1
|
Yamout B, Al-Jumah M, Sahraian MA, Almalik Y, Khaburi JA, Shalaby N, Aljarallah S, Bohlega S, Dahdaleh M, Almahdawi A, Khoury SJ, Koussa S, Slassi E, Daoudi S, Aref H, Mrabet S, Zeineddine M, Zakaria M, Inshasi J, Gouider R, Alroughani R. Consensus recommendations for diagnosis and treatment of Multiple Sclerosis: 2023 revision of the MENACTRIMS guidelines. Mult Scler Relat Disord 2024; 83:105435. [PMID: 38245998 DOI: 10.1016/j.msard.2024.105435] [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: 10/26/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for Multiple Sclerosis (MS), most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and time and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of MS therapies is critical to maximize patient benefit. The current guidelines review the current diagnostic criteria for MS and the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, progressive MS, pediatric cases and pregnant women. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
Collapse
Affiliation(s)
- B Yamout
- Neurology Institute and Multiple Sclerosis Center, Harley Street Medical Center, Abu Dhabi, United Arab Emirates.
| | - M Al-Jumah
- InterHealth hospital, Multiple Sclerosis Center, Riyadh, Saudi Arabia
| | - M A Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Y Almalik
- Division of Neurology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - J Al Khaburi
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - N Shalaby
- Neurology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - A Almahdawi
- Consultant Neurologist, Neurology Unit, Baghdad Teaching Hospital, Medical City Complex, Iraq
| | - S J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Koussa
- Multiple Sclerosis Center, Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | - E Slassi
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca, Morocco
| | - S Daoudi
- Hospital Center Nedir Mohamed, Faculty of Medicine, University Mouloud Mammeri Tizi-Ouzou, Algeria
| | - H Aref
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - S Mrabet
- Department of Neurology, CIC, Razi Universitary Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - M Zeineddine
- Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS), Beirut, Lebanon
| | | | - J Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - R Gouider
- Department of Neurology, CIC, Razi Universitary Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - R Alroughani
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait
| |
Collapse
|
2
|
Ziadeh T, Mjaess G, El Helou J, Zalaket J, Mouawad C, Azar C, Abboud H, Koussa S, Nemr E, El Helou E. Impact on quality of life in multiple sclerosis patients: Which urinary symptoms are to blame? Prog Urol 2022; 32:711-716. [PMID: 35715252 DOI: 10.1016/j.purol.2022.05.003] [Citation(s) in RCA: 2] [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: 02/06/2022] [Revised: 04/16/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the correlation between the Expanded Disability Status Scale (EDSS) in multiple sclerosis (MS) subjects, and the severity of lower urinary tract symptoms (LUTS), the bother caused by these symptoms and subjects' quality of life (QoL). MATERIAL AND METHODS This cross-sectional study included 50 subjects with persistent LUTS secondary to MS who were recruited from the registry of a national NGO, between October 2017 and November 2019. Subjects with a history of any disease besides MS that could otherwise explain the presence of LUTS, as well as those with other neurological conditions were excluded. Information including MS duration, subjects' EDSS, voiding and storage LUTS, voiding symptoms' subscore of the International Prostate Symptom Score (IPSS-V), Overactive Bladder Symptom Scores (OABSS), Urinary Bothersome Questionnaire in Multiple Sclerosis (UBQMS), and urologic QoL (SF-Qualiveen) was gathered. Correlations between these scores were assessed using Spearman's bivariate correlations. Wilcoxon's signed rank test was used to evaluate the difference of impact between voiding and storage LUTS on bother of subjects. RESULTS The median disease duration was 7±5.8years and the predominant lower urinary symptom was urgency (82%). Median OABSS and IPSS-V were respectively 8±3.8 and 8±3. Subjects were significantly more bothered from storage than voiding symptoms (2 vs. 1.6; P=0.03), and their QoL was directly affected by storage LUTS. Urgency urinary incontinence had the highest positive correlation with SFQ (r=0.542; P<0.01). MS duration and urologic QoL measured by SF-Q were negatively correlated (r=-0.345; P=0.01). CONCLUSION In MS patients with LUTS, urologic QoL is mainly affected by storage urinary symptoms. Physicians should use a holistic approach to reduce the risk of complications in these patients, by controlling both voiding and storage symptoms, in particular urgency urinary incontinence that mostly affects patient's QoL. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- T Ziadeh
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - G Mjaess
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Department of Urology, Université Libre de Bruxelles, Brussels, Belgium
| | - J El Helou
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - J Zalaket
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - C Mouawad
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - C Azar
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - H Abboud
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - S Koussa
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - E Nemr
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - E El Helou
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
3
|
Sukkarieh G, Waked C, Hachem K, Koussa S, Waked N. Dyschromatopsia as presenting sign of carotid occlusion. J Fr Ophtalmol 2022; 45:e209-e211. [DOI: 10.1016/j.jfo.2021.06.036] [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] [Received: 08/02/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
|
4
|
Bou‐Fakhredin R, Daadaa H, Koussa S, Abou Nasr T, Noun P, Taher AT. SARS-CoV-2 infection in patients with β-thalassemia: Experience from Lebanon. Am J Hematol 2021; 96:E285-E288. [PMID: 33914955 PMCID: PMC8212121 DOI: 10.1002/ajh.26211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Rayan Bou‐Fakhredin
- Division of Hematology‐Oncology, Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Hisham Daadaa
- Division of Hematology‐Oncology, Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | | | | | - Peter Noun
- Division of Pediatric Hematology‐OncologySaint George Hospital University Medical CenterBeirutLebanon
| | - Ali T. Taher
- Division of Hematology‐Oncology, Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| |
Collapse
|
5
|
Bou-Fakhredin R, Ghanem NN, Kreidieh F, Tabbikha R, Daadaa H, Ajouz J, Koussa S, Taher AT. A Report on the Education, Employment and Marital Status of Thalassemia Patients from a Tertiary Care Center in the Middle East. Hemoglobin 2020; 44:278-283. [PMID: 32727228 DOI: 10.1080/03630269.2020.1797776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Very few reports in the literature have focused on the psychosocial status of patients with thalassemia. The aim of this study was to report on the education, employment, and marital status of thalassemia patients in Lebanon and potential influencing factors. A total of 228 patients from the Chronic Care Center, Hazmieh, Lebanon, were incorporated for the data analysis. Demographic, social, and clinical variables were collected. Statistical analysis was performed using the Pearson χ2 test, Fisher Exact test, and binary logistic regression. In this sample, 54.4% were employed, and 45.6% not employed. Of those employed, 65.3% were male, 62.9% single or divorced, 77.4% splenectomized. University level was reached by 26.3% subjects, 7.9% reached high school level, and 32.5% have a level less than high school. Multivariate analysis revealed higher education was most likely attained by males [odds ratio (OR) = 2.23, 95% confidence interval (95% CI): 0.23-0.86] and those with no heart disease and no joint disease (OR = 27.5, 95% CI: 2.80-270 and OR = 3.40, 95% CI: 0.90-12.7, respectively). For employment, a lower average ferritin was associated with current employment. Neither the type of thalassemia nor transfusion status or type of chelation therapy corresponded with higher education or employment status. In conclusion, this is one of the few studies in the literature to look at education, employment, and marital status of thalassemia patients. Such information is essential to develop effective psychosocial support plans for our thalassemia patients.
