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Mansour A.M.,American University of Beirut | Mansour A.M.,Rafic Hariri University Hospital | Ghabra M.,Dar Oyoun Hospital
Case Reports in Ophthalmology | Year: 2012

There has been the unsubstantiated clinical impression that laser refractive surgery accelerates cataract development along with solid experimental data about the cataractogenic effects of excimer laser treatment. We present the first documented case of significant cataract formation in a young myope after repeat excimer laser ablation necessitating phacoemulsification with a posterior chamber implant. Proposed explanations include focusing of the ablation wave on the posterior capsule (acoustic wave lens epithelial damage), photooxidative stress of the lens (ultraviolet and inflammatory oxidative stress), and corticosteroid-induced cataract (lens toxicity). Copyright © 2012 S. Karger AG, Basel.

Bertaina A.,Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesu Childrens Hospital | Merli P.,Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesu Childrens Hospital | Rutella S.,Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesu Childrens Hospital | Rutella S.,Catholic University Medical School | And 19 more authors.
Blood | Year: 2014

Twenty-three children with nonmalignant disorders received HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) after ex vivo elimination of αβ+ T cells and CD19+ B cells. The median number of CD34+, αβ+CD3 +, and B cells infusedwas 16.8 × 106, 40 × 103, and 40 × 103 cells/kg, respectively. No patient received any posttransplantation pharmacologic prophylaxis for graft-versus-host disease (GVHD). All but 4 patients engrafted, these latter being rescued by a second allograft. Three patients experienced skin-only grade 1 to 2 acute GVHD. No patient developed visceral acute or chronic GVHD. Cumulative incidence of transplantation-related mortality was 9.3%. With a median follow-up of 18 months, 21 of 23 children are alive and disease-free, the 2-year probability of disease-free survival being 91.1%. Recovery of γδ+ T cells was prompt, but αβ+ T cells progressively ensued over time.Our datasuggest that thisnovelgraftmanipulation strategy is safe and effective for haplo-HSCT. This trial was registered at www.clinicaltrials.gov as #NCT01810120. © 2014 by The American Society of Hematology.

Aschner P.,Pontifical Xavierian University | Chan J.,Chinese University of Hong Kong | Owens D.R.,University of Cardiff | Picard S.,Point Medical Rond Point de la Nation | And 5 more authors.
The Lancet | Year: 2012

Background In people with type 2 diabetes, a dipeptidyl peptidase-4 (DPP-4) inhibitor is one choice as second-line treatment after metformin, with basal insulin recommended as an alternative. We aimed to compare the efficacy, tolerability, and safety of insulin glargine and sitagliptin, a DPP-4 inhibitor, in patients whose disease was uncontrolled with metformin. Methods In this comparative, parallel, randomised, open-label trial, metformin-treated people aged 35-70 years with glycated haemoglobin A1c (HbA1c) of 7-11%, diagnosis of type 2 diabetes for at least 6 months, and body-mass index of 25-45 kg/m 2 were recruited from 17 countries. Participants were randomly assigned (1:1) to 24-week treatment with insulin glargine (titrated from an initial subcutaneous dose of 0·2 units per kg bodyweight to attain fasting plasma glucose of 4·0-5·5 mmol/L) or sitagliptin (oral dose of 100 mg daily). Randomisation (via a central interactive voice response system) was by random sequence generation and was stratified by centre. Patients and investigators were not masked to treatment assignment. The primary outcome was change in HbA 1c from baseline to study end. Efficacy analysis included all randomly assigned participants who had received at least one dose of study drug and had at least one on-treatment assessment of any primary or secondary efficacy variable. This trial is registered at ClinicalTrials.gov, NCT00751114. Findings 732 people were screened and 515 were randomly assigned to insulin glargine (n=250) or sitagliptin (n=265). At study end, adjusted mean reduction in HbA 1c was greater for patients on insulin glargine (n=227; -1·72%, SE 0·06) than for those on sitagliptin (n=253; -1·13%, SE 0·06) with a mean difference of -0·59% (95% CI -0·77 to -0·42, p<0·0001). The estimated rate of all symptomatic hypoglycaemic episodes was greater with insulin glargine than with sitagliptin (4·21 [SE 0·54] vs 0·50 [SE 0·09] events per patient-year; p<0·0001). Severe hypoglycaemia occurred in only three (1%) patients on insulin glargine and one (<1%) on sitagliptin. 15 (6%) of patients on insulin glargine versus eight (3%) on sitagliptin had at least one serious treatment-emergent adverse event. Interpretation Our results support the option of addition of basal insulin in patients with type 2 diabetes inadequately controlled by metformin. Long-term benefits might be expected from the achievement of optimum glycaemic control early in the course of the disease.

Nemr R.,University Medical Center Rizk Hospital | Almawi A.W.,Arabian Gulf University | Echtay A.,Rafic Hariri University Hospital | Sater M.S.,Arabian Gulf University | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2012

We investigated the association of CDKAL1 (rs7754840 and rs7756992) and CDKN2A/2B (rs10811661) variants with T2DM. Higher MAF of rs7754840 and rs7756992 were seen in patients, and both were associated with T2DM under additive, dominant, and recessive models. CDKAL1 rs7754840 and rs7756992, but not CDKN2A/2B rs10811661, are associated with T2DM in Lebanese. © 2011 Elsevier Ireland Ltd.

Almawi W.Y.,Arabian Gulf University | Nemr R.,University Medical Center Rizk Hospital | Keleshian S.H.,Haigazian University | Echtay A.,Rafic Hariri University Hospital | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2013

Aim: Recent genome-wide association scans (GWAS) and replication studies have expanded the list of validated type 2 diabetes (T2DM) susceptibility loci. We replicated T2DM association of 19 SNPs from 15 candidate loci in Lebanese Arabs. Methods: Case-control association study, comprising 995 T2DM patients and 1076 control participants. We genotyped by the allelic discrimination method 19 SNPs in/near ADAM30, NOTCH2, THADA, TMEFF2, COL8A1, ADAMTS9-AS2, WFS1, JAZF1, SLC30A8, KCNQ1, LOC387761, ALX4, TSPAN8, FTO, and HNF1. Results: Allele frequencies of the tested SNPs were comparable with those of Caucasians. COL8A1 rs792837 (P=2.9×10-9), KCNQ1 rs2237892 (P=1.8×10-18) and rs2237895 (P=0.002), ALX4 rs729287 (Pc=7.5×10-5), and HNF1 rs4430796 (P=0.003) were significantly associated with T2DM, with similar effect sizes to those of Europeans. While FTO rs8050136 and rs17817449, ADAMTS9 rs4607103, and WFS1 rs10010131 were initially associated with T2DM, this was lost upon multiple testing correction. The remaining variants were not associated with T2DM, possibly resulting from insufficient power to detect smaller allele effects. Conclusion: In addition to previous findings on the association of IGF2BP2, CDKAL1, TCF7L2 variants with T2DM among Lebanese, here we extend these by validating the association of five additional loci with T2DM in Lebanese Arabs. © 2013 Elsevier Ireland Ltd.

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