A Surgical Case of Complete Resection of the Focal Cortical and Subcortical Dysplasia in the Motor Cortex.

BACKGROUND: Focal cortical dysplasias (FCDs) are highly epileptogenic and frequently associated with medically refractory focal epilepsy. FCDs are frequently located in the frontal lobe, making its complete resection highly challenging when in proximity to the motor cortex. CASE DESCRIPTION: We report a case of a 25-year-old woman with medically refractory epilepsy secondary to a focal cortical dysplasia in the motor cortex and extending deeply into the subcortical white matter. A detailed presurgical evaluation and invasive electroencephalographic monitoring performed at our epilepsy monitoring unit, along with the use of motor mapping, functional magnetic resonance imaging, diffusion tensor imaging, and the Stealth navigation system resulted in the complete resection of the lesion without a permanent postoperative motor deficit. The patient remained seizure-free at a 63-month follow-up while being maintained on a single antiepileptic drug. CONCLUSION: A detailed presurgical evaluation, accurate mapping of the functional and dysplastic cortex, and a well-planned tailored and complete surgical resection of the cortical dysplasia can result in a favorable outcome with relatively little risk of postoperative neurologic deficit.

Assessment of Dietary Intake Patterns and Their Correlates among University Students in Lebanon.

INTRODUCTION: Unhealthy dietary habits are major risk factors for chronic diseases, particularly if adopted during early years of adulthood. Limited studies have explored the food consumption patterns among young adults in Lebanon. Our study aimed to examine common dietary patterns and their correlates among a large sample of university student population in Lebanon, focusing on correlation with gender and body mass index (BMI). METHODS: A cross-sectional study was carried out on 3384 students, using a proportionate cluster sample of Lebanese students from both public and private universities. A self-administered food frequency questionnaire was used to assess dietary intake of university students. Factor analysis of food items and groups, cluster analysis of dietary patterns, and multivariate regressions were carried out. RESULTS: Three dietary patterns were identified among university youth namely a vegetarian/low calorie dietary pattern (characterized mainly by consumption of plant-based food while avoiding "western" food, composite dishes, and bread); a mixed dietary pattern (characterized by high consumption of plant-based food, followed by composite dishes, bread, and a low consumption of western type food); and finally, a westernized dietary pattern (characterized by high consumption of white bread and western food, and a strong avoidance of plant food and composite dishes). We observed significant differences between males and females in terms of their reported food intake and dietary patterns. Females were particularly more prone to adopt the vegetarian/low calorie diet than males (ORa = 1.69; p < 0.001), while males were more likely to adopt a westernized diet (ORa = 1.51; p < 0.001), seemingly in private universities (p = 0.053). Students with high income and obese students (BMI ≥ 30 kg/m(2)) were more likely to consume vegetarian/low calorie diets (p < 0.05). CONCLUSION: Male university students reported a higher consumption of the westernized dietary pattern as compared to female university students in Lebanon, while the latter reported a higher adoption of a vegetarian diet. Health promotion programs are needed to address the dietary intakes and lifestyle behaviors of young adults in Lebanon to help prevent obesity and other associated comorbidities.

Hyperreactive airway disease in adults: data from a national study in Lebanon.

BACKGROUND: Asthma and hyperreactive airway (HRA) disease are a major cause of health resource utilization and poor quality of life worldwide; its prevalence in adults may widely vary according to the definition used. It is mainly a childhood disease, but its natural history till adulthood is not well known. This is due to other confounding factors such as smoking and environmental factors that may lead to misdiagnose asthma as chronic obstructive pulmonary disease. Correct and timely diagnosis of asthma and HRA is important because it can be treated successfully and affected individuals may achieve good control of their disease. OBJECTIVE: To evaluate the prevalence of asthma and HRA in Lebanese adults, their symptoms and predictors. METHODS: A cross-sectional study using a multistage cluster sample was carried out in Lebanon, between October 2009 and September 2010.Lebanese residents aged 40 and above participated to the study; a post-bronchodilator spirometry was performed to confirm diagnosis. RESULTS: Out of 2201 individuals, 218 (99%) were considered to have HRA. The following factors were found associated with HRA in the Lebanese population: Northern (ORa: 3.54) and Bekaa Plain (ORa: 2.44)] versus other regions; occupational exposure to toxic gases and fumes (ORa: 2.08); heating home with wood (ORa: 1.75); having a family history of chronic respiratory disease (ORa: 2.19), a history of childhood lung problem (ORa: 5.53), and father smoking during childhood (ORa: 1.47). Added to these factors, HRA was also predicted by female gender (ORa: 1.81); lower education (ORa: 120); older age (ORa: 1.28) and low birth weight (ORa: 3.14). CONCLUSION: This is the first epidemiological study in Lebanon that determined physician diagnosed asthma prevalence and hyperreactive airway disease and their associated factors among Lebanese adults. It also provides useful contributions that local health organizations may use for national programming and a foundation for health researchers to pursue further study in asthma research. Public awareness about the increased risk of asthma associated with heating homes with wood and exposure to passive smoking should be raised; Lebanese policy makers should also generate higher efforts to implement and reinforce the smoking ban law in public places.

