The off-label use of rituximab for the management of inflammatory disorders: American University of Beirut Medical Center experience

Objectives: This study aims to evaluate the efficacy of off-label use of rituximab with possible side effects.; Patients and methods: Records of the 44 American University of Beirut Medical Center pharmacies were searched for patients who used rituximab over the past 4.5 years, and data on rituximab dosage, protocol and side effects were documented. The majority of patients had systemic lupus erythematosus. Autoimmune thrombocytopenic purpura, antiphospholipid syndrome, Sjögren's syndrome, Wegener’s granulomatosis, autoimmune hemolytic anemia, dermatomyositis, and pemphigus vulgaris were also reported. Outcome measures were improvement in signs and symptoms during a follow-up period of two years.; Results: Twenty-nine out of the 44 patients had complete response without relapse. Of those, 12 patients were in remission after the first cycle. Of the systemic lupus erythematosus cases, 12 had complete response without relapse; of which, five patients had remission after the first cycle. No significant toxicities were noted.; Conclusion: The off-label use of rituximab in various inflammatory diseases showed improvement in symptoms with no significant side effects in patients who have failed previous treatment with multiple conventional regimens. © 2014 Turkish League Against Rheumatism. All rights reserved

Metronomic chemotherapy for patients with metastatic breast cancer: Review of effectiveness and potential use during pandemics

Metronomic chemotherapy (M-CT) is defined as dose dense administration of chemotherapy at lower doses than maximum tolerated dose but at shorter free intervals, to obtain a near continuous exposure of cancer cells to those potentially effective drugs. M-CT is a useful strategy to obtain response, overcome resistance and reduce side effects, with low costs. This review will focus on the use of M-CT in advanced breast cancer (ABC). Cytostatic and cytotoxic effect on cancer cells, the anti-angiogenic and the immunomodulatory effects are its main mechanisms of actions. Many clinical trials proved the efficacy and tolerability of different monotherapies and combinations of chemotherapeutic agents administered in metronomic doses and frequencies in ABC. M-CT is a reasonable option for second and later lines of chemotherapy in metastatic breast cancer including those with prior anthracycline or taxane exposure, older patients and patients with comorbidities, and even as first-line in certain groups of patients. The acceptable efficacy and low toxicity of oral metronomic chemotherapy makes it a reasonable option during COVID-19 pandemic as well as in the post-COVID era which is projected to last for some time. © 2020 Elsevier Lt

Genetic Counseling, Screening and Risk-Reducing Surgery in Patients with Primary Breast Cancer and Germline BRCA Mutations: Unmet Needs in Low- and Middle- Income Countries

Objective: Worldwide genetic counseling practices are variable and often not reported in low- and middle-income countries (LMICs). We present the follow-up genetic counseling, breast screening, risk-reducing salpingo-oophorectomy (RRSO) and contralateral prophylactic mastectomy (CPM) in a cohort of study patients with either BRCA pathogenic mutations or BRCA variant of unknown significance (VUS). Materials and Methods: Chart review and phone calls for the collection of information. Out of a cohort of 250 patients, 14 had deleterious mutations and 31 had a VUS, of whom 19 had primary early breast cancer. We collected information about genetic counseling, screening, CPM and RRSO. Results: Fourteen patients with deleterious mutations (7 BRCA1 and 7 BRCA2) and 19 patients with VUS mutations (20 VUS, 4 BRCA1, 16 BRCA2; 1 patient had both) were surveyed. Of 14 patients with deleterious BRCA mutations, 57.14% (8/14 patients) received genetic counseling from their oncologist. Subsequently 85.71% (12/14) are undergoing mammography screening and 35.71% (5/14) breast screening magnetic resonance imaging (MRI). Furthermore, 50% of them underwent CPM and 57.14% underwent RRSO. Of 19 patients with VUS mutations, 10.5% received genetic counseling from their oncologist; 78.9% were undergoing regular screening mammogram and 31.5% were undergoing breast MRI; one patient underwent CPM and two patients RRSO. Conclusion: Within three years from knowing they have a mutation, 50% of patients with germline BRCA mutations had undergone CPM and 60% RRSO, the majority of them had screening mammography surveillance but only 50% had screening MRI. Follow-up of patients with VUS with mammography was 78% but MRI was only 31%. Lack of MRI surveillance reflects both limited resources and insufficient counseling. Genetic counseling was done by medical oncologists, which reflects a trend in LMIC. Our Data shows the importance of the need for professional genetic counselors and optimal surveillance in Lebanon and other LMICs. © 2022 by the the Turkish Federation of Breast Diseases Societies

Optimized Stockwell transform for the segmentation of ECG signals

International audienceIn this study, an optimized Stockwell transform is applied on ECG signals. The optimization of time-frequency representation helps to separate better the different complex of ECG signal. The envelope of the signal is extracted by applying non linear transform on the optimized time-frequency matrix and a peak detector algorithm is applied to detect the different ECG complex. The proposed method is evaluated on synthetic and real ECG signals for healthy adult's volunteers. The robustness against noise of the proposed method is also tested and discussed

Time-Frequency Analysis Based on Stockwell Transfrom: Application on Detection and Identification of Explosives and Illicit Substances in Terahertz Spectroscopy

International audienc

S-transform based on compact support kernel

International audienceIn this paper, the use of a Compact Support Kernel (CSK) instead of the Gaussian window in the S-transform is proposed. The CSK is derived from the Gaussian but overcomes its practical drawbacks while preserving a large number of its useful properties. The width of the CSK is controlled by some parameters making it more flexible. These parameters are selected to optimize the energy concentration in the time–frequency domain. Compared to other versions of S-transform, other time–frequency representations and continuous wavelet transform, the achieved results obtained using synthetic and real data show a significant improvement in the time and frequency resolution, energy concentration and instantaneous frequency estimation

QRS detection using S-Transform and Shannon energy

International audienceThis paper presents a novel method for QRS detection in electrocardiograms (ECG). It is basedon the S-Transform, a new time frequency representation (TFR). The S-Transform providesfrequency-dependent resolution while maintaining a direct relationship with the Fourierspectrum. We exploit the advantages of the S-Transform to isolate the QRS complexes in thetime–frequency domain. Shannon energy of each obtained local spectrum is then computedin order to localize the R waves in the time domain.Significant performance enhancement is confirmed when the proposed approach is testedwith the MIT-BIH arrhythmia database (MITDB). The obtained results show a sensitivityof 99.84%, a positive predictivity of 99.91% and an error rate of 0.25%. Furthermore, to bemore convincing, the authors illustrated the detection parameters in the case of certainECG segments with complicated patterns

Smart wheelchair: integration of multiple sensors

International audienceThe aim of the present work is to develop a smart wheelchair by integrating multiple sensors for measuring user’s physiological signals and subsequently transmitting and monitoring the treated signals to the user, a designated person or institution. Among other sensors, force, accelerometer, and temperature sensors are successfully integrated within both the backrest and the seat cushions of the wheelchair; while a pulse sensor is integrated within the armrest. The pulse sensor is connected to an amplification circuit board that is, in turn, placed within the armrest. The force and temperature sensors are integrated into a textile cover of the cushions by means of embroidery and sewing techniques. The signal from accelerometer is transmitted through Wi-Fi connection. The electrical connections needed for power supplying of sensors are made by embroidered conductive threads