Publications by authors named "Mohamad Khalife"

53 Publications

Short-Term Efficacy and Safety of Oral and Nasal Corticosteroids in COVID-19 Patients with Olfactory Dysfunction: A European Multicenter Study.

Pathogens 2021 Jun 4;10(6). Epub 2021 Jun 4.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France.

: The objective of this study was to investigate the efficacy and safety of early administration of oral corticosteroids (OC) or nasal corticosteroids (NC) as an add-on to olfactory training (OT) versus OT alone in patients with olfactory dysfunction (OD) related to coronavirus disease 2019 (COVID-19). : Patients with a positive diagnosis of COVID-19 and OD were prospectively recruited from March 22 to December 15, 2020 from 4 European hospitals. Patients had confirmed OD on psychophysical testing. All patients undertook OT, with add-on 10 days of OC (group 1: OC + OT), or 1 month of NC (group 2: NC + OT) or olfactory training alone (group 3: OT). Olfactory evaluations (Sniffin'Sticks tests) were carried out at the time of inclusion, 1 and 2 months after the start of the therapeutic course. : A total of 152 hyposmic or anosmic patients completed the study. Group 1, 2 and 3 included 59, 22 and 71 patients, respectively and all patient groups were comparable regarding baseline Sniffin'Sticks tests. The median Sniffin'Sticks test values significantly improved from pre- to post-intervention in all groups. The increase of Sniffin'Sticks test values was higher in group 1 (OC + OT) compared with groups 2 and 3 ( < 0.001) at one month after treatment but did not remain so at 2 months. Groups 1, 2 and 3, respectively, presented parosmia in 20/71 (28.2%), 9/22 (40.9%) and 42/71 (59.2%) patients. This difference was statistically significant between group 1 and 3 ( < 0.001). There were no patients with a worsening of the disease or an increase of the severity of the COVID-19 symptoms. : The use of OCs in patients with OD related to mild COVID-19 is generally well-tolerated without any case of deterioration of symptoms. OC is associated with greater improvement in psychophysical olfactory evaluations at 1-month post-treatment but there was no difference at 2 months. Parosmia may be reduced following treatment with OC and NC. On the basis of these preliminary results, it is possible to state that considering the 2 months efficacy of OC and NC with respect to the OT alone and the risk-benefit ratio, the benefit to start a specific treatment of COVID-19 related OD cannot be demonstrated and there is a need for a randomised controlled trial to assess this further.
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http://dx.doi.org/10.3390/pathogens10060698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228154PMC
June 2021

Predictive factors of smell recovery in a clinical series of 288 coronavirus disease 2019 patients with olfactory dysfunction.

Eur J Neurol 2021 Jun 22. Epub 2021 Jun 22.

Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium.

Background And Purpose: The aim was to evaluate potential predictive factors of smell recovery in a clinical series of 288 patients presenting olfactory dysfunction (OD) related to coronavirus disease 2019 (COVID-19). Potential correlations were sought between epidemiological, clinical and immunological characteristics of patients and the persistence of OD at 60 days.

Methods: COVID-19 positive patients presenting OD were prospectively recruited from three European hospitals. Baseline clinical and olfactory evaluations were performed within the first 2 weeks after OD onset and repeated at 30 and 60 days. In a subgroup of patients, anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies were measured in serum, saliva and nasal secretions at 60 days.

Results: A total of 288 COVID-19 patients with OD were included in the study. Two weeks after the onset of the loss of smell, 52.4% of patients had OD on psychophysical tests, including 113 cases (39.2%) of anosmia and 38 cases (13.2%) of hyposmia. At 60-day follow-up, 25.4% of the patients presented persistent OD. There was no significant correlation between sex, age, viral load on nasopharyngeal swab or COVID-19 severity and poor olfactory outcome. In a subgroup of 63 patients, it was demonstrated that patients with poor olfactory outcomes at 60 days had lower levels of salivary and nasal immunoglobulin G (IgG) and IgG1, but similar levels of antibodies in the serum.

Conclusions: No clinical markers predicted the evolution of OD at 60 days. Patients with poor olfactory outcome at 60 days had lower saliva and nasal antibodies, suggesting a role for local immune responses in the persistence of COVID-19 related OD.
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http://dx.doi.org/10.1111/ene.14994DOI Listing
June 2021

Prevalence of Insomnia among Pancreatic Cancer Patients following Pancreaticoduodenectomy.

Sleep Disord 2021 4;2021:5535220. Epub 2021 May 4.

Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Introduction: Sleep disturbances are more common in cancer patients than in the general population; however, there is limited research pertaining to the occurrence of such disturbances that subsequently impact patients' quality of life. The aim of our study is to describe the prevalence of insomnia among pancreatic cancer patients who have recently undergone recent pancreaticoduodenectomy.

