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A randomized controlled trial of imipramine in patients with irritable bowel syndrome

World Journal of Gastroenterology 2009年第29期15卷 3636-3642页

作者： heitham abdul-baki Ihab I El Hajj Lara ElZahabi Cecilio Azar Elie Aoun Assaad Skoury Hani Chaar Ala I Sharara Department of Internal Medicine Division of Gastroenterology American University of Beirut Medical Center Riad El Solh 110 72020 Beirut Lebanon

AIM: To study the efficacy of low-dose imipramine in relieving symptoms associated with the irritable bowel syndrome (IBS). METHODS: A randomized, double-blind trial of 25 mg imipramine vs matched placebo for 12 wk was performed. Doubling the dose was allowed once at week 2 in case of an unsatisfactory early response. Primary efficacy variables were subjective global symptom relief and quality of life (QoL) using SF-36 at week 12. RESULTS: One hundred and seven patients were enrolled by advertisement or referral by general practitioners and 56 (31 imipramine: 25 placebo) completed the 16-wk study. Baseline characteristics were comparable. A high overall dropout rate was noted in the imipramine and placebo arms (47.5% vs 47.9%, P > 0.05), a mean of 25.0 and 37.4 d from enrollment, respectively (P 0.05). CONCLUSION: Imipramine may be effective in the treatment of IBS patients and is associated with improved QoL. Careful patient selection, initiation of a low dose with gradual escalation and monitoring for side effects may result in an improved therapeutic response.

关键词： Tricyclic antidepressants Quality of life Functional gastrointestinal disorders Irritable bowelsyndrome Pain

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Old vs new: Risk factors predicting early onset colorectal cancer

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World Journal of Gastrointestinal Oncology 2019年第11期11卷 1011-1020页

作者： Aslam R Syed Payal Thakkar Zachary D Horne heitham abdul-baki Gursimran Kochhar Katie Farah Shyam Thakkar Division of Gastroenterology Allegheny Health NetworkPittsburghPA 15212United States Allegheny Singer Research Institute Allegheny Health NetworkPittsburghPA 15212United States Division of Radiation Oncology Allegheny Health Network Cancer InstitutePittsburghPA 15212United States

BACKGROUND Colorectal cancer(CRC)is the second leading cause of all cancer related deaths in the United States and *** the incidence has been decreasing for individuals’≥50,it has been on the rise for individuals<*** To identify potential risk factors for early-onset *** A population-based cohort analysis using a national database,Explorys,screened all patients with an active electronic medical record from January 2012 to December 2016 with a diagnosis of *** were stratified based on age(25–49 years vs≥50 years).Demographics,comorbidities,and symptom profiles were recorded and compared between both age ***,the younger group was also compared with a control group consisting of individuals aged 25-49 years within the same timeframe without a diagnosis of *** points for CRC related factors were analyzed to identify potential risk factors specific to early-onset *** A total of 68860 patients were identified with CRC,of which 5710(8.3%)were younger than 50 years old,with 4140(73%)between 40-49 years of *** analysis was reported using odds ratio(OR)with 95%CI and demonstrated that several factors were associated with an increased risk of CRC in the early-onset group versus the later-onset *** factors included:African-American race(OR 1.18,95%CI:1.09-1.27,P<0.001),presenting symptoms of abdominal pain(OR 1.82,95%CI:1.72-1.92,P<0.001),rectal pain(OR 1.50,95%CI:1.28-1.77,P<0.001),altered bowel function(OR 1.12,95%CI:1.05-1.19,P=0.0005),having a family history of any cancer(OR 1.78,95%CI:1.67-1.90,P<0.001),gastrointestinal(GI)malignancy(OR 2.36,95%CI:2.18-2.55,P<0.001),polyps(OR 1.41,95%CI:1.08-1.20,P<0.001),and obesity(OR 1.14,95%CI:1.08-1.20,P<0.001).Comparing the early-onset cohort versus the control group,factors that were associated with an increased risk of CRC were:male gender(OR 1.34,95%CI:1.27-1.41),P<0.001),Caucasian(OR 1.48,95%CI:1.40-1.57,P<0.001)and African-American race(OR 1

