International experts focus on spina bifida prevention and treatment

 

 

Doha, September 27. The prevention and treatment of spina bifida was the focus of a major three-day international medical conference that got underway today with the latest research data and innovative new treatment options available.

Spina bifida is a serious birth defect that occurs when the bones of the spine do not form properly around part of a baby’s spinal cord. There is no definitive cure for spina bifida.

Most children who have spina bifida do not have problems from it but it can affect how the skin on the back looks. And in severe cases, it can make walking or daily activities difficult.

Hosted by Weill Cornell Medical College in Qatar in association with Hamad Medical Corporation and Sidra, the International Conference on Spina Bifida: Genetic-Environmental Causes, Prevention and Treatment meeting attracted acclaimed international leaders in epidemiology, genetics, fetal surgery, metabolomics and epigenetics. Guest faculty from WCMC-Q, Hamad and Sidra who are all leading geneticists, practitioners in neurology, maternal fetal medicine and nephrology working in Qatar and the region also attended.

Representing WCMC-Q on the public forum panel was Assistant Research Professor of Neurology Alice Abdel Aleem who was also a session moderator.

In his opening address, WCMC-Q Dean Dr. Javaid Sheikh welcomed the distinguished group of experts and praised the work of researchers and the developments that have been made in advancing treatment of spina bifida.

“Weill Cornell Medical College in Qatar remains committed to innovative and high quality research not only for the benefit or the development of Qatar but also for international advancement and for the benefit of all those who are in need.  So it is indeed a special honor for WCMC-Q to be associated with this international spina bifida conference. It shows our commitment to the international community and points to our rapidly growing legacy in promoting quality medical research and a leader of medical education in the Gulf region,” Dean Sheikh said.

Organizers said the meeting was designed to be highly interactive, geared toward regional physicians, geneticists and healthcare providers practicing in the GCC community. Participants had ample opportunity to discuss clinical experiences, therapeutic challenges and practical solutions in the near term as well as long-term prospects to accelerate advances in the field of spina bifida treatment and prevention.

Neural Tube Defects (NTDs), primarily spina bifida and anencephaly, are major developmental disorders with prevalence worldwide of one in 1,000 live births. Infants with spina bifida often survive and face a life challenged by paralysis and a variety of urological and neurological complications.

The exact cause of this birth defect is not known. Experts think that genes and the environment are part of the cause. Children with a severe defect are sometimes born with fluid buildup in the brain. They may also have this problem after birth. It can cause seizures, intellectual disability, or sight problems. Some children also develop a curve in the spine, such as scoliosis.

The conference programs presented the latest information regarding the genetic and environmental factors contributing to the development of NTDs. It also provided a forum for overview and discussion of NTDs encountered in Qatar and the MENA region. In addition, an evening public forum provided an opportunity for the Doha non-medical community to hear about the latest research into prevention and treatment of spina bifida and other NTDs from experts in the field.

WCMC-Q study finds Arab women at higher risk of aggressive breast cancer

Doha, September 13. The clinical features of breast cancer among Arab women are quite different from other populations and Middle East women often present with more aggressive forms of breast cancer than Western women, a research report by Weill Cornell Medical College in Qatar has found.

Breast cancer is a major health problem in both developed and developing countries. The report finds that the incidence of breast cancer is lower in Arabic countries than in Europe and the United States but is rising fast. The report also finds breast cancers in women from Arab populations have different characteristics to those reported in women from the United States and Europe.  At 48, the average age of presentation of breast cancer in Arab women is 10 years younger than patients in the US and Europe.

WCMC-Q Assistant Dean for Basic Science Curriculum Professor Lotfi Chouchane said Arab populations have some particularities in terms of cancer, especially breast cancer, and also the clinical features of breast cancer among Arab women are different from other populations.

“Inflammatory breast cancer is the most lethal form of the disease and constitutes 1-2 per cent of all breast cancer tumors in the United States. But a higher proportion of cases are reported in Arab populations. For example in Tunisia, seven to 10 per cent of all breast cancer is inflammatory. Similarly, in a population-based study in the Gharbiah region of Egypt, inflammatory breast cancer was confirmed as more prevalent than in the United States, constituting up to 11 per cent as opposed to 1-2 per cent in the United States. ”

Professor Chouchane was lead author of the report published in the latest edition of The Lancet Oncology, an internationally respected medical journal. Co-authors were WCMC-Q research associate in microbiology and immunology Dr. Konduru Sastry and Dr. Hammouda Boussen from Tunisia.