Methods: We performed a 6-year (2014-2020) retrospective cohort analysis of all adult patients aged 18 and above with pancreatic cancer who underwent pancreaticoduodenectomy at our institution. Insomnia was characterized using the Pittsburgh Sleep Quality Index (PSQI). Symptoms of insomnia and the impact caused by these symptoms on daily lives were assessed with the Insomnia Severity Index (ISI), and patients were divided into mild insomnia (ISI 8-14) or moderate to severe insomnia (ISI ≥ 15).

Results: Out of forty patients with pancreatic cancer that have undergone pancreaticoduodenectomy, 19 (47.2%) reported that their sleep disturbances had a significant effect on their quality of life. A total of 22 (55.0%) patients reported insomnia, with 63.2% reporting mild insomnia. Chemotherapy was found to significantly increase the risk of moderate to severe insomnia. The mean ISI score was 7.2 ± 6.9, and the mean PSQI score was 7.0 ± 5.1. ISI and PSQI showed a strong positive correlation ( = 0.78, < 0.01).

Conclusion: Sleep disturbances such as insomnia following pancreatic cancer surgery are highly prevalent. Treating physicians and surgeons should recognize and routinely screen for sleep disorders through the management of a multidisciplinary team in order to alleviate some of the burden on the patients' mental well-being.
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http://dx.doi.org/10.1155/2021/5535220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112949PMC
May 2021

Neutrophilic Dermatosis of Hands as Oncological Finding: Importance of Follow-Up.

ORL J Otorhinolaryngol Relat Spec 2021;83(3):206-208. Epub 2021 Mar 10.

Department of Otolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium.

Neutrophilic febrile dermatosis (NFD) is a rare paraneoplastic syndrome that may be found in patients with head and neck cancer. NFD may appear before the neoplasia and may only concern the dorsal faces of the hands. This article reports the NFD findings of a patient with pharyngeal cancer, which was developed 2 years after the occurrence of NFD. The development of NFD in patient with alcohol and tobacco consumption should lead otolaryngologists and dermatologists to suspect head and neck malignancy. In cases of normal otolaryngological examination, patients have to be followed.
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http://dx.doi.org/10.1159/000513630DOI Listing
May 2021

Splenic flexure colonic lipoma causing intussusception.

JRSM Open 2021 Jan 11;12(1):2054270420983088. Epub 2021 Jan 11.

Department of Surgery, American University of Beirut Medical Center, 1107 Beirut, Lebanon.

Colonic lipomas are rare benign tumours that are usually asymptomatic. However, giant colonic lipomas tend to be symptomatic and can occasionally result in intussusception and intermittent colonic obstruction. As adult intussusception is an uncommon occurrence, the identification of the underlying aetiology is essential due to its high association with malignancy. Computed Tomography remains the tool of choice for the diagnosis of colonic lipomas. Surgical excision remains the mainstay treatment of giant symptomatic colonic lipomas. We hereby present the case of a 51-year-old male found to have a colonic lipoma causing recurrent intussusception. We discuss the approach, diagnostic tools and available treatment modalities for colonic lipomas. We also provide a brief literature review of intussusception in adults.
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http://dx.doi.org/10.1177/2054270420983088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804352PMC
January 2021

Psychophysical Evaluation of the Olfactory Function: European Multicenter Study on 774 COVID-19 Patients.

Pathogens 2021 Jan 12;10(1). Epub 2021 Jan 12.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France.

Background: The objective evaluation of the olfactory function of coronavirus disease 2019 patients is difficult because of logistical and operator-safety problems. For this reason, in the literature, the data obtained from psychophysical tests are few and based on small case series.

Methods: A multicenter, cohort study conducted in seven European hospitals between March 22 and August 20, 2020. The Sniffin-Sticks test and the Connecticut Chemosensory Clinical Research Center orthonasal olfaction test were used to objectively evaluate the olfactory function.

Results: This study included 774 patients, of these 481 (62.1%) presented olfactory dysfunction (OD): 280 were hyposmic and 201 were anosmic. There was a significant difference between self-reported anosmia/hyposmia and psychophysical test results ( = 0.006). Patients with gastroesophageal disorders reported a significantly higher probability of presenting hyposmia (OR 1.86; = 0.015) and anosmia (OR 2.425; < 0.001). Fever, chest pain, and phlegm significantly increased the likelihood of having hyposmia but not anosmia or an olfactory disturbance. In contrast, patients with dyspnea, dysphonia, and severe-to-critical COVID-19 were significantly more likely to have no anosmia, while these symptoms had no effect on the risk of developing hyposmia or an OD.

Conclusions: Psychophysical assessment represents a significantly more accurate assessment tool for olfactory function than patient self-reported clinical outcomes. Olfactory disturbances appear to be largely independent from the epidemiological and clinical characteristics of the patients. The non-association with rhinitis symptoms and the high prevalence as a presenting symptom make olfactory disturbances an important symptom in the differential diagnosis between COVID-19 and common flu.
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http://dx.doi.org/10.3390/pathogens10010062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827350PMC
January 2021

Case report: Back pseudocyst of unknown origin.

