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Kassab J, Hadi El Hajjar A, Wardrop RM, Brateanu A. Accuracy of Online Artificial Intelligence Models in Primary Care Settings. Am J Prev Med 2024; 66:1054-1059. [PMID: 38354991 DOI: 10.1016/j.amepre.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION The importance of preventive medicine and primary care in the sphere of public health is expanding, yet a gap exists in the utilization of recommended medical services. As patients increasingly turn to online resources for supplementary advice, the role of artificial intelligence (AI) in providing accurate and reliable information has emerged. The present study aimed to assess ChatGPT-4's and Google Bard's capacity to deliver accurate recommendations in preventive medicine and primary care. METHODS Fifty-six questions were formulated and presented to ChatGPT-4 in June 2023 and Google Bard in October 2023, and the responses were independently reviewed by two physicians, with each answer being classified as "accurate," "inaccurate," or "accurate with missing information." Disagreements were resolved by a third physician. RESULTS Initial inter-reviewer agreement on grading was substantial (Cohen's Kappa was 0.76, 95%CI [0.61-0.90] for ChatGPT-4 and 0.89, 95%CI [0.79-0.99] for Bard). After reaching a consensus, 28.6% of ChatGPT-4-generated answers were deemed accurate, 28.6% inaccurate, and 42.8% accurate with missing information. In comparison, 53.6% of Bard-generated answers were deemed accurate, 17.8% inaccurate, and 28.6% accurate with missing information. Responses to CDC and immunization-related questions showed notable inaccuracies (80%) in both models. CONCLUSIONS ChatGPT-4 and Bard demonstrated potential in offering accurate information in preventive care. It also brought to light the critical need for regular updates, particularly in the rapidly evolving areas of medicine. A significant proportion of the AI models' responses were deemed "accurate with missing information," emphasizing the importance of viewing AI tools as complementary resources when seeking medical information.
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Affiliation(s)
- Joseph Kassab
- Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Richard M Wardrop
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
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Hariri EH, Badwan O, Kassab J, Layoun H, Skoza W, Burton R, Harb SC, Puri R, Reed GW, Krishnaswamy A, Svensson LG, Kapadia S. Role of aortic valve replacement in moderate aortic stenosis: a 10-year outcomes study. Open Heart 2024; 11:e002616. [PMID: 38769066 PMCID: PMC11110558 DOI: 10.1136/openhrt-2024-002616] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Patients with moderate aortic stenosis (AS) exhibit high morbidity and mortality. Limited evidence exists on the role of aortic valve replacement (AVR) in this patient population. To investigate the benefit of AVR in moderate AS on survival and left ventricular function. METHODS In a retrospective cohort study, patients with moderate AS between 2008 and 2016 were selected from the Cleveland Clinic echocardiography database and followed until 2018. Patients were classified as receiving AVR or managed medically (clinical surveillance). All-cause and cardiovascular mortality were assessed by survival analyses. Temporal haemodynamic and structural changes were assessed with longitudinal analyses using linear mixed effects models. RESULTS We included 1421 patients (mean age, 75.3±5.4 years and 39.9% women) followed over a median duration of 6 years. Patients in the AVR group had lower risk of all-cause (adjusted HR (aHR)=0.51, 95% CI: 0.34 to 0.77; p=0.001) and cardiovascular mortality (aHR=0.50, 95% CI: 0.31 to 0.80; p=0.004) compared with those in the clinical surveillance group irrespective of sex, receipt of other open-heart surgeries and underlying malignancy. These findings were seen only in those with preserved left ventricular ejection fraction (LVEF) ≥50%. Further, patients in the AVR group had a significant trend towards an increase in LVEF and a decrease in right ventricular systolic pressure compared with those in the clinical surveillance group. CONCLUSIONS In patients with moderate AS, AVR was associated with favourable clinical outcomes and left ventricular remodelling.
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Affiliation(s)
- Essa H Hariri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Burton
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Ashok Kumar P, Ghimire K, Haroun E, Kassab J, Saba L, Gentile T, Dutta D, Lim SH. Utilization and outcome disparities in allogeneic hematopoietic stem cell transplant in the United States. Eur J Haematol 2024; 112:328-338. [PMID: 37899652 DOI: 10.1111/ejh.14129] [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: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplant (allo-HSCT) is increasingly being used in the United States (US) and across the world as a curative therapeutic option for patients with certain high-risk hematologic malignancies and non-malignant diseases. However, racial and ethnic disparities in utilization of the procedure and in outcome following transplant remain major problems. Racial and ethnic minority patients are consistently under-represented in the proportion of patients who undergo allo-HSCT in the US. The transplant outcomes in these patients are also inferior. The interrelated driving forces responsible for the differences in the utilization and transplant outcome of the medical intervention are socioeconomic status, complexity of the procedure, geographical barriers, and the results of differences in the genetics and comorbidities across different races. Bridging the disparity gaps is important not only to provide equity and inclusion in the utilization of this potentially life-saving procedure but also in ensuring that minority groups are well represented for research studies about allo-HSCT. This is required to determine interventions that may be more efficacious in particular racial and ethnic groups. Various strategies at the Federal, State, and Program levels have been designed to bridge the disparity gaps with varying successes. In this review paper, we will examine the disparities and discuss the strategies currently available to address the utilization and outcome gaps between patients of different races in the US.
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Affiliation(s)
- Prashanth Ashok Kumar
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Krishna Ghimire
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Elio Haroun
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Joseph Kassab
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ludovic Saba
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Teresa Gentile
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Seah H Lim
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
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Kassab J, Harb SC, Desai MY, Gillinov AM, Layoun H, El Dahdah J, Chedid El Helou M, Nakhla S, Elgharably H, Kapadia SR, Cremer PC, Mentias A. Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery. J Am Heart Assoc 2024; 13:e032760. [PMID: 38293932 PMCID: PMC11056159 DOI: 10.1161/jaha.123.032760] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. METHODS AND RESULTS Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all-cause mortality and readmission with endocarditis or heart failure on follow-up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17-1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02-1.23], P=0.02), preoperative second-degree heart block (RR, 2.20 [95% CI, 1.81-2.69], P<0.0001), right bundle-branch block (RR, 1.21 [95% CI, 1.03-1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06-1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01-1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16-4.75], P<0.0001). After a median follow-up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93-1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14-1.43], P<0.001). CONCLUSIONS PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization.
