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Celiac disease in Middle Eastern and North African countries:A new burden?

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World Journal of Gastroenterology 2010年第12期16卷 1449-1457页

作者： kassem barada Abbas Bitar Mohamad Abdul-Razak Mokadem Jana Ghazi Hashash Peter Green Division of Gastroenterology Department of Internal MedicineAmerican University of Beirut Medical Center Department of Internal Medicine American University of Beirut Medical Center Department of Internal Medicine Indiana University School of Medicine Department of Internal Medicine University of Pittsburgh Medical Center Division of Gastroenterology Department of Internal MedicineColumbia University College of Physicians and Surgeons

Celiac disease(CD) is now recognized as a common disorder among Middle Eastern(ME) and North African(NA) *** aim of this review is to assess the available data regarding CD in the ME and NA and to compare this information with that of Western countries.A literature review was performed using the electronic databases PubMed and Medline(1950-2008) as search engines,and "celiac disease" was used as a Mesh *** search was limited to ME and NA *** prevalence of CD in ME and NA countries among low risk populations is similar to that of Western countries,but is higher in high risk populations such as those with type 1 *** is underestimated because of lack of clinical suspicion and lack of patient *** presentations in term of gastrointestinal,hematologic,skeletal,and liver manifestations are similar between both populations except for a high prevalence of short stature in some ME and NA *** studies have addressed atypical or silent *** in the West,diagnosis is initially made by serological tests and is confirmed by small intestinal ***-free diet is the main mode of treatment with a higher apparent adherence rate than in the *** disease complications result from *** disease is strongly associated with HLA DQ2 and to a lesser extent with HLA DQ8 *** conclusion,CD prevalence is underestimated,with little data available about its malignant *** parameters in the ME and NA are otherwise similar to those in Western countries.

关键词： Celiac disease Gluten-free diet Insulin dependent diabetes mellitus Iron defi ciency anemia Middle East

Wilson's disease in Lebanon and regional countries: Homozygosity and hepatic phenotype predominance

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World Journal of Gastroenterology 2017年第36期23卷 6715-6725页

作者： kassem barada Aline El Haddad Meghri Katerji Mustapha Jomaa Julnar Usta Department of Internal Medicine American University of Beirut Medical Center Department of Biochemistry and Molecular Genetics Faculty of Medicine American University of Beirut

AIM To determine the phenotypes and predominant diseasecausing mutations in Lebanese patients with Wilson's disease,as compared to regional non-European *** The clinical profile of 36 patients diagnosed in Lebanon was studied and their mutations were determined by molecular *** patients underwent full physical exam,including ophthalmologic slit-lamp examination ultrasound imaging of the liver,as well as measurement of serum ceruloplasmin and 24-h urinaryCu *** addition,genetic screening using PCR followed by sequencing to determine disease-causing mutations and polymorphisms in the ATP7B gene was carried on extracted DNA from patients and immediate family *** phenotypic-genotypic findings were then compared to reported mutations in Wilson's disease patients from regional Arab and non-European countries. RESULTS Patients belonged to extended consanguineous *** majority were homozygous for the disease-causing mutation,with no predominant mutation identified. The most common mutation,detected in 4 out of 13families,involved the ATP hinge region and was present in patients from Lebanon,Egypt,Iran and ***,mutations in Lebanese patients and those of the region were scattered over 17 exons of *** the homozygous exon 12 mutation Trp939Cys was only detected in patients from Lebanon but none from the regional countries,the worldwide common mutation H1069Q was not present in the Lebanese and was rare in the *** hepatic phenotype was predominant in patients from both Lebanon and the region(25%-65%).Furthermore,the majority of patients,including those who were asymptomatic,had evidence of some hepatic *** neurologic phenotype was rare. CONCLUSION Findings do not support presence of a founder *** and genetic screening is recommended for family members with index patients and unexplained hepatic dysfunction.

关键词： Wilson Disease Cu-metabolism Phenotype Genotype ATP7B Hepatic manifestations

Giant sporadic fundic gland polyp:Endoscopic and endosonographic features and management

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World Journal of Gastroenterology 2008年第42期14卷 6593-6595页

作者： Ihab I El Hajj Mohamad Hawchar Assaad Soweid Karim Maasri Ayman Tawil kassem a barada Department of Internal Medicine Division of Gastroenterology and Hepatology American University of Beirut Medical Center PO Box 11-0236 Beirut 11072020 Lebanon Department of Pathology and Laboratory Medicine American University of Beirut Medical Center Beirut 11072020 Lebanon

Fundic gland polyps are the most common gastric polyps. They are usually small in size, sporadic and asymptomatic. We present a case of giant fundic gland polyp. Our case is particular because of the clinical presenta... 详细信息

关键词： Fundic gland polyp Anemia Endoscopic ultrasonography

Effect of mucin production on survival in colorectal cancer:A case-control study

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World Journal of Gastroenterology 2008年第45期14卷 6981-6985页