Int J Surg Case Rep 2020 29;75:235-237. Epub 2020 Aug 29.

Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address:

Introduction: Soft tissue masses are fairly encountered clinical entities. Among the rare forms of soft tissues masses are non-pancreatic pseudocysts which are defined as encapsulated fluid collections not lined by epithelium. We are presenting a rare case of a pseudocyst of the back located within the paravertebral muscles at a tertiary care center.

Case Description: Patient presented with a progressively enlarging painless back mass. CT scan was done which showed a 10 × 10 cm cystic lesion along the paravertebral muscles of the back. Surgical excision of the mass was performed revealing an irregularly shaped multilocular cyst. Final pathology showed the lesion to be a pseudocyst.

Discussion: Pseudocysts can arise in a variety of locations such as omentum, adrenal glands, spleen or lungs. The etiology of these pseudocysts is highly variable and can be related to trauma, inflammation, or surgery. The diagnosis of these entities requires proper imaging and histopathologic examination.

Conclusion: Pseudocysts arise due to a myriad of conditions and their diagnosis remains a challenge. Our case comprises the first reported case of idiopathic pseudocyst of the back. Although rare, pseudocysts should be considered in the differential of unexplained masses.
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http://dx.doi.org/10.1016/j.ijscr.2020.08.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509366PMC
August 2020

Spectrum of liver diseases in patients referred for Fibroscan: A single center experience in the Middle East.

Ann Med Surg (Lond) 2020 Sep 25;57:166-170. Epub 2020 Jul 25.

Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon.

Background: Liver diseases is a worldwide etiology causing high morbidity and mortality. Fibroscan is a quick, painless examination performed in clinic or at the patient's bedside. It is used to evaluate liver status for patients with suspected liver disease prognosis. This study aims at describing the spectrum of liver diseases among patients performing Fibroscan at a tertiary care center in Lebanon.

Methods: This is a retrospective data collection study on patients who underwent Fibroscan at the American University of Beirut hepatobiliary unit between 2015 and 2018. Medical charts of all patients were reviewed. Data were collected and analyzed using SPSS 25 software.

Results: A total of 620 patients presented to the hepatobiliary unit for Fibroscan, of which 419 (67.5%) were males. The mean age was 47.8 ± 13.4 (range 18-84). 362(58.3%) had NAFLD, 89 (14.3%) had Hepatitis-B, 69 (11.1%) had Hepatitis-C, 48 (7.7%) had ALD, 20 (3.3%) had DILI, and 13 (2.9%) had autoimmune hepatitis. 190 (30.6%) were overweight (BMI over 25), 128 (20.6%) had diabetes. Liver stiffness corresponding to the diagnosis of F4 liver fibrosis stage on Fibroscan was mostly reported in 6 (46.5%) autoimmune hepatitis, 101 (27.9%) NAFLD, and 18 (26.1%) HCV patients. 141 (45.5%) patients who had one or more metabolic risk factors suffered from severe stage steatosis compared with 78 (28.9%) who had not any risk factors with -value 0.04.

Conclusions: Based on our sample NAFLD is emerging as a predominant etiology of CLD, followed by, HBV, and HCV. This is the first study that reports CLD status in Lebanon, further studies that describe the prevalence and incidence of the disease at a larger scale are needed.
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http://dx.doi.org/10.1016/j.amsu.2020.07.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394832PMC
September 2020

Objective Olfactory Findings in Hospitalized Severe COVID-19 Patients.

Pathogens 2020 Jul 31;9(8). Epub 2020 Jul 31.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), F92150 Paris, France.

Objective: We investigate the prevalence of the self-reported and objective sudden loss of smell (SLS) in patients with severe coronavirus disease 2019 (COVID-19).

Methods: Severe COVID-19 patients with self-reported SLS were recruited at hospitalization discharge. Epidemiological and clinical data were collected. The Sino-nasal Outcome Test-22 (SNOT-22) was used to evaluate rhinological complaints. Subjective olfactory and gustatory functions were assessed with the National Health and Nutrition Examination Survey (NHNES). Objective SLS was evaluated using psychophysical tests. Potential associations between olfactory evaluation and the clinical outcomes (duration of hospitalization; admission biology; one month serology (IgG), and chest computed tomography findings) were studied.

Results: Forty-seven patients completed the study (25 females). Subjectively, eighteen (38.3%) individuals self-reported subjective partial or total SLS. Among them, only three and four were anosmic and hyposmic, respectively (38.9%). Considering the objective evaluation in the entire cohort, the prevalence of SLS was 21.3%. Elderly patients and those with diabetes had lower objective olfactory evaluation results than young and non-diabetic individuals.

Conclusions: The prevalence of SLS in severe COVID-19 patients appears to be lower than previously estimated in mild-to-moderate COVID-19 forms. Future comparative studies are needed to explore the predictive value of SLS for COVID-19 severity.
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http://dx.doi.org/10.3390/pathogens9080627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460289PMC
July 2020

Protocol for a randomized controlled trial comparing wound COmplications in elective midline laparotomies after FAscia Closure using two different Techniques Of Running sutures: COFACTOR trial.

