Pre-diabetes in overweight youth and early atherogenic risk

PURPOSE: To compare atherogenic lipoprotein particles and vascular smooth muscle biomarkers in overweight youth with pre-diabetes (PD) vs. normal glucose tolerance (NGT). METHODS: 144 adolescents (60 black, 84 white; 102 female; PD=45, NGT=99) aged 10-19 years underwent a fasting blood draw and 2-h OGTT. Lipoprotein particle size and subclass concentration and vascular smooth muscle biomarkers (ICAM-1, VCAM-1 and E-selectin) were compared between youth with PD and NGT. RESULTS: Compared with NGT, PD adolescents had smaller LDL (mean±SE: 20.5±0.1 vs. 21.0±0.1 nm; P=0.002) and HDL (8.62±0.05 vs. 8.85±0.04 nm; P=0.013) size and elevated medium small (159.2±10.3 vs. 123.8±6.4 nmol/L; P=0.037) and very small (626.3±45.4 vs. 458.5±26.4 nmol/L; P=0.032) LDL particle concentrations, after adjustment for race and BMI. Further adjusting for fasting insulin or visceral adiposity obviated these differences between the groups except for LDL size. ICAM-1 and E-selectin did not differ in youth with PD but correlated with LDL and HDL size, and small LDL particle concentrations. CONCLUSIONS: Overweight adolescents with PD have an atherogenic lipoprotein profile of small LDL and HDL size and increased concentrations of small LDL, moderated by insulin resistance and visceral adiposity, but independently driven by dysglycemia for LDL size. Associations between smooth muscle biomarkers and lipoproteins could be an early signal heralding the atherogenic process. It remains to be determined if correction of dysglycemia and associated lipoprotein abnormalities in obese youth could prove effective in halting this process

Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries

Tamoxifen metabolism predicts drug concentrations and outcome in premenopausal patients with early breast cancer

Tamoxifen is the standard-of-care treatment for estrogen receptor-positive premenopausal breast cancer. We examined tamoxifen metabolism via blood metabolite concentrations and germline variations of CYP3A5, CYP2C9, CYP2C19 and CYP2D6 in 587 premenopausal patients (Asians, Middle Eastern Arabs, Caucasian-UK; median age 39 years) and clinical outcome in 306 patients. N-desmethyltamoxifen (DM-Tam)/(Z)-endoxifen and CYP2D6 phenotype significantly correlated across ethnicities (R2: 53%, P<10?77). CYP2C19 and CYP2C9 correlated with norendoxifen and (Z)-4-hydroxytamoxifen concentrations, respectively (P<0.001). DM-Tam was influenced by body mass index (P<0.001). Improved distant relapse-free survival (DRFS) was associated with decreasing DM-Tam/(Z)-endoxifen (P=0.036) and increasing CYP2D6 activity score (hazard ratio (HR)=0.62; 95% confidence interval (CI), 0.43–0.91; P=0.013). Low (<14?nM) compared with high (>35?nM) endoxifen concentrations were associated with shorter DRFS (univariate P=0.03; multivariate HR=1.94; 95% CI, 1.04–4.14; P=0.064). Our data indicate that endoxifen formation in premenopausal women depends on CYP2D6 irrespective of ethnicity. Low endoxifen concentration/formation and decreased CYP2D6 activity predict shorter DRFS

Managing lung cancer during coronavirus disease 2019 pandemic

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as a pandemic by the World Health Organization. As this disease continues to spread worldwide, it has posed enormous challenges on the healthcare of several diseases, especially cancer, because hospital facilities have invested health resources for patients with COVID-19. In-deed, patients with lung cancer are particularly vulnerable because of their poor baseline lung function and cancer-related treatment. In ad-dition, once infected, they are at an increased risk of pulmonary complications from COVID-19. Oncologists are thus facing a challenge as how to balance the treatment plans to control the disease while protecting the patients with lung cancer from COVID-19. In fact, it is crucial to provide individualized treatment recommendations to limit the risks during these difficult times. This review highlights the key challenges that oncologists face when diagnosing COVID-19 among patients with lung cancer and examines the current recommendations from available literature, clinical expertise, and expert opinions regarding managing lung cancer in the era of COVID-19. It also explores the treatment approach recommended for patients with lung cancer while avoiding putting them at excessive risk of contracting COVID-19 infection. © 2020 by Turkish Thoracic Society