The Lancet Oncology is a peer-reviewed and edited journal that is recognized for providing a global, authoritative, and independent forum for the highest quality clinical oncology research and opinion. With an impact factor of 25.12, the journal ranks among the top 3 oncology journals worldwide, is the leading clinical research journal in oncology, and is in the top 0.5% of all scientific journals, of any discipline, in the world.

 “This report is going to be the reference for anybody who wan to undertake studies about breast cancer in Arab populations and researchers will refer to it because here we describe all the characteristics of breast cancer in Arab populations based on our own findings and based also on the literature what is found,” Professor Chouchane said.

The reduction of the incidence in breast cancer and its mortality can be achieved with major efforts in screening and early detection, Professor Chouchane said. “Although several awareness campaigns have been undertaken, no structured national programs exist for population mammography screening in Arab countries.

“The cultural value of modesty and misconceptions about cancer, coupled with insufficient levels of education about breast cancer and difficulties in accessing healthcare facilities can often prohibit women from participating in breast screening. And this can lead to delayed detection,” Professor Chouchane said.

He said breast cancer mortality could be reduced if the disease was detected at an early stage by the implementation of proper   awareness and screening programs that would be possible in countries with sufficient resources. Further research on cancer should also be given priority in Arab countries, Professor Chouchane said.

This study was supported by the Biomedical Research Program fund at Weill Cornell Medical College in Qatar and by grants from the Qatar National Research Fund. The rapidly expanding Research Department at WCMC-Q seeks to establish a state of the art biomedical research program focused on tackling the most pressing health needs in Qatar and the region.

Cancer accounts for 10 percent of all deaths in Qatar and the leadership of Qatar has moved to improve the healthcare of patients  with the Supreme Council of Health establishing the National Cancer Strategy. WCMC-Q supports the mission of Qatar’s National Cancer strategy that was launched in 2011 by Her Highness Sheikha Moza bint Nasser, Vice Chairperson of the Supreme Council of Health.

 It was the first-ever initiative of its kind in the region to combat a disease. The cancer strategy is closely linked to the National Health Strategy (NHS).  With an investment of more than QR2,204m, the strategy also includes a plan for refurbishment of Al Amal Hospital to establish National Center for Cancer Care and Research, and a new cancer hospital, over the next five years.

http://www.healthcanal.com/cancers/breast-cancer/43163-wcmc-q-study-finds-arab-women-at-higher-risk-of-aggressive-breast-cancer.html

http://www.bi-me.com/main.php?id=63334&t=1&c=35&cg=4

http://www.menafn.com/1093701340/WCMC-Q-study-finds-Arab-women-at-higher-risk-of-aggressive-breast-cancer

WCMC-Q graduates impress with international cardiac research

By Hilton Kolbe and agencies

Weill Cornell Medical College in Qatar Class of 2010 graduate Dr. Mohamed Badreldin Elshazly and Dr. Mohammed Al-Hijji, WCMC-Q graduate in the Class of 2011 have stepped into the spotlight of international cardiac research as co-authors of a major clinical investigation of lipids that has been published in the prestigious Journal of the American College of Cardiology.

Dr. Elshazly is currently working in the Osler Internal Medicine Residency program at Johns Hopkins Hospital in Baltimore, Maryland and has also taken up Cardiology Fellowship at Cleveland Clinic, in Ohio.  Dr. Al-Hijji, is currently doing his final year of internal medicine residency at Johns Hopkins Hospital.

The title of the study is: Non-HDL Cholesterol, Guideline Targets, and Population Percentiles for Secondary Prevention in a Clinical Sample of 1.3 Million Adults The Very Large Database of Lipids (VLDL-2 Study).

The study presents a new analysis of 1.3 million individuals that highlights the magnitude of patient-level discordance between LDL and non-HDL percentiles.

According to the report, there is significant discordance between LDL and non-HDL percentiles at lower LDL and higher triglyceride levels.

In the study, Dr. Elshazly and colleagues wrote: “Current non-HDL cutpoints for high-risk patients may need to be lowered to match percentiles of LDL cutpoints. Relatively small absolute reductions in non-HDL cutpoints result in substantial reclassification of patients to higher treatment categories with potential implications for risk assessment and treatment.”

The researchers investigated whether non-HDL goals should be used at the same population percentiles as LDL goals, as suggested by previous research. They examined lipid profiles of 1,310,440 US adults (mean age, 59 years; 52% women) included in the Very Large Database of Lipids. Participants had triglyceride levels of less than 400 mg/dL and underwent lipid testing by vertical spin density gradient ultracentrifugation (Atherotech) from 2009 to 2011.

