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Background/Objective Stroke symptoms in the absence of diagnosed stroke are common worldwide and associated with stroke risk factors and great impact on the physical and mental health functioning. The aim of this study was to assess, at the national level, the association of stroke symptoms with mental and physical health. Methods Quality of life was assessed using physical and mental component summary scores (PCS and MCS) of the Short Form 12v2 Health Survey in the Lebanese population. We assessed the differences in the mean PCS and MCS scores among asymptomatic individuals with no stroke/transient ischemic attack (TIA) history (n = 1167), symptomatic individuals with no stroke/TIA history (n = 125) and those with stroke/TIA history (n = 46). Psychometric properties of the Lebanese version of the SF- 12v2 were evaluated using principal component analysis . Results Symptomatic individuals had an average PCS scores of 2.31 (95%CI: 0.75–3.88) points lower and those with stroke/TIA history had 3.26 (95%CI: 1.01–5.51) points lower when compared with asymptomatic individuals with no stroke/TIA history. Similarly, MCS scores for symptomatic individuals were 2.58 (95%CI: 1.02–4.13) points lower and those with stroke/TIA history had 3.28 (95%CI: 1.06–5.50) points lower than asymptomatic individuals. Conclusion Physical and mental health functioning declined among symptomatic individuals and those with stroke/TIA history. Thus, frequent monitoring for the early detection of stroke symptoms may be recommended.

The World Health Organization declared waterpipe smoking as a growing public health concern. Our study aimed to assess waterpipe smoking knowledge and attitude among current waterpipe smokers in comparison with nonsmokers and to evaluate its association with current and cumulative waterpipe smoking. A cross-sectional study was carried between May and December 2018 using a multistage cluster sample across Lebanon. Nonsmokers or exclusive current waterpipe smokers were eligible to participate. A total of 4046 adult individuals participated in the study, 38.3% (n = 1550) being current waterpipe smokers. Current waterpipe smoking was positively associated with female gender [adjusted odds ratio (aOR) 1.79, 95%CI 1.40-2.28] and having a mother who is a regular smoker (aOR 1.47, 95%CI 1.15-1.88) while it was negatively associated with better knowledge about waterpipe smoking harm (aOR 0.95, 95%CI 0.93-0.97) and positive attitude toward waterpipe smoking ban (aOR 0.98, 95%CI 0.96-0.99). Cumulative waterpipe smoking was negatively associated with female gender (β = - 0.012), higher education level (β = - 0.28), and positive attitude toward WPS ban (β = - 0.06). Waterpipe smoking is largely present among the Lebanese population, with waterpipe smokers showing lower knowledge about harm and more intolerant attitude about banning. Health awareness supported by media campaigns and governmental initiatives should be conducted to educate people and change their perceptions regarding waterpipe smoking.

Introduction: Comorbidity has been shown to increase length of stay (LOS), and mortality in diabetic patients. However, in Lebanon there is no data that studies the impact of comorbidity on mortality. Our aim was to assess whether comorbid conditions affect LOS and mortality in the sample under study. Study Design and Setting: A case-control retrospective pilot study was undertaken using data of patients admitted to Rafik Hariri University Hospital for six months. Comorbidity information was collected using Charlson Comorbidity Index (CCI), and Cumulative Illness Rating Scale (CIRS). Bivariate and multivariate analyses were conducted. Results: We studied 361 patients (33.2% were diabetic). In comparison to non-diabetic patients, diabetic patients had more comorbidity (5.28 vs 4.04; p

