Sola Aoun Bahous
Lebanese American University, Medicine, Faculty Member
Research Interests: Psychology and Trait
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Background We report findings of a qualitative evaluation of fixed-dose combination therapy for patients with established atherosclerotic cardiovascular disease (ASCVD) attending Médecins Sans Frontières (MSF) clinics in Lebanon.... more
Background We report findings of a qualitative evaluation of fixed-dose combination therapy for patients with established atherosclerotic cardiovascular disease (ASCVD) attending Médecins Sans Frontières (MSF) clinics in Lebanon. Cardiovascular disease is a leading cause of death and disability worldwide, and humanitarian actors are increasingly faced with the challenge of providing care for chronic diseases such as ASCVD in settings where health systems are disrupted. Secondary prevention strategies, involving 3–5 medications, are known to be effective for patients at risk of heart attack or stroke, but supply and adherence are challenging in humanitarian settings. Fixed dose combination therapy, combining two or more medications in one tablet, may be a strategy to address this. Methods The evaluation was nested within a prospective mixed-methods study in which eligible ASCVD patients were followed for 1 year during (i) 6 months of usual care then (ii) 6 months of fixed dose combin...
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Coronavirus disease COVID-19 upended the whole world with everyone needing to practice social distancing, and quarantine These measures affected education in general, and medical education in particular Educators were faced with the... more
Coronavirus disease COVID-19 upended the whole world with everyone needing to practice social distancing, and quarantine These measures affected education in general, and medical education in particular Educators were faced with the dilemma of protecting the students versus fulfilling the mission of preparing qualified future healthcare providers In Lebanon, the seven medical schools had to act quickly to set up distance education in response to the requested closure of universities and social distancing measures, in a way that preserves student education despite the challenging times This paper will focus on the changes introduced to the curricula of the undergraduate medical education programs in Lebanon, involving both the teaching and learning facets and the assessment component at the preclinical and clinical phases
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OBJECTIVES: The majority of extracorporeal membrane oxygenation patients develop acute kidney injury, and 40–60% require renal replacement therapy. This study aimed to examine determinants of major adverse kidney events in extracorporeal... more
OBJECTIVES: The majority of extracorporeal membrane oxygenation patients develop acute kidney injury, and 40–60% require renal replacement therapy. This study aimed to examine determinants of major adverse kidney events in extracorporeal membrane oxygenation survivors. DESIGN: Retrospective cohort study. SETTING: Barnes Jewish Hospital, St. Louis, MO. PATIENTS: Patients admitted at Barnes Jewish hospital between 2008 and 2017 and requiring extracorporeal membrane oxygenation. Patients 18 years old and older who survived to hospital discharge were considered for the study. INTERVENTIONS: None. MEASURES AND MAIN RESULTS: Patients who were admitted to a single center between 2008 and 2017, were on extracorporeal membrane oxygenation for more than 24 hours and survived hospital discharge were included. Major adverse kidney event was defined as either doubling serum creatinine, incident end-stage renal disease, or death. Acute kidney injury was defined as Kidney Disease: Improving Global...
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Background Cardiovascular disease, and more recently, subclinical cardiac dysfunction have both been implicated as important risk factors for cognitive decline. Several measures have been used to detect subclinical cardiac dysfunction,... more
Background Cardiovascular disease, and more recently, subclinical cardiac dysfunction have both been implicated as important risk factors for cognitive decline. Several measures have been used to detect subclinical cardiac dysfunction, with global longitudinal strain (GLS) emerging as an important and more sensitive indicator than traditional measures. Yet, the association of GLS with cognitive function remains relatively unexplored. Objective The aim of this review is to systematically summarize the literature exploring the association between GLS and cognitive function. Methods We conducted a systematic review of the literature following PRISMA guidelines using the following databases: PubMed, OVID Medline, Embase, Web of Science, and CINAHL. Inclusion criteria were observational studies published in English, measuring GLS and assessing cognitive function through neuropsychiatric tests or brain imaging. Quality assessment was done using the Newcastle Ottawa Scale. Results The init...
