Publications by authors named "Mohammad Diab"

78 Publications

Ureteral injury following anterior thoracolumbar spinal instrumented fusion for adolescent idiopathic scoliosis: a case report with CT angiography analysis of surgically relevant anatomy.

Spine Deform 2021 Jun 1. Epub 2021 Jun 1.

Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), 1825 4th St., San Francisco, CA, 94158, USA.

Purpose: To report a rare ureteral injury following anterior spinal fusion for adolescent idiopathic scoliosis (AIS) that resulted in complete nephrectomy and to delineate the anatomical relationship between the proximal ureter and the anterior lumbar spine based on CT angiography (CTA).

Methods: Thoracolumbar spine CTAs of children with AIS were reviewed. We measured the following relationships to the ureters: lateral-most aspect of vertebral body, anterior psoas at intervertebral disc/vertebral body levels, and lateral psoas at vertebral body level. Spine level at which the renal arteries originated from the aorta was identified. Distance from origin to corresponding vertebral body/intervertebral disc also was measured.

Results: Forty-one girls and seven boys (mean age 12 years, range 7-18) were analyzed. Scoliosis lumbar convexity was left 94% and right 6%. From L1 to L4, ureter was identified within 1-2 cm of vertebral body. Distance between ureter and vertebral body and ureter and anterior psoas at intervertebral disc/vertebral body levels was less on left vs. right from L1 to L4 (p < 0.0001). Distance between ureter and lateral psoas was less on left vs. right from L1 to L2 (p = 0.0205; p = 0.0132) and greater on left vs. right from L3 to L4 (p = 0.0022; p = 0.0076). Renal artery originated at L1/L2 in > 50%. There was no difference in distance from renal artery origin to vertebral body/intervertebral disc (p = 0.4764).

Conclusion: Ureteral injury is a potentially morbid complication of anterior spine surgery. Injury can occur secondary to disrupted blood supply and mechanical tissue damage. Surgeons must clearly understand the juxta-spinal anatomy to limit dissection and modify retraction to reduce risk.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s43390-021-00363-xDOI Listing
June 2021

Ureteral injury following anterior thoracolumbar spinal instrumented fusion for adolescent idiopathic scoliosis: a case report with CT angiography analysis of surgically relevant anatomy.

Spine Deform 2021 Jun 1. Epub 2021 Jun 1.

Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), 1825 4th St., San Francisco, CA, 94158, USA.

Purpose: To report a rare ureteral injury following anterior spinal fusion for adolescent idiopathic scoliosis (AIS) that resulted in complete nephrectomy and to delineate the anatomical relationship between the proximal ureter and the anterior lumbar spine based on CT angiography (CTA).

Methods: Thoracolumbar spine CTAs of children with AIS were reviewed. We measured the following relationships to the ureters: lateral-most aspect of vertebral body, anterior psoas at intervertebral disc/vertebral body levels, and lateral psoas at vertebral body level. Spine level at which the renal arteries originated from the aorta was identified. Distance from origin to corresponding vertebral body/intervertebral disc also was measured.

Results: Forty-one girls and seven boys (mean age 12 years, range 7-18) were analyzed. Scoliosis lumbar convexity was left 94% and right 6%. From L1 to L4, ureter was identified within 1-2 cm of vertebral body. Distance between ureter and vertebral body and ureter and anterior psoas at intervertebral disc/vertebral body levels was less on left vs. right from L1 to L4 (p < 0.0001). Distance between ureter and lateral psoas was less on left vs. right from L1 to L2 (p = 0.0205; p = 0.0132) and greater on left vs. right from L3 to L4 (p = 0.0022; p = 0.0076). Renal artery originated at L1/L2 in > 50%. There was no difference in distance from renal artery origin to vertebral body/intervertebral disc (p = 0.4764).

Conclusion: Ureteral injury is a potentially morbid complication of anterior spine surgery. Injury can occur secondary to disrupted blood supply and mechanical tissue damage. Surgeons must clearly understand the juxta-spinal anatomy to limit dissection and modify retraction to reduce risk.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s43390-021-00363-xDOI Listing
June 2021

Physician Ratings: Determinants, Accuracy, and Impact.

J Bone Joint Surg Am 2021 Apr;103(7):e27

Department of Orthopaedic Surgery, University of California- San Francisco, San Francisco, California.

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http://dx.doi.org/10.2106/JBJS.20.01048DOI Listing
April 2021

Neurophysiologic Detection of Spinal Cord Ischemia During Anterior Vertebral Tethering.

Spine (Phila Pa 1976) 2020 Dec;45(24):E1703-E1706

Department of orthopædic surgery, University of California - San Francisco (UCSF), San Francisco, CA.

Study Design: Case report.

Objective: The aim of this study was to present how computed tomographic angiography (CTA) and intraoperative neurophysiologic monitoring (IONM) detect spinal cord ischemia during anterior spine surgery. These data directed expedient surgical and anesthetic interventions that restored IONM signals and prevented neurologic sequalæ.

Summary Of Background Data: Anterior vertebral tethering (AVT) is a fusionless surgical treatment of adolescent idiopathic scoliosis (AIS).

Methods: AVT was performed on a skeletally immature patient with AIS. Preoperative CTA detailed location of the dominant radicular artery (DRA). Transcranial motor (tcMEP) and somatosensory (SEP) evoked potentials were monitored during operation.

Results: There was significant decline in tcMEP, but not SEP, after compression of the DRA during cable tensioning of AVT. There was complete tcMEP recovery following release of instrumentation.