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Affiliation(s)
- Joseph Kassab
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Serge C. Harb
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Milind Y. Desai
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - A. Marc Gillinov
- Department of Cardiovascular SurgeryHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Habib Layoun
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Joseph El Dahdah
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Michel Chedid El Helou
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Shady Nakhla
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Haytham Elgharably
- Department of Cardiovascular SurgeryHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Samir R. Kapadia
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Paul C. Cremer
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Amgad Mentias
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
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Hariri EH, El Halabi J, Kassis N, Al Hammoud MM, Badwan OZ, Layoun H, Kassab J, Al Shuab W, Bansal A, Farwati M, Harb SC, Popović ZB, Svensson L, Menon V, Kapadia SR. Sex Differences in the Progression and Long-Term Outcomes of Native Mild to Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:1-12. [PMID: 37498256 DOI: 10.1016/j.jcmg.2023.06.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND There are limited data on the sex differences in the hemodynamic progression and outcomes of early-stage aortic stenosis (AS). OBJECTIVES The authors sought to determine sex differences in hemodynamic progression and outcomes of mild to moderate native AS. METHODS This was a retrospective observational cohort study including patients with mild to moderate native tricuspid AS from the Cleveland Clinic echocardiographic database between 2008 and 2016 and followed until 2018. All-cause mortality, aortic valve replacement (AVR), and disease progression assessed by annualized changes in echocardiographic parameters were analyzed based on sex. RESULTS The authors included 2,549 patients (mean age, 74 ± 7 years and 42.5% women) followed over a median duration of 5.7 years. There was no difference in all-cause mortality between sexes irrespective of age, baseline disease severity, progression to severe AS, and receipt of AVR. Relative to men, women had similar all-cause mortality but lower risk of AVR (adjusted HR: 0.81 [95% CI: 0.67-0.91]; P = 0.009) at 10 years. On 1:1 propensity-matched analysis, men had a significantly faster disease progression represented by greater increases in the median of annualized change in mean gradient (2.10 vs 1.15 mm Hg/y, respectively, P < 0.001), maximum transvalvular velocity (0.42 vs 0.28 m/s/y), left ventricular end-diastolic diameters (0.15 vs 0.048 mm/m2.7/y) (P = 0.014). Women have significantly higher left ventricular ejection fraction, filling pressures, and left ventricular septum thickness over time on follow-up echocardiograms compared with men. CONCLUSIONS Women with mild to moderate AS had slower hemodynamic progression of AS, were more likely to have preserved left ventricular ejection fraction and concentric left ventricular hypertrophy in addition to lower incidence of AVR compared with men despite similar mortality. These findings provide further evidence that there are distinct sex-specific longitudinal echocardiographic and clinical profiles in patients with AS.
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Affiliation(s)
- Essa H Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jessica El Halabi
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mazen M Al Hammoud
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Osamah Z Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wael Al Shuab
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Agam Bansal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Medhat Farwati
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lars Svensson
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Chedid El Helou M, Abadie BQ, Kassab J, El Dahdah J, Renapurkar R, Bakaeen F, Collier P. Multimodality Imaging in the Evaluation and Management of a Right Atrial Mass. CASE (Phila) 2024; 8:30-35. [PMID: 38264614 PMCID: PMC10801809 DOI: 10.1016/j.case.2023.09.010] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
•Primary cardiac tumors are mostly cardiac myxomas but rarely present in the RA. •Multimodality imaging can help characterize cardiac masses and guide management. •CMR with a comprehensive protocol provides valuable diagnostic information.
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Affiliation(s)
- Michel Chedid El Helou
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Q. Abadie
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rahul Renapurkar
- Department of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Puri R, Kassab J, Harb SC. Transfemoral Intrepid Transcatheter Mitral Valve Replacement at 1-Year Early Feasibility: Is the Journey Forward More or Less Trepid? JACC Cardiovasc Interv 2023; 16:2880-2883. [PMID: 38092494 DOI: 10.1016/j.jcin.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Puthenpura M, Kassab J, Ghobrial J, Weiss A, Harb SC, Moudgil R. Multimodality Imaging and Multidisciplinary Approach to Post-Myocardial Infarct Ventricular Septal Defect Management. CJC Open 2023; 5:934-937. [PMID: 38204854 PMCID: PMC10774077 DOI: 10.1016/j.cjco.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/09/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Max Puthenpura
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Joseph Kassab
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Joanna Ghobrial
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aaron Weiss
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C. Harb
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rohit Moudgil
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Kassab J, Kapadia V, Massad C, Sarraju A, Ramchand J, Kapadia SR, Harb SC. Comparative Analysis of Chat-Based Artificial Intelligence Models in Addressing Common and Challenging Valvular Heart Disease Clinical Scenarios. J Am Heart Assoc 2023; 12:e031787. [PMID: 37982246 PMCID: PMC10727287 DOI: 10.1161/jaha.123.031787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Joseph Kassab
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Vishwum Kapadia
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Christopher Massad
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Ashish Sarraju
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Jay Ramchand
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Samir R. Kapadia
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
| | - Serge C. Harb
- Heart, Vascular and Thoracic InstituteCleveland Clinic FoundationClevelandOHUSA
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Kerbage A, Kassab J, El Dahdah J, Burke CA, Achkar JP, Rouphael C. Accuracy of ChatGPT in Common Gastrointestinal Diseases: Impact for Patients and Providers. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00946-1. [PMID: 37984563 DOI: 10.1016/j.cgh.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/04/2023] [Revised: 10/22/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
Since its release in 2022, Chat Generative Pre-Trained Transformer (ChatGPT) became the most rapidly expanding consumer software application in history,1 and its role in medicine is underscored by its potential to enhance patient education and physician-patient communication. Previous studies in gastroenterology and hepatology have focused primarily on the earlier Generative Pre-Trained Transformer 3 (GPT-3) model, with none investigating ChatGPT's ability to generate supportive references for its responses, or its applicability as a physician educational tool.2-6 Our study evaluated the accuracy of the more recent ChatGPT, powered by GPT-4, in addressing frequently asked questions by patients on irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), colonoscopy and colorectal cancer (CRC) screening, questions on CRC screening from a physician perspective, and reference generation and suitability.
