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Keeping an eye on care of the future
Dr. Khaldon Abbas is using his curiosity and passion for ophthalmology to improve patient care and outcomes for people with eye diseases and disorders.
While in university, Dr. Khaldon Abbas had a deeply moving experience as a volunteer with the Canadian Centre for Victims of Torture (CCVT) that changed the trajectory of his life and career.
The community-based organization helps victims of war and torture, and Abbas, whose family immigrated to Canada from Iraq a little more than a decade before, wanted to share his skills as a translator and tutor with newcomers.
“I came to Canada when I was 12. I had limited English, we had no family or friends here, and it was really hard to acclimate,” says Abbas. “I wanted to give back to the community and to be there for immigrant families who were facing similar challenges that my family had to deal with.”
During one shift with CCVT, Abbas was paired with a family from Syria, whose nine-year old daughter was losing her eyesight. She was living with retinal dystrophy, a degenerative disorder that can progress to complete blindness.
Witnessing the impact the eye disorder had on the young girl and her family inspired Abbas to further his own education and set a goal to become an ophthalmologist.
That was eight years ago. Since then, Abbas spent several years working as a clinical research coordinator and completed four years of medical school at the University of British Columbia.
Today, he is a clinical research fellow at the Ivey Eye Institute of St. Joseph’s Health Care London (St. Joseph’s) – a position supported through St. Joseph’s Health Care Foundation thanks to the generosity of donors.
During the next year, Abbas’ research will focus on improving patient care and outcomes for people with eye diseases and disorders.
Drs. Phil Hooper, Verena Juncal and Tom Sheidow, all retinal surgeons at Ivey Eye, are the impetus behind the fellowship and now serve as Abbas’ mentors. Through the fellowship, the trio wanted to expand their clinical research program which is heavily focused on clinical trials. Their goal was to delve into quality improvement projects and explore, among other things, patient data, referral patterns and wait times – information that could guide Ivey Eye in refining care to better understand how to improve the overall flow of patient care.
As surgeons at the largest single-site eye care centre in Canada committed to innovative care, the Ivey Eye physician leaders felt a responsibility to make this work a reality.
“We started talking about this about three years ago,” says Sheidow. “We were familiar with similar roles at other academic eye care centres and we were fortunate to have some funding, so we brought the idea to the foundation and started to craft the terms of reference,” he adds.
Abbas is the second physician in this fellowship, following in the footsteps of Dr. Amy Basilious, who is now in her second year of residency at Ivey Eye.
“Amy did an exceptional job as our inaugural fellow and we were looking for someone with similar characteristics – bright, curious, motivated, a self-starter and a passion for ophthalmology,” says Sheidow. “Khaldon has all of that and more,” he adds, referring to Abbas’ interest and background in clinical trial work.
Even before arriving in London for the fellowship, Abbas began working with his new team to generate research project ideas and shape a research plan. Among the projects he will tackle is one that will assess the effectiveness and complications of lens exchange surgeries, and another in collaboration with Basilious focused on macular hole repairs.
He will also spearhead two quality improvement studies aimed at streamlining the referral process to Ivey Eye for optometrists and enhancing education and information resources for patients with eye diseases and disorders. Through his work, Abbas is excited to build his research skills, forge new professional connections and see some of his research translated into tangible improvements in patient care.
He’s grateful to Hooper, Juncal and Sheidow, along with St. Joseph’s and the Foundation, for their vision and spirit of innovation in establishing the fellowship.
“Everyone has been extremely welcoming and supportive of me, especially my mentors and fellow co-workers” he says. “There’s a real family environment at St. Joseph’s. I feel like this is my new home away from home.”
Landmark study investigates potential of Ambroxol, a cough medicine, to slow Parkinson’s-related dementia
Researchers at Lawson are studying Ambroxol - a common cough medicine in Europe - as a potential treatment for dementia linked to Parkinson’s disease.
LONDON, Ont. – Dementia poses a major health challenge with no safe, affordable treatments to slow its progression.
Researchers at Lawson Research Institute (Lawson), the research arm of St. Joseph’s Health Care London, are investigating whether Ambroxol - a cough medicine used safely for decades in Europe - can slow dementia in people with Parkinson’s disease.
Published today in the prestigious JAMA Neurology, this 12-month clinical trial involving 55 participants with Parkinson’s disease dementia (PDD) monitored memory, psychiatric symptoms and GFAP, a blood marker linked to brain damage.
Parkinson’s disease dementia causes memory loss, confusion, hallucinations and mood changes. About half of those diagnosed with Parkinson’s develop dementia within 10 years, profoundly affecting patients, families and the health care system.
