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Ehrhardt H, Lambe J, Moussa H, Vasileiou ES, Kalaitzidis G, Murphy OC, Filippatou AG, Pellegrini N, Douglas M, Davis S, Nagy N, Quiroga A, Hu C, Zambriczki Lee A, Duval A, Fitzgerald KC, Prince JL, Calabresi PA, Sotirchos ES, Bermel R, Saidha S. Effects of Ibudilast on Retinal Atrophy in Progressive Multiple Sclerosis Subtypes: Post Hoc Analyses of the SPRINT-MS Trial. Neurology 2023; 101:e1014-e1024. [PMID: 37460235 PMCID: PMC10491449 DOI: 10.1212/wnl.0000000000207551] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/08/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ganglion cell + inner plexiform layer (GCIPL) thinning, measured by optical coherence tomography (OCT), reflects global neurodegeneration in multiple sclerosis (MS). Atrophy of the inner (INL) and outer nuclear layer (ONL) may also be prominent in progressive MS (PMS). The phase 2, SPRINT-MS trial found reduced brain atrophy with ibudilast therapy in PMS. In this post hoc analysis of the SPRINT-MS trial, we investigate (1) retinal atrophy (2) differences in response by subtype and (3) associations between OCT and MRI measures of neurodegeneration. METHODS In the multicenter, double-blind SPRINT-MS trial, participants with secondary progressive MS (SPMS) or primary progressive MS (PPMS) were randomized to ibudilast or placebo. OCT and MRI data were collected every 24 weeks for 96 weeks. Extensive OCT quality control and algorithmic segmentation produced consistent results across Cirrus HD-OCT and Spectralis devices. Primary endpoints were GCIPL, INL, and ONL atrophy, assessed by linear mixed-effects regression. Secondary endpoints were associations of OCT measures, brain parenchymal fraction, and cortical thickness, assessed by partial Pearson correlations. RESULTS One hundred thirty-four PPMS and 121 SPMS participants were included. GCIPL atrophy was 79% slower in the ibudilast (-0.07 ± 0.23 µm/y) vs placebo group (-0.32 ± 0.20 µm/y, p = 0.003). This effect predominated in the PPMS cohort (ibudilast: -0.08 ± 0.29 µm/y vs placebo: -0.60 ± 0.29 µm/y, a decrease of 87%, p < 0.001) and was not detected in the SPMS cohort (ibudilast: -0.21 ± 0.28 µm/y vs placebo: -0.14 ± 0.27 µm/y, p = 0.55). GCIPL, INL, and ONL atrophy rates correlated with whole brain atrophy rates across the cohort (r = 0.27, r = 0.26, and r = 0.20, respectively; p < 0.001). Power calculations from these data show future trials of similar size and design have ≥80% power to detect GCIPL atrophy effect sizes of approximately 40%. DISCUSSION Ibudilast treatment decreased GCIPL atrophy in PMS, driven by the PPMS cohort, with no effect seen in SPMS. Modulated atrophy of retinal layers may be detectable in sample sizes smaller than the SPRINT-MS trial and correlate with whole brain atrophy in PMS, further highlighting their utility as outcomes in PMS. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that ibudilast reduces composite ganglion cell + inner plexiform layer atrophy, without reduction of inner or outer nuclear layer atrophy, in patients with primary progressive MS but not those with secondary progressive MS.
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Affiliation(s)
- Henrik Ehrhardt
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Jeffrey Lambe
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Hussein Moussa
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Eleni S Vasileiou
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Grigorios Kalaitzidis
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Olwen C Murphy
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Angeliki G Filippatou
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Nicole Pellegrini
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Morgan Douglas
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Simidele Davis
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Natalia Nagy
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Agustina Quiroga
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Chen Hu
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Alexandra Zambriczki Lee
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Anna Duval
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Kathryn C Fitzgerald
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Jerry L Prince
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Peter A Calabresi
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Elias S Sotirchos
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Robert Bermel
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Shiv Saidha
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH.