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Affiliation(s)
- Anthony Kerbage
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Kassab
- Research Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Carol Rouphael
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio.
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Kassab R, Khalil MA, Kassab J, Kourie HR. Immune checkpoint inhibitors in BRAF-mutated advanced colorectal cancer. Future Oncol 2023; 19:2417-2424. [PMID: 37990891 DOI: 10.2217/fon-2022-0978] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Colorectal cancer has been around for a long time, but is still a challenge nonetheless. However, the heterogeneity of the disease opens new potential therapeutic doors. BRAF-mutated advanced colorectal cancer is a demanding entity that does not respond to standard chemotherapy regimens (FOLFOX, capecitabine) and the presence of the mutation significantly weakens the prognosis, but the rise of immunotherapy could reverse the trend. Indeed, pembrolizumab and nivolumab have boasted promising outcomes and increased survival rates among this subset of patients. This article is a collection of these results which could potentially bring immunotherapy to the front line.
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Affiliation(s)
- Rebecca Kassab
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
| | - Michel Abou Khalil
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kassab
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
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Kassab J, Gebrael G, Chedid El Helou M, El Dahdah J, Haroun E, Kassab R, Abou Ali S, Khabbaz Z, Kassab R. Case report: Primary cardiac lymphoma manifesting as superior vena cava syndrome. Front Cardiovasc Med 2023; 10:1257734. [PMID: 37808889 PMCID: PMC10556236 DOI: 10.3389/fcvm.2023.1257734] [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: 07/12/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
A 64-year-old man presented with symptoms indicative of superior vena cava syndrome. Imaging work-up revealed an obstructing right atrial mass, which was subsequently excised and diagnosed as primary cardiac lymphoma. Post-surgery, the patient showed significant clinical improvement and was started on a chemotherapy regimen with complete remission at 1 year.
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Affiliation(s)
- Joseph Kassab
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Georges Gebrael
- Department of Medicine, Saint Joseph University of Beirut, Achrafieh, Beirut, Lebanon
| | - Michel Chedid El Helou
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Joseph El Dahdah
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Elio Haroun
- Cleveland Clinic Foundation, Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Rebecca Kassab
- Department of Medicine, Saint Joseph University of Beirut, Achrafieh, Beirut, Lebanon
| | - Saad Abou Ali
- Department of Cardiovascular Medicine, Sacre Coeur Hospital, Baabda, Beirut, Lebanon
| | - Ziad Khabbaz
- Department of Cardiovascular Medicine, Hotel-Dieu De France, Achrafieh, Beirut, Lebanon
| | - Roland Kassab
- Department of Cardiovascular Medicine, Hotel-Dieu De France, Achrafieh, Beirut, Lebanon
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13
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Dahdah JE, Kassab J, Helou MCE, Gaballa A, Sayles S, Phelan MP. ChatGPT: A Valuable Tool for Emergency Medical Assistance. Ann Emerg Med 2023; 82:411-413. [PMID: 37330721 DOI: 10.1016/j.annemergmed.2023.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Joseph El Dahdah
- Research Institute, Cleveland Clinic Main Campus, Cleveland, OH.
| | - Joseph Kassab
- Research Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | | | - Andrew Gaballa
- Research Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | - Stephen Sayles
- Center for Emergency Medicine-West, Cleveland Clinic Foundation, Brunswick, OH
| | - Michael P Phelan
- Center for Emergency Medicine, Cleveland Clinic Main Campus, Cleveland, OH
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14
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Badwan OZ, Layoun H, Kassab J, El Dahdah J, El Helou MC, Krishnaswamy A, Puri R, Kapadia SR, Miyasaka RL, Harb SC. Venae Cavae Anatomic Characteristics in Severe Tricuspid Regurgitation: Implications for Transcatheter Interventions. Struct Heart 2023; 7:100199. [PMID: 37745684 PMCID: PMC10512007 DOI: 10.1016/j.shj.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/25/2023] [Accepted: 04/13/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Osamah Z. Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michel Chedid El Helou
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rhonda L. Miyasaka
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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15
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Kassab J, Nakhla S, Miyasaka RL, Saliba W, Ghobrial J, Wazni O, Kapadia SR, Kanj M, Harb SC. The Added Value of Preprocedural Cardiac Computed Tomography in Planning Left Atrial Appendage Closure With the Watchman FLX Device. Struct Heart 2023; 7:100188. [PMID: 37745676 PMCID: PMC10513000 DOI: 10.1016/j.shj.2023.100188] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 09/26/2023]
Abstract
•Cardiac computed tomography (CCT) can be used as a useful complementary tool in preprocedural planning of left atrial appendage closure.•CCT planning includes assessing exclusion criteria, device sizing, sheath selection, anticipating challenging anatomies, and transseptal puncture planning.•Procedural 3D intracardiac echocardiography (3D-ICE) is increasingly being used instead of transesophageal echocardiography. In this setting, preprocedural CCT is useful to compensate for 3D ICE's reduced resolution.
