Salam Itani

Acrodermatitis Continua of Hallopeau Is a Clinical Phenotype of DITRA: Evidence that It Is a Variant of Pustular Psoriasis

Acrodermatitis continua of Hallopeau (ACH) is a rare, chronic, sterile, pustular eruption that predominantly affects the fingertips with nail involvement. While some consider ACH a distinct entity, many believe it to be a variant of pustular psoriasis, especially as cases of ACH progressing to generalized pustular psoriasis (GPP) have been reported. Recently, recessively inherited mutations in the IL36RN gene, which encodes interleukin-36 receptor antagonist (IL-36Ra), have been demonstrated to be the cause of familial GPP, a condition termed DITRA (deficiency of IL-36Ra). Here, we identified a homozygous missense mutation c.338C>T (p.Ser113Leu) in the IL36RN gene in a male patient with ACH, as well as in his sister who had a history of GPP.

The effect of war stress on multiple sclerosis exacerbations and radiological disease activity

OBJECTIVE The relationship between stressful life events and multiple sclerosis (MS) exacerbations or radiological disease activity is at best controversial. The aim of this study is to examine the relationship between exposure to war-related events incurred during the July 2006 Israeli-Lebanese war and clinical relapses and MRI disease activity among Lebanese MS patients. METHODS We studied a group of 216 patients with clinically definite relapsing remitting MS (RRMS), on whom clinical data was available for the war period and for the preceding and following year(s). The number of relapses was determined during the war period and during similar periods over a 3-year span. All patients with brain MRI during the war period had their scans reviewed for evidence of disease activity as defined by the presence of gadolinium enhancing (Gd+) lesions. A group of patients with brain MRI performed outside the war period was used for comparison. RESULTS The total number of relapses during the war period (n=23) was significantly higher than during non-war periods (mean=8.4, SD=0.86) (p=0.006). Of the 18 patients with brain MRI during the war, 5/7 with relapses and 1/11 without relapses had Gd+ lesions (p=0.013). More patients had Gd+ lesions during the war period (33%) compared to controls (13%) (p=0.075). INTERPRETATION Our study shows that exposure to war-related events is likely to lead to an increase in both clinical relapses and MRI disease activity in patients with MS.

Prognostic Factors of Multiple Sclerosis in Lebanon

ABSTRACT Background: Multiple sclerosis (MS) has a variable disease course. Identifying early predictive prognostic factors is of paramount importance. Most of the data on these factors however comes from studies performed in western countries. Such data is lacking in the Arab World. The objective of this study is to identify early predictors of disability among MS patients in Lebanon. Methods: 75 relapsing-remitting MS patients with 5 year follow-up from disease onset were selected from Project MS Lebanon database. The following parameters were studied as potential causes of early disability as defined by an EDSS ≥3, after five years from disease onset: age at onset of MS, gender, interval between first and second attack, residual deficit after first attack, initial symptoms, treatment for at least 1 year in the first 5 years, and the number of relapses in the first 2 and 5 years. Results: Patients with incomplete recovery from the first relapse were 11.66 times more likely to have a higher EDSS after 5 years (CI = 2.02–67.31, p = .001). Furthermore, the number of relapses during the first 5 years was also an independent predictor of EDSS ≥ 3 at 5 years (p = .024). Other factors were not shown to predict a worse outcome. Conclusion: Overall, early predictors of disability in MS among the Lebanese population were not very different from similar predictors in western countries.

High prevalence of metabolic syndrome in patients with psoriasis in Lebanon: a prospective study

Psoriasis is a chronic inflammatory disease that affects not only the skin but also other organs as well. Genetic factors play an important role in individual predisposition. Lately, a positive association has been confirmed between psoriasis and metabolic syndrome (MBS), in western as well as in Middle Eastern countries.

Acute coronary syndromes: clinical characteristics, management, and outcomes at the American University of Beirut Medical Center, 2002-2005.

Data on acute coronary syndromes (ACS) in developing countries is scarce. In this report, we analyze the temporal trends in the management and outcomes of a large series of ACS patients hospitalized at the American University of Beirut Medical Center (AUBMC), a tertiary referral university hospital located in a middle income Middle Eastern developing country.

Celiac disease, Behçet, and idiopathic thrombocytopenic purpura in siblings of a patient with multiple sclerosis

Multiple sclerosis (MS) is a demyelinating disease of uncertain etiology. Many genetic and environmental risk factors have been associated with this disease including certain human leukocyte antigen haplotypes, Epstein-Barr virus infection, and vitamin D deficiency. We report a 30-year-old woman with MS, the product of consanguineous marriage, and three siblings with three different autoimmune diseases: idiopathic thrombocytopenic purpura, celiac disease, and Behçet’s disease.

Management of acute coronary syndromes in developing countries: Are we complying with practice guidelines?

Abstract Comparative clinical data on acute coronary syndromes (ACS) in developing countries to those from international registries are non-existing, particularly regarding adherence to practice guidelines and its association with clinical outcomes. In this report, we compare the management and in-hospital outcomes of 1025 patients hospitalized with ACS at the American University of Beirut Medical Center (AUBMC) to recent data from the GRACE registry. The overall revascularization rate was similar between AUBMC and GRACE (48% vs 49%), but the utilization rates of reperfusion therapy, glycoprotein IIb/IIIa inhibitors, aspirin, clopidogrel, beta blockers, ACE/ARB, and statins were consistently lower than those reported in GRACE ( p p

The interaction of gender and clinical risk profile in patients referred for exercise nuclear imaging versus exercise echocardiography

BACKGROUND Exercise myocardial perfusion imaging (E-MPI) and exercise echocardiography (E-Echo) are thought to be compatible for the non-invasive evaluation of patients with suspected coronary artery disease (CAD). The interaction of gender and clinical risk profile in the referral of patients to either of these two imaging modalities has not been well studied. METHODS AND RESULTS This was a prospective study of 922 consecutive patients who were referred for either E-MPI (331 patients) or E-Echo (591 patients) at the American University of Beirut Medical Center in the year of 2008. Men undergoing E-MPI had a higher risk profile than those undergoing E-Echo. They were older (58±12 years versus 55±12 years, p=0.002) and had a higher prevalence of multiple (>2) CAD risk factors (55% versus 37%, p<0.001) as well as a higher prevalence of prior PCI (22% versus 15%, p=0.017) or CABG (12% versus 7%, p=0.016). Furthermore, they achieved lower METS in their exercise (9.4±2.0 versus 10.4±2.3, p<0.001) and had a higher incidence of ischemia and on their scans (16% versus 9.1%, p=0.008). In contrast, women undergoing E-MPI had a similar profile to those undergoing E-Echo in terms of prevalence of risk factors, prior history of coronary events and the prevalence of ischemia or impaired ejection fraction on their scans. CONCLUSION There is an important interaction between gender and clinical risk profile in patients undergoing E-MPI versus E-Echo. In men, E-MPI seems to be the preferred test for the higher risk profile patients, whereas in women the two tests are interchangeable.

Genetic analysis of epidermolysis bullosa: Identification of mutations in LAMB3 and COL7A1 genes in three families

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