Rafic Hariri University Hospital

Beirut, Lebanon

Rafic Hariri University Hospital

Beirut, Lebanon
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Mansour A.M.,Rafic Hariri University Hospital
Retina | Year: 2017

PURPOSE:: To report the clinical outcome after intravitreal dexamethasone implant in patients with retinitis pigmentosa and cystoid macular edema. METHODS:: Multicenter retrospective case series of eyes with retinitis pigmentosa and cystoid macular edema that underwent intravitreal dexamethasone implant. Primary outcome measures were best-corrected visual acuity in LogMAR and central macular thickness. Statistical analyses used two-tailed comparison with Wilcoxon signed-rank test. RESULTS:: There were a total of 45 eyes from 34 patients with a mean age of 32.7 years (range 16–57) and mean follow-up of 15.5 ± 13.0 months. At Month 3 after the first injection, mean initial best-corrected visual acuity improved from 0.61 ± 0.38 (20/81) to 0.37 ± 0.16 (20/47) (P = 0.012), whereas mean central macular thickness (μm) decreased from 506 ± 288 μm to 311.7 ± 71.6 μm (P < 0.001) and mean intraocular pressure increased from 15.7 ± 2.3 mmHg to 19.8 ± 11.0 mmHg (P = 0.01). Fourteen eyes had multiple injections (1–7 reinjections) at a mean interval of 6 months. Treatment effect was durable with multiple injections, but with seven eyes developing visually significant cataracts. CONCLUSION:: Best-corrected visual acuity improved up to 4 months in around half of the eyes. Eyes that benefited the most were pseudophakic, steroid nonresponsive, with large initial central macular thickness, and profuse fluorescein dye leakage. © 2017 by Ophthalmic Communications Society, Inc.

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.

Biffi A.,San Raffaele Scientific Institute | Montini E.,San Raffaele Scientific Institute | Lorioli L.,San Raffaele Scientific Institute | Lorioli L.,Vita-Salute San Raffaele University | And 38 more authors.
Science | Year: 2013

Metachromatic leukodystrophy (MLD) is an inherited lysosomal storage disease caused by arylsulfatase A (ARSA) deficiency. Patients with MLD exhibit progressive motor and cognitive impairment and die within a few years of symptom onset. We used a lentiviral vector to transfer a functional ARSA gene into hematopoietic stem cells (HSCs) from three presymptomatic patients who showed genetic, biochemical, and neurophysiological evidence of late infantile MLD. After reinfusion of the gene-corrected HSCs, the patients showed extensive and stable ARSA gene replacement, which led to high enzyme expression throughout hematopoietic lineages and in cerebrospinal fluid. Analyses of vector integrations revealed no evidence of aberrant clonal behavior. The disease did not manifest or progress in the three patients 7 to 21 months beyond the predicted age of symptom onset. These findings indicate that extensive genetic engineering of human hematopoiesis can be achieved with lentiviral vectors and that this approach may offer therapeutic benefit for MLD patients.

Bertaina A.,Instituto Of Ricovero E Cura A Carattere Scientifico Bambino Gesu Childrens Hospital | Merli P.,Instituto Of Ricovero E Cura A Carattere Scientifico Bambino Gesu Childrens Hospital | Rutella S.,Instituto Of 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.

Nasser H.A.,Rafic Hariri University Hospital | Iskandarani F.,Rafic Hariri University Hospital | Berjaoui T.,Rafic Hariri University Hospital | Fleifel S.,Rafic Hariri University Hospital
Journal of Pediatric Surgery | Year: 2011

Cervical chondrocutaneous remnants are very rare entities. They are thought to originate either from the second branchial arch or from auricular tissues. To date, less than 40 cases have been reported in the medical literature, and only 7 cases were bilateral. We report the case of a 1-month-old girl presenting with bilateral neck lesions since birth, with no other anomalies. Complete surgical excision was performed, the pathology of which confirmed the diagnosis of chondrocutaneous remnants. Follow-up after 9 months showed no clinical evidence of complications or recurrence. © 2011 Elsevier Inc.

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.

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.

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.

Mansour A.M.,American University of Beirut | Jaroudi M.O.,Rafic Hariri University Hospital
Clinical Ophthalmology | Year: 2013

Introduction: Hemorrhagic retinal macrocysts are extremely rare retinal lesions that can be mistaken for malignancy with subsequent enucleation. Such a case was diagnosed, by a retina specialist based on ultrasonography, as a choroidal melanoma with exudative retinal detachment and the patient was advised to have brachytherapy. Case presentation: A 15-year-old Caucasian boy suffered sudden visual loss in the left eye and exam revealed vitreous hemorrhage. Magnetic resonance imaging revealed the mass as hyperintense on T1-weighted images and isointense on T2-weighted images with no enhancement after gadolinium dye. Following scleral buckle, the hemorrhagic retinal macrocyst collapsed gradually over a period of 5 weeks. The patient recovered visual acuity of 6/7.5 at the 1-year follow up. Conclusion: A hemorrhagic retinal macrocyst can be erroneously diagnosed as choroidal melanoma. Hints for the presence of retinal macrocysts include: egg shape; cyst wall configuration; no attachment to the choroid; and presence of retinal detachment. © 2013 Mansour and Jaroudi, publisher and licensee Dove Medical Press Ltd.

Mansour A.M.,American University of Beirut | Mansour A.M.,Rafic Hariri University Hospital
International Medical Case Reports Journal | Year: 2016

Purpose: We report an unusual case of bilateral vertical lacquer crack with no history of ocular trauma and with progressive marked enlargement and consequent visual loss. Methods: Three-year follow-up was completed using best-corrected visual acuity, serial fundus photographs, intravenous fluorescein angiography, and optical coherence tomography. Results: We report the occurrence of lacquer crack in a 43-year-old woman with no history of trauma except for laser in situ keratomileusis surgery for mild myopia (as reported by the patient) in the past 5 years and habitual ocular rubbing. Lacquer crack started in the right eye and became evident 1 year later in the left eye. Serial photography after repeated intravitreal injections of ranibizumab for subfoveal choroidal new vessel showed the lacquer crack widened gradually in both eyes. Axial length measurement revealed the presence of high myopia. Best-corrected visual acuity dropped to 20/200 bilaterally. Conclusion: We hypothesize that a thin Bruch’s membrane in high myopia is prone for small rupture initially either spontaneously or following laser in situ keratomileusis and subsequent widening of the rupture by oculopression and intravitreal injections from rise in intraocular pressure. © 2016 Mansour.

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