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ObjectivesThis pre–post implementation study evaluated the introduction of fixed dose combination (FDC) medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention into routine care in a humanitarian... more
ObjectivesThis pre–post implementation study evaluated the introduction of fixed dose combination (FDC) medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention into routine care in a humanitarian setting.SettingTwo Médecins sans Frontières (MSF) primary care clinics serving Syrian refugee and host populations in north Lebanon.ParticipantsConsenting patients ≥18 years with existing ASCVD requiring secondary prevention medication were eligible for study enrolment. Those with FDC contraindication(s) or planning to move were excluded. Of 521 enrolled patients, 460 (88.3%) were retained at 6 months, and 418 (80.2%) switched to FDC. Of these, 84% remained on FDC (n=351), 8.1% (n=34) discontinued and 7.9% (n=33) were lost to follow-up by month 12.InterventionsEligible patients, enrolled February–May 2019, were switched to Trinomia FDC (atorvastatin 20 mg, aspirin 100 mg, ramipril 2.5/5/10 mg) after 6 months’ usual care. During the study, the COVID-19 pandemic, a...
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Abstract This narrative review aims to synthesize evidence on factors that may influence the severity, occurrence, and incidence of vasomotor symptoms (VMS) that encompass hot flashes and/or night sweats. A comprehensive literature search... more
Abstract This narrative review aims to synthesize evidence on factors that may influence the severity, occurrence, and incidence of vasomotor symptoms (VMS) that encompass hot flashes and/or night sweats. A comprehensive literature search was conducted electronically using Web of Science, Ovid MEDLINE, PubMed, and Google Scholar to retrieve all English language studies on predictors of VMS from 2000 to 2018. Studies evaluating treatment options for VMS, studies of women with comorbidities such as breast cancer or osteoporosis, studies on VMS outcomes, and studies on quality of life among women with VMS were excluded. After screening, 88 articles were reviewed. Findings showed that different factors such as biological, demographic, behavioral, social, and non-traditional were associated with VMS. The most consistent risk factors of VMS were: being in later menopausal stages, smoking, lower socioeconomic status, higher follicle stimulating hormone levels, ethnicity, and higher body mass index. Most studies were either cross-sectional or observational in design, and were conducted in western countries. A more nuanced understanding of the factors contributing to VMS can assist clinicians in screening women for optimal VMS counseling and treatment. This review found that further large-scale studies set in developing countries that examine VMS factors are warranted.
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Subclinical vitamin K deficiency is prevalent among renal transplant recipients and is associated with an increased risk of cardiovascular disease. However, the association between vitamin K supplementation and improvement of arterial... more
Subclinical vitamin K deficiency is prevalent among renal transplant recipients and is associated with an increased risk of cardiovascular disease. However, the association between vitamin K supplementation and improvement of arterial stiffness has not been explored in the renal transplant population. The KING trial (vitamin K2 In reNal Graft) is a single-arm study that evaluated the association between the change in vitamin K status and indices of arterial stiffness following 8 weeks of menaquinone-7 (vitamin K2) supplementation (360 μg once daily) among renal transplant recipients (n = 60). Arterial stiffness was measured using carotid-femoral pulse wave velocity (cfPWV). Subclinical vitamin K deficiency was defined as plasma concentration of dephosphorylated-uncarboxylated matrix Gla protein (dp-ucMGP) >500 pmol/L.At baseline, 53.3% of the study subjects had subclinical vitamin K deficiency. Supplementation was associated with a 14.2% reduction in mean cfPWV at 8 weeks (cfPWV ...
Research Interests: Biomarkers, Kidney transplantation, Medicine, Prospective studies, Population, and 15 moreHumans, Internal Medicine, Female, Male, Dietary Supplements, Arterial stiffness, Prevalence, Middle Aged, Adult, Calcium Binding Proteins, Pilot Projects, Pulse Wave Velocity, Extracellular Matrix Proteins, Cardiovascular medicine and haematology, and Pulse wave analysis
This review presents findings on the role of female reproductive factors on longevity.A comprehensive systematic literature search was conducted using four electronic databases: OVID Medline, Web of Science, PubMed and Google Scholar from... more
This review presents findings on the role of female reproductive factors on longevity.A comprehensive systematic literature search was conducted using four electronic databases: OVID Medline, Web of Science, PubMed and Google Scholar from inception until May 2020 and restricted to English language articles that tackle the relationship between reproductive factors and longevity in its various definitions. Our search yielded a total of 306 articles. After screening based on the eligibility criteria,37 articles were included for review. The majority of studies were prospective and conducted in Western populations. The most consistent findings were between parity and increased longevity. The role of ages at menarche and menopause, premature menopause, as well as reproductive lifespan on longevity were not conclusive. Whether gender of offspring is related to maternal longevity is yet to be fully elucidated.Variations in findings are in the majority due to differentials in the definition...
