Search

Background: Schistosoma mansoni is a trematode helminth responsible for liver fibrosis or cirrhosis. Aim of the work: In the present work natural products Thymoquinone loaded with chitosan nanoparticle (TQ/ChNP)) (TQ/ChNP) were used to determine their therapeutic effect on S. mansoni infection. Materials and methods: A total of 40 healthy Swiss albino mice, 20-25 g in weight, procured from Theodor Bilharz Research Institute (TBRI) Imbaba, Egypt's Schistosome Biological Supply Center (SBSC). Results: The infected mice treated with TQ/ChNP showed a significant decrease in the total worm burden. Treatment with TQ/ChNP had a highly significant effect on mature worm burden, TQ/ChNP in prophylactic and therapeutic doses significantly increased the mean number of dead ova in comparison to control. TQ/ChNP had a high decrease effect on ova count in intestinal tissue and a moderate reduction on ova count in hepatic tissue. Prophylactic dose gave a high reduction effect on ova count in intestinal tissue. As regards the size of hepatic granuloma, TQ/ChNP had the highest significant reduction on mean granuloma diameter with noticeable improvement of hepatic pathology. TQ/ChNP treated group showed observable improvement of liver pathology with mild degeneration and slight-sized fibrocellular. Conclusion: Based on the outcome of this study, TQ/ChNP proved to have potential bioactivity against S. mansoni adult stages and its potentiality in improving hepatic pathology. Efficacy of TQ/ChNP to postpone progression in chronic liver diseases must be considered as preventive medicine in patients with hepatic disorders.

Background Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. Methods Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. Results Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. Conclusion Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.

Human cystic echinococcosis is a zoonosis occurring due to dogs handling and exposure toEchinococcus granulosus ova in their stools being an accidental intermediate host. Serologyremains the only sure and important tool to diagnose this disease. We aimed to improve thedetection of circulating antigen by sandwich ELISA through its binding to gold nanoparticleand proving the role of minute nanoparticles in serodiagnosis. Gold nanoparticles (AuNPs)were employed for the capture of the antigens of protoscolices (pAg) in the patient’s serum bysandwich ELISA. Cross-reactivity for antigens from Hymenolepis nana, Entrobius vermicularis,and Fasciola gigantica was ruled out by using anti-protoscolices polyclonal IgG antibodies(ppAb). Antigen of sonicated protoscolices which were removed from camel lungcysts, was purified and injected to a New-zealand white rabbit giving ppAb which then loadedon AuNPs being used as a diagnostic indicator for circulating pAg by both sandwich ELISAand nanogold sandwich ELISA techniques. Nanogold sandwich ELISA was able to give positiveresults with 96.3% of hydatid patients and 5% of non-hydatid patients while sandwichELISA showed 81.4% and 20% positive cases of the same groups respectively. The sensitivityand specificity of nanogold sandwich ELISA were 96.3% & 95% against 81.5% & 80% forthose of sandwich ELISA respectively. The conjugation of AuNPs to anti-Echinococcus IgGantibodies seems to be beneficial to increase PPV, NPV, and efficiency and reduce the overallcost of the assay as less antibody was needed.

Physical activity in all stages of life maintains and improves cardio respiratory fitness, reduces the risk of obesity and associated comorbidities and results in greater longevity. Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modifications to exercise routines may be necessary because of normal anatomic, physiologic changes and fetal requirements. So, this is a hospital longitudinal study extended from January 2015 to August 2015 on 100 female subjects all are volunteers seen in first stage of labor of full-term pregnancy, 63 subjects are performing relatively maternal muscle activity and 37 female subjects are performing strenuous muscle activity are included in the study. Then all participants had their labor and new born outcomes evaluated through consultation of medical records. There were statistically significant differences between the two groups regarding duration of 2nd stage of labour, type of labour, Apgar score and placental separation whether early or late, but no significant difference between the two groups regarding complete or partial separation of placenta. Conclusion: Relatively maternal muscle activity of women is healthy and beneficial and is associated with less disturbance of pregnancy and labor outcomes, while on the other hand strenuous muscle activity is harmful being associated with many pregnancy complications such as prolonged second and third stage of labor, lower odds ratio of eutocic birth, statistically significant decrease in first and fifth minute APGAR score after labor, increased rate of Cesarean section and difficult vaginal delivery. Recommendation: All obstetricians, family medicine doctors and health care providers trained for advice and intervention to modify pregnant physical activity to adapt her life circumstances and her pregnancy issues. Further studies to examine association between maternal muscle activity and pregnancy and labor outcomes.

Background: The main pathology of Schistosoma mansoni (S. mansoni) infection is induced by a granulomatous tissue reaction against the parasite eggs. Unfortunately, no therapy has been proven to prevent the progression of hepatic fibrosis associated with granulomatous hypersensitivity to parasite eggs. Accumulating evidence has demonstrated a critical pathogenic role for both interleukin 17 (IL-17) and interleukin 13 (IL-13) in organ fibrosis. Objective: The present study investigated the role of IL-17 and IL-13 in the pathogenesis of liver fibrosis during S. mansoni infection. Material and Methods: Thirty female C57BL/6 mice were divided into three groups, normal, infected, and anti- mouse IL-17 treated groups. The infected and anti-mouse IL-17 groups were infected with 40±5 cercariae of S. mansoni per mouse. Neutralizing rat anti-mouse IL-17 mAb or an isotype-matched rat IgG mAb was first administered intraperitoneally 3 weeks after S. mansoni infection (62.5μg per mouse) then at the same dose every third day until 2 days before killing. Serum IL-17, IL-13, and proinflammatory cytokines levels were determined by ELISA. Liver granulomas were measured by an ocular micrometer. Results: Serum level of IL-17 was significantly higher in infected mice compared with non-infected animals. Reducing IL-17 activity using anti-IL-17 monoclonal antibodies improves liver functions and reduces the size of the liver granulomas. Meanwhile, Th-2 profibrogenic cytokine IL-13 was also decreased in infected/anti-IL-17 mAB- treated mice. IL-17-induced proinflammatory mediators (IL-1Land TNF-that involved in liver fibrosis were markedly reduced in anti-IL-17 mAB-treated mice. Conclusion: IL-17 and IL-13 contribute to granulomatous inflammatory and fibrosing reactions in murine schistosomiasis.