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Kalaitzidis G, Filippatou A, Fioravante N, Rothman A, Sotirchos ES, Vasileiou E, Ehrhardt H, Quiroga A, Pellegrini N, Murphy OC, Moussa H, Ladakis D, Lambe J, Fitzgerald KC, Solnes L, Venkatesan A, Calabresi PA, Saidha S, Probasco JC. Visual Pathway Involvement in NMDA Receptor Encephalitis: A Clinical, Optical Coherence Tomography, and 18-Fluorodeoxyglucose PET/CT Approach. J Neuroophthalmol 2023; 43:220-226. [PMID: 36000788 PMCID: PMC9950287 DOI: 10.1097/wno.0000000000001696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-NMDA receptor (NMDAR) encephalitis patients have been reported to exhibit visual dysfunction without retinal thinning. The objective of our study was to examine the involvement of the visual pathway structure and function in anti-NMDAR encephalitis by assessing postrecovery visual function and retinal structure, and acute-phase occipital cortex function. METHODS In this cross-sectional study, patients diagnosed with anti-NMDAR encephalitis per consensus criteria underwent postrecovery visual acuity (VA) testing and optical coherence tomography (OCT) with automated retinal layer segmentation. Clinical data and acute-phase brain 18F-fluorodeoxyglucose (FDG) PET/CT (performed within 90 days of symptom onset, assessed qualitatively and semi-quantitatively) were retrospectively analyzed. VA and OCT measures were compared between anti-NMDAR and age, sex, and race-matched healthy controls (HC). When available, FDG-PET/CT metabolism patterns were analyzed for correlations with VA, and OCT measures. RESULTS A total of 16 anti-NMDAR (32 eyes) and 32 HC (64 eyes) were included in the study. Anti-NMDAR exhibited lower low-contrast VA (2.5% contrast: -4.4 letters [95% CI; -8.5 to -0.3]; P = 0.04, 1.25% contrast: -6.8 letters [95%CI; -12 to -1.7]; P = 0.01) compared with HC, but no differences were found on OCT-derived retinal layer thicknesses. Acute-phase FDG-PET/CT medial occipital cortex metabolism did not correlate with follow-up low-contrast VA or ganglion cell/inner plexiform layer thickness (GCIPL) (n = 7, 2.5% contrast: r = -0.31; P = 0.50, 1.25% contrast: r = -0.34; P = 0.45, GCIPL: r = -0.04; P = 0.94). CONCLUSIONS Although the visual system seems to be involved in anti-NMDAR encephalitis, no retinal structural or occipital cortex functional abnormalities seem to be responsible for the visual dysfunction. When detected acutely, occipital lobe hypometabolism in anti-NMDAR encephalitis does not seem to associate with subsequent retrograde trans-synaptic degenerative phenomena, potentially reflecting reversible neuronal/synaptic dysfunction in the acute phase of the illness rather than neuronal degeneration.
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Affiliation(s)
- Grigorios Kalaitzidis
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Angeliki Filippatou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicholas Fioravante
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alissa Rothman
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elias S. Sotirchos
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eleni Vasileiou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Henrik Ehrhardt
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Agustina Quiroga
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicole Pellegrini
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Olwen C. Murphy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hussein Moussa
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dimitrios Ladakis
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey Lambe
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kathryn C. Fitzgerald
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lilja Solnes
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arun Venkatesan
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter A. Calabresi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John C. Probasco
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Advanced Clinical Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Nord D, Langerude L, Gill B, Moussa H, Emtiazjoo A, Shahmohammadi A, Rackauskas M, Atkinson C. Increased Circulating Cell Junction Proteins are Associated with the Development of Primary Graft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1479] [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: 04/05/2023] Open
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Kalaitzidis G, Pellegrini N, Nagy N, Vasileiou E, Ehrhardt H, Reppen A, Murphy OC, Moussa H, Filippatou A, Lambe J, DuVal A, Fioravante N, Kwakyi O, Nguyen J, Davis S, Douglas M, Ramirez A, Ecoff K, Valenzuela A, Reyes-Mantilla M, Hu C, Fitzgerald KC, Sotirchos ES, Saidha S, Calabresi PA. Effects of Myopia on Rates of Change in Optical Coherence Tomography Measured Retinal Layer Thicknesses in People with Multiple Sclerosis and Healthy Controls. Curr Eye Res 2023; 48:312-319. [PMID: 36440535 DOI: 10.1080/02713683.2022.2149806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To quantify the associations of myopia with longitudinal changes in retinal layer thicknesses in people with multiple sclerosis (PwMS) and healthy controls (HC). METHODS A cohort of PwMS and HC with recorded refractive error (RE) prospectively scanned on Cirrus HD-OCT at the Johns Hopkins MS Center was assessed for inclusion. Exclusion criteria included OCT follow-up < 6 months, ocular comorbidities, incidental OCT pathologies, and inadequate scan quality. Eyes were classified as having high myopia (HM) (RE≤ -6 diopters), low myopia (LM) (RE> -6 and ≤ -3 diopters), or no myopia (NM) (RE> -3 and ≤ +2.75). Linear mixed-effects regression models were used in analyses. RESULTS A total of 213 PwMS (eyes: 67 HM, 98 LM, 207 NM) and 80 HC (eyes: 26 HM, 37 LM, 93 NM) were included. Baseline average ganglion cell/inner plexiform (GCIPL) and peri-papillary retinal nerve fiber layer (pRNFL) thicknesses were lower in MS HM compared with MS NM (diff: -3.2 µm, 95% CI: -5.5 to -0.8, p = 0.008 and -5.3 µm, 95% CI: -9.0 to -1.7, p = 0.004, respectively), and similarly in HC HM, as compared with HC NM. Baseline superior, inferior, and nasal pRNFL thicknesses were lower in HM compared with NM, while temporal pRNFL thickness was higher, both in MS and HC (MS: 7.1 µm, 95% CI: 2.7-11.6, p = 0.002; HC: 4.7 µm, 95% CI: -0.3 to 9.7, p = 0.07). No longitudinal differences in rates of GCIPL change were noted between HM and LM vs. NM, either in MS or HC. CONCLUSION Cross-sectional differences in average GCIPL and pRNFL thicknesses are commonly seen in people with HM as compared to reference normative values from people with NM and can lead to false attribution of pathology if RE is not taken into account. However, our study suggests that longitudinal changes in average GCIPL thickness in PwMS with myopia are similar in magnitude to PwMS with NM, and therefore are appropriate for monitoring disease-related pathology.
