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Iyizoba-Ebozue Z, Fatimilehin A, Kayani M, Khan A, McMahon M, Stewart S, Croney C, Sritharan K, Khan M, Obeid M, Igwebike O, Batool R, A-Hakim R, Aghadiuno T, Ruparel V, O'Reilly K. Unveiling Disparities: Exploring Differential Attainment in Postgraduate Training Within Clinical Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e119-e127. [PMID: 38582627 DOI: 10.1016/j.clon.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
AIMS Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. MATERIALS AND METHODS This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. RESULT Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. CONCLUSION Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.
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Affiliation(s)
- Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
| | - A Fatimilehin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M Kayani
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - A Khan
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - M McMahon
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - S Stewart
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - C Croney
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - K Sritharan
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - M Khan
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - M Obeid
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - O Igwebike
- Department of Clinical Oncology, Western Park Cancer Centre, Sheffield, UK
| | - R Batool
- Department of Clinical Oncology, The University Hospital Coventry, West midlands, UK
| | - R A-Hakim
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - T Aghadiuno
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, Wales, UK
| | - V Ruparel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland UK
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Haanen J, Obeid M, Spain L, Carbonnel F, Wang Y, Robert C, Lyon AR, Wick W, Kostine M, Peters S, Jordan K, Larkin J. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:1217-1238. [PMID: 36270461 DOI: 10.1016/j.annonc.2022.10.001] [Citation(s) in RCA: 170] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- J Haanen
- Division of Medical Oncology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - M Obeid
- Immunology and Allergy Service, CHUV, Lausanne; Lausanne Center for Immuno-oncology Toxicities (LCIT), CHUV, Lausanne; Department of Oncology, CHUV, Lausanne, Switzerland
| | - L Spain
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne; Department of Medical Oncology, Eastern Health, Melbourne; Monash University Eastern Health Clinical School, Box Hill, Australia
| | - F Carbonnel
- Gastroenterology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Bicêtre, Le Kremlin Bicêtre, France; Université Paris Saclay 11, Le Kremlin-Bicêtre, France
| | - Y Wang
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Robert
- Department of Medicine, Gustave Roussy Cancer Centre, Villejuif; Paris-Saclay University, Villejuif, France
| | - A R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, London; National Heart and Lung Institute, Imperial College London, London, UK
| | - W Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg; DKTK and Clinical Cooperation Unit NeuroOncology, DKFZ, Heidelberg, Germany
| | - M Kostine
- Department of Rheumatology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - S Peters
- Department of Oncology, CHUV, Lausanne, Switzerland
| | - K Jordan
- Department of Haematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital Potsdam, Potsdam; Department of Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK
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Megarbane A, Bizzari S, Deepthi A, Sabbagh S, Mansour H, Chouery E, Hmaimess G, Jabbour R, Mehawej C, Alame S, Hani A, Hasbini D, Ghanem I, Koussa S, Al-Ali MT, Obeid M, Talea DB, Lefranc G, Levy N, Leturcq F, El Hayek S, Delague V, Urtizberea A. A 20-year Clinical and Genetic Neuromuscular Cohort Analysis in Lebanon: An International Effort. J Neuromuscul Dis 2021; 9:193-210. [PMID: 34602496 PMCID: PMC8842757 DOI: 10.3233/jnd-210652] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical and molecular data on the occurrence and frequency of inherited neuromuscular disorders (NMD) in the Lebanese population is scarce. OBJECTIVE This study aims to provide a retrospective overview of hereditary NMDs based on our clinical consultations in Lebanon. METHODS Clinical and molecular data of patients referred to a multi-disciplinary consultation for neuromuscular disorders over a 20-year period (1999-2019) was reviewed. RESULTS A total of 506 patients were diagnosed with 62 different disorders encompassing 10 classes of NMDs. 103 variants in 49 genes were identified. In this cohort, 81.4%of patients were diagnosed with motor neuron diseases and muscular dystrophies, with almost half of these described with spinal muscular atrophy (SMA) (40.3%of patients). We estimate a high SMA incidence of 1 in 7,500 births in Lebanon. Duchenne and Becker muscular dystrophy were the second most frequently diagnosed NMDs (17%of patients). The latter disorders were associated with the highest number of variants (39) identified in this study. A highly heterogeneous presentation of Limb Girdle Muscular Dystrophy and Charcot-Marie-Tooth disease was notably identified. The least common disorders (5.5%of patients) involved congenital, metabolic, and mitochondrial myopathies, congenital myasthenic syndromes, and myotonic dystrophies. A review of the literature for selected NMDs in Lebanon is provided. CONCLUSIONS Our study indicates a high prevalence and underreporting of heterogeneous forms of NMDs in Lebanon- a major challenge with many novel NMD treatments in the pipeline. This report calls for a regional NMD patient registry.
