Sami Azar

University of Balamand, Faculty of Medecine, Faculty Member

American University of Beirut, Internal Medicine-Endocrinology, Faculty Member

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Papers by Sami Azar

Wearable flexible body matched electromagnetic sensors for personalized non-invasive glucose monitoring

Scientific Reports, Sep 1, 2022

This work introduces novel body-matched, vasculature-inspired, quasi-antenna-arrays that act as e... more This work introduces novel body-matched, vasculature-inspired, quasi-antenna-arrays that act as electromagnetic sensors to instantaneously, continuously, and wirelessly sense glucose variations in the bloodstream. The proposed sensors are personalized, leverage electromagnetic waves, and are coupled with a custom machine-learning-based signal-processing module. These sensors are flexible, and embedded in wearable garments such as socks, which provide conformity to curved skin surfaces and movement resilience. The entire wearable system is calibrated against temperature, humidity, and movement resulting in high accuracy in glucose variations tracking. In-Vivo experiments on diabetic rats and pigs exhibit a 100% diagnostic accuracy over a wide range of glucose variations. Human trials on patients with diabetes and healthy individuals reveal a clinical accuracy of continuous glucose monitoring of 99.01% in twenty-eight subjects who underwent Oral Glucose Tolerance Tests. Hence, our approach ensures the continuous tracking of glucose variations from hypo-to-hyper glycemic levels with great fidelity.

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19-Nor-deoxycorticosterone production from aldosterone-producing adenomas

Hypertension, Apr 1, 1992

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Phonatory symptoms and impact on quality of life in female patients with goiter

PubMed, Jul 1, 2016

Our objective is to report on the prevalence of phonatory symptoms and impact on quality of life ... more Our objective is to report on the prevalence of phonatory symptoms and impact on quality of life in a group of female patients with goiter who had not been selected for surgery or who had not presented to the emergency room with respiratory distress. A total of 40 patients with goiter and 14 controls were enrolled in this study. Demographic data included age, sex, laryngopharyngeal reflux disease, allergy, smoking, duration of disease, presence or absence of compressive symptoms, presence or absence of thyroid gland nodules, vascular status, presence or absence of calcifications, and thyroid-stimulating hormone levels. Phonatory symptoms included hoarseness, vocal fatigue, vocal straining, lump sensation, and aphonia. The Voice Handicap Index 10 was used to assess the impact of phonatory symptoms on quality of life. The most common phonatory symptom in the patients with goiter was vocal fatigue followed by lump sensation. The only phonatory symptom that was significantly more present in patients with goiter was vocal straining. As for the impact of phonatory symptoms on quality of life, 15.8% of goiter patients had a Voice Handicap Index score >7 compared with 7.7% of controls. Phonatory symptoms are common in patients with goiter, with vocal straining occurring significantly more frequently than in controls. In 1 of 6 patients, the presence of phonatory symptoms had an impact on quality of life.

Vocal tract symptoms: Severity and frequency in patients on statins

PubMed, Jun 26, 2018

The objective of the study was to analyze the frequency and severity of vocal tract symptoms in p... more The objective of the study was to analyze the frequency and severity of vocal tract symptoms in patients on statins. A total of 73 patients were enrolled in this study, 44 patients who were taking statins and 29 controls not taking statins. The severity and frequency of vocal tract discomfort was assessed using the Vocal Tract Discomfort scale. The most frequent vocal tract symptom in patients on statins was dryness followed by tightness and lump sensation. The difference in the mean of the total score and in the mean frequency of any vocal tract symptom was not significant between patients taking statins and controls. The most severe (highest mean values) vocal tract symptom in patients taking statins also was dryness followed by tightness and lump sensation. The difference in the mean of the total score and in the mean severity of any vocal tract symptom between patients taking statins and controls was not significant. This study failed to demonstrate a higher prevalence or severity of vocal tract symptoms in patients receiving statins. Despite the lack of a significant difference in the means of vocal tract discomfort symptom frequency and severity, this study carries clinical significance when considering that a higher prevalence and severity of vocal tract discomfort symptoms should alert physicians to the possible development of statin-induced myotoxicity in the laryngopharyngeal complex.

