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Acquired haemophilia A (AHA) is a rare immune-mediated disorder characterised by the development of autoantibodies against factor VIII. Morbidity and mortality are in general high due to multiple factors including the age of the patient, underlying diseases, toxic effects of available treatments and bleeding itself. To assess the awareness about AHA among healthcare professionals (HCPs) in Lebanon where patients can present to non-haematologists with life-threatening bleeding disorders. A cross-sectional survey was conducted in September and October 2017 all over Lebanon among HCPs. The survey covered: (i) the geographic area of practice and specialty; (ii) bleeding disorders encountered within the last 2 years; (iii) assessment of knowledge on AHA; and (iv) importance of increasing awareness on AHA among HCPs. A total of 362 participants completed and returned the questionnaire (response rate 100%). The majority of the HCPs were practicing in Beirut (n=164; 45.3%) and were internists (n=106; 29.3%). 332 (93%) HCPs have encountered patients with bleeding problems within the last 2 years all over Lebanon. 327 (92.1%) HCPs agreed that increasing awareness on AHA among health care professionals is important. HCPs gave an average of 75.9% of correct answers on the survey. Appropriate treatment and diagnosis are essential when dealing with AHA. Knowledge gaps exist in the clinical practice when dealing with patients who have AHA. This study shows the need for increasing awareness about AHA among HCPs in Lebanon regarding the diagnosis and treatment of this disorder.

Diabetic hypoglycaemia affects medication adherence, patients' productivity and quality of life. It is also associated with an increased risk of cardiovascular complications.To examine the impact of hypoglycaemia in insulin-treated patients in the Lebanese cohort of the Hypoglycaemia Assessment Tool (HAT) study.The HAT study was an observational study covering a 6-month retrospective and a 4-week prospective period in 24 countries including Lebanon. Data were collected using self-assessment questionnaires and patient diaries from 1158 invited lebanese patients, aged ≥ 18 years, with type 1 or type 2 diabetes mellitus (T1DM/T2DM) treated with insulin for12 months. The primary endpoint was the proportion of patients experiencing ≥ 1 hypoglycaemic event during the 4-week follow-up period.After 4 weeks of follow-up, 177/225 [78.7%; 95% confidence interval (CI): 72.7-83.8] of patients with T1DM and 291/630 (46.2%; 95% CI: 42.2-50.2) patients with T2D experienced at least 1 hypoglycaemic event. Rates of nocturnal and severe hypoglycaemia were 10.7 (95% CI: 9.1-12.3) and 13.2 (95% CI: 11.5-14.9) events/patient-year for T1DM, and 3.3 (95% CI: 2.8-3.8) and 4.2 events/patient-year (95% CI: 3.6-4.8) for T2DM, respectively. Fear of hypoglycaemia was significantly associated with nocturnal and severe hypoglycaemia in both diabetes types (P0.001).The results suggest that the less-advanced healthcare systems in Lebanon are implicated in lower levels of patient knowledge about hypoglycaemia and related preventive measures. Treatment strategies and glycaemia goals should be individualized according to patient preference, medical benefits, and risk of hypoglycaemia.دراسة معنية بأداة تقييم نقص سكر الدم: تحليل فرعي لمجموعة أترابية من سكان لبنان.ميراي عمّ، محمّد روّاس، زيليا فرنسيس، مايا شهاب الدين، أمل شلفون، مازن العاقل، ماري مرعب.يؤثر نقص السكر في الدم بسبب داء السُّكَّري على مدى الامتثال للعلاج، وإنتاجية المريض، وجودة الحياة. كما يقترن أيضاً بزيادة مخاطر مضاعفات أمراض القلب والأوعية الدموية.هدفت الدراسة إلى دراسة أثر نقص السكر في الدم في مجموعة أترابية من المرضى في لبنان من الذين يُعالَون بالأنسولين، وشملتهم الدراسة المعنية بأداة تقييم نقص السكر في الدم.