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Affiliation(s)
- Grigorios Kalaitzidis
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Pellegrini
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalia Nagy
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Vasileiou
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henrik Ehrhardt
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abbey Reppen
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olwen C Murphy
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hussein Moussa
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angeliki Filippatou
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Lambe
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna DuVal
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Fioravante
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Nguyen
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Simidele Davis
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Morgan Douglas
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra Ramirez
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Ecoff
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alyssandra Valenzuela
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria Reyes-Mantilla
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias S Sotirchos
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD,USA
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Ayoubi NKE, Moussa H, Younes A, Haddad R, Khoury SJ. Use of retinal optical coherence tomography to differentiate suspected neuromyelitis optica spectrum disorder from multiple sclerosis: A cross-sectional study. Mult Scler Relat Disord 2022; 68:104160. [PMID: 36113276 DOI: 10.1016/j.msard.2022.104160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Retinal optical coherence tomography (OCT) can differentiate definite NMOSD (dNMOSD) from multiple sclerosis (MS), but has not been evaluated in patients with a high clinical suspicion of NMOSD and not fulfilling the current consensus diagnostic criteria, referred in this paper as "potential" NMOSD (pNMOSD). AIM To compare the retinal OCT measurements between patients with pNMOSD, dNMOSD, MS, and reference healthy controls (HC). MATERIAL AND METHODS In this cross-sectional study, clinical and demographic characteristics, as well as OCT measurements of peripapillary retinal nerve fiber layer (pRNFL), inner nuclear layer (INL), macular retinal nerve fiber layer (mRNFL), outer nuclear layer (ONL) ganglion cell/inner plexiform layer (GCIPL), and macular volume (MV) were compared between groups. Mixed-effects regression models adjusting for within-patient inter-eye correlations, controlling for age, gender, disease duration and history of optic neuritis per eye were explored. Subgroup analyses were performed on eyes with previous optic neuritis. RESULTS 234 eyes (20 pNMOSD, 33 dNMOSD, 138 MS, and 43 HC) were included. Controlling for age, gender, disease duration, and history of optic neuritis per eye, pNMOSD eyes showed decreased GCIPL, pRNFL, mRNFL and MV thicknesses, similar to eyes with dNMOSD, but significantly thinner than MS and HC subjects' eyes. Similar results were obtained for the pRNFL, mRNFL, GCIPL, INL and MV thickness in the subgroup analysis exploring only eyes with history of optic neuritis (12 pNMOSD, 15 dNMOSD, and 27 MS). CONCLUSION Retinal OCT measurements in patients with pNMOSD were similar to dNMOSD, but significantly lower than patients with MS and healthy controls. This suggests that retinal OCT measures could be helpful markers supportive of NMOSD diagnosis and should be explored in larger studies as a valuable addition to the current consensus diagnostic criteria.
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Affiliation(s)
- Nabil K El Ayoubi
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon
| | - Hussein Moussa
- Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Antoine Younes
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon
| | - Ribal Haddad
- Department of Neurology, the University of Chicago, Chicago, IL, USA
| | - Samia J Khoury
- Department of Neurology, Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon.
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Moussa H, Sawaya RA, Deeb R, El Ayoubi N. Correlation of Pattern Reversal and Flash Visual Evoked Potential Latencies With Optical Coherence Tomography Measures in Patients With Optic Neuropathy and Patients With Multiple Sclerosis Without Optic Neuropathy. J Clin Neurophysiol 2022; 39:637-642. [PMID: 33555731 DOI: 10.1097/wnp.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The object of the study is to relate the pattern reversal visual evoked potential (PRVEP) and flash VEP (f-VEP) latencies with retinal neurons and their fibers. METHODS We studied 104 eyes. Forty-two eyes from patients with optic neuritis (ON), 28 eyes from patients with multiple sclerosis without involvement of the optic nerves (MS-non-ON), and 34 eyes of normal controls. RESULTS Pattern reversal visual evoked potential latency is more delayed in patients with ON than in patients with multiple sclerosis nonON. Flash visual evoked potential (f-VEP) latency was delayed in both categories. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell/inner plexiform layer (GCIPL) thickness was lower in patients with ON and multiple sclerosis non-ON. In patients with ON, f-VEP latencies correlated negatively with pRNFL thickness but not GCIPL thickness. In patients with ON, PRVEP latencies did not correlate with pRNFL thickness but correlate negatively with GCIPL thickness. CONCLUSIONS Patients with ON have delayed VEPs and thinner optical coherence tomography values. Flash visual evoked potentials correlate with pRNFL, indicating axonal pathology. PRVEP correlate with GCIPL, indicating ganglion cell pathology. Abnormal PRVEP with preserved normal f-VEP indicate isolated myelin damage. Abnormalities in both PRVEP and f-VEP indicate myelin and axonal damage in the optic nerve. Combining the results of PRVEP, f-VEP, pRNFL, and GCIPL, one can define the location, type, and extent of the lesion in the macula and optic nerve.
