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Anouti A, Al Hariri M, VanWagner LB, Lee WM, Mufti A, Pedersen M, Shah J, Hanish S, Vagefi PA, Cotter TG, Patel MS. Early Graft Failure After Living-Donor Liver Transplant. Dig Dis Sci 2024; 69:1488-1495. [PMID: 38381224 DOI: 10.1007/s10620-024-08280-5] [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: 08/29/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Living-donor liver transplantation (LDLT) has been increasing in the USA. While data exist on longer-term patient and graft outcomes, a contemporary analysis of short-term outcomes is needed. AIM Evaluate short-term (30-day) graft failure rates and identify predictors associated with these outcomes. METHODS Adult (≥ 18) LDLT recipients from 01/2004 to 12/2021 were analyzed from the United States Scientific Registry of Transplant Recipients. Graft status at 30 days was assessed with graft failure defined as retransplantation or death. Comparison of continuous and categorical variables was performed and a multivariable logistic regression was used to identify risk factors of early graft failure. RESULTS During the study period, 4544 LDLTs were performed with a graft failure rate of 3.4% (155) at 30 days. Grafts from male donors (aOR: 0.63, CI 0.44-0.89), right lobe grafts (aOR: 0.40, CI 0.27-0.61), recipients aged > 60 years (aOR: 0.52, CI 0.32-0.86), and higher recipient albumin (aOR: 0.73, CI 0.57-0.93) were associated with superior early graft outcomes, whereas Asian recipient race (vs. White; aOR: 3.75, CI 1.98-7.10) and a history of recipient PVT (aOR: 2.7, CI 1.52-4.78) were associated with inferior outcomes. LDLTs performed during the most recent 2016-2021 period (compared to 2004-2009 and 2010-2015) resulted in significantly superior outcomes (aOR: 0.45, p < 0.001). CONCLUSION Our study demonstrates that while short-term adult LDLT graft failure is uncommon, there are opportunities for optimizing outcomes by prioritizing right lobe donation, improving candidate nutritional status, and careful pre-transplant risk assessment of candidates with known PVT. Notably, a period effect exists whereby increased LDLT experience in the most recent era correlated with improved outcomes.
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Affiliation(s)
- Ahmad Anouti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - William M Lee
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Arjmand Mufti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mark Pedersen
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jigesh Shah
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Steven Hanish
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Parsia A Vagefi
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar S Patel
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA.
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Zahran TE, Al Hassan S, Al Karaki V, Hammoud L, Helou CE, Khalifeh M, Al Hariri M, Tamim H, Majzoub IE. Outcomes of critically ill COVID-19 patients boarding in the emergency department of a tertiary care center in a developing country: a retrospective cohort study. Int J Emerg Med 2023; 16:73. [PMID: 37833683 PMCID: PMC10576402 DOI: 10.1186/s12245-023-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Boarding of critically ill patients in the emergency department (ED) has long been known to compromise patient care and affect outcomes. During the COVID-19 pandemic, multiple hospitals worldwide experienced overcrowded emergency rooms. Large influx of patients outnumbered hospital beds and required prolonged length of stay (LOS) in the ED. Our aim was to assess the ED LOS effect on mortality and morbidity, in addition to the predictors of in-hospital mortality, intubation, and complications of critically ill COVID-19 ED boarder patients. METHODS This was a retrospective cohort study, investigating 145 COVID-19-positive adult patients who were critically ill, required intensive care unit (ICU), and boarded in the ED of a tertiary care center in Lebanon. Data on patients who boarded in the emergency from January 1, 2020, till January 31, 2021, was gathered and studied. RESULTS Overall, 66% of patients died, 60% required intubation, and 88% developed complications. Multiple risk factors were associated with mortality naming age above 65 years, vasopressor use, severe COVID pneumonia findings on CT chest, chemotherapy treatment in the previous year, cardiovascular diseases, chronic kidney diseases, prolonged ED LOS, and low SaO2 < 95% on triage. In addition, our study showed that staying long hours in the ED increased the risk of developing complications. CONCLUSION To conclude, all efforts need to be drawn to re-establish mitigation strategies and models of critical care delivery in the ED to alleviate the burden of critical boarders during pandemics, thus decreasing morbidity and mortality rates. Lessons from this pandemic should raise concern for complications seen in ED ICU boarders and allow the promotion of health measures optimizing resource allocation in future pandemic crises.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Sally Al Hassan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Victoria Al Karaki
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Hammoud
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle El Helou
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Khalifeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- QU Health, Qatar University, Doha, Qatar