Trials 2020 Jul 2;21(1):608. Epub 2020 Jul 2.

Department of Surgery, American University of Beirut Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon.

Background: Wound complications following midline laparotomies are common and the main source of postoperative morbidity including superficial or deep wound infection, skin dehiscence, fascia dehiscence, and incisional hernia. Abdominal closure complications are strongly associated with suture technique and material, in addition to other factors related to the patient and type of surgery performed. The traditional technique is to place the fascia sutures 1 cm apart and at least 1 cm away from the fascia edge. A Swedish study described a new technique of placing the sutures 5 mm apart and 5 mm away from the fascia edge, resulting in lower rates of abdominal wound complications. This study has a number of limitations. There is a need for improved quality evidence to convince the surgical community to change the closure technique of abdominal wounds aiming to reduce morbidity, which is exemplified in incisional hernias and other various postop complications.

Methods: This is a 1:1 randomized, controlled, patient- and assessor-blinded, parallel design, superiority trial, with a primary endpoint of incisional hernia at 1 year. The study will be conducted at AUBMC over a 3-year period. Patients planned for a non-emergent midline laparotomy for general surgery or vascular procedure will be randomized to either fascia closure technique. In order to detect a drop of 12% in the incidence of incisional hernia, with 80% power and an alpha of 0.05, we will need to recruit 114 patients per arm. After adjusting for loss to follow-up, target recruitment is 274 subjects. We will compare both arms for the primary, secondary, and exploratory outcomes, using chi-square or t test as appropriate. Univariate and multivariate logistic regression will be done.

Discussion: This trial will assess postop complications following abdominal midline wound closures via two different suturing techniques. This trial will generate evidence-based conclusions that will allow surgeons to assess the role of a new abdominal closure technique in decreasing short- and long-term postoperative complications, for a commonly performed procedure.

Trial Registration: ClinicalTrials.gov NCT03527433 . Registered on 17 May 2018 before starting participant enrollment.
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http://dx.doi.org/10.1186/s13063-020-04507-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330541PMC
July 2020

Features of Mild-to-Moderate COVID-19 Patients With Dysphonia.

J Voice 2020 Jun 4. Epub 2020 Jun 4.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Quironsalud Valencia, Spain.

Introduction: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients.

Methods: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis.

Results: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough.

Conclusion: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.
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http://dx.doi.org/10.1016/j.jvoice.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269945PMC
June 2020

Psychophysical Olfactory Tests and Detection of COVID-19 in Patients With Sudden Onset Olfactory Dysfunction: A Prospective Study.

Ear Nose Throat J 2020 Nov 29;99(9):579-583. Epub 2020 May 29.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

Objective: To investigate the coronavirus disease 2019 (COVID-19) status of patients with initial sudden olfactory anosmia (ISOA) through nasopharyngeal swabs for reverse transcription-polymerase chain reaction (RT-PCR) analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation.

Methods: A total of 78 ISOA patients were recruited from April 6, 2020, to April 10, 2020, through a public call of University of Mons (Mons, Belgium). Patients benefited from nasopharyngeal swabs and fulfilled the patient-reported outcome questionnaire. Among them, 46 patients performed psychophysical olfactory evaluation using olfactory identification testing. Based on the duration of the ISOA, 2 groups of patients were compared: patients with olfactory dysfunction duration ≤12 days (group 1) and those with duration >12 days (group 2).

Results: In group 1, 42 patients (87.5%) had a positive viral load determined by RT-PCR and 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. The psychophysical olfactory evaluation reported that anosmia and hyposmia occurred in 24 (52%) and 11 (24%) patients, respectively. Eleven patients were normosmic. The viral load was significantly higher in patients of group 1 compared with those of group 2.

Conclusions: Coronavirus disease 2019 was detected in a high proportion of ISOA patients, especially over the first 12 days of olfactory dysfunction. Anosmia is an important symptom to consider in the detection of COVID-19 infection.
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http://dx.doi.org/10.1177/0145561320929169DOI Listing
November 2020

Objective olfactory evaluation of self-reported loss of smell in a case series of 86 COVID-19 patients.

Head Neck 2020 Jul 21;42(7):1583-1590. Epub 2020 May 21.

Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

Objective: To investigate olfactory dysfunction (OD) in patients with mild coronavirus disease 2019 (COVID-19) through patient-reported outcome questionnaires and objective psychophysical testing.

Methods: COVID-19 patients with self-reported sudden-onset OD were recruited. Epidemiological and clinical data were collected. Nasal complaints were evaluated with the sinonasal outcome-22. Subjective olfactory and gustatory status was evaluated with the National Health and Nutrition Examination Survey. Objective OD was evaluated using psychophysical tests.