Conclusion: This article identifies a rare but potentially catastrophic vascular hazard associated with anterior spine operation, including AVT. Sacrifice of multiple unilateral segmental vessels may overwhelm the capacity of collateral spinal cord perfusion to compensate for DRA blood supply. This vascular risk may be eliminated by identifying the DRA in order that it may be preserved during the procedure.

Level Of Evidence: 5.
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http://dx.doi.org/10.1097/BRS.0000000000003688DOI Listing
December 2020

Evaluating prescribing competencies covered in a Canadian-accredited undergraduate pharmacy program in Qatar: a curriculum mapping process.

BMC Med Educ 2020 Aug 6;20(1):253. Epub 2020 Aug 6.

College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar.

Background: The objective of this study was to evaluate the existing Bachelor of Science in Pharmacy [BSc (Pharm)] curriculum at Qatar University College of Pharmacy (QU CPH), for addressing international prescribing competencies.

Methods: The Australian National Prescribing Service (NPS MedicineWise) Competencies Required to Prescribe Medicines framework (the Prescribing Competencies Framework) was used in the BSc (Pharm) curriculum mapping process. The NPS MedicineWise Prescribing Competencies Framework outlines seven competency areas that are essential for pharmacist prescribing. The first mapping activity assessed the learning outcomes (LOs) of 62 courses within the BSc (Pharm) curriculum for covering and addressing the NPS MedicineWise competencies. The second mapping activity involved matching the LOs identified to address the NPS MedicineWise prescribing competencies, to the 2017 Association of Faculties of Pharmacy of Canada (AFPC) educational outcomes, on which the QU CPH BSc (Pharm) program is based. The AFPC educational outcomes address seven key program-level learning outcomes.

Results: The QU CPH BSc (Pharm) curriculum addresses most of the prescribing competencies listed in the NPS MedicineWise Prescribing Competencies Framework. However, gaps were identified in the curricular content and in the LOs that were related, but not restricted, to the following: electronic prescribing, physical examinations/preparing patients for investigations, and policies/procedures and quality assurace related to prescribing. Other gaps identified include legislative and workplace requirements for obtaining consent to access confidential patient's health information.

Conclusion: The curriculum mapping exercise provided evidence that, for the most part, the existing BSc (Pharm) curriculum at QU CPH prepares pharmacy graduates for prescribing. However, there are areas that need better alignment between the taught curriculum and training on prescribing in practice. The results of this study are important to consider if pharmacist prescribing is to be implemented in Qatar.
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http://dx.doi.org/10.1186/s12909-020-02109-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409697PMC
August 2020

Human Metapneumovirus Escapes NK Cell Recognition through the Downregulation of Stress-Induced Ligands for NKG2D.

Viruses 2020 07 20;12(7). Epub 2020 Jul 20.

The Concern Foundation Laboratories at the Lautenberg Center for Immunology and Cancer Research, Institute for Medical Research Israel-Canada (IMRIC), Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel.

The Pneumoviridae family includes human metapneumovirus (HMPV) and human orthopneumovirus, which is also known as a respiratory syncytial virus (HRSV). These are large enveloped, negative single-strand RNA viruses. HMPV and HRSV are the human members, which commonly infect children. HMPV, which was discovered in 2001, infects most children until the age of five, which causes an influenza-like illness. The interaction of this virus with immune cells is poorly understood. In this study, we show that HMPV evades natural killer (NK) cell attack by downregulating stress-induced ligands for the activating receptor NKG2D including: Major histocompatibility complex (MHC) class I polypeptide-related sequences A and B (MICA, MICB), UL16 binding proteins ULBP2, and ULBP3, but not ULBP1. Mechanistically, we show that the viral protein G is involved in the downregulation of ULBP2 and that the viral protein M2.2 is required for MICA and MICB downregulation. These findings emphasize the importance of NK cells, in general, and NKG2D, in particular, in controlling HMPV infection, which opens new avenues for treating HMPV.
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http://dx.doi.org/10.3390/v12070781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412239PMC
July 2020

Bilateral optic disc pits in a pediatric patient with Cobb syndrome.

Am J Ophthalmol Case Rep 2020 Sep 18;19:100749. Epub 2020 May 18.

Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.

Purpose: To describe a patient with Cobb Syndrome, a rare congenital disorder characterized by cutaneous and spinal arteriovenous malformations, who was found to have bilateral optic nerve pits.

Observations: A 15-year-old boy diagnosed with Cobb Syndrome, manifesting as a large cutaneous port-wine stain associated with an underlying left paraspinous arteriovenous malformation resulting in severe scoliosis, presented for a screening ophthalmological exam. The patient had no visual symptoms. On examination, his visual acuity was 20/20 in each eye; however, bilateral optic disc pits were discovered on biomicroscopy and confirmed by spectral-domain optical coherence tomography.

Conclusion And Importance: The unusual finding of bilateral optic disc pits in this rare congenital neurocutaneous disorder represents the first report of ophthalmic abnormalities in association with Cobb syndrome. Patients with Cobb Syndrome may be considered for screening ophthalmological exam for the detection of subclinical optic nerve abnormalities.
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http://dx.doi.org/10.1016/j.ajoc.2020.100749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270543PMC
September 2020

Preoperative CT Angiography Informs Instrumentation in Anterior Spine Surgery for Idiopathic Scoliosis.

J Am Acad Orthop Surg Glob Res Rev 2020 04 1;4(4). Epub 2020 Apr 1.

Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA.

The objective of this study is to evaluate whether the artery of Adamkiewicz localization with preoperative CT angiography influences anterior spinal instrumentation.

Methods: Children with idiopathic scoliosis who underwent anterior instrumentation and with a preoperative CT angiography were evaluated retrospectively. Data included curve type, artery of Adamkiewicz level/laterality, surgical approach laterality, number of instrumented levels and segmental vessels ligated, intraoperative neuromonitoring changes, and postoperative neural complications.

Results: Thirty-nine girls and eight boys (mean age 12 years [6.7 to 16.8 years]) were analyzed. Instrumented curves indicate 28 thoracic, 14 thoracolumbar, and seven double major. The artery of Adamkiewicz: T6 (left-1), T8 (left-1), T9 (left-4/right-2), T10 (left-11/right-4), T11 (left-4/right-4), T12 (left-1/right-2), L1 (left-2/right-1), and L2 (left-3/right-2). Four had bilateral dominant segmentals, whereas in nine patients, none was identified. T10 (32%) and left side (57%) were most frequent. On average, 7.1 (4 to 11) segmentals were ligated case (total 355). Dominant vessels were ipsilateral to/within instrumentation levels in 30%.

Discussion: In children with idiopathic scoliosis who underwent anterior instrumentation, the artery of Adamkiewicz was identified on the left in >50% and at T10 in 32%. In one-third of the patients, the artery was within intended surgical levels and resulted in instrumentation modification.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188266PMC
April 2020

The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: a systematic review.

J Antimicrob Chemother 2020 09;75(9):2394-2410

School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.

Objectives: This systematic review (SR) reviews the evidence on use of theory in developing and evaluating behaviour change interventions (BCIs) to improve clinicians' antimicrobial prescribing (AP).

Methods: The SR protocol was registered with PROSPERO. Eleven databases were searched from inception to October 2018 for peer-reviewed, English-language, primary literature in any healthcare setting and for any medical condition. This included research on changing behavioural intentions (e.g. in simulated scenarios) and research measuring actual AP. All study designs/methodologies were included. Excluded were: grey literature and/or those which did not state a theory. Two reviewers independently extracted and quality assessed the data. The Theory Coding Scheme (TCS) evaluated the extent of the use of theory.

Results: Searches found 4227 potentially relevant papers after removal of duplicates. Screening of titles/abstracts led to dual assessment of 38 full-text papers. Ten (five quantitative, three qualitative and two mixed-methods) met the inclusion criteria. Studies were conducted in the UK (n = 8), Canada (n = 1) and Sweden (n = 1), most in primary care settings (n = 9), targeting respiratory tract infections (n = 8), and medical doctors (n = 10). The most common theories used were Theory of Planned Behaviour (n = 7), Social Cognitive Theory (n = 5) and Operant Learning Theory (n = 5). The use of theory to inform the design and choice of intervention varied, with no optimal use as recommended in the TCS.

Conclusions: This SR is the first to investigate theoretically based BCIs around AP. Few studies were identified; most were suboptimal in theory use. There is a need to consider how theory is used and reported and the systematic use of the TCS could help.
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http://dx.doi.org/10.1093/jac/dkaa154DOI Listing
September 2020

Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar.

Int J Clin Pharm 2020 Feb 2;42(1):110-123. Epub 2020 Jan 2.

College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.

Background Pharmacists in many developed countries have been granted prescribing authorities under what is known as "non-medical prescribing" or "pharmacist prescribing". However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists' perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.
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http://dx.doi.org/10.1007/s11096-019-00946-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162834PMC
February 2020

Patient Satisfaction: Inception, Impact, and Correlation with Outcomes.

J Bone Joint Surg Am 2019 Nov;101(21):e115

Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California.

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http://dx.doi.org/10.2106/JBJS.18.01499DOI Listing
November 2019

Idiopathic stroke after syndromic and neuromuscular scoliosis surgery: a case report and literature review.

AME Case Rep 2019 6;3:28. Epub 2019 Aug 6.

Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, CA 94158, USA.

Children with syndromic and neuromuscular scoliosis undergoing corrective surgery experience higher complication rates than those with idiopathic scoliosis. A rare but devastating complication is stroke, which occurs in 0.57% of operations for neuromuscular scoliosis but accounts for 7.6% of deaths. Comorbidities associated with non-idiopathic scoliosis that increase risk of stroke include hypercoagulability, cardiac dysfunction, and contractures, which interfere with positioning and risk vascular compromise. Syndromic and neuromuscular diseases may predispose patients to intraoperative dural tears, either primarily (e.g., dural ectasia) or secondarily, in particular due to severity of deformity. We present the case of a perioperative, idiopathic stroke in a 15-year-old boy with scoliosis in the setting of neurofibromatosis type I, reviewing possible causes as well as strategies for preoperative assessment and postoperative monitoring.
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http://dx.doi.org/10.21037/acr.2019.07.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736787PMC
August 2019

Setting the agenda for clinical pharmacy in Qatar: thematic and content analyses of news media headlines.

Pharm Pract (Granada) 2019 Apr-Jun;17(2):1448. Epub 2019 Jun 6.

School of Pharmacy, University of Otago. Dunedin (New Zealand).

Background: Public awareness of the role of pharmacists and availability of pharmacy services in Qatar is low. As per agenda-setting theory, mass media may be contributing toward this problem by selecting and disseminating headlines and stories according their own objectives and not those of the profession.