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A. Fayol1, J. Malloisel-Delaunay2, D. Fouassier3, C. Cristian4, C. Leguy4, M.P. Bareille5, E. Mousseaux6, H. Khettab1, P. Boutouyrie1, 7.1CHU Européen Georges Pompidou Service de Pharmacologie Clinique (APHP), Paris, FRANCE, 2CHU Rangueil... more
A. Fayol1, J. Malloisel-Delaunay2, D. Fouassier3, C. Cristian4, C. Leguy4, M.P. Bareille5, E. Mousseaux6, H. Khettab1, P. Boutouyrie1, 7.1CHU Européen Georges Pompidou Service de Pharmacologie Clinique (APHP), Paris, FRANCE, 2CHU Rangueil Service de Médecine Vasculaire, Toulouse, FRANCE, 3CHU Européen Georges Pompidou Centre d’Investigation Clinique (APHP), Paris, FRANCE, 4DLR, Kohln, GERMANY, 5MEDES, Toulouse, FRANCE, 6CHU Européen Georges Pompidou Service de Radiologie (APHP), Paris, FRANCE, 7Unité INSERM U970 Team 7, PARCC INSERM, Paris, FRANCE
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Sickle cell nephropathy is a major complication of sickle cell disease. It manifests in different forms, including glomerulopathy, proteinuria, hematuria, and tubular defects, and frequently results in end-stage renal disease (ESRD).... more
Sickle cell nephropathy is a major complication of sickle cell disease. It manifests in different forms, including glomerulopathy, proteinuria, hematuria, and tubular defects, and frequently results in end-stage renal disease (ESRD). Different pathophysiologic mechanisms have been proposed to explain the development of nephropathy in SCD, where hemolysis and vascular occlusion are the main contributors in the manifestations of this disease. Markers of renal injury, such as proteinuria and tubular dysfunction, have been associated with outcomes among patients with sickle cell nephropathy and provide means for early detection of nephropathy and screening prior to progression to renal failure. In small-sized clinical trials, hydroxyurea has demonstrated to be effective in slowing the progression to ESRD. Dialysis and renal transplantation represent the last resort for patients with sickle cell nephropathy. Nevertheless, despite the availability of diagnostic and therapeutic strategies,...
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Research Interests: Cardiology, Medicine, Prospective studies, Humans, Internal Medicine, and 15 moreFemale, Male, Regression Analysis, Arterial stiffness, Clinical Sciences, Aged, Middle Aged, Adult, Cardiovascular Diseases, Pulse Wave Velocity, Renal Dialysis, Carotid Arteries, Cardiovascular medicine and haematology, Medical biochemistry and metabolomics, and Pulse wave analysis
In a population of 56,242 individuals living in France, we showed that individuals born in France have significantly different levels of blood pressure (BP) and cardiovascular (CV) risk factors than African and Asian populations born in... more
In a population of 56,242 individuals living in France, we showed that individuals born in France have significantly different levels of blood pressure (BP) and cardiovascular (CV) risk factors than African and Asian populations born in their own country but living long-term in France (average duration of stay, 5-10 years). The objective of our study was to investigate the impact of country of birth on BP and CV risk factors in a subpopulation of 9245 patients selected solely on the diagnosis of hypertension, either alone or with simultaneous type 2 diabetes. In the subgroup of individuals with hypertension alone, brachial systolic, diastolic, mean and pulse pressure (PP), heart rate (HR), augmentation index and PP amplification were significantly higher in African-born than French- and Asian-born populations. In the subgroup of individuals with both hypertension and diabetes, only augmentation index, PP amplification and brachial and central PP, but not brachial systolic, diastolic...