“Low-density lipoprotein cholesterol (LDL-C) has always been referred to as the “bad” cholesterol and high-density lipoprotein (HDL-C) as the “good” cholesterol. However, as the prevalence of obesity, diabetes mellitus and metabolic syndrome increased over the past few decades, we have witnessed an increase in other types of “bad” cholesterol such as Very Low-density lipoprotein, Intermediate density lipoprotein, cholesterol remnants and Lipoprotein[a],” Dr. Elshazly said.

“All these atherogenic lipoproteins in addition to LDL-C are included in non-HDL cholesterol, which is simply calculated by subtracting HDL-C (good cholesterol) from total cholesterol and available in the standard lipid profile at no additional cost or inconvenience. “

Dr. Elshazly said over the past two decades, numerous studies have suggested that non-HDL-C is a better marker of cardiovascular disease risk and a better target for lipid-lowering therapy than LDL-C but this has not been reflected in the most recent cholesterol guidelines. The current worldwide guidelines recommend using non-HDL-C only as a secondary treatment target in patients with triglyceride levels of at least 200 mg/dl.  Therefore, we are potentially treating some patients only to their optimal LDL-C goal while their non-HDL-C value remains above goal.

“Our research group at the Johns Hopkins Ciccarone Center for prevention acquired a database of 1.3 million patients who underwent lipid profiling by direct ultracentrifugation (Vertical Autoprofile test by Atherotech, Birmingham, Alabama, USA) from 2009 to 2011. Their age, sex and lipid parameter distributions closely matched those of the National Health and Nutrition Examination survey, a nationally representative sample of the USA population.,” he said.

“It is registered on clinicaltrials.gov as the Very Large Database of Lipids (NCT01698489). We aimed to use this gigantic database to highlight the amount of patient-level discordance between non-HDL-C and LDL-C percentiles and the potential for inadequate treatment in the structure of current guidelines.

“We found that a significant proportion of individuals are reclassified to higher ATP III (Adult Treatment Panel III) treatment categories when non-HDL-C is used to classify them rather than LDL-C. In addition, there is significant discordance between population percentiles of LDL-C and non-HDL-C particularly when accuracy is most crucial; at LDL-C in the treatment range of high-risk patients and at high triglycerides.

“For example, in patients with LDL-C levels less than 70 mg/dl, 15% had a non-HDL-C value of at least 100 mg/dl, the cutpoint recommended by guidelines, while 25% had a non-HDL-C level of at least 93 mg/dl, the cutpoint based on percentile equivalence. The percentages increased to 22% and 50%, respectively, if triglycerides were 150 mg/dl to 199 mg/dl concurrently.

“We concluded that lowering conventional non–HDL-C cutpoints for high-risk patients to match percentiles of LDL-C cutpoints as well as wider adoption of non–HDL-C in clinical practice might potentially improve secondary prevention outcomes and residual risk assessment and treatment. Therefore, clinicians should be more aggressive about treating their high-risk patients to LDL-C as well as non-HDL-C goals. They should consider using lower non-HDL-C goals for secondary prevention as highlighted in our study.”

Dr. Elshazly first got involve in the project in 2011 when he I started working with the Ciccarone Center of Prevention of the Johns Hopkins Department of Cardiology.  

“We started working on this 1.3 million patients database called the Very Large Database of Lipids and published our first paper in the Journal of the American College of Cardiology (Martin SS. Blaha MJ, Elshazly MB. Friedewald) of estimated versus directly measured low-density lipoprotein cholesterol and treatment implications.

“We presented several abstracts from this database in the American College of Cardiology meetings in 2012 and 2013, American Heart Association meetings in 2012 and 2013 and Arteriosclerosis, Thrombosis and Vascular Biology Scientific Sessions in 2013. And I also participated in an interview on Yahoo Health with Dr. Blaha,” Dr. Elshazly said.

Later he moved on to work on his non-HDL-C study with his mentors Dr. Steven Jones and Dr. Seth Martin at Johns Hopkins Hospital, who are experts in the fields of lipids and atherosclerosis.

 Dr. Elshazly was lavish in praise of his medical and research training in Doha. “WCMC-Q had a great impact on what I am doing today. There were tremendous opportunities to do research in medical school such as summer research scholarships to WCMC-NY as well as state supported funds to do research in Qatar such as UREP and QNRF and I participated in both.

“In addition, WCMC-Q was my road to joining internal medicine residency at Johns Hopkins followed by cardiology fellowship at the Cleveland Clinic. Therefore, I will always be grateful to Qatar Foundation, WCMC-Q and Qatar’s leadership for their investment in research and the human potential and I hope I will be able to use my research expertise to help advance medicine and cardiovascular research in the Middle East,” Dr. Elshazly said.