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El Zahran T, Al Hassan S, Khalifeh M, Aboukhater D, Hammoud L, Al Hariri M, Kazzi Z. Melitracen and flupentixol (deanxit) use disorder in Lebanon. Heliyon 2023; 9:e15847. [PMID: 37215807 PMCID: PMC10195893 DOI: 10.1016/j.heliyon.2023.e15847] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit use disorder, assess the source of the medication, and the consumers' awareness of the therapeutic and side effects of Deanxit, among the Lebanese population. Methods This is a cross-sectional study that included all patients taking Deanxit and visited the Emergency Department between October 2019 and October 2020. All patients who agreed to participate in the research through written consent forms were contacted by telephone and a questionnaire was filled out. Results A total of 125 patients taking Deanxit were included in the study. According to the DSM-V criteria, 36% (n = 45) had a Deanxit use disorder. Most of the participants were females (n = 99, 79.2%), married (n = 90, 72%), and between the ages of 40-65 years (n = 71, 56.8%). Most patients (n = 41, 91%) had Deanxit prescribed by a physician for anxiety (n = 28, 62%), and obtained it using a prescription (n = 41, 91%). Almost half of all patients (n = 60, 48%) did not have sufficient knowledge of the reason it was prescribed, 54.4% (n = 68) were not sure they are taking the medication appropriately, and 19.2% (n = 23) were satisfied by the overall explanation of the physicians concerning Deanxit use. Conclusion Deanxit use disorder is underrecognized among Lebanese patients. Most of our patients were prescribed Deanxit by their physicians but reported inadequate knowledge of its side effects and risk of abuse.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Al Hassan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Khalifeh
- Stony Brook Cancer Center, Stony Brook University, NY, USA
| | - Diana Aboukhater
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Hammoud
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
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Rizk J, Al Hariri M, Khalifeh M, Mghames A, Hitti E. Predictors for hospital admission in emergency department patients with benign paroxysmal positional vertigo: A retrospective review. PLoS One 2023; 18:e0280903. [PMID: 36693076 PMCID: PMC9873188 DOI: 10.1371/journal.pone.0280903] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE This study aims to assess the incidence of Emergency Department (ED) visits for benign paroxysmal positional vertigo (BPPV), describe patient characteristics, management practices and predictors of inpatient admission of BPPV patients. METHODS This was a retrospective chart review of patients presenting with BPPV to a single ED between November 2018 and August 2020. Patients' characteristics, ED management, discharge medications, disposition and unscheduled return visits were determined. RESULTS In total, 557 patients were included. Average age was 49 years, 54.2% were females and 12.4% required hospital admission. In the ED, 51.1% received intravenous hydration, 33.8% received anti-emetics, 10.1% received benzodiazepines, 31.8% underwent canalith repositioning maneuvers (CRMs) and 56.7% were discharged on acetyl-leucine. Of discharged patients, 2.5% had unscheduled return visits. A higher likelihood of admission was associated with age above 54 years (aOR = 4.86, p<0.001, 95% CI [2.67, 8.86]), home use of proton pump inhibitors (PPIs) (aOR = 2.44, p = 0.03, 95% CI [1.08, 5.53]), use of anti-emetics and benzodiazepines in the ED (aOR = 2.34, p = 0.003, 95% CI [1.34, 4.07]) and (aOR = 2.18, p = 0.04, 95% CI [1.03, 4.64]), respectively. CONCLUSION While BPPV is a benign diagnosis, a significant number of patients presenting to the ED require admission. Predictors of admission include older age, PPIs use and ED treatment with anti-emetics and benzodiazepines. Although CRMs are the gold standard for management, CRMs usage did not emerge as protective from admission, and our overall usage was low.
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Affiliation(s)
- Jennifer Rizk
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Vice President for Medical and Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Malak Khalifeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdo Mghames
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- * E-mail:
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Al Hariri M, Zgheib H, Abi Chebl K, Azar M, Hitti E, Bizri M, Rizk J, Kobeissy F, Mufarrij A. Assessing the psychological impact of Beirut Port blast: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31117. [PMID: 36253992 PMCID: PMC9575829 DOI: 10.1097/md.0000000000031117] [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] [Indexed: 12/02/2022] Open
Abstract
Beirut Port blast's magnitude is considered the third after Hiroshima and Nagasaki atomic bombings. This blast occurred in the densely populated section of Beirut, leaving more than six thousand injured patients. The psychological disturbances were assessed in the blast survivors who presented to the Emergency Department (ED) at the American University of Beirut Medical Center (AUBMC). This was a cross-sectional study at the ED of AUBMC. Identified patients were contacted and consented to participate in the study. Post-Traumatic Stress Disorder (PTSD) was selected as an outcome. Depression, PTSD, and concussion were assessed using patient health questionnaire (PHQ)-9, PTSD checklist for DSM-5 (PCL5), and brain injury symptoms (BISx) tools, respectively. The association of patients and injury characteristics with the study outcome was assessed using logistic regression. 145 participants completed the study procedures. The participants' average age was 39.8 ± 15.4 years, and 60% were males. Almost half of the participants showed depression on PHQ, and 2-thirds had PTSD. The participant's age was negatively associated with PTSD, whereas being a female, having depression, and having a concussion were positively associated with PTSD. The results of this study were in line with the previous literature report except for the association between younger age and PTSD, which warrants further investigations to delineate the reasons.
