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Ayache S.S.,University Paris Est Creteil | Creange A.,University Paris Est Creteil | Farhat W.H.,University Paris Est Creteil | Zouari H.G.,University Paris Est Creteil | And 6 more authors.
European Journal of Neurology | Year: 2014

Background and purpose: High-dose steroid administration is the usual treatment of multiple sclerosis (MS) relapse, but it remains to determine whether this treatment may act by changing the excitability of cortical circuitry. Methods: The functional cortical effects of high-dose steroids in 21 MS patients before and after 3 days of intravenous administration of methylprednisolone (1 g/day) for the treatment of MS relapse were studied. Investigations included various clinical scales [Kurtzke Functional System Scale (KFSS), Expanded Disability Status Scale and Fatigue Severity Scale, 10-m walk] and transcranial magnetic stimulation (TMS) tests of cortical excitability [resting motor threshold, recruitment curve of motor evoked potentials, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) at various interstimuli intervals (ISIs), cortical silent period and interhemispheric inhibition]. Results: Following steroid administration, clinical improvement was significant for the KFSS pyramidal (motor) and total scores, whilst TMS showed a reduction of SICI (mean and maximum values) and an increase of ICF at 10 ms ISI. Conclusions: Very rapid functional changes in the excitability of cortical circuits involved in motor control can be induced by steroids, before any process of remyelination or axonal regeneration has time to occur. The net effect of steroids on the balance between intracortical GABAergic inhibition and glutamatergic facilitation was in favour of weaker inhibition or stronger facilitation, which could lead to improving the motor performance in MS patients. © 2014 EFNS.


Ahdab R.,University Paris Est Creteil | Ahdab R.,University Medical Center Rizk Hospital | Ayache S.S.,University Paris Est Creteil | Farhat W.H.,University Paris Est Creteil | And 5 more authors.
Human Brain Mapping | Year: 2014

Image-guided navigation systems dedicated to transcranial magnetic stimulation (TMS) have been recently developed and offer the possibility to visualize directly the anatomical structure to be stimulated. Performing navigated TMS requires a perfect knowledge of cortical anatomy, which is very variable between subjects. This study aimed at providing a detailed description of sulcal and gyral anatomy of motor cortical regions with special interest to the inter-individual variability of sulci. We attempted to identify the most stable structures, which can serve as anatomical landmarks for motor cortex mapping in navigated TMS practice. We analyzed the 3D reconstruction of 50 consecutive healthy adult brains (100 hemispheres). Different variants were identified regarding sulcal morphology, but several anatomical structures were found to be remarkably stable (four on dorsoventral axis and five on rostrocaudal axis). These landmarks were used to define a grid of 12 squares, which covered motor cortical regions. This grid was used to perform motor cortical mapping with navigated TMS in 12 healthy subjects from our cohort. The stereotactic coordinates (x-y-z) of the center of each of the 12 squares of the mapping grid were expressed into the standard Talairach space to determine the corresponding functional areas. We found that the regions whose stimulation produced almost constantly motor evoked potentials mainly correspond to the primary motor cortex, with rostral extension to premotor cortex and caudal extension to posterior parietal cortex. Our anatomy-based approach should facilitate the expression and the comparison of the results obtained in motor mapping studies using navigated TMS. © 2013 Wiley Periodicals, Inc.


Hammoudeh A.J.,Istishari Hospital | Echtay A.,Lebanese University | Ghanem G.Y.,University Medical Center Rizk Hospital | Haddad J.,Istishari Hospital
Current Medical Research and Opinion | Year: 2014

