water pipes, adjusting for possible confounders using linear regression. RESULTS Participants who use water pipes and control participants had similar demographic characteristics. BP and HR increased acutely after WPS (brachial systolic BP by 4.13 mm Hg [95% CI, 1.91-6.36 mm Hg]; aortic systolic BP by 2.31 mm Hg [95% CI, 0.28-4.33 mm Hg]; brachial diastolic BP by 3.69 mm Hg [95% CI, 1.62-5.77 mm Hg]; aortic diastolic BP by 3.03 mm Hg [95% CI, 0.74-5.33 mm Hg]; and HR by 7.75 beats/min [95% CI, 5.46-10.04 beats/min]), but not in the control group. AI was significantly higher in participants who use water pipes compared with those who do not (9.02% vs 3.06%; P = .03), including after adjusting for BMI and family history of cardiovascular disease (β = 6.12; 95% CI, 0.55-11.69; P = .03) and when assessing habitual tobacco use via water-pipe extent (water pipes used/day × water-pipe use duration) in water-pipe-years (β = 2.51/water-pipe-year; 95% CI, 0.10-4.92/water-pipe-year; P = .04). However, CFPWV was similar in those who use water pipes and those who do not, and AI and CFPWV did not change acutely after WPS. INTERPRETATION In apparently healthy young individuals from the community, habitual WPS was associated with increased AI, a predictor of cardiovascular risk, and one WPS session acutely increased HR and brachial and aortic BP.
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Affiliation(s)
- Hassan A Chami
- School of Medicine, Johns Hopkins University, Baltimore, MD; School of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Maya Diab
- University of Michigan, Ann Arbor, MI
| | - Nour Zaouk
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samir Arnaout
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Alan Shihadeh
- School of Engineering, American University of Beirut, Beirut, Lebanon
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Chami HA, Isma'eel H, Mitchel GF, Tamim H, Makki M, Berbari A, Al Mulla A. The association of waterpipe smoking with arterial stiffness and wave reflection in a community-based sample. Blood Press 2021; 30:300-309. [PMID: 34236258 DOI: 10.1080/08037051.2021.1947778] [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] [Indexed: 10/20/2022]
Abstract
PURPOSE The evidence linking waterpipe smoking to cardiovascular disease is limited. We evaluated the association of waterpipe smoking (WPS) with arterial stiffness and wave reflection measured by augmentation pressure (AP), augmentation index (AIx), and carotid-femoral pulse wave velocity (CFPWV), which are validated predictors of cardiovascular disease. MATERIALS AND METHODS Community-based, cross-sectional study including 205 exclusive waterpipe smokers and 199 matched never-smokers aged 35 years or older (mean age 51.7 ± 8.9 years, 36% females). Smoking and its extent were assessed using a validated questionnaire and urine cotinine levels. CFPWV, AP, AIx (AP/aortic pulse pressure) and heart rate adjusted AIx (AIx@75) were determined using tonometry and compared between smokers and non-smokers, and the association of WPS with tonometry measures was assessed using linear regression adjusting for possible confounders. RESULTS Waterpipe smokers and non-smokers had similar mean age and sex distribution. Compared to non-smokers, waterpipe smokers had significantly higher adjusted AP (10.5 ± 3.9 vs. 9.4 ± 3.9 mmHg respectively; p = 0.01), AIx (28.1 ± 8.4 vs. 25.7 ± 8.5% respectively; p = 0.01) and AIx@75 (24.2 ± 8.7 vs. 21.8 ± 8.9% respectively; p = 0.01). AIx was significantly associated with WPS extent, measured by a number of waterpipe smoked/day (β = 1.04/waterpipe, 95%CI:[0.50-1.58]), duration of waterpipe smoking (β = 0.77/10-years, 95%CI:[0.16-1.38]), their products in waterpipe-years (β = 0.30/10-waterpipe-year, 95%CI:[0.12-0.47]) and plasma cotinine (β = 0.56/100 ng/ml, 95%CI:[0.14-0.98]), adjusting for possible confounders, and so were AP and AIx@75. CFPWV however, was not associated with waterpipe smoking. CONCLUSION In a community-based sample, exclusive WPS and its extent were associated with a dose-dependent increase in AIx and AP, accounting for other risk factors, suggesting that waterpipe smokers are at increased risk of cardiovascular disease.
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Affiliation(s)
- Hassan A Chami
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Hani Tamim
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Adel Berbari
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ahmad Al Mulla
- Tobacco Control Center-WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Kamar A, Maalouf N, Hitti E, El Eid G, Isma'eel H, Elhajj IH. Challenge of forecasting demand of medical resources and supplies during a pandemic: A comparative evaluation of three surge calculators for COVID-19. Epidemiol Infect 2021; 149:e51. [PMID: 33531094 PMCID: PMC7925989 DOI: 10.1017/s095026882100025x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/28/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022] Open
Abstract
Ever since the World Health Organization (WHO) declared the new coronavirus disease 2019 (COVID-19) as a pandemic, there has been a public health debate concerning medical resources and supplies including hospital beds, intensive care units (ICU), ventilators and protective personal equipment (PPE). Forecasting COVID-19 dissemination has played a key role in informing healthcare professionals and governments on how to manage overburdened healthcare systems. However, forecasting during the pandemic remained challenging and sometimes highly controversial. Here, we highlight this challenge by performing a comparative evaluation for the estimations obtained from three COVID-19 surge calculators under different social distancing approaches, taking Lebanon as a case study. Despite discrepancies in estimations, the three surge calculators used herein agree that there will be a relative shortage in the capacity of medical resources and a significant surge in PPE demand if the social distancing policy is removed. Our results underscore the importance of implementing containment interventions including social distancing in alleviating the demand for medical care during the COVID-19 pandemic in the absence of any medication or vaccine. The paper also highlights the value of employing several models in surge planning.
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Affiliation(s)
- A. Kamar
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - N. Maalouf
- Maroun Semaan Faculty of Engineering and Architecture, Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - E. Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - G. El Eid
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - H. Isma'eel
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - I. H. Elhajj
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Maroun Semaan Faculty of Engineering and Architecture, Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
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Ahmad A, Ibrahim Z, Sakr G, El-Bizri A, Masri L, Elhajj IH, El-Hachem N, Isma'eel H. A comparison of artificial intelligence-based algorithms for the identification of patients with depressed right ventricular function from 2-dimentional echocardiography parameters and clinical features. Cardiovasc Diagn Ther 2020; 10:859-868. [PMID: 32968641 DOI: 10.21037/cdt-20-471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Recognizing low right ventricular (RV) function from 2-dimentiontial echocardiography (2D-ECHO) is challenging when parameters are contradictory. We aim to develop a model to predict low RV function integrating the various 2D-ECHO parameters in reference to cardiac magnetic resonance (CMR)-the gold standard. Methods We retrospectively identified patients who underwent a 2D-ECHO and a CMR within 3 months of each other at our institution (American University of Beirut Medical Center). We extracted three parameters (TAPSE, S' and FACRV) that are classically used to assess RV function. We have assessed the ability of 2D-ECHO derived parameters and clinical features to predict RV function measured by the gold standard CMR. We compared outcomes from four machine learning algorithms, widely used in the biomedical community to solve classification problems. Results One hundred fifty-five patients were identified and included in our study. Average age was 43±17.1 years old and 52/156 (33.3%) were females. According to CMR, 21 patients were identified to have RV dysfunction, with an RVEF of 34.7%±6.4%, as opposed to 54.7%±6.7% in the normal RV population (P<0.0001). The Random Forest model was able to detect low RV function with an AUC =0.80, while general linear regression performed poorly in our population with an AUC of 0.62. Conclusions In this study, we trained and validated an ML-based algorithm that could detect low RV function from clinical and 2D-ECHO parameters. The algorithm has two advantages: first, it performed better than general linear regression, and second, it integrated the various 2D-ECHO parameters.