Collapse
Affiliation(s)
- Rayan Bou-Fakhredin
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim N Ghanem
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kreidieh
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Tabbikha
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hisham Daadaa
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
6
|
Makhoul J, Ghaoui N, Sleilaty G, Koussa S, Abbas S, Azar C, El Helou J. Restless legs syndrome among multiple sclerosis patients in Lebanon. Mult Scler Relat Disord 2020; 41:101997. [PMID: 32113183 DOI: 10.1016/j.msard.2020.101997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/27/2019] [Revised: 01/07/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is often associated with fatigue, with an increased prevalence of sleep disorders compared to the general population, notably restless legs syndrome (RLS). The aim of this study was to evaluate the prevalence and severity of RLS as well the co-occurrence of spinal demyelination lesions in patients with MS in Lebanon. METHODS In this cross-sectional study, we consulted the MS database of the Lebanese association against Multiple Sclerosis and sent out questionnaires to 300 MS patients to screen then confirm the presence of RLS. The final sample included 28 MS participants with confirmed RLS. We conducted further questionnaires to collect demographic data, screen for comorbidities, gather spinal MRI results, and evaluate the severity of both diseases (using the EDSS and the JHRLSS). RESULTS Prevalence of RLS was 15% among MS patients in our study. 46.4% of RLS-affected MS patients had spinal cord demyelination lesions on their MRIs. Participants with MRI lesions had a lower severity score on the JHRLSS (p = 0.088). No association was found between the EDSS results and JHRLSS, demographic data, or comorbidities. CONCLUSION Restless legs syndrome is commonly found among patients with multiple sclerosis in Lebanon, is underdiagnosed, and ought to be systematically evaluated for in order to improve the patients' quality of life.
Collapse
Affiliation(s)
- J Makhoul
- Department of Neurology, Hôtel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - N Ghaoui
- Department of Neurology, Hôtel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - G Sleilaty
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - S Koussa
- Department of Neurology, Hôtel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - S Abbas
- Department of Neurology, Hôtel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - C Azar
- Department of Neurology, Hôtel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - J El Helou
- Department of Neurology, Hôtel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
7
|
Yamout B, Sahraian M, Bohlega S, Al-Jumah M, Goueider R, Dahdaleh M, Inshasi J, Hashem S, Alsharoqi I, Khoury S, Alkhawajah M, Koussa S, Al Khaburi J, Almahdawi A, Alsaadi T, Slassi E, Daodi S, Zakaria M, Alroughani R. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines. Mult Scler Relat Disord 2019; 37:101459. [PMID: 31670208 DOI: 10.1016/j.msard.2019.101459] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of multiple sclerosis (MS) therapies is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, and progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
Collapse
Affiliation(s)
- B Yamout
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon.
| | - M Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Al-Jumah
- King Fahad Medical Cit, MOH, Riyadh, Saudi Arabia
| | - R Goueider
- Service de Neurologie, Hôpital Razi, Manouba, Tunis
| | | | - J Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - S Hashem
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - I Alsharoqi
- Dept of Clinical Neurosciences, Salmaniya Medical Complex, Manama, Bahrain
| | - S Khoury
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Alkhawajah
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - S Koussa
- MS Center- Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | - J Al Khaburi
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - A Almahdawi
- Consultant neurologist, neurology unit, Baghdad Teaching Hospital, Medical City Complex, Iraq
| | - T Alsaadi
- American Center for Psychiatry & Neurology- UAE
| | - E Slassi
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca- Morocco
| | - S Daodi
- Hospital Center Nedir Mohamed, Faculty of Medicine University Mouloud Mammeri Tizi-ouzou Algeria
| | | | - R Alroughani
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait
| |
Collapse
|
8
|
Sharara AI, Rustom LBO, Marrache M, Rimmani HH, Bou Daher H, Koussa S, Taher A. Sofosbuvir/velpatasvir for chronic hepatitis C infection in patients with transfusion-dependent thalassemia. Am J Hematol 2019; 94:E43-E45. [PMID: 30394575 DOI: 10.1002/ajh.25339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Ala I. Sharara
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Luma Basma O. Rustom
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Majd Marrache
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Hussein H. Rimmani
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Halim Bou Daher
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | | | - Ali Taher
- Division of Hematology/Oncology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| |
Collapse
|
9
|
Brancaleoni V, Moukhadder HM, Consonni D, Koussa S, Di Pierro E, Cappellini MD, Taher A. Common fetal hemoglobin variants in Lebanese patients bearing the codon 29 beta gene mutation associated with different thalassemia phenotypes. Ann Hematol 2018; 98:833-840. [PMID: 30506348 DOI: 10.1007/s00277-018-3567-3] [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: 11/11/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
Beta-thalassemia can present with a wide spectrum of phenotypes determined by the coinheritance of α-thalassemia, hereditary persistence of fetal hemoglobin, and polymorphic variants in the BCL11A, HMIP, and HBB clusters. The codon 29 (cd29) mutation in the beta gene has been associated with a broad diversity of thalassemia phenotypes, possibly through genetic modifiers determining the genotype-phenotype relationship. In this study, we evaluated the effect of 10 single nucleotide polymorphisms (SNPs) on β-thalassemia severity in a group of 21 Lebanese patients bearing the cd29 mutation. Hematological parameters and clinical characteristics were evaluated according to transfusion dependence. The proportions and absolute concentrations of HbF were found to be higher in non-transfusion-dependent (NTD) patients than in transfusion-dependent (TD) ones. Iron parameters were found to be higher in TD patients. The SNPs that were evaluated included the XmnI-158 polymorphism in the HBG gene and SNPs in the BCL11A and HMIP loci. It was noted that individuals homozygous or heterozygous for the effect allele in the BCL11A and HMIP SNPs had higher HbF levels, lower ferritin concentrations, and lower liver iron content and were less likely to be transfusion dependent. Our results showed that HbF production variants may have an important impact on the severity of β-thalassemia, which might provide a severity prediction tool that can help in the anticipation of patients' phenotypes and therefore in future therapeutic decision making.