Erectile dysfunction in diabetic patients

PubMed, Jan 26, 2006

Erectile dysfunction (ED) appears to be highly prevalent in diabetic patients (around 50% at 50 y... more Erectile dysfunction (ED) appears to be highly prevalent in diabetic patients (around 50% at 50 years of age) and more severe than in the rest of the population. Its etiology is multifactorial in this subset of patients. ED is highly correlated to multiple vascular risk factors and can be considered as a manifestation of endothelial dysfunction in general, alerting the physician to look at underlying silent coronary bed atherosclerosis. It is also dependent on the poor control of diabetes and on the presence of its chronic complications. Because of the multiple etiologies of ED in diabetics, a multifactorial approach is warranted to get an optimal response in treating such patients: diabetes control, use of phosphodiesterase 5 inhibitors, psychosexual counseling, and choice of antihypertensive medications.

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Prevalence and Co-prevalence of Comorbidities Among Patients with Type 2 Diabetes Mellitus in the MENA Region: A Systematic Review

Current Diabetes Reviews, Jul 31, 2023

Objective-Patients with type 2 diabetes (T2DM) often have multiple comorbidities which may impact... more Objective-Patients with type 2 diabetes (T2DM) often have multiple comorbidities which may impact the selection of antihyperglycemic therapies. The purpose of this study was to quantify the prevalence and co-prevalence of common comorbidities. Research design and methods-A retrospective study was conducted using the Quintiles Electronic Medical Record database. Adult patients with T2DM who had ≥1 encounter from July 2014 to June 2015 (index period) with ≥1 year medical history available were included. The index date was defined as the most recent encounter date during the one year index period. Main outcome measures-Comorbid conditions were assessed using all data available prior to and including the index date. Patient characteristics, laboratory measures, and comorbidities were summarized via descriptive analyses, overall and by subgroups of age (<65, 65-74, 75+ years) and gender. Results-Of the 1,389,016 eligible patients, 53% were female and the median age was 65 years. 97.5% of patients had at least one comorbid condition in addition to T2DM and 88.5% had at least two. The comorbidity burden tended to increase in older age groups and was higher in men than women. The most common conditions in patients with T2DM included hypertension (HTN) in 82.1%; overweight/obesity in 78.2%; hyperlipidemia in 77.2%; chronic kidney disease (CKD) in 24.1%; and cardiovascular disease (CVD) in 21.6%. The highest co-prevalence was demonstrated for the combination of HTN and hyperlipidemia (67.5%), followed by overweight/obesity and HTN (66.0%), overweight/obesity and hyperlipidemia (62.5%), HTN and CKD (22.4%), hyperlipidemia and CKD (21.1%), HTN and CVD (20.2%), hyperlipidemia and CVD (20.1%), overweight/obesity and CKD (19.1%) and overweight/obesity and CVD (17.0%). Limitations-Limitations include the potential for misclassification/underreporting due to the use of diagnostic codes, drug codes, or laboratory measures for identification of medical conditions. Conclusions-The vast majority of patients with T2DM have multiple comorbidities. To ensure a comprehensive approach to patient management, the presence of multimorbidity should be considered in the context of clinical decision making.

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Dysregulation of cytokine expression in diabetes

Genomic and Proteomic Study of the Inflammatory Pathway in Patients with Atrial Fibrillation and Cardiometabolic Syndrome