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Affiliation(s)
- Ali Ahmad
- Vascular Medicine Program, Division of Cardiology, American University of Beirut, Beirut, Lebanon.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zahi Ibrahim
- Vascular Medicine Program, Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Georges Sakr
- Department of Computer Engineering, St Joseph University of Beirut, Beirut, Lebanon
| | - Abdallah El-Bizri
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Lara Masri
- Vascular Medicine Program, Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Imad H Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - Nehme El-Hachem
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Program, Division of Cardiology, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Zahwe M, Skouri H, Rachidi S, Khoury M, Noureddine S, Isma'eel H, Tamim H, Al-Hajje A. Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study. Int J Pharm Pract 2020; 28:652-659. [PMID: 32677747 DOI: 10.1111/ijpp.12651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/02/2020] [Accepted: 06/04/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Primary objectives were to evaluate the use of potentially inappropriate medication (PIM) use in elderly heart failure (HF) patients and the factors associated with the number of PIMs. Secondary objectives were to test for the correlation between PIMs and quality of life (QOL) and depression. METHODS A cross-sectional study was conducted among 125 elderly Lebanese HF patients with left ventricular ejection fraction <50%. Data on socio-demographics, clinical data and medications were collected. Patients were interviewed with Minnesota living with Heart Failure Questionnaire (MLHFQ) and Patient Health Questionnaire-9 (PHQ-9). Medication profile per patient was evaluated for PIMs using Beers Criteria. The correlations between the number of PIMs and the MLHFQ, PHQ-9 and the number of medications were tested using Pearson's correlation. Linear regression was done to predict the factors associated with the number of PIMs. KEY FINDINGS Patients were taking a total of 1035 medications with a mean of 8.28 ± 3.14 medications. In total, 80.0% of patients were taking at least one PIM. Diuretics (55.2%) and proton pump inhibitors (41.6%) were most commonly prescribed PIMs. The number of PIMs was moderately correlated with the number of medications and the MLHFQ score. Linear regression showed that the number of medications, age ≥85 years, chronic kidney disease and HF with New York Heart Association III were associated with more PIMs. CONCLUSIONS A high percentage of PIMs was found among a sample of elderly Lebanese HF patients. HF multidisciplinary team is needed to control the prescription of PIMs in this vulnerable population.
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Affiliation(s)
- Mariam Zahwe
- Doctoral School of Science and Technology, Lebanese University, Beirut, Lebanon.,Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Hadi Skouri
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Maurice Khoury
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samar Noureddine
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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Isma'eel H, Noureddine S, Mohammad M, Zgheib A, Abou Arbid S, Njeim M, Nasr S, Bassil R, Sarkis A, Abi Saleh B, El Sayed M. Out-of-hospital cardiopulmonary resuscitation: a position statement of the Lebanese Society of Cardiology and the Lebanese Society of Emergency Medicine. Cardiovasc Diagn Ther 2019; 9:609-612. [PMID: 32038951 DOI: 10.21037/cdt.2019.11.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Early cardiopulmonary resuscitation (CPR) and early defibrillation are key to improving outcomes of patients with OHCA including return of spontaneous circulation (ROSC) and survival to hospital discharge with good neurologic outcomes. Lebanon like other developing countries, suffers from absence of organized prehospital cardiac arrest care bundle and from absence of a legal framework for community involvement in cardiac arrest care. Scientific societies, involved non-governmental organizations (NGOs) and local governmental stakeholders organized a national meeting to launch a strategy aiming at improving OHCA outcomes in Lebanon. This article represents a position statement of the Lebanese Society of Cardiology and the Lebanese Society of Emergency Medicine summarizing the strategy to improve out-of-hospital CPR. Participating stakeholders developed and submitted a law proposal of a "Good Samaritan Law" to the Lebanese parliament. Several of activities were also launched aiming at establishing public access defibrillation programs and at training bystanders in different areas in Lebanon to perform bystander CPR and use automated external defibrillators (AEDs). Additional recommendations were proposed to local emergency medical system (EMS) agencies to improve prehospital care and introduce medical direction to prehospital activities.
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Affiliation(s)
- Hussain Isma'eel
- Clinical Medicine, Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Noureddine
- Graduate Division, School of Nursing, American University of Beirut, Beirut, Lebanon
| | | | - Ali Zgheib
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Abou Arbid
- Division of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mario Njeim
- Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Samer Nasr
- Department of Cardiology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Rania Bassil
- Saint Joseph University and Keserwan Medical Center, Beirut, Lebanon
| | - Anthony Sarkis
- Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bernard Abi Saleh
- Section of Electrophysiology, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Emergency Medical Services and Prehospital Care, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Baydoun M, Safatly L, Abou Hassan OK, Ghaziri H, El Hajj A, Isma'eel H. High Precision Digitization of Paper-Based ECG Records: A Step Toward Machine Learning. IEEE J Transl Eng Health Med 2019; 7:1900808. [PMID: 32166049 PMCID: PMC6876931 DOI: 10.1109/jtehm.2019.2949784] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 02/01/2023]
Abstract
Introduction: The electrocardiogram (ECG) plays an important role in the diagnosis of
heart diseases. However, most patterns of diseases are based on old datasets and stepwise
algorithms that provide limited accuracy. Improving diagnostic accuracy of the ECG can be
done by applying machine learning algorithms. This requires taking existing scanned or
printed ECGs of old cohorts and transforming the ECG signal to the raw digital (time
(milliseconds), voltage (millivolts)) form. Objectives: We present a MATLAB-based tool and
algorithm that converts a printed or scanned format of the ECG into a digitized ECG
signal. Methods: 30 ECG scanned curves are utilized in our study. An image processing
method is first implemented for detecting the ECG regions of interest and extracting the
ECG signals. It is followed by serial steps that digitize and validate the results.
Results: The validation demonstrates very high correlation values of several standard ECG
parameters: PR interval 0.984 +/−0.021 (p-value < 0.001), QRS
interval 1+/− SD (p-value < 0.001), QT interval 0.981
+/− 0.023 p-value < 0.001, and RR interval 1 +/− 0.001
p-value < 0.001. Conclusion: Digitized ECG signals from existing paper or scanned
ECGs can be obtained with more than 95% of precision. This makes it possible to
utilize historic ECG signals in machine learning algorithms to identify patterns of heart
diseases and aid in the diagnostic and prognostic evaluation of patients with
cardiovascular disease.
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Affiliation(s)
| | - Lise Safatly
- 2Electrical and Computer Engineering DepartmentAmerican University of BeirutBeirutLebanon
| | | | - Hassan Ghaziri
- 1Beirut Research and Innovation CenterBeirut2052 6703Lebanon
| | - Ali El Hajj
- 2Electrical and Computer Engineering DepartmentAmerican University of BeirutBeirutLebanon
| | - Hussain Isma'eel
- 3Internal Medicine DepartmentAmerican University of BeirutBeirutLebanon
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Zahwe M, Isma'eel H, Skouri H, Al-Hajje A, Rachidi S, Tamim H, Noureddine S. Validation of the Arabic Version of the Minnesota Living with Heart Failure Questionnaire. Heart Lung 2019; 49:36-41. [PMID: 31679804 DOI: 10.1016/j.hrtlng.2019.10.006] [Citation(s) in RCA: 10] [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: 07/12/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is commonly used to measure quality of life (QOL) in patients with heart failure (HF). We examined the psychometric properties and cultural validity of an Arabic version of the MLHFQ. METHODS An observational cross-sectional study was conducted with 210 adult HF outpatients. Patients were interviewed with the Arabic MLHFQ and the Patient Health Questionnaire (PHQ-9). Cronbach's alpha coefficient and confirmatory factor analysis were conducted. Patients with different NYHA classes and HF-hospitalization histories were compared on QOL to test known-group validity. RESULTS The confirmatory factor analysis yielded 3 factors: physical, emotional, and social. Three items (4, 8, and 15) had low loadings. The overall Cronbach's alpha coefficient was 0.92. There were significant differences in MLHFQ by PHQ-9 categories, NYHA class, and HF-hospitalization history. CONCLUSIONS This Arabic version of MLHFQ is valid and reliable and can be used in Arabic-speaking Lebanese HF populations.
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Affiliation(s)
- Mariam Zahwe
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Doctoral School of Science and Technology, Lebanese University, Beirut, Lebanon
| | - Hussain Isma'eel
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hadi Skouri
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Hani Tamim
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samar Noureddine
- Hariri School of Nursing, American University of Beirut, Maamari Street, PO Box 11-0236, Beirut 1107 2020, Lebanon.