Carbon monoxide and respiratory symptoms in young adult passive smokers: a pilot study comparing waterpipe to cigarette.

OBJECTIVES: Studies have correlated second hand smoke (SHS) with many diseases, especially respiratory effects. The goal of this study was to measure the impact of SHS on the respiratory symptoms and exhaled carbon monoxide. MATERIAL AND METHODS: The study population consisted of 50 young workers in restaurants serving waterpipes, 48 university students who sit frequently in the university cafeteria where cigarette smoking is allowed and 49 university students spending time in places where smoking is not allowed. Subjects completed questionnaires on socio-demographic characteristics, respiratory symptoms and exposure to SHS. Exhaled carbon monoxide levels were measured. ANOVA and Chi-square tests were used when applicable as well as linear and logistic regression analysis. RESULTS: Exposure to cigarette smoke in university (adjusted odds ratio (ORa) = 6.06) and occupational exposure to waterpipe smoke (ORa = 7.08) were predictors of chronic cough. Being married (ORa = 6.40), living near a heavy traffic road (ORa = 9.49) or near a local power generator (ORa = 7.54) appeared responsible for chronic sputum production. Moreover, predictors of chronic allergies were: being male (ORa = 7.81), living near a local power generator (ORa = 5.52) and having a family history of chronic respiratory diseases (ORa = 17.01). Carbon monoxide levels were augmented by the number of weekly hours of occupational exposure to waterpipe smoke (ß = 1.46) and the number of daily hours of exposure to cigarette smoke (ß = 1.14). CONCLUSIONS: In summary, young non-smoker subjects demonstrated more chronic cough and elevated carbon monoxide levels when exposed to SHS while the effect of waterpipe was even more evident.

Lung cancer correlates in Lebanese adults: a pilot case--control study.

BACKGROUND: Lung cancer is one of the most prevalent types of cancers. However, there are no epidemiological studies concerning lung cancer and its risk factors in Lebanon. This study was carried out to determine the association between lung cancer and its most common risk factors in a sample of the Lebanese population. METHODS: A hospital-based case-control study was conducted. Patients were recruited in a tertiary health care center. A questionnaire in Arabic was designed to assess the possible risk factors for lung cancer. RESULTS: For females, cigarette smoking (ORa=9.76) and using fuel for heating (ORa=9.12) were found to be the main risk factors for lung cancer; for males, cigarette smoking (ORa=156.98), living near an electricity generator (ORa=13.26), consuming low quantities of fruits and vegetables (ORa=10.54) and a family history of cancer (ORa=8.75) were associated with lung cancer. Waterpipe smoking was significantly correlated with lung cancer in the bivariate analysis. CONCLUSION: In this pilot study, it was found that in addition to smoking, outdoor and indoor pollution factors were potential risk factors of lung cancer. Additional studies would be necessary to confirm these findings.

The Young Adults' Cigarette Dependence (YACD) score: an improved tool for cigarette dependence assessment in university students.

BACKGROUND: Cigarette smoking induces dependence in young smokers. PURPOSE: The primary objective of this work was to validate the use of the Fagerström Test for Nicotine Dependence (FTND) in young Lebanese university students, and to improve it eventually by adding new items covering DSM-IV and ICD-10 dependence components. METHODS: We used data from a cross-sectional study on university students. A standardized questionnaire was administered, with items related to cigarette dependence: the FTND and the new Young Adults' Cigarette Dependence (YACD) scale. For both tools, factor and reliability analyses were performed. RESULTS: Although the FTND test showed satisfactory psychometric properties, the YACD showed better construct validity and reliability, covered dependence concept better and discriminated better between those who wanted to stop smoking and those who did not. CONCLUSIONS: FTND could be used in university students' population; however, the YACD scale could be more useful.

Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study.

