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Obaid K, Basrak MT, Sawaf B, Habib H, Alkhatib M, Ashour AA, Habib MB. Rhinovirus infection presenting with symptomatic hyponatremia-Atypical presentation of a common infection. Clin Case Rep 2024; 12:e8773. [PMID: 38654937 PMCID: PMC11035375 DOI: 10.1002/ccr3.8773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Key Clinical Message Rhinovirus infection has the potential to exhibit unconventional symptoms like symptomatic hyponatremia. Health care professionals should remain vigilant about this potential complication, especially in cases with uncommon presentations. Timely identification and effective management of hyponatremia can mitigate potential complications and enhance patient prognosis. Abstract The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a prominent contributor to low sodium levels. Various factors can contribute to hyponatremia, affecting the diagnosis and treatment of the condition. Of note, some infections have been identified as potential causes of SIADH. Although rhinovirus infection has been linked to SIADH, it is usually associated with severe respiratory infections. Herein, we present a distinctive case where rhinovirus caused significant hyponatremia symptoms, even in the absence of typical respiratory symptoms or fever.
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Affiliation(s)
- Koutaibah Obaid
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | | | - Bisher Sawaf
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Hiba Habib
- Internal Medicine DepartmentAl‐Mowasat HospitalDamascusSyria
| | | | - Anas A. Ashour
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Mhd Baraa Habib
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
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2
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Iqbal P, Habib MB, Hatim A, Alkhatib M, Bakar MA, Koya SH, Alshurafa A, Rehman HU. Dilemma of Thrombolysis in a patient with high-risk Pulmonary Embolism with severe Thrombocytopenia: A case report. Qatar Med J 2024; 2023:39. [PMID: 38223832 PMCID: PMC10787518 DOI: 10.5339/qmj.2023.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Managing a high-risk pulmonary embolism (PE) in a critically ill patient with severe thrombocytopenia can present a challenging dilemma. There is a high risk of fatal bleeding due to anticoagulation in high-risk PE with thrombocytopenia; therefore, risks and benefits are balanced while dealing with such a critical scenario. CASE REPORT We present a case of a female patient with thrombocytopenia who was admitted for management of lymphoma. Her hospital course was complicated by high-risk PE, leading to acute respiratory failure and hypotension, necessitating urgent transfer to the medical intensive care unit. She was intubated and placed on mechanical ventilation. Multiple cardiac arrests occurred due to compromised cardiac output from a severely dilated right ventricle on bedside transthoracic echocardiography. As a last resort to save her life in this critical state and severe thrombocytopenia, she was given a half bolus dose of the recommended drug, i.e., 50mg IV of Alteplase. Subsequently, she stabilized and was extubated without any further complications. DISCUSSION High-risk PE needs prompt management with anticoagulation to avoid fatal outcomes. However, on the other hand, anticoagulation carries a high risk of bleeding, especially in patients with thrombocytopenia. These challenges prompt a modern perspective in situations where clear guidelines are absent. CONCLUSION We aim to discuss our contemporary clinical practice in managing such a complex case and highlight the need for further studies.
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Affiliation(s)
- Phool Iqbal
- Department of Internal Medicine, New York Medical College/Metropolitan Hospital Center, New York, USA
| | - Mhd Baraa Habib
- Department of Internal Medicine, Hamad Medical Corporation, Qatar
| | - Ahmed Hatim
- Department of Internal Medicine, Hamad Medical Corporation, Qatar
| | | | | | | | - Awni Alshurafa
- Department of Hematology, Hamad Medical Corporation, Qatar
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3
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Mohamed A, Alkhatib M, Alshurafa A, El Omri H. Refractory cold agglutinin disease successfully treated with daratumumab. A case report and review of literature. Hematology 2023; 28:2252651. [PMID: 37664905 DOI: 10.1080/16078454.2023.2252651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Cold agglutinin disease (CAD) is immune-mediated hemolytic anemia. The disease is caused by cold reactive autoantibodies that induce hemolysis through the activation of the complement pathway. Most patients with CAD are elderly, and half may have refractory CAD that may not respond to the first-line treatment option (i.e. rituximab). Some cases are refractory to multiple lines of therapy, including chemotherapeutic agents, which might be toxic, especially for elderly patients. Daratumumab is a human monoclonal antibody targeting CD 38 glycoprotein, a transmembrane protein highly expressed in lymphoid and plasma cells. Daratumumab is currently approved for treating multiple myeloma and is used mainly as a combination therapy with other agents. CASE PRESENTATION Our patient is a 69-year-old female diagnosed with CAD after presenting with severe anemia and significant circulatory symptoms. Rituximab was not effective in controlling her disease, and she refused other available chemotherapeutic agents due to their side effects profile. We used daratumumab combined with erythropoietin, which led to a dramatic response measured by stabilizing her hemoglobin levels and transfusion independence. CONCLUSION Our case is the third reported case of refractory CAD successfully treated with daratumumab, which suggests that daratumumab might be a potential agent for the treatment and control of refractory Cold Agglutinin Disease.