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9
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Walsh JL, AlJaroudi WA, Lamaa N, Abou Hassan OK, Jalkh K, Elhajj IH, Sakr G, Isma'eel H. A speckle-tracking strain-based artificial neural network model to differentiate cardiomyopathy type. SCAND CARDIOVASC J 2019; 54:92-99. [PMID: 31623474 DOI: 10.1080/14017431.2019.1678764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/25/2022]
Abstract
Objectives. In heart failure, invasive angiography is often employed to differentiate ischaemic from non-ischaemic cardiomyopathy. We aim to examine the predictive value of echocardiographic strain features alone and in combination with other features to differentiate ischaemic from non-ischaemic cardiomyopathy, using artificial neural network (ANN) and logistic regression modelling. Design. We retrospectively identified 204 consecutive patients with an ejection fraction <50% and a diagnostic angiogram. Patients were categorized as either ischaemic (n = 146) or non-ischaemic cardiomyopathy (n = 58). For each patient, left ventricular strain parameters were obtained. Additionally, regional wall motion abnormality, 13 electrocardiographic (ECG) features and six demographic features were retrieved for analysis. The entire cohort was randomly divided into a derivation and a validation cohort. Using the parameters retrieved, logistic regression and ANN models were developed in the derivation cohort to differentiate ischaemic from non-ischaemic cardiomyopathy, the models were then tested in the validation cohort. Results. A final strain-based ANN model, full feature ANN model and full feature logistic regression model were developed and validated, F1 scores were 0.82, 0.79 and 0.63, respectively. Conclusions. Both ANN models were more accurate at predicting cardiomyopathy type than the logistic regression model. The strain-based ANN model should be validated in other cohorts. This model or similar models could be used to aid the diagnosis of underlying heart failure aetiology in the form of the online calculator (https://cimti.usj.edu.lb/strain/index.html) or built into echocardiogram software.
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Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Nader Lamaa
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama K Abou Hassan
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalil Jalkh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad H Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - George Sakr
- Computer Engineering Department, St Joseph University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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10
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Chami HA, Ghandour B, Isma'eel H, Nasreddine L, Nasrallah M, Tamim H. Sleepless in Beirut: sleep duration and associated subjective sleep insufficiency, daytime fatigue, and sleep debt in an urban environment. Sleep Breath 2019; 24:357-367. [PMID: 31028521 DOI: 10.1007/s11325-019-01833-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/06/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Insufficient sleep is not well studied in developing countries. We assessed sleep duration among adults in Lebanon and examined its potential predictors and relationship with subjective sleep insufficiency, daytime fatigue, and weekday sleep debt. METHODS This cross-sectional study included 501 adults (mean age 45.2 (SD15.2) years, 64% females) from the community in Beirut and Mount Lebanon. Socio-demographic, lifestyle and health characteristics, subjective sleep insufficiency, daytime fatigue, and weekday sleep debt (weekend vs. weekdays sleep duration) were compared between individuals who reported sleeping < 6:00, 6-7:59(reference), or ≥ 8:00 h/night. Symptoms and predictors of sleep duration were assessed using logistic regression. RESULTS Thirty-nine percent of participants reported sleeping < 6 h/night while 15% reported sleeping ≥ 8:00 h/night. Age (OR = 1.16/year, 95% CI [1.02-1.33]) and female sex (OR = 1.71, 95% CI [1.14-2.58]) were significant predictors of short sleep (< 6:00 h/night) in multivariable adjusted analyses. Compared to referent (6:00-7:59 h/night) and long sleepers (≥ 8:00 h/night), short sleepers were significantly more likely to report subjective sleep insufficiency (OR = 3.00, 95% CI [2:00-4.48], and OR = 4.52, 95% CI [2.41-8.51]; respectively) and daytime fatigue (OR = 1.53, 95% CI [1.04-2.24], and OR = 1.83, 95% CI [1.06-2.04]; respectively). Compared to long weekdays sleepers, short and referent weekdays sleepers were more likely to sleep longer on weekend (OR = 2.47, 95% CI [1.18-5.15], and OR = 4.16, 95% CI [2.03-8.5]; respectively). CONCLUSIONS Short sleep is highly prevalent in this urban cohort from a low- to medium-income country especially among women and older adults, and is associated with subjective sleep insufficiency, daytime fatigue, and weekday sleep debt. The socio-cultural determinants of sleep duration need to be studied across different populations to better evaluate the causes and implications of short sleep.
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Affiliation(s)
- Hassan A Chami
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 11-0236, Lebanon
| | - Blanche Ghandour
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 11-0236, Lebanon
| | - Hussain Isma'eel
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 11-0236, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mona Nasrallah
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 11-0236, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 11-0236, Lebanon.
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Chami HA, Bechnak A, Isma'eel H, Talih F, Nasreddine L, Nasrallah M, Tamim H. Sleepless in Beirut: Sleep Difficulties in an Urban Environment With Chronic Psychosocial Stress. J Clin Sleep Med 2019; 15:603-614. [PMID: 30952222 DOI: 10.5664/jcsm.7724] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/09/2019] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVES The prevalence of sleep disorders in the Lebanese population is unknown. We assessed the prevalence of insomnia and sleep apnea risk and examined their relationship with sociodemographic, lifestyle, and health characteristics in a sample from Greater Beirut. METHODS This cross-sectional pilot survey included 501 adults from the community (age 45.2 ± 15.2 years, 64% females). Insomnia symptoms, insomnia disorder, and sleep apnea risk were assessed using the Sleep Heart Health Study and Berlin Questionnaire. Characteristics were compared between individuals with and without insomnia symptoms, insomnia disorder, and sleep apnea. Correlates were assessed using multivariate regression. RESULTS A total of 44.5% of participants reported insomnia symptoms > 15 nights/mo and 34.5% reported insomnia. Predictors of insomnia symptoms and disorder included female sex (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.01-2.27 and OR 1.76, 95% CI 1.13-2.75, respectively), education level below high school (OR 1.96, 95% CI 1.31-2.95 and OR 2.40, 95% CI 1.52-3.77, respectively) and medical comorbidities (OR 2.27, 95% CI 1.30-3.95 and OR 3.02, 95% CI 1.3-5.27, respectively). Although 31% of participants were at high risk for sleep apnea, only 5% received the diagnosis from a physician. Increased sleep apnea risk was associated with unemployment (OR 1.96, 95% CI 1.11-3.49), high body mass index (OR 1.17, 95% CI 1.11-1.24), snoring (OR 16.7, 95% CI 9.0-31.0), hypertension (OR 4.33, 95% CI 2.28-8.22), arthritis (OR 2.00, 95% CI 1.01-4.01), and other medical comorbidities (OR 2.65, 95% CI 1.24-5.68). CONCLUSIONS Insomnia and sleep apnea are highly prevalent and likely underdiagnosed in this cohort from Lebanon and are associated with disadvantaged socioeconomic status and medical comorbidities. This alarming prevalence of sleep difficulties and disorders calls for future research exploring the causes including the potential effect of social, economic, and political instability, mental and psychological stress, local customs, and environmental factors.