Results: Eighty-six patients completed the study. The most common symptoms were fatigue (72.9%), headache (60.0%), nasal obstruction (58.6%), and postnasal drip (48.6%). Total loss of smell was self-reported by 61.4% of patients. Objective olfactory testings identified 41 anosmic (47.7%), 12 hyposmic (14.0%), and 33 normosmic (38.3%) patients. There was no correlation between the objective test results and subjective reports of nasal obstruction or postnasal drip.

Conclusion: A significant proportion of COVID-19 patients reporting OD do not have OD on objective testing.
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http://dx.doi.org/10.1002/hed.26279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280665PMC
July 2020

Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study.

Eur Arch Otorhinolaryngol 2020 Aug 6;277(8):2251-2261. Epub 2020 Apr 6.

Department of Metabolic and Molecular Biochemistry, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

Objective: To investigate the occurrence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection.

Methods: Patients with laboratory-confirmed COVID-19 infection were recruited from 12 European hospitals. The following epidemiological and clinical outcomes have been studied: age, sex, ethnicity, comorbidities, and general and otolaryngological symptoms. Patients completed olfactory and gustatory questionnaires based on the smell and taste component of the National Health and Nutrition Examination Survey, and the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS).

Results: A total of 417 mild-to-moderate COVID-19 patients completed the study (263 females). The most prevalent general symptoms consisted of cough, myalgia, and loss of appetite. Face pain and nasal obstruction were the most disease-related otolaryngological symptoms. 85.6% and 88.0% of patients reported olfactory and gustatory dysfunctions, respectively. There was a significant association between both disorders (p < 0.001). Olfactory dysfunction (OD) appeared before the other symptoms in 11.8% of cases. The sQO-NS scores were significantly lower in patients with anosmia compared with normosmic or hyposmic individuals (p = 0.001). Among the 18.2% of patients without nasal obstruction or rhinorrhea, 79.7% were hyposmic or anosmic. The early olfactory recovery rate was 44.0%. Females were significantly more affected by olfactory and gustatory dysfunctions than males (p = 0.001).

Conclusion: Olfactory and gustatory disorders are prevalent symptoms in European COVID-19 patients, who may not have nasal symptoms. The sudden anosmia or ageusia need to be recognized by the international scientific community as important symptoms of the COVID-19 infection.
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http://dx.doi.org/10.1007/s00405-020-05965-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134551PMC
August 2020

Orofacial Strength and Voice Quality as Outcome of Levodopa Challenge Test in Parkinson Disease.

Laryngoscope 2020 12 2;130(12):E896-E903. Epub 2020 Apr 2.

Department of Neurology, EpiCURA Hospital, Baudour, Belgium.

Objective: To assess the usefulness of orofacial strength and voice quality as assessment of response to levodopa challenge test (LCT) used in the diagnosis of early idiopathic Parkinson disease (IPD).

Study Design: Controlled Prospective Study.

Methods: From January 2014 to April 2019, patients with early IPD and healthy individuals were recruited and evaluated for clinical findings (Hoehn and Yahr scale; Unified Parkinson's Disease Rating Scale); Voice Handicap Index (VHI); grade of dysphonia, roughness, breathiness, asthenia, and strain and instability (GRBASI); maximal phonation time; phonation quotient; acoustic parameters; and orofacial muscle strength Oral Performance Instrument (IOPI; IOPI Medical, Woodinville, WA, USA) t) at baseline and 45 minutes after the levodopa intake (LCT).

Results: A total of 32 IPD patients and 20 healthy individuals completed the study. Healthy individuals exhibited better VHI, grade of dysphonia, breathiness, asthenia, strain, instability, and acoustic measurements (noise-related, tremor, F0 short- and mid-term and intensity short-term parameters) than healthy subjects. The mean values of muscle strength of lips, cheeks, fundamental frequency (F0), highest F0, and shimmer significantly improved from pre- to post-LCT in IPD patients. Healthy individuals did not exhibit significant changes of orofacial strength and voice quality assessment from pre- to post-LCT. Significant associations were found between clinical, orofacial strength, and some aerodynamic and acoustic measurements.

Conclusion: Orofacial strength and acoustic voice quality measurements may be used as objective outcomes of the LCT responsiveness in patients with early IPD.

Level Of Evidence: 3A. Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.28645DOI Listing
December 2020

Gender differences in liver fibrosis among patients younger than 50 years: A retrospective cohort study.

Clin Res Hepatol Gastroenterol 2020 10 11;44(5):733-738. Epub 2020 Mar 11.

Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center Beirut, Beirut, Lebanon. Electronic address:

Background & Aims: Liver fibrosis is a metabolic disease associated with several factors, mainly age, gender, immune suppression, viral hepatitis, alcohol and metabolic diseases. Here, we are assessing the gender impact on liver status in NAFLD patients younger than 50 years.

Methods: All males younger than 50 years and premenopausal females diagnosed with NAFLD were included in this study. Fibroscan results, demographics and clinical data were collected and analyzed by SPSS software. Patients were stratified based on fibrosis scores as mild or no fibrosis for F0-F1-F2 and severe fibrosis for F3 and F4. Data was analyzed and compared based on gender.

