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Biomedical subjects

S Khoury

Publications and source records attributed to S Khoury.

At least 37 records · Page 2Linked to original sources
PubMed1997

The endemicity of Leishmania tropica (zymodeme MON-137) in the Eira-Yarqa area of Salt District, Jordan.

The endemicity of cutaneous leishmaniasis (CL) caused by Leishmania tropica was ascertained in a focus of the disease around Eira and Yarqa in Salt District, Jordan. This focus is about 10 km to the east of another focus of CL, where L. major is the causative agent. As CL occurs sporadically in the study area, with nine cases diagnosed between 1993 and 1995, it is probably zoonotic. Each case had one or two lesions and most lesions were on the face. Isoenzymatic electrophoresis showed that all the parasites isolated in the Eira-Yarqa focus and identified to zymodeme level belonged to zymodeme MON-137 and therefore differed from all the L. tropica isolates identified in other regions of Jordan. Eight species of Phlebotomus (P. alexandri, P. major, P. sergenti, P. papatasi, P. perfiliewi, P. jacusieli, P. canaaniticus and P. arabicus), two members of the Sergentomyia dentata group and S. tiberiadis and S. taizi were collected in the focus, using castor-oil traps. The epidemiological significance of the sandflies collected is discussed.

Adolescent↗
PubMed1996

Ischaemia of the hand after radial artery monitoring.

Percutaneous radial artery cannulation is commonly used for continuous monitoring of blood pressure and estimation of arterial blood gases. The purpose of this study is to define the incidence of radial artery thrombosis and associated hand ischaemia after cannulation. A prospective study of 40 patients who underwent radial artery cannulation was carried out with patients examined before and after cannulation for radial and ulnar pulses. Doppler waveforms, and finger/brachial and finger/wrist pressure indices were obtained. After cannulation 27.5% of patients developed abnormal radial artery flows with 10% having absent pulses and none having any symptoms of hand ischaemia. Radial artery cannulation is a safe procedure when performed properly and is associated with a very low incidence of hand ischaemia, despite a 27.5% incidence of abnormal radial artery flow after cannulation.

Adolescent↗
PubMed1996

Epidemiology of cutaneous leishmaniasis in Jordan: 1983-1992.

BACKGROUND: The extent of the problem of cutaneous leishmaniasis in Jordan during the decade 1983 to 1992 was investigated. METHODS: Data were collected from the dermatology departments and the laboratories of the Royal Medical Services and the Ministry of Health as well as from private dermatologists. Two thousand two hundred and ninety-five cases were verified of whom men represented 80%. The majority (80%) were < 25 years with the highest percentage (31%) occurring in the 16 to 20-year age group. RESULTS: The lowest number of cases was reported in June compared to the maximum in October, and the highest number recorded per year was 463 in 1992. For the decade, the Jordan Valley was the most important locality where 43% of the cases occurred. The incidence rate per 100,000 ranged from 1.89 in 1989 to 14.39 in 1984 and the period prevalence for the decade was 5.36 per 100,000. The time-lag between the appearance of a lesion and the first diagnosis extended from 0 to 23 months with the average being 2 months. The number of lesions per patient ranged from one to 45; 24% were located on the face, 28% on the upper extremity, 36% on the lower extremity, and 12% on other sites. CONCLUSIONS: The factors that contributed to the findings include infected rodent, nonexposed army recruits and farm workers, land reclamatory and relaxation of preventative measures.

Adolescent↗
PubMed1995

Relative androgenicity, blood pressure levels, and cardiovascular risk factors in young healthy women.

To test the hypothesis that androgens may play a role in the pathogenesis of atherosclerosis and hypertension, we investigated the association of delta 5 dehydroepiandrosterone sulfate [DHEAS]) and delta 4 (free testosterone [FT]) androgens with the resting, seated blood pressure (BP) levels and cardiovascular risk factors in 280 young, healthy women 18 to 24 years of age. After application of multiple regression analysis, systolic BP was positively and independently correlated with the ratio of dehydroepiandrosterone sulfate to free testosterone (DHEAS/FT), fasting insulin levels, and the diastolic BP with DHEAS/FT only. The DHEAS/FT ratio proved to be a stronger predictor of the BP levels than either hormone alone. Further, uric acid concentrations and HDL/total cholesterol ratio were independently correlated with both FT and body mass index in these young women. Serum triglycerides were independently correlated with FT and central body fat distribution. These data suggest that serum androgen concentrations are important independent predictors of cardiovascular risk factors and that the ratio of dehydroepiandrosterone sulfate to free testosterone ratio is an independent predictor of blood pressure levels in young women.