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Affiliation(s)
- Hassan A Chami
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amer Bechnak
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussain Isma'eel
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mona Nasrallah
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Chami HA, Isma'eel H, Tamim H, Adawi M, Al Kuwari M, Al Mullah A. The Association of Water-Pipe Smoking and Coronary Artery Calcium in a Community-Based Sample. Chest 2019; 155:1217-1225. [PMID: 30684475 DOI: 10.1016/j.chest.2019.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/02/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Water-pipe smoking is increasing in popularity, driven partly by a perception of reduced harm compared with cigarette smoking. This study evaluates the association of water-pipe smoking with coronary artery calcium (CAC), a marker of coronary heart disease (CHD) risk, in a community-based sample. METHODS A total of 175 exclusive water-pipe smokers and 170 nonsmokers, ≥ 35 years of age, were recruited from the community in Lebanon and Qatar. Water-pipe smoking was assessed using a validated questionnaire. CAC score was assessed using multidetector CT scan. The association of water-pipe smoking with the presence and extent of CAC was evaluated using regression analyses adjusted for CHD risk factors. RESULTS CAC was present in 41% of water-pipe smokers vs 28% of nonsmokers (P = .01), with an average CAC score ± SD of 90.6 ± 400.3 Agatston units (AUs) in water-pipe smokers and 52.4 ± 218.6 AUs in nonsmokers. In adjusted analyses, water-pipe smokers had significantly higher adjusted odds of having CAC (OR = 2.20; 95% CI, 1.20-4.01; P = .01) and being in the high CHD risk category defined by CAC > 300 AUs (OR = 3.41; 95% CI, 1.08-10.77; P = .04) or CAC > 75% of age, sex, and race-predicted (OR = 3.11; 95% CI, 1.55-6.24; P = .001) than nonsmokers. CAC extent was significantly associated with water-pipe smoking extent measured by smoking duration (β = 0.17/year; 95% CI, 0.05-0.29; P = .004) or the product of smoking duration and the number of water pipes smoked daily (β = 0.04/water-pipe-year; 95% CI, 0.003-0.07; P = .03). CONCLUSIONS Exclusive water-pipe smoking was associated with the presence and extent of CAC, with twice the risk of having CAC and three times the risk of being in the high CHD risk category while accounting for other risk factors.
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Affiliation(s)
- Hassan A Chami
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Hussain Isma'eel
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Marwa Adawi
- Institute of Public Health, United Arab Emirates University, Al Ain, UAE
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El Bizri A, Beydoun Z, Mailhac A, Sakr G, Tamim H, Isma'eel H. PO279 Socioeconomic Factors Associated With Hypertension Awareness Among Lebanese Population. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Baydoun M, Safatly L, Walsh J, Abou Hassan O, Jaroudi W, El Hajj A, Ghaziri H, Isma'eel H. PO086 Machine Learning Approaches Improve Noninvasive Prediction of Ischemic From Non-Ischemic Cardiomyopathies. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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15
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Walsh JL, Aridi H, Fathallah J, Al-Shaar L, Alam S, Nasreddine L, Isma'eel H. Impact of a hospital-based educational intervention on dietary salt-related knowledge and behaviour in a cardiac care unit population in Lebanon. Cardiovasc Diagn Ther 2018; 8:146-155. [PMID: 29850405 DOI: 10.21037/cdt.2017.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is the most common cause of morbidity and mortality worldwide. Numerous strategies have been effective in reducing cardiovascular disease risk, from pharmacological approaches to lifestyle modification interventions. One of these strategies includes the reduction in dietary sodium which in turn reduces cardiovascular risk by reducing high blood pressure, perhaps the most important cardiovascular risk factor. Methods We evaluated an educational dietary salt reduction intervention in a cardiac care unit population in Lebanon, assessing salt related knowledge and behaviours before and after administering an evidence-based educational leaflet to patients. Results Salt-related knowledge improved significantly immediately post-intervention and subsequently fell on 4-week follow-up, but remained above baseline. Three of the four salt-related behaviours measured improved on 4-week follow-up: trying to buy low-salt foods increased from 54% to 74% (P=0.007), adding salt at the table reduced from 44% to 34% (P=0.03) and trying to buy food with no added salt increased from 24% to 52% (P=0.02) of the cohort. Adding salt during cooking did not differ significantly. A trend towards improved behavioural risk category in the cohort overall was observed on follow-up (P=0.07), 32% of participants were categorised as high behavioural risk pre-intervention, reducing to 17% on follow-up. Multi-ordered regression modelling identified being in the high-risk behavioural category at baseline as a predictor of being in the high-risk or moderate-risk category on follow-up. Conclusions This hospital-based educational intervention had a modestly positive impact on salt-related knowledge and behaviour, with participants in the highest behavioural risk category at baseline being most resistant to behavioural improvement.
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Affiliation(s)
- Jason L Walsh
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Hussam Aridi
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Jihan Fathallah
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Samir Alam
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
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16
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Zgheib NK, Sleiman F, Nasreddine L, Nasrallah M, Nakhoul N, Isma'eel H, Tamim H. Short Telomere Length is Associated with Aging, Central Obesity, Poor Sleep and Hypertension in Lebanese Individuals. Aging Dis 2018; 9:77-89. [PMID: 29392083 PMCID: PMC5772860 DOI: 10.14336/ad.2017.0310] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 01/13/2017] [Accepted: 03/10/2017] [Indexed: 12/20/2022] Open
Abstract
In Lebanon, data stemming from national cross-sectional surveys indicated significant increasing trends in the prevalence of cardiovascular diseases and associated behavioral and age-related risk factors. To our knowledge, no data are available on relative telomere length (RTL) as a potential biomarker for age-related diseases in a Lebanese population. The aim of this study was to evaluate whether there is an association between RTL and demographic characteristics, lifestyle habits and diseases in the Lebanese. This was a cross-sectional study of 497 Lebanese subjects. Peripheral blood RTL was measured by amplifying telomere and single copy gene using real-time PCR. Mean ± SD RTL was 1.42 ± 0.83, and it was categorized into 3 tertiles. Older age (P=0.002) and wider waist circumference (WC) (P=0.001) were statistically significantly associated with shorter RTL. Multinomial logistic regression showed that subjects who had some level of sleeping difficulty had a statistically significantly shorter RTL when compared to those with no sleeping difficulties at all [OR (95% CI): 2.01 (1.11-3.62) in the first RTL tertile]. Importantly, statistically significantly shorter RTL was found with every additional 10 cm of WC [OR (95% CI): 1.30 (1.11-1.52) for first RTL tertile]. In addition, and after performing the multivariate logistic regression and adjusting for “predictors” of RTL, the odds of having hypertension or being treated for hypertension were higher in patients who had shorter RTL: OR (95% CI): 2.45 (1.36-4.44) and 2.28 (1.22-4.26) in the first RTL tertiles respectively with a similar trend, though not statistically significant, in the second RTL tertiles. This is the first study in Lebanon to show an association between age, central obesity, poor sleep and hypertension and RTL. It is hoped that telomere length measurement be potentially used as a biomarker for biological age and age-related diseases and progression in the Lebanese.
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Affiliation(s)
- Nathalie K Zgheib
- 1Department of Pharmacology & Toxicology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Fatima Sleiman
- 1Department of Pharmacology & Toxicology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Lara Nasreddine
- 2Department of Nutrition & Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Lebanon
| | - Mona Nasrallah
- 3Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Lebanon
| | - Nancy Nakhoul
- 3Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Lebanon
| | - Hussain Isma'eel
- 3Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Lebanon
| | - Hani Tamim
- 3Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Lebanon.,4Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Lebanon
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17
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Fayssal IA, Moukalled F, Alam S, Isma'eel H. An Outflow Boundary Condition Model for Noninvasive Prediction of Fractional Flow Reserve in Diseased Coronary Arteries. J Biomech Eng 2018; 140:2659642. [DOI: 10.1115/1.4038250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Indexed: 12/28/2022]
Abstract
This paper reports on a new boundary condition formulation to model the total coronary myocardial flow and resistance characteristics of the myocardial vascular bed for any specific patient when considered for noninvasive diagnosis of ischemia. The developed boundary condition model gives an implicit representation of the downstream truncated coronary bed. Further, it is based on incorporating patient-specific physiological parameters that can be noninvasively extracted to account for blood flow demand to the myocardium at rest and hyperemic conditions. The model is coupled to a steady three-dimensional (3D) collocated pressure-based finite volume flow solver and used to characterize the “functional significance” of a patient diseased coronary artery segment without the need for predicting the hemodynamics of the entire arterial system. Predictions generated with this boundary condition provide a deep understanding of the inherent challenges behind noninvasive image-based diagnostic techniques when applied to human diseased coronary arteries. The overall numerical method and formulated boundary condition model are validated via two computational-based procedures and benchmarked with available measured data. The newly developed boundary condition is used via a designed computational methodology to (a) confirm the need for incorporating patient-specific physiological parameters when modeling the downstream coronary resistance, (b) explain the discrepancies presented in the literature between measured and computed fractional flow reserve (FFRCT), and (c) discuss the current limitations and future challenges in shifting to noninvasive assessment of ischemia.