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Affiliation(s)
- Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.,Institut Jérôme Lejeune, Paris, France
| | | | | | - Sandra Sabbagh
- Department of Pediatrics, Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - Hicham Mansour
- Department of Pediatrics, Saint George Hospital, Balamand University, Beirut, Lebanon
| | - Eliane Chouery
- Department of Human Genetics, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ghassan Hmaimess
- Department of Pediatrics, Saint George Hospital, Balamand University, Beirut, Lebanon
| | - Rosette Jabbour
- Department of Neurology, Saint George Hospital, Balamand University, Beirut, Lebanon
| | - Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Saada Alame
- Department of Neuropediatrics, Lebanese University, Beirut, Lebanon
| | - Abeer Hani
- Departments of Pediatrics and Neurology, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dana Hasbini
- Department of Pediatric Neurology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopedics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Salam Koussa
- Department of Neurology, Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | | | - Marc Obeid
- Genetic laboratory, American University of Science and Technology, Lebanon
| | - Diana Bou Talea
- Genetic laboratory, American University of Science and Technology, Lebanon
| | - Gerard Lefranc
- Institut de Génétique Humaine, UMR 9002 CNRS-Université de Montpellier, France
| | - Nicolas Levy
- Aix Marseille Univ, Inserm, MMG, U 1251, Marseille, France
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Ghisoni E, Wicky A, Bouchaab H, Imbimbo M, Delyon J, Gautron Moura B, Gérard CL, Latifyan S, Özdemir BC, Caikovski M, Pradervand S, Tavazzi E, Gatta R, Marandino L, Valabrega G, Aglietta M, Obeid M, Homicsko K, Mederos Alfonso NN, Zimmermann S, Coukos G, Peters S, Cuendet MA, Di Maio M, Michielin O. Late-onset and long-lasting immune-related adverse events from immune checkpoint-inhibitors: An overlooked aspect in immunotherapy. Eur J Cancer 2021; 149:153-164. [PMID: 33865201 DOI: 10.1016/j.ejca.2021.03.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy but frequently cause immune-related adverse events (irAEs). Description of late-onset and duration of irAEs in the literature is often incomplete. METHODS To investigate reporting and incidence of late-onset and long-lasting irAEs, we reviewed all registration trials leading to ICI's approval by the US FDA and/or EMA up to December 2019. We analysed real-world data from all lung cancer (LC) and melanoma (Mel) patients treated with approved ICIs at the University Hospital of Lausanne (CHUV) from 2011 to 2019. To account for the immortal time bias, we used a time-dependent analysis to assess the potential association between irAEs and overall survival (OS). RESULTS Duration of irAEs and proportion of patients with ongoing toxicities at data cut-off were not specified in 56/62 (90%) publications of ICIs registration trials. In our real-world analysis, including 437 patients (217 LC, 220 Mel), 229 (52.4%) experienced at least one grade ≥2 toxicity, for a total of 318 reported irAEs, of which 112 (35.2%) were long-lasting (≥6 months) and about 40% were ongoing at a median follow-up of 369 days [194-695] or patient death. The cumulative probability of irAE onset from treatment initiation was 42.8%, 51.0% and 57.3% at 6, 12 and 24 months, respectively. The rate of ongoing toxicity from the time of first toxicity onset was 42.8%, 38.4% and 35.7% at 6, 12 and 24 months. Time-dependent analysis showed no significant association between the incidence of irAEs and OS in both cohorts (log Rank p = 0.67 and 0.19 for LC and Mel, respectively). CONCLUSIONS Late-onset and long-lasting irAEs are underreported but common events during ICIs therapy. Time-dependent survival analysis is advocated to assess their impact on OS. Real-world evidence is warranted to fully capture and characterise late-onset and long-lasting irAEs in order to implement appropriate strategies for patient surveillance and follow-up.
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Affiliation(s)
- E Ghisoni
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - A Wicky
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - H Bouchaab
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - M Imbimbo
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - J Delyon
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - B Gautron Moura
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - C L Gérard
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - S Latifyan
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - B C Özdemir
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - M Caikovski
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - S Pradervand
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - E Tavazzi
- Department of Information Engineering, University of Padova, Italy
| | - R Gatta
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - L Marandino
- Department of Oncology, University of Torino, Italy
| | - G Valabrega
- Department of Oncology, University of Torino, Italy; Candiolo Cancer Institute, FPO, IRCCS, Candiolo (TO), Italy
| | - M Aglietta
- Department of Oncology, University of Torino, Italy; Candiolo Cancer Institute, FPO, IRCCS, Candiolo (TO), Italy
| | - M Obeid
- Service Immunologie et Allergie, Lausanne University Hospital, Switzerland
| | - K Homicsko
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | | | - S Zimmermann
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - G Coukos
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - S Peters
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - M A Cuendet
- Department of Oncology, Lausanne University Hospital, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, USA
| | - M Di Maio
- Department of Oncology, University of Torino, Italy; Medical Oncology, A.O. Ordine Mauriziano, Torino, Italy
| | - O Michielin
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland.
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5
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Battisti N, Lee K, Nash T, Mappouridou S, Senthivel N, Asavisanu K, Obeid M, Tripodaki ES, Angelis V, Fleming E, Goode E, John S, Andres M, Allen M, Lyon A, Ring A. 222P Rates of cardiac adverse events in older versus younger adults receiving trastuzumab for HER2-positive early breast cancer: Results from 931 patients treated at The Royal Marsden. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.344] [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: 10/23/2022] Open
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6
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Özdemir BC, Latifyan S, Perreau M, Fenwick C, Alberio L, Waeber G, Spertini F, de Leval L, Michielin O, Obeid M. Cytokine-directed therapy with tocilizumab for immune checkpoint inhibitor-related hemophagocytic lymphohistiocytosis. Ann Oncol 2020; 31:1775-1778. [PMID: 32858151 DOI: 10.1016/j.annonc.2020.08.2101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- B C Özdemir
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Medical Oncology Department of Oncology, Lausanne, Switzerland; International Cancer Prevention Institute, Epalinges, Switzerland
| | - S Latifyan
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Medical Oncology Department of Oncology, Lausanne, Switzerland
| | - M Perreau
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Immunology and Allergy, Department of Medicine, Lausanne, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - C Fenwick
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Immunology and Allergy, Department of Medicine, Lausanne, Switzerland
| | - L Alberio
- University Hospital of Lausanne, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV), Service of Hematology Division, Department of Oncology and Central Hematology Laboratory, Department of Laboratory Medicine and Pathology, Lausanne, Switzerland
| | - G Waeber
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Immunology and Allergy, Department of Medicine, Lausanne, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - F Spertini
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Immunology and Allergy, Department of Medicine, Lausanne, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - L de Leval
- University Hospital of Lausanne, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV), Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne, Switzerland
| | - O Michielin
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Medical Oncology Department of Oncology, Lausanne, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - M Obeid
- Centre Hospitalier Universitaire Vaudois (CHUV), Service of Immunology and Allergy, Department of Medicine, Lausanne, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV), Vaccine and Immunotherapy Center, Lausanne, Switzerland.