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Alshurafa A, Alkhatib M, Abu-Tineh M, Yassin MA. Sickle cell leg ulcer successfully managed by hyperbaric oxygen: a case report. Front Med (Lausanne) 2023; 10:1171971. [PMID: 37396892 PMCID: PMC10310543 DOI: 10.3389/fmed.2023.1171971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Sickle cell leg ulcers (SCLUs) are usually chronic, painful, and devastating complications of sickle cell disease. Skin vaso-occlusion with compromised blood flow, chronic inflammation, and endothelial dysfunction is thought to be the underlying mechanism. It is usually slow to heal, and it may become chronic and superinfected. The management of SCLUs is usually challenging and requires a multidisciplinary team. Multiple systemic and local therapies have been tried in SCLU treatment. However, the outcome is variable: currently, there are no official recommendations for the best effective treatment. Herein, we report a 34-year-old male patient with non-transfusion-dependent sickle cell disease who was suffering from a chronic left ankle ulcer and was successfully managed with hyperbaric oxygen therapy, resulting in a complete resolution of this devastating complication.
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Affiliation(s)
- Awni Alshurafa
- Hematology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alkhatib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
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5
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Elhakeem I, Iqbal P, Nashwan AJ, Abubakar M, Jawad AT, AlHiyari MA, Chandra P, Osman MA, Mohamad SS, Alkhatib M, Yassin MA. Patients' experience and satisfaction using telemedicine for outpatient services in a Tertiary Cancer Center in Qatar during COVID-19: A cross-sectional study. Health Sci Rep 2022; 5:e883. [PMID: 36320657 PMCID: PMC9617592 DOI: 10.1002/hsr2.883] [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: 06/19/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Background and Aim The coronavirus-19 is an ongoing global pandemic resulting in millions of deaths worldwide. For a patient population at higher risk of infection, telemedicine is a promising means of providing safe and alternative care routes while minimizing their risk of exposure. This study gives insight into patients' experiences and satisfaction with telemedicine during this pandemic. Methods We conducted a cross-sectional study on 297 patients (RR: 85%) at the National Center for Cancer Care and Research (NCCCR), Qatar. Data was collected through electronic medical records of the eligibe patient population, and phone calls were made whereby the physician read a standard introductory script followed by a survey questionnaire. We focused on patients' experience with telemedicine services amid the pandemic. This was done using a six-point Likert scoring system of seven questions that were scaled from 1 to 6. Results More than 80% of patients somewhat to strongly agreed that telemedicine met their healthcare needs, improved their confidence in their healthcare system, and were generally satisfied with the quality of care provided. Nearly all patients (90%) understood their physicians' recommendations over the phone. In addition, more than half of the patients (89%) felt they could freely communicate their concerns. Patients also showed an inclination towards face-to-face consultations at 68%; however, 90% were willing to participate in future teleconsultations. Conclusion Our study indicates an overall positive experience among patients towards the use of telemedicine. Telemedicine is a safe, futuristic approach toward patient care management and, thus, provides healthcare professionals a platform to implement further patient and physician education. Even though our data also showed that patients liked in-person visits to some degree, this needs to be looked into more in future studies.