PURPOSE: Our objective was to assess the prevalence of chronic bronchitis and chronic obstructive pulmonary disease (COPD) and their correlates among a Lebanese nonsmoker group. MATERIAL AND METHODS: A cross-sectional study was conducted between October 2009 and September 2010, using a multistage cluster sample throughout Lebanon including Lebanese residents aged 40 years and above with no exclusion criteria. Pre- and postbronchodilator spirometry measurements were performed and carbon monoxide level was measured in exhaled air. COPD was defined and classified according to the Global Initiative for Chronic Obstructive Lung Disease guidelines or according to the lower limit of normal (forced expiratory volume in 1 second/forced vital capacity postbronchodilator < 5th percentile of the healthy population having the same age and sex). Chronic bronchitis was defined by the declaration of morning cough and expectorations for more than 3 months a year over more than 2 years in individuals with normal spirometry. RESULTS: Out of 2201 individuals, 732 were never-smokers: 25 (3.4%) of them had COPD, and 86 (11.75%) fulfilled the definition of chronic bronchitis. Correlates of COPD included a childhood respiratory disease, house heated by diesel, and older age. On the other hand, correlates of chronic bronchitis included childhood respiratory diseases, living in southern Lebanon versus other regions, heating home by gas, older age, number of smokers at work, and lower height. CONCLUSION: A substantial percentage of the nonsmoking population may exhibit chronic bronchitis or COPD. The significant correlates mentioned above should be taken into consideration in order to reduce the risk of developing such chronic and debilitating respiratory diseases.

Extracranial venous stenosis is an unlikely cause of multiple sclerosis.

BACKGROUND: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause of multiple sclerosis (MS). OBJECTIVE: The aim of this study was to determine the presence of EVS in MS patients. METHODS: We performed selective extracranial venography on 42 patients with early MS (EMS): clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS) of less than 5 years duration, and late MS (LMS): RRMS of more than 10 years duration. Magnetic resonance imaging (MRI) and clinical relapse data were reviewed for all patients with EVS. RESULTS: EVS was present in 7/29 patients with EMS and 12/13 patients with LMS, a highly significant statistical difference (p< 0.001). Only 3/42 patients (all in the LMS group) had two vessel stenoses, while the rest had only one vessel involved. EVS was seen in 1/11 patients with CIS compared with 6/18 RRMS patients of less than 5 years duration. Disease duration was greater in patients with EVS overall (p < 0.005). LMS remained an independent predictor of EVS following multivariate adjustment for gender, age at disease onset and Expanded Disability Status Scale (EDSS) (Adjusted Odds Ratio = 29 (3-298); p = 0.005]. Within the EMS group, patients with (n = 7) and without (n = 22) EVS had similar EDSS and disease duration, suggesting similar disease severity. No clear correlation could be found between site of EVS and anatomic localization of either clinical relapses or MRI gadolinium-enhancing lesions. CONCLUSIONS: We conclude that EVS is an unlikely cause of MS since it is not present in most patients early in the disease and rarely involves more than one extracranial vein. It is likely to be a late secondary phenomenon.

Complete response of brain metastases from breast cancer overexpressing Her-2/neu to radiation and concurrent Lapatinib and Capecitabine.

Breast cancers that overexpress the human epidermal growth factor receptor 2 (HER-2) have a predilection to metastasize to the brain. Therapeutic options for brain metastases with systemic therapy remain a challenge in those patients since targeted and chemotherapeutic agents have limited penetration through the blood-brain barrier. Here we report the case of a patient with brain metastases from breast cancer overexpressing HER-2 who achieved a complete radiologic response after treatment by radiation and concurrent Lapatinib and Capecitabine.

Technical modification in the intracarotid chemotherapy and osmotic blood-brain barrier disruption procedure to prevent the relapse of carboplatin-induced orbital pseudotumor.

The blood-brain barrier disruption (BBBD) procedure is an established strategy to enhance drug delivery to brain tumors. Complication rates associated with this procedure are usually low, but when complications do occur, they usually mandate discontinuation of treatment. Orbital pseudotumor is an inflammatory condition of one or more extraocular muscles that produces limitation of ocular motility. Patients usually experience sudden diplopia associated with orbital pain, conjunctival chemosis and injection, and proptosis. Imaging of the orbit shows diffuse enlargement of the extraocular muscles, exophthalmia, and, rarely, sinusal or intracranial infiltration. On pathologic examinations, the soft tissues of the orbit are infiltrated with a mixture of eosinophils, lymphocytes, and plasma cells. Many etiologies can induce this syndrome, including the intracarotid infusion of platinum molecules. As part of a phase II study, a total of 110 patients were treated for malignant brain tumors with intra-arterial carboplatin, enhanced by the BBBD procedure, at the Sherbrooke University Hospital. Here we report on three patients who developed orbital pseudotumor ipsilateral to the carotid infused a few hours to days after the procedure. After the occurrence of this syndrome in the first patient, we developed a technical modification to the procedure that enabled uninterrupted treatment in the other two patients. This modification was as follows: after the mannitol infusion, and before carboplatin, the catheter was changed for a 3.5 tracker and was repositioned just above the emergence of the ophthalmic artery.