Pneumonitis in Non-Small Cell Lung Cancer Patients Receiving Atezolizumab Post Chemo-Radiation

Objective: The use of Durvalumab following chemoradiotherapy in patients with stage III NSCLC, considerably increased PFS (progression free survival) and OS (overall survival). Unfortunately, Durvalumab is currently not reimbursed for this indication in Lebanon so far. We have used Atezolizumab on a series of patients to the similar mechanism of action. We report in this paper the incidence of pneumonitis using this approach. Methods: We selected from our lung cancer registry, a group of patients diagnosed with stage III NSCLC, who received Atezolizumab (Tecentriq) as consolidation therapy following concurrent chemoradiation therapy. We specifically look at the incidence and severity of pneumonitis based on Common Toxicity Criteria and Adverse Events (CTCAE). Finally, we analyzed patient and tumor characteristics looking for predictive markers for pneumonitis. Result: Of the 14 patients who met our selection criteria, 8 developed pneumonitis and 6 did not. Age, gender and smoking status did not affect the probability of having pneumonitis, with p-values of 0.98,1 and 0.86 respectively. The impact of having PDL-1 status on pneumonitis could not be assessed due to our small sample size. The mean onset of pneumonitis after completion of chemoradiotherapy is 3.62 and after starting Atezolizumab is 2.45 months. Conclusion: The administration of Atezolizumab carries a significant risk of developing pneumonitis following chemoradiation therapy for NSCLC. The presence of certain factors and tumor characteristics might affect the chances of having pneumonitis. However due to our small sample size, definitive conclusions could not be drawn. © This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License

Glycerol and natural sugar‐derived complex modulate differentially stratum corneum water‐binding properties and structural parameters in an in vitro Raman‐desorption model

The epidermal protective functions are closely associated with skin hydration homeostasis. The understanding of different states of water binding is a rising concept in assessing topically applied formulations and their interaction within the stratum corneum (SC). In addition to global water content, primary bound water, partially bound water, and unbound water and barrier-related lipid lateral packing and protein secondary structure can be measured by Raman spectroscopy. This study aimed to establish an in vitro SC model to evaluate differences in the efficacy of a natural sugar-derived complex in combination with glycerol and a botanical extract in modulating SC water binding and structural proteins and barrier lipids. These compounds were selected due to their water-binding and soothing properties. The SC water profiles were assessed at the surface and in 8 mu m SC depth. After a 12-hour hyperhydration and subsequent product incubation the measurements were performed during a 6 hours desiccation phase. The maximal water caption and the time until reaching a steady state are measured as well as water retention and resistance against water loss. Global water content, partially bound, and unbound water, as well as lipid and protein structures were assessed with confocal Raman microspectroscopy. Both the natural sugar-derived mixture and more pronounced, the same mixture with additional glycerol increased all three water-binding parameters at the surface and in 8 mu m SC depth at the beginning and during the desiccation phase. Further addition of botanical extract did not result in an additional increase of the water-binding. All three formulations showed an increase in the lipid lateral packing values prevented the protein alteration as measured by beta-sheets signal compared to blank. The present model is suited for screening studies comparing the specific effects of different compounds on hydration states. The natural sugar-derived mixture Aquaxyl showed evidence for an improvement of all SC hydration states, lipid and protein structure which was further enhanced by the addition of glycerol 5%. This improvement was evidenced at the surface and within the SC for all hydration-related parameters, and the lipid as well the protein structures. The addition of botanical extract phytoessence blue daisy did not show further improvement

Impact of thoracic multidisciplinary tumor boards on the management of patients with cancer: A retrospective study at the American university of Beirut medical center

