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Objectives Cancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. Methods This is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hotel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. Results Thirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. Conclusions Our study is a pilot study which for the first time investigates the implication of depression in a “spirituality-quality of life” association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

Background For a better assessment of thyroid function, each laboratory should establish its own reference intervals (RI). In Lebanon, no previous study has been conducted to establish the reference values for thyroid function tests. Methods This cross-sectional study included 301 volunteers aged between 18 and 65 years (65.8% women, 34.2% men), free from any thyroid pathology and any condition that could affect thyroid function tests. The reference intervals of thyroid-stimulating hormone (TSH), free T4 (FT4), free T3 (FT3), and total T3 (TT3) were measured on the Roche Cobas e411 machine. 39 subjects tested positive for thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TGAb), were excluded from the study. Results There was an increase in the 2.5th percentile for the TSH compared to the value provided by the manufacturer (from 0.27 to 0.53 mlU/L) as well as a decrease in the 97.5th percentile for the FT4, TT3, and FT3 (respectively, from 22 to 19.78 pmol/L for FT4, from 3.1 to 2.71 nmol/L for TT3, and from 6.80 to 6.10 pmol/L for FT3). Higher TT3 and FT3 values were noted in men compared to women (respectively, p = 0.068 and p < 0.0001). An age decrease in FT4 and FT3 was also observed (respectively, p = 0.045 and p < 0.0001). Conclusion The established RI of thyroid function tests for the Lebanese population were significantly different from the values recommended by the manufacturer (Roche Diagnostics). Changing our RI values will allow a more accurate diagnosis of thyroid dysfunction.

Basal cell carcinoma (BCC) data coming from the Levantine coast of the Mediterranean Sea are limited. The study aimed to primarily analyze the demographic, clinical, pathological, and prognostic characteristics of BCC in this region of the world and secondarily identify features associated with high-risk, recurrent, or multiple BCCs. Patients with at least one diagnosis of BCC registered in the pathology department between January 2015 and December 2019 were included in this analytical retrospective single-center cohort study. Patients with basal cell nevus syndrome were excluded. Patients' characteristics and pathological features were collected through file check for a first analysis. Risk factors and evolution were sought through a phone call interview for the second analysis. The first analysis included 506 BCCs corresponding to 365 patients with a mean age of 65 ± 15 years, twenty-two (6%) were less than 40 years old, 180 (49.3%) were women, and 85 (23.3%) had two or more BCCs. The second analysis included 279 BCCs corresponding to 205 patients. Periorificial and infiltrative BCCs were more frequent in men. Periorificial tumors were more frequently nodular or infiltrative and were associated with recurrence. Tumors with perineural involvement were histologically never nodular nor superficial. Recurrence was more frequent in BCCs having periorificial location, a size larger than 2 cm, or an infiltrative subtype. Multiple BCCs were more frequent in patients with light skin type or familial history of skin cancer. High-risk BCCs were more common in patients with low sun exposure.

Objectives Historically, headache was reported in up to 76% of hemodialysis patients. Some authors suggested that headache resulted from caffeine withdrawal. This study aims to compare the incidence of headache and hypotension between patients drinking regular or decaffeinated coffee during dialysis. Methods One-hundred fifty-six patients were enrolled in this randomized, double-blind, placebo-controlled, multicenter study. Patients with atrial fibrillation were excluded. Group A was given 80 mL of regular coffee and group B 80 mL of decaffeinated coffee (placebo) in the middle of the session for 12 consecutive sessions. Ultrafiltration rate was fixed to a maximum of 13 mL/kg/hour. The primary outcome was the incidence of headache during dialysis. Results A total of 139 patients completed the trial (6.4% vs. 15.4% of withdrawal in Groups A and B, respectively). The number of sessions with headache was not significantly different between Group A and B (33.3% vs. 37.1% respectively, P = .522), nor the number of sessions with hypotension (27% vs. 26% respectively, P = .539). In a subgroup analysis, headache tended to be more frequent in Group B (P = .06) in 2 categories of patients: those with the highest potassium dialysate (K = 2) and the non-hypertensive patients. Conclusions Headache occurred in 35% of patients during their chronic hemodialysis sessions. Caffeine intake did not prevent headache occurrence in these patients.