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Affiliation(s)
- Iyad A. Fayssal
- Computational Mechanics Laboratory, Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Fadl Moukalled
- Professor Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Samir Alam
- Professor Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Hussain Isma'eel
- Associate Professor Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
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Walsh JL, Harris BHL, Gharzuddine W, Isma'eel H. Myocardial infarction masquerading as myocarditis in a patient with factor V Leiden: unmasked with MR. BMJ Case Rep 2017; 2017:bcr-2017-220652. [PMID: 28720694 DOI: 10.1136/bcr-2017-220652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 21-year-old man presenting with sharp left-sided chest pain. A CT pulmonary angiogram was negative, ECG was unremarkable and a mild troponin rise was observed. Myocarditis was suspected as the most likely diagnosis, particularly in view of the patient's previous diagnosis of myocarditis 3 years prior. A cardiac MRI was indicative of an acute mid-anterior myocardial infarction (MI) and an old inferior MI with an associated aneurysm. A subsequent angiogram revealed a subtotal occlusion in the second diagonal artery, likely precipitated by homozygous factor V Leiden.This case illustrates the value of MRI in differentiating acute MI from myocarditis when clinical suspicion is low, as in this young patient with atypical chest pain. Further, it demonstrates the value of MRI in detecting previous MIs and reinforces the importance of searching for precipitants of MI in young patients.
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Affiliation(s)
- Jason Leo Walsh
- American University of Beirut Medical Center, Beirut, Lebanon
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Isma'eel H, Min D, Al-Shaar L, Hachamovitch R, Halliburton S, Gentry J, Griffin B, Schoenhagen P, Phelan D. Assessing Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Categorization Between Coronary Artery Calcium Score and the American College of Cardiology/American Heart Association Cardiovascular Prevention Guidelines and the Potential Impact on Treatment Recommendations. Am J Cardiol 2016; 118:1480-1485. [PMID: 27642113 DOI: 10.1016/j.amjcard.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to <7.5%) cohort, 85% had CACS <100 AU. Of the cohort categorized as reasonable to treat per the ASCVD prevention guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category.
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Affiliation(s)
- Hussain Isma'eel
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - David Min
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Laila Al-Shaar
- Department of Vascular Medicine, American University of Beirut, Beirut, Lebanon
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sandra Halliburton
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Gentry
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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Noureddine S, Avedissian T, Isma'eel H, El Sayed MJ. Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon. J Emerg Trauma Shock 2016; 9:115-21. [PMID: 27512333 PMCID: PMC4960778 DOI: 10.4103/0974-2700.185275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The survival rate of out-of-hospital cardiac arrest (OHCA) victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. METHODS A sample of 705 physicians working in emergency departments (EDs) was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany). Seventy-five participants responded, yielding 10.64% response rate. RESULTS The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%), underlying cardiac rhythm (93.1%), the physician's ethical duty to resuscitate (93.2%), transport time to the ED (89%), and down time (84.9%). The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival) and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8%) and lack of policy (30%). CONCLUSION In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.
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Affiliation(s)
- Samar Noureddine
- Department of Nursing, Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Tamar Avedissian
- Department of Nursing, Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Hussain Isma'eel
- Division of Cardiology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Mazen J El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Affiliation(s)
- Hussain Isma'eel
- 1 Division of Cardiology, American University of Beirut, Beirut, Lebanon ; 2 Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA ; 3 The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Paul Schoenhagen
- 1 Division of Cardiology, American University of Beirut, Beirut, Lebanon ; 2 Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA ; 3 The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Jacqui Webster
- 1 Division of Cardiology, American University of Beirut, Beirut, Lebanon ; 2 Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA ; 3 The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
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AlJaroudi W, Isma'eel H, El Merhi F, Assad T, Hourani M. Appropriateness and diagnostic yield of cardiac magnetic resonance imaging from a tertiary referral center in the Middle East. Cardiovasc Diagn Ther 2015; 5:88-97. [PMID: 25984448 DOI: 10.3978/j.issn.2223-3652.2014.11.01] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022]
Abstract
PURPOSE Cardiac magnetic resonance imaging (CMRI) is a novel non-invasive modality with many potential indications, and was recently introduced in Lebanon. We sought to assess the appropriateness and diagnostic yield of CMR studies performed at a tertiary referral center from the Middle East since the inception of the program. METHODS All patients who underwent CMR studies between January 1(st) 2013 and June 18(th) 2014 were enrolled in this study. CMR reports were retrospectively reviewed. The study indication, clinical history, and findings were extracted and analyzed. The appropriateness of the study was judged according to the 2010 updated Asian Society of Cardiac Imaging guidelines. RESULTS There were a total of 142 patients [mean age 42.1 (SD: 18) years, 24.6% females] that underwent CMR study. Two-thirds of studies were performed on an outpatient basis, and outside referrals constituted 16.2% of the entire cohort. The cardiologists referred 122 cases (86%) with main contribution from electrophysiology and imaging specialists. Of the 142 cases, 12 (8.4%) were not indicated and added little value. Of the remaining 130 appropriate studies (appropriateness level A8-A9), one-third had an incorrect diagnosis prior to CMR, and 8% had relevant findings that were missed on other studies but captured by CMR. Furthermore, CMR confirmed the diagnosis in 28% of the cases, provided relevant information on scar burden, shunt quantification, and ruled out infiltrative disease in the remaining patients. Also, CMR demonstrated the presence of scar in 45 of patients, among whom 20 (44%) had significant scar volume quantification (>5% of left ventricular myocardium). Finally, 9% of patients had a relevant extra-cardiac finding that needed further investigation. CONCLUSIONS Despite the recent launch of the CMR program at our institution, the majority of studies were appropriately indicated, provided relevant data and were clinically useful. Inappropriate or uncertain studies did not provide relevant data, and should be further minimized to avoid unnecessary costs and downstream testing. Large prospective CMR database with clinical follow-up is needed to provide more insight about cardiovascular disease and outcomes in our population.
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Affiliation(s)
- Wael AlJaroudi
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hussain Isma'eel
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fadi El Merhi
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tony Assad
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mukbil Hourani
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Isma'eel H, Sakr G, Habib R, Almedawar M, Zgheib N, Elhajj I. PW284 Improved Accuracy Of Anticoagulant Dose Prediction Using A Pharmacogenetic And Artificial Neural Network Based Method. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Isma'eel H, Taher A, Alam S, Arnaout MS. Massive pulmonary embolism in a Lebanese patient doubly heterozygous for MTHFR and Factor V Leiden presenting with syncope and treated with tenecteplase. J Thromb Thrombolysis 2014; 21:179-84. [PMID: 16622615 DOI: 10.1007/s11239-006-4663-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hussain Isma'eel
- American University of Beirut Medical Center, P.O. Box: 11- 0236/A19, Riad El Solh, 11072020, Beirut, Lebanon
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Kiramijyan S, Ahmadi N, Isma'eel H, Flores F, Shaw LJ, Raggi P, Budoff MJ. Impact of coronary artery calcium progression and statin therapy on clinical outcome in subjects with and without diabetes mellitus. Am J Cardiol 2013. [PMID: 23206921 DOI: 10.1016/j.amjcard.2012.09.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 11/28/2022]
Abstract
Coronary artery calcium (CAC) is a marker of atherosclerosis, and CAC progression is independently associated with all-cause mortality in the general population but not convincingly in subjects with diabetes mellitus (DM). The aim of this study was to ascertain the differences in the rates of CAC progression, the effect of statin therapy, and all-cause mortality in subjects with and without DM. The study group consisted of 296 asymptomatic subjects with type 2 DM and 300 controls (mean age 59 ± 6 years, 29% women) who underwent baseline and follow-up CAC scans within a 2-year interval. Absolute annual CAC score change, percentage annual CAC progression(ΔCAC%), event-free survival, and the effect of statin therapy on survival were all assessed. The mean follow-up duration was 56 ± 11 months. Absolute annual CAC score change was 81 ± 10 in subjects with DM and 34 ± 5 in controls (p = 0.0001). Percentage annual CAC progression was 29 ± 9% in subjects with DM and 10 ± 7% in controls (p = 0.0001). The hazard ratios of death in 3 groups of subjects with DM compared to controls without DM were 1.88 (95% confidence interval [CI] 1.51 to 2.36, p = 0.0001) for ΔCAC of 10% to 20%, 2.29 (95% CI 1.56 to 3.38, p = 0.0001) for ΔCAC of 21% to 30%, and 6.95 (95% CI 2.23 to 11.53, p = 0.0001) for ΔCAC >30%, all compared to ΔCAC <10%. The adjusted hazard ratios of all-cause mortality in subjects receiving compared to those not receiving statin therapy were 0.29 (95% CI 0.13 to 0.56, p = 0.001) in those without DM and without CAC progression, 0.51 (95% CI 0.21 to 0.73, p = 0.001) in those with DM and without CAC progression, and 0.71 (95% CI 0.25 to 0.91, p = 0.003) in those without DM and with CAC progression, with all 3 groups compared to 1.0 (reference) in those with DM, with CAC progression and without statin therapy. In conclusion, CAC progression was greater and event-free survival lower in patients with DM compared to controls in proportion to the extent of CAC progression. These results suggest that CAC progression is an independent predictor of all-cause mortality in patients with DM.