Background Lebanon, a developing Middle Eastern country, was hit by the COVID-19 pandemic that occurred amid a severe national economic crisis. Community pharmacists are responsible for dispensing appropriate medications and products in addition to counseling, informing and educating the public, and promoting disease prevention and infection control. Objective This study aimed to assess community pharmacists' knowledge, attitude, and practice towards the COVID-19 pandemic and evaluate behavior changes and safety measures. Methods An anonymous and standardized online questionnaire in English was disseminated via social media platforms to Lebanese community pharmacists. The questionnaire consisted of 95 items designed as Likert-scales and multiple-choice questions divided into four different sections: socio-demographic characteristics, knowledge-based, attitude-based, and pharmacy practice questions. Descriptive statistical analysis was used to summarize the demographic characteristics, and indices were created for knowledge, attitude, and practice by computing the correct answers for each section. Results A total of 310 questionnaires were completed. Around 61% have expressed their fear of getting infected with COVID-19 due to occupational exposure. The respondents were able to answer 80–90% of the knowledge-based questions of the survey. A more careful/anxious attitude, but not knowledge, was associated with overall better practice (p = 0.03). Also, respondents stated that they are dispensing protective equipment items such as masks (87%), gloves (60%), and sanitizers (77%) in small quantities due to limited availability. Conclusion Our findings revealed an adequate level of knowledge and good practice towards COVID-19 among Lebanese community pharmacists. Their fears of contracting the virus and compromising the safety of those around them are justified. However, their supply of protective equipment is limited.

Purpose To assess the knowledge, attitudes, and practices toward the coronavirus disease 2019 (COVID-19) among nurses in Lebanon. Methods An online questionnaire was completed by 311 Lebanese nurses between March and April 2020. Results Only 2% of nurses worked in a specialized COVID-19 ward and 20% have cared for a COVID-19 patient. The majority had sufficient knowledge of COVID-19; 62% declared being afraid of getting infected whereas 90% were afraid for their family members to get infected due to their occupational exposure. The majority of nurses (84.6%) declared following infection prevention and control precautions. Protective equipments were available in limited amounts in hospitals. Practice implications Nurses in Lebanon seem to have a satisfactory level of knowledge about COVID-19. Their safety and well-being remain a priority in this critical period.

Background Cardiovascular diseases (CVDs) are linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution to CVD, but results are inconsistent. Our objective was to assess this association in Lebanon, a Middle Eastern country. Methods A national cross-sectional study was conducted across Lebanon. CVD prevalence, which included prevalent ischemic heart and cerebrovascular diseases, was assessed. Moreover, in addition to self-reported items of pollution exposure, we assessed potential predictors of CVD, including sociodemographic characteristics, self-reported health information, and biological measurements. Results We assessed the dose-effect relationship of pollution items in relation with CVD. Self-reported indoor and outdoor pollution exposures were associated with CVD, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (44% increase in risk of CVD for every additional pollution exposure item), after adjustment for sociodemographic and biological characteristics. Conclusion Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of pollution on chronic diseases and the work of reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.

Arterial hypertension is a leading risk factor for cardiovascular disease and stroke. This study aimed to assess the predictors of uncontrolled systolic and diastolic blood pressure (BP) in Lebanon among treated hypertensive individuals. The authors included 562 participants 40 years and older. The potential predictors included sociodemographic characteristics, self‐reported health information, and medication adherence. Prevalence of uncontrolled systolic and diastolic BP reached 43.1% and 24.9%, respectively. Independent predictors of uncontrolled systolic BP were older age, male sex, and low and medium medication adherence level. Predictors of uncontrolled diastolic BP were younger age, obesity, and low medication adherence level. Married individuals and patients taking statins had better diastolic BP control. Uncontrolled BP is a major public health problem in Lebanon. The authors identified low adherence as a major modifiable risk factor for systolic and diastolic BP control and obesity as a major modifiable risk factor for diastolic BP control.

Hypertension is a risk factor of several diseases, linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution exposure items to hypertension, but results were inconsistent. Our objective was to assess the association of living conditions related to air pollution to hypertension in Lebanon, a Middle Eastern country. A national cross-sectional study was conducted all over Lebanon. Blood pressure and its related medications were assessed to be able to classify participants as hypertensive or not. Moreover, in addition to living conditions related to air pollution exposure, we assessed potential predictors of hypertension, including sociodemographic characteristics, self-reported health information and biological measurements. Furthermore, we assessed dose-effect relationship of air pollution items in relation with hypertension. Living conditions related to indoor and outdoor air pollution exposures were associated with hypertension, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (15% increase in risk of disease for every additional pollution exposure item), after adjustment for sociodemographics and biological characteristics (Ora = 1.15 [1.03-1.28]). Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of air pollution on chronic diseases. The work on reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.