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Affiliation(s)
- Israa Elhakeem
- Medical EducationHamad Medical CorporationDohaQatar,Hematology/Oncology DepartmentHamad Medical CorporationDohaQatar
| | - Phool Iqbal
- Internal Medicine DepartmentNew York Medical College/Metropolitan Hospital CenterNew YorkUSA
| | | | | | | | | | - Prem Chandra
- Academic Health SystemHamad Medical CorporationDohaQatar
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Alibrahim RS, Elmekaty EZ, Elmekaty MZI, Edbais M, Alkhatib M, Daghfal J, Almaslamani MA, Omrani AS. Remdesivir for patients with Coronavirus disease 2019 pneumonia requiring high oxygen support. Qatar Med J 2022; 2022:25. [PMID: 36072086 PMCID: PMC9421493 DOI: 10.5339/qmj.2022.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Treatment options for patients with critical Coronavirus Disease 2019 (COVID-19) are limited. This study aimed to describe the clinical characteristics and outcomes associated with remdesivir therapy in patients with COVID-19 who require non-invasive (NIV) ventilation or invasive mechanical ventilation (IMV). Methods: Data were retrospectively extracted for adults with COVID-19 confirmed using polymerase chain reaction (PCR) between August 1, 2020 and January 28, 2021 who received ≥ 48 hours of remdesivir therapy while on NIV or IMV. Clinical improvement was defined as two-category improvement on an eight-point ordinal severity scale. Results: A total of 133 individuals were included, of which 114 (85.7%) were on NIV and 19 (14.3%) were on IMV at the time of remdesivir initiation. The majority of the patients were males (62.4%), and the median age was 56 years. All the patients received concomitant dexamethasone therapy. Remdesivir treatment was commenced after a median of 7 days from onset of symptoms and was continued for a median of 5 days. Clinical improvement within 28 days was achieved in 101 patients (75.9%); among which, 78.1% and 63.2% were subjected to baseline NIV and IMV, respectively. Among the 11 (8.3%) patients who died of any cause by day 28, 9 (7.9%) and 2 (10.5%) were subjected to baseline NIV and IMV, respectively. The most frequent adverse events were sinus bradycardia (21, 13.1%) and alanine transaminase increase (18, 11.3%). Almost all adverse events were classified as Grades 1–3. Conclusion: The use of remdesivir in combination with systemic corticosteroids is associated with high recovery rates and low all-cause mortality in patients with COVID-19 pneumonia who require NIV or IMV. The results need confirmation from clinical trials of appropriate design and size.
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Affiliation(s)
- Rim S. Alibrahim
- Department of Pharmacy, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Eman Z. Elmekaty
- Department of Pharmacy, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammad Edbais
- Department of Pharmacy, Rumailah Hospital, Hamad Medical Corporation, Doha Qatar
| | - Mohammed Alkhatib
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha Qatar
| | - Joanne Daghfal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Muna A. Almaslamani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar#These authors contributed equally to this work
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Ali S. Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar#These authors contributed equally to this work
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar E-mail:
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Borghetti A, Alkhatib M, Dusina A, Duca L, Borghi V, Zazzi M, Di Giambenedetto S. Virological outcomes with dolutegravir plus either lamivudine or two NRTIs as switch strategies: a multi-cohort study. J Antimicrob Chemother 2021; 77:740-746. [PMID: 34849981 DOI: 10.1093/jac/dkab429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To compare the efficacy of dolutegravir plus lamivudine dual therapy (DT) with that of dolutegravir plus two NRTIs triple therapy (TT) as switch strategies. METHODS A multicentre cohort of HIV-positive, HBsAg-negative patients with viral suppression (HIV-RNA ≤50 copies/mL) switching to DT or TT was retrospectively selected from the ARCA database. The effect of DT versus TT on virological failure (VF; defined as two consecutive HIV-RNA values >50 copies/mL or one HIV-RNA value ≥200 copies/mL) was evaluated by multivariable Cox regression models, overall and after stratifying for the presence of NRTI resistance-associated mutations (RAMs). RESULTS From December 2014 to June 2020, 628 patients were eligible: 118 (18.8%) started tenofovir/emtricitabine/dolutegravir, 306 (48.7%) abacavir/lamivudine/dolutegravir and 204 (32.5%) lamivudine/dolutegravir. The DT group had significantly higher nadir and baseline CD4 counts, a higher duration of viral suppression and a lower prevalence of RAMs at historical genotype. Overall, 41 VF occurred after a median of 1.7 years of follow-up, with a lower, but not statistically significant, rate for DT [versus TT, adjusted HR (aHR) = 0.58, 95% CI = 0.25-1.34]. However, DT was associated with less VF in the absence of RAMs when compared with tenofovir-based TT (aHR = 0.20, 95% CI = 0.06-0.67), but not with abacavir-based TT (aHR = 0.43, 95% CI = 0.17-1.11). Conversely, in the setting of pre-existing M184V/I, DT showed a trend to increased risk of VF (versus tenofovir-based TT, aHR = 137.50, 95% CI = 4.24-4464.06; versus abacavir-based TT, aHR = 33.88, 95% CI = 1.75-656.47). CONCLUSIONS Lamivudine/dolutegravir maintenance DT showed similar efficacy to dolutegravir-based TT; however, past M184V/I may favour VF.
