Glomerular hyperfiltration and proteinuria in transfusion-independent patients with ß-thalassemia intermedia.

BACKGROUND/AIMS: Renal manifestations have been described in ß-thalassemia major and were attributed to transfusional iron overload and chelation therapy. Patients with the milder phenotype, ß-thalassemia intermedia (TI), remain largely transfusion and iron chelation independent while enduring a chronic hemolytic anemia and primary iron overload. Data on renal function in patients with TI is lacking. METHODS: In this cross-sectional study of 50 TI patients, we evaluated the association of estimated glomerular filtration rate (eGFR) and urinary protein to creatinine (UPr/UCr) ratio with relevant patient, disease and laboratory indices. RESULTS: The median age of patients was 28 years (44% males). The eGFR was >90 ml/min/1.73 m(2) in all patients, with a median value of 142.3 ml/min/1.73 m(2). The median UPr/UCr ratio was 213.2 mg/g. There was a negative correlation between age and eGFR, while the UPr/UCr ratio correlated positively with markers of anemia, hemolysis and iron overload. A total of 24 (48%) patients had evidence of glomerular hyperfiltration, while 7 (14%) had proteinuria (UPr/UCr ratio >500 mg/g). Patients with proteinuria were characterized by elevated liver iron concentration (>7 mg Fe/g dry weight), non-transferrin-bound iron levels and nucleated red blood cell counts. CONCLUSIONS: A considerable proportion of TI patients show evidence of abnormally elevated eGFR, with a declining trend towards advancing age. The occurrence of proteinuria is associated with anemia, hemolysis and iron toxicity.

In vitro activity of fosfomycin and other antimicrobials against uropathogenic Escherichia coli and Klebsiella pneumoniae at a tertiary care center in Lebanon.

BACKGROUND: The incidence of urinary tract infections (UTIs) caused by extended-spectrum-beta-lactamase (ESBL) producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) has been on the rise limiting oral treatment options. Fosfomycin was reported to be highly efficacious against these organisms, however, data is lacking in Lebanon and the Middle East. OBJECTIVE: To determine the in vitro activity of fosfomycin against ESBL and non-ESBL-producing E. coli and K. pneumoniae uropathogens in Lebanon. METHODS: A total of 542 consecutive non-duplicate isolates of ESBL-producing E. coli (n = 374) and K. pneumoniae (n = 168), and 291 isolates of non-ESBL-producing E. coli (n = 236) and K. pneumoniae (n = 55) were recovered from urine specimens of patients tested at the American University of Beirut Medical Center (AUBMC) during 2010. Each isolate was tested against a battery of 13 antimicrobials by disk diffusion according to the guidelines of CLSI testing and result interpretation criteria. RESULTS: The fosfomycin susceptibility for ESBL-producing vs. non-ESBL-producing isolates was 86% vs. 97% for E. coli and 62% vs. 78% for K. pneumoniae. This activity of fosfomycin among ESBL-EC and ESBL-KP was generally higher than cefepime (26% & 30%), ciprofloxacin (24% & 41%), Trimeth/sulfa (26% & 19%), Pip/taz (75% and 45%), gentamicin (45% & 42%), and tobramycin (32% & 26%). On the other hand, higher activity against both species of ESBL-producing bacteria was shown by amikacin (96% & 79%) and imipenem (99.7% & 98.8%). Nitroflurantoin was highly active against ESBL-EC (95%) but not against ESBL-KP (29%). CONCLUSION: Fosfomycin shows good activity, being higher against ESBL-producing E. coli than K. pneumoniae uropathogens in Lebanon.

Vitamin D receptor biochemical and genetic profiling and HLA-class II genotyping among Lebanese with multiple sclerosis - A pilot study.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune demyelinating disease affecting mostly young adult females with multifactorial etiology. Recent studies suggested that adequate vitamin D levels may lower the risk of developing MS. OBJECTIVES: Our aim was to explore the relationship between vitamin D receptor (VDR) polymorphism, HLA-DR locus genotype, and serum vitamins D and A levels in the Lebanese population. METHODS: Fifty MS patients were recruited for this study. The control group consisted of 48 healthy and 51 patients with other neurological disorders (non-MS). Biochemical analysis included serum 25 hydroxyvitamin D (25OHD) and vitamin A. Molecular analysis targeted VDR genotypes (ApaI, TaqI and BsmI) and low resolution HLA typing for DRB1 locus. RESULTS: Healthy and non-MS groups had comparable parameters and were combined into one control group. No significant differences were found between MS and control groups for VDR genotypes. The frequency of HLA-DRB1*15 was significantly higher in MS patients (22%) compared to controls (8%) (p=0.018). Odds ratio for MS in the presence of DRB1*15 allele was 3.21 (p=0.018). Cosegregation with A (ApaI) and b (BsmI) alleles did not influence the risk for MS. 25OHD levels were significantly higher in MS patients compared to controls (p=0.002), due to more frequent oral supplementation (p=0.005). Vitamin A levels were comparable between the two groups. When all parameters were included in a logistic regression model adjusted for supplementation, only HLA-DRB1*15 (OR=3.42; p=0.027) contributed significantly to MS risk. CONCLUSION: There was no association between serum vitamin D or A or VDR genotypes and MS. HLA-DRB1*15 was the major factor imposing more than 3 folds greater risk for developing MS among Lebanese.

Halzoun, an allergic pharyngitis syndrome in Lebanon: the trematode Dicrocoelium dendriticum as an additional cause.

Halzoun syndrome typically manifests in the form of an allergic pharyngitis following the consumption of raw or undercooked ovine liver. First described in Lebanon in 1905, it was initially attributed to Fasciola hepatica, while later publications have attributed it to other pathogens. There has been no definitive documentation of the pathogen causing the Lebanese Halzoun syndrome. The aim of our study was to identify the parasite responsible for the pathogenesis of the Lebanese Halzoun syndrome. 32 patients with typical clinical symptoms of Halzoun syndrome were recruited in the emergency room at our hospital from 2005 to 2007. One parasite was isolated from a patient's expectorations, and two others were isolated from pieces of a raw sheep liver retrieved from the patients' dishes. A piece of infected goat liver intended for consumption was also collected from a local butcher. All parasites were examined microscopically for identification. All patients presented with immune allergic-like symptoms of the eyes, ears, nose, or throat. All collected parasites were identified as Dicrocoelium dendriticum. Our study has identified D. dendriticum, rather than Linguatula serrata or F. hepatica, as the prime suspect in the pathogenesis of the Lebanese Halzoun syndrome.