作者： Mirna H Farhat kassem a barada Ayman N Tawil Doha M Itani Hassan A Hatoum Ali I Shamseddine Division of Hematology-Oncology Internal Medicine American University of Beirut Division of Gastroenterology Internal Medicine American University of Beirut Department of Pathology American University of Beirut

AIM： TO investigate the impact of mucin production on prognosis in colorectal cancer, in terms of overall survival （OS） and time to disease progression （TTP） in patients with mucinous compared to those with nonmucinous colorectal cancer （NMCRC）, matched for age, gender, and tumor stage. METHODS： Thirty five patients with mucinous colorectal cancer （MCRC） were matched for age, gender, and tumor stage with 35 controls having NMCRC. OS and TTP were compared among 4 groups divided according to mucin content： group A （50%-75% mucin）, group B （75%-100% mucin）, group C or controls （〈 50% mucin）. Group D consisted of all patients with tumors having 〈 75% mucin （controls and groups A together）. RESULTS： Median survival in MCRC and NMCRC groups was 46.2 and 112.9 mo, respectively （P = 0.26）. OS in groups A and B was 70.1 and 32.8 mo （P = 0.46）, and in groups B and D was 32.8 and 70.1 mo, respectively （P = 0.143）. TTP in MCRC and NMCRC was 50.17 and 44.77 too, respectively （P = 0.795）. TTP in groups A, B, and D was 70.1, 24.8, and 65.5 too, respectively. Twenty-eight percent of patients with MCRC had poorly differentiated adenocarcinoma versus 8.6% in NMCRC patients （P = 0.028）. CONCLUSION： MCRC is associated with a non-significant decrease in median survival and TTP, particularly when mucin content is 〉 75% of tumor volume. However, it tends to be more poorly differentiated. A larger study matching for stage and grade is needed.

关键词： Colorectal cancer Adenocarcinoma Mucin Mucinous Prognosis

Prognostic factors in patients with advanced cholangiocarcinoma: Role of surgery, chemotherapy and body mass index

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World Journal of Gastroenterology 2008年第20期14卷 3224-3230页

作者： Mirna H Farhat Ali I Shamseddine Ayman N Tawil Ghina Berjawi Charif Sidani Wael Shamseddeen kassem a barada Division of Hematology-Oncology Department of Internal Medicine American University of Beirut Medical Center Department of Pathology American Universityof Beirut Medical Center Department of Radiology American University of Beirut Medical Center Department of Public health American University of Beirut Medical Center Division of Gastroenterology Departmentof Internal Medicine American University of Beirut MedicalCenter

AIM： To study the factors that may affect survival of cholangiocarcinoma in Lebanon. METHODS： A retrospective review of the medical records of 55 patients diagnosed with cholangio- carcinoma at the American University of Beirut between 1990 and 2005 was conducted. Univariate and multivariate analyses were performed to determine the impact of surgery, chemotherapy, body mass index, bilirubin level and other factors on survival. RJ^SULTS： The median survival of all patients was 8.57 mo （0.03-105.2）. Univariate analysis showed that low bilirubin level （〈 10 mg/dL）, radical surgery and chemotherapy administration were significantly associated with better survival （P = 0.012, 0.038 and 0.038, respectively）, in subgroup analysis on patients who had no surgery, chemotherapy administration prolonged median survival significantly （17.0 mo vs 3.5 mo, P = 0.001）. Multivariate analysis identified only low bilirubin level 〈 10 mg/dL and chemotherapy administration as independent predictors associated with better survival （P 〈 0.05）. CONCLUSION： Our data show that palliative and postoperative chemotherapy as well as a bilirubin level 〈 10 mg/dL are independent predictors of a significant increase in survival in patients with cholangiocarcinoma.

关键词： Cholangiocarcinoma Biliary tract cancer Chemotherapy Bilirubin Prognosis

Inflammatory bowel disease in rats:Bacterial and chemical interaction

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World Journal of Gastroenterology 2008年第25期14卷 4028-4039页

作者： Inaya Abdallah Hajj Hussein Rania Tohme kassem barada Mostafa Hassan Mostafa Jean-Noel Freund Rosalyn A Jurjus Walid Karam Abdo Jurjus Faculty of Medicine 110236/41 Riad El-Slaleh 1107-2020 American University of Beirut Faculty of Science 115020 Beirut Arab University INSERM 682 Ontogenese et pathologie du system digestif Strasbourg France Institut National De Pathologie Beirut Lebanon