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Affiliation(s)
- Sarkis Kiramijyan
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA.
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D'Ascenzo F, Presutti DG, Picardi E, Moretti C, Omedè P, Sciuto F, Novara M, Yan AT, Goodman S, Mahajan N, Kosuge M, Palazzuoli A, Jong GP, Isma'eel H, Budoff MJ, Rubinshtein R, Gewirtz H, Reed MJ, Theroux P, Biondi-Zoccai G, Modena MG, Sheiban I, Gaita F. Prevalence and non-invasive predictors of left main or three-vessel coronary disease: evidence from a collaborative international meta-analysis including 22 740 patients. Heart 2012; 98:914-9. [PMID: 22626899 DOI: 10.1136/heartjnl-2011-301596] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, S Giovanni Battista Molinette Hospital, Corso Bramante 88-90, Turin 10126, Italy.
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Isma'eel H, Mohanna Z, Hamadeh G, Alam E, Badr K, Alam S, Rebeiz A. The public cost of 3 statins for primary prevention of cardiovascular events in 7 Middle East countries: not all of them can afford it. Int J Cardiol 2012; 155:316-8. [PMID: 22217486 DOI: 10.1016/j.ijcard.2011.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/03/2011] [Indexed: 12/31/2022]
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Hamirani YS, Zeb I, Pagali SR, Kadakia J, Saraff G, Choi T, Ahmadi N, Isma'eel H, Budoff MJ. Normalization of automatic plaque quantification in cardiac computed tomography (CCT). Int J Cardiol 2011; 146:282-90. [DOI: 10.1016/j.ijcard.2010.10.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 10/23/2010] [Indexed: 11/30/2022]
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Isma'eel H, Hamirani YS, Daga N, Kadakia J, Mao S, Ahmadi N, Budoff MJ. Determinants of left main calcifications in a cohort of 2136 diabetes patients. Int J Cardiol 2010; 142:e48-50. [DOI: 10.1016/j.ijcard.2008.12.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 12/14/2008] [Indexed: 01/07/2023]
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Isma'eel H, Shamseddeen W, El Khoury M, Dimassi A, Nasrallah A, Arnaout MS. Diabetes supersedes dobutamine stress echocardiography in predicting cardiac events in female patients. CLIN EXP OBSTET GYN 2010; 37:197-200. [PMID: 21077524] [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: 05/30/2023]
Abstract
BACKGROUND The many available choices for testing for coronary artery disease (CAD) brought about several questions regarding suitability of certain tests for different groups of patients and the prognostic value of obtained results in predicting events and mortality. The aim of this study is to describe the prognostic value of dobutamine stress echocardiography (DSE) results in predicting cardiac events and mortality in > or = 60-year-old females. METHODS 49 women (> or = 60 years old) who were referred for DSE were included in the study. Data including CAD risk factors, and results of tests and a follow-up of events (MI, unstable angina, progression of CHF) and death. RESULTS Eleven patients were considered to have a positive DSE result. There was no difference between DSE (+) and DSE (-) patients in cardiac events and cardiac death. However when interventions were included to events, analysis showed DSE (+) to have more overall events. Non-cardiac deaths and "all deaths" were 11 and 8 times more common among DSE (+) patients compared with DSE (-) patients p < 0.01. Multivariable logistic regression showed that diabetics and DSE (+) patients were 32 (p = 0.01) and 23 (p = 0.02) times more likely to have an event compared with non-diabetics and DSE (-) patients, respectively. CONCLUSION DSE is a safe procedure to be used in > or = 60-year-old female patients and can provide informative prognostic information regarding all-cause deaths and cardiac events (including interventions) over a 4-year period. In addition we find that diabetes is a strong predictor of events regardless of DSE result.
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Affiliation(s)
- H Isma'eel
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Hamirani YS, Isma'eel H, Budoff MJ. Bilateral elevated hemidiaphragms with visible compression of the heart. Tex Heart Inst J 2010; 37:248-249. [PMID: 20401309 PMCID: PMC2851415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Yasmin S Hamirani
- Department of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California 90502, USA.
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Taher A, El Rassi F, Isma'eel H, Koussa S, Inati A, Cappellini MD. Correlation of liver iron concentration determined by R2 magnetic resonance imaging with serum ferritin in patients with thalassemia intermedia. Haematologica 2008; 93:1584-6. [PMID: 18728025 DOI: 10.3324/haematol.13098] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Isma'eel H, Chafic AHE, Rassi FE, Inati A, Koussa S, Daher R, Gharzuddin W, Alam S, Taher A. Relation between iron-overload indices, cardiac echo-Doppler, and biochemical markers in thalassemia intermedia. Am J Cardiol 2008; 102:363-7. [PMID: 18638603 DOI: 10.1016/j.amjcard.2008.03.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 03/17/2008] [Accepted: 03/17/2008] [Indexed: 10/22/2022]
Abstract
Cardiovascular impairment is a major cause of morbidity and mortality in patients with thalassemia intermedia. In this study, echocardiographic assessment of left heart condition was performed in patients with thalassemia intermedia, and its relation to hematologic variables--amino terminal pro-brain natriuretic peptide (NT-proBNP), ferritin, hemoglobin--and liver iron concentration (LIC) was investigated. Echocardiographic assessment was performed using pulse-wave Doppler and tissue Doppler imaging. Data from 74 patients with thalassemia intermedia--35 men, 39 women, mean age 26.5 years (8 to 63)--were randomly selected and evaluated. Blood samples were collected for NT-proBNP levels in a random subgroup of 19 patients. Mean baseline values were hemoglobin 8.4 g/dl (4.9 to 13.1), serum ferritin 902.6 ng/ml (15 to 4,140), LIC 9.0 mg Fe/g (0.5 to 32.1), and NT-proBNP 113.5 pg/ml (16.4 to 371). Correlation between LIC and pulmonary artery systolic pressure was significant, suggesting that iron loading in the liver is indicative of cardiovascular sequelae. NT-proBNP was significantly correlated with the ratio of the left ventricular early rapid filling wave to early diastolic velocity at the mitral annulus (r = 0.50, p = 0.04) and hemoglobin (r = -0.49, p = 0.03), but not with other characteristics assessed. In conclusion, this study has highlighted the importance of using tissue Doppler imaging rather than pulse-wave Doppler to characterize left ventricular diastolic dysfunction in patients with thalassemia intermedia. Demonstration of the correlation of LIC and pulmonary artery systolic pressure independent of left ventricular filling pressures supports our hypothesis that left ventricular diastolic dysfunction does not contribute to the increased pulmonary artery systolic pressure in patients with thalassemia intermedia.