Collapse
Affiliation(s)
- Valentina Brancaleoni
- U.O.C. Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Hassan M Moukhadder
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Beirut, 11072020, Lebanon
| | - Dario Consonni
- U.O. Epidemiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Elena Di Pierro
- U.O.C. Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- U.O.C. Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Scienze cliniche e di comunità, Università degli Studi di Milano, Milan, Italy
| | - Ali Taher
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Beirut, 11072020, Lebanon.
| |
Collapse
|
10
|
Zalloua P, Shbaklo H, Abou Mourad Y, Koussa S, Taher A. Incidence of thromboembolic events in Lebanese thalassemia intermedia patients. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613588] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
11
|
Vichinsky E, El-Beshlawy A, Al Zoebie A, Kamdem A, Koussa S, Chotsampancharoen T, Bruederle A, Gilotti G, Han J, Elalfy M. Long-term safety and efficacy of deferasirox in young pediatric patients with transfusional hemosiderosis: Results from a 5-year observational study (ENTRUST). Pediatr Blood Cancer 2017; 64. [PMID: 28296163 DOI: 10.1002/pbc.26507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Children with red blood cell disorders may receive regular transfusions from an early age and consequently accumulate iron. Adequate iron chelation therapy can prevent organ damage and delayed growth/development. Deferasirox is indicated for treatment of pediatric patients with chronic iron overload due to transfusional hemosiderosis; however, fewer than 10% of patients in the registration studies were aged 2 to less than 6 years. PROCEDURE Deferasirox, a once-daily oral iron chelator, was evaluated in young pediatric patients with transfusional hemosiderosis during the observational 5-year ENTRUST study. Patients aged 2 to less than 6 years at enrollment received deferasirox according to local prescribing information, with the primary objective of evaluating safety, specifically renal and hepatic function. Serum ferritin was observed as a surrogate efficacy parameter. RESULTS In total, 267 patients (mean age 3.2 years) predominantly with β-thalassemia (n = 176, 65.9%) were enrolled. Mean ± standard deviation deferasirox dose was 25.8 ± 6.5 mg/kg per day over a median of 59.9 months. A total of 145 patients (54.3%) completed 5 years' treatment. The proportion of patients with two or more consecutive postbaseline measurements (≥7 days apart) of serum creatinine higher than age-adjusted upper limit of normal (ULN) and alanine aminotransferase more than five times the ULN was 4.4% (95% confidence interval [CI]: 2.1-7.9) and 4.0% (95% CI: 1.8-7.4), respectively. Median serum ferritin decreased from 1,702 ng/ml at baseline to 1,127 ng/ml at 5 years. There were no new safety signals. CONCLUSIONS Safety and efficacy of deferasirox in young pediatric patients in this long-term, observational study in everyday clinical practice were consistent with the known deferasirox profile.
Collapse
Affiliation(s)
- Elliott Vichinsky
- UCSF Benioff Children's Hospital & Research Center Oakland, Oakland, California
| | | | | | - Annie Kamdem
- Centre Hospitalier Intercommunal, Créteil, France
| | | | | | | | | | - Jackie Han
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | | |
Collapse
|
12
|
Inati A, Kahale M, Sbeiti N, Cappellini MD, Taher AT, Koussa S, Nasr TA, Musallam KM, Abbas HA, Porter JB. One-year results from a prospective randomized trial comparing phlebotomy with deferasirox for the treatment of iron overload in pediatric patients with thalassemia major following curative stem cell transplantation. Pediatr Blood Cancer 2017; 64:188-196. [PMID: 27576370 DOI: 10.1002/pbc.26213] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/28/2016] [Accepted: 07/20/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Iron overload is well documented in patients with β-thalassemia major, and patients who have undergone hematopoietic stem cell transplantation (HSCT) remain at risk as a result of pre- and immediate post-HSCT transfusions. PROCEDURE This is a prospective, randomized, 1-year clinical trial that compares the efficacy and safety of the once-daily oral iron chelator deferasirox versus phlebotomy for the treatment of iron overload in children with β-thalassemia major following HSCT. RESULTS Patients (aged 12.4 years) received deferasirox (n = 12, 10 mg/kg/day starting dose) or phlebotomy (n = 14, 6 ml/kg/2 weeks) for 1 year. In two and five patients, deferasirox dose was increased to 15 and 20 mg/kg/day, respectively. Magnetic resonance imaging (MRI)-assessed liver iron concentration (LIC) decreased with deferasirox (mean 12.5 ± 10.1 to 8.5 ± 9.3 mg Fe/g dry weight [dw]; P = 0.0005 vs. baseline) and phlebotomy (10.2 ± 6.8 to 8.3 ± 9.2 mg Fe/g dw; P = 0.05). LIC reductions were greater with deferasirox than with phlebotomy for patients with baseline serum ferritin 1,000 ng/ml or higher (-8.1 ± 1.5 vs. -3.5 ± 5.7 mg Fe/g dw; P = 0.048). Serum ferritin and non-transferrin-bound iron also decreased significantly. In two patients with severe cardiac siderosis, a clinically relevant improvement in myocardial T2* was seen, following phlebotomy and deferasirox therapy (n = 1 each). Adverse effects with deferasirox were skin rash, gastrointestinal upset, and increased liver function tests (all n = 1), while those for phlebotomy were difficulty with venous access (n = 4) and distress during procedure (n = 1). Parents of 13/14 children receiving phlebotomy wished to switch to deferasirox, with 1/14 being satisfied with phlebotomy. CONCLUSIONS Deferasirox treatment or phlebotomy reduces iron burden in pediatric patients with β- thalassemia major post-HSCT, with a manageable safety profile.