Objectives: The objective of this study was to examine the agenda set by mass media organizations in Qatar pertaining to the profession of pharmacy and to determine the frequency of professional identifiers that appear within news headlines.

Methods: Publicly available news headlines published between November 2016 and November 2018 were obtained from local news websites. Thematic analysis was performed using agenda-setting theory to explore how the public's agenda was set for pharmacy practice in Qatar. Content analysis was used to determine the proportion of headlines that contained a professional identifier linking the news report to the pharmacy profession.

Results: A total of 81 headlines were included in the analysis. The agenda for pharmacy practice in Qatar was set according to two themes: achievement and outreach/engagement. Achievement related to awards, use of new technologies, interprofessional education, and novel student training accomplishments. Outreach/engagement reported student and pharmacist involvement upon completion of a health awareness event. Approximately half (47%) of headlines contained a professional identifying word linking the headline to the profession of pharmacy.

Conclusions: The findings of this study demonstrate that the mass media's agenda for the pharmacy profession in Qatar does not inform the public of pharmacist's services or expanded scopes of practice. Furthermore, a lack of professional identifiers within headlines likely limits the public's agenda of pharmacist roles. The pharmacy profession must work collaboratively with news media to better align the public's agenda with pharmacists' roles and services.
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http://dx.doi.org/10.18549/PharmPract.2019.2.1448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594431PMC
June 2019

Schimke immunoosseous dysplasia and management considerations for vascular risks.

Am J Med Genet A 2019 07 30;179(7):1246-1252. Epub 2019 Apr 30.

Division of Medical Genetics, Department of Pediatrics, Institute for Human Genetics, University of California San Francisco, San Francisco, California.

Schimke immunoosseous dysplasia (SIOD) is a multisystemic condition characterized by early arteriosclerosis and progressive renal insufficiency, among other features. Many SIOD patients have severe, migraine-like headaches, transient neurologic attacks, or cerebral ischemic events. Cerebral events could be exacerbated or precipitated by hypertension, and it is unclear how these are related to arteriosclerotic changes as dyslipidemia is also a feature of SIOD. The correlation between hypercholesterolemia and cardiovascular risk in SIOD is unclear. Also, the etiology and management of headaches is not well characterized. Here we report our clinical observations in the management of SIOD in a patient who was diagnosed in school age despite early signs and symptoms. We describe biallelic variants, including a previously unreported c.1931G>A (p.Arg644Gln) variant in SMARCAL1. We specifically investigated whether migraine-like headaches and progressive nephropathy may be related to blood pressure dysregulation. We found a correlation between tighter blood pressure regulation using ambulatory blood pressure monitoring and a subjective decrease in headache symptoms. We discuss blood pressure medication management in SIOD. We also characterize dyslipidemia relative to atherosclerosis risks and provide new management strategies to consider for optimizing care.
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http://dx.doi.org/10.1002/ajmg.a.61148DOI Listing
July 2019

Exploring the Influence of Language on Assessment Given a Mismatch Between Language of Instruction and Language of Practice.

Simul Healthc 2019 Aug;14(4):271-275

From the College of Pharmacy, Qatar University, Doha, Qatar.

Statement: A phenomenon is occurring in international settings where the language of program delivery and assessment does not match the primary language of practice. It is unknown whether determining competence in English disadvantages students for practice in non-English settings. As such, we conducted a pilot study to determine student performance and perceptions after completion of two Objective Structured Clinical Examinations (OSCEs) examinations, one conducted in English and one conducted in Arabic within an Arabic-speaking Middle Eastern setting. Twenty-two students completed both OSCEs. Overall scores were similar but student rankings differed. Students were more confident performing in Arabic, felt that the Arabic examination was more reflective of practice, and believed that use of Arabic OSCEs can promote better patient care. Findings support the notion that student success may be influenced by language of assessment and that we may need to rethink how we determine assessment validity in these emerging international education settings.
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http://dx.doi.org/10.1097/SIH.0000000000000358DOI Listing
August 2019

Prevention and screening recommendations in type 2 diabetes: Review and critical appraisal of clinical practice guidelines.

Prim Care Diabetes 2019 06 12;13(3):197-203. Epub 2018 Dec 12.

College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar. Electronic address:

The aim of this review was to identify and appraise guidelines reporting recommendations for the screening and prevention of type 2 diabetes. Five guidelines were included for analysis and all were endorsed by national or international organizations. All guidelines were recommended for practice with or without modifications for both prevention and screening. The overall appraisal scores ranged from 62.5 to 91.7 for prevention and 62.5-83.3 for screening. The highest scored domain was 'clarity of presentation' and the lowest was 'rigor of development'. Findings call for greater attention to rigor when formulating recommendations for prevention and screening of diabetes.
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http://dx.doi.org/10.1016/j.pcd.2018.11.014DOI Listing
June 2019

A qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Qatar: integrating perspectives of patients and health care providers.

Patient Prefer Adherence 2018 17;12:2205-2216. Epub 2018 Oct 17.

College of Pharmacy, Qatar University, Doha, Qatar,

Purpose: To develop an in-depth understanding of the barriers to medication adherence among patients with uncontrolled diabetes attending primary health care (PHC) centers in Qatar by exploring and integrating patients' and health care providers' perspectives.