Journal of the American College of Cardiology, 2017

Background: Atrial fibrillation (AF) and cardiometabolic syndrome (CMS) have been linked to infla... more Background: Atrial fibrillation (AF) and cardiometabolic syndrome (CMS) have been linked to inflammation and fibrosis. We investigated inflammatory and fibrotic markers as well as cytokine genetic profiles in patients with lone AF and CMS. Methods: This study has three groups: CMS patients, lone AF patients, and patients with both lone AF and CMS. We assessed for genetic polymorphisms in inflammatory and fibrotic markers. Serum levels of connective tissue growth factor were tested along with other inflammatory markers including platelet-to-lymphocyte ratio (PLR), monocyte-to-HDL ratio (MHR), and red cell distribution width (RDW). Results: 39 patients (15 AF + CMS, 11 AF, 13 CMS) were tested. Connective tissue growth factor levels were highest in the AF + CMS group and lowest in the AF group (no statistical significance). PLR was highest in groups with CMS and lowest in the AF group (p < 0.05). Genotyping showed high percentages of patients in all groups with high secretor genotypes of transforming growth factor beta 1 and interleukin-6. No significant difference was seen in the RDW nor the MHR between groups. Conclusions: Connective tissue growth factor levels and PLR showed a pattern of being highest in the group with both AF + CMS, and lowest in the AF group. Genotyping showed high percentages of patients with high secretor genotypes of interleukin-6 and transforming growth factor beta 1. Combination of both CMS and AF may be associated with a higher degree of inflammation than what is seen in either CMS or AF alone.

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Exploring the World of Membrane Proteins: Techniques and Methods for Understanding Structure, Function, and Dynamics

Molecules

In eukaryotic cells, membrane proteins play a crucial role. They fall into three categories: intr... more In eukaryotic cells, membrane proteins play a crucial role. They fall into three categories: intrinsic proteins, extrinsic proteins, and proteins that are essential to the human genome (30% of which is devoted to encoding them). Hydrophobic interactions inside the membrane serve to stabilize integral proteins, which span the lipid bilayer. This review investigates a number of computational and experimental methods used to study membrane proteins. It encompasses a variety of technologies, including electrophoresis, X-ray crystallography, cryogenic electron microscopy (cryo-EM), nuclear magnetic resonance spectroscopy (NMR), biophysical methods, computational methods, and artificial intelligence. The link between structure and function of membrane proteins has been better understood thanks to these approaches, which also hold great promise for future study in the field. The significance of fusing artificial intelligence with experimental data to improve our comprehension of membrane p...

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Variation in postprandial ghrelin status following ingestion of high carbohydrate, high fat and high protein meals in healthy males

The FASEB Journal, Mar 1, 2006

Central Diabetes Insipidus in a Patient with Stiff Person Syndrome

American Journal of Internal Medicine, 2019

Background: Central diabetes insipidus (CDI) is a rare hypothalamic-pituitary disease due to the ... more Background: Central diabetes insipidus (CDI) is a rare hypothalamic-pituitary disease due to the deficiency of arginine vasopressin (AVP) synthesis of which more than one third of etiologies are unidentified. Autoimmunity is associated with one third of patients with apparently idiopathic CDI. The most common antibody detected in auto immune CDI is autoantibodies to AVP-secreting cells (AVPcAb). Stiff-person syndrome (SPS) is a rare neurological disorder with features of an autoimmune disease. It is characterized by fluctuating muscle rigidity in the trunk and limbs and a heightened sensitivity to stimuli. It is well known that SPS is associated with multiple auto immune endocrinopathy including auto immune diabetes and auto immune thyroid disease. The association between SPS and CDI is not well documented in the literature. Case information: We report a case of 51 year old female who developed CDI while being treated for SPS unmasked by high dose steroids. Result: Anti amphiphysin is the only antibody detected in our patient. Animal studies showed a high expression of amphiphysin in anterior and posterior pituitary gland, data in human are still vague .One theory is that anti-amphiphysin antibodies attack the amphiphysin molecules in the AVP secreting cells and inhibit release of AVP. Conclusion: This antibody could hint towards the autoimmune cause of CDI.