Multidisciplinary tumor boards (MDT) provide an opportunity for experts from different specialties and expertise to pool and complement each other's experience and inputs. Several factors impact the MDT discussions, including the meeting's structure, time management, and expert leadership. The process of MDT, their utilization, and efficacy need continuous assessment and improvement. A retrospective study was conducted to review the process of thoracic MDT, their plans of therapy, and changes in diagnosis and treatment plans for patients with cancer at the American University of Beirut Medical Center (AUBMC) over the period of one year. The primary outcome measure was the percentage of patients presented at the thoracic MDT who had a change in their treatment plan after the presentation. A total of 214 cases were scheduled for thoracic MDT during the study period. The majority, 132 (61.7%) did not have a treatment plan before presenting in the MDT. Of the 195 cases presented, only 43 (22.0%) did not have a change in their plan, while 88 (45.2%) of the cases presented had a change in their treatment plan. A total of 64 (32.8%) cases consisted of discussion of the diagnosis during MDT with either confirmation or modification of the patients' diagnosis. Of the 195 cases that were presented, the majority, 170 (87.2%), had their recommended treatment plan implemented after the MDT discussion. There was an association between the stage of cancer at the time of presentation and requesting additional tests (P=0.021), but there was no association between the stage of cancer and change in treatment plan (P=0.177) nor with implementation of recommendation (P=0.217). MDT are used to make upfront management decisions. In addition to considering change in management plans as an indicator of the benefit of MDT, it is suggested that making upfront multidisciplinary plans shall be considered an additional component of indicators of the benefit of MDT. © 2023, Spandidos Publications. All rights reserved

The educational and psychological impact of the COVID-19 pandemic on medical students: A descriptive survey at the American University of Beirut

AbstractThe SARS- CoV-2 virus has been a public health crisis since its emergence in 2019. It has affected nearly all aspects of life. Education has been particularly hit, and a lot of effort has been put to implement more and more virtual platforms through online classes, meetings and conferences. Medical education has also been affected, especially because of the need for hands-on education, specifically in the clinical setting of the last 2 years. This had a huge psychological impact on the medical students currently enrolled in medical schools around the globe.In this descriptive study, we sent all medical students at the American University of Beirut Faculty of Medicine (AUBFM) an online anonymous survey by email. The survey started with general questions (age, gender and medical school year), followed by 3 sections that contain questions pertaining to the attitudes of medical students towards clinical rotations and online classes. Data was then analyzed using SPSSv24 and was then reported as percentages.Students were almost equally divided among the medical school classes (Med 1, 2, 3, and 4). The majority of clinical students (Med 3 and Med 4) reported that they feel nervous during their rotations in the hospital. Moreover, they reported that they have increased their use of disinfectants and personal protective equipment since the emergence of the pandemic. Moreover, the majority of medical students reported that they feel more stressed after shifting to online classes. Medical students also reported that they would be willing to go back to on-campus classes.This study aimed at describing the response of medical students at AUBFM to the COVID-19 pandemic in terms of stress. Limited data exists in the literature concerning the psychological impact of the COVID-19 pandemic on medical students in the middle East. Medical students reported that they feel more stressed and nervous during their clinical rotations and after the shift to online education, affecting their academic and social life. Further studies using a larger sample size are needed. © Copyright 2021 the Author(s). Published by Wolters Kluwer Health, Inc

Efficacy of lung cancer screening at the American University of Beirut Medical Center

Introduction: In Lebanon, a dedicated screening program for lung cancer is absent. Screening is largely based on the recommendation of an informed physician or the initiative of a patient. To better understand the situation, it is important to look at the available data on patients currently being screened for lung cancer in this country. Our aim in this study is to review the data and compare it with that in the literature as well as to assess the efficacy of the screening process followed. Methods: Our study accessed the electronic medical records of patients at the American University of Beirut Medical Center (AUBMC), a tertiary care center in Lebanon. We collected information on patients who underwent screening low-dose computed tomography (LDCT) scan between June 2019 and June 2021 inclusive. Records of all patients who underwent a non-contrast computed tomography (CT) scan at AUBMC during this period were collected and analyzed. Results: On average, our population had a 52.6 pack-year smoking history. Moreover, 47% of our population had an accurate pack-year reported, while 12% did not have enough information to even estimate their pack-year history. When looking at the accurate and estimated data, 5% of our population did not even meet the ≥20 pack-year smoking history. Eight patients had positive findings on the screening LDCT, which we defined as suspicious findings that require further workup (e.g., PET/CT or biopsy) or other significant incidental findings. Conclusion: A well-organized program for lung cancer screening in Lebanon is absent. Screening largely depends on the initiative of the physician or the patient. We were able to uncover multiple flaws in the screening method used, including poor documentation and follow-up. Although the screening method adopted retained some benefits in terms of detecting early malignancy, it lacked proper organization and was not ideal. A better, systematized screening program is needed to have optimal outcomes. Copyright © 2023 Harb, Alhafi and Tfayli