شملت الدراسة المعْنية بأداة تقييم نقص السكر في الدم دراسة رَصْدية استرجاعية غطَّت فترة 6 أشهر، وأخرى استباقية غطَّت فترة 4 أسابيع في 24 بلداً، منها لبنان. وقد جُعت البيانات باستخدام استبيانات التقييم الذاتي ويوميات المرضى من 1158 مريضاً لبنانياً تتراوح أعمارهم بين 18 عاماً وأكثر، من المصابين بالنمط 1 أو 2 من داء السُّكَّري الذين ظلوا يُعالَون بالأنسولين لمدة تزيد عن 12 شهراً. وكانت نقطة النهاية المبدئية هي نسبة المرضى الذين يحدث لهم نقص السكر في الدم مرةً واحدةً أو أكثر خلال فترة المتابعة التي تبلغ 4 أسابيع.تبيَّ من المتابعة التي استمرت 4 أسابيع أن: 177/ 225 [78.7٪؛ بفاصل ثقة 95٪: 72.7−83.8] من المرضى المصابين بالنمط 1 من داء السُّكَّري، و291 / 630 (46.2٪؛ بفاصل ثقة 95٪: 42.2−50.2) من المرضى المصابين بالنمط 2 من داء السُّكَّري حدث لهم نقص السكر في الدم مرة واحدة على الأقل. وقد بلغت معدلات النقص الليلي الحاد لسكر الدم 10.7 (بفاصل ثقة 95٪: 9.1−12.3) و13.2 (بفاصل ثقة 95٪: 11.5−14.9) من الأحداث/ المرضى – السنة بالنسبة للنمط 1 من داء السُّكَّري، و3.3 (بفاصل ثقة 95٪: 2.8−3.8) و4.2 من الأحداث/المرضى – السنة (بفاصل ثقة 95٪: 3.6−4.8) بالنسبة للنمط 2 من داء السُّكَّري، على التوالي. وقد ارتبط نقص السكر في الدم ارتباطاً وثيقاً بحدوث نقص ليلي حاد لسكر الدم في كلا النمطين من داء السُّكَّري (0.001P).تُشير النتائج إلى ارتباط نُظم الرعاية الصحية الأقل تقدماً في لبنان بالمستويات الأدنى من معرفة المريض بنقص السكر في الدم والتدابير الوقائية ذات الصلة. ويجب أن تُعدّ استراتيجيات العلاج والمعدلات المُستهدفة لمستوى السكر في الدم حسب احتياجات كل فرد وَفقاً لتفضيل المريض، والمنافع الطبية، ومخاطر نقص السكر في الدم.Étude de l'outil d'évaluation de l'hypoglycémie : sous-analyse de la cohorte libanaise.L'hypoglycémie chez les patients diabétiques affecte leur observance thérapeutique, leur productivité et leur qualité de vie. Elle est également associée à un risque accru de complications cardio-vasculaires.Examiner l'impact de l'hypoglycémie chez les patients traités par insuline dans la cohorte libanaise faisant partie de l'étude de l'outil d'évaluation de l'hypoglycémie.L'étude de l'outil d'évaluation de l'hypoglycémie était une étude d’observation couvrant une période rétrospective de six mois et une période prospective de quatre semaines dans 24 pays, y compris le Liban. Les données ont été recueillies à l'aide de questionnaires d'auto-évaluation et des journaux de bord de 1158 patients libanais, âgés de 18 ans et plus, atteints de diabète sucré de type 1 ou 2 traités par insuline depuis plus de 12 mois, qui avaient été invités à participer à l’étude. Le principal critère d'évaluation était la proportion de patients ayant connu un épisode d'hypoglycémie ou plus pendant la période de suivi de quatre semaines.Après quatre semaines de suivi, 177 des 225 patients atteints de diabète sucré de type 1 [78,7 % ; intervalle de confiance (IC) à 95 % : 72,7-83,8] et 291 des 630 patients atteints de diabète sucré de type 2 (46,2 % ; IC à 95 % : 42.2-50.2) ont connu au moins un épisode d'hypoglycémie. Les taux d'hypoglycémie nocturne et sévère étaient respectivement de 10,7 (IC à 95 % : 9,1-12,3) et 13,2 (IC à 95 % : 11,5-14,9) épisodes/patient-année pour le diabète sucré de type 1, et de 3,3 (IC à 95 % : 2,8-3,8) et 4,2 épisodes/patient-année (IC à 95 % : 3,6-4,8) pour le diabète sucré de type 2. La peur de l'hypoglycémie était associée de manière significative à une hypoglycémie nocturne et sévère dans les deux types de diabète (p0,001).Les résultats indiquent que les systèmes de soins de santé moins avancés au Liban contribuent à la faible connaissance des patients en matière d’hypoglycémie ainsi que les mesures préventives qui y sont liées. Les stratégies de traitement et les objectifs en matière de glycémie doivent être individualisés en fonction des préférences du patient, des avantages médicaux et du risque d'hypoglycémie.