Backgrounds/Objectives: The effect of cobalamin and folate deficiency on cardiovascular disease is still unclear. We assessed the association of cobalamin and folate deficiency on lipidic and non-lipidic markers of cardiovascular disease in a large laboratory database. Subjects/Methods: We conducted a cross-sectional study on a large database of a tertiary hospital’s laboratory information system between 2017 and 2022. The study included laboratory data of Lebanese outpatients and cardiology inpatients. The following biological assays on serum were used: cobalamin, folate, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, creatinine, glycated hemoglobin, ferritin, C-reactive protein, fibrinogen, uric acid and homocysteine. Age, gender and a surrogate for cardiovascular disease were also used. Odds ratios adjusted for age, gender, inflammatory biomarkers and vitaminic status were derived using separate logistic regression models. Results: A total of 20,836 observations were included, of which 2.0% presented clinical cobalamin deficiency. The effect of cobalamin and folate deficiencies, while significantly affected cardiovascular biomarkers in univariate analyses, disappeared after adjusting on age, gender and inflammation biomarkers. Conclusion: In this exploratory analysis, cobalamin and folate deficiencies were not significantly associated with abnormal lipid values and non-lipidic markers of cardiovascular disease.

Hemodialysis is a necessary treatment for end-stage kidney disease patients. It imposes undergoing three sessions of dialysis per week in a specialized center. Amid the SARS-CoV-2 pandemic, precautionary measures were mandatory in all dialysis facilities and may have negatively impacted patients’ well-being. This study aimed to uncover the scale of this effect. We performed a cross-sectional study of all patients undergoing chronic hemodialysis in two dialysis units (one urban and another rural). Patients with Alzheimer’s disease were excluded. Patients filled a questionnaire including information on socio-demographics, factors related to the dialysis facility, and the impact of the COVID-19 epidemic on their mental health. A total of 72 patients responded. Their median age was 70 (60.79) years. Of them, 68% were males, 71% were married, and 10% were living alone. Following the pandemic, 35% felt more anxious, with a higher incidence of anxiety in the rural unit (p=0.021). Half of them felt very limited in their relationships, and 29% were isolated from their families. In total, 98% of patients were satisfied with the staff support. The imposed preventive measures were perceived as very strict in 27% of the surveyed patients. The majority of the urban group were bothered for not eating during the session, and they felt significantly more stress than the rural group (p=0.001). The SARS-CoV-2 pandemic increased anxiety among hemodialysis patients from a rural setting. Stress was more prevalent in the urban group and most probably related to limitations in eating during sessions. The majority were satisfied with staff support.

The general population is increasingly using YouTube as a source of information on breast cancer, the most frequent cancer among women. Arabs are the most interested population in breast cancer on YouTube. The transmission of accurate information is important to reduce mortality rates. This cross-sectional study aims to evaluate breast cancer videos on YouTube in the Arab world. A YouTube search for “breast cancer” in Arabic was performed. The most viewed 60 videos included were evaluated for global quality (GQS score), reliability (modified DISCERN score), content (content score), and misleading claims. Recorded and calculated data included views, duration, videos power index, and viewers’ interaction. Sources from legal persons (governments, universities, TV channels, physicians’ groups), and blogs (online health channels, individuals) were categorized. The median global quality (3/5), reliability (2/5), and content scores (4/11) were overall low. Misleading information was found in 42% of the videos. Although videos uploaded by legal persons were less popular (163,454 vs 327,488 views), they hosted more physicians (52% vs 15%), were less misleading (15% vs 64%), covered more content, and were of higher global quality and reliability than videos uploaded by blogs [p

Aim: The topography of vascular and valvular calcification could help accurately predict cardiovascular post-operative complications. The data on these calcifications remains scarce. Purpose: Identify the topographic distribution of the ascending aortic, left heart valves and coronary calcifications. Materials & methods: We extracted 26 variables from 557 patients, hospitalized between 2017 and 2020. The topography of calcification was evaluated by thoracic CT scans. Both multivariate logistic regression and classification and regression tree (CART) were used for statistical analysis. Results: Several comorbidities were associated with vascular or valvular calcification. This study proposes a CART tree for patients according to their age, sex, Euroscore and lipid profile. Conclusion: The proposed classification could represent an important clinical tool. More studies are warranted to better prune the current CART algorithm.

