Impact of the Conditioning Regimen Dose Intensity Before Autologous Stem Cell Transplantation on the Pulmonary Function Test Abnormalities in Patients With Lymphoma and Multiple Myeloma: Single Center Experience.

BACKGROUND: Most studies addressing the impact of hematopoietic stem cell transplantation (SCT) on pulmonary function test (PFT), and the various factors affecting that impact have been performed on the allogenic type. Few have addressed PFT changes in autologous SCT. This study describes PFT changes seen in autologous SCT recipients and addresses the various factors impacting these changes. PATIENTS AND METHODS: We reviewed the medical records of 223 consecutive adult autologous SCT recipients. We collected pre-transplant and post-transplant data, as well as PFT data and long-term mortality. RESULTS: A total of 123 patients with lymphoma receiving the BEAM (carmustine, etoposide, aracytin, and melphalan) conditioning regimen had a significant 5% drop in mean forced vital capacity and total lung capacity but no significant change in forced expiratory volume in one second/forced vital capacity ratio nor in diffusion lung capacity of carbon monoxide adjusted to volume. Fifteen percent of the patients with lymphoma had a clinically significant drop of 15% in their lung volume parameters. The patients with multiple myeloma receiving the melphalan conditioning regimen had no significant change in any of the PFT parameters. Smoking, baseline PFT parameters, and radiation did not affect lung function or mortality. CONCLUSIONS: Autologous SCT impact on lung function depends on the disease and conditioning regimen. It leads to a drop in lung volumes but no obstruction or decrease in diffusion in patients with lymphoma receiving the BEAM regimen. Autologous SCT did not affect lung functions in patients with multiple myeloma, and these patients may not need screening PFTs.

An Internal Medicine Intern Retreat to Facilitate Transition to PGME and Promote Peer Interaction.

BACKGROUND: Interns in the internal medicine program at American University of Beirut Medical Center (AUBMC) come from diverse educational backgrounds based on American, French, and Egyptian systems, similar to other settings in the Middle East. To help this diverse group of trainees integrate into their new role, the institution launched an intern retreat in 2014 and repeated the event 3 times to date. OBJECTIVE: We describe the experience with the AUBMC intern retreat and discuss the format and interns' perceptions of the benefits of the event. METHODS: The retreat was divided into workshops and team-building sessions. Workshop topics focused on communication, teamwork, time management, survival tips, patient-physician interaction, and resident well-being. Fun activities were meant to strengthen peer-to-peer relationship and included a treasure hunt, Jeopardy game, and basketball. RESULTS: Retreats took place in 2014, 2016, and 2017, and involved 72 of 102 interns (71%), as participation was optional. The 2015 retreat had to be canceled due to logistical problems. Of 72 eligible interns, 61 (85%) responded to the evaluation survey. The majority rated the activity as fun or interesting; sessions with the highest ratings included communication, patient-physician interaction, and resident well-being. There was unanimous agreement to make the retreat a yearly tradition. Each year, we collected feedback and made changes to further improve the retreat experience. CONCLUSIONS: The retreat is now an established activity. In an institution that accepts interns from different backgrounds, the retreat has strengthened peer-to-peer relations, improved communication, and contributed to a collegial and supportive work environment.

Endobronchial stenting for respiratory complications in relapsing polychondritis.

Relapsing polychondritis is characterized by recurrent inflammation and destruction of the cartilage and connective tissue. Respiratory complications are frequently severe during the course of the disease and usually signal a poor prognosis. We report a case of a 47-year-old man with known relapsing polychondritis who presented with bilateral narrowing of the airways complicated by refractory cavitary Pseudomonas aeruginosa pneumonia. Despite an aggressive antibiotic regimen, the patient's pneumonia did not improve until bronchial stenting 4 months later.

A review of the off-label use of recombinant activated factor VII in a developing country tertiary care center.

Recombinant activated factor VII (rFVIIa) was first approved for treatment of congenital hemophilia. It could, however, also have a role in management of patients without pre-existing coagulopathies who undergo surgical procedures, have life-threatening hemorrhages, or sustain traumas associated with major blood loss. A retrospective chart review was performed for all cases given rFVIIa at American University of Beirut Medical Center (AUB MC). Patients with a previous medical history of thrombophilia were excluded. There were four pediatric patients with a mean age younger than 1 year. Adult patients' mean age was 64.5 +/- 17.4 years. The most common off-label uses for rFVIIa are control of hemorrhage during the repair of aortic dissection (4/17 cases) or following intracerebral hemorrhage (4/17 case). One trauma patient received the medication. Complications included cerebral ischemia in one patient. Three of the patients died but their death was not related to the bleeding or the medication. Based on the prognostic score proposed by Biss and Hanley, seven patients were low risk, four intermediate risk, and six high risk. Although off-label use of rFVIIa at AUB MC was supported by published reports, and associated with few complications, guidelines are required to control use of this medication.

Thiazolidinediones associated with recurrent pleural effusions post coronary artery bypass surgery.

We report the case of a patient in which thiazolidinediones (TZDs) were associated with recurrent pleural effusions post coronary artery bypass surgery, in spite of a normal left ventricular function. The potential mechanisms are discussed, particularly in relation to the "vascular leak syndrome". This finding has important implications for the management of diabetic patients who are referred for coronary artery bypass surgery and who are on TZDs for glycemic control.