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Charafeddine K, Isma'eel H, Charafeddine M, Inati A, Koussa S, Naja M, Taher A. Survival and complications of beta-thalassemia in Lebanon: a decade's experience of centralized care. Acta Haematol 2008; 120:112-6. [PMID: 19001806 DOI: 10.1159/000171088] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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: 07/07/2008] [Accepted: 08/05/2008] [Indexed: 11/19/2022]
Abstract
beta-Thalassemia major is a debilitating disease with a considerable incidence in Lebanon (around 2-3% carriership). The present article describes our experience to this day with 214 patients, emphasizing the survival of beta-thalassemia major and development of complications among patients with different parameters. Fifteen deaths were reported. The most common cause of death was heart failure (60%). Patients with a ferritin level of 3,000 ng/ml showed better survival than those with a level >3,000 ng/ml (p < 0.006). In addition, patients with a ferritin level of 1,500 ng/ml showed less complication-free survival than those with a level >1,500 ng/ml (p < 0.024). High level of ferritin (1,500 ng/ml) is associated with increased risk of heart failure. Overall and complication-free survival were statistically different among patients classified according to birth cohort or ferritin level. The Chronic Care Center, a multidisciplinary center located in the suburbs of Beirut, led to an increase in complication-free as well as overall survival. Although patients are being diagnosed earlier and chelation therapy is being initiated at an earlier age, complications due to iron overload still persist. The introduction of new oral iron chelators and better iron overload quantitation methods will most likely modify this picture, and a follow-up study will examine their impact.
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Affiliation(s)
- K Charafeddine
- American University of Beirut Medical Center, Beirut, Lebanon
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Masroujeh R, Shamseddeen W, Isma'eel H, Otrock ZK, Khalil IM, Taher A. Underutilization of venous thromboemoblism prophylaxis in medical patients in a tertiary care center. J Thromb Thrombolysis 2007; 26:138-41. [PMID: 17701104 DOI: 10.1007/s11239-007-0084-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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: 07/04/2007] [Accepted: 07/30/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND New recommendations concerning the use of prophylactic anticoagulation for medically ill patients have been in use for some time now. This study aims at assessing how much house-staff in a tertiary care setting are implementing these new recommendations in the hope that through quantitative analysis of the deficiency we would be able to identify areas of weakness. METHODS About 250 patients were randomly selected from all patients admitted to the American University of Beirut Medical Center (AUBMC) during the year 2005 and stayed more than 48 h. The risk factor profiles, contraindications to thromboprophylaxis, if present, and whether these patients received the appropriate VTE pharmacologic prophylaxis during their stay in hospital were recorded. RESULTS About 139 patients were found to have two or more risk factors, with no absolute contraindications. About 37 patients (26.6%) received VTE prophylaxis. Upon reviewing the risk factors profile, the majority of patients (71.3%) were found to have 2-4 risk factors. Among risk factors studied, age > 40 years, admission to ICU, prior VTE, chronic lung disease, infection, respiratory failure, and central venous catheter were significantly associated with receiving prophylaxis. CONCLUSIONS VTE prophylaxis is underutilized at AUBMC, a tertiary care teaching hospital in the Middle East. Critical care patients were being acceptably anti-coagulated, whereas cancer patients are doing the worst.
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Affiliation(s)
- Ramy Masroujeh
- Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
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Isma'eel H, Zebian R, El-Accaoui R, Dimassi A, Rashid K, Alam S, Taher A, Khoury M, Arnaout MS. Anticoagulation clinics are needed in developing countries. Int J Cardiol 2007; 115:410-1. [PMID: 16757043 DOI: 10.1016/j.ijcard.2006.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 04/26/2006] [Indexed: 11/18/2022]
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Isma'eel H, Abdelbaki K, Obeid M, Arnaout MS. Prevalence of variety of cardiac tumors presenting to tertiary care center in Eastern Mediterranean area over 21 years. Int J Cardiol 2007; 114:121-2. [PMID: 16352353 DOI: 10.1016/j.ijcard.2005.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 11/05/2005] [Indexed: 11/28/2022]
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Isma'eel H, Arnaout MS, Shamseddeen W, Mahfouz R, Zeineh N, Jradi O, Taher A. Screening for inherited thrombophilia might be warranted among Eastern Mediterranean sickle-beta-0 thalassemia patients. J Thromb Thrombolysis 2006; 22:121-3. [PMID: 17008978 DOI: 10.1007/s11239-006-8953-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/28/2022]
Abstract
BACKGROUND The role of genetic thrombophilia in the development of both micro and macro vascular complications in patients with hemoglobinopathies (Sickle cell disease and thalassemia) have been investigated with some studies negating its role while others suggesting it. Lebanon is known to harbor sickle cell disease, thalassemia and sickle beta-thalassemia hemoglobinopathy patients along with a documented high prevalence of genetic thrombophilia mutations. METHODS Twelve sickle beta-0-thalassemia patients with no pervious history of thrombotic events were selected. These patients underwent a physical examination with history, echo Doppler, along with blood withdrawal for complete blood count and PCR analysis of a sample of DNA for Factor V Leiden G1691A, Factor II G20210A, and MTHFR C677T. Results were compared to a historical control of 50 Lebanese controls and 50 LebaneseThalassemia Intermedia (TI) patients. RESULTS The results showed that 42%, 59%, and 8% of patients carried heterozygous Factor V Leiden, abnormal (homozygous & heterozygous) MTHFR, and heterozygous Factor II mutations respectively. The sickle-thalassemia patients were 5.24 and 4.39 times more likely to have Factor V Leiden as compared to the normal controls and TI patients respectively (p < 0.05). DISCUSSION The increased prevalence of more than one prothrombotic genetic mutation among the group indicates a probable clustering phenomenon, unknown to us to which the high consanguinity rate (77%) may have contributed. The role of the specific MTHFR and Factor V Leiden double heterozygous combination in incidence, recurrence, and guidance of duration of therapy in VTE is not well defined in the literature despite the recognized higher risk of thrombosis among this patient population. Our findings suggest that genetic thrombophilia workup is necessary in patients with sickle-beta zero thalassemia presenting with thrombotic events and studies that include a larger number of patients are necessary in order to define specific guidelines.
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El Accaoui R, Isma'eel H, Khalil PB, Taher A. A review of the off-label use of recombinant activated factor VII in a developing country tertiary care center. Blood Coagul Fibrinolysis 2006; 17:647-50. [PMID: 17102651 DOI: 10.1097/01.mbc.0000252599.32648.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recombinant activated factor VII (rFVIIa) was first approved for treatment of congenital hemophilia. It could, however, also have a role in management of patients without pre-existing coagulopathies who undergo surgical procedures, have life-threatening hemorrhages, or sustain traumas associated with major blood loss. A retrospective chart review was performed for all cases given rFVIIa at American University of Beirut Medical Center (AUB MC). Patients with a previous medical history of thrombophilia were excluded. There were four pediatric patients with a mean age younger than 1 year. Adult patients' mean age was 64.5 +/- 17.4 years. The most common off-label uses for rFVIIa are control of hemorrhage during the repair of aortic dissection (4/17 cases) or following intracerebral hemorrhage (4/17 case). One trauma patient received the medication. Complications included cerebral ischemia in one patient. Three of the patients died but their death was not related to the bleeding or the medication. Based on the prognostic score proposed by Biss and Hanley, seven patients were low risk, four intermediate risk, and six high risk. Although off-label use of rFVIIa at AUB MC was supported by published reports, and associated with few complications, guidelines are required to control use of this medication.
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Abstract
Beta-thalassemia is a hereditary anemia that is quite prevalent in Lebanon. Most patients with beta-Thalassemia are treated and followed up mostly at a multidisciplinary center, located in the suburban area of Beirut: the Chronic Care Center (CCC), operational since 1994. We will review the experience with beta-Thalassemia accumulated through this institution. Four hundred and twenty five patients, aged 2 to 68 years are followed up at the CCC. Sixty four percent have thalassemia major (TM) while 36% have thalassemia intermedia (TI). Lebanese patients with TM receive periodic packed red cell transfusions to maintain a pre-transfusional hemoglobin level of 10 gm/dl at all times and desferrioxamine is the standard iron chelator in use. Since 1994, 12 patients with TM have died from complications of their disease, with heart failure being responsible for the majority of deaths. The incidence of cardiac, endocrinologic, and infectious complications will be reviewed. Finally, both current and prospective preventive measures will be discussed, specifically educational campaigns and premarital screening. The effects of prevention are starting to show as the number of newly diagnosed disease is diminishing.
