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Biomedical subjects

Imad Uthman

Publications and source records attributed to Imad Uthman.

At least 19 recordsLinked to original sources
PubMed2006

Antiphospholipid syndrome and the kidneys.

OBJECTIVES: To study the relationship between antiphospholipid antibodies and kidney diseases. METHODS: We reviewed the medical literature from 1968 to 2005 using MEDLINE and the keywords antiphospholipid syndrome, anticardiolipin antibodies, lupus anticoagulant, hypertension, renal artery stenosis, renal vascular thrombosis, thrombotic microangiopathy, and glomerulonephritis. RESULTS: The renal manifestations of the antiphospholipid syndrome may result from thrombosis occurring at any location within the renal vasculature, that is, in the renal artery trunk or branches, intraparenchymal arteries and arterioles, glomerular capillaries, and the renal veins. The spectrum of these manifestations includes renal artery stenosis and/or malignant hypertension, renal infarction, renal vein thrombosis, thrombotic microangiopathy, increased allograft vascular thrombosis, and reduced survival of renal allografts. More recently nonthrombotic conditions like glomerulonephritis have also been reported. CONCLUSION: The kidney appears to be a major target organ in both primary and secondary APS. Early detection of renal involvement may improve the prognosis of these patients.

Antibodies, Antiphospholipid↗
PubMed2005

Behçet's disease in Lebanon: clinical profile, severity and two-decade comparison.

The aim of this study is to describe the clinical features of Lebanese patients with Behçet's disease (BD) followed up at a tertiary care center in Lebanon. A retrospective review of medical records of 90 patients who fulfilled the International Study Group (ISG) criteria for diagnosis was performed. The clinical characteristics and severity score were compared with those reported from other populations of Arab and of Turkish origin using the same diagnostic criteria, and a comparison over two decades for the Lebanese population was made. The male-to-female ratio was 2.9:1, the mean age at onset, 25.4 years, and mean age at diagnosis, 29.2 years. One hundred percent of the patients had mouth ulceration; 72.2%, genital ulceration; 59.1%, arthritis; 55.7%, papulopustular skin lesion; 53.9%, ocular disease; 36.8%, vascular disease; 29.5%, erythema nodosum; and 23.0%, neurologic disease. The characteristics of our patient population are similar to that reported from other countries in the region. However, we found a higher prevalence of vascular and neurologic disease.

Adolescent↗
PubMed2005

Successful retreatment with infliximab in patients with prior severe infusion reactions.

Infusion of the antitumor necrosis factor-alpha chimeric monoclonal antibody infliximab can be associated with the development of severe infusion reactions (IR) during retreatment. We present the case of two rheumatoid arthritis patients with a history of severe acute IR to infliximab who subsequently underwent successful infusion using a prophylactic treatment with a combination of H1 and H2 receptor blockers, hydrocortisone, and diphenhydramine.

Adult↗
PubMed2005

Deep venous thrombosis in a patient with Behçet's disease and homozygous prothrombin (factor II) G20210A mutation on oral contraceptive pills.

Behçet's disease (BD) is a multisystemic disease of unknown aetiology characterized by chronic relapsing oral aphthous lesions, genital ulcers, uveitis, and vasculopathy of both arteries and veins of all sizes. We present the case of a female patient, with BD on oral contraceptive pills, who sustained deep venous thrombosis of the long saphenous vein. The patient was found to be a carrier of a homozygous mutation of the prothrombin (factor II) G20210A gene. Our case suggests that a thrombophilia work-up may be warranted in BD patients, especially young women before they are prescribed oral contraceptives.

Adult↗
PubMed2005

Familial Mediterranean fever mimicking septic arthritis.

We report the case of a young Lebanese female who presented with recurrent episodes of left knee and calf swelling and a synovial fluid leucocyte count suggestive of septic arthritis, however bacteriologic cultures were negative. Familial Mediterranean fever (FMF) was suspected in view of a positive family history and genetic analysis for the mutations in the pyrin/marenostrin (MEFV) gene revealing a homozygote mutation at methionine-694-valine. The arthritis was controlled with prophylactic colchicine therapy. FMF should be considered in the differential diagnosis of acute monoarticular arthritis with elevated synovial fluid white blood cells counts in regions with high incidence of FMF.

Adult↗
PubMed2005

The role of therapeutic plasma exchange in the catastrophic antiphospholipid syndrome.