Aim this study aims to assess the reliability and validity of an Arabic version of the Sleep Hygiene Index (SHI). Methods A methodological study was carried out in four stages: initial translation by 2 professional translators, evaluation and synthesis of the initial translation by project managers, back-translation and validation. The Arabic (SHI-AR) and English (SHI-ENG) versions of the SHI were administered across Lebanon as an anonymous online survey in April 2020. Internal consistency of the SHI-AR and inter-rater reliability were assessed by calculating Cronbach alpha (α) and Intraclass Correlation Coefficient (ICC) respectively. Inter-rater agreement for each item of the SHI was measured using Cohen's Kappa coefficient. Construct validity was investigated by exploratory factor analysis (EFA). Results 363 participants were enrolled in the study (129 men, 234 women, mean age 30 ± 11 years). There was no statistically significant difference between mean overall scores on the 2 versions of the SHI with mean scores of 19.16 ± 7.4 and 19.25 ± 7.6 on SHI-AR and SHI-ENG respectively (p = 0.265). Internal consistency was satisfactory (α = 0.749), and the inter-rater agreement for the total scores of the 2 versions of the SHI was excellent (ICC = 0.980). All items of the SHI showed substantial to high level of agreement between the 2 versions. EFA established four factors underlying the questionnaire. Conclusion The Arabic version of the SHI is a valid tool to assess sleep hygiene in Arabic speaking populations.

Objective We aim to prospectively validate a previously developed machine learning algorithm for low-density lipoprotein cholesterol (LDL-C) estimation. Methods We retrospectively and prospectively evaluated a machine learning algorithm based on k-nearest neighbors (KNN) according to age, sex, health care setting, and triglyceridemia against a direct LDL-C assay. The agreement of low-density lipoprotein-k-nearest neighbors (LDL-KNN) with the direct measurement was assessed using intraclass correlation coefficient (ICC). Results The analysis comprised 31,853 retrospective and 6599 prospective observations, with a mean age of 54.2 ± 17.2 years. LDL-KNN exhibited an ICC greater than 0.9 independently of age, sex, and disease status. LDL-KNN was in satisfactory agreement with direct LDL-C in observations with normal triglyceridemia and mild hypertriglyceridemia but displayed an ICC slightly below 0.9 in severely hypertriglyceridemic patients and lower in very low LDL-C observations. Conclusion LDL-KNN performs robustly across ages, genders, health care settings, and triglyceridemia. Further algorithm development is needed for very low LDL-C observations.

To validate an Arabic version of the short form of the Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome (CH-RLSq13).The Arabic version was created using a standard forward-backward translation method. A pre-final Arabic version was administered with the original English version to a group of bilingual subjects as a pretest. The inter-rater agreement between these two versions was measured. A finalized Arabic version was obtained. For the validation, the Arabic version of the CH-RLSq13 was administered to Lebanese subjects, above 18 years old, selected upon a clinical interview. The diagnosis provided by the Arabic version of the CH-RLSq13 was compared to the clinical diagnosis made by a neurologist at Hotel-Dieu de France hospital. Inter-rater agreement was assessed using Cohen's kappa coefficient. Sensitivity, specificity, and positive and negative predictive values of the translated questionnaire were calculated.Inter-rater agreement, between the 2 versions, for the entire questionnaire, was excellent (κ = 0.950). All items showed a substantial level of agreement between the two versions. In the validation process, 91 participants were included (17 patients diagnosed with RLS and 74 control subjects). The mean age was 40 years, with female predominance. The final Arabic version of the CH-RLSq13 had a sensitivity of 71%, a specificity of 100%, and with negative and positive predictive values of 94% and 100% respectively.The Arabic version of the CH-RLSq13 is a reliable tool for the screening and diagnosis of RLS in Lebanese and Arabic-speaking populations.