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Affiliation(s)
- A Borghetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - M Alkhatib
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - A Dusina
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Rome, Italy
| | - L Duca
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - V Borghi
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - M Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - S Di Giambenedetto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy.,Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Rome, Italy
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8
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Abstract
Background: Thyroid storm is a rare complication of hyperthyroidism. It can lead to life-threatening complications such as Arrhythmias, multiorgan failure and disseminated intravascular coagulation (DIC) (1). In pregnant patients can cause spontaneous abortions, fetal demise (2). Aggressive treatment under critical care settings is needed. Clinical Case: We report a case of 24-year-old Indian female twelve weeks pregnant; background of Graves’ disease for five years, was on carbimazole but she discontinued since she became pregnant. Presented to Hamad general hospital with nausea, vomiting and altered mental status for one day. She was afebrile, normotensive, tachypneic, tachycardiac with heart rate of 150bpm, and confused. Investigations showed supraventricular tachycardia aborted by adenosine and amiodarone, TSH was < 0.01mIU/l(0.3-4.2) and FT4> 100 pmol/L(11.6-21.9),normal baseline liver function and complete blood counts. In the emergency department, she was managed for thyroid storm with hydrocortisone, propranolol, propylthiouracil (PTU), iodine solution and cholestyramine. Then suddenly she deteriorated requiring intubation and vasopressor support under care of Medical Intensive Care Unit (MICU) progressed to multiorgan failure; acute liver injury, acute kidney injury and DIC. So, PTU was stopped and started on plasma exchange followed by total thyroidectomy and tracheostomy. US pelvis showed nonviable fetus, so dilation and curettage were done by obstetric team. Afterwards, she markedly improved except her conscious level and kidney function which required Hemodialysis. MRI brain showed small subdural hematoma treated conservatively and Wernicke encephalopathy treated with thiamine with substantial response and spontaneously breathing. Post thyroidectomy she required calcium supplementation and levothyroxine, liver function and coagulation parameters back to baseline. Conclusion: Thyroid storm in pregnancy is a medical emergency with high mortality rate, it needs high index of suspicion and early aggressive management by a multidisciplinary team. Plasmapheresis may be considered for challenging cases as a bridge for definitive therapy. Thyroidectomy may be the only option in selected cases like our case. References: 1. Karger S, Führer D. Thyreotoxische Krise--ein Update [Thyroid storm--thyrotoxic crisis: an update]. Dtsch Med Wochenschr. 2008 Mar;133(10):479-84. German. doi: 10.1055/s-2008-1046737. PMID: 18302101. 2. Ma Y, Li H, Liu J, Lin X, Liu H. Impending thyroid storm in a pregnant woman with undiagnosed hyperthyroidism: A case report and literature review. Medicine (Baltimore). 2018;97(3):e9606. doi:10.1097/MD.0000000000009606
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Elshami M, Bottcher B, Alkhatib M, Ismail I, Abu-Nemer K, Hana M, Qandeel A, Abdelwahed A, Yazji H, Abuamro H, Matar G, Alsahhar A, Abolamzi A, Baraka O, Elblbessy M, Samra T, Alshorbassi N, Elshami A. Perceived barriers to seeking cancer care in the Gaza Strip: a cross-sectional study. BMC Health Serv Res 2021; 21:28. [PMID: 33407426 PMCID: PMC7788935 DOI: 10.1186/s12913-020-06044-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors. METHODS A cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15-17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females. RESULTS Of 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with 'feeling scared' as the most reported barrier (n=1512, 52.4%). Females and adolescents were more likely to report 'feeling scared' as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report 'embarrassment', 'worry about wasting doctor's time' and 'difficulty arranging transport'. This was also seen for recalling risk factors, where 'embarrassment' and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting 'embarrassment' and 'feeling scared'. CONCLUSIONS The most commonly perceived barriers to seeking cancer care were 'feeling scared' and 'feeling worried about what the doctor might find', followed by practical and service barriers. Females and adolescents were more likely to report 'fear' as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.