Summary: Introduction: Indiscriminate use of antibiotics contributes to a global spread of antimicrobial resistance. Previous studies showed an excessive consumption of antibiotics purchased without medical prescription from community pharmacies, mainly in developing countries.There is a shortage of studies revealing the role of community pharmacists in the overuse of antibiotics. Our objective is to study the dispensing policy of non-medical prescription antibiotics in community pharmacies, assessing the possible influence of the socio-economic level of the area over this practice. Methods: A cross-sectional study was conducted between February and May 2011 among 100 pharmacists working in Beirut's pharmacies and its suburbs. Pharmacies were divided into 2 groups according to the socio-economic level of the population living in the pharmacy area. A self-administered questionnaire was filled by pharmacists. Results: Over-the-counter antibiotic availability existed in both higher and lower socio-economic areas: on the whole, 32% of antibiotics were dispensed without medical prescription, with higher frequency in lower socio-economic areas (p = 0.003). Dispensing injectable antibiotics without medical prescription was significantly higher in lower socio-economic areas (p = 0.021), as well as dispensing an association of 2 antibiotics without medical prescription (p = 0.001). Pharmacists working in lower socio-economic areas recommended more frequent antibiotics to children and the elderly (p

International audience; There is limited epidemiologic data on hypertension (HTN) in Lebanon. This study aimed to determine the prevalence and associated risk factors of HTN in the adult Lebanese population and evaluate the association between dietary and psychological factors on systolic blood pressure (SBP). Cross-sectional analyses were conducted using a multistage cluster sample across Lebanon. A total of 2014 participants were included. The prevalence and control rates of HTN were 31.2% and 28.7%, respectively. In women, educational level and physical activity were negatively associated with HTN (P < .05 for both) and adherence to the Lebanese Mediterranean diet was associated with a lower SBP. Other factors were associated with HTN in men. There was no relationship with SBP and psychological distress. Of the modifiable risk factors, body mass index persisted as the only contributory factor in both sexes (P < .01). Accordingly, prevention of HTN at the population level should focus mainly on overweight prevention.

In the last few years, a significant increase in the number of patients with aortic stenosis requiring surgical or transcatheter aortic replacement (SAVR) or (TAVR) has been observed due to the larger aging population. Conduction disturbances requiring permanent pace maker implantation (PPMI) has been observed after SAVR and TAVR. In fact the incidence of PPMI following SAVR reached 11 to 13% while it occurred in7 to 36% of patients undergoing TAVR. The majority of rhythm problems are secondary to a significant trauma to the conduction system. In order to decrease the incidence of PPMI in patients undergoing SAVR, we developed a modified technique of SAVR that we applied on a group of 63 patients (group B) and we compared the incidence of PPMI in this group to the one observed in a second group of 62 patients who underwent the classic SAVR (group A). It was significantly lower in group B (3.2% vs 14.5%). In conclusion, The low incidence of PPMI (3.2%) observed in the modified SAVR group encourages us to recommend this technique in all patients undergoing biological SAVR especially that this technique is simple to apply highly reproducible and reliable. However, further multicenter and larger studies will help confirm our findings.