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Haanen J, Ernstoff MS, Wang Y, Menzies AM, Puzanov I, Grivas P, Larkin J, Peters S, Thompson JA, Obeid M. Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: review of the literature and personalized risk-based prevention strategy. Ann Oncol 2020; 31:724-744. [PMID: 32194150 DOI: 10.1016/j.annonc.2020.03.285] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [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: 01/10/2020] [Revised: 03/03/2020] [Accepted: 03/07/2020] [Indexed: 02/08/2023] Open
Abstract
Patients with cancer and with preexisting active autoimmune diseases (ADs) have been excluded from immunotherapy clinical trials because of concerns for high susceptibility to the development of severe adverse events resulting from exacerbation of their preexisting ADs. However, a growing body of evidence indicates that immune-checkpoint inhibitors (ICIs) may be safe and effective in this patient population. However, baseline corticosteroids and other nonselective immunosuppressants appear to negatively impact drug efficacy, whereas retrospective and case report data suggest that use of specific immunosuppressants may not have the same consequences. Therefore, we propose here a two-step strategy. First, to lower the risk of compromising ICI efficacy before their initiation, nonselective immunosuppressants could be replaced by specific selective immunosuppressant drugs following a short rotation phase. Subsequently, combining ICI with the selective immunosuppressant could prevent exacerbation of the AD. For the most common active ADs encountered in the context of cancer, we propose specific algorithms to optimize ICI therapy. These preventive strategies go beyond current practices and recommendations, and should be practiced in ICI-specialized clinics, as these require multidisciplinary teams with extensive knowledge in the field of clinical immunology and oncology. In addition, we challenge the exclusion from ICI therapy for patients with cancer and active ADs and propose the implementation of an international registry to study such novel strategies in a prospective fashion.
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Affiliation(s)
- J Haanen
- Netherlands Cancer Institute, Division of Medical Oncology, Amsterdam, The Netherlands
| | - M S Ernstoff
- Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - Y Wang
- Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - I Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - P Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland
| | - J A Thompson
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, USA; National Cancer Institute/NIH, Bethesda, USA
| | - M Obeid
- Department of Medicine, Service of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Centre d'Immunothérapie et de Vaccinologie, Lausanne, Switzerland.
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Mégarbané A, Deepthi A, Obeid M, T Al-Ali M, Gambarini A, El-Hayek S. Homozygous deletion of exons 2-7 within TGFB3 gene in a child with severe Loeys-Dietz syndrome and Marfan-like features. Am J Med Genet A 2020; 182:1230-1235. [PMID: 32022420 DOI: 10.1002/ajmg.a.61508] [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] [Received: 09/11/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 01/16/2023]
Abstract
We describe a patient with palatal abnormalities-cleft palate and bifid uvula; distinctive facial features-long and triangular face, large ears and nose, thin lips and dental crowding; musculoskeletal abnormalities-severe scoliosis, joint laxity, long digits, flat feet, decreased muscle mass, and diminished muscle strength; and cardiac features-a dilatated ascending aorta at the level of Valsalva sinuses and a patent foramen ovale. Sequence analysis and deletion/duplication testing for a panel of genes involved in connective tissue disorders revealed the presence of a novel homozygous deletion of exons 2-7 in TGFB3 gene. Heterozygous pathogenic mutations in TGFB3 have been associated with Loeys-Dietz syndrome 5 (LDS5) and Arrhythmogenic Right Ventricular Dysplasia type 1. Here, we report the first case of a homozygous TGFB3 variant associated with a severe LDS5 and Marfan-like presentation.
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Affiliation(s)
| | - Asha Deepthi
- Centre for Arab Genomic Studies, Dubai, United Arab Emirates
| | - Marc Obeid
- American University of Science and Technology, Faculty of Health Sciences, Lebanon
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Nair P, Lama M, El-Hayek S, Abou Sleymane G, Stora S, Obeid M, Al-Ali MT, Delague V, Mégarbané A. COQ8A and MED25 Mutations in a Child with Intellectual Disability, Microcephaly, Seizures, and Spastic Ataxia: Synergistic Effect of Digenic Variants? Mol Syndromol 2018; 9:319-323. [PMID: 30800049 DOI: 10.1159/000494465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
We report on a girl, born to first-cousin Lebanese parents, with severe intellectual disability, congenital hip luxation, cardiac malformation, short stature, facial dysmorphic features including microcephaly, sparse hair, bilateral epicanthal folds, ataxia, seizures, and elevated lactate and pyruvate levels in serum. Whole exome sequencing was carried out on the patient's DNA. Potentially causal homozygous variants in the MED25 (p.Ile173Thr) and COQ8A (p.Arg512Trp) genes were found. The potential pathogenicity of these variants, and the possibility that the 2 variants could synergistically act to produce the phenotype reported, is discussed.