关键词： Colorectal cancer Early-onset colorectal cancer Colorectal cancer screening Epidemiology analysis Colorectal neoplasm Average-risk screening

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Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival

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World Journal of Gastroenterology 2006年第22期12卷 3575-3580页

作者： César Yaghi Ala I Sharara Paul Rassam Rami Moucari Khalil Honein Joseph BouJaoude Rita Slim Roger Noun heitham abdul-baki Mohamad Khalifeh Sami Ramia Raymond Sayegh Service de Gastroenterologie Hotel Dieu de France University Hospital BeirutLebanon Service de Gastroenterologie Hotel Dieu de France University Hospital.Beirut.Lebanon Departments of Internal Medicine and Surgery American University of Beirut Medical CenterBeirutLebanon Service de Gastroenterologie Hotel Dieu de France University Hospital BeirutLebanon Service de GastroenterologieHopital Saint GeorgesBeirutLebanon Departments of Internal Medicine and Surgery American University of Beirut Medical Center BeirutLebanon

AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver italian Program （CUP） score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS： Ninety-two patients （mean 60.5 ± 22.3 years） were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively （mean F/U 40.2 ± 23.5 mo）. Multivariate analysis identified three predictors of early mortality （〈 6 mo）： bilirubin 〉 3.2 mg/dL （P 〈 0.01）, HCC as first presentation of liver disease （P = 0.035）, and creatinine 〉 1 mg/dL （P = 0.017）. A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate.CONCLUSION： HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.

关键词： Liver Epidemiology Hepatitis Neoplasm Cancer Cirrhosis

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Frequency of diabetic retinopathy and associated risk factors in Khartoum,Sudan:population based study

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International Journal of Ophthalmology(English edition) 2017年第6期10卷 948-954页

作者： Einas S Elwali Ahmed O Almobarak Mona A Hassan Amir A Mahmooud heitham Awadalla Mohamed H Ahmed Department of Medicine and HIV Metabolic Clinic Milton Keynes University Hospital NHS Foundation Trust Eaglestone Milton Keynes Buckinghamshire MK 6 5LD UK

AIM： To assess the frequency and associated risk fac- tors of diabetic retinopathy among Sudanese individuals with diabetes attending Makka Eye complex in Khartoum, Sudan. METHODS： The cross sectional hospital based study recruited 316 individuals with diabetes from Makkah Eye Complex Retina Clinic. Standard questionnaire was used to collect demographic data, medical history and life style characteristics. Blood samples were taken to measure HbAlc and lipid profile. Fundus and slit lamp examination were performed for screening of diabetic retinopathy. RESULTS： Among 316 participants, 187 （59.2%） were males and 129 （40.8%） were females. The mean age of participants was 58.7＋_10.5y. The overall frequency of retinopathy was 261 （82.6%）. The percentages of the total participants with proliferative diabetic retinopathy （PDR） were 126 （39.9%） and non-proliferative diabetic retinopathy （NPDR） were 135 （42.7%）. importantly, duration of diabetes mellitus （DM）（72.2% of more than 10y）, being on oral hypoglycaemic drugs （versus insulin）, and hypertension were all significant risk factors for diabetic retinopathy （P=0.00, 0.01 and 0.00 respectively）. Complications ofdiabetes like diabetic foot （17.7%）, history of amputation （6.7%） and clinically significant macular edema （CSME）（47.4%） of the eyes were all significant risk factors （P〈0.05）. Logistic regression analysis showed that duration of diabetes, hypertension and CSME were found to be absolute risk factors （P=-0.007, 0.003 and 0,000 respectively）. Duration of DM of more than 10y have more than double risk （OR--2.8）, while having hypertension triples the risk of retinopathy （OR=3.1）. CONCLUSION： High rates of diabetic retinopathy are noted among individuals with diabetes attending Makkah Eye hospital in capital Khartoum. Urgent strategies are needed to monitor and treat hypertension and optimize diabetes control in individuals with diabetes. More investment in diabetes services is urgently needed.

关键词： diabetes Sudan diabetic retinopathy insulin

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