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Affiliation(s)
- Hussein Moussa
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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Moussa H, Robitaille K, Pelletier J, Hovington H, Duchesne T, Julien P, Savard J, Fradet V. 290 - Effet d'une supplémentation en oméga-3 sur la qualité de vie: un essai randomisé contrôlé. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.158] [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: 11/26/2022] Open
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Tourigny R, Moussa H, Robitaille K, Bussières V, Saad F, Carmel M, Aprikian A, Fradet Y, Network BIOCGR, Fradet V. 271 - Analyse de la qualité de vie des hommes à risque de cancer de la prostate. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.201] [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: 11/26/2022] Open
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Chaaban L, Safwan N, Moussa H, El‐Sammak S, Khoury S, Hannoun S. Central vein sign: A putative diagnostic marker for multiple sclerosis. Acta Neurol Scand 2022; 145:279-287. [PMID: 34796472 DOI: 10.1111/ane.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
The presence of a "central vein sign" (CVS) has been introduced as a biomarker for the diagnosis of multiple sclerosis (MS) and shown to have the ability to accurately differentiate MS from other white matter diseases (MS mimics). Following the development of susceptibility-based magnetic resonance venography that allowed the in vivo detection of CVS, a standard CVS definition was established by introducing the "40% rule" that assesses the number of MS lesions with CVS as a fraction of the total number of lesions to differentiate MS lesions from other types of lesions. The "50% rule," the "three-lesion criteria," and the "six-lesion criteria" were later introduced and defined. Each of these rules had high levels of sensitivity, specificity, and accuracy in differentiating MS from other diseases, which has been recognized by the Magnetic Resonance Imaging in MS (MAGNIMS) group and the Consortium of MS Centers task force. The North American Imaging in Multiple Sclerosis Cooperative even provided statements and recommendations aiming to refine, standardize and evaluate the CVS in MS. Herein, we review the existing literature on CVS and evaluate its added value in the diagnosis of MS and usefulness in differentiating it from other vasculopathies. We also review the histopathology of CVS and identify available automated CVS assessment methods as well as define the role of vascular comorbidities in the diagnosis of MS.
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Affiliation(s)
- Lara Chaaban
- Department of Agriculture and Food Sciences American University of Beirut Beirut Lebanon
| | - Nancy Safwan
- Department of Agriculture and Food Sciences American University of Beirut Beirut Lebanon
| | - Hussein Moussa
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
| | - Sally El‐Sammak
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
- Faculty of Medicine Abu‐Haidar Neuroscience Institute American University of Beirut Medical Center Beirut Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
- Medical Imaging Sciences Program Division of Health Professions Faculty of Health Sciences American University of Beirut Beirut Lebanon
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Abstract
Context: Non-traumatic spinal cord infarction in the young adult is usually associated with a single or multiple genetic mutations. There are certain gene mutations that are more commonly associated with spinal cord infarctions. Homozygous or heterozygous mutations, and single mutations or polymorphism, do not seem to determine the probability of spinal cord infarction.Findings: We add another case of spinal cord infarction in a young adult to the few reported in the literature, and discuss the value of genetic studies and genetic counseling.Conclusion: Non-traumatic spinal cord infarction is usually caused by a genetic mutation. Early recognition of this entity and definition of the mutation will limit unnecessary and invasive procedures and allows early rehabilitation, preventive measures for complications and genetic counseling.
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Affiliation(s)
- Maria Khoueiry
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - Hussein Moussa
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - Raja Sawaya
- Department of Neurology, American University Medical Center, Beirut, Lebanon,Correspondence to: Raja Sawaya, Clinical Neurophysiology Laboratory, AmericanUniversity Medical Center, POB: 113 - 6044 / C-27, Beirut, Lebanon; Ph: 00-961-3347377.
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Sawaya R, Saab G, Moussa H. Should tocilizumab be the first line treatment for neuromyelitis optica together with rituximab? Neurologia (Engl Ed) 2021; 36:642-643. [PMID: 34654538 DOI: 10.1016/j.nrleng.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- R Sawaya
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - G Saab
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Moussa
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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Abd EL-Sadek A, Mohamed E, Moussa H, El-Saeed A. Clinical Outcomes of Omalizumab as Add-on Therapy for Severe Asthma Patients. Benha Journal of Applied Sciences 2021; 6:1-7. [DOI: 10.21608/bjas.2021.167504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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13
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Sawaya R, Saab G, Moussa H. Should tocilizumab be the first line treatment for neuromyelitis optica together with rituximab? Neurologia 2020; 36:S0213-4853(20)30310-8. [PMID: 33176917 DOI: 10.1016/j.nrl.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- R Sawaya
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - G Saab
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Moussa
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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El Shazley N, Hamdy A, El-Eneen HA, El Backly RM, Saad MM, Essam W, Moussa H, El Tantawi M, Jain H, Marei MK. Bioglass in Alveolar Bone Regeneration in Orthodontic Patients: Randomized Controlled Clinical Trial. JDR Clin Trans Res 2016; 1:244-255. [PMID: 30931746 DOI: 10.1177/2380084416660672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/21/2022] Open
Abstract
This study was designed as a split-mouth randomized controlled clinical trial to evaluate the effects of a novel bioactive glass scaffold-tailored amorphous multiporous (TAMP)-for the preservation of alveolar bone following tooth extraction in class II orthodontic patients. TAMP scaffolds were prepared and sterilized. Patients were screened for eligibility, and 6 patients accounting for 14 extraction sockets were included in this stage. Sockets were randomly allocated to either control (left empty) or test (grafted with TAMP scaffold particles). Follow-up was done after 1, 2, 4, 8, and 12 to 17 wk with digital periapical radiographs to evaluate changes in crestal bone height and bone mineral density (BMD), 3-dimensional volumetric analysis of impression casts, and histologic analysis of core biopsies. Furthermore, alveolar bone marrow mesenchymal stem cells were cultured from control and test sockets following biopsy retrieval to evaluate the ability of TAMP bioactive glass scaffolds to recruit host progenitor cells. Results showed that sockets grafted with TAMP bioactive glass scaffolds better preserved height after 3 mo where mesially 57.1% of test cases showed preservation of socket height, compared with 28.6% of control cases. Distally, this was 42.9% of test cases versus none of the control cases. Regarding BMD, the test sides had higher BMD in all 3 sections of the socket, with the greatest reduction in BMD found in the coronal third. Results were not statistically significant. Histologically, sockets grafted with TAMP bioactive glass scaffolds showed a distinct pattern of bone healing characterized by vertical trabeculae and large vascularized marrow spaces with sockets showing corticalization. Volumetric analysis showed a better preservation of socket contour with TAMP bioactive glass scaffolds. TAMP bioactive glass scaffolds appeared to enhance the recruitment of stem cells from the grafted sockets. In conclusion, TAMP scaffolds appear to better preserve alveolar bone following extraction and allow for a more active bone modeling and remodeling process( ClinicalTrials.gov identifier:NCT01878084). Knowledge Transfer statement: The results of this study set the stage for the recommended use of novel biomimetic scaffolds, such as the tailored amorphous multiporous bioactive glass for preservation of the socket following extraction. This can be valuable for patients and clinicians alike when deciding on long-term prosthetic alternatives that not only result in immediate bone preservation but will accommodate the dynamic nature of bone.