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Lira-Ramadan : tolérance et sécurité du liraglutide en comparaison au sulfamide hypoglycémiant, en ajout de la metformine chez des patients DT2 durant et après le jeûne du Ramadan

Annales D Endocrinologie, Sep 1, 2016

Objectif Comparer l’efficacite et la tolerance du liraglutide au sulfamide hypoglycemiant (SH) ch... more Objectif Comparer l’efficacite et la tolerance du liraglutide au sulfamide hypoglycemiant (SH) chez des patients DT2 jeunant durant le Ramadan. Materiels et methodes Dans cet essai mene en ouvert avec un suivi ≤ 32 semaines des patients DT2 adultes avec l’intention de jeuner durant le Ramadan sous bitherapie metformine + SH a doses stables ont ete randomises pour recevoir soit le liraglutide 1,8 mg en substitution du SH (N = 172), soit pour maintenir la bitherapie anterieure (N = 171). Apres 3 a 4 semaines d’escalade de dose, une periode de maintenance de 6 a 19 semaines a precede le debut du jeune. Le critere primaire d’evaluation etait l’evolution de la fructosamine (FA) du debut jusqu’a la fin du Ramadan (lira N = 151 ; SH N = 165). Resultats Depuis l’inclusion et jusqu’ a la fin du Ramadan les reductions de FA et d’HbA1c ont ete significativement plus importantes sous liraglutide en comparaison au SH (39,6 vs. 29,3 μmol/L ; p = 0,0165 ; 1,24 vs.0,65 % ; p Discussion Malgre des conditions extremes d’evaluation, le controle glycemique sous liraglutide a ete significativement meilleur avec un risque hypoglycemique significativement plus faible. Les evenements indesirables gastro-intestinaux ont ete plus frequents sous liraglutide.

GLP 1 and Macrovascular Complications

Journal of diabetes & metabolism, 2011

Type two diabetes remains to be one of the most challenging chronic diseases affecting 26 million... more Type two diabetes remains to be one of the most challenging chronic diseases affecting 26 million people in the United States. Despite advances in the management of this illness, a large number of diabetics suffer from disease related complications. Heart disease and stroke account for a significant percentage of death in diabetics. Advancing treatment options for diabetics beyond glycemic control and Hba1c levels to prevent macrovascular complications should be the target of our management. GLP1, a member of the pro-glucagon incretin family, and GLP1 analogues seems to have beneficial effects on the macrovascular levels, in addition to their established effect on the glycemic control. This article reviews the potential effect of GLP1 family on the macrovascular complications including cardiovascular, cerebrovascular, and peripheral vascular diseases. Diabetic Cardiovascular Complications J ou rna l o f D ia be tes & M e ta bolism

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Epidemiology and Treatment of Obesity in Lebanon : A Narrative Review

Le Journal médical libanais. The Lebanese medical journal, Apr 1, 2021

Urinary 20-HETE: A prospective Non-Invasive prognostic and diagnostic marker for diabetic kidney disease

Journal of Advanced Research, Feb 1, 2023

19-Nordeoxycorticosterone synthesis by rat kidney inner medullary collecting duct cells

Steroids, Dec 1, 1991

19-Nordeoxycorticosterone (19~nor-Dot), a potent mineralocorticoid, was found to be synthesized b... more 19-Nordeoxycorticosterone (19~nor-Dot), a potent mineralocorticoid, was found to be synthesized by the isolated rat kidney perfused by an adrenal precursor (19-0x0-Doe). To determine if this bioconversion is a function of renal tubular cells, various adrenal precursors of 19-nor-Dot were added separately to rat kidney inner medullaty collecting duct cells culture media at a concentration of 10 nM. While 4.6% 2 IA?% of 19-0x0-Doe In = 3) and 14.4% * 1.4% of 19-oic-Doe (n = 3) were converted to 19~nor-Dot after 24 hours of incubation, Dot, and IPOH-Doe were not converted. This represents further evidence that Dot has to be metabolized to f9-0x0-Dot or I9-oic-Dot fl9-carboxy-Doe) before it can be converted by the kidney inner medullary collecting duct cells to 19-nor-Dot.