Schistosomiasis is a serious parasitic infection affecting millions worldwide. This study aimed to explore the anti-schistosomal activity of curcumin and curcumin loaded gold-nanoparticles (Cur-GNPs) with or without praziquantel (PZQ). We used six groups of the C57BL/6 mice in which five groups were infected with Schistosoma Mansoni (S. mansoni) cercariae and exhibited, separately, to different treatment regimens of curcumin, curcumin loaded nanoparticle, and PZQ, in addition to one untreated group which acts as a control. Mice were sacrificed at the 8th week where both worms and eggs were counted in the hepatic and porto-mesenteric vessels in the liver and intestine, respectively, in addition to a histopathological examination of the liver granuloma. Curcumin caused a significant reduction in the worms and egg count (45.45%) at the 3rd week. A significant schistosomicidal effect of PZQ was found in all groups. Cur-GNPs combined with PZQ 97.4% reduction of worm burden in the 3rd week and the highest reduction in the intestinal and hepatic egg content, as well, besides 70.1% reduction of the granuloma size. The results suggested the curcumin in combination with PZQ as a strong schistosomicidal regimen against S. mansoni as it alters the hematological, biochemical, and immunological changes induced.

TLRs in enterocytes play an important role in protecting the mucosal surface by promoting the innate inflammatory immune response following infection. Cryptosporidium parvum generally causes a short-term diarrheal illness that resolves spontaneously in immunocompetent hosts. But, in immunocompromised hosts, (e.g. on steroid therapy), it may cause a life-threatening, chronic, cholera-like illness. The mechanisms by which steroids reduced the host resistance toC. parvum infection are poorly understood. It was hypothesized that steroid may interfere with TLR activation and reduced proinflammatory cytokines production required for early infection containment. To test this hypothesis, sixty C57BL/6 mice were equally divided into three subgroups; G1 was daily given intraperitoneally dexamethasone (DEX) for 14 days before oocyst inoculation and throughout the study. G2 was non-immunosuppressed mice. G1 & G2 were inoculated intragastrically with C. parvum (106 oocysts). G3 was retained as naive non-infected control. Length and severity of infections were determined by monitoring oocyst shedding in fecal pellets using acid-fast (Ziehl-Neelsen) stained smear prepared from fresh pellets, by counting the number of oocysts in 10 microscopic fields under x100 for each mice group. Expression of TLR4 was assessed by immunohistochemistry, serum of proinflammatory cytokines level was determined by ELISA. The results showed that DEX immunosuppressed mice developed chronic cryptosporidiosis that lasted until the study end. Non-immunosuppressed mice developed a patent infection and the majority of them overcame the infection by the 21st day. The mean oocyst count was significantly higher in the immunosuppressed mice than in non-immunosuppressed ones, with a longer patent period in immunosuppressed mice. Expression of TLR4 was significantly increased in mice gut post-infection. Expression of TLR was significantly decreased in DEX immunosuppressed infected mice, with a significant decr ease was in proinflammatory cytokines serum levels compared to non-immunosuppressed ones.

Objectives: It has been estimated that one-third of the world population has been infected by toxoplasmosis. Our goal for this study was to evaluate the diagnostic performance of Nanogold beads-based ELISA in serodiagnosis of human toxoplasmosis and improving identification methods based on detection of circulating Toxoplasma surface antigen grade III (SAG3). Patients & Methods: This study was conducted on 100 individuals. They were divided into 3 groups: group (I):50 T. gondii infected patients g PPV (95.7% vs. 85.2%) and diagnostic accuracy (93% vs. 88%). Sandwich ELISA was higher than Nano-sandwich ELISA regarding sensitivity (92% vs.90%) and NPV (91.3 %vs. 90.6 %). In our work, we apply this new technique for the first trial for diagnosis of human toxoplasmosis. Conclusion: We concluded that the use of gold nanoparticles offers the potential advantage of improving the diagnostic testing of toxoplasmosis based on detection of circulating Toxoplasma surface antigen grade III(SAG3). The novel Nano diagnostic assay significantly increased specificity, PPV and diagnostic accuracy.