Collapse
Affiliation(s)
- Adlette Inati
- Lebanese American University and University Medical Center Rizk Hospital.,Rafik Hariri University Hospital, Beirut, Lebanon
| | - Mario Kahale
- Rafik Hariri University Hospital, Beirut, Lebanon
| | | | | | - Ali T Taher
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Hussein A Abbas
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | |
Collapse
|
13
|
Mallat NS, Wehbe D, Haddad A, Cappellini MD, Marcon A, Koussa S, Abboud MR, Radwan A, Taher AT. Priapism, an emerging complication in β-thalassemia intermedia patients. Hemoglobin 2015; 38:351-4. [PMID: 25271993 DOI: 10.3109/03630269.2014.960087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The increase in survival rate of β-thalassemia (β-thal) patients allowed for the appearance and manifestation of several complications in almost every organ system. Priapism in β-thal patients is rarely reported in the literature. We herein report and investigate the occurrence of two cases of priapism in two young patients with β-thal intermedia (β-TI). The potential mechanisms are due to either a cellular mechanism involving a thrombus obstructing the efferent venules of the corpora cavernosa leading to priapism, or a recently elucidated functional mechanism that causes alteration of nitric oxide (NO) response of the penis, ultimately causing priapism. This should incite clinicians for a close follow-up and monitoring of high risk patients who are susceptible to developing priapism.
Collapse
Affiliation(s)
- Naji S Mallat
- Department of Internal Medicine, American University of Beirut , Beirut , Lebanon
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Yamout B, Alroughani R, Al-Jumah M, Goueider R, Dahdaleh M, Inshasi J, Hashem S, Alsharoqi I, Sahraian M, Khoury S, Alkawi Z, Koussa S, Zakaria M, Al Khaburi J, Alsaadi T, Bohlega S. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: the Middle East North Africa Committee for Treatment and Research In Multiple Sclerosis (MENACTRIMS). Curr Med Res Opin 2015; 31:1349-61. [PMID: 25946578 DOI: 10.1185/03007995.2015.1047750] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 11/23/2022]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need re-evaluation and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate multiple sclerosis (MS) therapy selection is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, secondary progressive MS, and primary progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
Collapse
Affiliation(s)
- B Yamout
- MS Center, American University of Beirut Medical Center , Beirut , Lebanon
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Alroughani R, Aref H, Bohlega S, Sherooqi I, Dahdaleh M, Feki I, Jumah M, Al-Kawi M, Koussa S, Yamout B. Natalizumab treatment for multiple sclerosis: Middle East and North Africa regional recommendations for patient selection and monitoring. Mult Scler Relat Disord 2014. [DOI: 10.1016/j.msard.2014.09.188] [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: 10/24/2022]
|
16
|
Abi Saad M, Haddad AG, Alam ES, Aoun S, Maatouk P, Ajami N, Khairallah T, Koussa S, Musallam KM, Taher AT. Preventing Thalassemia in Lebanon: Successes and Challenges in a Developing Country. Hemoglobin 2014; 38:308-11. [DOI: 10.3109/03630269.2014.939279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Azzam R, Nahhas O, Rizk W, Koussa S, Haddad F, Maalouly G. Polyradiculonévrite chronique réfractaire au traitement et gammapathie monoclonale de signification indéterminée. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Abstract
OBJECTIVES Patients with beta-thalassemia intermedia tend to present later in life with milder anemia than beta-thalassemia major patients. The incidence of mortality and its causes in this patient population remains unknown. We aim to reveal the incidence and most common causes of death in this population. METHODS AND RESULTS We reviewed the charts of all of the beta-thalassemia intermedia patients who had been followed at the Chronic Care Center in Hazmieh, Lebanon during a 10-year period. A total of 18 patients out of 127 had died during the follow-up period giving a cumulative 10-year mortality incidence of 14%. The most common causes of cardiac deaths were due to renal and cardiac causes. DISCUSSION Most causes of death have been linked to the high levels of iron coupled with anemia present in this patient population. Many of deaths could be prevented by adequate treatment. CONCLUSION Larger studies with more comprehensive data capture on risk factors of mortality in this patient population are called for.