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Objectives: It has previously been demonstrated that single elevated measurements of carotid-femoral pulse wave velocity (CFPWV) among end-stage renal disease (ESRD) patients are associated with an increased risk of cardiovascular (CV)... more
Objectives: It has previously been demonstrated that single elevated measurements of carotid-femoral pulse wave velocity (CFPWV) among end-stage renal disease (ESRD) patients are associated with an increased risk of cardiovascular (CV) events. However, the association between single measurements of CFPWV and CV events was mostly driven by the high incidence of late events beyond 12 months of follow-up. The present prospective study aims to compare single measurements of CFPWV vs. the 2-year change in CFPWV (delta CFPWV) and their association with short-term development of CV events through 12 months in hemodialysis patients. Methods: Patients on hemodialysis were enrolled for a first measurement of CFPWV (CFPWV t=0 ) followed by a second measurement (CFPWV t=1 ) 2 years ± 1 month later. Patients were then followed up for an additional 12 months for the development of CV events (CV death, acute coronary syndrome, acute ischemic peripheral event necessitating intervention, or stroke)....
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December 2015 Clerkship Evaluation Follow-up Survey. This file presents the follow-up survey that was administered to students in the second cohort who completed the clerkship evaluation form with the bogus item (administered in December... more
December 2015 Clerkship Evaluation Follow-up Survey. This file presents the follow-up survey that was administered to students in the second cohort who completed the clerkship evaluation form with the bogus item (administered in December 2015). It intended to confirm the bias hypothesis (DOC 26 kb)
Study Design. This file is a representation of the study conduct including information about cohort sizes, response rates, and administration of the bogus item (DOC 47 kb)
2014/2015 Clerkship Evaluation Form. This file presents the clerkship evaluation form that was used in 2014â 2015 by the Deanâ s Office as a routine practice to collect studentsâ opinion about their learning experience during each... more
2014/2015 Clerkship Evaluation Form. This file presents the clerkship evaluation form that was used in 2014â 2015 by the Deanâ s Office as a routine practice to collect studentsâ opinion about their learning experience during each clerkship. (DOCX 24 kb)
Information about reprints can be found online at: Reprints: document. Permissions and Rights Question and Answer this process is available in the click Request Permissions in the middle column of the Web page under Services. Further... more
Information about reprints can be found online at: Reprints: document. Permissions and Rights Question and Answer this process is available in the click Request Permissions in the middle column of the Web page under Services. Further information about Office. Once the online version of the published article for which permission is being requested is located, can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialHypertensionin Requests for permissions to reproduce figures, tables, or portions of articles originally publishedPermissions: by guest on February 26,
Research Interests: Cardiovascular Risk, Elasticity, Humans, Kidney, Hypertension, and 15 moreBlood Pressure, Female, Arterial stiffness, Clinical Sciences, Adult, Cardiovascular Risk Factor, Graft Rejection, Cross sectional Study, Aorta, Blood Flow Velocity, Case Control Studies, Chronic Allograft Nephropathy, Kidney Function, Genetic factors, and Cardiovascular medicine and haematology
Composite scores are frequently used in medical education to reflect aggregate information about a student’s performance. Combining assessment scores into composites has been shown to be a successful practice in traditional medical... more
Composite scores are frequently used in medical education to reflect aggregate information about a student’s performance. Combining assessment scores into composites has been shown to be a successful practice in traditional medical education models and is normally driven by the educational system in place. The recent paradigm shift to competency-based medical education has been associated with many implications for assessment. A major challenge emerged about the procedure of combining assessment information in competency-based models, and the validity of decision-making based on composites. In this study, we examined validity evidence associated with traditional composite scores and consequential decision-making, and that associated with reformulated composites based on the competency framework. Furthermore, a third decision model about students’ academic progress was built from deliberations among education experts. All assessment data about third-year medical students were collect...