Participants And Methods: A descriptive qualitative methodology was used in this study. A trained researcher conducted semi-structured face-to-face interviews at two PHC centers. Patients with uncontrolled diabetes (with varied sociodemographic characteristics) and their respective health care providers (physicians, pharmacists, nurses, dieticians, and others) were purposively selected from the two PHC centers. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic content analysis.

Results: Thirty interviews (14 patients and 16 health care providers) were conducted. A number of barriers to medication adherence were identified and classified broadly under three main themes: 1) patient-related factors, which included patients' individual characteristics and patients' perception, attitude, and behavior; 2) patient-provider factors, which included communication and having multiple health care providers caring for the patient; and 3) societal and environmental factors, which included social pressure and traveling to visit friends and relatives.

Conclusion: Patients with uncontrolled diabetes face multiple barriers to medication adherence. Similar themes emerged from both patients and their care providers. This research highlights the need for concerted multidimensional efforts and series of interventions to overcome these barriers. One vital intervention is expanding the scope of pharmacists' role within the PHC centers through providing medication reconciliation, patient-tailored medication counseling, and medicines use review, which may improve treatment outcomes among patients with diabetes.
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http://dx.doi.org/10.2147/PPA.S174652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200070PMC
October 2018

The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study.

J Thorac Cardiovasc Surg 2018 11 5;156(5):1906-1915.e3. Epub 2018 Jun 5.

Departments of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, St George's Hospital, London, United Kingdom. Electronic address:

Objective: To examine the influence of prolonged intensive care unit (ICU) stay on quality of life and recovery following cardiac surgery.

Methods: Quality of life was assessed using the Short Form 36 Health Survey (SF36). The Postoperative Quality of Recovery Scale was used to assess quality of recovery, disability, and cognition after ICU discharge over 12 months' follow-up. Prolonged ICU stay was defined as ≥3 postoperative days. Mortality and major adverse cardiac and cerebrovascular events were recorded up to 12 months.

Results: For quality of life, the physical component improved over time in both groups (P < .01 for both groups), as did the mental component (P < .01 for both groups). The long ICU group had lower physical and mental components over time (both P values < .01), but by 12 months the values were similar. The overall quality of recovery was lower for the long ICU group (P < .01). Likewise, we found higher rates of recovery in the normal ICU group than in the long ICU group in terms of emotive recovery (P < .01), activities of daily living (P < .01), and cognitive recovery (P = .03) but no differences in terms of physiologic (P = .91), nociceptive (P = .89), and satisfaction with anesthetic care (P = .91). Major adverse cardiac and cerebrovascular events (P < .01), 30-day mortality (P < .01), and length of ward stay (P < .01) were all higher with prolonged ICU stay.

Conclusions: Patients with prolonged ICU stay have lower quality of life scores; however, they achieve similar midterm quality of recovery, but with reduced survival, increased major adverse cardiac and cerebrovascular events, and longer hospital length of stay.
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http://dx.doi.org/10.1016/j.jtcvs.2018.05.076DOI Listing
November 2018

Concurrent and Overlapping Surgery: Perspectives From Parents of Adolescents Undergoing Spinal Posterior Instrumented Fusion for Idiopathic Scoliosis.

Spine (Phila Pa 1976) 2019 Jan;44(1):53-59

Department of Orthopaedic Surgery, University of California, San Francisco, CA.

Study Design: Prospective cross-sectional survey.

Objective: To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation.

Summary Of Background Data: Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers, and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices.

Methods: A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. "Overlapping" was defined as simultaneity during "noncritical" parts of an operation. "Concurrent" was defined as simultaneity that includes "critical" part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement.

Results: On average, respondents "strongly agree" with the need to be informed about overlapping or concurrent surgery. They "disagree" with both overlapping and concurrent scheduling, and "disagree" with trainees operating without direct supervision, even for "noncritical" parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling.

Conclusion: Parents have a strong desire to be informed of simultaneous spinal surgery and anesthesia as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward.

Level Of Evidence: N/A.
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http://dx.doi.org/10.1097/BRS.0000000000002745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551350PMC
January 2019

Ethnic Variation in Satisfaction and Appearance Concerns in Adolescents With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion With Instrumentation.

Spine Deform 2018 Mar - Apr;6(2):148-155. Epub 2017 Oct 16.

Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA, USA.

Study Design: Cohort analysis.

Objective: Document satisfaction with management and appearance concerns in children of different ethnicity who underwent spinal fusion/instrumentation for adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: Scoliosis Research Society Questionnaire (SRS-30) outcomes in AIS indicate a link between appearance and satisfaction as well as ethnic variation in appearance domain. Exploration of these findings in the Scoliosis Appearance Questionnaire (SAQ) will allow better understanding of ethnic variation in appearance concerns.

Methods: Children with AIS who underwent posterior-only operations and completed the SAQ's question 31 were identified. Univariate logistic regression of SAQ questions 12-30 was used to assess relationships with ethnicity.

Results: 1,977 children [boys: 281, girls: 1,290, unspecified: 406; average age 15.1 ± 2.0 years preoperatively and 817 children (boys: 113, girls: 569, unspecified: 135; average age 15.1 ± 2.0 years) at 2 years' follow-up met inclusion criteria. The majority were Caucasian (57.3%). Few were Hispanic (3.4%). Preoperatively, the largest percentage of patients in each ethnic group answered "very true" to "wanting to be more even." Preoperatively, Asians were least likely to be concerned about evenness of shoulders, hips, waist, ribs, and chest in back (p < .05); however, they expressed greatest concern about height (p < .05). African Americans and Hispanics were more likely to be concerned about breast evenness and anterior chest and looking better in clothes (p < .05). African Americans were most concerned about overall evenness and evenness of shoulders, hips, waist, ribs, posterior chest, leg length, and looking more attractive (p < .05). Surgical scar was most important postoperatively for all ethnicities. African Americans and Hispanics were more self-conscious about scar (p < .05). African Americans were most likely to want to be more even and have more even shoulders, hips, waist, leg lengths, ribs, breasts, and chest postoperatively.