Diabetes mellitus in all its forms has been rapidly increasing worldwide, especially in the Eastern Mediterranean Region.This national study aimed to assess the prevalence and clinical aspects of diabetes mellitus in Lebanon with special focus on type 1 (T1DM).A national multistage, random household sample survey was conducted, using face-to-face interviews with 1 questionnaire per household. A total of 4500 households were selected from all areas based on a pre-existing sampling frame of the Lebanese population.The prevalence of previously diagnosed diabetes mellitus in the surveyed population of 17 832 persons (mean age ~36 years) was 7.95%. The prevalence of T1DM in particular was estimated at 0.1%, or almost 1% of all detected cases of diabetes mellitus. Most persons with diabetes mellitus reported obtaining their usual care from endocrinologists rather than primary healthcare physicians. Delayed performance of haemoglobin A1c test was reported in 25% of 1418 patients. Hypoglycaemic episodes recently occurred in 30% of patients; of whom, at least one third required medical attention, including hospital admission. Diagnosed complications were reported in 22% of cases, with retinopathy being the most common.Prevalence of T1DM in this population was lower than international estimates. Diabetes mellitus management appears to be deficient, based on delays in standard control testing, hypoglycaemic episodes and diabetes mellitus-related complications. Coordination of diabetic care management should be devolved to primary healthcare physicians, who can keep track of the need for referral to various types of diabetes mellitus care.انتشار داء السُّكَّرِيّ في لبنان وخصائصه: مسح وطني.إبراهيم بوعرم، سليم أديب.يتزايد انتشار داء السُّكَّرِيّ بكل صوره سريعاً في جميع أنحاء العالم، خاصةً في إقليم شرق المتوسط.تمثَّلَ الهدف من هذه الدراسة الوطنية في تقييم انتشار داء السُّكَّرِيّ وأعراضه السريرية في لبنان، مع التركيز خاصةً على النمط 1 من داء السُّكَّريّ.أُجري مسح وطني متعدد المراحل على عينة عشوائية من الأسر من خلال عقد مقابلات وجهاً لوجه باستخدام استبيان واحد فقط لكل أسرة. وبلغ إجمالي عدد الأسر المُختارة 4500 أسرةٍ من جميع المناطق، استناداً إلى إطار موجود سلفاً لأخذ العينات من السكان اللبنانيين.بلغت نسبة انتشار داء السُّكَّرِيّ الذي شُخِّصَ سابقاً في السكان الذين شملهم المسح والبالغ عددهم 17832 شخصاً (متوسط العمر هو 36 عاماً تقريباً) 7.95٪. وقُدر انتشار النمط 1 من داء السُّكَّريّ بحوالي 0.1٪، أو 1٪ تقريباً من جميع الحالات التي اكتُشفت إصابتها بداء السُكَّريّ. وأفاد معظم المصابين بداء السُكَّريّ بأنهم يحصلون على خدمات الرعاية المعتادة من أطباء الغدد الصماء، لا من أطباء الرعاية الصحية الأولية. وأُبلغ عن تدنِّ أداء اختبار HbA1C في 25٪ من 1418 مريضاً. وحدثت مؤخراً نوبات انخفاض السكر في الدَّم لحوالي 30٪ من المرضى؛ واحتاج ثلثهم على الأقل رعاية طبية استلزمت دخول المستشفى. وأُبلغ عن وجود مضاعفات لدى 22٪ من الحالات، وكان أكثرها شيوعاً هو اعْتِلال الشَّبَكِيَّةِ.كان انتشار النمط 1 من داء السُّكَّريّ بين هذه الفئة السكانية أقل من التقديرات الدولية. ويبدو أن هناك قصوراً في علاج داء السُّكَّريّ بسبب التأخر فيإجراء الفحوصات الدورية، ونوبات نقص السكر في الدم، والمضاعفات المرتبطة بداء السُّكَّريّ. وينبغي أن تؤول مسؤولية التنسيق بشأن التدبير العلاجي لداء السُّكَّريّ إلى أطباء الرعاية الصحية الأولية، الذين يمكنهم متابعة الحاجة بالإضافة الإحالة للحصول على أنواع مختلفة من خدمات الرعاية الصحية لداء السُّكَّريّ.Prévalence et caractéristiques cliniques du diabète au Liban : enquête nationale.Le nombre des cas du diabète, sous toutes ses formes, a augmenté rapidement dans le monde entier, et en particulier dans la Région de la Méditerranée orientale.Cette enquête nationale visait à évaluer la prévalence et les caractéristiques cliniques du diabète sucré au Liban, en mettant l’accent sur le diabète de type 1.Une enquête nationale par sondage à plusieurs degrés a été menée auprès des ménages sélectionnés de manière aléatoire utilisant des entretiens en présentiel et plus particulièrement. Au total, 4 500 ménages ont été sélectionnés dans toutes les régions à partir d’un cadre d’echantillonnage de la population libanaise.La prévalence d’un diabète déjà diagnostiqué parmi les 17 832 personnes interrogées (âge moyen de 36 ans) était de 7,95 %. La prévalence du diabète de type 1 en particulier a été estimée à 0,1 %, soit près de 1 % de tous les cas de diabète détectés. La plupart des personnes souffrant de diabète ont indiqué être habituellement suivies par un endocrinologue plutôt que par un médecin de soins de santé primaires. Un retard dans la réalisation du test d’hémoglobine A1c a été signalé chez 25 % des 1 418 patients. Des épisodes d’hypoglycémie sont récemment survenus chez 30 % des patients, parmi lesquels un tiers au moins nécessitaient des soins médicaux, y compris une admission à l’hôpital. Des complications ont été diagnostiquées dans 22 % des cas, la rétinopathie étant la plus courante.La prévalence du diabète de type 1 au sein de cette population était inférieure aux estimations internationales. La prise en charge du diabète semble être insuffisante en raison des retards concernant la réalisation des tests de suivi ainsi que des épisodes d’hypoglycémie et des complications liées à la maladie. La coordination de la gestion des soins aux diabétiques devrait être confiée aux médecins de soins de santé primaires, qui peuvent répondre aux besoins des patients en les orientant vers les différents types de soins.