Acetone↗
PubMed1995

Incrimination of Phlebotomus papatasi as vector of Leishmania major in the southern Jordan Valley.

The status of sandflies as vectors of cutaneous leishmaniasis in the southern Jordan Valley was investigated during 1992. Sandflies were collected from domestic habitats and from burrows of Psammomys obesus. Of 686 Phlebotomus papatasi females collected from burrows, fourteen harboured promastigotes in their guts. On the other hand, none of 1446 P.papatasi females collected from domestic habitats were found infected. The highest infection rate (5.5%) was recorded in November at the end of the sandfly season. Six leishmanial stocks isolated from P.papatasi females were typed by cellulose acetate electrophoresis using the six enzymes G6PDH, 6PGDH, PGI, PGM, FK and ME. Five of the leishmanial stocks were identical to a Leishmania major reference strain (MHOM/SU/73/5-ASKH). The sixth isolate was a 6PGDH variant of L.major. These findings present the first direct evidence of the role of P.papatasi as a vector of L.major in Jordan.

Animals↗
PubMed1995

The status of bladder-preserving therapeutic strategies in the management of patients with muscle-invasive bladder cancer.

The recommended treatment for medically fit patients with muscle-invading bladder cancer is usually radical cystectomy. However, transurethral resection of the tumor, partial cystectomy, irradiation and systemic chemotherapy are each effective in some patients. These latter treatments allow bladder preservation and cure as an alternative to radical cystectomy although when used unselectively the survival rates are inferior to those of radical cystectomy. The updated results of conservative surgery, radiation therapy and systemic chemotherapy as monotherapy, as well as strategies of combined modality treatment were reviewed. Based on this review many areas of consensus were reached which include: 1. The primary goal of any treatment for a patient with muscle-invading bladder cancer is survival; bladder preservation in the interest of quality of life is a secondary objective. 2. Only a small proportion of carefully selected patients may be cured by transurethral surgery alone, or by partial cystectomy alone. 3. Radiation therapy is currently the standard bladder-preserving therapy against which all other bladder-preserving methods must be compared. 4. Systemic chemotherapy as monotherapy is inadequate and cannot be recommended. 5. The addition of cisplatin-containing systemic chemotherapy to radiation therapy or conservative surgery appears to improve local control. While no multi-modality therapeutic regimen has yet been shown to be clearly optimal with regard to local efficacy and minimizing toxicity, monotherapy for bladder preservation is probably not desirable as a routine approach. 6. Deferring the patient from immediate cystectomy does not appear to compromise survival, nor does the addition of primary systemic chemotherapy appear to significantly increase the morbidity of cystectomy or radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1994

Phase I trial of high-dose fosfestrol in hormone-refractory adenocarcinoma of the prostate.

Androgen deprivation displays the mean therapy of advanced stage prostatic cancer. The development of hormone-resistant disease leads to a fatal tumor progression. High-dose fosfestrol (diethylstilbestrol disphosphate) has been suggested to circumvent hormone resistance and to induce a direct cytotoxic effect. Twenty-one patients with hormone-refractory prostate cancer were enrolled in a phase I trial of continuous infusion of high, daily escalating dose of fosfestrol. Fosfestrol was given in a 3.5 hr infusion in 0.9% normal saline at a starting dose of 1.5 g/d. The dose was increased daily in the same patient according to the following schedule: 1.5, 1.8, 2.4, 3.0, 3.6, 3.9, 4.5, 5.1 and 5.7 g/d. The duration of the infusion was prolonged to 7 or 10.5 hr, if a major side effect occurred. There was neither hematological nor cardiovascular toxicity. The main dose-limiting toxicities were nausea/vomiting in 17 patients, edema in 2 patients, and more than 5% weight gain in 3 patients. The planned maximal dose was reached in 10 patients during a 3.5 hr infusion, and in 3 additional patients, after infusion prolongation. Seven patients experienced a subjective improvement: Prostatic acid phosphatase and prostatic specific antigen decreased in 4 out of 11 and in 7 out of 12 patients, respectively. The suggested dose to phase II trial is 4 g/d in 3.5 hr infusion for a duration of up to 10 days.

Acid Phosphatase↗
PubMed1994

Cost effectiveness of 24-hour ambulatory blood pressure monitoring in evaluation and treatment of essential hypertension.