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Affiliation(s)
- N El Shazley
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - A Hamdy
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - H A El-Eneen
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - R M El Backly
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,3 Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M M Saad
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,4 Oral Biology Department, Faculty of Dentistry, Pharos University, Alexandria, Egypt
| | - W Essam
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,5 Department of Pedodontics and Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - H Moussa
- 6 Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M El Tantawi
- 7 Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - H Jain
- 8 Department of Materials Science and Engineering, Lehigh University, Bethlehem, Pennsylvania, USA
| | - M K Marei
- 1 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,9 Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Fischer F, Collange O, Mahoudeau G, Simon M, Moussa H, Thibaud A, Steib A, Pottecher T, Mertes M. [VENTILOP survey. Survey in peroperative mechanical ventilation]. ACTA ACUST UNITED AC 2014; 33:389-94. [PMID: 24930761 DOI: 10.1016/j.annfar.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/08/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Mechanical ventilation can initiate ventilator-associated lung injury and postoperative pulmonary complications. The aim of this study was to evaluate (1) how mechanical ventilation was comprehended by anaesthetists (physician and nurses) and (2) the need for educational programs. METHODS A computing questionnary was sent by electronic-mail to the entire anaesthetist from Alsace region in France (297 physicians), and to a pool of 99 nurse anaesthetists. Mechanical ventilation during anaesthesia was considered as optimized when low tidal volume (6-8mL) of ideal body weight was associated with positive end expiratory pressure, FiO2 less than 50%, I/E adjustment and recruitment maneuvers. RESULTS The participation rate was 50.5% (172 professionals). Only 2.3% of professionals used the five parameters for optimized ventilation. Majority of professionals considered that mechanical ventilation adjustment influenced the patients' postoperative outcome. Majority of the professionals asked for a specific educational program in the field of mechanical ventilation. DISCUSSION Only 2.3% of professionals optimized mechanical ventilation during anaesthesia. Guidelines and specific educational programs in the field of mechanical ventilation are widely expected.
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Affiliation(s)
- F Fischer
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Unité de simulation pédagogique, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - O Collange
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Unité de simulation pédagogique, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
| | - G Mahoudeau
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Unité de simulation pédagogique, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - M Simon
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - H Moussa
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Thibaud
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Steib
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - T Pottecher
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Unité de simulation pédagogique, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - M Mertes
- Réanimation chirurgicale polyvalente, NHC, pôle anesthésie, réanimation chirurgicale, SAMU, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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Moussa H, Bouzaouache H, Guillot A, Cammarata A, Lemonier E. Support of an amputee in hospital at home rehabilitation (HAH-R). About a case and review of literature. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.460] [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]
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Moussa H, Bouzaouache H, Abitche M, Ponsinet C, Le Gall F, Sauzieres P. Luxation postérieure de l’épaule associée à une fracture céphalo-tubérositaire de l’humérus. À propos d’un cas : intérêt d’un programme de rééducation. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1045] [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: 11/26/2022]
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18
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Moussa H, Bouzaouache H, Abitche M, Ponsinet C, Le Gall F, Sauzieres P. Posterior dislocation of the shoulder associated with a proximal humerus fracture, about one case; interest of a rehabilitation program. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.995] [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: 11/27/2022]
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Kamel M, Moussa H, Ismail A. Prevalence of venous thrombo-embolism in acute exacerbations of chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis 2013. [DOI: 10.1016/j.ejcdt.2013.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Moussa H, Chenani H, Bouzaouache H, Carlier H, Sarkis A, Schmutz S, Lautridou C. Partial resection of the scapula and peri-scapular muscles after peri-scapular desmoid fibromatosis. About one case; interest of a rehabilitation program. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.649] [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: 11/25/2022]
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Moussa H, Chenani H, Bouzaouache H, Carlier H, Sarkis A, Schmutz S, Lautridou C. Résection partielle de la scapula et des muscles péri-scapulaires suite à une fibromatose desmoïde péri-scapulaire. À propos d’un cas ; intérêt d’un programme de rééducation. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.648] [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: 10/26/2022]