Collapse
|
19
|
Inati A, Kahale M, Perrine SP, Chui DHK, Taher AT, Koussa S, Abi Nasr T, Abbas HA, Ghalie RG. A phase 2 study of HQK-1001, an oral fetal haemoglobin inducer, in β-thalassaemia intermedia. Br J Haematol 2013; 164:456-8. [PMID: 24224649 DOI: 10.1111/bjh.12635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Adlette Inati
- Lebanese American University, Beirut, Lebanon; Rafik Hariri University Hospital, Beirut, Lebanon
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Khoury B, Musallam KM, Abi-Habib R, Bazzi L, Ward ZAL, Succar J, Halawi R, Hankir A, Koussa S, Taher AT. Prevalence of depression and anxiety in adult patients with β-thalassemia major and intermedia. Int J Psychiatry Med 2013; 44:291-303. [PMID: 23885513 DOI: 10.2190/pm.44.4.a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate and compare the prevalence and risk factors for anxiety and depression in adults with beta-thalassemia major (TM) and intermedia (TI). METHOD A cross-sectional study of TI and TM patients at a Chronic Care Center in Lebanon. A total of 80 patients agreed to participate (32 TI (median age 24 years) and 48 TM (median age 23 years)). The Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires were used to assess the depression and anxiety levels of patients, respectively. Data on patient demographics, clinical complications, and socioeconomic status were also collected. RESULTS Patients with TM had a significantly longer median duration with a known thalassemia diagnosis than patients with TI (p < 0.001). A considerable proportion of patients had depression (35.0%), State (S)-anxiety (22.5%) or Trait (T)-anxiety (36.2%). Patients with TI had a higher median S-anxiety score compared with TM (p = 0.035), although the median T-anxiety and depression scores were similar. On linear regression analysis, the significant association between the thalassemia diagnosis (TM versus TI) and S-anxiety score (beta: 5.740; 95% CI: 0.201 to 11.278; p = 0.042) was no longer observed upon adjustment for the co-variate duration with a known thalassemia diagnosis (beta: 3.162; 95% CI: -2.949 to 9.274; p = 0.306). CONCLUSIONS A considerable proportion of adult patients with TM and TI show evidence of depression and anxiety. Patients with TI are more liable to state anxiety than TM patients of a similar age, which is attributed to a shorter duration of living with a thalassemia diagnosis.
Collapse
|
21
|
Matta BN, Abbas O, Maakaron JE, Koussa S, Daderian RH, Taher AT. Leg ulcers in patients with β-thalassaemia intermedia: a single centre's experience. J Eur Acad Dermatol Venereol 2013; 28:1245-50. [DOI: 10.1111/jdv.12211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/12/2013] [Indexed: 12/30/2022]
Affiliation(s)
- B. N. Matta
- Department of Internal Medicine; Division of Hematology & Oncology; American University of Beirut Medical Center; Beirut Lebanon
| | - O. Abbas
- Department of Dermatology; American University of Beirut Medical Center; Beirut Lebanon
| | - J. E. Maakaron
- Department of Internal Medicine; Division of Hematology & Oncology; American University of Beirut Medical Center; Beirut Lebanon
| | - S. Koussa
- Chronic Care Center; Hazmieh Lebanon
| | | | - A. T. Taher
- Department of Internal Medicine; Division of Hematology & Oncology; American University of Beirut Medical Center; Beirut Lebanon
- Department of Dermatology; American University of Beirut Medical Center; Beirut Lebanon
| |
Collapse
|
22
|
Mallat NS, Beydoun A, Musallam KM, Koussa S, Taher AT. Deferiprone-induced seizures in a patient with β-thalassemia major. Blood Cells Mol Dis 2013; 51:94-5. [PMID: 23587452 DOI: 10.1016/j.bcmd.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 11/24/2022]
|
23
|
Fucharoen S, Inati A, Siritanaratku N, Thein SL, Wargin WC, Koussa S, Taher A, Chaneim N, Boosalis M, Berenson R, Perrine SP. A randomized phase I/II trial of HQK-1001, an oral fetal globin gene inducer, in β-thalassaemia intermedia and HbE/β-thalassaemia. Br J Haematol 2013; 161:587-93. [PMID: 23530969 DOI: 10.1111/bjh.12304] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
Abstract
β-thalassaemia intermedia (BTI) syndromes cause haemolytic anaemia, ineffective erythropoiesis, and widespread complications. Higher fetal globin expression within genotypes reduces globin imbalance and ameliorates anaemia. Sodium 2,2 dimethylbutyrate (HQK-1001), an orally bioavailable short-chain fatty acid derivative, induces γ-globin expression experimentally and is well-tolerated in normal subjects. Accordingly, a randomized, blinded, placebo-controlled, Phase I/II trial was performed in 21 adult BTI patients (14 with HbE/β(0) thalassaemia and seven with β(+)/β(0) thalassaemia intermedia, to determine effective doses for fetal globin induction, safety, and tolerability. HQK-1001 or placebo were administered once daily for 8 weeks at four dose levels (10, 20, 30, or 40 mg/kg per day), and subjects were monitored for laboratory and clinical events. Pharmacokinetic profiles demonstrated a t(1/2) of 10-12 h. Adverse events with HQK-1001 treatment were not significantly different from placebo treatment. The 20 mg/kg treatment doses increased median HbF above baseline levels by 6·6% and 4·4 g/l (P < 0·01) in 8/9 subjects; total haemoglobin (Hb) increased by a mean of 11 g/l in 4/9 subjects. These findings identified a safe oral therapeutic which induces fetal globin in BTI. Further investigation of HQK-1001 with longer dosing to definitively evaluate its haematological potential appears warranted.
Collapse
Affiliation(s)
- Suthat Fucharoen
- Thalassemia Research Centre, Mahidol University, Nakhonpathon, Thailand
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Shatila AR, Koussa S, Jabbour R, Mourad A, Aouad A, Sabbagh G, Kallab K, Hilal R, Khalifeh R, Gebeily S, Tourbah A. LSN MS guidelines for the management of multiple sclerosis. Rev Neurol (Paris) 2013; 169:950-5. [PMID: 23434141 DOI: 10.1016/j.neurol.2012.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/21/2012] [Accepted: 12/13/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. METHODS Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. RESULTS Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. CONCLUSIONS The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects.