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Affiliation(s)
- A Inati
- Chronic Care Center, Baabda, Lebanon
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Taher A, Isma'eel H, Mehio G, Bignamini D, Kattamis A, Rachmilewitz EA, Cappellini MD. Prevalence of thromboembolic events among 8,860 patients with thalassaemia major and intermedia in the Mediterranean area and Iran. Thromb Haemost 2006; 96:488-91. [PMID: 17003927] [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: 05/12/2023]
Abstract
Beta-thalassaemia is a congenital haemolytic anaemia characterized by partial (intermedia, TI) or complete (major, TM) deficiency in the production of beta-globin chains. The primary aim of this study was to determine the prevalence of thromboembolic events in patients with beta-thalassaemia. To achieve this, a multiple choice questionnaire was sent to 56 tertiary referral centres in eight countries (Lebanon, Italy, Israel, Greece, Egypt, Jordan, Saudi Arabia and Iran), requesting specific information on patients who had experienced a thromboembolic event. The study demonstrated that thromboembolic events occurred in a clinically relevant proportion (1.65%) of 8,860 thalassaemia patients (TI - 24.7% or TM - 75.3%) from the Mediterranean and Iran. Thromboembolism occurred 4.38 times more frequently in TI than TM (p < 0.001), with more venous events occurring in TI and more arterial events occurring in TM. Thrombosis in thalassaemia was also more common in females, splenectomized patients and those with profound anaemia (haemoglobin <9 g/dl). Due to the increased risk of thromboembolic events, the rationale for splenectomy should perhaps be re-assessed and the role of transfusion therapy for the prophylaxis of thrombosis, among other complications, be evaluated prospectively.
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Affiliation(s)
- Ali Taher
- Internal Medicine, American University of Beirut, Beirut, Lebanon
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Isma'eel H, El Accaoui R, Shamseddeen W, Taher A, Alam S, Mahfouz R, Arnaout MS. Genetic thrombophilia in patients with VTE in eastern Mediterranean located tertiary care center; is it time to change the algorithm for thrombophilia work up decision making? J Thromb Thrombolysis 2006; 21:267-70. [PMID: 16683219 DOI: 10.1007/s11239-006-5537-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/24/2022]
Abstract
BACKGROUND Genetic thrombophilia work up performance is subject to debate because of the utility of the information it provides regarding prognosis of recurrence of venous thromboembolism (VTE) and guidance of duration of therapy with anticoagulation. Certain algorithms have been locally developed to guide decision making process to increase the yield of thrombophilia work up. These algorithms are not based on locally derived data. Data from the Eastern Mediterranean area (Lebanon) have shown high prevalence of thrombophilia mutations. Therefore the aim of this study was to describe the experience of a tertiary care center in thrombophilia work up among patients diagnosed with VTE. METHODS A retrospective chart analysis of the cases diagnosed with pulmonary embolism or deep venous thrombosis with radiological confirmation. RESULTS A total of 133 patients' charts were reviewed, 27 patients had thrombophilia work up performed, 56% had heterozygous MTHFR mutation, 44% were heterozygous for the Factor V Leiden mutation and 3.2% were found to have Factor II heterozygous mutations, and a total of 33.3% of patients had more than one genetic mutation. The common causes of provoked VTE were 59.53% malignancy, 22.64% post surgery, 12.98% bed ridden patients, and 4.85% oral contraceptive pills. Only 14% of patients with a malignancy who presented with VTE where receiving prophylactic heparin. DISCUSSION Doubly heterozygous prothrombotic genetic mutations are commonly present among Eastern Mediterranean patients with VTE. A prospective study to determine the predictive (negative and positive) power of the currently followed algorithm for genetic thrombophilia work up remains of significant importance. Stressing the favorable role of VTE prophylaxis among patients suffering from malignancies remains a target for raising awareness among oncologists.
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Affiliation(s)
- H Isma'eel
- American University of Beirut Medical Center, Beirut, Lebanon
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Isma'eel H, Taher A, Shamseddeen W, Khoury M, Gharzuddine W, Arnaout MS, Alam S. SAECG parameters and left ventricular chamber sizes: lesson from anemia conditions in thalassemia major patients. Int J Cardiol 2006; 113:E102-4. [PMID: 16887209 DOI: 10.1016/j.ijcard.2006.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 06/02/2006] [Indexed: 11/16/2022]
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Abstract
Thalassemia intermedia encompasses a wide clinical spectrum of beta-thalassemia phenotypes. Some thalassemia intermedia patients are asymptomatic until adult life, whereas others are symptomatic from as young as 2 years of age. A number of clinical complications commonly associated with thalassemia intermedia are rarely seen in thalassemia major, including extramedullary hematopoiesis, leg ulcers, gallstones and thrombophilia. Prevention of these complications, possibly with blood transfusion therapy, is ideal since they may be difficult to manage. Currently, many patients with thalassemia intermedia receive only occasional or no transfusions, since they are able to maintain hemoglobin levels between 7-9 g/dl; the risk of iron overload, necessitating adequate chelation therapy, is also a contributing factor. At present, there are no clear guidelines for initiating and maintaining transfusions in thalassemia intermedia for the prevention or treatment of complications. Here, we review the major clinical complications in thalassemia intermedia and suggest some therapeutic strategies based on retrospective clinical observations.
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Affiliation(s)
- Ali Taher
- Department of Internal Medicine, Hematology-Oncology Division, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon.
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El-Beshlawy A, Abd El Raouf E, Mostafa F, Talaat M, Isma'eel H, Aoun E, Hoffbrand AV, Taher A. Diastolic dysfunction and pulmonary hypertension in sickle cell anemia: is there a role for L-carnitine treatment? Acta Haematol 2006; 115:91-6. [PMID: 16424656 DOI: 10.1159/000089472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Clinical manifestations of cardiovascular abnormalities in patients with sickle cell (SC) anemia are well documented. Many variables were assessed in our study before and after administration of L-carnitine to randomly selected 37 SC disease (SCD) children for a period of 6 months. Variables such as weight, height, serum ferritin levels, units of blood transfused and the number of veno-occlusive crises all showed significant improvement after the 6 months of therapy with L-carnitine. Our study also showed that cardiac diastolic function and pulmonary hypertension are common in pediatric SCD patients. These two disorders showed some improvement after L-carnitine administration. Therefore, L-carnitine deserves a rigorous large-scale randomized clinical trial to evaluate its potential benefits as treatment for SCD patients with cardiac complications.
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Affiliation(s)
- A El-Beshlawy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
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El-Beshlawy A, Seoud H, Ibrahim A, Youssry I, Gabre H, Isma'eel H, Aoun E, Taher A. Apoptosis in thalassemia major reduced by a butyrate derivative. Acta Haematol 2005; 114:155-9. [PMID: 16227679 DOI: 10.1159/000087890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Accepted: 05/18/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES In cases of beta-thalassemia major, apoptosis appears to be greatly enhanced in the early-stage erythroid precursors in the bone marrow leading to ineffective erythropoiesis. L-Carnitine is found to strongly reduce apoptosis in different diseases. We investigated the effect of oral L-carnitine therapy on apoptosis in thalassemia major patients. METHODS Eighteen thalassemia major patients with a mean age of 12.2 +/- 6.6 years were included. Detection of apoptosis was done by photometric enzyme immunoassay (ELISA) and agarose gel electrophoresis before and after 6 months of oral therapy with L-carnitine (50 mg/kg/day). RESULTS A significant decrease of apoptosis frequency in the erythroid precursors in the bone marrow of studied cases was noted after therapy. The quantity of nucleosomes measured by ELISA dropped from 3.65 +/- 1.338 to 1.60 +/- 0.65 after therapy (p = 0.005). A positive ladder pattern reflecting apoptosis on agarose gel electrophoresis was detected in 88.9% of cases prior to treatment versus 16.7% after therapy (p = 0.006). Patients also had a significant decrease in the frequency of transfusions and increase in the pre-transfusion hemoglobin levels after therapy. CONCLUSION L-Carnitine seems to be a good modulator of apoptotic processes in thalassemic patients leading to a decreased frequency of programmed erythroblast death and general improvement of the disease condition.
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Affiliation(s)
- A El-Beshlawy
- Pediatric Department, School of Medicine and Al Azhar Universities, Cairo, Egypt
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