Results: A total of 221 patients 134 males and 80 premenopausal females were included. Factors that affected liver fibrosis scores were different between males and females, where only body-mass index (BMI), white blood cells (WBC) count, and glucose level were associated with severe liver fibrosis in females. Also, liver fibrosis scores were associated with severe liver fibrosis in males only, no difference in these scores was observed in premenopausal females with severe or mild liver fibrosis.

Conclusions: Gender differences are prominent in NAFLD and different factors are associated with liver status in males as compared to females. Besides, fibrosis score could predict liver status in males but not in females. Further larger-scale studies are necessary to verify gender impact on liver fibrosis development.
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http://dx.doi.org/10.1016/j.clinre.2020.01.001DOI Listing
October 2020

Perioperative Management of Pancreaticoduodenectomy: Avoiding Admission to the Intensive Care Unit.

Gastrointest Tumors 2019 Oct 17;6(3-4):108-115. Epub 2019 Sep 17.

Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Introduction: With the advancement in surgical expertise at high-volume centers and advances in perioperative management, pancreaticoduodenectomy is becoming safer and remains the gold standard for treating periampullary pathologies. We describe our experience in optimizing perioperative management in order to avoid admission to the intensive care unit and improve outcomes.

Method: Retrospective data were collected on 370 surgical patients who underwent a pancreaticoduodenectomy between the years 1994 and 2016.

Results: Of the 370 patients, 200 operated between 2009 and 2016 did not require intensive care admission, blood transfusion, or central line insertion. The results were compared between different time intervals: before the year 1998, between the years 1998 and 2008, and between the years 2009 and 2016. The median blood loss dropped from 800 to 400 to 300 mL, respectively. The median operative time also dropped from 360 to 335 to 215 min, respectively. In addition, the median length of hospital stay decreased from 25 to 16 to 7 days, respectively.

Conclusion: With the centralization of pancreaticoduodenectomy in high-volume centers and with specialized surgeons performing the surgery, there is a significant decrease in the onset of postoperative complications with a lesser need for blood transfusions and, subsequently, better recovery of patients without the need for intensive care unit admission.
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http://dx.doi.org/10.1159/000502887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873035PMC
October 2019

Fibroscan and low-density lipoprotein as determinants of severe liver fibrosis in diabetic patients with nonalcoholic fatty liver disease.

Eur J Gastroenterol Hepatol 2019 Dec;31(12):1540-1544

Department of Surgery, Faculty of Medicine.

Background: Fibroscan is an effective and noninvasive tool to quantify fibrosis and steatosis in liver diseases including nonalcoholic fatty liver disease (NAFLD). Type-2-diabetes is a known risk factor for worse prognosis in NAFLD. In this study, we compare liver status in NAFDL diabetic and nondiabetic patients, identify potential risk factors, and determine the usefulness of Fibroscan in this population.

Patients And Methods: The charts of all patients with NAFLD who underwent Fibroscan at our institution were reviewed. Fibroscan results, demographics, and clinical data were collected and analyzed using SPSS software.

Results: Of the 248 NAFLD patients, 73 (29.4%) were diabetic and 175 (70.6%) were nondiabetic. As detected by the NAFLD' liver stiffness measure, 35 (47.94%) diabetic patients had severe liver fibrosis (F4) in contrast to only 46 (26.3%) nondiabetics. Diabetic patients also presented more with hypertension, dyslipidemia, coronary artery disease, and chronic kidney disease. Liver steatosis, liver function tests, and noninvasive scores did not vary significantly between the two groups, except for γ-glutamyltransferase, prothrombin time-international normalized ratio, and BMI-alanine aminotransferase ratio-diabetes score. Diabetic patients had significantly lower high-density lipoproteins and low-density lipoproteins.

Conclusion: Fibroscan results and low-density lipoprotein are potential diagnostic factors of liver fibrosis in diabetic patients with NAFLD. Further studies are necessary to verify liver fibrosis diagnostic tools and prognostic and genetic markers in diabetic patients.
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http://dx.doi.org/10.1097/MEG.0000000000001461DOI Listing
December 2019

Clinical and Acoustical Voice Quality Evolutions Throughout Empirical Treatment for Laryngopharyngeal Reflux Disease According to Gender: A Preliminary Study.

Folia Phoniatr Logop 2020 27;72(4):257-266. Epub 2019 May 27.

Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.

Objective: To compare symptoms, signs, and acoustical voice quality changes throughout the 6-month course of empirical treatment between laryngopharyngeal reflux (LPR) males and females.

Materials And Methods: Forty clinically diagnosed LPR females and 40 males with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations during 3 or 6 months according to their evolution. RSI, RFS, and acoustic parameters were assessed at baseline and 3 and 6 months posttreatment. A correlation analysis between videolaryngostroboscopic findings and acoustic measurements was performed.