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Affiliation(s)
- Pratibha Nair
- Centre for Arab Genomic Studies, Dubai, United Arab Emirates
| | - Maher Lama
- Pediatric Department El-Rassoul Hospital, Beirut, Lebanon
| | | | - Gretta Abou Sleymane
- Department of Laboratory Science and Technology, American University of Science and Technology, Beirut, Lebanon
| | | | - Marc Obeid
- Department of Laboratory Science and Technology, American University of Science and Technology, Beirut, Lebanon
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Saber SEDM, Ahmed MHM, Obeid M, Ahmed HMA. Root and canal morphology of maxillary premolar teeth in an Egyptian subpopulation using two classification systems: a cone beam computed tomography study. Int Endod J 2018; 52:267-278. [PMID: 30225932 DOI: 10.1111/iej.13016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/12/2018] [Indexed: 12/27/2022]
Abstract
AIM To investigate the number of roots and root canal configurations using two coding systems and the root canal diverging and merging levels in extracted maxillary premolars in an Egyptian subpopulation using cone beam computed tomography (CBCT). METHODOLOGY A total of 700 maxillary premolars were examined using CBCT in an Egyptian subpopulation. The number of roots was identified, and root canal configurations were classified according to Vertucci's classification and a new system for classifying root and canal morphology. In addition, the position where roots bifurcated and the levels where canals merged or diverged were identified. Fisher's exact test and independent t-test were used for statistical analysis, and the level of significance was set at 0.05 (P = 0.05). RESULTS More than half of maxillary first premolars were double-rooted, and the majority of maxillary second premolars were single-rooted (P < 0.001). Most of the double-rooted samples had bifurcations in the middle of the root. According to the Vertucci classification, canal configuration type IV was the most common in both first and second maxillary premolars. According to the new system, the code 2 FP B1 P1 was the most common for maxillary first premolars, whilst 2 SP B1 P1 , 1 SP2 and 1 SP2-1 codes were the most common for maxillary second premolars. The three-canalled morphology in double- and three-rooted maxillary premolars had considerable variations. Root canal merging and diverging levels were comparable in both tooth types. CONCLUSION Maxillary premolars in this Egyptian subpopulation had a wide range of root and canal anatomical variations. Clinicians should be aware of where canals merge and diverge to facilitate the treatment of all canals. The new system for classifying canal morphology describes the root and canal configurations in a more accurate and practical manner compared to the Vertucci classification.
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Affiliation(s)
- S E D M Saber
- Department of Endodontics, Ain Shams University, Cairo, Egypt.,Department of Endodontics, British University, Cairo, Egypt
| | - M H M Ahmed
- Department of Endodontics, Ain Shams University, Cairo, Egypt
| | - M Obeid
- Department of Endodontics, Ain Shams University, Cairo, Egypt
| | - H M A Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Mallah N, Obeid M, Abou Sleymane G. Comprehensive matrices for regulatory approvals and genetic characterization of genetically modified organisms. Food Control 2017. [DOI: 10.1016/j.foodcont.2017.03.053] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schwann TA, Hashim SW, Bonnell MR, Badour S, Obeid M, Tranbaugh R, Engoren MC, Habib RH. 101 * RADIAL ARTERY VERSUS RIGHT INTERNAL THORACIC ARTERY AS THE BEST SECOND CONDUIT IN MULTI-ARTERIAL CORONARY ARTERY BYPASS GRAFTING: A MULTI-INSTITUTIONAL STUDY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.101] [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: 11/15/2022] Open
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Bitar FF, Shbaro R, Mroueh S, Yunis K, Obeid M. Dextrocardia and corrected transposition of the great arteries (I,D,D) in a case of Kartagener's syndrome: a unique association. Clin Cardiol 2009; 21:298-9. [PMID: 9562943 PMCID: PMC6656174 DOI: 10.1002/clc.4960210414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Kartagener's syndrome (KS) usually includes mirror-image dextrocardia. The incidence of congenital heart disease in KS is comparable with that in the general population. This paper reports on a case of Kartagener's syndrome associated with dextrocardia, corrected transposition of the great arteries (I,D,D), ventricular septal defect, and valvar pulmonary stenosis in an 8-year-old girl.
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Affiliation(s)
- F F Bitar
- Department of Pediatrics, American University of Beirut, Lebanon
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Abstract
A 52-year-old man presented with atrial flutter and was found to have an atrial septal defect (ASD). The paper describes an effective surgical approach for the treatment of this atrial arrhythmia utilizing a right sided Cox-maze III procedure concomitant with ASD closure. Review of the literature and clinical implications are discussed.