The study population included 1,310,440 U.S. adults who had triglyceride levels below 400 mg/dL. Their mean age was 59 years, and 52% were women. The authors found that LDL-C cutpoints of 70 mg/dL, 100 mg/dL, 130 mg/dL, 160 mg/dL and 190 mg/dL corresponded to the same population percentiles as non-HDL-C levels of 93 mg/dL, 125 mg/dL, 157 mg/dL, 190 mg/dL and 223 mg/dL, respectively.

When patients were reclassified by non-HDL-C, a significant proportion moved to a higher treatment category compared with LDL-C, especially high-risk patients and patients with a triglyceride level of 150 mg/dL or greater.

Fifteen percent of patients with an LDL-C level below 70 mg/dL had a non-HDL-C level of 100 mg/dL, the guideline-based cutpoint, while 25% had a non-HDL-C of 93 mg/dL or greater, the percentile-based cutpoint. When triglyceride levels between 150 and 199 mg/dL were also considered, 22% of patients with an LDL-C level below 70 mg/dL had a non-HDL-C level of 100 mg/dL and 50% had a non-HDL-C of 93 mg/dL or greater.

The authors acknowledged that clinical and demographic data were limited and that they could not determine the effect of reclassification on clinical outcomes, among other limitations. However, they concluded that patient-level discordance exists between non-HDL-C and LDL-C percentiles, especially at lower LDL-C and higher triglyceride levels, when they said accuracy is most critical.

"Lowering conventional non-HDL-C cutpoints for high-risk patients to match percentiles of LDL-C cutpoints as well as wider adoption of non-HDL-C in clinical practice may potentially improve secondary prevention outcomes and residual risk assessment and treatment," the authors wrote.

The study results were first published online August 21, 2013 by the Journal of the American College of Cardiology.

PANEL BOX plus photos for illustration

Study: Non-HDL Cholesterol, Guideline Targets, and Population Percentiles for Secondary Prevention in a Clinical Sample of 1.3 Million Adults The Very Large Database of Lipids (VLDL-2 Study).

Mohamed B. Elshazly, MD; Seth S. Martin, MD; Michael J. Blaha, MD, MPH; Parag H. Joshi, MD; Peter P. Toth, MD, PhD, FACC; John W. McEvoy, MB BCh; Mohammed A. Al-Hijji, MD; Krishnaji R. Kulkarni, PhD; Peter O. Kwiterovich, MD; Roger S. Blumenthal, MD, FACC; Steven R. Jones, MD, FACC

J Am Coll Cardiol.  

Link: http://content.onlinejacc.org/article.aspx?articleid=1731125

Abstract

Objectives 

To examine patient-level discordance between population percentiles of non-HDL cholesterol (non-HDL-C) and LDL cholesterol (LDL-C).

Background 

Non-HDL-C is an alternative to LDL-C for risk stratification and lipid-lowering therapy. The justification for the present guideline-based non-HDL-C cutpoints of 30 mg/dL higher than LDL-C cutpoints remains largely untested.

Methods 

We assigned population percentiles to non-HDL-C and Friedewald-estimated LDL-C values of 1,310,440 U.S. adults with triglycerides < 400 mg/dL who underwent lipid testing by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011.

Results 

LDL-C cutpoints of 70, 100, 130, 160, and 190 mg/dL were in the same population percentiles as non-HDL-C values of 93, 125, 157, 190, and 223 mg/dL, respectively. Non-HDL-C reclassified a significant proportion of patients within a higher treatment category compared with Friedewald LDL-C, especially at LDL-C levels in the treatment range of high-risk patients and at triglyceride levels ≥ 150 mg/dL. Of patients with LDL-C < 70 mg/dL, 15% had a non-HDL-C ≥ 100 mg/dL (guideline-based cutpoint) and 25% had a non-HDL-C ≥ 93 mg/dL (percentile-based cutpoint); 22% and 50% respectively if triglycerides concurrently 150-199 mg/dL.

Conclusions 

There is significant patient-level discordance between non-HDL-C and LDL-C percentiles at lower LDL-C and higher triglycerides; a finding with implications for treatment of high-risk patients. Current non-HDL-C cutpoints for high-risk patients may need to be lowered to match percentiles of LDL-C cutpoints. Relatively small absolute reductions in non-HDL-C cutpoints result in substantial reclassification of patients to higher treatment categories with potential implications for risk assessment and treatment.

Clinical trial info VLDL-2; NCT01698489