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Affiliation(s)
- Joseph Kassab
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shady Nakhla
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rhonda L. Miyasaka
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Walid Saliba
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Joanna Ghobrial
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R. Kapadia
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C. Harb
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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16
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Haroun E, Agrawal K, Leibovitch J, Kassab J, Zoghbi M, Dutta D, Lim SH. Chronic graft-versus-host disease in pediatric patients: Differences and challenges. Blood Rev 2023; 60:101054. [PMID: 36805299 DOI: 10.1016/j.blre.2023.101054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Despite the use of high-resolution molecular techniques for tissue typing, chronic graft-versus-host disease (cGVHD) remains a major complication following allogeneic hematopoietic stem cell transplant. cGVHD adversely affects the life-expectancy and quality of life. The latter is particularly important and functionally relevant in pediatric patients who have a longer life-expectancy than adults. Current laboratory evidence suggests that there is not any difference in the pathophysiology of cGVHD between adults and pediatric patients. However, there are some clinical features and complications of the disease that are different in pediatric patients. There are also challenges in the development of new therapeutics for this group of patients. In this review, we will discuss the epidemiology, pathophysiology, clinical features and consequences of the disease, and highlight the differences between pediatric and adult patients. We will examine the current treatment options for pediatric patients with moderate to severe cGVHD and discuss the challenges facing therapeutic development for cGVHD in the pediatric population.
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Affiliation(s)
- Elio Haroun
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, NY, United States of America
| | - Kavita Agrawal
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, NY, United States of America
| | - Jennifer Leibovitch
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, NY, United States of America
| | - Joseph Kassab
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Marianne Zoghbi
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Dibyendu Dutta
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, NY, United States of America
| | - Seah H Lim
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, NY, United States of America,; Sanofi Oncology, Cambridge, MA, United States of America.
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17
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Kassab J, Nasr L, Gebrael G, Chedid El Helou M, Saba L, Haroun E, Dahdah JE, Nasr F. AI-based online chat and the future of oncology care: a promising technology or a solution in search of a problem? Front Oncol 2023; 13:1176617. [PMID: 37305580 PMCID: PMC10250003 DOI: 10.3389/fonc.2023.1176617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Joseph Kassab
- Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Lewis Nasr
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Georges Gebrael
- Department of Hematology and Oncology, Saint-Joseph University of Beirut, Beirut, Lebanon
| | | | - Ludovic Saba
- Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Elio Haroun
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Joseph El Dahdah
- Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Fadi Nasr
- Department of Hematology and Oncology, Saint-Joseph University of Beirut, Beirut, Lebanon
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18
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Kapadia SR, Kassab J, Harb SC. Severe mitral regurgitation complicating myocardial infarction: Adding fuel to the fire. Kardiol Pol 2023:VM/OJS/J/95592. [PMID: 37191189 DOI: 10.33963/kp.a2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
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19
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Kassab J, El Dahdah J, El Helou MC, Layoun H, Sarraju A, Laffin L, Cho L, Kapadia SR, Collier P, Harb SC. Assessing the Accuracy of an Online Chat-Based Artificial Intelligence Model in Providing Recommendations on Hypertension Management in Accordance With the 2017 American College of Cardiology/American Heart Association and 2018 ESC/European Society of Hypertension Guidelines. Hypertension 2023. [PMID: 37190998 DOI: 10.1161/hypertensionaha.123.21183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Joseph Kassab
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Joseph El Dahdah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Michel Chedid El Helou
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Luke Laffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Leslie Cho
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, OH
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20
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Bou Zerdan M, Kassab J, Saba L, Haroun E, Bou Zerdan M, Allam S, Nasr L, Macaron W, Mammadli M, Abou Moussa S, Chaulagain CP. Liquid biopsies and minimal residual disease in lymphoid malignancies. Front Oncol 2023; 13:1173701. [PMID: 37228488 PMCID: PMC10203459 DOI: 10.3389/fonc.2023.1173701] [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: 02/25/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Minimal residual disease (MRD) assessment using peripheral blood instead of bone marrow aspirate/biopsy specimen or the biopsy of the cancerous infiltrated by lymphoid malignancies is an emerging technique with enormous interest of research and technological innovation at the current time. In some lymphoid malignancies (particularly ALL), Studies have shown that MRD monitoring of the peripheral blood may be an adequate alternative to frequent BM aspirations. However, additional studies investigating the biology of liquid biopsies in ALL and its potential as an MRD marker in larger patient cohorts in treatment protocols are warranted. Despite the promising data, there are still limitations in liquid biopsies in lymphoid malignancies, such as standardization of the sample collection and processing, determination of timing and duration for liquid biopsy analysis, and definition of the biological characteristics and specificity of the techniques evaluated such as flow cytometry, molecular techniques, and next generation sequencies. The use of liquid biopsy for detection of minimal residual disease in T-cell lymphoma is still experimental but it has made significant progress in multiple myeloma for example. Recent attempt to use artificial intelligence may help simplify the algorithm for testing and may help avoid inter-observer variation and operator dependency in these highly technically demanding testing process.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Joseph Kassab
- Cleveland Clinic, Research Institute, Cleveland, OH, United States
| | - Ludovic Saba
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Elio Haroun
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, New York, NY, United States
| | | | - Sabine Allam
- Department of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Lewis Nasr
- University of Texas MD Anderson Cancer Center, Texas, TX, United States
| | - Walid Macaron
- University of Texas MD Anderson Cancer Center, Texas, TX, United States
| | - Mahinbanu Mammadli
- Department of Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | | | - Chakra P. Chaulagain
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, United States
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21
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Boustany A, Kassab J, Ramahi N, Onwuzo S, Acar P, Asaad I. Splenic Subcapsular Hematoma After Endoscopic Retrograde Cholangiopancreatography. ACG Case Rep J 2023; 10:e01052. [PMID: 37235003 PMCID: PMC10208697 DOI: 10.14309/crj.0000000000001052] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/28/2023] Open
Abstract
The complications of endoscopic retrograde cholangiopancreatography (ERCP) are numerous and mainly intraluminal. We present a unique case of a patient who developed splenic hematoma after ERCP. A 41-year-old woman was hospitalized for evaluation of chronic abdominal pain, for which she underwent an ERCP. The next day, the patient developed hemorrhagic shock. She was found to have a large ruptured subcapsular splenic bleed. Splenic artery embolization was performed, and the patient was stabilized. In conclusion, a high index of suspicion should be kept when managing patients presenting with unstable vital signs and/or acute anemia after ERCP.