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Affiliation(s)
- H A Dakik
- Division of Cardiology, American University of Beirut, Lebanon
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16
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Apetoh L, Ghiringhelli F, Tesniere A, Obeid M, Mignot G, Ullrich E, Kroemer G, Zitvogel L. Cancer is not just a disease of a tissue: it is a host disease. How to reactivate host defense against tumors using conventional therapies of cancer? Ann Endocrinol (Paris) 2008; 69:151-2. [PMID: 18420177 DOI: 10.1016/j.ando.2008.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- L Apetoh
- Institut Gustave-Roussy, 39 rue Camille-Desmoulins, 94805 Villejuif, France
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Obeid M, Panaretakis T, Joza N, Tufi R, Tesniere A, van Endert P, Zitvogel L, Kroemer G. Calreticulin exposure is required for the immunogenicity of gamma-irradiation and UVC light-induced apoptosis. Cell Death Differ 2007; 14:1848-50. [PMID: 17657249 DOI: 10.1038/sj.cdd.4402201] [Citation(s) in RCA: 361] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Zahed L, Oreibi G, El-Amine H, Obeid M, Bitar FF. A new patient with pure trisomy 4p resulting from isochromosome formation and whole arm translocation. Am J Med Genet A 2004; 128A:60-2. [PMID: 15211659 DOI: 10.1002/ajmg.a.30084] [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] [Indexed: 11/06/2022]
Abstract
Short arm isochromosome formation with translocation of the entire long arm of the same chromosome is an unusual constitutional abnormality that has been observed, to our knowledge, in 18 cases. Only one of these previously reported cases involved chromosome 4, resulting in pure trisomy 4p. Pure trisomy 4p has been reported in a number of cases, the majority of them due to familial chromosome rearrangements, and is associated with a distinct pattern of abnormal findings. We report here a second case of a de novo chromosome 4 whole arm translocation with short-arm isochromosome formation, which we have delineated further by FISH studies.
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Affiliation(s)
- L Zahed
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO Box 11-236, Beirut, Lebanon.
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El Hassan N, Dbaibo G, Diab K, Musallam S, Haidar R, Obeid M, Bitar F. Pseudomonas pericarditis in an immunocompetent newborn: unusual presentation with review of the literature. J Infect 2002; 44:49-51. [PMID: 11972421 DOI: 10.1053/jinf.2001.0894] [Citation(s) in RCA: 5] [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: 12/19/2022]
Abstract
Acute purulent pericarditis is a rare entity in the neonatal age group. The most common isolated organisms are Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Other organisms, like Pseudomonas aeruginosa, have been seldom implicated with only one case of Pseudomonas pericarditis reported in the neonatal period. The prognosis is often considered very poor in this age group. This article describes Pseudomonas pericarditis in a 1-week-old immunocompetent female newborn who was successfully managed with combined medical and surgical therapy.
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Affiliation(s)
- N El Hassan
- Department of Paediatrics, American University of Beirut, Medical Center, Lebanon
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20
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Jamaleddine G, Obeid M. Reply to Pezzella. Eur J Cardiothorac Surg 2001. [DOI: 10.1016/s1010-7940(01)00980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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21
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Bitar FF, Diab KA, Sabbagh M, Siblini G, Obeid M. Cardiac disease in children in Lebanon: the AUB-MC Children's Cardiac Registry experience. J Med Liban 2001; 49:304-10. [PMID: 12744630] [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: 03/02/2023]
Abstract
OBJECTIVE To study the epidemiology of cardiac disease in children and their outcome in Lebanon, we established a Children's Cardiac Registry Center (CCRC) at the American University of Beirut-Medical Center. DESIGN/METHODS The CCRC included prospectively all pediatric patients with congenital heart disease (CHD) and/or acquired heart disease (AHD) who were evaluated at our center, between March 1, 1997 and July 31, 2000. RESULTS Out of the 1000 patients with cardiac anomalies enrolled in the CCRC, 917 (91.7%) had CHD and the rest had AHD. Ventricular septal defect was the most common cardiac malformation with a relative frequency of 25.3%, followed by pulmonary stenosis (14.6%), aortic anomalies (8%), ASD (8%) and tetralogy of Fallot (7.8%). Complex cardiac lesions like HLHS, TGA and AVC had lower frequencies at 0.4%, 3.7% and 3.5% respectively. The most common AHD was rheumatic heart disease (42.2%). 34.9% of the registry patients with CHD and 10.8% with AHD underwent surgical intervention. There were 4.8% and 2.4% mortality rates in the CHD and AHD groups, respectively during the 40-month study period. CONCLUSION The prevalence of many of the cardiac malformations in the CCRC was similar to that reported in the literature. However, some of the complex cardiac lesions were less common. The outcome of the two groups of patients is comparable to the outcome of children with cardiac malformation from developed countries. The establishment of a registry at the national level is important. Appropriate identification of the cardiac disease, its epidemiology, and outcome is of utmost importance in guiding adequate care.
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Affiliation(s)
- F F Bitar
- Department of Pediatrics, American University of Beirut-Medical Center (AUB-MC), Beirut, Lebanon.
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Abstract
The need to perform coronary artery bypass grafting in patients who have a single lung is not uncommon. To date, the safety of such procedures has not been well documented. In this article, we review the literature using the Medline 1966 to September 2000 database to identify patients with pneumonectomy who underwent coronary artery grafting and we provide a compilation of all reported cases. We also present an additional case in whom the use of nasal bilevel positive airway pressure was beneficial in preventing postoperative pulmonary complications.