Initiation of exclusive breastfeeding (EBF) at birth, followed by introduction of complementary food (CF) at six months of age, is necessary for the lifelong health of the child. In Jordan, EBF rates are not optimal. To our knowledge, there have been no studies to date on breastfeeding practices in the Aqaba region. Therefore, this study aimed to determine the factors affecting EBF and early introduction of CF in this region. A cross-sectional study was conducted with 448 Jordanian mothers who were recruited from three primary health care centers in Aqaba. They were interviewed and asked to complete a questionnaire concerning the following variables: socio-demographic information, reproductive health of the mother and infant and postpartum conditions and events. Of the 488 mothers recruited, we found that the number who breastfed exclusively for

Background The yearly Think Tank Meeting of the Italian Network for Tumor Biotherapy (NIBIT) Foundation, brings together in Siena, Tuscany (Italy), experts in immuno-oncology to review the learnings from current immunotherapy treatments, and to propose new pre-clinical and clinical investigations in selected research areas. Main While immunotherapies in non-small cell lung cancer and melanoma led to practice changing therapies, the same therapies had only modest benefit for patients with other malignancies, such as mesothelioma and glioblastoma. One way to improve on current immunotherapies is to alter the sequence of each combination agent. Matching the immunotherapy to the host’s immune response may thus improve the activity of the current treatments. A second approach is to combine current immunotherapies with novel agents targeting complementary mechanisms. Identifying the appropriate novel agents may require different approaches than the traditional laboratory-based discovery work. For example, artificial intelligence-based research may help focusing the search for innovative and most promising combination partners. Conclusion Novel immunotherapies are needed in cancer patients with resistance to or relapse after current immunotherapeutic drugs. Such new treatments may include targeted agents or monoclonal antibodies to overcome the immune-suppressive tumor microenvironment. The mode of combining the novel treatments, including vaccines, needs to be matched to the patient’s immune status for achieving the maximum benefit. In this scenario, specific attention should be also paid nowadays to the immune intersection between COVID-19 and cancer.

This Letter to the Editor aims to reflect on the current challenges to increase the coverage of COVID-19 vaccination in the fragile and conflict-affected setting of Lebanon, which is currently experiencing one of the biggest economic crises globally as well as a recent surge in COVID-19 cases. Addressing the supply- and demand-related factors affecting vaccination would increase COVID-19 vaccine coverage and prevent the complete collapse of an already overwhelmed Lebanese health care system.

Background: The exact determination of gestational age is so important in management of the antepartum care, and for adequate planning of proper intervention or therapy. Tanscerebellar diameter has great advantages in prediction of gestational age in cases of uncertain dates or in suspected intrauterine growth retardation. There are minimal data available about the relationship between tanscerebellar diameter and biparietal diameter in third trimester of pregnancy. Objective: The aim of the present study was to assess the accuracy of transcerebellar diameter (TCD) measurement in estimation of the gestational age during the third trimester compared to the current fetal biometric measurements including femur length and biparietal diameter. Patient and Method: The study included 500 pregnant women with sure and reliable dates fulfilling the inclusion criteria at the Department of Obstetrics and Gynecology, Al-Azhar (Bab Alsheria ) university Hospital, (inpatient and outpatient) from May 2018 till November 2018. The entire subjects were in the third trimester of pregnancy seen at 31 – 36 weeks, the transcerebellar diameter, the biparietal diameter and femur length were measured for determination of gestational age. Results: The results showed that the transcerebellar diameter (TCD) is more accurate than the biparietal diameter (BPD). There were insignificant statistical difference between transcerebellar diameter (TCD) and femur length (FL) for determination of gestational age in the third trimester whereas there was a significant difference between the transcerebellar diameter (TCD) and the biparietal diameter (BPD) for determination of gestational age in the third trimester. All those data were compared to the last menstrual period. Conclusion: Transcerebellar diameter is more reliable method of gestational age determination in third trimester of pregnancy than biparietal diameter. Transcerebellar diameter (TCD) and femur length (FL) can be used as a tool to assist in the assessment of gestational age in third trimester

Purpose This study aims to evaluate trends in the increasing costs of oncology drugs procured by the Lebanese Ministry of Public Health (MOPH) between 2014 and 2016 and to assess the impact of the introduction in mid-2015 of new immunotherapy drugs for the treatment of lung cancer on the overall and specific costs of that treatment. Methods A secondary analysis of data from the MOPH Cancer Drug Scientific Committee data base was conducted using a total of 18,133 cancer files between 2014 and 2016. Results Over the 3-year period, about $140 million (USD) was spent on cancer drugs by the MOPH free cancer drug dispensing program. The expenditures increased by 27% after immunotherapy was phased in. The average cost of drugs per patient per year measured across all cancer types increased from $7,000 in 2014 to $8,400 in 2016. Trastuzumab, approved for treating human epidermal growth factor receptor 2–positive breast cancer ranked first in total expenditures for 2014-2015. By 2016, two new immunotherapy drugs had topped the list: pembrolizumab ranked first and nivolumab ranked third, representing 64% of the total cost of lung cancer treatment and approximately 19% of the total yearly budget; beneficiaries represented only 3% of all patients. Conclusion This update documents the increasing financial impact of newer cancer drugs on the procurement process in the middle-income country of Lebanon. The trend is aligned with the financial burden of cancer drugs worldwide, which calls for a collaborative global response to this crisis.