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Hosny H, Abdel-Hafiz H, Moussa H, Soliman A. Metabolic syndrome and systemic inflammation in patients with chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis 2013. [DOI: 10.1016/j.ejcdt.2013.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Moussa H, Tsochandaridis M, Chakroun T, Jridi S, Abdelneji B, Hmida S, Silvy M, Bailly P, Gabert J, Levy-Mozziconacci A, Jemni-Yacoub S. Molecular background of D-negative phenotype in the Tunisian population. Transfus Med 2012; 22:192-8. [PMID: 22420413 DOI: 10.1111/j.1365-3148.2012.01142.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most studies of the molecular basis of Rhesus D-negative phenotype have been conducted in Caucasian and African populations. A comprehensive survey of RHD alleles was lacking in people from North Africa (Tunisians, Moroccans and Algerians) which could be very efficient for managing donors and patients carrying an RHD molecular variant. We analyse the molecular background of D-negative population in Tunisia in the present study. MATERIALS AND METHODS Blood samples were collected from native Tunisians. A total of 448 D-negative donors from different regions of Tunisia were analysed by RHD genotyping according to an adopted strategy using real-time PCR, ASP-PCR and sequencing. RESULTS Among the 448 D-negative samples, 443 were phenotyped unequivocally as true D-negative including three molecular backgrounds which were RHD gene deletion (n = 437), RHDψ pseudogene (n = 2) and RHD-CE-D hybrid gene (n = 4) with the respective frequencies of 0·9900, 0·0023 and 0·0046. The remaining five samples, in discordance with the serological results, were identified as two weak D type 11, one weak D type 29, one weak D type 4·0 and one DBT-1 partial D. CONCLUSION This study showed that the Tunisian population gets closer to Caucasians, given that the RHD gene deletion is the most prevalent cause of D-negative phenotype, but it is slightly different by the presence of the RHDψ pseudogene which was found with a very low frequency compared with that described in the African population. Nevertheless, the relative occurrence of weak D variants among studied serologically D-negative samples make necessary the adaptation of RHD genotyping strategy to the spectrum of prevalent alleles.
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Affiliation(s)
- H Moussa
- Unité de Recherche UR06SP05 Centre Régional de Transfusion Sanguine, Sousse, Tunisia
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Zerrouki W, Moussa H. The use of lasers in dentistry: Results of a survey about 300 Algerians practitioners. Med Oral Patol Oral Cir Bucal 2012. [DOI: 10.4317/medoral.17643769] [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: 11/05/2022] Open
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Zaoui A, Lajili H, Kanoun S, Hmida M, Moussa H, Bacha O, Rejeb N. Instabilité C1–C2 et rhumatisme psoriasique. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.261] [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: 11/28/2022]
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Zaoui A, Moussa H, Mallat F, Slama A, Bouassida K, Bouker S, Mosbah F, Rejeb N. Transcutaneous electric stimulation (TENS) for the treatment of neurogenic and idiopathic overactive bladder: 24 cases. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.153] [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: 10/17/2022]
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27
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Bouassida K, Moussa H, Zaoui A, Mallat F. Evaluation of sexuality in 53 paraplegic patients. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.154] [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: 10/17/2022]
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28
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Abstract
Drought stress is the main limiting factor in soybean production. However, no work has been done on how the application of a low dose of gamma rays could help to overcome water deficits during critical stages of soybean development. Gamma rays at a dose of 20 Gray (Gy) were applied to dry seeds of soybean before planting. Two levels of soil moisture (80% field capacity for well-watered control and 35% for drought-stressed treatment) were applied at pod initiation. Gamma irradiation increased biomass accumulation and seed yield in both treatments. It also increased the chlorophyll content, photosynthetic activity (14CO2fixation) and leaf water potential and enhanced the enzyme activities of RuBPCase and PEPCase of control plants compared with drought-stressed plants. Gamma irradiation (20 Gy) increased the soluble sugars, protein and proline content and the activities of peroxidase and superoxide dismutase in drought-stressed soybean leaves. It also increased the chloroplast size, which was reduced by drought treatment, and rebuilt, to some extent, the chloroplast ultrastructure. However, it decreased the malondialdehyde concentration and the electrical conductivity of the leaves under drought stress. Overall, the results indicated that pre-treatment with gamma rays (20 Gy) to dry seeds of soybean before planting could be used to enhance drought tolerance and minimize the yield loss caused by water deficit.
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Affiliation(s)
- H. Moussa
- 1 Atomic Energy Authority Radioisotope Department Dokki, Giza Egypt
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Moussa H, Hachfi L, Trimèche M, Najjar MF, Sakly R. Accumulation of mercury and its effects on testicular functions in rats intoxicated orally by methylmercury. Andrologia 2010; 43:23-7. [PMID: 21219378 DOI: 10.1111/j.1439-0272.2009.01003.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
All forms of mercury are considered poisonous. Methylmercury, one organic form, is highly toxic to many organs. The aim of the present study was to assess the effects of this form on the reproductive system in the rat. For this, 20 male rats were divided into two groups. One, which is considered as reference, received tap water. The second group received tap water containing methylmercury at the rate of 20 mg l⁻¹ for 8 weeks. At the end of the experiment, blood samples were collected for the determination of total mercury and plasma testosterone. The left testes were used for the determination of total mercury and histological examination. Appropriate centrifugation was applied on right testes to extract interstitial and seminiferous tubular fluids. The epididymides were homogenised for the sperm count. Our results showed a dramatic fall in the plasma testosterone in the contaminated animals. The fall in plasmatic testosterone seems to be in relation with the decrease in the secretion of testosterone. In association with this, the concentration of testosterone in seminiferous tubules fluid dropped about 55% in the poisoned animals in comparison with the controls. Despite this, no decrease in the epididymal sperm count in contaminated rats was observed.
