rabih bechara - Academia.edu (original) (raw)

Papers by rabih bechara

American Journal of Respiratory and Critical Care Medicine, 2021

Background: Evidence regarding timing of tracheostomy in adult patients with COVID-19 is unknown.... more Background: Evidence regarding timing of tracheostomy in adult patients with COVID-19 is unknown. Intensive care unit(ICU) mortality as high as 42-78% has been reported in critically ill COVID-19 patients. Medical literature has not shown mortality benefit in early tracheostomy, with exceptions in traumatic brain injury and neurological injury. There is some evidence to support shorter ICU length of stay and reduced ventilator-free days with early tracheostomy. This study aims to compare tracheostomy outcomes at day 28 between COVID-19 and non- COVID-19 patients, and to assess if timing of tracheostomy from intubation impacts outcomes. Methods: A prospective single-system multi-center observational cohort study will be performed on patients who underwent percutaneous dilatational tracheostomy(PDT) for prolonged mechanical ventilation. Results: Thus far, thirty patients have undergone PDT due to respiratory failure from COVID-19 and 28 for non-COVID-19 patients. We will evaluate 28-d...

Photodiagnosis and Photodynamic Therapy, Sep 1, 2015

Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cance... more Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in womenworldwide. The highest incidence rates are in Africa, as well as South-Central Asia and South America. According to the National Institute of Cancer (INCA) at the last year, it was estimated 15,590 new cases of cervical cancer in Brazil. About 90% of cervical cancers originate in the evolution of cervical intraepithelial neoplasia (CIN) which is classified on the basis of cyto-histological characteristics (low and high grade lesions). The equipment (CerCa 150 System, MMOptics Ltda., Trubios LLC, Brazil-USA) and the medication (20% MAL cream, PDTPharma, Brazil) are produced in Brazil with relative low cost. The Photodynamic Therapy is a promising procedure and it is even known as safe to normal tissue. The device includes two components specifically adapted to detect and treat abnormal cervical tissue, enabling proper lighting of the cervix. It is portable and does not require special infrastructure or installation. More than 60 patients between the ages of 14-57 years and with CIN 1 were treated and presented 100% of cure. Based on these results a larger randomized study with patients with CIN 2, placebo and follow-up only is ongoing.

Alcoholism: Clinical and Experimental Research, Jun 1, 2003

Background: Alcohol abuse increases the risk of acute lung injury in critically ill patients. We ... more Background: Alcohol abuse increases the risk of acute lung injury in critically ill patients. We have shown that alveolar epithelial cell (AEC) apoptosis in response to inflammatory mediators, including tumor necrosis factor-␣ (TNF-␣), parallels endotoxin-mediated acute lung injury in ethanol-fed rats. Although angiotensin II mediates TNF-␣-induced apoptosis of AECs in vitro, its role in ethanol-mediated susceptibility to AEC apoptosis is unknown. Methods: Adult male rats were fed the Lieber-DeCarli diet for 6 weeks. AECs were isolated, and TNF-␣-and angiotensin II-induced cytotoxicity (by terminal transferase-mediated dUTP nick end labeling staining) was determined with or without the addition of the angiotensin-converting enzyme inhibitor (lisinopril) or a selective blocker of the angiotensin II type 1 receptor (AT 1) or type 2 receptor (AT 2). Finally, the relative expression of the AT 1 and AT 2 receptors in AECs was determined by Western blot analysis. Results: TNF-␣-induced cytotoxicity, but not angiotensin II-induced cytotoxicity, was prevented by lisinopril, indicating that de novo angiotensin II synthesis is required for TNF-␣-induced apoptosis in these cells. Both TNF-␣-and angiotensin II-induced cytotoxicity in AECs from control-fed and ethanol-fed rats were inhibited by the selective AT 2 blocker, PD123319, but not by the selective AT 1 blocker, losartan. In parallel, ethanol ingestion doubled AT 2 expression in AECs (by Western blot) but had no significant effect on AT 1 receptor expression. Conclusions: Chronic ethanol ingestion increases AT 2 expression in the alveolar epithelium and enhances TNF-␣-and angiotensin II-induced cytotoxicity, both of which act via AT 2. Together, these findings suggest that selective AT 2 receptor inhibition could limit the development of acute lung injury in alcoholic patients.