Violence against health care providers is one of the most pressing problems faced by health care systems around the world. Because of unpredictability and acuity of emergency cases, emergency nurses are more vulnerable to workplace violence. Violence against emergency nurses is a complex and multidimensional problem that has a devastating impact on the physical, psychological, and social well-being of nurse victims. The purpose of this review is to integrate evidence on manifestations, contributing factors, and consequences of workplace violence perpetrated by patients and/or their relatives against emergency nurses, in addition to behavioral responses of emergency nurse victims toward workplace violence. An integrative review was conducted by searching 3 main electronic databases: Web of Sciences, MEDLINE, and ScienceDirect. Eighteen studies met the inclusion criteria and were included in the final review process. The review identified the most common forms, contributing factors, unpleasant consequences of workplace violence, and behavioral reaction of nurse victims toward violence acts. Reporting rates of workplace violence among emergency nurses were found to be low. It is recommended to develop more effective workplace violence prevention and reporting programs.

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p

Waterpipe tobacco smoking (WTS) has become a serious public health threat in the Middle East and beyond. To estimate the prevalence rates of cigarette and WTS among Lebanese women and describe characteristics associated with each behavior. Secondary analysis of women's health data obtained in a national survey in 2010. Of 2,255 selected women, 78 percent reported no or past long-term WTS. Among the 12 percent of regular waterpipe smokers, 40 percent were light users (mean three waterpipe heads weekly), while 60 percent were heavy users (mean of 11 heads per week). About 70 percent were never or past long-term cigarette smokers. Younger age, location within Greater Beirut (GB) and having professional employment were significantly associated with use of WTS. Older age, GB location, lower education, and ever-married were significantly associated with cigarette smoking. WTS is becoming a socially normative behavior among empowered professional women, who can spare the time and expense to engage in this behavior in easily accessible cafés, which prohibit cigarette smoking. Government, media, and NGO campaigns against smoking should target waterpipe use, not only in Lebanon but also across the Arab world and among Arab communities in the Diaspora with messages different from anti-cigarette campaigns.

She-camels face down-regulation of immune responses during pregnancy that may lead to viral and bacterial infections so increases the dangers affecting their newborn calves. This study aimed to improve the body weight and immune responses of she-camels and their newborn calves. A total of 10 dams were divided into two equal groups; G1 (fed the basal diet only) and G2 (fed the basal diet & Saccharomyces cerevisiae (SC); 0.5 g/head/day). Dams' and calves' plasma, milk samples were collected. Quantitative analysis of IgG, IgA & IFN-γ levels in samples was done by ELISA and Body weights were recorded monthly. Results revealed significant increases (P

In recent years, there has been an increasing interest in oncolytic adenoviral vectors as an alternative anticancer therapy. The induction of an immune response can be considered as a major limitation of this kind of application. Significant research efforts have been focused on the development of biodegradable polymer poly-gamma-glutamic acid (&gamma, PGA)-based nanoparticles used as a vector for effective and safe anticancer therapy, owing to their controlled and sustained-release properties, low toxicity, as well as biocompatibility with tissue and cells. This study aimed to introduce a specific destructive and antibody blind polymer-coated viral vector into cancer cells using &gamma, PGA and chitosan (CH). Adenovirus was successfully encapsulated into the biopolymer particles with an encapsulation efficiency of 92% and particle size of 485 nm using the ionic gelation method. Therapeutic agents or nanoparticles (NPs) that carry therapeutics can be directed specifically to cancerous cells by decorating their surfaces using targeting ligands. Moreover, in vitro neutralizing antibody response against viral capsid proteins can be somewhat reduced by encapsulating adenovirus into &gamma, PGA-CH NPs, as only 3.1% of the encapsulated adenovirus was detected by anti-adenovirus antibodies in the presented work compared to naked adenoviruses. The results obtained and the unique characteristics of the polymer established in this research could provide a reference for the coating and controlled release of viral vectors used in anticancer therapy.

Dementia characterized by gradual cognitive decline is an increasing public health problem due to population ageing. This study aims at assessing the prevalence and determinants of cognitive decline among Lebanese older adults.Secondary analysis of data from a cross-sectional sample of 502 elders from two Lebanese governorates was conducted. Cognitive decline was assessed using the Arabic Version of 16-item Informant Questionnaire on Cognitive Decline for the older adults (A-IQCODE 16). A multivariable logistic regression model assessed the associations of socio-demographic, clinical and behavioral factors with the presence of cognitive decline.Almost one of six Lebanese older adults (14.8%) scored below 3.34. Higher odds of cognitive decline were associated with higher age, being female, having heart disease and suffering from depression. Pack-years of cigarette smoking showed a protective effect and this relationship seems to be only statistically significant among older adults aged more than 75 years.Screening programs of cardiovascular risk factors and early detection of depression are 'best buy' public health interventions that could prevent cognitive decline among Lebanese older adults. Differential survival bias seems the reasonable explanation for the protective effect of smoking that is not the common finding from the literature.

Country-specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age- and sex-specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research.

Nanoparticles NPS of cadmium oxide CdO were generated by laser ablation of a solid target (cadmium) in polyvinylpyrrolidone (PVP) solution. CdO colloidal nanoparticles have been synthesized by laser ablation Nd:YAG (1064 nm, 100 pulses, pulse energy= 400 mJ) when the solid target CdO was immersed in PVP. Structure, topography and optical properties of the CdO nanoparticles NPS have been studied using X-ray diffraction (XRD), atomic force microscope (AFM) and the UV-Vis absorption respectively.