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Title: Voluntary vs. Compulsory Student Evaluation of Clerkships: Effect on Validity and Potential Bias Authors: Sola Aoun Bahous (sola.bahous@lau.edu.lb) Pascale Salameh (pascalesalameh1@hotmail.com) Angelique Salloum... more
Title: Voluntary vs. Compulsory Student Evaluation of Clerkships: Effect on Validity and Potential Bias Authors: Sola Aoun Bahous (sola.bahous@lau.edu.lb) Pascale Salameh (pascalesalameh1@hotmail.com) Angelique Salloum (angelique.salloum@lau.edu.lb) Wael Salameh (wael.salame@lau.edu.lb) Yoon Soo Park (yspark2@uic.edu) Ara Tekian (tekian@uic.edu) Version: 1 Date: 26 Sep 2017 Author’s response to reviews: Ms. Ref. No.: MEED-D-17-00327 Title: Voluntary vs. Compulsory Student Evaluation of Clerkships: Effect on Validity and Potential Bias
This review aims to explore the burden of hypertension among refugees in the Middle East by reporting its prevalence, risk factors and access to care. A comprehensive literature search was performed using Web of Science, Ovid MEDLINE,... more
This review aims to explore the burden of hypertension among refugees in the Middle East by reporting its prevalence, risk factors and access to care. A comprehensive literature search was performed using Web of Science, Ovid MEDLINE, PubMed, SCOPUS, CINHAL+, WHO Regional Office for the Eastern Mediterranean (EMRO) and United Nations High Commissioner for Refugees (UNHCR) on articles spanning from 1948 until 2020. Most studies were cross-sectional in design. After applying eligibility criteria 17 articles and 4 reports were included. Findings showed that hypertension represents a major burden among refugees. Hypertension risk factors present among the refugee population included increased salt intake, physical inactivity, and smoking. The majority of hypertensive refugees sought care for their condition at the public health care services. Barriers to seeking care included high cost of healthcare, accessibility to provided services, and lack of knowledge for the need to seek care. No...
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Organ procurement and transplant improve health outcomes among patients with organ failure. Although many strategies have been developed to overcome the organ shortage, the worldwide rates of organ donation remain suboptimal. The lack of... more
Organ procurement and transplant improve health outcomes among patients with organ failure. Although many strategies have been developed to overcome the organ shortage, the worldwide rates of organ donation remain suboptimal. The lack of commitment to the health care mission of organ donation and the limited expertise of health care professionals reflect 2 major barriers to organ procurement and raise the need to teach organ procurement to health care professionals early during their undergraduate education. To accommodate the various available curricular models and to develop a homogeneous and equitable teaching methodology irrespective of the adopted design, an early step is to set clear goals and objectives for an organ procurement program. Outcomes should be matched to different academic levels and tailored to the duration of each medical and nursing curriculum. In all cases, hands-on experience leads to a better understanding of the topic, especially with the advent of simulati...
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Objectives Sleep disorders are prevalent and underrecognized during both economic and political crises. They are a major reason for poor overall health and decreased quality of life. Sleep medicine education is limited at most medical... more
Objectives Sleep disorders are prevalent and underrecognized during both economic and political crises. They are a major reason for poor overall health and decreased quality of life. Sleep medicine education is limited at most medical schools, resulting in limited awareness of this important aspect of healthcare. The aim of the study is to assess sleep medicine knowledge of graduating medical students in Lebanon and to assess their readiness to tackle sleep health issues in a country during an unprecedented crisis. Methods Final-year medical students at 7 medical schools in Lebanon were invited to fill a survey between January 2020 and March 2021. The Assessment of Sleep Knowledge in Medical Education survey was used to assess their knowledge in sleep medicine. The curriculum organizers at the medical schools were also surveyed. Student’s t-test was used for analysis. Results 158 and 58 students completed the survey during 2020 and 2021, with a mean overall score on sleep knowledge ...
Abstract Introduction The Corona Virus Disease-19 (COVID-19) pandemic disrupted medical education across the world. Online teaching has grown rapidly under lockdown. Yet the online approach for assessment presents a number of challenges,... more
Abstract Introduction The Corona Virus Disease-19 (COVID-19) pandemic disrupted medical education across the world. Online teaching has grown rapidly under lockdown. Yet the online approach for assessment presents a number of challenges, particularly when evaluating clinical competencies. The aim of this study was to investigate the feasibility, acceptability, reliability and validity of an online Virtual Clinical Encounter Examination (VICEE) to assess non-psychomotor competencies (non-procedure or manual skills) of medical students. Method Sixty-one final year medical students took the VICEE as part of the final summative examination. A panel of faculty experts developed the exam cases and competencies. They administered the test online via real-time interaction with artificial intelligence (AI) based virtual patients, along with faculty and IT support. Results Student and faculty surveys demonstrated satisfaction with the experience. Confirmatory factor analysis supported convergent validity of VICEE with Direct Observation Clinical Encounter Examination (DOCEE), a previously validated clinical examination. The observed sensitivity was 81.8%, specificity 64.1% and likelihood ratio 12.6, supporting the ability of VICEE to diagnose ‘clinical incompetence’ among students. Conclusion Our results suggest that online AI-based virtual patient high fidelity simulation may be used as an alternative tool to assess some aspects of non-psychometric competencies.