Collapse
Affiliation(s)
- A R Shatila
- Neurology Division Makassed Hospital, Ouzai Street Tarik Al-Jadida, Beirut, Lebanon
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ziyadeh FN, Musallam KM, Mallat NS, Mallat S, Jaber F, Mohamed AA, Koussa S, Taher AT. Glomerular hyperfiltration and proteinuria in transfusion-independent patients with β-thalassemia intermedia. Nephron Clin Pract 2012; 121:c136-43. [PMID: 23235469 DOI: 10.1159/000339787] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/28/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/AIMS Renal manifestations have been described in β-thalassemia major and were attributed to transfusional iron overload and chelation therapy. Patients with the milder phenotype, β-thalassemia intermedia (TI), remain largely transfusion and iron chelation independent while enduring a chronic hemolytic anemia and primary iron overload. Data on renal function in patients with TI is lacking. METHODS In this cross-sectional study of 50 TI patients, we evaluated the association of estimated glomerular filtration rate (eGFR) and urinary protein to creatinine (UPr/UCr) ratio with relevant patient, disease and laboratory indices. RESULTS The median age of patients was 28 years (44% males). The eGFR was >90 ml/min/1.73 m(2) in all patients, with a median value of 142.3 ml/min/1.73 m(2). The median UPr/UCr ratio was 213.2 mg/g. There was a negative correlation between age and eGFR, while the UPr/UCr ratio correlated positively with markers of anemia, hemolysis and iron overload. A total of 24 (48%) patients had evidence of glomerular hyperfiltration, while 7 (14%) had proteinuria (UPr/UCr ratio >500 mg/g). Patients with proteinuria were characterized by elevated liver iron concentration (>7 mg Fe/g dry weight), non-transferrin-bound iron levels and nucleated red blood cell counts. CONCLUSIONS A considerable proportion of TI patients show evidence of abnormally elevated eGFR, with a declining trend towards advancing age. The occurrence of proteinuria is associated with anemia, hemolysis and iron toxicity.
Collapse
Affiliation(s)
- Fuad N Ziyadeh
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Chahwan D, Maalouly G, Hokayem N, Abi Saleh R, Jammal M, Abdo L, Serhal L, Azzam R, Abou Nakad S, Koussa S, Tohme A. Un syndrome pseudobulbaire et une ganglionopathie sensitive dévoilant un syndrome de Gougerot-Sjögren chez une patiente sclérodermique. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.165] [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: 10/27/2022]
|
27
|
Maalouly G, Serhal L, Jaafar D, Fiani C, Chahwan D, Abdo L, Koussa S, Haddad F. Myélite transverse : étiologies et association aux anticorps antiphospholipides dans une série de 11 cas. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Haddad F, Jammal M, Chehwane D, Abi Saleh R, Koussa S. Trouble de la marche révélant un syndrome de sécrétion inappropriée d’hormone antidiurétique associé à la prégabaline. Rev Med Interne 2012; 33:e49-51. [DOI: 10.1016/j.revmed.2012.08.013] [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] [Received: 02/28/2011] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
|
29
|
Jabbour R, Koussa S, Delague V, Megarbane A, Khoury M, Atweh S. Epidemiology of Charcot-Marie-Tooth in Lebanon: Clinical, Genetic and Electrophysiological Correlation (P05.150). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.150] [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
|
30
|
Musallam KM, Beydoun A, Hourani R, Nasreddine W, Raad R, Koussa S, Taher AT. Brain magnetic resonance angiography in splenectomized adults with β-thalassemia intermedia. Eur J Haematol 2011; 87:539-46. [PMID: 21913989 DOI: 10.1111/j.1600-0609.2011.01706.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hypercoagulability and venous thromboembolism are common in patients with β-thalassemia intermedia (TI), especially in the splenectomized adult. Although arterial involvement is not commonly reported, we have recently observed a high prevalence (60%) of silent brain infarction on brain MRI in 30 splenectomized adults with TI. The pathophysiology of these white matter lesions remains unknown. METHODS In this prospective work, we evaluated magnetic resonance angiography (MRA) scans of the same cohort of 30 patients. Data collected were the presence or absence of vascular lesions, their locations, and severity. Correlations between MRA abnormality and patients/disease characteristics were evaluated. Comparisons between MRA and previous MRI findings were made. RESULTS Of 29 evaluable patients, 8 (27.6%) had evidence of arterial stenosis on MRA. The majority of lesions had mild narrowing and mostly involved the internal carotid artery. Five patients (17.2%) had evidence of aneurysms. Low total hemoglobin and high non-transferrin-bound iron levels independently characterized patients with evidence of stenosis on MRA. Among the 18 patients with silent brain infarction on MRI, three had evidence of stenosis on MRA with only one patient having lesions that could explain the silent infarcts. CONCLUSIONS Cerebral vasculopathy is common in splenectomized adults with TI. However, large-vessel disease does not explain the occurrence of silent brain infarction. The combined use of MRA and MRI better identifies splenectomized TI adults with neuroimaging abnormalities.
Collapse
Affiliation(s)
- Khaled M Musallam
- Division of Hematology & Oncology, Department of Internal Medicine, American University of Beirut Medical Center
| | | | | | | | | | | | | |
Collapse
|
31
|
Karimi M, Musallam KM, Cappellini MD, Daar S, El-Beshlawy A, Belhoul K, Saned MS, Temraz S, Koussa S, Taher AT. Risk factors for pulmonary hypertension in patients with β thalassemia intermedia. Eur J Intern Med 2011; 22:607-10. [PMID: 22075289 DOI: 10.1016/j.ejim.2011.05.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/20/2011] [Accepted: 05/27/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary hypertension (PHT) is a common yet poorly understood complication of β thalassemia intermedia (TI). METHODS We herein evaluated risk factors for PHT in TI, through comparing 64 TI patients with evidence of PHT by symptomatology and echocardiography (Group I) to age- and sex-matched TI patients without PHT (Group II). Retrieved data included demographics, laboratory parameters, clinical characteristics, and received treatments that may influence PHT development; and reflected the period prior to PHT occurrence in Group I. RESULTS The mean age of Group I patients at development of PHT was 37.3±10.6years; with 44% being males. Among studied parameters, Group I patients were more likely to be splenectomized (4.9-times), transfusion-naive (3.5-times); hydroxyurea-naive (2.6-times), or iron chelation-naive (2.3-times); and have nucleated red blood cell count ≥300×10(6)/l (2.59-times) or a previous history of thromboembolic events (3.69-times). CONCLUSION TI patients who eventually develop PHT may be identified early on by being splenectomized, having high nucleated red blood cell counts and a previous history of thromboembolism. Prospective clinical trials that evaluate the efficacy, safety, and cost effectiveness of transfusion, iron chelation, and hydroxyurea therapy in preventing PHT in TI are invited.