Background Synovial sarcoma is a rare soft tissue sarcoma which most commonly affects the extremities of young adults. Axilla involvement by this sarcoma is very rare especially with involvement of the brachial plexus. This combination adds to the challenge in approaching such tumors which might significantly affect survival and function. Case presentation Herein, we present a 48-year-old female patient who presented with an isolated painless lump in her right axilla. Initially, her workup, looking for possible breast cancer, included fine-needle aspiration (FNA) which did not provide the diagnosis. Core-needle biopsy, performed later, revealed monophasic synovial sarcoma. Her workup studies revealed no metastasis. Then, through extensile deltopectoral approach, the tumor was dissected out from within the brachial plexus. Ulnar nerve was sacrificed in order not to compromise the surgical margins which were confirmed tumor free by final pathology. The patient did not receive chemotherapy or radiation upon consultations with medical and radiation oncology teams. Her follow-up revealed no tumor recurrence with no restriction of her right shoulder motion. Conclusion Our case report represents a very rare occurrence of synovial sarcoma in the axilla with involvement of the brachial plexus. When clinical and radiological findings are suggestive of soft tissue sarcoma of the axilla, we recommend getting core-needle biopsy rather than fine-needle aspiration for earlier diagnosis. Early referral and multidisciplinary approach may contribute to better management.

Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Background Colorectal cancer (CRC) is the first most common cancer in males and the third most common cancer in females in Saudi Arabia. Dietary habits are strongly associated with the inhibition or proliferation of malignancy. Therefore, this study is aiming to investigate the risks and protective benefits of dietary factors affecting CRC in the Mecca region of Saudi Arabia. Methods A case-control study was conducted from June 2014 to March 2015. One hundred thirty-seven patients with colon and/or rectal cancer were recruited in the case group, while 164 healthy participants were recruited in the control group. A questionnaire was completed with the help of trained dietitians to study the effects of several dietary patterns on the risk of CRC. Results Dairy product intake of 1–5 servings/day, legume intake of 3–5 servings/week, leafy vegetables intake of 1–5 servings/week, olive oil intake of 1–5 servings/week, black tea intake of three or more cups/day, and coffee intake of one or more cups/day was found to decrease the risk of CRC in participants. Conclusion This study highlights the importance of changing dietary habits to decrease CRC incidence in the Mecca region.

Emotional intelligence (EI) is known to be a risk factor for several types of addiction. The purpose of this study was to investigate, in a cross-sectional design, the presence of a relationship between the level of EI and nicotine dependence in a sample of Lebanese adults. A self-administered questionnaire was used to determine the sociodemographic characteristics, the level of nicotine dependence, and the level of EI in a sample of 142 Lebanese participants from the community. The sample was 51.4% women, with a mean age of 33.9 years. There was no difference in EI level between smokers and non-smokers (p = 0.66), and there were no associations between EI level and the level of nicotine dependence (p = 0.59). However, EI was positively correlated with age (p = 0.023). Due to the fact that smokers have been dependent on nicotine for many years and that EI is known to increase with age, findings suggest that low EI may be a risk factor for initiation, rather than maintenance, of nicotine dependence.

Evaluation of bone marrow involvement (BMI) is paramount in diffuse large B-cell lymphoma (DLBCL) for prognostic and therapeutic reasons. PET/CT scanner (PET) is now a routine examination for the staging of DLBCL with prognostic and therapeutic implications. This study evaluates the role of PET for detecting marrow involvement compared to bone marrow biopsy (BMB). This monocentric study included 54 patients diagnosed with DLBCL between 2009 and 2013 and who had FDG PET/CT in a pre-treatment setting. A correlation analysis of the detection of BMI by PET and BMB was performed. A prognostic evaluation of BMI by BMB and/or PET/CT and correlation with an overall 2-year survival were analyzed. PET was more sensitive for the detection of BMI than BMB (92.3% vs. 38.5%). It can be considered a discriminatory Pre-BMB test with a negative predictive value of 97.6%. In addition, BMI by PET had a prognostic value with strong correlation with progression-free survival (PFS) (HR = 3.81; p = 0.013) and overall survival (OS) (HR = 4.12; p = 0.03) while the BMB had not. PET shows superior performance to the BMB for the detection of marrow involvement in DLBCL. It may be considered as the first line examination of bone marrow instead of the biopsy.

This study aimed to examine the chemical characteristics and antioxidant content properties of cold-pressed milk thistle seed oil. Acidity and peroxide value were determined by chemical standard titration method and oxidative stability index was determined by Rancimate. Using GLC, fatty acid composition, phytosterols and squalene were measured. While, alpha-tocopherol content was determined by HPLC. The total phenolic content, radical-scavenging capacity and total antioxidant capacity were determined spectrophotometrically. The chemical characteristics of cold-pressed oil were as follows: acidity (0.64%), peroxide value (0.34 meq O2/kg of oil), oxidative stability index (55.7 and 12.9 h at 80 and 100°C, respectively), fatty acid composition (19.5, 22.9 and 57.6% for SAT, MUFA and PUFA, respectively), phytosterol (2520 mg/kg), squalene (9.35 mg/kg), alpha-tocopherol content (237.4 mg/kg), total phenolic content (1.16 mg GAE/g oil), radical-scavenging capacity against stable DPPH radical (IC50 = 3.34 mg/mL) and total antioxidant capacity (2.29 mmol/L). These data suggest that cold-pressed milk thistle seed oil may serve as dietary source of high PUFA and MUFA, phytosterols, phenolic compounds and natural antioxidants and can be a remarkable candidate for use in healthy food preparations mixed with other vegetable oils or alone.