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Affiliation(s)
- K A Diab
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Bitar FF, Jawdi RA, Dbaibo GS, Yunis KA, Gharzeddine W, Obeid M. Paediatric infective endocarditis: 19-year experience at a tertiary care hospital in a developing country. Acta Paediatr 2000; 89:427-30. [PMID: 10830454 DOI: 10.1080/080352500750028131] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A retrospective study was undertaken to study children who presented with infective endocarditis (IE) to a university teaching hospital in Beirut, Lebanon, between January 1977 and May 1995. Of 41 patients with IE (24F, 17M), 28 (68%) were diagnosed between 1977 and 1985. Patients' ages ranged from 3 to 18 y (mean age 11.3+/-2.8 y), and 13 patients were <10 y of age. Clinical presentations included: fever (in 88%), heart failure (in 39%), neurologic findings (in 20%) and embolic phenomena (in 22%). Nineteen patients (46%) had underlying congenital heart disease (CHD) with tetralogy of Fallot and pulmonary stenosis being the most common. Sixteen patients (39%) had underlying rheumatic heart disease (RHD). A total of 5 children (12%) with normal cardiac anatomy had IE. One had underlying acquired viral myocarditis with mitral insufficiency. Echocardiography showed vegetations in 60%. Blood cultures were positive in 31 patients (76%). IE occurred in three patients following cardiac surgery. In one patient it occurred within 2 mo of surgery and in the other two it occurred within 6 mo. Streptococcus viridans and Staphylococcus aureus were the two most commonly isolated bacteria. Overall mortality rate was 29% (not statistically significant between patients presenting between 1977-1985 and 1986-1995; p = 0.17). There was no statistically significant difference in mortality among the groups (five in the group with CHD, six with RHD and one with structurally normal heart). This study demonstrates that RHD is an important underlying cause of IE in children in our community. This finding is similar to those in other developing countries and different from those in developed countries. Distribution of pathogens and CHD in our study is comparable to some reports in the literature, except for the higher proportion of patients with underlying pulmonary stenosis. Bacterial endocarditis prophylaxis should be emphasized in patients with RHD or pulmonary stenosis.
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Affiliation(s)
- F F Bitar
- Department of Pediatrics, American University of Beirut, Lebanon.
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Abstract
Clinical data from 91 patients with rheumatic fever (RF), who were hospitalized at a tertiary hospital in Lebanon between 1980 and 1995, were reviewed retrospectively. Age on hospitalization was 11.1+/-2.9 years (mean +/- SD, range 3-17 years). Nineteen patients were <6 years of age. Manifestations included carditis (93%), arthritis (39%), Sydenham's chorea (2%), erythema marginatum (4%), subcutaneous nodules (1%), fever (62%), arthralgia (55%), and acute congestive heart failure (CHF) on initial presentation (44%). Pericardial effusion occurred in 11%. There was positive family history of RF in 14%. Mitral insufficiency and aortic insufficiency occurred in 67 and 35%, respectively. Both mitral and aortic valves were involved in 30% of cases. Tricuspid insufficiency developed in 3% and pulmonary insufficiency in 1%. Mitral stenosis developed in 19%. Twenty-eight patients underwent surgical intervention: mitral valve repair and commissurotomy in 9/91 (10%), mitral valve replacement in 18/91 (20%), and aortic valve replacement in 9/91 (10%). Overall mortality was 12%: 5 following surgical intervention (3 after mitral valve surgery and 2 after mitral and aortic valve surgery). All patients that died had CHF on initial presentation (p = 0.006). This study includes hospitalized patients with predominant rheumatic heart disease. Initial presentation with CHF is a risk factor for surgical intervention and mortality. A significant high surgical intervention rate is noted that is probably related to the nature of the selected group studied. This study emphasizes the significant morbidity and death in patients with RF and carditis.
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Affiliation(s)
- F F Bitar
- Department of Pediatrics, American University of Beirut, 850 Third Avenue, 18th Floor, New York, NY 10022, USA
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Bitar FF, Baltaji N, Dbaibo G, Abed el-Jawad M, Yunis KA, Obeid M. Congenital heart disease at a tertiary care center in Lebanon. Middle East J Anaesthesiol 1999; 15:159-64. [PMID: 10513374] [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: 02/14/2023]
Abstract
OBJECTIVE AND METHODS To study the epidemiology of congenital heart disease (CHD) at the American University of Beirut-Medical Center, we reviewed the medical records of all cardiac patients seen at our outpatient cardiology clinic (OPD) between 1980 and 1995. The charts of all patients with CHD seen as inpatients and/or outpatients at our center during the year 1995 were also reviewed. A cardiologist evaluated all patients and the diagnosis was confirmed at least by echocardiography. The frequency of CHD was reported among three groups: 1980-1995 OPD groups (Group A); the group with CHD seen during the year 1995 (Group B); and (Group C), a subgroup of group B, included all newborns with CHD born at our hospital during the year 1995. Stillbirth and premature infants with the diagnosis of patent ductus arteriosus were excluded from the study. RESULTS Group A included 883 patients. 344 patients were evaluated in Group B, with a mean age of 3.8 years. The incidence of CHD was 11.5/1,000 live births at our center. There was a relatively low prevalence of complex lesions (i.e., hypoplastic left heart syndrome, transposition of the great arteries) and a relatively high prevalence of the simpler cardiac malformation (i.e., ventricular and atrial septal defects, pulmonary stenosis) in Groups A and B. CONCLUSION The relatively low prevalence of complex cardiac lesions in our study is probably related to the age of the studied patients, and reflects the high mortality of these complex lesions in our country early in life. The incidence of CHD of 11.5/1,000 live births at our center is higher than that reported in the literature, with evidence of more frequent ventricular septal defects and pulmonary atresia lesions. This may be related to high rate of consanguinity in our population. This review underscores the need for a national cardiac registry center for children in a developing country like Lebanon. Such a database will allow referral and care of complex cardiac lesions.