Collapse
Affiliation(s)
- Mehran Karimi
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Musallam KM, Nasreddine W, Beydoun A, Hourani R, Hankir A, Koussa S, Haidar M, Taher AT. Brain positron emission tomography in splenectomized adults with β-thalassemia intermedia: uncovering yet another covert abnormality. Ann Hematol 2011; 91:235-41. [DOI: 10.1007/s00277-011-1291-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/01/2011] [Indexed: 12/15/2022]
|
33
|
Musallam KM, Khoury B, Abi-Habib R, Bazzi L, Succar J, Halawi R, Hankir A, Koussa S, Taher AT. Health-related quality of life in adults with transfusion-independent thalassaemia intermedia compared to regularly transfused thalassaemia major: new insights. Eur J Haematol 2011; 87:73-9. [DOI: 10.1111/j.1600-0609.2011.01623.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
34
|
Haddad F, Jammal M, Maalouly G, Abi Saleh R, Chehwane D, Koussa S. « B12 normal » associée à des troubles cognitifs : mythe ou réalité ? Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
Haddad F, Anouti S, Maalouly G, Koussa S. [Narcolepsy associated with systemic lupus erythematosus]. Rev Med Interne 2010; 32:e114-5. [PMID: 21145142 DOI: 10.1016/j.revmed.2010.10.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
Many neurologic and psychiatric manifestations have been associated with systemic lupus erythematosus. Narcolepsy, currently hypothesized as related to an autoimmune process, has been rarely associated with systemic lupus erythematosus. We report a 36-year-old woman who presented with narcolepsy and who subsequently developed systemic lupus erythematosus. Excessive daytime sleepiness resolved after the administration of four intravenous bolus of cyclophosphamide and methylprednisolone followed by maintenance therapy with hydroxychloroquine, aspirine and prednisone. Narcolepsy should be included in the neuropsychiatric manifestations of systemic lupus erythematosus and it may have a parallel clinical course to the activity of the lupus.
Collapse
Affiliation(s)
- F Haddad
- Service de médecine interne, hôpital universitaire Hôtel-Dieu de France, Ashrafieh, Beyrouth, Liban.
| | | | | | | |
Collapse
|
36
|
Haddad F, Asmar G, Jammal M, Anouti S, Nemnoum R, Maalouly G, Abi Saleh R, Koussa S. Un syndrome cérébelleux révélant une encéphalomyélite aiguë disséminée associé à des anticorps antiphospholipides. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.257] [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: 10/19/2022]
|
37
|
Koussa S, Rustom M. [Association between myasthenia gravis and extrathymic non-Hodgkin's lymphoma]. Rev Neurol (Paris) 2010; 166:752-3. [PMID: 20471662 DOI: 10.1016/j.neurol.2010.03.005] [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] [Received: 01/17/2010] [Accepted: 03/03/2010] [Indexed: 11/26/2022]
|
38
|
Haddad F, Maalouly G, Jammal M, Asmar G, Kamouh W, Zein E, Koussa S. Atteinte du douzième nerf crânien au cours de la fièvre méditterrannéenne familiale. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Charafeddine K, Isma'eel H, Charafeddine M, Inati A, Koussa S, Naja M, Taher A. Survival and complications of beta-thalassemia in Lebanon: a decade's experience of centralized care. Acta Haematol 2008; 120:112-6. [PMID: 19001806 DOI: 10.1159/000171088] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 08/05/2008] [Indexed: 11/19/2022]
Abstract
beta-Thalassemia major is a debilitating disease with a considerable incidence in Lebanon (around 2-3% carriership). The present article describes our experience to this day with 214 patients, emphasizing the survival of beta-thalassemia major and development of complications among patients with different parameters. Fifteen deaths were reported. The most common cause of death was heart failure (60%). Patients with a ferritin level of 3,000 ng/ml showed better survival than those with a level >3,000 ng/ml (p < 0.006). In addition, patients with a ferritin level of 1,500 ng/ml showed less complication-free survival than those with a level >1,500 ng/ml (p < 0.024). High level of ferritin (1,500 ng/ml) is associated with increased risk of heart failure. Overall and complication-free survival were statistically different among patients classified according to birth cohort or ferritin level. The Chronic Care Center, a multidisciplinary center located in the suburbs of Beirut, led to an increase in complication-free as well as overall survival. Although patients are being diagnosed earlier and chelation therapy is being initiated at an earlier age, complications due to iron overload still persist. The introduction of new oral iron chelators and better iron overload quantitation methods will most likely modify this picture, and a follow-up study will examine their impact.
Collapse
Affiliation(s)
- K Charafeddine
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Abou-khaled K, Koussa S, Chemaly R. Isolted vertigo as a manifestation of stroke. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90449-x] [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: 10/22/2022]
|
42
|
Koussa S, Hage Chahine S, Zoghbi A, Yazbeck P. État de mal épileptique et gatifloxacine. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Abstract
INTRODUCTION The epileptogenic potential of quinolones differs from one product to the other. The rare epileptic seizures induced by gatifloxacin were seen with the intravenous route. PATIENTS We report two old ladies presenting with generalized status epilepticus after being treated orally with normal doses of gatifloxacin, with a good recovery. Past medical history of convulsion was the only factor found. Brain MR imaging was unremarkable. In one patient, EEG showed continuous bilateral paroxysmal discharges, predominantly frontal. CONCLUSION Caution is warranted when using quinolones in elderly patients, especially those suffering from epilepsy.