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Affiliation(s)
- H Moussa
- Laboratoire de Physiologie, E.S.S.T.S, Monastir, Tunisia
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30
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Abstract
Treatment with CdCl
2
(0, 100, 400 and 1000 μM) resulted in the inhibition of root dry biomass and root elongation and to increased Cd accumulation in the roots. These treatments also decreased the relative water content, chlorophyll content,
14
CO fixation, phosphoenol pyruvate carboxylase and ribulose-1,5-bisphosphate carboxylase activity and abscisic acid (ABA) content, while increasing the malondialdehyde, hydrogen peroxide and free proline contents and causing changes in the chloroplast and root ultrastructure. Pretreatment of seeds with SA (500 μM) for 20 h resulted in the amelioration of these effects.
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Affiliation(s)
- H. Moussa
- 1 Atomic Energy Authority Radioisotope Department Cairo Egypt
| | - S. EL-Gamal
- 2 Monofya University Agriculture Botany Department, Faculty Of Agriculture Monofya Egypt
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Abstract
The effect of gamma irradiation on
Vicia faba
L. plants was investigated by exposing dry seeds to doses ranging from 0 to 100 Gray (Gy) and studying the activities and isozyme patterns of the key enzymes involved in oxidative stress defence, such as superoxide dismutases (SOD, EC 1.15.1.1), catalases (CAT, EC 1.11.1.6), peroxidases (POX, EC 1.11.1.7), ascorbate peroxidases (APOX, EC 1.11.1.11), monodehydroascorbate reductase (MDHAR, EC 1.6.5.4) and glutathione reductase (GR, EC 1.6.4.2), as well as the activity of an enzyme involved in a specific intermediary metabolic pathway, glucose-6-phosphate dehydrogenase (G
6
PDH, EC 1.1.1.49). The H
2
O
2
contents of faba bean leaves were also measured. None of the γ-irradiation doses used (0–100 Gy) had any effect on the activity of MDHAR, but they increased the enzyme activities of GR, APOX, SOD and G
6
PDH. Gamma rays at 20 Gy decreased the H
2
O
2
content, but the 100 Gy dose significantly increased the H
2
O
2
content compared with the non-irradiated plants. The results implied that the isozymes of SOD, CAT and POX present in faba bean cells growing in the presence of 0–15 Gy γ-irradiation are required to remove the reactive oxygen species (ROS) produced during normal, physiological processes. When the dose of γ-irradiation is ≥20 Gy, the level of ROS (produced indirectly by γ-irradiation) becomes too high to be dealt with by the existing antioxidant isozymes. The present research shows for the first time that the switch between the physiological oxidative response and a stress-related one occurs within a very narrow range of stress factor intensities, i.e. γ-irradiation doses. In the present study, this change took place between 15 and 20 Gy. Further investigations, using molecular biology techniques will be needed to determine the mechanisms involved in enzyme induction under ionizing conditions in order to evaluate changes in the gametic genomes at two possible levels: (i) the structural level, for studying mutations occurring in the DNA, and (ii) the functional level, by studying differential genetic expression between irradiated and non-irradiated plants.
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Affiliation(s)
- H. Moussa
- 1 Atomic Energy Authority Department of Radioisotopes Dokki, Giza Egypt
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Rao R, Moussa H, Vanderwaal RP, Sampson E, Atkinson LJ, Weil GJ. Effects of gamma radiation on Brugia malayi infective larvae and their intracellular Wolbachia bacteria. Parasitol Res 2005; 97:219-27. [PMID: 15997407 DOI: 10.1007/s00436-005-1421-8] [Citation(s) in RCA: 7] [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: 01/12/2005] [Accepted: 05/10/2005] [Indexed: 10/25/2022]
Abstract
Prior studies have shown that irradiated filarial larvae are developmentally stunted but capable of inducing partial immunity to filariasis in animals. The mechanisms for these effects are poorly understood. Recent studies suggest that intracellular Wolbachia bacteria are necessary for the normal development, reproduction and survival of filarial nematodes. The purpose of this study was to examine the effects of irradiation on Wolbachia in Brugia malayi infective larvae (L3) and on L3 development. The L3 were exposed to 0, 25, 35, 45, 55, 65 or 75 krad of gamma irradiation from a (137) Cesium source and cultured in vitro at 37 degrees C in NCTC/IMDM medium with 10% FCS for 12 days. Irradiation prevented molting of L3 to the L4 stage in a dose-dependent manner. Electron microscopy studies showed that irradiation damaged Wolbachia (25 krad) or cleared them from worm tissues (45 krad). In addition, majority of the irradiated L3s failed to develop the L4 cuticle. Real-time PCR studies showed that irradiation reduced Wolbachia DNA in worm tissues. Parallel in vivo studies confirmed decreased development of irradiated L3 in jirds, with associated effects on Wolbachia. Jirds injected s.c with normal L3 developed antibodies to Wolbachia surface protein (wsp) shortly after the onset of microfilarial patency. In contrast, jirds injected with irradiated L3 did not develop microfilaremia or antibodies to wsp. Additional studies are needed to test the hypothesis that irradiation retards growth and development of filarial L3 by killing Wolbachia.