We wanted to determine if use of ambulatory blood pressure monitoring (ABPM) was cost effective, preventing unnecessary drug therapy in patients misdiagnosed as having essential hypertension, with elevated office blood pressures and normal ambulatory blood pressure. To address this issue we surveyed costs to the patient for antihypertensive drug therapy in 1990 of five local pharmacies in southeastern Michigan. Patients studied (n = 192) were seen in a private, general internal medicine practice in rural southeastern Michigan and received ABPM to assess the presence of hypertension and the adequacy of blood pressure treatment. We ascertained the average, minimal, and maximal drug cost to the patient per unit dose at the local pharmacies. The average yearly cost for patients on antihypertensive medications at pharmacies in southwestern Michigan was $578.40, with figures varying from $94.90 to $4361.75. Although there is no standard reimbursement amount for ABPM, at $188 per monitoring, the cost of monitoring this entire group of patients would offset exactly the cost of medication for the group of patients found to have only office hypertension. As such, third-party insurance carriers should consider reimbursement for ABPM in hypertension to decrease pharmaceutical cost and its attendant potential side effects. In conclusion, our study results suggest that ABPM is cost effective in an outpatient setting in preventing unwarranted drug therapy and the inappropriate diagnosis of hypertension.

Ambulatory Care↗
PubMed1993

Penetrating missile embolisation.

The present case report is that of a 13-year-old boy, who was admitted to the Emergency Unit at the American University of Beirut Medical Center (AUBMC), with a bullet injury to the right upper quadrant with no exist. Chest X-ray and KUB failed to reveal the bullet and there was no evidence of haemo- or pneumothorax. X-ray of both thighs showed the bullet at the level of the right groin. The bullet penetrated the liver, diaphragm and pericardium. It entered through the left ventricle and embolised through the arterial circulation to the right superficial femoral artery. Included in this report is a review and analysis of patients with missile embolisation, who were treated at the AUBMC over the last 10 years.

Abdominal Injuries↗
PubMed1992

Ambulatory blood pressure monitoring in a nonacademic setting. Effects of age and sex.

Twenty-four-hour ambulatory blood pressure measurements (ABPM) are likely to eliminate the stress of visits and observer bias in office blood pressure (BP) recordings, allow consideration of the circadian variability in BP, and correlate well with target organ damage. To define the prevalence of "white coat" hypertension in a rural community to a nonacademic setting, and to assess age and sex related differences, we studied 131 patients who had more than two prior office diastolic BP measurements greater than 90 mm Hg and less than 115 mm Hg. Blood pressure was measured every 10 to 60 min for 24 h using the SpaceLabs 90207 device. Office BP readings were higher than ABPM in the group as a whole, in individual age groups, and in both sexes. The differences were more pronounced at night. Average differences between office and ambulatory BP ranged between 14.4 +/- 1.7/2.9 +/- 2.0 (ABPM at 10:00), and 33.8 +/- 2.3/22.8 +/- 1.5 mm Hg (systolic/diastolic +/- SE) (ABPM at 01:00). The nighttime drop in systolic BP was not apparent in subjects more than 65 years old. Women had a proportionately higher mean office BP than men (115.0 +/- 0.9 office v 110.2 +/- 1.3 mm Hg ABPM in women and 112.3 +/- 0.9 v 104.3 +/- 1.1 mm Hg in men) (P = .013), and the elderly did not display the relationship between ambulatory and office mean BP seen in younger subjects (r = 0.15, P = .30 v r = 0.36, P = .0004, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1992

Future directions in the management of benign prostatic hyperplasia.

A meeting of the International Consultation on Benign Prostatic Hyperplasia (BPH) in June 1991 provided an update on the management of PBH. It is recognised that the development of complications in what may be regarded as a relatively well tolerated disease may necessitate surgical intervention. Current treatment is directed towards circumventing or ameliorating the complications of BPH and perhaps to find minimally invasive or non-invasive alternatives to surgery that could eliminate this modality altogether. Anticipated changes in the management of BPH include establishment of an improved scoring system and response criteria; implementation of stenting techniques, physical modalities such as hyperthermia and laser therapy to replace transurethral resection of the prostate; development of more specific alpha blockers with fewer adverse effects; and administration of hormonal therapy, possibly as an eventual preventative of BPH. The 1991 International Consultation on Benign Prostatic Hyperplasia (BPH), which took place in Paris, France, under the joint sponsorship or the World Health Organization and the major international and national societies of urology, provided an excellent opportunity to review current knowledge on the subject of BPH and to explore future trends in its management. Most of the information included in this report is drawn from the conclusions of the consultation participants.