Collapse
Affiliation(s)
- S Koussa
- Service de Neurologie, Hôpital Hôtel-Dieu de France, Université Saint-Joseph, Beyrouth, Liban.
| | | | | | | |
Collapse
|
44
|
Tohmé A, Koussa S, Haddad-Zébouni S, El-Rassi B, Ghayad E. Manifestations neurologiques de la maladie de Behçet. Étude de 22 observations. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.039] [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: 10/24/2022]
|
45
|
Abstract
Beta-thalassemia is a hereditary anemia that is quite prevalent in Lebanon. Most patients with beta-Thalassemia are treated and followed up mostly at a multidisciplinary center, located in the suburban area of Beirut: the Chronic Care Center (CCC), operational since 1994. We will review the experience with beta-Thalassemia accumulated through this institution. Four hundred and twenty five patients, aged 2 to 68 years are followed up at the CCC. Sixty four percent have thalassemia major (TM) while 36% have thalassemia intermedia (TI). Lebanese patients with TM receive periodic packed red cell transfusions to maintain a pre-transfusional hemoglobin level of 10 gm/dl at all times and desferrioxamine is the standard iron chelator in use. Since 1994, 12 patients with TM have died from complications of their disease, with heart failure being responsible for the majority of deaths. The incidence of cardiac, endocrinologic, and infectious complications will be reviewed. Finally, both current and prospective preventive measures will be discussed, specifically educational campaigns and premarital screening. The effects of prevention are starting to show as the number of newly diagnosed disease is diminishing.
Collapse
Affiliation(s)
- A Inati
- Chronic Care Center, Baabda, Lebanon
| | | | | | | | | | | |
Collapse
|
46
|
Sharara AI, Aoun E, Koussa S, Inati A, Taher A. Treatment of acute hepatitis C in a child with thalassemia major using weight-based peginterferon alpha-2b. J Gastroenterol Hepatol 2006; 21:1221. [PMID: 16824084 DOI: 10.1111/j.1440-1746.2006.04174.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
47
|
Nassar AH, Usta IM, Rechdan JB, Koussa S, Inati A, Taher AT. Pregnancy in patients with beta-thalassemia intermedia: outcome of mothers and newborns. Am J Hematol 2006; 81:499-502. [PMID: 16755576 DOI: 10.1002/ajh.20654] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 11/07/2022]
Abstract
Little is known about the outcome of pregnancy in women with beta-thalassemia intermedia (TI). Over 10 years, maternal and neonatal outcomes of women with TI followed at a single thalassemia center were reviewed. Nine spontaneous pregnancies in five women with TI were studied. Six pregnancies resulted in live newborns; two were complicated by first-trimester abortions and one by an unexplained intrauterine fetal death at 36 weeks' gestation. Two patients had splenectomy before pregnancy: one required cesarean delivery and splenectomy at 31(2/7) weeks' gestation for worsening hemolytic anemia and thrombocytopenia and another had splenectomy 8 weeks postpartum for symptomatic hypersplenism. Two patients had received transfusions before pregnancy, and two required them for the first time during pregnancy and developed antibodies, which contributed to worsening of their anemia and repeated transfusions. The mean number of transfusions received during pregnancy was 8.0 +/- 5.2 units. The mean lowest hemoglobin level in pregnancy was 5.2 +/- 2.0 g/dl. Cesarean delivery was performed in 42.9% of cases. Mean gestational age at delivery was 36.7+/- 3.1 weeks with intrauterine growth restriction (IUGR) complicating 57.1% of cases. In conclusion, IUGR complicates more than half of pregnancies with TI. Transfusions are needed in most cases, even in non-transfusion-dependent patients. Postpartum splenectomy might be necessary in some patients.
Collapse
Affiliation(s)
- Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
INTRODUCTION Epileptic seizures complicating treatment with selective inhibitors of phosphodiesterase type 5 are scarcely reported. CASE REPORT A previously non-epileptic 78-year-old patient presented with a partial epileptic seizure following oral intake, for the second time, of 10mg of vardenafil (Levitra). The brain MRI failed to show any preexisting lesion. To our knowledge, only 2 cases of generalized tonic-clonic seizures induced by sildenafil (Viagra) use have been reported. In our patient, the seizure could be due to the epileptogenic potential of the drug or to its vascular complications. CONCLUSION Further studies are needed to elucidate the association of phosphodiesterase inhibitors use and epileptic seizures.
Collapse
Affiliation(s)
- S Koussa
- Service de Neurologie, Hôpital Hôtel-Dieu de France, Université Saint Joseph, Beyrouth, Liban.
| | | | | | | |
Collapse
|
49
|
Affiliation(s)
- S Koussa
- Service de Neurologie, CHU Hôtel-Dieu de France, Beyrouth-Liban, France.
| | | | | |
Collapse
|
50
|
Inati A, Taher A, Ghorra S, Koussa S, Taha M, Aoun E, Sharara AI. Efficacy and tolerability of peginterferon alpha-2a with or without ribavirin in thalassaemia major patients with chronic hepatitis C virus infection. Br J Haematol 2005; 130:644-6. [PMID: 16098081 DOI: 10.1111/j.1365-2141.2005.05645.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [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: 11/28/2022]
Abstract
Thalassaemia patients with genotype 1 or 4 chronic hepatitis C virus (HCV) infection were randomised to receive peginterferon alpha-2a 180 mg/week ribavirin for 48 weeks. Primary efficacy variable was sustained viral response (SVR) at 72 weeks. Thirty-two patients were evaluated; 20 enrolled. Baseline characteristics were comparable. SVR occurred in four of 12 and five of eight patients in the monotherapy and combination groups (30% and 62.5%; P=0.19), respectively. Undetectable RNA at 12 weeks and age <18 years were associated with improved SVR (P<0.05). Transfusion requirements rose by 34% in the combination arm (P=0.08). Peginterferon/ribavirin was effective in thalassaemics with HCV and moderate iron overload.
Collapse
Affiliation(s)
- Adlette Inati
- Chronic Care Center, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | | | | | | |
Collapse
|