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Affiliation(s)
- F F Bitar
- Department of Pediatrics, American University of Beirut, Lebanon.
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Bitar FF, Orm SA, Dbaibo GS, Obeid M, Muwakkit S. Disappearance of patent ductus arteriosus in a child with leukemia receiving chemotherapy. Med Pediatr Oncol 1998; 31:558. [PMID: 9835921 DOI: 10.1002/(sici)1096-911x(199812)31:6<558::aid-mpo26>3.0.co;2-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Intrapericardial teratomas are rare and usually present early in infancy or childhood. PROCEDURE We describe herein a rare case of an adult patient with an intrapericardial teratoma who presented with fever, cardiac arrhythmias, and oppressive substernal chest pain. Preoperative diagnosis was suggested by echocardiography and computerized tomography of the chest. The tumor weighed 530 g and its histologic features were those of a mature cystic teratoma. It was excised totally and 10 years' follow-up revealed no evidence of residual disease. DISCUSSION Our patient is one of the very few adult patients with intrapericardial teratomas who was treated successfully with surgery. Both echocardiography and tomography of the chest suggested the diagnosis and delineated the relationship of the tumor to the great vessels. CONCLUSION The diagnosis of Intrapericardial teratomas is suspected by echocardiography and/or tomography of the chest and confirmed by specific histologic features. These tumors should be excised whenever detected.
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Affiliation(s)
- F F Bitar
- Division of Cardiothoracic Surgery, American University of Beirut, New York, NY 10022, USA
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Affiliation(s)
- U Hadi
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut, New York, New York 10022, USA
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Abstract
The performance of a PIN silicon photodiode as a microdosimetric detector was explored. Microdosimetric spectra of a 137Cs gamma source and that of an americium-beryllium neutron source were determined with a PIN photodiode as well as with a tissue-equivalent proportional counter of 1 micron simulated diameter. The spectra were compared.
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Affiliation(s)
- A Kadachi
- Electrical Engineering Department, College of Engineering, King Saud University, Riyadh, Saudia Arabia
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Mahyoub F, Obeid M, Kadachi A, Waheed A. Microdosimetry of irregular field paraffin collimation in fast neutron therapy. Strahlenther Onkol 1993; 169:377-80. [PMID: 8316940] [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: 01/29/2023]
Abstract
The King Faisal Specialist Hospital and Research Centre is the only fast neutron therapy facility to utilize paraffin collimation for irregular beam ports. The application of this treatment modification to clinical practice required the microdosimetric characteristics of paraffin to be established. Measurements were made with a tissue equivalent (Rossi) proportional counter at different spatial locations in a water phantom and in air. The neutron beam was shaped by a 10 x 10 cm paraffin collimator. The analytically derived effective relative biological effectiveness (RBE) for 80% survival was approximately 3.5, which is similar to the standard 10 x 10 cm Benelex collimator and is in good agreement with empirical biological observations for this neutron beam.
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Affiliation(s)
- F Mahyoub
- Biological Physics Department, King Faisal Spacialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Abstract
Two-hundred ninety-nine patients who sustained penetrating ballistic trauma to the abdomen were divided into two groups: Group A consisted of 133 patients with shell fragment injuries from mortar artillery and Group B of 166 patients with bullet injuries from rifles and automatic or semiautomatic weapons. Both groups were analyzed retrospectively in order to compare the extent of injury and outcome. In Group A, the findings at laparotomy were negative in 15 of 133 patients (10%) compared with 9 of 166 patients (5%) in Group B (p less than 0.05). The most commonly injured abdominal organs in Group A were the colon (42%), liver (22%), small bowel (20%), stomach (14%), diaphragm (11%), spleen (10%), major vessels (40%) [corrected], and kidney (9%). The abdominal organs commonly injured in Group B were the colon (50%), small bowel (41%), liver (33%), major vessels (20%), diaphragm (17%), stomach (15%), spleen (15%), and kidney (15%). Associated extra-abdominal injuries were present in 26% of Group A patients and in 21% of Group B patients (p greater than 0.05) [corrected]. Major postoperative complications occurred in 7.5% and 8.4% of the patients in Group A and Group B, respectively (p less than 0.05). Perioperative mortality was 2.3% in Group A versus 7.2% in Group B (p less than 0.01). Our data suggest that high energy bullets to the abdomen cause higher tissue penetration and a greater blast effect than shell fragments.