Conclusions: Ethnicity influenced appearance concerns in pre- and postoperative SAQ evaluation. Ethnic variation in appearance concerns should be taken into account and differentiated when counseling patients about AIS and surgical correction.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jspd.2017.07.003DOI Listing
December 2018

Application of a systematic approach to evaluating psychometric properties of a cumulative exit-from-degree objective structured clinical examination (OSCE).

Curr Pharm Teach Learn 2017 Nov 4;9(6):1091-1098. Epub 2017 Sep 4.

College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar. Electronic address:

Background And Purpose: Objective structured clinical examinations (OSCEs) are considered gold standard performance-based assessments yet comprehensive evaluation data is currently lacking. The objective of this study was to critically evaluate the psychometric properties of a cumulative OSCE for graduating pharmacy students in Qatar for which policies and procedures were adapted from a Canadian context.

Educational Activity And Setting: A 10-station OSCE was conducted for graduating students in Qatar. Evaluation included assessment of pass rates, predictive validity, concurrent validity, internal validity, content validity, interrater reliability, and internal consistency.

Findings: Twenty-six students completed the OSCE. Three stations achieved pass rates < 80%. Scores from professional skills and case-based learning courses, formative OSCEs, and cumulative grade point averages correlated with OSCE scores (p < 0.05). Average correlation between assessors' analytical and global scoring was moderate (r = 0.52). Average interrater reliability was excellent for analytical scoring (ICC = 0.88) and moderate for global scoring (ICC = 0.61). Excellent internal consistency was demonstrated for overall performance (α = 0.927). Students generally agreed stations represented real practice scenarios (range per station, 30-100%).

Discussion And Summary: The evaluation model identified strengths and weaknesses in assessment and curricular considerations. The OSCE demonstrated acceptable validity and reliability as an adapted assessment.
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http://dx.doi.org/10.1016/j.cptl.2017.07.011DOI Listing
November 2017

Assessing prevalence of and barriers to medication adherence in patients with uncontrolled diabetes attending primary healthcare clinics in Qatar.

Prim Care Diabetes 2018 04 21;12(2):116-125. Epub 2017 Nov 21.

College of Pharmacy, Qatar University, Doha, Qatar. Electronic address:

Background: Studies conducted in Qatar have reported a high prevalence of diabetic nephropathy, retinopathy, and neuropathy. These complications are often associated with poor medication adherence and uncontrolled diabetes. The objectives of this study were to determine the rate of medication adherence among patients with uncontrolled diabetes, and to compare the characteristics and identified barriers between patients with good and those with poor medication adherence.

Method: A cross-sectional quantitative study was conducted among patients living in Qatar with uncontrolled diabetes attending primary healthcare clinics from October 2016 to January 2017. An interviewer-administered questionnaire comprising three sections was utilized in the study: patients' characteristics, Adherence to Refill and Medications Scale in Diabetes (ARMS-D), and barriers to medication adherence. ARMS-D is a validated tool that is used to identify adherence level among patients with diabetes. Descriptive and inferential statistics including regression analysis were used for data analysis.

Results: A total of 260 patients were included in the analysis. Overall, 73% (n=191) were nonadherent to their diabetes medications (ARMS-D score above 11). Nonadherent patients reported the majority of the pre-determined barriers to medication adherence with forgetfulness being the most commonly reported barrier. Multivariate linear regression analysis found age, ethnicity, education level, income level and HbA1c to be independent predictors of adherence.

Conclusion: The findings of this study reaffirm the notion that non-adherence to medications among patients with uncontrolled diabetes within primary care setting is higher than the general diabetes population. This high prevalence is concerning and necessitates urgent interventions. Nonetheless, an in-depth understanding of barriers to medication adherence often requires qualitative research approach as these barriers are very complex and multifactorial in nature.
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http://dx.doi.org/10.1016/j.pcd.2017.11.001DOI Listing
April 2018

Zika Virus Escapes NK Cell Detection by Upregulating Major Histocompatibility Complex Class I Molecules.

J Virol 2017 11 27;91(22). Epub 2017 Oct 27.

Lautenberg Center for General and Tumor Immunology, Department of Immunology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University Medical School, Jerusalem, Israel