OBJECTIVES Postoperative atrial fibrillation (POAF) is common following coronary artery bypass grafting (CABG) surgery. Hypomagnesemia is frequent after CABG surgery. No previous trials have assessed the effect of preoperative magnesium (Mg) loading on POAF incidence. METHODS This was a single-centre, double-blind, placebo-controlled, parallel-group trial, with balanced randomization [1:1]. The participants were recruited from November 2018 until May 2019. Patients received either 3.2 g of Mg daily (4 tablets of 0.4 g each twice daily) for 72 h preoperatively and 1.6 g of Mg (4 tablets) on the day of surgery or placebo tablets. RESULTS The primary outcome was the incidence of POAF. Secondary outcomes included time to extubation, transfusion rate, critical care unit and hospital length of stay. Of the 210 randomized participants, 200 (100 in each group) completed the study. A total of 10 (10%) and 22 (22%) subjects developed POAF in the Mg and placebo groups, respectively (RR = 0.45, 95% confidence interval: 0.23–0.91). Hospital and critical care unit length of stay were comparable between the 2 groups. No side effects related to Mg administration were documented. CONCLUSIONS In this randomized controlled trial, preoperative loading with oral administration of Mg for 3 days in patients admitted for CABG surgery decreases the incidence of POAF compared to placebo. Clinical trial registration number NCT03703349.

BACKGROUND AND AIMS Treatment with erythropoietin (EPO) is well established for anemia in chronic kidney disease patients but not well studied in acute kidney injury (AKI). This study aims to assess the transfusion need, renal recovery and all-cause mortality of AKI patients with anemia whether treated or not with EPO. METHOD This is a multicenter, randomized, pragmatic controlled clinical trial. It included 134 hospitalized patients with anemia [hemoglobin (Hb) The trial is registered on ClinicalTrials.gov (NCT03401710). RESULTS The general characteristics of both groups are summarized in Table 1. There was no statistically significant difference in transfusions, renal recovery or mortality between the treated group and the control (Table 2). A conditional regression analysis found phosphate, Hb on admission, CRP at the end of the hospitalization, the need for transfusions, the absence of renal recovery and inotrope use as factors associated with mortality (OR = 1.34, 95% CI 1.09–1.63; P = 0.004; OR = 0.61, 95% CI 0.41–0.92; P = 0.018; OR = 1.014, 95% CI 1.005–1023; P = 0.003; OR = 4.48, 95% CI 1.53–13.07; P = 0.006; OR = 22.1, 95% CI 6.36–76.74; P CONCLUSION EPO treatment in patients with AKI and anemia has no significant impact on transfusion need, renal recovery or death.

AIM Febuxostat is initiated in chronic kidney disease (CKD) patients to lower uric acid but without any renal dosing scheme. This study aimed to determine a formula that predicts the effective dose of febuxostat in patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min and asymptomatic hyperuricemia. MATERIALS AND METHODS This is a retrospective analysis of 100 CKD patients treated with febuxostat for asymptomatic hyperuricemia in two private Lebanese clinics. Patients with gout were excluded. Collected variables were age, sex, weight, serum creatinine, serum uric acid (sUA) before and after febuxostat, dose of febuxostat used, and diuretic use. Multiple regression analysis was used to derive a formula predicting the dose of febuxostat based on eGFR (2009 Chronic Kidney Disease Epidemiology Collaboration equation), baseline sUA, and sUA reduction ratio. A prospective cohort of 24 patients was then used to validate the derived model. RESULTS 100 patients were included with a median age of 71.5 years (interquartile range (IQR), 64.2 - 79.0); 69% were men. Median baseline sUA was 9.1 mg/dL (IQR, 8.4 - 10.1). Mean eGFR was 31.80 ± 12.96 mL/min/1.73m2. Of the included patients, 18% had CKD stage 3a, 36% had CKD stage 3b, 38% had CKD stage 4, and 8% had non-dialysis CKD stage 5. A formula was computed to predict febuxostat dosing. Variables that were predictive of febuxostat dose and used in the final equation were eGFR, diuretic use, baseline sUA, and sUA reduction ratio. The validation cohort showed no significant difference between the expected sUA and the measured one (p = 0.16). CONCLUSION With this new formula, physicians can initiate febuxostat in CKD patients at an effective dose for any desired sUA reduction ratio.