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Affiliation(s)
- Antoine Boustany
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Joseph Kassab
- Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Noor Ramahi
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Philippe Acar
- Department of Radiology, University of Montreal, Montreal, Quebec, Canada
| | - Imad Asaad
- Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
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22
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Haroun E, Kumar PA, Saba L, Kassab J, Ghimire K, Dutta D, Lim SH. Intestinal barrier functions in hematologic and oncologic diseases. J Transl Med 2023; 21:233. [PMID: 37004099 PMCID: PMC10064590 DOI: 10.1186/s12967-023-04091-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
The intestinal barrier is a complex structure that not only regulates the influx of luminal contents into the systemic circulation but is also involved in immune, microbial, and metabolic homeostasis. Evidence implicating disruption in intestinal barrier functions in the development of many systemic diseases, ranging from non-alcoholic steatohepatitis to autism, or systemic complications of intestinal disorders has increased rapidly in recent years, raising the possibility of the intestinal barrier as a potential target for therapeutic intervention to alter the course and mitigate the complications associated with these diseases. In addition to the disease process being associated with a breach in the intestinal barrier functions, patients with hematologic and oncologic diseases are particularly at high risks for the development of increased intestinal permeability, due to the frequent use of broad-spectrum antibiotics and chemoradiation. They also face a distinct challenge of being intermittently severely neutropenic due to treatment of the underlying conditions. In this review, we will discuss how hematologic and oncologic diseases are associated with disruption in the intestinal barrier and highlight the complications associated with an increase in the intestinal permeability. We will explore methods to modulate the complication. To provide a background for our discussion, we will first examine the structure and appraise the methods of evaluation of the intestinal barrier.
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Affiliation(s)
- Elio Haroun
- Division of Hematology and Oncology, State University of New York Upstate Medical University, SUNY Upstate Medical University, 750 E Adams, Syracuse, NY, 13210, USA
| | - Prashanth Ashok Kumar
- Division of Hematology and Oncology, State University of New York Upstate Medical University, SUNY Upstate Medical University, 750 E Adams, Syracuse, NY, 13210, USA
| | - Ludovic Saba
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Joseph Kassab
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Krishna Ghimire
- Division of Hematology and Oncology, State University of New York Upstate Medical University, SUNY Upstate Medical University, 750 E Adams, Syracuse, NY, 13210, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, State University of New York Upstate Medical University, SUNY Upstate Medical University, 750 E Adams, Syracuse, NY, 13210, USA.
| | - Seah H Lim
- Division of Hematology and Oncology, State University of New York Upstate Medical University, SUNY Upstate Medical University, 750 E Adams, Syracuse, NY, 13210, USA.
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23
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Kassab J, Layoun H, El Helou MC, Dahdah JE, Kassab RY. MANAGEMENT OF A SEVERELY SYMPTOMATIC PRIMARY CARDIAC LYMPHOMA: A CASE REPORT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03794-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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24
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Layoun H, Kassab J, Harb SC. Quantitative echocardiographic assessment of secondary mitral regurgitation: need for solutions. Eur Heart J Cardiovasc Imaging 2023; 24:e49. [PMID: 36638253 DOI: 10.1093/ehjci/jeac271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Habib Layoun
- Department of Cardiovascular Imaging, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Joseph Kassab
- Department of Cardiovascular Imaging, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Serge C Harb
- Department of Cardiovascular Imaging, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
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25
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Layoun H, Mentias A, Kanaan C, Badwan O, Matta M, Kassab J, Gillinov MA, Hodges K, Griffin BP, Kapadia SR, Harb SC. Differences in patterns of progression of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 24:223-231. [PMID: 36256596 DOI: 10.1093/ehjci/jeac200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS Little data exist about the natural history and disease progression of secondary mitral regurgitation (SMR). We sought to study the temporal progression of left-sided volumes and functions in patients who progress to develop severe SMR. METHODS AND RESULTS We screened patients with chronic severe SMR who had at least one previous transthoracic echocardiography showing non-severe MR. Unsupervised phenotypic clustering based on baseline and rate of change in left ventricular (LV) and left atrial (LA) volumes, ejection fraction (EF), and MR severity progression identified two different phenotypes. We then compared them in terms of clinical characteristics, mechanistic and anatomical features, management, and outcomes. A total of 257 patients were included. Cluster 1 started with lower EF and LA strain and higher LV and LA volumes compared with Cluster 2, with a slower progression into severe SMR. At the onset of severe MR, Cluster 2 still had higher EF, lower LV volumes, but similar LA volumes and strain, and less proportionate SMR, compared with Cluster 1. They also had higher tenting height and more compensatory leaflet growth. On follow-up, Cluster 1 had more ventricular-directed therapies, whereas Cluster 2 received more mitral valve interventions. While the heart failure burden was higher in Cluster 1, there was no difference in mortality rates. CONCLUSION Based on disease progression, two distinct progression patterns of SMR exist, having different anatomical and mechanistic features with variation in management and outcomes.
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Affiliation(s)
- Habib Layoun
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Amgad Mentias
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Christopher Kanaan
- Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Osamah Badwan
- Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Milad Matta
- Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Joseph Kassab
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Marc A Gillinov
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Kevin Hodges
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Brian P Griffin
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Samir R Kapadia
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Serge C Harb
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
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26
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Kassab J, Saba L, Gebrael G, Kais S, Kassab R, Kourie HR. Update on immunotherapy in the management of gallbladder cancer. Immunotherapy 2023; 15:35-42. [PMID: 36617963 DOI: 10.2217/imt-2022-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Gallbladder cancer (GBC) is a relatively infrequent but highly lethal cancer with a poor prognosis. Management remains challenging and controversial, and most patients are diagnosed at an advanced stage. However, with the progressive advances in the use of immunotherapies, new treatment modalities are being implemented. In September 2022, the US FDA approved durvalumab (a PD-L1 inhibitor) in combination with chemotherapy for adult patients with locally advanced or metastatic GBC. This groundbreaking news is the first FDA approval for the use of immunotherapy in biliary tract cancers. This article reviews the newest advances and trials regarding immunotherapy for GBC.