Journal of Investigative Medicine, 2004

Journal of bronchology & interventional pulmonology, 2019

Background: Thoracentesis is one of the most commonly performed medical procedures with an excell... more Background: Thoracentesis is one of the most commonly performed medical procedures with an excellent safety profile. Clopidogrel (a compound that inhibits adenosine diphosphate-induced platelet aggregation) is often prescribed for primary or secondary prevention of cardiovascular disease and has been associated with bleeding complications in patients undergoing surgical procedures. The purpose of this study was to assess the safety of ultrasound (US)-guided thoracentesis in patients receiving clopidogrel therapy. Methods: Data were collected on 30 consecutive patients taking clopidogrel without other known underlying coagulation problems. These patients underwent 45 US-guided thoracenteses over 26 months. Clopidogrel was not discontinued before the thoracentesis in patients presenting with symptomatic pleural effusion. Thoracenteses were performed in these patients and the incidence of bleeding and other complications among patients was reported. Results: Between June 2009 and August 2011, there were 30 consecutive patients on clopidogrel at the time of thoracenteses. These patients presented with respiratory distress because of pleural effusion and underwent a total of 45 thoracenteses. There was no significant bleeding or other complications in this patient population. No patient required transfusion after the procedure. Conclusion: Patients who are receiving clopidogrel and present with symptomatic pleural effusion can safely undergo US-guided thoracentesis without interrupting clopidogrel before the procedure. Larger studies are required to confirm these results.

American Journal of Physiology-lung Cellular and Molecular Physiology, 2004

Chronic alcohol abuse increases the risk of developing acute lung injury approximately threefold ... more Chronic alcohol abuse increases the risk of developing acute lung injury approximately threefold in septic patients, and ethanol ingestion for 6 wk in rats impairs alveolar epithelial barrier function both in vitro and in vivo. Granulocyte/macrophage colony-stimulating factor (GM-CSF) is a trophic factor for the alveolar epithelium, and a recent phase II clinical study suggests that GM-CSF therapy decreases sepsis-mediated lung injury. Therefore, we hypothesized that GM-CSF treatment could improve ethanolmediated defects in the alveolar epithelium during acute stresses such as endotoxemia. In this study, we determined that recombinant rat GM-CSF improved lung liquid clearance (as reflected by lung tissue wet:dry ratios) in ethanol-fed rats anesthetized and then challenged with 2 ml of saline via a tracheostomy tube. Furthermore, GM-CSF treatment improved lung liquid clearance and decreased epithelial protein leak in both control-fed and ethanol-fed rats after 6 h of endotoxemia induced by Salmonella typhimurium lipopolysaccharide given intraperitoneally, but with the greater net effect seen in the ethanol-fed rats. Our previous studies indicate that chronic ethanol ingestion decreases lung liquid clearance by increasing intercellular permeability. Consistent with this, GM-CSF treatment in vitro decreased permeability of alveolar epithelial monolayers derived from both control-fed and ethanol-fed rats. As in the endotoxemia model in vivo, the effect of GM-CSF was most dramatic in the ethanol group. Together, these results indicate that GM-CSF treatment has previously unrecognized effects in promoting alveolar epithelial barrier integrity and that these salutary effects may be particularly relevant in the setting of chronic alcohol abuse.