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We aimed to examine arterial stiffness and vitamin K2 status in migraine subjects by comparison to controls.
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Damage to podocytes is a key event in glomerulopathies. While energy dense food can contribute to kidney damage, the role of the orixegenic hormone “ghrelin” in podocyte biology is still unknown. In the present study, we investigated the... more
Damage to podocytes is a key event in glomerulopathies. While energy dense food can contribute to kidney damage, the role of the orixegenic hormone “ghrelin” in podocyte biology is still unknown. In the present study, we investigated the effect of ghrelin on podocyte survival as well as the signalling pathways mediating ghrelin effect in immortalized cultured rat podocytes. RT‐PCR analysis revealed that GHS‐R1 is expressed in rat podocytes. Western blot analysis showed that ghrelin upregulated COX‐2 protein expression in a time and dose‐dependent manner. Additionally, ghrelin activated P38 MAPK, AKT, and ERK1/2 pathways and also induced P38 MAPK phosphorylation in high glucose conditions. Ghrelin induced ROS release and dose dependently reduced podocyte survival. Ghrelin mediated podocyte cell death was partially reversed by pharmacologically inhibiting P38 MAPK or phospholipase C (PLC). Furthermore, PLC inhibitor (U73122) inhibited ghrelin induced P38 MAPK activation. While PI3K inhibitor (LY294002) was without effect on cell survival or P38 MAPK activation, it inhibited ghrelin induced ERK1/2 phosphorylation. Finally, ghrelin induced TAU phosphorylation was reversed by pharmacologic inhibitors of either P38 MAPK or PKA. In conclusion, ghrelin activated harmful molecular pathways in podocytes that can be damaging to the glomerular filtration barrier
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: Evidence suggests that aortic stiffness may antedate and contribute initially to the development of hypertension and cardiovascular risk (CVR). In treated hypertensive patients, both diabetes and end-stage renal disease (ESRD) are... more
: Evidence suggests that aortic stiffness may antedate and contribute initially to the development of hypertension and cardiovascular risk (CVR). In treated hypertensive patients, both diabetes and end-stage renal disease (ESRD) are comorbid conditions associated with increased aortic stiffness and high CVR. Thus, the pathophysiological relationship between aortic stiffness, blood pressure (BP) and CVR may have clinical implication in the management of hypertension. In patients with diabetes or ESRD, aortic stiffness is a significant predictor of CVR, independently of BP control. The hallmark of accelerated aortic stiffening in these patients associates the presence of vascular calcification, which is considered as a time-dependent process. Aortic stiffness represents a marker of structural but also functional arterial damage associated with increased pressure pulsatility. Carotid-femoral pulse wave velocity (cf-PWV), as a marker of aortic stiffness, may provide a readily available information for the effectiveness of risk reduction strategies. SBP, hyperglycemia and progressive alteration of renal function are considered as determinants of accelerated aortic stiffening. These findings suggest that earlier and intensive treatment of glycemia and BP could be important to limit or even reverse stiffening process. In patients with ESRD, more specific and potentially modifiable kidney disease-related parameters such as phosphocalcic disorders and vitamin K deficiency, appear correlated with aortic calcification and cf-PWV. An important and recent finding is that the magnitude of longitudinal increase in cf-PWV may represent a clinically pertinent surrogate for cardiovascular events. Aortic stiffness may be, thus, considered as an intermediate marker to monitor effectiveness of preventive strategies in these high-risk patients.