Median raphe cyst is an uncommon developmental anomaly that can develop anywhere along the midline of the external genitals. Only a few hundred cases have been published in the English literature and the lack of awareness of this entity can lead to confusion and misdiagnosis. We report here a case of median raphe cyst located in the midline of the anterior scrotum of a 35-year-old man. Clinically, the patient presented with a scrotal mass increasing substantially in size over two days associated with tenderness, skin erythema, and scrotal pain. Radiologic interpretation of a sonogram and computed tomography scan suggested a thrombosed vessel. The patient was diagnosed with septic thrombophlebitis associated with overlying cellulitis. Despite conservative therapy with antibiotics, the patient developed pyrexia, tachycardia, and leukocytosis prompting surgical excision of the lesion. Histopathologic examination revealed an infected median raphe cyst. The cyst wall was lined by a stratified epithelium that included numerous Alcian blue positive goblet cells. The epithelial cells showed reactive changes with infiltration by numerous neutrophils. Our objective is to bring attention to and thereby facilitate the diagnosis of this unusual entity.

Context: With advancements in the field of minimally invasive surgery, a variety of general surgical, gynecological, and urological diseases are amenable to treatment by this approach. Combined procedures can be performed for treating coexisting abdominal pathologies. Aims: The study aimed to evaluate our experience of combining multiple minimally invasive procedures in terms of its safety and efficacy. Settings and Design: An observational study was conducted at three hospitals in Kashmir. Materials and Methods: A total of 149 patients underwent combined laparoscopic or combined laparoscopic and endoscopic procedures for the treatment of coexisting abdominal diseases. The outcome was analyzed in terms of mean operative time, postoperative visual analog scale score (0–10), requirement of additional postoperative analgesics, complications, hospital stay, and patient satisfaction. Statistical Analysis: Prospective sample survey analyzing the percentage and mean values. Results: Of 149 patients, 48 (32.2%) were male and 101 (67.7%) were female. Age ranged between 18-58 years in females and 24–70 years in males. The mean operative time ranged between 27 and 115 min. It was the longest in patients who underwent laparoscopic cholecystectomy (LC) with laparoscopically assisted vaginal hysterectomy. The most common organ-specific procedures performed were LC, appendectomy, and ovarian cystectomy in 120, 34, and 15 patients, respectively. Urological procedures were done in 36 patients undergoing either LC or appendectomy. Additional parenteral postoperative analgesics were required in 128 (85.9%) patients. A total of five major and 32 minor complications were noted in 22 (14.7%) patients. Three (2.01%) patients required conversion to open surgery. Orals were started on the 1st postoperative day in the majority of the patients. The mean hospital stay was 2.4 days (range 1–6 days). Overall, 93.9% of the patients expressed satisfaction to the combined procedure. Conclusions: Simultaneous minimally invasive procedures are feasible for coexisting abdominal pathologies in selected patients with the advantages of single anesthesia and hospital admission, low morbidity, and excellent patient satisfaction.

Background: With advancements in field of minimally invasive surgery, increasing number of patients with ectopic pregnancy (EP) can be managed laparoscopically. Aims and Objective: To evaluates our experience of laparoscopic management of ectopic pregnancy in terms of its safety and efficacy. This is an observational study conducted over a period of seven years at Guru Multi-specialty Hospital Sopore, Kashmir, India. Materials and Methods: A total of 84 patients with EP were included in the study. The diagnosis was made by detailed history, clinical examination, βHCG assay, abdominal and transvaginal ultrasonography. All patients underwent laparoscopic salpingectomy or salpingostomy depending on the clinical scenario. The outcome was analysed in terms of details of the procedure, mean operative time, post-operative VAS score (0-10), complications, hospital stay and subsequent fertility. Histopathological examination of the resected fallopian tubes was also evaluated. Statistical analysis was done as a prospective sample survey analyzing percentage and mean values. Results: Sixty-one patients had chronic ectopic while 23 presented acutely. Seventy-seven (91.66%) patients were diagnosed by clinical, laboratory and sonographic modalities while 7 (14.17%) required diagnostic laparoscopy for confirmation. Ampulla was the site of EP in 75% of cases. Ruptured fallopian tubes were found in 20 (86.95%) and 9 (14.75%) patients who presented with acute and chronic ectopic respectively. The patients with chronic ectopic were managed with laparoscopic salpingectomy and laparoscopic salpingostomy in 45 (73.77%) and 16 (26.22%) patients respectively. Patients with acute ectopic were underwent laparoscopic salpingectomy in 18 (78.26%) and salpingostomy in another 5 (21.73%) cases. The operative time was longer in patients with chronic ectopic ranging between 55-135 minutes. A total of five (5.95%) patients required blood transfusions. One each case of chronic and acute ectopic required conversion to open surgery. Histopathological examination of salpingectomy specimen revealed chronic salpingitis was seen in 39.68% of the cases. On follow-up, a total of 18 (29.5%) and 9 (39.13%) patients conceived within a year and another 5 (8.19%) and 2 (8.69%) did so between 1-2 years who presented with chronic and acute ectopic respectively. Conclusions: Laparoscopic approach in treatment of EP is safe and feasible irrespective of the type of presentation with all advantages of minimal access surgery and greatly reduced morbidity.

Background Cervical cancer is a very common malignancy amongst women worldwide. Pap smear is an effective and inexpensive screening test in asymptomatic women. The aim of this paper was to assess the prevalence of Pap smear screening for cervical cancer among Lebanese women and to determine associated sociodemographic and psychosocial characteristics. Methods This national survey included 2255 women, selected by multi-stage random cluster sampling across Lebanon. A questionnaire about practices and perceptions related to cervical cancer screening was developed based on the “Health Belief Model”. Results The weighted national prevalence of “ever-use” of the Pap smear for screening purposes was 35%. Most important determinants of screening behavior were: residence within Greater Beirut, higher socio-economic status and educational attainment, marriage status, presence of a health coverage, awareness of Pap smear usefulness, knowing someone who had already done it, and a balance between perceived benefits and perceived barriers to Pap smear screening. Conclusion Regular information campaigns regarding the availability and effectiveness of the test should be devised, targeting in priority the sexually vulnerable women in Lebanon. Moreover, healthcare providers should be encouraged to discuss with their patients the opportunity of obtaining a Pap smear.