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Affiliation(s)
- Moustafa Al Hariri
- Vice President for Medical and Health Science Office, QU Health, Qatar University, Doha, Qatar
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hady Zgheib
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karen Abi Chebl
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maria Azar
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Bizri
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jennifer Rizk
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Afif Mufarrij
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Afif Mufarrij, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236/ Riad El-Solh/ Beirut 1107 2020, Lebanon (e-mail: )
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El Zahran T, Mostafa H, Hamade H, Al Hariri M, Saab A, Tamim H, Tohme R, Al Hamod DA, Sinno D, Sawaya RD, Kazzi Z. Lead screening in children presenting to three hospitals in Lebanon. Arch Dis Child 2022; 107:251-256. [PMID: 34429329 DOI: 10.1136/archdischild-2021-322012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lead damages most body organs and its effects are most profound in children. In a study in Beirut in 2003, before banning the leaded gasoline, 79% of the participants showed blood lead levels (BLLs) higher than 5 µg/dL. The prevalence of lead exposure in Lebanon after the ban on leaded gasoline has not been studied. This study assessed the BLL in Lebanese children aged 1-6 years. METHODS This cross-sectional study was conducted in three hospitals in Beirut. The children's BLLs were tested, and their caregiver completed a questionnaire to identify subgroups at risk of exposure. Participants were provided with a WHO brochure highlighting the risks of lead. RESULTS Ninety children with a mean age of 3.5±1.5 years were enrolled in the study and had a mean BLL of 1.1±0.7 µg/dL, with all values being below 5.0 µg/dL, showing a marked decrease in BLL compared with the mean BLL before the ban on leaded gasoline in 2002. Having a father or a mother with a college degree (p=0.01 and p=0.035, respectively) and having a monthly household income greater than $1000 (p=0.021) were associated with significantly lower BLL. Having more rooms at home and residing close to construction sites were associated with a significantly lower BLL (p=0.001 and p=0.026, respectively). Residing in a house aged >40 years and receiving traditional remedies were associated with a significantly higher BLL (p=0.009 and p<0.0001, respectively). CONCLUSION BLLs have declined among Lebanese children and this could be attributed to multiple factors including the ban of leaded gasoline. It would be beneficial to conduct a larger study with a nationally representative sample to better characterise the BLL.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Mostafa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Hamade
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aed Saab
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rasha Tohme
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Dany A Al Hamod
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Durriyah Sinno
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rasha Dorothy Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Al Hariri M, Hamade B, Bizri M, Salman O, Tamim H, Al Jalbout N. Psychological impact of COVID-19 on emergency department healthcare workers in a tertiary care center during a national economic crisis. Am J Emerg Med 2021; 51:342-347. [PMID: 34808456 PMCID: PMC8571126 DOI: 10.1016/j.ajem.2021.10.055] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/07/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022] Open
Abstract
Background Since the declaration of the novel Corona Virus Disease (COVID-19) as a global pandemic by the World Health Organization, frontline healthcare workers (HCWs) and staff in the Emergency Departments (ED) started experiencing feelings of anxiety and fear from the projected exponential spread and the potential burden on the healthcare system and infrastructure. In Lebanon, major local factors contributing to this fear were the rapid escalation of COVID-19 cases across the country, the lack of preparedness, and the shortage of personal protective equipment, in addition to the evolving economic crisis and financial restrictions. This study aims to investigate the immediate psychological impact of the COVID-19 outbreak on ED staff working in a hospital environment in relation to their household income. Methods Self-reported cross-sectional survey was delivered to the frontline staff working at the Department of Emergency Medicine of AUBMC in Beirut, Lebanon. General demographic characteristics, scores of Generalized Anxiety Disorder 7 (GAD-7), scores of Patient Health Questionnaire 9 (PHQ-9), and scores of Burnout Measure-Short (BMS) version were collected. Results 74 HCWs (49.6%) participated in the study. The mean age for participants was (31.78 ± 9.49). More than half of the participants were nurses and more than 70% reported a monthly salary of less than 2000 USD. The household income was negatively associated with the participants' scores on the GAD-7 and PHQ-9, but not the BMS. Previous mental health diagnosis was positively associated with the PHQ-9 and BMS scores, while seeking mental health care was negatively associated with the PHQ-9 and BMS scores. Conclusion At our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.
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Affiliation(s)
- Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Bachar Hamade
- Emergency Services Institute, Department of Intensive Care and Resuscitation, Cleveland Clinic Foundation, Cleveland, OH, United States of America.
| | - Maya Bizri
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Oday Salman
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Nour Al Jalbout
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
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Sawaya RD, Wakil C, Shayya S, Al Hariri M, Dakessian A, Wazir A, Makki M, Jamali S, Tamim H. Pediatric emergency department utilisation during Ramadan: a retrospective cross-sectional study. Arch Dis Child 2021; 106:272-275. [PMID: 32978143 DOI: 10.1136/archdischild-2020-319173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/15/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the impact of Ramadan on patient characteristics, diagnoses and metrics in the paediatric emergency department (PED). DESIGN Retrospective cross-sectional study. SETTING PED of a tertiary care centre in Lebanon. PATIENTS All paediatric patients. EXPOSURE Ramadan (June 2016 and 2017) versus the months before and after Ramadan (non-Ramadan). MAIN OUTCOME MEASURES Patient and illness characteristics and PED metrics including peak patient load; presentation timings; length of stay; and times to order tests, receive samples and report results. RESULTS We included 5711 patients with mean age of 6.1±5.3 years and 55.4% males. The number of daily visits was 28.3±6.5 during Ramadan versus 31.5±7.3 during non-Ramadan (p=0.004). The peak time of visits ranged from 18:00 to 22:00 during non-Ramadan versus from 22:00 to 02:00 during Ramadan. During Ramadan, there were significantly more gastrointestinal (GI) and trauma-related complaints (39.0% vs 35.4%, p=0.01 and 2.9% vs 1.8%, p=0.005). The Ramadan group had faster work efficiency measures such as times to order tests (21.1±21.3 vs 24.3±28.1 min, p<0.0001) and to collect samples (50.7±44.5 vs 54.8±42.6 min, p=0.03). CONCLUSIONS Ramadan changes presentation patterns, with fewer daily visits and a later peak time of visits. Ramadan also affects illness presentation patterns with more GI and trauma cases. Fasting times during Ramadan did not affect staff work efficiency. These findings could help EDs structure their staffing to optimise resource allocation during Ramadan.
