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Background Although, guidelines for the appropriate use of enoxaparin are published, yet the extent of their implementation in clinical practice is still questionable. Furthermore, the optimal dosing of enoxaparin in special populations such as renal insufficiency and obesity remains controversial. In the Middle East, there are insufficient data on the appropriateness of enoxaparin use in different indications. Objective (1) To assess the appropriateness of enoxaparin dosing and duration per indication in compliance with the recommended guidelines and their impact on safety and efficacy outcomes in Lebanese health care centers. (2) To evaluate the influence of the hospital type (teaching vs. non-teaching) on the extent of compliance with established guidelines. Setting Seventeen health care centers in Lebanon, including teaching and non-teaching hospitals. Methods An observational, cross-sectional, multicenter study was conducted in 17 Lebanese hospitals. Data on demographics, indication, dosing regimen and clinical outcomes were collected. The appropriateness of dosing practices was determined as per the ACCP guidelines and the FDA dosing recommendations. Main outcome measure The appropriateness of enoxaparin dosing was compared across different hospital type and among special populations including severe renal insufficiency and very obese patients. Results Of the 463 patients who participated in the study, 40% received improper enoxaparin dosing, which was mostly observed in the VTE prophylaxis group (41.6%, P < 0.001). When comparing the overall dosing practices in Lebanese hospitals, there was no statistically significant difference in the correctness of enoxaparin dosing between teaching and non-teaching hospitals (61.6% vs. 58.2%, P = 0.449), respectively. Only 11.5% of renally impaired patients and 59.4% of obese patients received correct doses. Conclusion This study highlighted the improper practice and thus the need of implementation of clinical practice guidelines for the dosing of enoxaparin, in Lebanese hospitals. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of multiple sclerosis (MS) has been studied in many countries of the Middle East but the prevalence and incidence of MS in Lebanon is still unknown., Objectives: To determine the incidence and prevalence of MS in Lebanon., Methods: Lebanese patients diagnosed with MS between January 2018 and December 2018 were identified using the database of governmental third-party payers. The crude, age- and sex-specific 2018 prevalence and incidence among Lebanese patients were calculated., Results: 2248 MS patients were identified of whom 67.1% were women (female: male ratio 2:1) with a mean age of 41.8 ± 12.96 years. The 2018 prevalence of MS was 62.91 cases per 100,000 persons (95% CI: 60.41 - 65.41). The overall incidence of MS in Lebanon was 8.36 cases per 100,000 (95% CI: 7.45 - 9.27) with a mean age at onset of 34.5 ± 12.5 years., Conclusion: This is the first study to assess prevalence and incidence of MS in Lebanon, confirming that Lebanon is a moderate to high-risk area for MS. Those high rates are commensurate with recently published studies from the Middle East, pointing to a significant rise in incidence and prevalence of this disease in our region., (Copyright © 2021. Published by Elsevier B.V.)

Food loss and food waste occur along the food supply chain, negatively impacting the environment, global economy, and food security. There is a growing global interest in tackling this issue to mitigate or handle the waste generated and limit its repercussions, as one in eight people suffer from undernourishment worldwide. In the Arab world, where there is a high dependency on imports and limited potential of increasing local food production, addressing food loss and waste becomes substantial. Research has mainly been focused on household food waste generation, while data on post-consumer plate food waste in the foodservice sector remains scarce. In this study, managers from a representative sample of 222 restaurants located in Municipal Beirut, Lebanon, were surveyed about food waste generation. Plate food waste was measured to establish baseline information. Multiple Tobit regression analyses were performed to explore the determinants for plate food waste generation. Plate waste generation was also compared between Lebanese and non-Lebanese cuisine restaurants. Results revealed that 1,620 tons of plate food waste are generated per year in Beirut, equivalent to 0.15% of Lebanon's total organic waste. Furthermore, Lebanese cuisine restaurants serving Mediterranean Mezze were found to generate 34 kg of organic waste per day more than restaurants that serve international non-Lebanese cuisine. The type of cuisine, kind of service, and menu planning were significantly associated with post-consumer food waste generation. This study revealed an increasing concern towards the amount of plate waste generated in Beirut, and thereby further research is needed to create baseline information at the national level., Competing Interests: The authors have declared that no competing interests exist.

Background: Relapse rate in women with Multiple Sclerosis (MS) is reduced during pregnancy especially in the third trimester according to the previous studies., Objectives: To measure the annual relapse rate (ARR) in women with MS during pregnancy., Methods: A retrospective study was conducted using prospectively collected data from two MS registries in Kuwait and Lebanon. Demographics, clinical characteristics including relapses, disease modifying therapies (DMTs) and their washout periods were extracted. The annual relapse rates pre and post pregnancies were compared and the relationship between relapses and prior use of different DMTs was assessed., Results: Data of 164 pregnancies (132 MS patients) was reviewed. Mean age and disease duration at the time of pregnancy confirmation were 32.4 ± 5.3 and 7.8 ± 4.7 years respectively. Most patients (91.7%; n = 121) were on DMTs in the year prior to pregnancy. The pre-pregnancy ARR was 0.10 (95% CI: 0.04 - 0.13), which increased to 0.20 (95% CI: 0.13- 0.29) during pregnancy. Most relapses occurred either during the 1 st (ARR = 0.24; 95% CI: 0.12 - 0.44) or 3 rd (ARR = 0.32; 95%CI: 0.17 - 0.53) trimesters. Fingolimod (31.8%) and natalizumab (22.7%) were the most commonly prescribed DMTs in patients who sustained relapses during pregnancy. The mean washout period was significantly longer among subjects with relapses (9.3 ± 6.6 vs. 2.5 ± 3.9; p < 0.001) than those of without relapses., Conclusions: Relapse rate during pregnancy was higher than previous studies conducted in patients on platform therapies or untreated. Longer washout period prior to conception was associated with increased relapses especially in fingolimod and natalizumab treated patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)