To study feasibility and results of cholecystectomy at the time of cesarean section.Thirty-two patients were subjected to cholecystectomy at cesarean section. Most of them were diagnosed with cholelithiasis at or before the first antenatal scan. Cholecystectomy was performed by subcostal mini-laparotomy, after assessing the anatomy via the cesarean wound.Cholecystectomy was combined with lower segment cesarean section in all the patients. Under general anaesthesia, surgeries were performed with an mean duration of 90 minutes. Difficult anatomy at calots was found in 3 patients, who required extension of subcostal incision by 3-4 cm. One woman required blood transfusion during operation. There were no other intraoperative or postoperative complications. No extra antibiotics or analgesics doses were needed. Patients were discharged on 5(th)-7(th) postoperative day.Combined cesarean section and cholecystectomy avoids rehospitalisation for separate cholecystectomy. With an additional small subcostal incision, single anaesthesia, and single hospital stay, the combined procedure confers valuable advantages for both patient and hospital in time, cost, and convenience, including avoiding the separation of mother from newborn entailed by reoperation. It also prevents the possibility of developing acute cholecystitis while the patient is waiting for cholecystectomy. Our results indicate that the combination approach is safe, effective, and well accepted.Sezaryen ameliyatı sırasında kolesistektominin uygulanabilirliğini ve sonuçlarını incelemek.Otuz iki hastada sezaryen ameliyatı sırasında kolesistektomi yapıldı. Hastaların çoğu doğum öncesi ilk tarama sırasında veya öncesinde kolelitiazis tanısı almıştı. Kolesistektomi sezaryen yarası aracılığıyla anatominin değerlendirilmesinden sonra kosta altı mini-laparotomi ile gerçekleştirildi.Hastaların tamamında kolesistektomi alt segment sezaryen ameliyatı ile kombine edildi. Ameliyatlar, genel anestezi altında, ortalama 90 dakikalık süre içinde yapıldı. Üç hastada “calot”’larda zor anatomi saptandı ve kosta altı kesinin 3–4 cm uzatılması gerekti. Bir kadında ameliyat sırasında kan transfüzyonu gerekti. Bunlar dışında ameliyat sırasında veya sonrasında komplikasyon gözlenmedi. İlave antibiyotik veya analjezik dozları gerekmedi. Hastalar ameliyat sonrası 5.–7. günde taburcu edildi.Kombine sezaryen ameliyatı ve kolesistektomi, ayrıca kolesistektomi için yeniden hastaneye yatışı önler. İlave küçük bir kosta altı kesisi, tek bir anestezi ve hastaneye bir kez yatış ile kombine işlem; hem hasta hem de hastane için zaman, maliyet ve rahatlık bakımından değerli avantajlar sağlar, anne ve yenidoğan tekrar bir ameliyat sonucu ayrı kalmamış olur. Ayrıca hastanın kolesistektomi için beklerken akut kolesistit geçirme olasılığını da önler. Sonuçlarımız kombine yaklaşımın güvenli, etkili ve iyi kabul gördüğünü göstermektedir.

e18917Background: Lebanon is facing a mounting burden from cancer with heavy financial consequences on the healthcare system. This study aims to evaluate increasing trends in the cost of oncology d...

Objective To determine the prognostic value of p53 gene mutations and P53 overexpression for predicting the incidence of recurrence, progression and long-term survival of patients with transitional cell carcinoma (TCC) of the bladder. Methods Prospective cohort study with 94 consecutive patients diagnosed and treated for TCC. DNA was obtained from tumor tissue to perform PCR-SSCP of p53 exons 5–9, with automatic sequencing of any mutated samples. Immunohistochemistry using anti-human P53 monoclonal antibody was also performed. Survival was analyzed and the survival curves compared (Mantel-Haenszel). Lastly, a Cox proportional hazards model was constructed. Results Mutations were found in 46.8% of samples, with 61.8% in infiltrating tumors. Exon 8 was involved in 42.3%. P53 overexpression (cutoff ≥20%) was found in 52.1%. Mean follow-up was 44.1 months; 43.6% had died by the end of this period. Mean survival was lower in patients with exon 8 mutations (38.4 months), compared with patients without this exon mutated ( P = 0.016). There were no differences in patient survival based on positive or negative immunohistochemistry (cutoff ≥20%), although survival was lower in patients with a percentage higher than 50% of antibody-stained cells ( P = 0.02). In the Cox analysis, tumor stage, pM stage, and interaction between stage ≥pT2 and mutated p53 gene were independent risk factors, with a 6.13-fold risk of death in these patients ( P = 0.019). The number of tumors, nuclear grade, pTa stage, and the interaction between GI degree and nonmutated p53 gene remained in the Cox model for superficial tumors, such that these patients had a lower risk of recurrence or progression ( P = 0.008). Conclusions Alterations in the p53 gene may be indicative of poorer prognosis and greater recurrence in patients with urothelial bladder tumor, in particular, the presence of mutations in exon 8 and a greater percentage of stained cells in the immunohistochemistry. Nevertheless, the classic prognostic factors (primarily, pTNM stage) should still be considered the most useful factors for follow-up of these patients.