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Affiliation(s)
- Rasha D Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cynthia Wakil
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sami Shayya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alik Dakessian
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adonis Wazir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Jamali
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon .,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hariri MA, Jaffa MA, Saoud R, Zhao J, Zhu R, Jaffa AA, El-Achkar GA, Moussa M, Kobeissy F, Hassan A, Ziyadeh FN, Mechref Y, Jaffa AA. Vascular Cells Proteome Associated with Bradykinin and Leptin Inflammation and Oxidative Stress Signals. Antioxidants (Basel) 2020; 9:antiox9121251. [PMID: 33316969 PMCID: PMC7764689 DOI: 10.3390/antiox9121251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
Among the primary contributors to cardiovascular diseases are inflammation and oxidative imbalance within the vessel walls as well as the fibrosis of rat aortic smooth muscle cell (RASMC). Bradykinin (BK) and leptin are inflammatory modulators that are linked to vascular injury. In this study, we employed tandem LC-MS/MS to identify protein signatures that encompass protein abundance in RASMC treated with BK or leptin followed by systems biology analyses to gain insight into the biological pathways and processes linked to vascular remodeling. In the study, 1837 proteins were identified in control untreated RASMC. BK altered the expression of 72 (4%) and 120 (6.5%) proteins, whereas leptin altered the expression of 189 (10.2%) and 127 (6.5%) proteins after 24 and 48 h, respectively, compared to control RASMC. BK increased the protein abundance of leptin receptor, transforming growth factor-β. On the other hand, leptin increased the protein abundance of plasminogen activator inhibitor 1 but decreased the protein abundance of cofilin. BK and leptin induced the expression of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β) and pathway analysis revealed the activation of mitogen-activated protein kinases (MAPKs) and AKT pathways. The proteome profile in response to BK and leptin revealed mechanistic interplay of multiple processes that modulate inflammation and oxidative stress signals in the vasculature.
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Affiliation(s)
- Moustafa Al Hariri
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
| | - Miran A. Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
| | - Richard Saoud
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
| | - Jingfu Zhao
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (J.Z.); (R.Z.)
| | - Rui Zhu
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (J.Z.); (R.Z.)
| | - Aneese A. Jaffa
- Faculty of Arts and Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
| | - Ghewa A. El-Achkar
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
| | - Mayssam Moussa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
| | - Anwarul Hassan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha 2713, Qatar;
| | - Fuad N. Ziyadeh
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, USA; (J.Z.); (R.Z.)
- Correspondence: (Y.M.); (A.A.J.); Tel.: +1812-219-1972 (Y.M.); +961-1-350000 (A.A.J.)
| | - Ayad A. Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 11-0236, Lebanon; (M.A.H.); (R.S.); (G.A.E.-A.); (M.M.); (F.K.); (F.N.Z.)
- Correspondence: (Y.M.); (A.A.J.); Tel.: +1812-219-1972 (Y.M.); +961-1-350000 (A.A.J.)
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Itani HA, Jaffa MA, Elias J, Sabra M, Zakka P, Ballout J, Bekdash A, Ibrahim R, Al Hariri M, Ghemrawi M, Abi-Saleh B, Khoury M, Alam S, Mahfouz R, Jaffa AA, Azar ST, Refaat MM. Genomic and Proteomic Study of the Inflammatory Pathway in Patients With Atrial Fibrillation and Cardiometabolic Syndrome. Front Cardiovasc Med 2020; 7:613271. [PMID: 33344519 PMCID: PMC7738559 DOI: 10.3389/fcvm.2020.613271] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/10/2020] [Indexed: 01/26/2023] Open
Abstract
Atrial fibrillation (AF) and cardiometabolic syndrome (CMS) have been linked to inflammation and fibrosis. However, it is still unknown which inflammatory cytokines contribute to the pathogenesis of AF. Furthermore, cardiometabolic syndrome (CMS) risk factors such as obesity, hypertension, insulin resistance/glucose intolerance are also associated with inflammation and increased level of cytokines and adipokines. We hypothesized that the inflammatory immune response is exacerbated in patients with both AF and CMS compared to either AF or CMS alone. We investigated inflammatory cytokines and fibrotic markers as well as cytokine genetic profiles in patients with lone AF and CMS. CMS, lone AF patients, patients with both lone AF and CMS, and control patients were recruited. Genetic polymorphisms in inflammatory and fibrotic markers were assessed. Serum levels of connective tissue growth factor (CTGF) were tested along with other inflammatory markers including platelet-to-lymphocyte ratio (PLR), monocyte-to-HDL ratio (MHR) in three groups of AF+CMS, AF, and CMS patients. There was a trend in the CTGF levels for statistical significance between the AF and AF+CMS group (P = 0.084). Genotyping showed high percentages of patients in all groups with high secretor genotypes of Interleukin-6 (IL-6) (P = 0.037). Genotyping of IFN-γ and IL-10 at high level showed an increase in expression in the AF + CMS group compared to AF and CMS alone suggesting an imbalance between the inflammatory and anti-inflammatory cytokines which is exacerbated by AF. Serum cytokine inflammatory cytokine levels showed that IL-4, IL-5, IL-10, IL-17F, and IL-22 were significant between the AF, AF+CMS, and CMS patients. Combination of both CMS and AF may be associated with a higher degree of inflammation than what is seen in either CMS or AF alone. Thus, the identification of a biomarker capable of identifying metabolic syndrome associated with disease will help in identification of a therapeutic target in treating this devastating disease.