Results: RSI, RFS, and many acoustic measurements (i.e., percent jitter, percent shimmer, phonatory fundamental frequency range, fundamental frequency variation, and peak-to-peak amplitude variation) significantly improved from baseline to 3 months posttreatment in male group. In female group, RSI and RFS total score significantly improved along the 3 first months of treatment. However, some clinical outcomes (i.e., RSI total score, hoarseness, cough, and globus) continued to improve from 3 to 6 months of treatment. We did not identify significant improvement of acoustic measurements in female group. The correlation study did not reveal significant correlation between videolaryngostroboscopic findings and acoustic measurements.

Conclusion: This preliminary study suggests the occurrence of gender-related differences in the LPR therapeutic response. Further studies need to clarify whether females require a longer course of therapy than males.
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http://dx.doi.org/10.1159/000500085DOI Listing
May 2019

Perceptual, Aerodynamic, and Acoustic Characteristics of Voice Changes in Patients with Laryngopharyngeal Reflux Disease.

Ear Nose Throat J 2019 Jul 8;98(6):E44-E50. Epub 2019 Apr 8.

1 Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants.
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http://dx.doi.org/10.1177/0145561319840830DOI Listing
July 2019

Pancreaticoduodenectomy in the Middle East: Achieving optimal results through specialization and standardization.

Hepatobiliary Pancreat Dis Int 2019 Oct 21;18(5):478-483. Epub 2019 Feb 21.

Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Background: Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri‑ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015.

Methods: We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann-Whitney U and Fisher's exact tests were used to report statistical differences between groups.

Results: Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0% (15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative length of hospital stay was 12 (5-76) days. Thirty-two patients required re-laparotomies; 10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management.

Conclusions: The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.
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http://dx.doi.org/10.1016/j.hbpd.2019.02.001DOI Listing
October 2019

Moraxella nonliquefaciens septic arthritis in a hematopoietic stem cell transplant patient a case report and review of the literature.

J Infect Public Health 2019 May - Jun;12(3):309-312. Epub 2019 Jan 30.

Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address:

Background: Septic arthritis is a common rheumatologic condition with myriad microbiological causative agents. Moraxella is one of the very rare causes of septic arthritis. We hereby present the third case of Moraxella nonliquefaciens septic arthritis and the first case in a hematopoietic stem cell transplant patient (HSCT) along with a brief review of the literature.

Methods: We used PubMed with google search engine to search the literature for reported cases of moraxella septic arthritis.

Results: Information on 19 other cases of moraxella infectious arthritis was found. M. catarrhalis was the most common species isolated. Only 2 reports on M. nonliquefaciens were found; the first one in a multiple myeloma patient and the second one in a diabetic patient on hemodialysis. Predisposing conditions included inflammatory arthritis, prosthetic joints, diabetes, Human Immunodeficiency Virus (HIV) infection, Hepatitis C, hemodialysis, esophageal cancer, valve replacements, alcoholism and Intravenous (IV) drug use. The age group of the reported cases ranged from 3 months to 78 years.

Conclusion: Infectious arthritis with Moraxella spp. is a very rare entity which can occur in any age group and in the setting of various underlying medical conditions.
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http://dx.doi.org/10.1016/j.jiph.2019.01.059DOI Listing
June 2019

Alkaline, protein, low-fat and low-acid diet in laryngopharyngeal reflux disease: Our experience on 65 patients.

Clin Otolaryngol 2019 05 10;44(3):379-384. Epub 2019 Jan 10.

Faculty of Medicine, Laboratory of Anatomy and Cell Biology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

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http://dx.doi.org/10.1111/coa.13269DOI Listing
May 2019

Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study.

J Voice 2020 Jan 13;34(1):112-120. Epub 2018 Sep 13.

Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Faculté de medicine, CHU Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium.

Purpose: To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease.

Material And Methods: A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted.

Results: Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations.

Conclusion: Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.
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http://dx.doi.org/10.1016/j.jvoice.2018.08.018DOI Listing
January 2020

Impact of Laryngopharyngeal Reflux on Subjective, Aerodynamic, and Acoustic Voice Assessments of Responder and Nonresponder Patients.

J Voice 2019 Nov 27;33(6):929-939. Epub 2018 Jul 27.

Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium.

Objective: To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR).

Material And Methods: Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted.

Results: Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters.

Conclusion: Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement.
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http://dx.doi.org/10.1016/j.jvoice.2018.05.014DOI Listing
November 2019

Triple thrombophilic simultaneous mutations in patients after bariatric surgery: is there a role for screening in the Eastern Mediterranean?

J Surg Case Rep 2018 Jun 15;2018(6):rjy135. Epub 2018 Jun 15.

Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Background And Purpose: Thrombophilia is a hypercoagulable state that predisposes to thrombosis. Several genetic risk factors have been shown to predispose to thromboembolic events. Homozygosity to a thrombophilic mutation certainly predisposes the affected patient to more serious symptoms.