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Affiliation(s)
- Joseph Kassab
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 1104 2020, Lebanon
| | - Ludovic Saba
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 1104 2020, Lebanon
| | - Georges Gebrael
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 1104 2020, Lebanon
| | - Sami Kais
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 1104 2020, Lebanon
| | - Rebecca Kassab
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 1104 2020, Lebanon
| | - Hampig R Kourie
- Department of Hematology & Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 1104 2020, Lebanon
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27
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Agrawal A, Arockiam AD, Jamil Y, El Dahdah J, Honnekeri B, Chedid El Helou M, Kassab J, Wang TKM. Contemporary risk models for infective endocarditis surgery: a narrative review. Ther Adv Cardiovasc Dis 2023; 17:17539447231193291. [PMID: 37646184 PMCID: PMC10469256 DOI: 10.1177/17539447231193291] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Infective endocarditis is a complex heterogeneous condition involving the infection of the endocardium and heart valves, leading to severe complications, including death. Surgery is often indicated in patients with infective endocarditis but is associated with elevated risk compared with other forms of cardiac surgery. Risk models play an important role in many cardiac surgeries as they can help inform clinicians and patients regarding procedural risk, decision-making to proceed or not, and influence perioperative management; however, they remain under-utilized in the infective endocarditis settings. Another crucial role of such risk models is to assess predicted versus found mortality, thereby allowing an assessment of institutional performance in infective endocarditis surgery. Traditionally, general cardiac surgery risk models such as European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and Society of Thoracic Surgeon's score have been applied to endocarditis surgery. However, there has been the development of many endocarditis surgery-specific scores over the last decade. This review aims to discuss clinical characteristics and applications of all contemporary risk scores in the setting of surgical treatment of infective endocarditis.
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Affiliation(s)
- Ankit Agrawal
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasser Jamil
- Yale-Waterbury, Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bianca Honnekeri
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michel Chedid El Helou
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH 44195, USA
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Hariri E, Layoun H, Hansen J, Abou Hassan O, Kassab J, Kassis N, Cremer PC, Hanna M, Mentias A, Flamm SD, Daou R, Griffin B, Elgharably H, Unai S, Pettersson G, Kapadia S, Harb SC. Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery. Open Heart 2022; 9:openhrt-2022-002124. [PMID: 36522126 PMCID: PMC9756202 DOI: 10.1136/openhrt-2022-002124] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Isolated tricuspid valve surgery (TVS) may be associated with high morbidity and mortality. The aim of this study was to investigate the association of preoperative imaging and haemodynamic data derived from echocardiography (ECHO), cardiac magnetic resonance (CMR) and right heart catheterisation (RHC) with postoperative outcomes following TVS. METHODS In a retrospective cohort study, patients who underwent isolated TVS at our institution between 2012 and 2020 were screened and followed up to 1 year. We only included those who had all three tests before surgery: ECHO, CMR and RHC. Patients with congenital heart disease, infective endocarditis and those who underwent concomitant valve or pericardial surgery were excluded. The primary outcome was a composite of mortality and congestive heart failure at 1 year. Time-to-event analyses at 1 year and Cox proportional hazards regression analyses were performed. RESULTS A total of 60 patients were included (mean age of 60±14 years, 63% women), of whom 67% underwent TV repair. The primary outcome occurred in 16 patients (27%) with a 1-year mortality of 7%. It was associated with ECHO-derived right ventricular (RV) free wall strain and RHC-derived RV systolic and diastolic as well as mean pulmonary pressures. On multivariable Cox regression analysis, only RV systolic and diastolic pressures were significantly associated with the primary outcome at 1 year (HRs=5.9 and 3.4, respectively, p<0.05). CONCLUSION Baseline invasive haemodynamic assessment could have a strong association with clinical outcomes and help risk-stratify patients undergoing isolated TVS.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Habib Layoun
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan Hansen
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ossama Abou Hassan
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph Kassab
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mazen Hanna
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amgad Mentias
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott D Flamm
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Remy Daou
- Family Medicine Department, Hotel-Dieu De France, Achrafieh, Lebanon
| | - Brian Griffin
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Haytham Elgharably
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gosta Pettersson
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C Harb
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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29
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Bou Zerdan M, Kassab J, Meouchy P, Haroun E, Nehme R, Bou Zerdan M, Fahed G, Petrosino M, Dutta D, Graziano S. The Lung Microbiota and Lung Cancer: A Growing Relationship. Cancers (Basel) 2022; 14:cancers14194813. [PMID: 36230736 PMCID: PMC9563611 DOI: 10.3390/cancers14194813] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In the past few years, the microbiota has emerged as a major player in cancer management. The efficacy of chemotherapy or immunotherapy may be influenced by the concomitant use of antibiotics before, during, or shortly after treatment with immune checkpoint inhibitors. Despite this, the mechanism linking the microbiota, host immunity, and malignancies are not clear, and the role of microbiota manipulation and analyses in cancer management is underway. In this manuscript, we discuss the role of the microbiota in the initiation, progression, and treatment outcomes of lung cancer. Abstract The lung is home to a dynamic microbial population crucial to modulating immune balance. Interest in the role of the lung microbiota in disease pathogenesis and treatment has exponentially increased. In lung cancer, early studies suggested an important role of dysbiosis in tumor initiation and progression. These results have helped accelerate research into the lung microbiota as a potential diagnostic marker and therapeutic target. Microbiota signatures could represent diagnostic biomarkers of early-stage disease. Lung microbiota research is in its infancy with a limited number of studies and only single-center studies with a significant methodological variation. Large, multicenter longitudinal studies are needed to establish the clinical potential of this exciting field.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
- Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, FL 33326, USA
| | - Joseph Kassab
- Faculty of Medicine, Saint-Joseph University, Beirut 11072180, Lebanon
| | - Paul Meouchy
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut 11072020, Lebanon
| | - Elio Haroun
- Department of Medicine, Division of Hematology and Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Rami Nehme
- Department of Medicine, University of Pavia, 27100 Pavia, Italy
| | - Morgan Bou Zerdan
- Faculty of Medicine, American University of Beirut, Beirut 11072020, Lebanon
| | - Gracia Fahed
- Faculty of Medicine, American University of Beirut, Beirut 11072020, Lebanon
| | - Michael Petrosino
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Dibyendu Dutta
- Department of Medicine, Division of Hematology and Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
- Correspondence: (D.D.); (S.G.)
| | - Stephen Graziano
- Department of Medicine, Division of Hematology and Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
- Correspondence: (D.D.); (S.G.)