NK cells are innate lymphocytes that participate in many immune processes encompassing cancer, bacterial and fungal infection, autoimmunity, and even pregnancy and that specialize in antiviral defense. NK cells express inhibitory and activating receptors and kill their targets when activating signals overpower inhibitory signals. The NK cell inhibitory receptors include a uniquely diverse array of proteins named killer cell immunoglobulin-like receptors (KIRs), the CD94 family, and the leukocyte immunoglobulin-like receptor (LIR) family. The NK cell inhibitory receptors recognize mostly major histocompatibility complex (MHC) class I (MHC-I) proteins. Zika virus has recently emerged as a major threat due to its association with birth defects and its pandemic potential. How Zika virus interacts with the immune system, and especially with NK cells, is unclear. Here we show that Zika virus infection is barely sensed by NK cells, since little or no increase in the expression of activating NK cell ligands was observed following Zika infection. In contrast, we demonstrate that Zika virus infection leads to the upregulation of MHC class I proteins and consequently to the inhibition of NK cell killing. Mechanistically, we show that MHC class I proteins are upregulated via the RIGI-IRF3 pathway and that this upregulation is mediated via beta interferon (IFN-β). Potentially, countering MHC class I upregulation during Zika virus infection could be used as a prophylactic treatment against Zika virus. NK cells are innate lymphocytes that recognize and eliminate various pathogens and are known mostly for their role in controlling viral infections. NK cells express inhibitory and activating receptors, and they kill or spare their targets based on the integration of inhibitory and activating signals. Zika virus has recently emerged as a major threat to humans due to its pandemic potential and its association with birth defects. The role of NK cells in Zika virus infection is largely unknown. Here we demonstrate that Zika virus infection is almost undetected by NK cells, as evidenced by the fact that the expression of activating ligands for NK cells is not induced following Zika infection. We identified a mechanism whereby Zika virus sensing via the RIGI-IRF3 pathway resulted in IFN-β-mediated upregulation of MHC-I molecules and inhibition of NK cell activity. Countering MHC class I upregulation and boosting NK cell activity may be employed as prophylactic measures to combat Zika virus infection.
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http://dx.doi.org/10.1128/JVI.00785-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660495PMC
November 2017

Key challenges for implementing a Canadian-based objective structured clinical examination (OSCE) in a Middle Eastern context.

Can Med Educ J 2016 Dec 5;7(3):e4-e9. Epub 2016 Dec 5.

College of Pharmacy, Qatar University.

Globalization of medical education is occurring at a rapid pace and many regions of the world are adapting curricula, teaching methods, and assessment tools from established programs. In the Middle East, the use of Objective Structured Clinical Examinations (OSCEs) is rare. The College of Pharmacy at Qatar University recently partnered with the University of Toronto and the Supreme Council of Health in Qatar to adapt policies and procedures of a Canadian-based OSCE as an exit-from-degree assessment for pharmacy students in Qatar. Despite many cultural and contextual barriers, the OSCE was implemented successfully and is now an integrated component of the pharmacy curriculum. This paper aims to provide insight into the adoption and implementation process by identifying four major cultural and contextual challenges associated with OSCEs: assessment tools, standardized actors, assessor calibration, and standard setting. Proposed solutions to the challenges are also given. Findings are relevant to international programs attempting to adapt OSCEs into their contexts, as well as Canadian programs facing increasing rates of cultural diversity within student and assessor populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342886PMC
December 2016

NK-cell receptors NKp46 and NCR1 control human metapneumovirus infection.

Eur J Immunol 2017 04 6;47(4):692-703. Epub 2017 Mar 6.

The Lautenberg Center for General and Tumor Immunology, the BioMedical Research Institute Israel-Canada of the Faculty of Medicine (IMRIC), The Hebrew University Hadassah Medical School, Jerusalem, Israel.

Natural killer (NK) cells are capable of killing various pathogens upon stimulation of activating receptors. Human metapneumovirus (HMPV) is a respiratory virus, which was discovered in 2001 and is responsible for acute respiratory tract infection in infants and children worldwide. HMPV infection is very common, infecting around 70% of all children under the age of five. Under immune suppressive conditions, HMPV infection can be fatal. Not much is known on how NK cells respond to HMPV. In this study, using reporter assays and NK-cell cytotoxicity assays performed with human and mouse NK cells, we demonstrated that the NKp46-activating receptor and its mouse orthologue Ncr1, both members of the natural cytotoxicity receptor (NCR) family, recognized an unknown ligand expressed by HMPV-infected human cells. We demonstrated that MHC class I is upregulated and MICA is downregulated upon HMPV infection. We also characterized mouse NK-cell phenotype in the blood and the lungs of HMPV-infected mice and found that lung NK cells are more activated and expressing NKG2D, CD43, CD27, KLRG1, and CD69 compared to blood NK cells regardless of HMPV infection. Finally, we demonstrated, using Ncr1-deficient mice, that NCR1 plays a critical role in controlling HMPV infection.
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http://dx.doi.org/10.1002/eji.201646756DOI Listing
April 2017

National Trends in the Surgical Management of Adolescent Idiopathic Scoliosis: Analysis of a National Estimate of 60,108 Children From the National Inpatient Sample Over a 13-Year Time Period in the United States.

Spine Deform 2017 Jan;5(1):56-65

Department of Orthopaedic Surgery, University of California-San Francisco, 550 16th. Street, Box 3212, San Francisco, CA 94158, USA. Electronic address:

Study Design: Analysis of Nationwide Inpatient Sample (NIS).

Objective: Evaluate evolution of operative treatment of adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: Spinal surgery is one of the most rapidly evolving branches of surgery. Changes in AIS operations are incompletely defined.

Methods: Children (10-18 years) with ICD-9 diagnosis of idiopathic scoliosis who underwent thoracic and/or lumbar spinal fusion identified in the NIS (1998-2011) were analyzed. Population-based utilization rates were calculated from US Census data. Patient demographics, surgical approach, operative techniques, complications during hospitalization, hospital stay length, and charges were analyzed.