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Affiliation(s)
- Hana A Itani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Medicine, Clinical pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Joseph Elias
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Mohammad Sabra
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Patrick Zakka
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, United States
| | - Jad Ballout
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Amira Bekdash
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rand Ibrahim
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Mirna Ghemrawi
- Department of Pathology and Laboratory Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Bernard Abi-Saleh
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Maurice Khoury
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Samir Alam
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Ayad A Jaffa
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Sami T Azar
- Department of Internal Medicine, Endocrinology Diabetes and Metabolism Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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11
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Saoud R, Jaffa MA, Habib A, Zhao J, Al Hariri M, Zhu R, Hasan A, Ziyadeh FN, Kobeissy F, Mechref Y, Jaffa AA. Modulation of proteomic and inflammatory signals by Bradykinin in podocytes. J Adv Res 2020; 24:409-422. [PMID: 32518694 PMCID: PMC7270529 DOI: 10.1016/j.jare.2020.05.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023] Open
Abstract
Podocyte damage is one of the hallmarks of diabetic nephropathy leading to proteinuria and kidney damage. The underlying mechanisms of podocyte injury are not well defined. Bradykinin (BK) was shown to contribute to diabetic kidney disease. Here, we evaluated the temporal changes in proteome profile and inflammatory signals of podocytes in response to BK (10−7M). Protein profile was evaluated by liquid chromatography mass Spectrometry (LC-MS/MS) analysis. Proteome profile analysis of podocytes treated with BK (10−7M) for 3 and 6 h, revealed 61 proteins that were differentially altered compared to unstimulated control podocytes. Pathway enrichment analysis suggested inhibition of cell death pathways, engagement of cytoskeletal elements and activation of inflammatory pathways. One of the inflammatory proteins that was identified to be induced by BK treatment is Prostaglandin (PG) H Synthase-2 (Cyclooxygenase-2, COX-2). In addition, BK significantly induced the production and release of PGE2 and this effect was inhibited by both COX-2 and MEK Kinase inhibitors, demonstrating that the production of PGE2 by BK is mediated via COX-2 and MAPK-dependent mechanisms. These findings provide a global understanding of the effector modulated proteome in response to BK and also reveal BK as an important modulator of inflammation and a potential player in podocyte injury.
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Affiliation(s)
- Richard Saoud
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Aida Habib
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon.,INSERM-U1149, Centre de Recherche sur l'Inflammation, Sorbonne Paris Cité, Laboratoire d'Excellence Inflamex, Faculté de Médecine, Site Xavier Bichat, Université de Paris, France
| | - Jingfu Zhao
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, United States
| | - Moustafa Al Hariri
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon
| | - Rui Zhu
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, United States
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, Qatar University, Qatar
| | - Fuad N Ziyadeh
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon.,Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409, United States
| | - Ayad A Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon
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12
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Zgheib H, Al Souky N, El Majzoub I, Wakil C, Sweidan K, Kaddoura R, Al Hariri M, Chebel RB. Comparison of outcomes in ST-elevation myocardial infarction according to age. Am J Emerg Med 2020; 38:485-490. [DOI: 10.1016/j.ajem.2019.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 01/23/2023] Open
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13
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Hitti E, Hadid D, Tamim H, Al Hariri M, El Sayed M. Left without being seen in a hybrid point of service collection model emergency department. Am J Emerg Med 2019; 38:497-502. [PMID: 31128935 DOI: 10.1016/j.ajem.2019.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This study identifies reasons and predictors of LWBS and examines outcomes of patients in a model that uses "point-of-service" (POS) collection for low acuity patients. METHODS This was a matched case-control study of all patients who left without being seen from the ED of a tertiary care center in Beirut Lebanon between June 2016 and May 2017. Matching was done for the ESI score, date and time (±2 h). A descriptive analysis and a bivariate analysis were conducted comparing patients who LWBS and those who completed their medical treatment. This was followed by a Logistic regression to identify predictors of LWBS. RESULTS 133 LWBS cases and 133 matched controls were enrolled in the study. Mean age for LWBS patients was (31.69 ± 15.29). The average reported wait time of LWBS patients was reported as 27.48 min (±25.09). Reasons for LWBS were; non-compensable status (66.9%), financial reasons (12.8%), long waiting times (12.8%), and others (8.3%). The majority of LWBS patients (81.2%) sought medical care after leaving the ED, and 8.3% of the LWBS patients represented to the ED after 48 h. Important predictors of LWBS included male gender, lower than undergraduate education level, waiting room time, non-compensable coverage status and fewer ED visits in the past year. CONCLUSION In an ED setting with POS collection for low acuity patients, non-compensable coverage status was the strongest predictor for LWBS. Further studies are needed to assess the outcomes of patients who LWBS in this model of care.
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Affiliation(s)
- Eveline Hitti
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
| | - Dima Hadid
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
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14
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Faris N, Baroud E, Al Hariri M, Bachir R, El-Khoury J, Batley NJ. Characteristics and dispositional determinants of psychiatric emergencies in a University Hospital in Beirut. Asian J Psychiatr 2019; 42:42-47. [PMID: 30951932 DOI: 10.1016/j.ajp.2019.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/04/2019] [Revised: 03/02/2019] [Accepted: 03/25/2019] [Indexed: 11/19/2022]
Abstract
Mental health problems are common in Lebanon, and so are psychiatric emergencies. In order to show the characteristics of psychiatric emergencies in Lebanon along with their dispositional determinants, we conducted this retrospective, single-center, chart-review study of patients who presented to the Emergency Department between July 1, 2016 until December 31, 2016 and required an official psychiatrist consultation. Our sample included 195 patients of all age groups. The most common diagnosis was depression (75 patients) followed by anxiety (61 patients). 107 patients (54.8%) required admission for adequate treatment; however only 72 (67.3%) of those were actually admitted, and the rest (32.7%) left the hospital against medical advice. Increased hospital admission was associated with being a female (OR = 3.042), having family history of psychiatric disease (OR = 2.040) and having suicidal ideations (OR = 12.949). In a country that has inadequate health coverage, financial coverage can also be a determining factor in whether or not patients get the admission they need.