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Corticotropin-Independent Effect of Ovine Corticotropin-Releasing Hormone on Cortisol Release in Man

The American Journal of the Medical Sciences, Apr 1, 1992

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Role of the Nox4/AMPK/mTOR signaling axe in adipose inflammation-induced kidney injury

Clinical Science, Feb 1, 2020

Diabetic kidney disease is one of the most serious complications of diabetes worldwide and is the... more Diabetic kidney disease is one of the most serious complications of diabetes worldwide and is the leading cause of end-stage renal disease. While research has primarily focused on hyperglycemia as a key player in the pathophysiology of diabetic complications, recently, increasing evidence have underlined the role of adipose inflammation in modulating the development and/or progression of diabetic kidney disease. This review focuses on how adipose inflammation contribute to diabetic kidney disease. Furthermore, it discusses in detail the underlying mechanisms of adipose inflammation, including pro-inflammatory cytokines, oxidative stress, and AMPK/mTOR signaling pathway and critically describes their role in diabetic kidney disease. This in-depth understanding of adipose inflammation and its impact on diabetic kidney disease highlights the need for novel interventions in the treatment of diabetic complications.

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Glycemic Benefits of Liraglutide 1.2 mg daily in Overweight Pre-diabetic Compared to Overweight Normoglycemic Individuals

Archives of Medicine, 2017

Objective: The aim was to compare the ability of liraglutide 1.2 mg daily to improve glucose cont... more Objective: The aim was to compare the ability of liraglutide 1.2 mg daily to improve glucose control in overweight prediabetic compared to overweight normoglycemic subjects. Research design and Methods: We followed 100 overweight individuals (mean age, 44 ± 12 years) treated with liraglutide 1.2 mg daily over a period of 18 months. Based on their HbA1c, they were divided in two groups: prediabetes group (A) and normoglycemic group (B). All subjects were advised to decrease calorie intake by 500 kcal/day. Weight, BMI, waist circumference, blood pressure, HbA1c, lipid profile and TSH were assessed. Results: Six of 45 individuals (13%) in group A discontinued the study during the 18 months period compared with 8 out of 55(14%) in group B (P=0.46). Subjects in group A (n=39) lost the same percentage weight as those in group B (n=47; 5.8 vs. 7.3%; P=0.26). The percentage change in BMI was similar in both groups A and B (5.8 vs. 7.7%; P=0.19). The percentage drop in waist circumference was less in group A compared to group B (5.1 vs. 8.1%; P=0.04). The drop in HbA1c was higher in group A compared to group B (0.3 vs. 0.1%; P=0.04). The percentage of patients that regressed to normoglycemia in group A was 15% whereas the percentage of patients that progressed to prediabetes in group B was 8%. Only two subjects progressed to diabetes in group A and none in group B. There were no differences between the two groups with respect to percent changes in BP; triglycerides; total, LDL and HDL cholesterols; and TSH. Pre-diabetic subjects with any of the metabolic syndrome components (group A1) lost more percentage weight compared to those without any of the metabolic components (group A2) (7.3 vs. 4.8%; P=0.05). The percentage change in BMI was more in A1 compared to A2 (7.4 vs. 5.0%; P=0.03). The percentage drop in waist circumference was similar in A1 compared to A2 (7.0 vs. 6.2%; P=0.4). The drop in HbA1c was higher in A1 compared to A2 (0.4 vs. 0.08%; P=0.04). Conclusion: The addition of liraglutide 1.2 mg daily to calorie restriction to both pre-diabetic and normoglycemic overweight subjects resulted in a significantly more beneficial glycemic control in the pre-diabetic group despite a lower reduction in waist circumference and a similar reduction in body weight. Liraglutide resulted in normalization of glycemia in 15% of these pre-diabetic subjects and in this group, the presence of any of the metabolic syndrome component results in further weight loss and a better glycemic control.

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Thyroid hemiagenesis coexisting with brain cavernoma and pituitary Rathke′s cleft cyst

Journal of Postgraduate Medicine, 2016

Sami Azar

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