Functional MRI (fMRI) is gaining importance in the preoperative assessment of language. Selecting the appropriate language to test by fMRI in trilingual patients is intricate. Our objective is to compare fMRI maps for all three languages in left- and right-handed trilingual subjects. 15 right- and 15 left-handed trilingual volunteers were included in the study. We performed fMRI for each volunteer with a visual responsive naming paradigm that was repeated three times, once in each language. The activated areas and the laterality indices were calculated and correlation with the age of acquisition and proficiency of each language was determined. Strong statistical correlation was found between the Laterality Index (LI) of the three languages, in both the right and left-handed groups. Discordant lateralization of language was only observed in four left-handed subjects who demonstrated bilateral and left-lateralization. In right-handed subjects, the activation maps for the first and the second acquired language were similar. The largest activation was seen with the last acquired language. Irrespective of language proficiency and age of acquisition, the language lateralization might change for left-handed subjects. In right-handed subjects, there is no change and the last acquired language results in the largest activation. fMRI performed for a single language can accurately determine language lateralization in right-handed subjects, whereas in left-handed subjects, it is mandatory to test all languages.

Background Treatment with erythropoietin is well established for anemia in chronic kidney disease patients but not well studied in acute kidney injury. Methods This is a multicenter, randomized, pragmatic controlled clinical trial. It included 134 hospitalized patients with anemia defined as hemoglobin n = 67) and the second received standard of care (control; n = 67) during the hospitalization until discharge or death. The primary outcome was the need for transfusion; secondary outcomes were death, renal recovery, need for dialysis. Results There was no statistically significant difference in transfusion need (RR = 1.05, 95%CI 0.65,1.68; p = 0.855), in renal recovery full or partial (RR = 0.96, 95%CI 0.81,1.15; p = 0.671), in need for dialysis (RR = 11.00, 95%CI 0.62, 195.08; p = 0.102) or in death (RR = 1.43, 95%CI 0.58,3.53; p = 0.440) between the erythropoietin and the control group. Conclusions Erythropoietin treatment had no impact on transfusions, renal recovery or mortality in acute kidney injury patients with anemia. The trial was registered on ClinicalTrials.gov (NCT03401710, 17/01/2018).

Purpose: Anorexia nervosa (AN) is a serious mental illness that is frequently accompanied with a history of childhood maltreatment (CM) which may constitute a specific ecophenotype of the eating disorder necessitating special assessment and management. Chronic stress inflicted by CM in patients with AN may manifest through increased low grade inflammation reflected by an increase in ratios from white blood cells count such as neutrophils to lymphocytes ratio (NLR) platelets to lymphocytes ratio (PLR) and monocytes to lymphocytes ratio (MLR). Methods: N=206 participants were evaluated in an eating disorders daycare unit in Montpellier, France between March 2013 and January 2020. CM was assessed using childhood trauma questionnaire (CTQ). AN clinical severity was assessed using eating disorder examination (EDE-Q). The MINI was used to assess other clinical characteristics. Results: NLR has been found to be higher in patients with AN and a history of CM (p=0.029) as well as in patients with AN and a history of emotional abuse (p=0.021) when compared to patients with AN and without a history of CM. In the multivariate analysis, emotional abuse (β=0.17; p=0.027) contributed significantly to NLR’s variability. Conclusion: NLR is a low grade inflammation marker that is influenced by multiple sociodemographic, clinical and biological factors in patients with AN. It is more directly affected by certain subtypes of CM, especially emotional abuse than by the presence or absence of a history of CM. Future studies may focus on mediators between CM and increased inflammation such as interoceptive awareness, emotional dysregulation, food addiction and stress-sensitization.Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies

Perioperative anemia is common in cardiac surgery. Few studies investigated the effect of postoperative intravenous (IV) iron supplementation and were mostly inconclusive.Design: A randomized single-center, double-blind, placebo-controlled, parallel-group trial.195 non-anemic patients were recruited from December 2018 to December 2020: 97 patients received 1 g of ferric carboxymaltose (FCM) and 98 patients received 100 mL of physiological serum on postoperative day 1.hemoglobin levels, reticulocyte count, serum iron, serum ferritin, and transferrin saturation were measured at induction of anesthesia, postoperative days 1, 5, and 30. Transfusion rate, duration of mechanical ventilation, critical care unit length of stay, and side effects associated with IV iron administration were measured. The primary outcome was hemoglobin level on day 30. Secondary outcomes included iron balance, transfused red cell packs, and critical care unit length of stay.At day 30, the hemoglobine level was higher in the FCM group than in the placebo group (mean 12.9 ± 1.2 vs. 12.1 ± 1.3 g/dL (95%CI 0.41-1.23, p-value0.001)). Patients in the FCM group received fewer blood units (median 1[0-2] unit vs. 2 [0-3] units, p-value = 0.037) and had significant improvement in iron balance compared to the control group. No side effects associated with FCM administration were reported.In this randomized controlled trial, administration of FCM on postoperative day 1 in non-anemic patients undergoing cardiac surgery increased hemoglobin levels by 0.8 g/dL on postoperative day 30, leading to reduced transfusion rate, and improved iron levels on postoperative day 5 and 30.NCT03759964.

Early evidence from China suggested that blood groups may be involved in susceptibility to COVID‐19. Several subsequent studies reported controversial results. We conducted a retrospective matched case‐control study that aims to investigate the association between blood groups and the risk and/or severity of COVID‐19. We compared the blood groups distribution of 474 patients admitted to the hospital for COVID‐19 between March 2020 and March 2021, to that of a positive control group of outpatients infected with COVID‐19 and matched them for sex and age, as well as to the distribution in the general population. Three hundred and eighteen HC+ pairs with available blood group information were matched. The proportion of group A Rh+ in hospitalized patients (HC+) was 39.9% (CI 35.2%–44.7%), compared to 44.8% (CI 39.8%–49.9%) and 32.3% in the positive outpatient controls (C+) and the general population (C−), respectively. Both COVID‐19‐positive groups (HC+ and C+) had significantly higher proportions of group A Rh+ compared to the general population (p = 0.0019 and p

Introduction Several studies have shown that COVID-19 pandemic has a negative impact on type 2 diabetic mellitus (T2DM) patients’ quality of life (QoL). However, very few studies were performed in Middle Eastern countries. Aim The aim of the current study was to assess, the QoL and diabetes-specific QoL, treatment satisfaction and psychological distress of Lebanese patients with T2DMs using: the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and Kessler 10 (K10) questionnaires and to compare results to those obtained during the pre-COVID-19 period. Results 461 patients with T2DM participated in the study; 52.6% men, 47.4% women; median age 59 years old. The respective median ADDQoL and DTSQs scores were − 2.2 (interval interquartile range (IQR) − 3.9, − 0.8) (range from − 9 maximum negative impact to + 3 maximum positive impact) and 30(IQR22-36) (range from 0 maximum dissatisfaction to 36 maximum satisfaction). K10 median score was 26(IQR18-35) (range from minimum score of 10 indicating no distress to maximum score of 50 indicating severe distress). Rural dwelling, lack of exercise, current smoking, diabetic complications, injectable diabetes treatment, and previous COVID-19 infection were all associated with significantly worse ADDQoL, DTSQs, and K10 score indicating greater distress. A significant worsening of ADDQoL scores followed onset of the pandemic with no significant change in DTSQs scores. Conclusion During the COVID-19 pandemic, T2DM Lebanese patients experienced more negative impact of diabetes on QoL and mental health. Those infected with COVID-19 also reported worse QoL, treatment satisfaction and mental health. This highlights the need for community and individual support.