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Affiliation(s)
- Nagham Faris
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Evelyne Baroud
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph El-Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nicholas J Batley
- Departments of Family and Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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15
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Al Hariri M, Elmedawar M, Zhu R, Jaffa MA, Zhao J, Mirzaei P, Ahmed A, Kobeissy F, Ziyadeh FN, Mechref Y, Jaffa AA. Proteome profiling in the aorta and kidney of type 1 diabetic rats. PLoS One 2017; 12:e0187752. [PMID: 29121074 PMCID: PMC5679573 DOI: 10.1371/journal.pone.0187752] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/25/2017] [Indexed: 01/04/2023] Open
Abstract
Diabetes is associated with a number of metabolic and cardiovascular risk factors that contribute to a high rate of microvascular and macrovascular complications. The risk factors and mechanisms that contribute to the development of micro- and macrovascular disease in diabetes are not fully explained. In this study, we employed mass spectrometric analysis using tandem LC-MS/MS to generate a proteomic profile of protein abundance and post-translational modifications (PTM) in the aorta and kidney of diabetic rats. In addition, systems biology analyses were employed to identify key protein markers that can provide insights into molecular pathways and processes that are differentially regulated in the aorta and kidney of type 1 diabetic rats. Our results indicated that 188 (111 downregulated and 77 upregulated) proteins were significantly identified in the aorta of diabetic rats compared to normal controls. A total of 223 (109 downregulated and 114 upregulated) proteins were significantly identified in the kidney of diabetic rats compared to normal controls. When the protein profiles from the kidney and aorta of diabetic and control rats were analyzed by principal component analysis, a distinct separation of the groups was observed. In addition, diabetes resulted in a significant increase in PTM (oxidation, phosphorylation, and acetylation) of proteins in the kidney and aorta and this effect was partially reversed by insulin treatment. Ingenuity pathway analysis performed on the list of differentially expressed proteins depicted mitochondrial dysfunction, oxidative phosphorylation and acute phase response signaling to be among the altered canonical pathways by diabetes in both tissues. The findings of the present study provide a global proteomics view of markers that highlight the mechanisms and putative processes that modulate renal and vascular injury in diabetes.
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Affiliation(s)
- Moustafa Al Hariri
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Elmedawar
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rui Zhu
- Department of Chemistry and Biochemistry, Texas Tech University, Memorial Circle & Boston, Lubbock, Texas, United States of America
| | - Miran A. Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jingfu Zhao
- Department of Chemistry and Biochemistry, Texas Tech University, Memorial Circle & Boston, Lubbock, Texas, United States of America
| | - Parvin Mirzaei
- Department of Chemistry and Biochemistry, Texas Tech University, Memorial Circle & Boston, Lubbock, Texas, United States of America
| | - Adnan Ahmed
- Center for Biotechnology & Genomics, Texas Tech University, Canton & Main, Experimental Sciences building, Lubbock, Texas, United States of America
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fuad N. Ziyadeh
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Memorial Circle & Boston, Lubbock, Texas, United States of America
| | - Ayad A. Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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16
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Al Hariri M, Zibara K, Farhat W, Hashem Y, Soudani N, Al Ibrahim F, Hamade E, Zeidan A, Husari A, Kobeissy F. Cigarette Smoking-Induced Cardiac Hypertrophy, Vascular Inflammation and Injury Are Attenuated by Antioxidant Supplementation in an Animal Model. Front Pharmacol 2016; 7:397. [PMID: 27881962 PMCID: PMC5101594 DOI: 10.3389/fphar.2016.00397] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 07/13/2016] [Accepted: 10/07/2016] [Indexed: 01/05/2023] Open
Abstract
Background: Cardiovascular diseases are the leading causes of morbidity and mortality worldwide. Cigarette smoking remains a global health epidemic with associated detrimental effects on the cardiovascular system. In this work, we investigated the effects of cigarette smoke exposure on cardiovascular system in an animal model. The study then evaluated the effects of antioxidants (AO), represented by pomegranate juice, on cigarette smoke induced cardiovascular injury. This study aims at evaluating the effect of pomegranate juice supplementation on the cardiovascular system of an experimental rat model of smoke exposure. Methods: Adult rats were divided into four different groups: Control, Cigarette smoking (CS), AO, and CS + AO. Cigarette smoke exposure was for 4 weeks (5 days of exposure/week) and AO group received pomegranate juice while other groups received placebo. Assessment of cardiovascular injury was documented by assessing different parameters of cardiovascular injury mediators including: (1) cardiac hypertrophy, (2) oxidative stress, (3) expression of inflammatory markers, (4) expression of Bradykinin receptor 1 (Bdkrb1), Bradykinin receptor 2 (Bdkrb2), and (5) altered expression of fibrotic/atherogenic markers [(Fibronectin (Fn1) and leptin receptor (ObR))]. Results: Data from this work demonstrated that cigarette smoke exposure induced cardiac hypertrophy, which was reduced upon administration of pomegranate in CS + AO group. Cigarette smoke exposure was associated with elevation in oxidative stress, significant increase in the expression of IL-1β, TNFα, Fn1, and ObR in rat's aorta. In addition, an increase in aortic calcification was observed after 1 month of cigarette smoke exposure. Furthermore, cigarette smoke induced a significant up regulation in Bdkrb1 expression level. Finally, pomegranate supplementation exhibited cardiovascular protection assessed by the above findings and partly contributed to ameliorating cardiac hypertrophy in cigarette smoke exposed animals. Conclusion: Findings from this work showed that cigarette smoking exposure is associated with significant cardiovascular pathology such as cardiac hypertrophy, inflammation, pro-fibrotic, and atherogenic markers and aortic calcification in an animal model as assessed 1 month post exposure. Antioxidant supplementation prevented cardiac hypertrophy and attenuated indicators of atherosclerosis markers associated with cigarette smoke exposure.