AIM：To develop a novel model of colitis in rats, using a combination of iodoacetamide and enteropathogenic E. coli（EPEC）, and to elucidate the pathophysiologic processes implicated in the development of ulcerative colitis （UC）. METHODS： Hale Sprague-Dawley rats （/7 = 158） were inoculated intrarectally on a weekly basis with 4 different combinations：（a） 1% methylcellulose （HC）, （b） 100 μL of 6% iodoacetamide （IA） in 1% HC, （c） 200 p.L containing 4×10^8 colony factor units （CFU） of EPEC, and （d） combined treatment of （IA） followed by bacteria （13） after 2 d. Thirty days post treatment, each of the four groups was divided into two subgroups; the inoculation was stopped for one subgroup and the other subgroup continued with biweekly inoculation until the end of the experiment. Colitis was evaluated by the clinical course of the disease, the macroscopic and microscopic alterations, activity of myeloperoxidase （HPO）, and by TNF-α gene expression. RESULTS： Findings indicative of UC were seen in the combined treatment （IA ＋ B） as well as the IA continued treatment groups： the animals showed slow rate of increase in body weight, diarrhea, bloody stools, high colonic ulcer score, as well as histological alterations characteristic of UC, with an extensive inflammatory reaction. During the course of the experiment, the MPO activity was consistently elevated and the TNF-α gene expression was upregulated compared to the control animals. CONCLUSION： The experimental ulcerative colitis model used in the present study resembles, to a great extent, the human disease. It is reproducible with characteristics indicative of chronicity.

关键词： Colitis Escherichchia coli Iodoacetamide Inflammatory bowel disease model Gastrointestinalinflammation

N-Acetyl Cysteine to Treat <i>Polygonum multiflorum</i>Hepatotoxicity: A Case Report

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Case Reports in Clinical Medicine 2021年第1期10卷 1-7页

作者： Musa S. ALfaifi kassem A. barada Ziad N. Kazzi Zeina S. Mneimneh Eveline A. Hitti Maher A. Malaeb Santina A. Mustapha Melissa H. Gittinger Emory University School of Medicine Atlanta USA American University of Beirut Beirut Lebanon

Background: Polygonum multiflorum (brand name Fo-ti) is a Chinese herb used as an antioxidant, antiaging agent, and liver and kidney health. It can cause acute hepatotoxicity and even death. There is no published data on the effectiveness of N-Acetyl cysteine (NAC) as a sole effective therapy. Case: A 23-year-old, healthy male, presented with jaundice and malaise of one-month duration. He had been taking a Chinese herb named Fo-Ti for 2 months. Physical examination revealed jaundice, with no stigmata of chronic liver disease. His laboratory results showed transaminitis with markedly elevated transaminases. Testings for infectious and autoimmune causes were unremarkable. The patient was admitted to the hospital. Fo-Ti was stopped and he was started on oral NAC as peroral protocol. He was discharged home on esomeprazole and oral NAC. He returned on the second day with worsening jaundice. He was readmitted and esomeprazole was discontinued. NAC was continued and his liver enzymes eventually improved. The supplement was tested by gas-chromatography mass spectrometry and measured the presence of emodin. Discussion: This case highlights the potential benefit of NAC as treatment of Polygonum multiflorum induced hepatotoxicity. The proposed mechanism of emodin induced liver injury is through disturbing glutathione metabolism in liver cells. This could explain the favorable response as NAC has the ability to replenish intracellular glutathione. Conclusion: Polygonum multiflorum use has been associated with severe and prolonged hepatotoxicity. Oral NAC should be considered in the treatment of these patients due to the favorable risk-benefit ratio.

关键词： Polygonum multiflorum N-Ace Tylcysteine Hepatotoxicity

Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding

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世界胃肠外科杂志：英文版（电子版） 2016年第7期8卷 501-507页

作者： Karina M Souk Hani M Tamim Hussein A Abu Daya Don C Rockey kassem a barada Department of Internal Medicine American University of Beirut-Medical Center Biostatistics Support Unit Clinical Research Institute American University of Beirut-Medical Center Department of Internal Medicine University of Pittsburgh Medical Center Department of Internal Medicine the Medical University of South Carolina Division of Gastroenterology and Hepatology American University of Beirut-Medical Center

AIM: To compare outcomes of patients with nonvariceal upper gastrointestinal bleeding(NVUGIB) taking aspirin for primary prophylaxis to those not taking ***: Patients not known to have any vascular disease(coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics. We also compared frequency of in hospital complications and length of hospital stay between the two ***: Of 357 eligible patients, 94 were on aspirin and 263 patients were on no antithrombotics(controlgroup). Patients in the aspirin group were older, the mean age was 58 years in controls and 67 years in the aspirin group(P < 0.001). Patients in the aspirin group had significantly more co-morbidities, including diabetes mellitus and hypertension [25(27%) vs 31(112%) and44(47%) vs 74(28%) respectively,(P = 0.001)], as well as dyslipidemia [21(22%) vs 16(6%), P < 0.0001).Smoking was more frequent in the aspirin group [34(41%) vs 60(27%), P = 0.02)]. The frequencies of endoscopic therapy and surgery were similar in both groups. Patients who were on aspirin had lower inhospital mortality rates(2.1% vs 13.7%, P = 0.002),shorter hospital stay(4.9 d vs 7 d, P = 0.01), and fewer composite outcomes(10.6% vs 24%, P = 0.01). The frequencies of in-hospital complications and re-bleeding were similar in the two ***: Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes. Thus aspirin may have a protective effect beyond its cardiovascular benefits.

关键词： Aspirin Morbidity Mortality Non-variceal upper gastrointestinal bleeding Outcomes