In Middle-Eastern countries, more particularly in Lebanon, the incidence of vitamin D deficiency has been found to be surprisingly high in schoolchildren and young individuals. However, the prevalence and risk factors for vitamin D inadequacy amongst Lebanese osteoporotic women seeking medical health care has never been studied. We analysed vitamin D-inadequacy risk factors among the 251 Lebanese postmenopausal osteoporotic women (from both Muslim and Christian communities) who participated in a vitamin D international epidemiological study. Vitamin D inadequacy prevalence (25-hydroxyvitamin D (25(OH)D) r − 0·41; P r 0·37; P r 0·17; P r 0·48; P P P P P P = 0·002 and P = 0·02 respectively). There is an urgent need to increase vitamin D supplement use in Middle-Eastern osteoporotic women, more particularly in those from the Muslim community.

Sami T Azar,1 Hadi Abu Hantash,2 Selim Jambart,3 Mohammad M El-Zaheri,4 Rachoin Rachoin,5 Amal Chalfoun,6 Layla Lahoud,6 Osama Okkeh,2 Peter Bramlage,7 Philippe Brudi,8 Baishali M Ambegaonkar81American University of Beirut Medical Center, Beirut, Lebanon; 2Istishari Hospital, Amman, Jordan; 3St Joseph University Faculty of Medicine, Beirut, Lebanon; 4Jordan Hospital, Amman, Jordan; 5Notre Dame des Secours Hospital, Jbeil, Lebanon; 6MSD Levant, Beirut, Lebanon; 7Institut für Pharmakologie und präventive Medizin, Mahlow, Germany; 8Merck and Co, Inc., Whitehouse Station, NJ, USABackground: Cardiovascular disease is the leading cause of death and disability worldwide. Therefore, as part of the Dyslipidemia International Study (DYSIS), we have analyzed the prevalence of lipid abnormalities and risk factors for dyslipidemia in statin-treated patients in Lebanon and Jordan.Methods: This cross-sectional, multicenter study enrolled 617 patients at 13 hospitals in Lebanon and Jordan. Patients were at least 45 years old and had been treated with statins for at least 3 months. Multivariate logistic regression analysis was used to determine patient characteristics contributing to dyslipidemia during statin therapy.Results: Our findings indicated that 55.9% of statin-treated patients (mean age 60.3 years, 47% female) in Lebanon and Jordan did not achieve goal levels for low-density lipoprotein cholesterol which were dependent on Systematic Coronary Risk Evaluation (SCORE) risk, and 70% of patients (76% men and 63.3% of women) were at very high cardiovascular risk. Low-density lipoprotein cholesterol goals were not achieved in 67.2% of those with very high cardiovascular risk. The most commonly prescribed statin was atorvastatin (44.6%), followed by simvastatin (27.7%), rosuvastatin (21.2%), fluvastatin (3.3%), pravastatin (3%), and lovastatin (0.2%). Approximately half of the population was treated with a statin dose potency of 4, equaling 40 mg of simvastatin. In Lebanon and Jordan, the strongest independent associations with low-density lipoprotein cholesterol not at goal were current smoking (odds ratio [OR] 1.96; 95% confidence [CI] 1.25–3.08), diabetes mellitus (OR 2.53; 95% CI 1.70–3.77), and ischemic heart disease (OR 2.26; 95% CI 1.45–3.53), while alcohol consumption was associated with reduced risk (OR 0.12; 95% CI 0.03–0.57).Conclusion: We observed that many patients in Lebanon and Jordan experienced persistent dyslipidemia during statin treatment, supporting the notion that novel lipid-lowering strategies need to be developed. Also, social programs aimed at combating the extremely high rates of tobacco use and obesity in Lebanon and Jordan are critical for combating cardiovascular disease in these countries.Keywords: cardiovascular disease, lipid abnormalities, statins, low-density lipoprotein cholesterol