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Affiliation(s)
- Mohamedraed Elshami
- Harvard Medical School, Boston, MA, USA. .,Ministry of Health, Gaza, Palestine.
| | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Iyad Ismail
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Khitam Abu-Nemer
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Mustafa Hana
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Qandeel
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Abdelwahed
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Hamza Yazji
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Hisham Abuamro
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ghadeer Matar
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Alsahhar
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Abolamzi
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Obay Baraka
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Tahani Samra
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Alaa Elshami
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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10
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Salpini R, Pietrobattista A, Piermatteo L, Basso MS, Bellocchi MC, Liccardo D, Carioti L, Francalanci P, Aragri M, Alkhatib M, Scutari R, Candusso M, Ciotti M, Svicher V. Establishment of a Seronegative Occult Infection With an Active Hepatitis B Virus Reservoir Enriched of Vaccine Escape Mutations in a Vaccinated Infant After Liver Transplantation. J Infect Dis 2020; 220:1935-1939. [PMID: 31412121 DOI: 10.1093/infdis/jiz411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023] Open
Abstract
We describe the establishment of a seronegative occult hepatitis B virus (HBV) infection (OBI) in a successfully vaccinated infant who underwent liver transplantation from an donor positive for antibody to hepatitis B core antigen (anti-HBc). The use of highly sensitive droplet digital polymerase chain reaction assays revealed a not negligible and transcriptionally active intrahepatic HBV reservoir (circular covalently closed DNA, relaxed circular DNA, and pregenomic RNA: 5.6, 2.4, and 1.1 copies/1000 cells, respectively), capable to sustain ongoing viral production and initial liver damage. Next-generation sequencing revealed a peculiar enrichment of hepatitis B surface antigen vaccine-escape mutations that could have played a crucial role in OBI transmission. This clinical case highlights the pathobiological complexity and the diagnostic challenges underlying OBI.
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Affiliation(s)
- Romina Salpini
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Andrea Pietrobattista
- Department of Hepatology and Gastroenterology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Lorenzo Piermatteo
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Maria Sole Basso
- Department of Hepatology and Gastroenterology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Maria C Bellocchi
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Daniela Liccardo
- Department of Hepatology and Gastroenterology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Luca Carioti
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Paola Francalanci
- Department of Pathology, Bambino Gesù Children Hospital, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Marianna Aragri
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Mohammed Alkhatib
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Rossana Scutari
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Manila Candusso
- Department of Hepatology and Gastroenterology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Marco Ciotti
- Department of Clinical Microbiology and Virology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Valentina Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
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11
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Abdalhadi AM, Alshurafa A, Alkhatib M, Abou Kamar M, Yassin MA. Confirmed Coronavirus Disease-19 (COVID-19) in a Male with Chronic Myeloid Leukemia Complicated by Febrile Neutropenia and Acute Respiratory Distress Syndrome. Case Rep Oncol 2020; 13:569-577. [PMID: 32547383 PMCID: PMC7275193 DOI: 10.1159/000508378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 01/07/2023] Open
Abstract
Coronavirus disease-19 is a respiratory viral disease that commonly presents with mild symptoms. However, it can cause serious complications such as acute respiratory disease, especially in patients with comorbidities. As it is a new disease, the full picture of the disease and its complications are not yet fully understood. Moreover, the patients at risk of complications are not well identified; and the data about the risk in patients with hematological malignancies is limited. Here, we report a 65-year-old male with accelerated phase chronic myeloid leukemia, on dasatinib, tested positive for coronavirus disease-19, then complicated with febrile neutropenia acute respiratory distress syndrome.