The catastrophic antiphospholipid syndrome (CAPS) is a life-threatening sub-entity of the antiphospholipid syndrome (APS) resulting in multiorgan failure and a mortality rate that may reach 50%. The optimal treatment regimen for CAPS is unknown. To evaluate the benefit of therapeutic plasma exchange (TPE) therapy in CAPS, we undertook a computer-assisted (MEDLINE, National Library of Medicine, Bethesda, MD) search of the literature to locate all cases of CAPS (case reports and reviews) treated with TPE. In view of the published literature so far, TPE has shown reasonable therapeutic benefits and improved survival for patients with CAPS. The use of this technique, along with anticoagulation and if needed pharmacological immunosuppression, should be considered for the acute management of patients who present with this life-threatening condition.

Antiphospholipid Syndrome↗
PubMed2004

Lupus anticoagulant, factor V Leiden, and methylenetetrahydrofolate reductase gene mutation in a lupus patient with cerebral venous thrombosis.

We describe the case of a young Lebanese woman with systemic lupus erythematosus (SLE) and a positive lupus anticoagulant (LAC) who developed right internal jugular vein and sigmoid sinus thrombosis. Coagulation studies showed that in addition to the LAC the patient was heterozygous for the factor V (FV) Leiden mutation, and C677T mutation of the methylenetetrahydrofolate reductase gene. The high prevalence of FV Leiden in the eastern Mediterranean region suggests that we should probably screen our SLE patients in this area, especially those with anticardiolipin antibodies and/or LAC who have no history of thrombosis, for this and other thrombophilia markers. The detection of such abnormalities may have major practical consequences for the long-term management of these patients to prevent further thrombotic episodes.

Adolescent↗
PubMed2004

Pharmacological therapy of vasculitis: an update.

Systemic vasculitis represents a broad range of diseases characterized by the presence of blood vessel inflammation. Immunosuppressive therapy forms the foundation of treatment for almost all forms of systemic vasculitis. Newer agents such as mycophenolate mofetil, rituximab and tumour necrosis factor-alpha inhibitors are finding new indications in the therapy of conditions such as systemic lupus erythematosus, idiopathic thrombocytopenic purpura, skin vasculitis, cytoplasmic antineutrophil antibodies-positive vasculitis, sarcoidosis, ocular inflammation, nephritis, inflammatory bowel disease and Takayasu's arteritis. However, older agents such as methotrexate, cyclophosphamide and interferon-alpha are still being explored for newer, more effective and less toxic indications in conditions such as giant cell arteritis and cutaneous polyarteritis nodosa.

Antineoplastic Agents↗
PubMed2003

Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the safety and efficacy of long-term intraarticular (IA) steroid injections for knee pain related to osteoarthritis (OA). METHODS: In a randomized, double-blind trial, 68 patients with OA of the knee received IA injections of triamcinolone acetonide 40 mg (34 patients) or saline (34 patients) into the study knee every 3 months for up to 2 years. The primary outcome variable was radiologic progression of joint space narrowing of the injected knee after 2 years. Measurements of minimum joint space width were performed by an automated computerized method on standardized fluoroscopically guided radiographs taken with the patient standing and with the knee in a semiflexed position. The clinical efficacy measure of primary interest was the pain subscale from the Western Ontario and McMaster Universities OA Index (WOMAC). Efficacy measures of secondary interest were the total score on the WOMAC, physician's global assessment, patient's global assessment, patient's assessment of pain, range of motion (ROM) of the affected knee, and 50-foot walking time. Clinical symptoms were assessed just before each injection. RESULTS: At the 1-year and 2-year followup evaluations, no difference was noted between the two treatment groups with respect to loss of joint space over time. The steroid-injected knees showed a trend toward greater symptom improvement, especially at 1 year, for the WOMAC pain subscale, night pain, and ROM values (P = 0.05) compared with the saline-injected knees. Using area under the curve analyses, knee pain and stiffness were significantly improved throughout the 2-year study by repeated injections of triamcinolone acetonide, but not saline (P < 0.05). CONCLUSION: Our findings support the long-term safety of IA steroid injections for patients with symptomatic knee OA. No deleterious effects of the long-term administration of IA steroids on the anatomical structure of the knee were noted. Moreover, long-term treatment of knee OA with repeated steroid injections appears to be clinically effective for the relief of symptoms of the disease.

Adult↗