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Affiliation(s)
- Moustafa Al Hariri
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Kazem Zibara
- ER045, PRASE, DSST, Lebanese UniversityBeirut, Lebanon; Laboratory of Cardiovascular Diseases and Stem Cells, Biochemistry Department, Faculty of Sciences-1, EDST, Lebanese UniversityBeirut, Lebanon
| | - Wissam Farhat
- ER045, PRASE, DSST, Lebanese University Beirut, Lebanon
| | - Yasmine Hashem
- Department of Physiology, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Nadia Soudani
- Department of Physiology, Faculty of Medicine, American University of BeirutBeirut, Lebanon; Department of Biology, Faculty of Sciences, EDST, Lebanese UniversityHadath, Lebanon
| | - Farah Al Ibrahim
- Laboratory of Cardiovascular Diseases and Stem Cells, Biochemistry Department, Faculty of Sciences-1, EDST, Lebanese University Beirut, Lebanon
| | - Eva Hamade
- ER045, PRASE, DSST, Lebanese UniversityBeirut, Lebanon; Laboratory of Cardiovascular Diseases and Stem Cells, Biochemistry Department, Faculty of Sciences-1, EDST, Lebanese UniversityBeirut, Lebanon
| | - Asad Zeidan
- Department of Physiology, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Ahmad Husari
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, American University of Beirut Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut Beirut, Lebanon
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17
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Nokkari A, Mouhieddine TH, Itani MM, Abou-Kheir W, Daoud G, Zhu R, Mechref Y, Soueid J, Al Hariri M, Mondello S, Jaffa AA, Kobeissy F. Correction: Characterization of the Kallikrein-Kinin System Post Chemical Neuronal Injury: An In Vitro Biochemical and Neuroproteomics Assessment. PLoS One 2015; 10:e0136345. [PMID: 26288275 PMCID: PMC4543601 DOI: 10.1371/journal.pone.0136345] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Nokkari A, Mouhieddine TH, Itani MM, Abou-Kheir W, Daoud G, Zhu R, Meshref Y, Soueid J, Al Hariri M, Mondello S, Jaffa AA, Kobeissy F. Characterization of the Kallikrein-Kinin System Post Chemical Neuronal Injury: An In Vitro Biochemical and Neuroproteomics Assessment. PLoS One 2015; 10:e0128601. [PMID: 26047500 PMCID: PMC4457722 DOI: 10.1371/journal.pone.0128601] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/28/2015] [Indexed: 01/11/2023] Open
Abstract
Traumatic Brain Injury (TBI) is the result of a mechanical impact on the brain provoking mild, moderate or severe symptoms. It is acknowledged that TBI leads to apoptotic and necrotic cell death; however, the exact mechanism by which brain trauma leads to neural injury is not fully elucidated. Some studies have highlighted the pivotal role of the Kallikrein-Kinin System (KKS) in brain trauma but the results are still controversial and inconclusive. In this study, we investigated both the expression and the role of Bradykinin 1 and 2 receptors (B1R and B2R), in mediating neuronal injury under chemical neurotoxicity paradigm in PC12 cell lines. The neuronal cell line PC12 was treated with the apoptotic drug Staurosporine (STS) to induce cell death. Intracellular calcium release was evaluated by Fluo 4-AM staining and showed that inhibition of the B2R prevented calcium release following STS treatment. Differential analyses utilizing immunofluorescence, Western blot and Real-time Polymerase Chain Reaction revealed an upregulation of both bradykinin receptors occurring at 3h and 12h post-STS treatment, but with a higher induction of B2R compared to B1R. This implies that STS-mediated apoptosis in PC12 cells is mainly conducted through B2R and partly via B1R. Finally, a neuroproteomics approach was conducted to find relevant proteins associated to STS and KKS in PC12 cells. Neuroproteomics results confirmed the presence of an inflammatory response leading to cell death during apoptosis-mediated STS treatment; however, a “survival” capacity was shown following inhibition of B2R coupled with STS treatment. Our data suggest that B2R is a key player in the inflammatory pathway following STS-mediated apoptosis in PC12 cells and its inhibition may represent a potential therapeutic tool in TBI.
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Affiliation(s)
- Amaly Nokkari
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- * E-mail: (AN); (FK); (WAK)
| | - Tarek H. Mouhieddine
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Wassim Abou-Kheir
- Faculty of Medicine, Department of Anatomy, Cell Biology and Physiology, American University of Beirut, Beirut, Lebanon
- * E-mail: (AN); (FK); (WAK)
| | - Georges Daoud
- Faculty of Medicine, Department of Anatomy, Cell Biology and Physiology, American University of Beirut, Beirut, Lebanon
| | - Rui Zhu
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas, United States of America
| | - Yehia Meshref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas, United States of America
| | - Jihane Soueid
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Moustafa Al Hariri
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | | | - Ayad A. Jaffa
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Faculty of Medicine, Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- * E-mail: (AN); (FK); (WAK)
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Hasan A, Nurunnabi M, Morshed M, Paul A, Polini A, Kuila T, Al Hariri M, Lee YK, Jaffa AA. Recent advances in application of biosensors in tissue engineering. Biomed Res Int 2014; 2014:307519. [PMID: 25165697 PMCID: PMC4140114 DOI: 10.1155/2014/307519] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/28/2014] [Indexed: 12/29/2022]
Abstract
Biosensors research is a fast growing field in which tens of thousands of papers have been published over the years, and the industry is now worth billions of dollars. The biosensor products have found their applications in numerous industries including food and beverages, agricultural, environmental, medical diagnostics, and pharmaceutical industries and many more. Even though numerous biosensors have been developed for detection of proteins, peptides, enzymes, and numerous other biomolecules for diverse applications, their applications in tissue engineering have remained limited. In recent years, there has been a growing interest in application of novel biosensors in cell culture and tissue engineering, for example, real-time detection of small molecules such as glucose, lactose, and H2O2 as well as serum proteins of large molecular size, such as albumin and alpha-fetoprotein, and inflammatory cytokines, such as IFN-g and TNF-α. In this review, we provide an overview of the recent advancements in biosensors for tissue engineering applications.