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Elshami M, Elshami A, Alshorbassi N, Alkhatib M, Ismail I, Abu-Nemer K, Hana M, Qandeel A, Abdelwahed A, Yazji H, Abuamro H, Matar G, Alsahhar A, Abolamzi A, Baraka O, Elblbessy M, Samra T, Bottcher B. Knowledge level of cancer symptoms and risk factors in the Gaza Strip: a cross-sectional study. BMC Public Health 2020; 20:414. [PMID: 32228661 PMCID: PMC7106782 DOI: 10.1186/s12889-020-08553-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/18/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In low-income settings, cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals. Therefore, this study examined public knowledge of cancer signs and symptoms as well as risk factors in Gaza. METHODS This was a cross-sectional study. Participants were recruited from adult visitors (≥18 years) to governmental hospitals covering all five governorates of Gaza, and adolescent students (15 to 17 years) from 10 high schools in corresponding locations. An Arabic version of the Cancer Awareness Measure (CAM) was completed in a face-to-face interview. It described demographic data and knowledge of: cancer prevalence, age-related risk, signs and symptoms as well as risk factors both in recall and recognition questions. RESULTS Of 3033 participants invited, 2886 completed the CAM (response rate = 95.2%). Adult mean age ± standard deviation was 33.7 ± 11.7 years and that of adolescents was 16.3 ± 0.8 years. Half of the participants (n = 1457, 50.5%) were adolescent (781 females; 53.6%) and 1429 (49.5%) were adult (702 females; 49.1%). About two thirds (n = 1885) thought about cancer as unrelated to age. Only 196 participants (6.8%) identified colorectal cancer as the most common cancer among men. Awareness of cancer signs/symptoms was poor to fair, where 'lump' was most commonly recognized (n = 2227, 77.2%) and 'change of bowel habit' the least (n = 670, 23.2%). Only 217 participants (7.5%) had a good level of recognizing risk factors with 'smoking' being the most identified and 'eating less than five portions of fruits and vegetables a day' the least. There was a higher likelihood for adults to identify most cancer signs/symptoms and risk factors than adolescents, except for recalling 'unexplained pain', 'persistent cough/hoarseness', 'non-healing ulcer', 'smoking', and 'eating less than five portions of fruits and vegetables a day'. CONCLUSION Public awareness of cancer signs/symptoms and risk factors needs to improve to facilitate early presentation and diagnosis in Gaza. Combining the delivery of public campaigns with tailored education to population groups, including the youth, may increase their knowledge and maintain its impact.
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Affiliation(s)
- Mohamedraed Elshami
- Ministry of Health, Gaza, Palestine. .,Harvard Medical School, Boston, MA, USA.
| | - Alaa Elshami
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | | | - Mohammed Alkhatib
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Iyad Ismail
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Khitam Abu-Nemer
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Mustafa Hana
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Qandeel
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Abdelwahed
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Hamza Yazji
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Hisham Abuamro
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ghadeer Matar
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Alsahhar
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Ahmed Abolamzi
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Obay Baraka
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Mahmood Elblbessy
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Tahani Samra
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
| | - Bettina Bottcher
- Faculty of Medicine, Islamic Unviersity of Gaza, Gaza, 108, Palestine
