Rana Sharara-Chami
I was in the Majzoub’s lab from June 2005-June 2009. I investigated the role glucocorticoids have on catecholamines synthesis and secretion. I discovered in my first manuscript that high doses of steroids do not affect epinephrine synthesis and secretion in the basal unstressed state. However, high doses of exogenous glucocortcoids could decrease epinephrine synthesis and secretion under stress. I then investigated the role of epinephrine in the metabolism of fasting by studying the phenotype and the fasting behavior of an epinephrine-deficient mouse model. I discovered that epinephrine does not have an essential in the glucose response to fasting, unlike what is historically believed. On the other hand, I showed that epinephrine has an essential an essential role in lipid trafficking and fat metabolism under fasting conditions and the lack of epinephrine results in severe hepatic steatosis or fatty liver in mice. This manuscript is currently under review. Because I am an intensivist and hypothermia is a hot topic in the critical care literature, I investigated the role of epinephrine in temperature regulation in epinephrinedeficient mice (manuscript currently under review). I showed that although epinephrine-deficient mice did not become hypothermic when placed at 4℃ for 24 hours, the normal brown fat response to hypothermia was defective and the mice were able to keep their body temperature because of higher white fat metabolism. Hence, unlike what was believed, that norepinephrine is the only catecholamine involved in brown fat thermogenesis, we show that epinephrine has an essential role as well. Being of Lebanese origin and having grown in a country with limited resources, I joined Dr. Burns, Chief of Critical Care Medicine at Children’s, on his web-based initiative entitled PICU Without Walls. The website will contain essential pediatric critical care guidelines and protocols, simulation of ventilator management, an interactive health maps and lectures on essential critical care topics provided by world experts in the field. Research has long documented that practitioners and institutions that perform higher volume are associated with comparatively better outcomes. Only a relatively few practitioners and institutions across the world have been able to capture this volume-outcome relationship in caring for critically ill children, yet the need for knowledge on how to care for a child who’s life hangs in the balance exists across the globe. In Beirut, Lebanon, this problem is especially acute. There are currently only two fully trained Pediatric Critical Care physicians caring for children with life threatening illnesses for a population of nearly 1 million children. As a result, most critically ill children in Lebanon are actually treated by local pediatricians and general practitioners with knowledge or experience in this context. I have applied for an internal pilot grant through the office of sponsored research at Children’s Hospital Boston. My goals are to:
- Determine the domains of information resources needed by physicians in Beirut to provide optimal care to critically ill children.
- Develop and implement a pilot initiative based on the domains identified above to be deployed over the existing PICU Without Walls website.
- To test the effectiveness of the intervention in increasing knowledge and consultation among participating physicians in Lebanon.
Having acquired the critical thinking through my basic science work, I hope to be able to target the needs of physicians and Lebanon and to ultimately affect the outcome of critically ill children.