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Affiliation(s)
- Anwarul Hasan
- Biomedical Engineering and Department of Mechanical Engineering, Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107 2020, Lebanon ; Center for Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Md Nurunnabi
- Department of Chemical and Biological Engineering, Korea National University of Transportation, 50 Daehak-ro, Chungju 380-702, Republic of Korea
| | - Mahboob Morshed
- Tissue Engineering Centre, Faculty of Medicine, National University of Malaysia (Universiti Kebangsaan Malaysia), 56000 Cheras, Kuala Lumpur, Malaysia
| | - Arghya Paul
- Center for Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA ; Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS 66045-7609, USA
| | - Alessandro Polini
- Center for Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tapas Kuila
- Surface Engineering & Tribology Division, CSIR-Central Mechanical Engineering Research Institute, Mahatma Gandhi Avenue, Durgapur, West Bengal 713209, India
| | - Moustafa Al Hariri
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Yong-kyu Lee
- Department of Chemical and Biological Engineering, Korea National University of Transportation, 50 Daehak-ro, Chungju 380-702, Republic of Korea
| | - Ayad A Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
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Jaffa MA, Kobeissy F, Al Hariri M, Chalhoub H, Eid A, Ziyadeh FN, Jaffa AA. Global renal gene expression profiling analysis in B2-kinin receptor null mice: impact of diabetes. PLoS One 2012; 7:e44714. [PMID: 23028588 PMCID: PMC3445541 DOI: 10.1371/journal.pone.0044714] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/07/2012] [Indexed: 02/06/2023] Open
Abstract
Diabetic nephropathy (DN), the leading cause of end-stage renal failure, is clinically manifested by albuminuria and a progressive decline in glomerular filtration rate. The risk factors and mechanisms that contribute to the development and progression of DN are still incompletely defined. To address the involvement of bradykinin B2-receptors (B2R) in DN, we used a genome wide approach to study the effects of diabetes on differential renal gene expression profile in wild type and B2R knockout (B2R−/−) mice. Diabetes was induced with streptozotocin and plasma glucose levels and albumin excretion rate (AER) were measured at predetermined times throughout the 23 week study period. Longitudinal analysis of AER indicated that diabetic B2R−/−D null mice had a significantly decreased AER levels compared to wild type B2R+/+D mice (P = 0.0005). Results from the global microarray study comparing gene expression profiles among four groups of mice respectively: (B2R+/+C, B2R+/+D, B2R−/−C and B2R−/−D) highlighted the role of several altered pathological pathways in response to disruption of B2R and to the diabetic state that included: endothelial injury, oxidative stress, insulin and lipid metabolism and inflammatory process with a marked alteration in the pro-apoptotic genes. The findings of the present study provide a global genomics view of biomarkers that highlight the mechanisms and putative pathways involved in DN.
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Affiliation(s)
- Miran A. Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Departments of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Moustafa Al Hariri
- Departments of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Hussein Chalhoub
- Departments of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Assaad Eid
- Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fuad N. Ziyadeh
- Departments of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Ayad A. Jaffa
- Departments of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
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Abstract
Twenty-five CAT-scan-confirmed stroke patients and 25 matched controls were studied. All the stroke patients were stable 2-3 months after unilateral hemispheric stroke. Those with ear disease, other central neurological disorder, severe dysphasia and acute or chronic confusion were excluded. There were no significant differences between the groups for average pure tone hearing threshold (APTT) or ability to discriminate pre-recorded speech presented to one ear at 35 decibels (dB) above APTT. The stroke subjects had significantly impaired performance on dichotic competing sentence testing (DCST). Seventeen stroke patients but only one control subject failed DCST. Failure rate was similar for left and right stroke and for temporal and non-temporal lobe involvement. Two-thirds of patients failing DCST did so in the ear opposite the side of the cortical lesion. We conclude that (i) DCST is useful in detecting central auditory dysfunction in stroke patients; and (ii) stroke can affect central auditory perception in older patients.
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Affiliation(s)
- M A Hariri
- Department of Audiological Medicine, Central Manchester Hospitals Trust
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Abstract
We report a case of septicaemia and death due to occult sinusitis in an otherwise healthy adult. Septicaemia was diagnosed on clinical grounds and blood culture grew Streptococcus pneumoniae. Maxillary sinusitis was discovered incidentally on a CT scan four days after the onset of symptoms. A sinus wash-out revealed pus which on culture was positive for Streptococcus pneumoniae. The patient deteriorated gradually and died despite appropriate therapy. We conclude that sinusitis should be suspected in any case of septicaemia where the primary focus is not known and the patient does not respond quickly to treatment.
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Affiliation(s)
- M A Hariri
- Centre for Audiology, Education of the Deaf & Speech Pathology, University of Manchester
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Abstract
Eighteen patients were seen over a period of 3 years. Twenty of their ears were diagnosed as having bullous myringitis. Pure tone audiograms and stapedial reflexes were performed within 48 h of referral. Six ears demonstrated sensorineural hearing loss, 7 ears mixed loss and 4 conductive loss. Recovery of sensorineural hearing loss complete in 8 out of 13 ears. Stapedial reflexes were elicited in 5 patients and all showed recruitment. The findings of this study confirms the fact that sensorineural hearing loss is more common in bullous myringitis than previously thought and that it is temporary in many cases. The stapedial reflex results suggest that the site of the lesion is in the cochlea.
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Affiliation(s)
- M A Hariri
- ENT Department, Royal Preston Hospital, UK
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Abstract
We report a case of osteoradionecrosis of the temporal bone which presented with symptoms and signs of cerebellopontine angle lesion. The clinical, radiological, histological and bacteriological findings are reported. The occurrence of osteoradionecrosis of the temporal bone and the factors which predispose to it are discussed with particular emphasis on the time lapse between radiotherapy and its development. This presentation has not previously been reported.
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Affiliation(s)
- M Small
- ENT Department, Royal Preston Hospital, UK
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