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Sickle cell nephropathy is a major complication of sickle cell disease. It manifests in different forms, including glomeru-lopathy, proteinuria, hematuria, and tubular defects, and frequently results in end-stage renal disease (ESRD).... more
Sickle cell nephropathy is a major complication of sickle cell disease. It manifests in different forms, including glomeru-lopathy, proteinuria, hematuria, and tubular defects, and frequently results in end-stage renal disease (ESRD). Different pathophysiologic mechanisms have been proposed to explain the development of nephropathy in SCD, where hemolysis and vascular occlusion are the main contributors in the manifestations of this disease. Markers of renal injury, such as proteinuria and tubular dysfunction, have been associated with outcomes among patients with sickle cell nephropathy and provide means for early detection of nephropathy and screening prior to progression to renal failure. In small-sized clinical trials, hydroxyurea has demonstrated to be effective in slowing the progression to ESRD. Dialysis and renal transplantation represent the last resort for patients with sickle cell nephropathy. Nevertheless, despite the availability of diagnostic and therapeutic strategies...
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Background Subclinical vitamin K deficiency is prevalent among renal transplant recipients and is associated with an increased risk of cardiovascular disease. However, the association between vitamin K supplementation and improvement of... more
Background Subclinical vitamin K deficiency is prevalent among renal transplant recipients and is associated with an increased risk of cardiovascular disease. However, the association between vitamin K supplementation and improvement of arterial stiffness has not been explored in the renal transplant population. Methods The KING trial (vitamin K2 In reNal Graft) is a single-arm study that evaluated the association between the change in vitamin K status and indices of arterial stiffness following 8 weeks of menaquinone-7 (vitamin K2) supplementation (360 μg once daily) among renal transplant recipients (n=60). Arterial stiffness was measured using carotid-femoral pulse wave velocity (cfPWV). Subclinical vitamin K deficiency was defined as plasma concentration of dephosphorylated-uncarboxylated Matrix Gla Protein (dp-ucMGP) > 500 pmol/L. Results At baseline, 53.3% of the study subjects had subclinical vitamin K deficiency. Supplementation was associated with a 14.2% reduction in me...
Research Interests: Biomarkers, Kidney transplantation, Treatment Outcome, Medicine, Prospective studies, and 15 moreHumans, Renal Medicine and Kidney Transplantation, Female, Male, Dietary Supplements, Arterial stiffness, Prevalence, Middle Aged, Adult, Calcium Binding Proteins, Vascular Calcification, Pilot Projects, Renal Dialysis, Extracellular Matrix Proteins, and Cardiovascular medicine and haematology
Despite adequate glycemic and blood pressure control, treated type 2 diabetic hypertensive subjects have a significantly elevated overall/cardiovascular risk. We studied 244 816 normotensive and 99 720 hypertensive subjects (including... more
Despite adequate glycemic and blood pressure control, treated type 2 diabetic hypertensive subjects have a significantly elevated overall/cardiovascular risk. We studied 244 816 normotensive and 99 720 hypertensive subjects (including 7480 type 2 diabetics) attending medical checkups between 1992 and 2011. We sought to identify significant differences in overall/cardiovascular risk between hypertension with and without diabetes mellitus. Mean follow-up was 12.7 years; 14 050 all-cause deaths were reported. From normotensive to hypertensive populations, a significant progression in overall/cardiovascular mortality was observed. Mortality was significantly greater among diabetic than nondiabetic hypertensive subjects (all-cause mortality, 14.05% versus 7.43%; and cardiovascular mortality, 1.28% versus 0.7%). No interaction was observed between hemodynamic measurements and overall/cardiovascular risk, suggesting that blood pressure factors, even during drug therapy, could not explain t...
Research Interests: Medicine, Comorbidity, Multivariate Analysis, Humans, Blood Glucose, and 15 moreHypertension, Female, Male, Incidence, Clinical Sciences, Middle Aged, Longitudinal Studies, Adult, Prognosis, Cardiovascular Diseases, Reference Values, Cross Sectional Studies, Proportional Hazards Models, Cause of death, and Cardiovascular medicine and haematology
Background. Prior studies have demonstrated that conventional and emerging CV risk factors are associated with worsening arterial stiffness among end-stage renal disease (ESRD) patients on hemodialysis. The present cross-sectional study... more
Background. Prior studies have demonstrated that conventional and emerging CV risk factors are associated with worsening arterial stiffness among end-stage renal disease (ESRD) patients on hemodialysis. The present cross-sectional study evaluates the association between the etiology of ESRD and arterial stiffness among a cohort of hemodialysis patients.Methods. Etiology of ESRD was identified from patients’ medical records and classified as either vascular renal disease, diabetic nephropathy, nondiabetic glomerulopathy, tubular interstitial nephropathy, hereditary nephropathy, or ESRD of unconfirmed etiology.Results. A total of 82 subjects were enrolled. cfPWV was independently associated with the composite of either diabetic nephropathy or vascular renal disease (p=0.022), pulse pressure (p=0.001), and a history of CV events (p=0.025), but not history of hypertension or diabetes mellitus alone. The median cfPWVs in diabetic nephropathy and vascular renal disease were comparable and...