Background Chronic kidney disease (CKD) is the 12th leading cause of death worldwide. Cost-of-illness studies of CKD are scarce in developing countries. This study aims to estimate the cost of illness of all stages of CKD in Lebanon, from early stages until dialysis and kidney transplantation. The secondary objective is to identify factors related to the highest financial burden. Methods This is a cross-sectional study of CKD patients who presented to two nephrology clinics during November 2020. Their medical and administrative records were reviewed for collection of demographics, CKD characteristics, direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. Logistic regression analysis was used to evaluate risk factors associated with costs. Results The sample included 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 transplant patients. Their mean age was 66.74 ± 15.36 years, 57.5% were males and 42.5% diabetics. The total median cost per year of CKD across all categories was assessed to be 7,217,500 Lebanese Pounds (3,750,000–35,535,250; 1 $USD = 1515 LBP in 2019) from the societal perspective and 5,685,500 LBP (2,281,750- 32,386,500) from the third-party payer perspective. Statistical analysis showed a higher total cost in hemodialysis (p p p r = -0.391, p = 0.013); the regression analysis found diabetes as a risk factor for higher cost (OR = 2.3; 95%CI: 0.638,8.538; p = 0.201). In the subcategory of CKD-ND patients, age correlated with total societal cost (r = 0.323, p = 0.001); diabetes and coronary artery disease were significantly associated with higher total cost (OR = 2.4; 95%CI: 1.083,5.396; p = 0.031; OR = 3.7; 95%CI: 1.535,8.938; p = 0.004). Conclusions This cost of illness study showed a high burden of hemodialysis and peritoneal dialysis cost compared to transplant and non-dialysis CKD patients. It revealed a significantly higher cost of medications in transplant patients. Health policies should target interventions that prevent end-stage kidney disease and encourage kidney transplantation.

IntroductionThe biological actions of vitamin D are mediated through vitamin D receptor (VDR). Numerous single-nucleotide polymorphisms (SNPs) in the VDR gene have been identified, and some have been associated with cardiovascular disease (CVD) risk factors. This study aims to evaluate the association of five SNPs in the VDR gene with 25-hydroxyvitamin D (25[OH]D) levels in patients with at least one CVD risk factor.Material and methodsGenomic DNA was sequenced using standard Sanger methods for five VDR SNPs (BsmI rs1544410; ApaI rs7975232; Cdx2 rs11568820; TaqI rs731236; FokI rs2228570) in 50 Mediterranean subjects having hypovitaminosis D with at least one documented CVD risk factor, aged 18 years or more. The collected variables were serum levels of (25[OH]D), HbA1c, fasting plasma glucose, triglycerides, LDL cholesterol, and total cholesterol.ResultsBsmI, ApaI, and TaqI were moderately to highly intercorrelated. Cdx2 was less frequent than expected. With respect to the number of mutations in FokI, levels of (25 [OH]D) were 11.2 ±5.5 ng/ml in the absence of mutations, 12.6 ±4.7 ng/ml in the presence of one mutation, and 16.5 ± 5.5 ng/ml in the presence of two mutations.ConclusionsFokI polymorphism is more frequent in subjects with cardiovascular risk factors than in the general Caucasian population.

Highlights • Taller-than-wide thyroid nodules are more likely to require surgery. • A taller-than-wide, solid and hypoechoic thyroid nodule is likely a Bethesda 4 or 5. • Taller-than-wide sonographic sign is the strongest in predicting thyroid malignancy., Purpose To develop a Classification and Regression Tree (CART) model in order to recognize the most suspicious sonographic features of thyroid nodules and efficiently guide their management. Methods 791 thyroid fine needle aspiration cytology (FNAC) performed under ultrasound guidance between January 2015 and January 2017 were reviewed. Retrieved data consisted in qualitative (patient’s gender, composition, echogenicity, shape, margins and echogenic foci of the nodule) and quantitative (patient’s age and maximal diameter of the nodule) variables as well as the Bethesda score. Results Patients were 48.5 ± 13.7 years old with female to male ratio of 8:2. The nodules had median size of 2.3 (1.5–3.5) cm with a majority of solid (62.5 %) and isoechoic (50.8 %) features. 700 nodules (88.5 %) had a wider-than-tall shape, 600 (75.9 %) smooth margins and 113 (14.3 %) ill-defined ones. Echogenic foci were absent in 388 nodules (49.1 %) and, when present, largely dominated by punctate foci (32.5 %). Bethesda classes 3, 4 and 5, which require surgery, represented only 10.6 % of cases. They were significantly correlated with the taller-than-wide shape and with solid or predominantly solid features. There was no significant correlation between echostructure and Bethesda scores but we did find more nodules classified Bethesda 4 and 5 in the categories hypoechoic and severely hypoechoic. In the CART model we developed, the sequence leading to most nodules classified Bethesda 4 and 5 is: taller-than-wide shape, solid composition and hypoechoic or severely hypoechoic feature. Conclusions Taller-than-wide, solid or predominantly solid, hypoechoic or severely hypoechoic nodules are likely to require surgery and might benefit from FNAC.