Background: Several studies that evaluated achieving lipid goals have demonstrated an undertreatment of dyslipidemia. We evaluated the use and efficacy of lipid-lowering agents (LLAs) in reducing low-density lipoprotein cholesterol (LDL-C) to recommended levels in the Levant region. Design and methods: A multi-center, cross-sectional survey enrolled 1002 dyslipidemic patients (August 2010 - January 2011) on LLAs for 3 months. Collection of data and blood samples was done over one visit. Physicians and patients filled out questionnaires pertaining to dyslipidemia diagnosis and treatment. LDL-C target levels were defined according to international guidelines. Results: The full analysis set included 992 patients. Mean age was 58.0 ± 11.6 years (41% women, 65.7% diabetics and 51.5% had history of coronary heart disease). LLAs were prescribed for primary prevention or secondary prevention or familial hypercholesterolemia in 45.8% and 52.8% and 1.4% of patients; respectively. Overall, 64.0% and 56.8% of the patients attained their LDL-C goal recommended by the NCEP ATP III and TJETF guidelines, respectively. According to the 2004 NCEP ATP III updated guidelines, about 24.8% of the very high risk group attained their LDL goal of 70 mg/dL. Smoking, diabetes, metabolic syndrome, history of cardiovascular disease, increased waist circumference, and elevated pre-treatment LDL-C level were all associated with not reaching LDL-C goals. Conclusions: Although the study cohort was a relatively high risk group and might not be representative of the general population, we found that about 60% of enrolled individuals achieved the LDL-C treatment goals and 24.8% of the very high risk group achieved the recommended LDL-C targets of 70 mg/dl; national strategies and aggressive awareness campaigns to effectively control lipid levels to recommended target levels, especially in the high risk groups, are urgently needed. © 2014 Informa UK Ltd.


Ahdab R.,University Paris Est Creteil | Ahdab R.,University Medical Center Rizk Hospital | Ayache S.S.,University Paris Est Creteil | Ayache S.S.,University Medical Center Rizk Hospital | And 3 more authors.
Brain Topography | Year: 2016

The hand motor hot spot (hMHS) is one of the most salient parameters in transcranial magnetic stimulation (TMS) practice, notably used for targeting. It is commonly accepted that the hMHS corresponds to the hand representation within the primary motor cortex (M1). Anatomical and imaging studies locate this representation in a region of the central sulcus called the “hand knob”. The aim of this study was to determine if the hMHS location corresponds to its expected location at the hand knob. Twelve healthy volunteers and eleven patients with chronic neuropathic pain of various origins, but not related to a brain lesion, were enrolled. Morphological magnetic resonance imaging of the brain was normal in all participants. Both hemispheres were studied in all participants except four (two patients and two healthy subjects). Cortical mapping of the hand motor area was conducted using a TMS-dedicated navigation system and recording motor evoked potentials (MEPs) in the contralateral first dorsal interosseous (FDI) muscle. We then determined the anatomical position of the hMHS, defined as the stimulation site providing the largest FDI-MEPs. In 45 % of hemispheres of normal subjects and 25 % of hemispheres of pain patients, the hMHS was located over the central sulcus, most frequently at the level of the hand knob. However, in the other cases, the hMHS was located outside M1, most frequently anteriorly over the precentral or middle frontal gyrus. This study shows that the hMHS does not always correspond to the hand knob and M1 location in healthy subjects or patients. Therefore, image-guided navigation is needed to improve the anatomical accuracy of TMS targeting, even for M1. © 2016, Springer Science+Business Media New York.


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.


Wagner G.J.,RAND Corporation | Aunon F.M.,RAND Corporation | Kaplan R.L.,University of California at Berkeley | Rana Y.,RAND Corporation | And 5 more authors.
PLoS ONE | Year: 2012

Men who have sex with men (MSM) may account for most new HIV infections in Lebanon, yet little is known about the factors that influence sexual risk behavior and HIV testing in this population. Qualitative interviews were conducted with 31 MSM living in Beirut, and content analysis was used to identify emergent themes. Mean age of the participants was 28.4 years, and all identified as either gay (77%) or bisexual (23%). Half reported not using condoms consistently and one quarter had not been HIV-tested. Many described not using condoms with a regular partner in the context of a meaningful relationship, mutual HIV testing, and a desire to not use condoms, suggesting that trust, commitment and intimacy play a role in condom use decisions. Condoms were more likely to be used with casual partners, partners believed to be HIV-positive, and with partners met online where men found it easier to candidly discuss HIV risk. Fear of infection motivated many to get HIV tested and use condoms, but such affect also led some to avoid HIV testing in fear of disease and social stigma if found to be infected. Respondents who were very comfortable with their sexual orientation and who had disclosed their sexuality to family and parents tended to be more likely to use condoms consistently and be tested for HIV. These findings indicate that similar factors influence the condom use and HIV testing of MSM in Beirut as those observed in studies elsewhere of MSM; hence, prevention efforts in Lebanon can likely benefit from lessons learned and interventions developed in other regions, particularly for younger, gay-identified men. Further research is needed to determine how prevention efforts may need to be tailored to address the needs of men who are less integrated into or do not identify with the gay community. © 2012 Wagner et al.