Research Interests: Medicine, Humans, Hypertension, Blood Pressure, Female, and 15 moreMale, Risk factors, Biomed, Aged, Middle Aged, Adult, Cardiovascular Diseases, Risk Factors, Medical Records, Cross Sectional Studies, Chronic Kidney Failure, Renal Dialysis, Cohort Studies, Vascular Diseases, and Diabetic nephropathies
With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the... more
With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students' confidence in their history-taking skills in their native language. This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n = 457). The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical his...
Research Interests: Multilingualism, Lebanon, Medical Students, Humans, Comprehension, and 10 moreFemale, Undergraduate medical education, Male, Public health systems and services research, Curriculum and Pedagogy, Cross Sectional Studies, Clinical clerkship, Surveys and Questionnaires, western world, and Medical History Taking
Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with... more
Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBP MAP/DBPcal ), or bSBP/diastolic blood pressure (cSBP SBP/DBPcal ), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime va...
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Students evaluations of their learning experiences can provide a useful source of information about clerkship effectiveness in undergraduate medical education. However, low response rates in clerkship evaluation surveys remain an... more
Students evaluations of their learning experiences can provide a useful source of information about clerkship effectiveness in undergraduate medical education. However, low response rates in clerkship evaluation surveys remain an important limitation. This study examined the impact of increasing response rates using a compulsory approach on validity evidence. Data included 192 responses obtained voluntarily from 49 third-year students in 2014-2015, and 171 responses obtained compulsorily from 49 students in the first six months of the consecutive year at one medical school in Lebanon. Evidence supporting internal structure and response process validity was compared between the two administration modalities. The authors also tested for potential bias introduced by the use of the compulsory approach by examining students' responses to a sham item that was added to the last survey administration. Response rates increased from 56% in the voluntary group to 100% in the compulsory gro...
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min/1.73 m 2 thereafter. The first-year decline was related to smoking and acute rejection. Later decline was significantly associated with donor age and aortic stiffness. In living donors, renal function decline after the first year... more
min/1.73 m 2 thereafter. The first-year decline was related to smoking and acute rejection. Later decline was significantly associated with donor age and aortic stiffness. In living donors, renal function decline after the first year corresponded to 0.7 ml/min/1.73 m 2 , was significantly lower than that of recipients (p < 0.001), and was determined by donor age at nephrectomy. Conclusion: Recipients of kidney grafts show a glomerular filtration rate decline over time that is significantly associated with donor age and aortic stiffness after the first post-transplant year, while donors demonstrate a lower decline that is mostly determined by age at nephrectomy.
The association between single measurements of carotid-femoral pulse wave velocity (cfPWV) and cardiovascular (CV) events is driven by late events beyond 12 months of follow-up. This prospective study compares single measurements of cfPWV... more
The association between single measurements of carotid-femoral pulse wave velocity (cfPWV) and cardiovascular (CV) events is driven by late events beyond 12 months of follow-up. This prospective study compares single measurements of cfPWV vs the 2-year delta cfPWV and the association with short-term development of CV events in hemodialysis patients. cfPWV was performed at t=0 and t=1 two years later, and patients were followed-up for development of CV events through 12 months (n=66). In Cox regression models adjusted for CV risk factors, history of CV events and delta cfPWV remained associated with the development of CV events (hazard ratio for prior CV events=8.9, P=.03; hazard ratio for delta cfPWV=1.14; P=.002). When delta cfPWV was substituted for single cfPWV measurement, none of the single measures were associated with new CV events. The change in cfPWV, but not single measurements of cfPWV, was associated with the development of CV events through 12 months.