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Salpini R, Surdo M, Cortese MF, Palumbo GA, Carioti L, Cappiello G, Spanò A, Trimoulet P, Fleury H, Vecchiet J, Pasquazzi C, Mirabelli C, Scutari R, Sacco A, Alkhatib M, Missale G, Francioso S, Sarmati L, Andreoni M, Angelico M, Ceccherini-Silberstein F, Levrero M, Perno CF, Belloni L, Svicher V. The novel HBx mutation F30V correlates with hepatocellular carcinoma in vivo, reduces hepatitis B virus replicative efficiency and enhances anti-apoptotic activity of HBx N terminus in vitro. Clin Microbiol Infect 2018; 25:906.e1-906.e7. [PMID: 30472417 DOI: 10.1016/j.cmi.2018.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to investigate HBx genetic elements correlated with hepatitis B virus (HBV) -related hepatocellular carcinoma (HCC) and their impact on (a) HBV replicative efficiency, (b) HBx binding to circular covalently closed DNA (cccDNA), (c) apoptosis and cell-cycle progression, and (d) HBx structural stability. METHODS This study included 123 individuals chronically infected with HBV: 27 with HCC (77.9% (21/27) genotype D; 22.1% (6/27) genotype A) and 96 without HCC (75% (72/96) genotype D; 25.0% (24/96) genotype A). HepG2 cells were transfected by wild-type or mutated linear HBV genome to assess pre-genomic RNA (pgRNA) and core-associated HBV-DNA levels, HBx-binding onto cccDNA by chromatin immunoprecipitation-based quantitative assay, and rate of apoptosis and cell-cycle progression by cytofluorimetry. RESULTS F30V was the only HBx mutation correlated with HCC (18.5% (5/27) in HCC patients versus 1.0% (1/96) in non-HCC patients, p 0.002); a result confirmed by multivariate analysis. In vitro, F30V determined a 40% and 60% reduction in pgRNA and core-associated HBV-DNA compared with wild-type (p <0.05), in parallel with a significant decrease of HBx binding to cccDNA and decreased HBx stability. F30V also decreased the percentage of apoptotic cells compared with wild-type (14.8 ± 6.8% versus 19.1 ± 10.1%, p <0.01, without affecting cell-cycle progression) and increased the probability of HBx-Ser-31 being phosphorylated by PI3K-Akt kinase (known to promote anti-apoptotic activity). CONCLUSIONS F30V was closely correlated with HBV-induced HCC in vivo, reduced HBV replicative efficiency by affecting HBx-binding to cccDNA and increased anti-apoptotic HBx activity in vitro. This suggests that F30V (although hampering HBV's replicative capacity) may promote hepatocyte survival, so potentially allowing persistent production of viral progeny and initiating HBV-driven hepatocarcinogenesis. Investigation of viral genetic markers associated with HCC is crucial to identify those patients at higher risk of HCC, who hence deserve intensive liver monitoring and/or early anti-HBV therapy.
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Affiliation(s)
- R Salpini
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - M Surdo
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - M F Cortese
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G A Palumbo
- Department of Internal Medicine-DMISM, Sapienza University, Rome, Italy
| | - L Carioti
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | | | - A Spanò
- 'S. Pertini Hospital', Rome, Italy
| | | | - H Fleury
- Hôpital Pellegrin Tripode, Bordeaux, France
| | | | | | - C Mirabelli
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy; University of Michigan Medical School, Ann Arbor, MI, USA
| | - R Scutari
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - A Sacco
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | - M Alkhatib
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy
| | | | - S Francioso
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
| | - L Sarmati
- Infectious Diseases Unit, Tor Vergata University Hospital, Rome, Italy
| | - M Andreoni
- Infectious Diseases Unit, Tor Vergata University Hospital, Rome, Italy
| | - M Angelico
- Hepatology Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - M Levrero
- Department of Internal Medicine-DMISM, Sapienza University, Rome, Italy; INSERM U1052 - Cancer Research Centre of Lyon, 69008 Lyon, France
| | - C F Perno
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy; Haematology and Oncohaematology, University of Milan, Italy
| | - L Belloni
- Department of Internal Medicine-DMISM, Sapienza University, Rome, Italy; Centre for Life NanoSciences, IIT-Sapienza, Rome, Italy
| | - V Svicher
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata' Rome, Italy.
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Elshami M, Alkhatib M, Elshami A, Abu-Nemer K, Qandeel A, Hana M, Alshorbassi N, Matar G, Baraka O, Elblbessy M, Albarqouni L, Bottcher B. Public awareness of cancer in the Gaza-Strip: A cross-sectional study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy297.012] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Elshami M, Alaloul E, Dabbour R, Alkhatib M, Abd-Alghafoor T, Böttcher B. An Evidence-Based Study: Evaluating the Management of Acute Heart Failure in the Gaza-Strip Hospitals. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.328] [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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