Aouad M.T.,American University of Beirut | Yazbeck-Karam V.G.,University Medical Center Rizk Hospital | Mallat C.E.,American University of Beirut | Esso J.J.,American University of Beirut | And 2 more authors.
Paediatric Anaesthesia | Year: 2012

Summary Intubation without prior administration of muscle relaxants is a common practice in children. However, succinylcholine may be considered as the golden standard for optimizing intubating conditions. We conducted a systematic review of the literature to identify drug combinations that included induction of anesthesia with sevoflurane or propofol. Our aim was to select drug combinations that yield excellent intubating conditions ≥80%; we identified six combinations in children aged 1-9 years. Sevoflurane with remifentanil (1 or 2 μg·kg -1), lidocaine (2 mg·kg -1), or propofol (2 mg·kg -1) as the adjuvant shared the following characteristics: premedication with midazolam and/or ketamine, long sevoflurane exposure time, high inspired and endtidal sevoflurane concentration, and assisted ventilation. One combination using sevoflurane with propofol (3 mg·kg -1) without premedication, with shorter sevoflurane exposure time, and spontaneous breathing indicated that propofol may be the adjuvant of choice for a rapid sevoflurane induction. The only adjuvant identified in propofol induction was remifentanil (4 μg·kg -1). No serious adverse events were reported with these combinations. © 2012 Blackwell Publishing Ltd.


Ahdab R.,University Medical Center Rizk Hospital | Riachi N.,University Medical Center Rizk Hospital
European Neurology | Year: 2014

Objective: Investigate the added value of hyperventilation (HV) and intermittent photic stimulation (IPS) to the routine electroencephalogram (EEG). Method: This is a retrospective review of 1,172 successive EEGs. The records with evidence of epileptogenic activity were identified and further analyzed to identify if the activation techniques could trigger the expression of epileptic activity not seen otherwise in the nonactivated tracing. Results: Activation procedures provided additional information in 9.5% of the abnormal EEG files. They helped establish the diagnosis of an epileptic disorder or further characterize the epileptic syndrome. This occurred exclusively in the younger age group (age <36 years), and predominantly in women. Conclusion: IPS and HV are easy to perform and remain important adjuncts to routine EEG. They may trigger the expression of epileptogenic activity in an otherwise uneventful EEG. Whereas their diagnostic value was obvious in the younger age group, we found no evidence to support their usefulness in the middle-age and elderly groups. © 2013 S. Karger AG, Basel.


Sfeir M.,Lebanese University | Sfeir M.,University of Miami | Obeid Y.,University Medical Center Rizk Hospital | Eid C.,University Medical Center Rizk Hospital | And 6 more authors.
American Journal of Infection Control | Year: 2014

Background There is an increasing concern about methicillin-resistant Staphylococcus aureus (MRSA) infections in the community. This study aimed to evaluate the rate of S aureus nasopharyngeal colonization in outpatients as the primary endpoint, and also to study the impact of several possible risk factors, including recent hospitalization, recent surgical procedures, and antibiotic intake. Methods A total of 1,526 consecutive outpatients underwent surveillance cultures after completing a questionnaire. Isolated S aureus strains were tested for antibiotic susceptibility. The Pearson χ2 test was used for statistical analysis. The differences were considered to be statistically significant at a P value <.05. Results Out of the 1,526 outpatients tested, 133 (8.7%) carried S aureus in the nose and/or throat. Only 2 of those cases were MRSA, and both were isolated from the nose. One hundred thirty-one patients had methicillin-sensitive S aureus, 13 with simultaneous carriage in the nose and throat. Among the risk factors, a relative working in health care, presence of an intravascular device, recent dental procedure, and health club use were significantly associated with an increased risk of S aureus colonization, with P values of.00,.02,.04, and.00, respectively, calculated by the χ2 test. Conclusions The prevalence of MRSA is still low in our study population within the Lebanese community. The only significant risk factors playing a role in increasing the carriage of S aureus were related to health care exposure.

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