Adrenergic alpha-Antagonists↗
PubMed1992

MIDAS: hypertension and atherosclerosis. A trial of the effects of antihypertensive drug treatment on atherosclerosis. MIDAS Research Group.

Although clinical trials of the efficacy of antihypertensive treatment have demonstrated impressive reductions in the incidence of stroke, the reduction in coronary artery disease mortality has been less impressive. It may be that the antihypertensive drugs used in these trials induced metabolic disturbances, or produced inadequate regression of left ventricular hypertrophy, thus blunting the reduction in risk of coronary artery disease expected with blood pressure-lowering. Isradipine, a dihydropyridine calcium antagonist known to be an effective antihypertensive agent, has also displayed pronounced antiatherogenic effects in animals. Thus, a reasonable hypothesis could be that isradipine not only reduces the level of blood pressure, but also may have a positive effect on the evolution of atherosclerotic plaque in coronary and carotid arteries, thereby leading to prevention of clinical sequelae of atherosclerosis. On this basis, a 3-year clinical trial is being carried out in the United States--the Multicenter Isradipine/Diuretic Atherosclerosis Study (MIDAS)--to establish the efficacy of isradipine in inhibiting atherogenesis and retarding the progression of atherosclerosis in carotid arteries of hypertensive patients. The primary end point of the study is intima-media thickness and the extent of atherosclerotic plaque in the carotid arteries, as measured by B-mode ultrasonography.

Antihypertensive Agents↗
PubMed1991

Phase II study of fotemustine in recurrent supratentorial malignant gliomas.

38 adults with recurrent supratentorial malignant gliomas, including glioblastoma multiforme (21), anaplastic astrocytomas (9), probably transformed low-grade astrocytomas (6), pinealoblastoma (1) and non-metastatic tumour of unknown histology (1), were treated with fotemustine 100 mg/m2 intravenously every week for 3 consecutive weeks followed by a 5-week rest period. Maintenance treatment consisted of one infusion every 3 weeks. Patients were divided into three groups according to treatment effect. 10 objective responses (26%) with a median time without progression of 32.7 weeks, 18 stabilisations (47%) and 10 failures (26%) were observed. Pathological findings of the initial primary tumour and neurological functional status were unequally distributed in these groups. Haematological and liver toxicities were mild, delayed, transient and reversible. Thrombocytopenia and leukopenia were more frequent (30%) in patients treated with prior chemotherapy. Fotemustine is a well tolerated active drug in recurrent malignant gliomas with an original and short treatment schedule.

Adolescent↗
PubMed1991

Mechanisms of hypertension in diabetes.

Hypertension in insulin resistance states is generally attributed to hyperinsulinemia, with resulting increases in renal sodium retention and/or sympathetic nervous system activity. However, recent data from our laboratory suggest that cellular insulin resistance, rather than hyperinsulinemia per se, may lead to hypertension. The basic tenet proposed in this review is that the common mechanism involved in the development of hypertension in both type I and type II diabetes mellitus is a deficiency of insulin at the cellular level. Recent observations suggest that impaired cellular response to insulin predisposes to increased vascular smooth muscle (VSM) tone (the hallmark of hypertension in the diabetic state). For example, recently reported studies from our laboratory demonstrate that insulin in physiological doses attenuates the vascular contractile response to phenylephrine, serotonin, and potassium chloride. Thus, insulin appears to normally modulate (attenuate) VSM contractile responses to vasoactive factors, and insulin resistance should accordingly be associated with enhanced vascular reactivity. Abnormal VSM cell calcium [Ca2+]i homeostasis may be the nexus between insulin resistance and increased VSM tone. The genetically obese, hyperinsulinemic, insulin-resistant Zucker rat demonstrates increased vascular reactivity, reduced membrane Ca2(+)-ATPase activity, increased cellular Ca2+ levels, and a marked impairment in vascular smooth muscle Ca2+ efflux compared to lean controls. Insulin stimulates membrane Ca-ATPase, blocks Ca2+ currents, and Ca2(+)-driven action potentials. Thus, an insulin-resistant state as exists in the Zucker rat may be associated with increased Ca2+ influx through voltage-dependent sarcolemmal Ca2+ channels and/or decreased production or activation of the VSM cell Ca-ATPase pump.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium↗