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Affiliation(s)
- B A Georgi
- Department of Surgery, American University, Beirut Medical Center, Lebanon
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DeLeon S, Ilbawi M, Arcilla R, Cutilletta A, Egel R, Wong A, Quinones J, Husayni T, Obeid M, Sulayman R. Choreoathetosis after deep hypothermia without circulatory arrest. Ann Thorac Surg 1990; 50:714-9. [PMID: 2241329 DOI: 10.1016/0003-4975(90)90668-v] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [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: 12/30/2022]
Abstract
In 8 of 758 patients undergoing an intracardiac operation under cardiopulmonary bypass and hypothermia, choreoathetosis developed 3 to 7 days postoperatively. Before the onset of choreoathetosis, varying degrees of neurological dysfunction were noted. Electroencephalography and neuroimaging failed to detect any responsible functional or structural changes. Six patients are alive 1 to 3 years postoperatively, and their condition is improving. Two patients died of aspiration or sepsis. All patients were grouped based on factors identified as being possibly causative: depth of hypothermia, cooling time, flow rate, and repeated hypothermia. The incidence of choreoathetosis was significantly different in group A (rectal temperature greater than 25 degrees C) compared with group B (rectal temperature less than or equal to 25 degrees C) (0/295 versus 8/463; p = 0.02). Based on cooling time, the incidence of choreoathetosis was significantly different in group B1 (cooling time less than 1 hour) compared with group B2 (cooling time greater than or equal to 1 hour) (1/220 versus 7/243; p = 0.05). Based on flow rate during cooling, group B2 was further divided into the low-flow group (less than 1,500 mL.min-1.m-2) and the high-flow group (greater than or equal to 1,500 mL.min-1.m-2). Although not significant, the incidence of choreoathetosis was higher in the high-flow group (6/153 versus 1/90; p = 0.22). In group B patients having reoperation, the incidence of choreoathetosis was higher than in patients operated on for the first time (5/54 versus 3/409; p less than or equal to 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S DeLeon
- Heart Institute for Children and Pediatric Neurology, Christ Hospital and Medical Center, Oak Lawn, IL 60453
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Affiliation(s)
- S N Singh
- Veterans Administration Medical Center, Cardiology Section, Washington, DC 20422
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Hall CL, Sansom JR, Obeid M, Blainey JD, Robinson BH, Mackintosh P, Dawson-Edwards P, Barnes AD. Results of 250 consecutive cadaver kidney transplants. Br Med J 1976; 1:547-50. [PMID: 769890 PMCID: PMC1639358 DOI: 10.1136/bmj.1.6009.547-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The results of 250 cadaver kidney transplants performed at this hospital between May 1968 and December 1974 were analysed. A functioning transplant was defined strictly as one that maintained the recipient in good health with a serum creatinine below 442 mumol/1 (5 mg/100 ml) without any need for dialysis. The proportions of kidneys functioning after one, two, and three years were 40-4%, 33-9%, and 31-1% respectively, the corresponding survival rates of patients being 62-6%, 57-4%, and 43-8%. The primary failure rate overall was 21-6%, while the failure rates for first, second, and third transplants were 18-1%, 39-9%, and 66-7% respectively. Half of the primary failures were attributed to the use of cadaver kidneys with abnormal vasculature or long ischaemic times or originating from non-ventilated donors. Of the initially successful transplants 49% were subsequently lost due to rejection (53%) or death of the patient with a functioning transplant (46%), and of the secondary losses 58% occurred within three months of transplantation. HLA matching of donor and recipient for two or more antigens was associated with a significant increase in transplant survival--46% at three years as opposed to 9-5% at three years for kidneys with poorer matches.
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Hall CL, Sansom JR, Obeid M, Dawson-Edwards P, Robinson BH, Barnes AD, Blainey JD. Agonal phase, ischaemic times, and renal vascular abnormalities and outcome of cadaver kidney transplants. Br Med J 1975; 3:667-70. [PMID: 1100186 PMCID: PMC1674618 DOI: 10.1136/bmj.3.5985.667] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A retrospective study of 250 cadaver kidney transplants was carried out to determine the effects of the agonal period, the warm and cold ischaemic times, and the use of kidneys with vascular anomalies on the primary success and failure and the subsequent level of function of the transplants. Kidneys with vascular anomalies or from non-ventilated donors had a primary failure rate of over 30%, whereas those with normal vasculature or from ventilated donors had a rate of 17%. An initial warm ischaemic time of more than 60 minutes was associated with a primary failure rate of 57% and a cold ischaemic time of over 550 minutes with a primary failure rate of 47%. The interrelationship between the warm and cold ischaemic times in the primary success or failure of the transplants was examined and criteria defined for selecting potentially viable cadaver kidneys for transplantation, as follows: (1) The donor should be (a) ventilated, (b) aged 6-50 years, and (c) have normal ante-mortem renal function and have secreted more than 1-5 1 of urine in the 24 hours before death (or an equivalent volume if the urinary output was recorded for less than 24 hours before death); (2) the kidney should have normal renal vasculature enabling single arterial and venous anastomoses to be performed; (3) kidneys with I.W.I.T.s of longer than 60 minutes should not be used; (4) for kidneys with I.W.I.T.s of less than 20 minutes the C.I.T. is not critical but should not exceed 12 hours; (5) for kidneys with I.W.I.T.s of 20-60 minutes the C.I.T. should not exceed 450 minutes.
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Din ASE, Obeid M. Ecological Studies of the Vegetation of the Sudan. IV. The Effect of Simulated Grazing on the Growth of Acacia senegal (L.) Willd. Seedlings. J Appl Ecol 1971. [DOI: 10.2307/2402139] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Din ASE, Obeid M. Ecological Studies of the Vegetation of the Sudan. II. The Germination of Seeds and Establishment of Seedlings of Acacia senegal (L.) Willd. Under Controlled Conditions in the Sudan. J Appl Ecol 1971. [DOI: 10.2307/2402137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Obeid M, Din ASE. Ecological Studies of the Vegetation of the Sudan. III. The Effect of Simulated Rainfall Distribution at Different Isohyets on the Regeneration of Acacia senegal (L.) Willd. on Clay and Sandy Soils. J Appl Ecol 1971. [DOI: 10.2307/2402138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Obeid M, Din ASE. Ecological Studies of the Vegetation of the Sudan. I. Acacia senegal (L.) Willd. and Its Natural Regeneration. J Appl Ecol 1970. [DOI: 10.2307/2401975] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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