Journal of bronchology & interventional pulmonology, Oct 1, 2012

C73. THE TERRIBLE Ts: SESSIONS IN THE MEDIASTINUM, May 1, 2022

Critical Care Medicine, 2012

The American Surgeon, 2010

Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all g... more Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all genetic backgrounds. Pancreatic involvement is rare; the first case was described on autopsy in 1937. We present a case of pancreatic sarcoidosis without a history of the disease presenting as biliary obstruction mimicking pancreatic malignancy. We also review the literature with respect to management and outcomes of similar cases. The patient described here presented with all the signs and symptoms of a pancreatic malignancy, which was confirmed on a CT scan; the positron emission tomography scan and the CA 19-9 level were also confirmatory of the suspected diagnosis. In this setting, if the mass looks resectable, a Whipple procedure would be the next logical step. However, such strategy would be aggressive management for a benign condition that could be palliated with diverting rather than resective procedures without changing the outlook of the disease. We suggest keeping a high index ...

The Bangkok Medical Journal, 2017

OBJECTIVE: Suspicious pulmonary nodules have become a more common finding since the advent of CT ... more OBJECTIVE: Suspicious pulmonary nodules have become a more common finding since the advent of CT scans as a screening method for lung cancer. The challenge is to find a safer, practical and more accurate way to diagnose peripheral nodules and lesions while minimizing harm to the patient. Electromagnetic Navigation Bronchoscopy (ENB) is a cutting edge technology that enables pulmonologists to precisely target small and difficult to reach peripheral pulmonary nodules by using technology similar to a global positioning system (GPS).This study describes our experience in using ENB with Endobronchial ultrasound (EBUS) as a diagnostic tool on patients suspected of lung malignancy. MATERIALS AND METHODS: A retrospective analysis was conducted for 33 patients between November 2014 and November 2015 at our institution. Yield was determined by attaining final diagnosis from tissue analysis of every patient who underwent the ENB and EBUS procedure for suspected lung malignancy. Patients with no definite diagnosis were referred to surgery for further examination. Intraoperative and postoperative complications were recorded. RESULTS: The ENB and EBUS procedure was completed in all 33 subjects on lung nodules measuring from 2 to 108mm. The patients were 67% (22) male, 33% (11) female, 88% (29) Asian, with a mean age of 61 years old. Lung nodules were located in the upper lobe (52%), lower lobe (43%) and middle lobe (5%). Lymph node involvement was present in 33% of cases. Of the patients in the study, 26 cases (79%) were accurately diagnosed using ENB and EBUS, 6 cases (18%) were referred to surgery and 1 patient (3%) refused further investigation. No bleeding or pneumothorax complications were reported. CONCLUSION: ENB is an effective, accurate and a novel method that provides real time directions toward lung lesions and nodules. This tool allows flexibility that aids biopsy of hard to reach areas, and attains adequate tissue samples. This instrument compliments other bronchoscopic methods such as EBUS.

Journal of Clinical Oncology, May 20, 2015

In this retrospective study of patients with advanced pulmonary adenocarcinoma treated with pemet... more In this retrospective study of patients with advanced pulmonary adenocarcinoma treated with pemetrexed-based chemotherapy in an Irish Oncology Unit, tumor expression of TTF-1 was associated with improved survival. Further prospective study of TTF-1 expression as a predictive biomarker to individualize chemotherapy decisions is warranted.

Clinics in Chest Medicine, Mar 1, 2018

Point-of-care ultrasound has vast potential and is generally underused in the critical care setti... more Point-of-care ultrasound has vast potential and is generally underused in the critical care setting. The rapid and portable nature of ultrasound makes it an ideal tool to help guide decision making in time-sensitive scenarios. As professional societies continue to formulate and adapt training protocols or standards in ultrasound, it is rapidly becoming an indispensable tool for the intensivist.

TP137. TP137 THORACIC ONCOLOGY: DIAGNOSIS AND TREATMENT: IP, SURGERY, AND RADIATION, 2021

TP135. TP135 THORACIC ONCOLOGY: MALIGNANT PLEURAL DISEASE, 2021