Led by Cognitive Neurologist Dr. Stephen Pasternak, the study gave one group daily Ambroxol while the other group received a placebo.
“Our goal was to change the course of Parkinson’s dementia,” says Pasternak. “This early trial offers hope and provides a strong foundation for larger studies.”
Key findings from the clinical trial include:
Ambroxol was safe, well-tolerated and reached therapeutic levels in the brain.
Psychiatric symptoms worsened in the placebo group but remained stable in those taking Ambroxol.
Participants with high-risk GBA1 gene variants showed improved cognitive performance on Ambroxol.
A marker of brain cell damage (GFAP) increased in the placebo group but stayed stable with Ambroxol, suggesting potential brain protection.
Although Ambroxol is approved in Europe for treating respiratory conditions and has a long-standing safety record - including use at high doses and during pregnancy - it is not approved for any use in Canada or the U.S.
“Current therapies for Parkinson’s disease and dementia address symptoms but do not stop the underlying disease,” explains Pasternak. “These findings suggest Ambroxol may protect brain function, especially in those genetically at risk. It offers a promising new treatment avenue where few currently exist.”
An old drug with new possibilities
Ambroxol supports a key enzyme called glucocerebrosidase (GCase), which is produced by the GBA1 gene. In people with Parkinson’s disease, GCase levels are often low. When this enzyme doesn’t work properly, waste builds up in brain cells, leading to damage.
Pasternak learned about Ambroxol during a fellowship at The Hospital for Sick Children (SickKids) in Toronto, where it was identified as a treatment for Gaucher disease - a rare genetic disorder in children caused by a deficiency of GCase. He is now applying that research to explore whether boosting GCase with Ambroxol could help protect the brain in Parkinson’s related diseases.
“This research is vital because Parkinson’s dementia profoundly affects patients and families,” says Pasternak. “If a drug like Ambroxol can help, it could offer real hope and improve lives.”
Funded by the Weston Family Foundation, this study is an important step toward developing new treatments for Parkinson’s disease and other cognitive disorders, including dementia with Lewy bodies. Pasternak and his team plan to start a follow-up clinical trial focused specifically on cognition later this year.
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Dr. Stephen Pasternak is available for interviews on June 30.
To arrange, please contact:
Allison Hansen, Communication Consultant
St. Joseph’s Health Care London
Cell: 519-933-4272
About Lawson Research Institute: Lawson Research Institute, the health innovation arm of St. Joseph's Health Care London, is committed to making and sharing discoveries that improve lives locally and internationally. Every day, Lawson researchers work to transform imagination to innovation to patient impact. Lawson leads health-care research. Find us online at sjhc.london.on.ca/research and on social media @stjosephslondon
Law Summaries
The HULC Clinical Research Laboratory provides a number of lay summaries every year to share the important findings of our research with public audience. The following are a list of lay summaries that anyone can access to read.
View lay summeries in the following categories:
Neck/Shoulder
- A systematic review of the cross-cultural adaptations and measurement properties of the Shoulder Pain and Disability Index.
- Evaluating the reproducibility of the short version of the Western Ontario Rotator Cuff Index (Short-WORC) prospectively
- A narrative review and content analysis of functional and quality of life measures used to evaluate the outcome after total shoulder arthroplasty (TSA): an ICF linking application.
Elbow
- The use of Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire in patients with Tennis Elbow
Wrist/Hand
Lawson and Western researchers suggest walking and talking can be an early predictor of dementia
In a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints.
Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry, is leading the “Gait and Brain Study.” His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia.
Dr. Montero-Odasso with study participant, Roy Bratty
“Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease,” says Dr. Montero-Odasso. The study, funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia.
“While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles and maintenance of navigation,” says Dr. Montero-Odasso. “We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to see brain function.”
The “gait cost,” or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle with executive functions such as attention keeping and time management.
“Our results reveal a ‘motor signature’ of cognitive impairment that can be used to predict dementia,” adds Dr. Montero-Odasso. “It is conceivable that we will be able to diagnose Alzheimer’s disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia.”
The study, “Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment”, was published in the journal, JAMA NEUROLOGY.
Members of the study’s research team, from left to right: Korbin Blue, Research Assistant (Co-op Student); Yanina Sarquis-Adamson, Lab Research Assistant; Frederico Faria, Post-Doctoral Fellow; Dr. Montero Odasso, Director, Gait and Brain Lab; research participant; Alanna Black, Lab Research Coordinator; Stephanie Cullen, Research Assistant (Undergraduate Student); and, Navena Lingum, Research Assistant (Master Student).