Materials And Methods: Here we present a case of a 56-year-old male patient who underwent sleeve gastrectomy for morbid obesity, presenting to our institution with abdominal pain. Investigations revealed thrombosis of the splenic, axillary vein as well as the right pulmonary artery. The patient was found to have triple thrombophilic mutations.

Results: To our knowledge, this is the first reported case of three specific simultaneous thrombophilic mutations in a patient from the Eastern Middle East.

Conclusion: We suggest a role for screening for thrombophilic mutations in the Eastern Mediterranean patients undergoing bariatric surgeries for morbid obesity due to the increased risk of thrombosis in this group of patients.
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http://dx.doi.org/10.1093/jscr/rjy135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007279PMC
June 2018

Gender differences in the presentation of dysphonia related to laryngopharyngeal reflux disease: a case-control study.

Eur Arch Otorhinolaryngol 2018 Jun 26;275(6):1513-1524. Epub 2018 Mar 26.

Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Avenue du Champ de mars, 6, 7000, Mons, Belgium.

Objective: To investigate the voice quality impairments in patients with laryngopharyngeal reflux (LPR) according to the gender.

Design: Controlled multi-center study.

Materials And Methods: 80 LPR patients (40 males and 40 females) with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were included and clinically compared according to gender. To be considered as LPR patients, subjects responded to an empiric therapeutic trial based on pantoprazole intake and diet recommendations for 3 months or had positive pH/Impedance metry. Voice Handicap Index (VHI); Short Form Healthy Survey 36 (SF36), blinded Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI); aerodynamic and acoustic measurements were assessed in all patients and compared with 80 healthy controls (40 males and 40 females) according to gender.

Results: The most common reasons for the consultation were, respectively, globus sensation in males (22.5%) and dysphonia (27.5%) in female who complained more of breathing difficulties and choking episodes related to LPR than males (p = 0.024). From a quality of life standpoint, female had increased significant impact of LPR disease on vitality and mental health than male. Compared to healthy subjects, both LPR male and female patients had stronger values of G, R, B, S, I, VHI, percent jitter, percent shimmer, and soft palate index than controls. In addition, LPR female had stronger values of lowest fundamental frequency and all aerodynamic measurements than controls.

Conclusion: As showed in many other laryngeal conditions, voice quality of female could be more impaired by LPR than male. Some anatomical, histological and functional factors can be suspected and need additional future researches.
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http://dx.doi.org/10.1007/s00405-018-4951-2DOI Listing
June 2018

Contact allergy to benzalkonium chloride in patients using a steroid nasal spray: A report of 3 cases.

Ear Nose Throat J 2018 Jan-Feb;97(1-2):E20-E22

Corresponding author: Department of Otolaryngology-Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Rue Louis Cathy, B7331, Baudour, Belgium.

Benzalkonium chloride (BAC) is a bactericidal preservative excipient commonly found in steroid nasal sprays used to treat allergic rhinitis and nasal polyposis. In rare cases, BAC can be responsible for type I and type IV hypersensitivity reactions that can manifest as rhinorrhea, which a clinician might misinterpret as a lack of response to nasal spray therapy rather than a complication of it. We report 3 cases of type IV hypersensitivity reactions in patients who were being treated with mometasone nasal spray. We describe the epidemiology, clinical features, diagnosis, and treatment of these reactions.
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http://dx.doi.org/10.1177/0145561318097001-205DOI Listing
September 2018

Life Threatening Complications Post-Liposuction.

Aesthetic Plast Surg 2018 Apr 31;42(2):384-387. Epub 2018 Jan 31.

Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon.

Background: Liposuction is one of the most commonly performed aesthetic procedures. It is performed worldwide as an outpatient procedure. However, the complications are underestimated and underreported by caregivers. We present a case of delayed diagnosis of bilothorax secondary to liver and gallbladder injury after tumescent liposuction.

Methods: A 26-year-old female patient was transferred to our emergency department from an aesthetic clinic with worsening dyspnea, tachypnea and fatigue. She had undergone extensive liposuction of the thighs, buttocks, back and abdomen 5 days prior to presentation.

Results: A chest X-ray showed significant right-sided pleural effusion. Thoracentesis was performed and drained bilious fluid. CT scan of the abdomen revealed pleural, liver and gall bladder injury. An exploratory laparoscopy confirmed the findings, the collections were drained; cholecystectomy and intraoperative cholangiogram were performed. The patient did very well postoperatively and was discharged home in 2 days.

Conclusion: Even though liposuction is considered a simple office-based procedure, its complications can be fatal. The lack of strict laws that exclusively place this procedure in the hands of medical professionals allow these procedures to still be done by less experienced hands and in outpatient-based settings. Our case serves to highlight yet another unique but potentially fatal complication of liposuction.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-017-1058-xDOI Listing
April 2018

Acrokeratosis paraneoplastica (Bazex syndrome).

Ear Nose Throat J 2017 Oct-Nov;96(10-11):413-414

Department of Otolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Rue Louis Cathy, Baudour, Belgium.

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http://dx.doi.org/10.1177/0145561317096010-1119DOI Listing
November 2018
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