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Abstract
Esophageal cancer (EC) is relatively frequent and highly lethal cancer, being the sixth most common cause of cancer death worldwide. The progressive approvals of immunotherapy as first-line and second-line treatment options have paved the way for an evolving new approach to the treatment of this disease. Management of EC is challenging and requires a multimodality approach. Treatment options include surgery, chemoradiotherapy (CRT) and, recently, immunotherapy. The newest guidelines and FDA approvals regarding immunotherapy for EC are reviewed here.
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Affiliation(s)
- Joseph Kassab
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
| | - Ludovic Saba
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
| | - Rebecca Kassab
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
| | - Hampig R Kourie
- Department of Hematology & Oncology, Saint Joseph University, Beirut, Lebanon
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31
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Zerdan MB, Nasr L, Kassab J, Saba L, Ghossein M, Yaghi M, Dominguez B, Chaulagain CP. Adhesion molecules in multiple myeloma oncogenesis and targeted therapy. Int J Hematol Oncol 2022; 11:IJH39. [PMID: 35663420 PMCID: PMC9136637 DOI: 10.2217/ijh-2021-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/16/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
Every day we march closer to finding the cure for multiple myeloma. The myeloma cells inflict their damage through specialized cellular meshwork and cytokines system. Implicit in these interactions are cellular adhesion molecules and their regulators which include but are not limited to integrins and syndecan-1/CD138, immunoglobulin superfamily cell adhesion molecules, such as CD44, cadherins such as N-cadherin, and selectins, such as E-selectin. Several adhesion molecules are respectively involved in myelomagenesis such as in the transition from the precursor disorder monoclonal gammopathy of undetermined significance to indolent asymptomatic multiple myeloma (smoldering myeloma) then to active multiple myeloma or primary plasma cell leukemia, and in the pathological manifestations of multiple myeloma.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Hematology-Oncology, Myeloma & Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Lewis Nasr
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Joseph Kassab
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Ludovic Saba
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Myriam Ghossein
- Department of Medicine & Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Marita Yaghi
- Department of Hematology-Oncology, Myeloma & Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Barbara Dominguez
- Department of Hematology-Oncology, Myeloma & Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Chakra P Chaulagain
- Department of Hematology-Oncology, Myeloma & Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL 33331, USA
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32
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Gimbel HV, Sun R, Furlong MT, van Westenbrugge JA, Kassab J. Accuracy and predictability of intraocular lens power calculation after photorefractive keratectomy. J Cataract Refract Surg 2000; 26:1147-51. [PMID: 11008040 DOI: 10.1016/s0886-3350(00)00480-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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: 11/20/2022]
Abstract
PURPOSE To investigate the accuracy and predictability of intraocular lens (IOL) power calculation in postoperative photorefractive keratectomy (PRK) eyes. SETTING Gimbel Eye Centre, Calgary, Alberta, Canada. METHODS The results in 5 cataract surgery eyes that had had PRK were analyzed retrospectively. Target refractions based on actual and refraction-derived keratometric values were compared with postoperative achieved refractions. The target refractions calculated using 5 IOL formulas and 2 A-constants were also compared with the achieved refractions. RESULTS In postoperative PRK eyes, the power calculation was more accurate and predictable when the smaller of either the actual or refraction-derived keratometric value was used to calculate the IOL power. The difference between target and achieved refractions appeared smaller when the Binkhorst formula was used. No significant hyperopic shift was observed after cataract surgery. CONCLUSION The smaller of the actual or the refraction-derived keratometric value is recommended for calculating IOL power in post-PRK eyes.
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Affiliation(s)
- H V Gimbel
- Gimbel Eye Centre, Calgary, Alberta, Canada.
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33
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Khanna PB, Bhowmick BK, Kassab J. Coagulation Factors in Acute Stroke and Transient Ischaemic Attacks. Age Ageing 1995. [DOI: 10.1093/ageing/24.suppl_2.p15-a] [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: 11/13/2022] Open
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Abstract
Endothelin is a recently described, potent renal vascular and systemic vasoconstrictor peptide. To evaluate the response of this peptide to volume contraction, we measured eight baseline and posthemodialysis samples from seven children, aged 14.5 +/- 3 years, with chronic renal failure. Plasma was extracted and endothelin-1 was measured by radioimmunoassay. Dialysis was performed for a 3- to 3 1/2-hour period, and body weight decreased from 38.0 +/- 14.3 to 36.2 +/- 13.8 kg (p < 0.01) during this time. There were no significant changes in heart rate or respiratory rate after dialysis, but blood pressure fell from 127/80 +/- 22/16 to 114/72 +/- 20/21 mm Hg (p = 0.05 for the systolic pressure). Plasma endothelin-1 concentration increased from 1.5 +/- 1.2 pg/ml at baseline to 7.3 +/- 8.9 pg/ml (p = 0.06) after dialysis; the fall in body weight from dialysis correlated with the increase in endothelin (r = -0.75; p = 0.05). Thus volume contraction from hemodialysis is associated with a rise in plasma endothelin-1, which is related to the acute change in body weight.