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Affiliation(s)
- R Rao
- Infectious Diseases Division, Department of Internal Medicine, School of Medicine, Washington University, Campus Box 8051, 660 S Euclid Ave, St. Louis, MO 63110, USA.
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Sidhom I, Kamel A, El-Sharkawy N, Yassin D, Shaaban K, Hussein H, Aboul Naga S, Moussa H, Mosallam G, El-Nahass Y. Prognostic significance of natural killer expression in Egyptian pediatric acute myeloid leukemia. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I. Sidhom
- National Cancer Institute, Cairo, Egypt
| | - A. Kamel
- National Cancer Institute, Cairo, Egypt
| | | | - D. Yassin
- National Cancer Institute, Cairo, Egypt
| | | | | | | | - H. Moussa
- National Cancer Institute, Cairo, Egypt
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Michel-Laaengh N, Abadie M, Ranovona C, Moussa H, Knafo D, Maugourd MF. [Urinary incontinence in the elderly: what management for which patient?]. Presse Med 2001; 30:308-12. [PMID: 11262803] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
THERAPEUTIC OPTIONS Appropriate management of urinary incontinence in the elderly basically depends on the patient's medical status and degree of dependence and the type of incontinence. For outpatients, secondary effects of drugs limit their use, in favor of behavioral intervention and pelvic floor training, with good success. Recently proposed surgical approaches offer a promising alternative for the aged population. TEAM MANAGEMENT: Assessment and management of institutional urinary incontinence should be systematically elaborated by the medical care team. Potentially reversible conditions and precipitating factors may be causing or contributing to the incontinence. Their correction and bladder training are the principal items of the management scheme.
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Affiliation(s)
- N Michel-Laaengh
- Service de Gérontologie 3, Hôpital G. Clemenceau, F91750 Champcueil.
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Abstract
PURPOSE To investigate the in vitro radiosensitivity of microcolonies from head and neck cancers of varying degrees of differentiation. MATERIALS AND METHODS The location of individual squamous-cell carcinoma (SCC) cells in tissue culture flasks was recorded using computerized microscopy. This allowed the positions of the cells to be continually revisited, which enabled manual sizing of individual microcolonies, both at the time of irradiation (0-5 Gy) and following a post-irradiation incubation period during which the microcolonies were assessed for clonogenic survival. RESULTS When irradiated as microcolonies with 0-3 Gy, malignant cells had plating efficiencies (PE; applying multiplicity corrections) that were lower than expected when compared with the PE of cells irradiated individually. However, at between 2 Gy and 3 Gy the PE values became similar and at higher doses the 'corrected PE' of microcolonies became higher than that of individually irradiated cells. CONCLUSION These data show that cell cell interactions can occur in malignant cells in a manner similar to that demonstrated previously in non-malignant cells. Cells within microcolonies demonstrate increased radioresistance compared with cells irradiated singly.
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Affiliation(s)
- H Moussa
- Gray Laboratory Cancer Research Trust, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom
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Asindi A, Saleh A, Sobande A, Abbag F, Moussa H, Malhotra R, Habeeb S. Abha septuplets and total infant survival. Saudi Med J 1999; 20:468-471. [PMID: 27632658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Full text is available as a scanned copy of the original print version.
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Affiliation(s)
- A Asindi
- Department of Child Health, College of Medicine, King Saud Univeristy, Abha, Kingdom of Saudi Arabia
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Saleh AK, Sobande A, Moussa H. The Abha septuplets: prepregnancy, pregnancy, and outcome. Int J Gynaecol Obstet 1999; 64:65-6. [PMID: 10190672 DOI: 10.1016/s0020-7292(98)00175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A K Saleh
- Department of Obstetrics and Gynaecology, King Saud University, Abha, Saudi Arabia
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38
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Bouratbine A, Moussa H, Aoun K, Ben Ismaïl R. [Anthropologic research and understanding pediatric visceral leishmaniasis in Tunisia]. Bull Soc Pathol Exot 1998; 91:183-7. [PMID: 9642482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to determine the social and cultural factors which delay hospitalization of children suffering from visceral leishmaniasis (VL), a study was carried out in the rural area of Kairouan (Tunisia). Qualitative techniques were used to investigate beliefs and behaviours associated with the symptoms of VL. The study has demonstrated that the folk interpretation of the disease interferes largely with the choice of the therapy. Regarding VL, the subdivision of the disease into two groups of symptoms, fever and splenomegaly, incites parents to consult doctors in the presence of fever and use traditional healers when splenomegaly appears. This is responsible for long delays before the patients can have access to official health care. This investigation clearly demonstrated that a health education programme is needed in VL endemic areas in Tunisia in order to shorten delays between the appearance of symptoms and their diagnosis. For this objective to be achieved, it would also seem necessary to implement simple serodiagnostic techniques at the periphery level.
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Affiliation(s)
- A Bouratbine
- Laboratoire de parasitologie clinique, Institut Pasteur de Tunis, Tunisie
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39
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Brauner R, Moussa H, Khrouf N, Hamza B. [Anemia in Tunisian children more than 2 years old. Retrospective study of 164 hospitalization records]. Pediatrie 1981; 36:345-51. [PMID: 7290853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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