Results: 60,108 children (46,256 girls, 13,776 boys, 76 gender not specified; average age 14.1 years) were identified. Thoracic fusions were the majority. Number of operations increased over time. For thoracic fusions, posterior operations significantly increased, whereas anterior and anterior/posterior operations decreased significantly. Although anterior operations for lumbar fusions declined, this was not as steep as thoracic. Use of autogenous bone graft (including iliac crest) significantly increased, which mirrored significant decreases in alternative fusion agents. Thoracoplasty significantly decreased, whereas osteotomy significantly increased. The average complication rate was 3.7%. Rates of blood transfusions, infection, and neural injury did not differ significantly from 1998 to 2011. Device-related complications increased significantly over time. Average lengths of hospital stay decreased significantly, whereas average total hospital charges increased significantly.

Conclusions: In a representative sample of the US population from 1998 to 2011, operative approaches and techniques for AIS significantly changed. Anterior procedure is rarely performed for thoracic curves; lumbar curves continue to be treated with anterior and posterior approaches. Osteotomy and autogenous bone graft increased, while thoracoplasty decreased. Overall complication rates remain stable, whereas hospital lengths of stays decreased and charges increased.
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http://dx.doi.org/10.1016/j.jspd.2016.09.001DOI Listing
January 2017

Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity.

Spine J 2017 03 17;17(3):369-379. Epub 2016 Oct 17.

Department of Orthopædic Surgery, UCSF, 500 Parnassus Ave, MU 320-W, San Francisco, CA 94143, USA. Electronic address:

Background Context: Short-term readmission rates are becoming widely used as a quality and performance metric for hospitals. Data on unplanned short-term readmission after spine fusion for deformity in pediatric patients are limited.

Purpose: To characterize the rate and risk factors for short-term readmission after spine fusion for deformity in pediatric patients.

Study Design: This is a retrospective cohort study.

Patient Sample: Data were obtained from the State Inpatient Database from New York, Utah, Nebraska, Florida, North Carolina (years 2006-2010), and California (years 2006-2011).

Outcome Measures: Outcome measures included 30- and 90-day readmission rates.

Materials And Methods: Inclusion criteria were patients aged 0-21 years, a primary diagnosis of spine deformity, and a primary 3+-level lumbar or thoracic fusion. Exclusion criteria included revision surgery at index admission and cervical fusion. Readmission rates were calculated and logistic analyses were used to identify independent predictors of readmission.

Results: There were a total of 13,287 patients with a median age of 14 years. Sixty-seven percent were girls. The overall 30- and 90-day readmission rates were 4.7% and 6.1%. The most common reasons for readmission were infection (38% at 30 days and 33% at 90 days), wound dehiscence (19% and 17%), and pulmonary complications (12% and 13%). On multivariate analysis, predictors of 30-day readmission included male sex (p=.008), neuromuscular (p<.0001) or congenital scoliosis (p=.006), Scheuermann kyphosis (p=.003), Medicaid insurance (p<.0001), length of stay of ≤3 days or ≥6 days (p<.0001), and surgery at a teaching hospital (p=.011). Surgery at a hospital performing >80 operations/year was associated with a 34% reduced risk of 30-day readmission (95% confidence interval 12%-50%, p=.005) compared with hospitals performing <20 operations/year.

Conclusions: The short-term readmission rate for pediatric spine deformity surgery is driven by patient-related factors, as well as several risk factors that may be modified to reduce this rate.
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http://dx.doi.org/10.1016/j.spinee.2016.10.008DOI Listing
March 2017

Quality of Life in Relation to Length of Intensive Care Unit Stay After Cardiac Surgery.

J Cardiothorac Vasc Anesth 2017 06 21;31(3):1080-1090. Epub 2016 Jun 21.

Department of Cardiothoracic Surgery, St. George's University of London, London, United Kingdom. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2016.06.025DOI Listing
June 2017

Cardiac sarcoma presenting with abdominal pain and mimicking myxoma on echocardiogram.

JRSM Open 2016 Sep 1;7(9):2054270416649286. Epub 2016 Sep 1.

Department of Cardiothoracic Surgery, St. George's Hospital, London SW17 0QT, UK.

Cardiac sarcoma's are highly aggressive tumours. Clear resection margins ± autotransplant, followed by chemotherapy, offers the best survival chance. Therefore, frozen section should be preformed when there is ambiguity in diagnosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011307PMC
http://dx.doi.org/10.1177/2054270416649286DOI Listing
September 2016

Suppression of human metapneumovirus (HMPV) infection by the innate sensing gene CEACAM1.

Oncotarget 2016 Oct;7(41):66468-66479

The Lautenberg Center for General and Tumor Immunology, The BioMedical Research Institute Israel Canada of the Faculty of Medicine, The Hebrew University Hadassah Medical School, Jerusalem, Israel.

The innate sensing system is equipped with PRRs specialized in recognizing molecular structures (PAMPs) of various pathogens. This leads to the induction of anti-viral genes and inhibition of virus growth. Human Metapneumovirus (HMPV) is a major respiratory virus that causes an upper and lower respiratory tract infection in children. In this study we show that upon HMPV infection, the innate sensing system detects the viral RNA through the RIG-I sensor leading to induction of CEACAM1 expression. We further show that CEACAM1 is induced via binding of IRF3 to the CEACAM1 promoter. We demonstrate that induction of CEACAM1 suppresses the viral loads via inhibition of the translation machinery in the infected cells in an SHP2-dependent manner. In summary, we show here that HMPV-infected cells upregulates CEACAM1 to restrict HMPV infection.
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http://dx.doi.org/10.18632/oncotarget.11979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341814PMC
October 2016