Rouba Karen Zeidan,1 Rita Farah,2 Mirna N Chahine,3 Roland Asmar,3 Hassan Hosseini,4,5 Pascale Salameh,6,7 Atul Pathak8 1Doctoral School of Biology Health and Biotechnologies, Toulouse III University, Toulouse, 2Doctoral School of Life and Health Sciences, Paris-Est University, Creteil, France; 3Foundation-Medical Research Institutes, F-MRI®, Beirut, Lebanon; 4Department of Neurology, Henri Mondor Hospital AP-HP, 5EA 4391, Nerve Excitability and Therapeutics, Université Paris-Est, Creteil, France; 6School of Pharmacy, Lebanese American University, Byblos, 7Laboratory of Clinical and Epidemiology Research, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon; 8Department of Cardiovascular Medicine, Hypertension, Risk Factors and Heart Failure Unit, Clinique Pasteur, Toulouse, France Background: Lebanon is experiencing a growing epidemic of coronary heart diseases (CHDs), as most low- and middle-income countries currently are. However, this growth can be attenuated if effective preventive strategies are adopted. Purpose: To provide the first national population-based prevalence of CHD and to describe the profile of Lebanese adults with prevalent CHD. Methods: We carried out a cross-sectional study using a multistage cluster sample across Lebanon. We interviewed residents aged 40 years and older using a questionnaire that captured the presence of CHDs and their risk factors (RFs). Results: Our study showed that 13.4% of the Lebanese population aged ≥40 years suffer from a prevalent CHD. CHD seemed to appear more prematurely than in developed countries, and males seemed to be more subject to CHD than females until a certain age. CHD was associated with older age, male sex, a lower economic situation, hypercholesterolemia, hypertension, having a family history of premature cardiovascular diseases, and suffering from diabetes. However, smoking and waist circumference did not seem to have an independent effect on CHD, but rather an effect mediated by biological RFs. Conclusion: This is the first nationwide endeavor conducted in Lebanon to assess the prevalence of CHD. This study also confirms the relevance of the classic RFs of CHD and their applicability to the Lebanese population, thus allowing for prevention strategies. Keywords: coronary heart disease, correlates, epidemiology, prevalence, risk factors

Background Stroke symptoms are common among people without a history of stroke or transient ischemic attack. Reported stroke symptoms may represent stroke episodes that failed to reach the threshold for clinical diagnosis. Aims This study aimed to assess in the Lebanese population the prevalence of self-reported stroke symptoms in a stroke-and transient ischemic attack-free population, and the association of these symptoms with major risk factors for stroke. Methods We carried out a cross-sectional study using a multistage cluster sample across Lebanon. We interviewed residents aged 40 years and more. Stroke symptoms were assessed using the Questionnaire for Verifying Stroke-Free Status. Results We included 1515 individuals (mean age was 57.2 ± 12.4 years, 783 women, 51.7%). Among 1460 participants stroke- and transient ischemic attack-free, 175 had experienced at least one stroke symptom (12.1%, 95% CI 9.9%-14.3%). Arterial hypertension (adjOR 4.37, 95% CI 2.68-7.12), history of heart disease (adjOR 3.34, 95% CI 2.00-5.56), current waterpipe smoking (adjOR 3.88, 95% CI 2.33-6.48), current and former cigarette smoking (adjOR 1.84, 95% CI 1.18-2.87 and adjOR 2.01, 95% CI 1.13-3.5, respectively), psychological distress (adjOR 1.04, 95% CI 1.02-1.05), the Mediterranean diet score (adjOR 0.87, 95% CI 0.76-0.99), and regular physical activity (adjOR 0.45, 95% CI 0.26-0.77) were independently associated with stroke symptoms. Conclusions This is the first study conducted in the Middle East, assessing self-reported stroke symptoms among stroke-free residents. Our study showed that almost one in eight residents without a history of stroke or transient ischemic attack has had stroke symptoms. Major vascular risk factors are associated with these symptoms, thus allowing for prevention strategies.

Glutathione (GSH) is known to play a role in cellular sensitivity to some chemotherapeutic agents and to radiation. Depletion of cellular GSH has been demonstrated to result in enhanced toxicity of these drugs, and this approach is being explored in the clinic as a form of biochemical modulation, using the drug buthionine sulfoximine (BSO). The fact that some drug-resistant cell lines have increased glutathione levels, and that enhancing GSH concentrations in animal tissues protects against a variety of xenobiotic agents, suggest a different potential approach to improving anti-cancer therapy. We have examined the efficacy of the cysteine "pro-drug" L-2-oxothiazolidine-4-carboxylate (OTZ) at enhancing normal tissue versus tumor GSH. Animals were treated with OTZ or BSO, and the concentrations of GSH in normal tissues and tumor were measured. We found that the presence of the tumor itself decreased bone marrow GSH, but that OTZ significantly increased it in this setting. Interestingly, OTZ administration significantly depleted tumor GSH levels to the same level as did BSO. OTZ could offer a selective biochemical modulation of GSH.