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Affiliation(s)
- R D Ross
- Division of Cardiology, Children's Hospital of Michigan, Detroit 48201
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Abstract
Endothelin-1 (ET), a potent vasoconstrictor peptide, has been found to be elevated in children with pulmonary hypertension associated with congenital heart defects. To evaluate the effect of pulmonary blood flow on ET concentrations, 5 ml blood samples were obtained peripherally at cardiac catheterization from 35 patients, ages 0.13 to 17 years (median 2). Plasma was extracted and ET measured by radioimmunoassay. Patients were classified into 2 groups based on the presence (group A) or absence (group B) of increased pulmonary blood flow defined as a Qp/Qs > or = 1.5. When the 13 patients (37%) in group A were compared with the 22 patients (63%) in group B there were no significant differences in age, cardiac index, or pulmonary and systemic resistances. ET concentrations were significantly higher in group A patients (median 3.25, range 0 to 16.5 vs median 0, range 0 to 6.35 pg/ml; p < or = 0.05). Pulmonary blood flow and pulmonary artery pressure were also higher in group A patients (p < or = 0.01). When patients within group A were subdivided into those with and without pulmonary hypertension, no difference was present in their ET concentrations (mean/SD: 4.4/4.3 vs 4.0/6.4 pg/ml, p = NS). Thus, ET is elevated in patients with congenital heart disease associated with left-to-right shunts and it appears that this increase is related to increased pulmonary blood flow independent of pulmonary artery pressure.
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Affiliation(s)
- J A Vincent
- Division of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201
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36
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Last T, Self N, Kassab J, Rajan A. Extended role of the nurse in ICU. Br J Nurs 1992; 1:672-5. [PMID: 1467644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A popular definition of a nurse's extended role is a procedure that is not covered in basic training and for which further training is needed (Rowden, 1987). Nurses' past need for certification and the concept that certain procedures are part of an extended role negates nurses' professionalism. Many nurses fear that the UKCC's abolishment of certification for extended role procedures will open the floodgates for unsafe practice and strip the profession of its protection. This survey analysed what procedures intensive care nurses were performing, how responsibility was related to status, whether certain procedures were classified as extending their role and how staff related these procedures to patient care, staffing levels and professionalism.
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Kassab J, Morgan G, Williams E, Davies C. Smoking prevalence and attitudes of Gwynedd Health Authority staff towards passive smoking and the Authority's non-smoking policy. Health Trends 1991; 24:8-13. [PMID: 10122496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In 1989, a postal survey was undertaken to investigate the smoking prevalence and attitudes of Gwynedd Health Authority employees towards the Authority's non-smoking policy, passive smoking and other related issues. The results show a smoking prevalence rate of 22% for those participating in the survey, with over half of all smokers expressing a wish to stop. Although the rate was similar for males and females, it was marginally higher amongst nursing staff and young employees. Smoking prevalence was highest among the ancillary staff, and lowest among the medical and dental professions. Most employees were in broad agreement with the Authority's non-smoking policy, and a majority thought it about right or favoured extending it. Most non-smokers and ex-smokers believed passive smoking to be a health hazard, with an increased number rating it anti-social. Attitudes towards these issues were similar for males and females, with marked differences between the groups employed in different areas of the service. Younger employees were more aware of the dangers of passive smoking, but less sympathetic towards the policy than the older ones. The findings of this study highlight the differences between smokers and non-smokers on all smoking issues. The implications for health education and the Authority's non-smoking policies are discussed.
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Affiliation(s)
- J Kassab
- Centre for Applied Statistics, University of Wales, Bangor
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38
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Weinstock JV, Kassab J. Chemotactic response of splenic mononuclear cells to angiotensin II in murine schistosomiasis. J Immunol 1986; 137:2020-4. [PMID: 3091696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Murine Schistosomiasis mansoni is a parasitic infection associated with a delayed-type hypersensitivity granulomatous reaction to the schistosome eggs. This reaction is characterized by the accumulation of mononuclear cells and other inflammatory cell types around the eggs. Granuloma macrophages produce angiotensin II (AII), which appears to have immunoregulatory function. By using an in vitro chemotaxis assay, this study demonstrated that AII is a chemotactic factor for splenic mononuclear cells derived from infected mice. The response was bimodal, with peak activities occurring at 10(-10) and 10(-6) M. AII was chemotactic for T lymphocytes, B lymphocytes, and a large population of unidentified mononuclear cells at the optimal chemotactic concentrations of the peptide. At high concentrations, AII was also chemotactic for phagocytic mononuclear cells. Sar1, ala8-AII, an analog of AII with antagonist activity, completely blocked AII-induced chemotaxis. A [3H]-AII binding assay revealed high-affinity specific binding on spleen cells. The binding was rapid, was dependent on radioligand concentration, and was reversible. These latter observations suggest that the chemotactic activity of AII for subpopulations of splenic mononuclear cells is mediated via AII receptors.
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39
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Weinstock JV, Kassab J. Chemotactic response of splenic mononuclear cells to angiotensin II in murine schistosomiasis. The Journal of Immunology 1986. [DOI: 10.4049/jimmunol.137.6.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Murine Schistosomiasis mansoni is a parasitic infection associated with a delayed-type hypersensitivity granulomatous reaction to the schistosome eggs. This reaction is characterized by the accumulation of mononuclear cells and other inflammatory cell types around the eggs. Granuloma macrophages produce angiotensin II (AII), which appears to have immunoregulatory function. By using an in vitro chemotaxis assay, this study demonstrated that AII is a chemotactic factor for splenic mononuclear cells derived from infected mice. The response was bimodal, with peak activities occurring at 10(-10) and 10(-6) M. AII was chemotactic for T lymphocytes, B lymphocytes, and a large population of unidentified mononuclear cells at the optimal chemotactic concentrations of the peptide. At high concentrations, AII was also chemotactic for phagocytic mononuclear cells. Sar1, ala8-AII, an analog of AII with antagonist activity, completely blocked AII-induced chemotaxis. A [3H]-AII binding assay revealed high-affinity specific binding on spleen cells. The binding was rapid, was dependent on radioligand concentration, and was reversible. These latter observations suggest that the chemotactic activity of AII for subpopulations of splenic mononuclear cells is mediated via AII receptors.
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