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Background Migraine constitutes a major public health concern since it negatively affects both the quality of life and the productivity of patients. Migraine among students can cause impaired academic performance and limit their daily activities. Objective This study aims to assess the prevalence of migraine among university students using the ID Migraine screening tool and to evaluate risk factors associated with migraine. Methods A cross-sectional study was performed over a period of six months targeting 1144 university students recruited from the different faculties. Results Migraine was suggested in 35.8% of subjects based on ID-Migraine. Migraine prevalence was significantly higher among women (42% versus 23.3% of men). After adjusting for covariates, women, daily coffee consumption, having unorganized meals, eating fast food and fasting were the main predictors of migraine. Almost 41% of migraine students had a family history of migraine and only 26.7% sought medical help. Interestingly, most of the migraine students (84.8%) took headache medications without referring them to their doctor. Conclusion Recognizing headache risk factors among migraine students and adopting lifestyle changes accordingly can be an effective strategy to prevent the chronification of the attacks, decrease headache frequency and improve patients’ quality of life.

The goal of epilepsy treatment is to control seizures without drug related problems (DRPs). The evaluation of anti-seizure drugs (ASD) strategies and identification of DRPs are rarely studied. This study aimed primarily to evaluate the choice of ASD according to international guidelines and secondarily to identify and describe anti-seizure drug-related problems.A cross-sectional study was conducted during 1 year among Lebanese adults with epilepsy attending neurology clinics. The choice of ASD was compared to National Institute for Health and Care Excellence guidelines. Drug-drug interactions were evaluated by the Lexicomp database, and the DRP classification was performed using the Pharmaceutical Care Network Europe classification.A total of 404 patients with epilepsy were included. The prescription for an ASD was in accordance with the indication set in guidelines in 75.0% of population, and 1078 DRPs were identified. The main DRPs detected were adverse drug reactions (51.0%), inappropriate combinations of drugs (50.0%), and suboptimal drug regimens (46.3%). Single and divorced patients, who living in Mount Lebanon, and who took the old with the new generation had a less risk to have an inadequate prescription to guidelines. However, female gender, controlled epilepsy, multiple ASDs, and living in a rural region increased DRPs.This study showed that quarter of the population used ASDs contraindicated according to international guidelines. Since DRPs were related to the number and type of ASD prescribed, it is important to assess the case of each patient by a clinical pharmacist to prevent drug-drug interactions and iatrogenic issues.

Objectives This study aimed to investigate the willingness to pay (WTP) for a hypothetical vaccine and its associated determinants among the Lebanese general population during one of the peak episodes during the coronavirus disease 2019 (COVID-19) pandemic in Lebanon. Methods An online survey was developed and delivered to the Lebanese general population. The questionnaire included the participants’ sociodemographic characteristics, financial situation, attitude toward vaccination, and WTP for the hypothetical vaccine. The study was based on the contingent valuation method. Results Among 500 individuals solicited, 352 individuals agreed to participate (participation rate = 70.4%); among them, 66% were between 18 and 45 years old, and 54% were women. Notably, 78.1% of the respondents were ready to pay for this hypothetical vaccine even if the vaccine will not be covered. The maximum WTP of the Lebanese population was approximately $60 ± $66 (range $3-$500) after excluding extreme values in the sensitivity analysis and ranged between $3 and $500. WTP was associated with the severity of COVID-19 (P

Background: This study aims to estimate the knowledge, attitude, and practices of patients with diabetes towards the disease and to assess the predictors of a higher awareness of diabetes. Methods: A multi-center cross-sectional study was performed targeting 384 patients from five endocrinology clinics in Lebanon. A self-reported survey was developed and validated and an awareness score was generated. Results: Around 18% of patients reported that they stopped taking diabetes medication when feeling good and 21.1% stopped them when in bad health status. In the case of hyperglycemia, 16.6% said that they doubled the dose of medication, and 14.6% stopped taking it when fasting. The mean awareness score of patients was 15.7±3.9 over 25. After adjusting for covariates, The odds for higher awareness were 2.24 and 3.11 times higher among patients with higher education levels. These odds were 38% lower among patients with medical assistance at home. Physical activity significantly increased the odds of high awareness than those not practicing. Conclusion: Moderate awareness was noted among patients with lower knowledge of the symptoms of diabetes and good practices. Practice implications: Based on the findings of this study, healthcare stakeholders can explore the knowledge gaps and promote targeted interventions.

Pharmaceutical interventions can reduce negative outcomes related to potentially inappropriate prescriptions (PIPs).The objective of this study was to compare the impact of interventions on the reduction of PIPs and on different clinical outcomes using two electronic explicit tools.A randomized controlled trial was conducted in patients hospitalized between 2018 and 2019 at the Acute Care for Elders unit at Lausanne University Hospital in Switzerland. A medication review was conducted using PIM-Check in the first arm and STOPP/START in the second arm. Proposed interventions were communicated to the physicians. Clinical outcomes evaluated were incidence of falls, delirium, activities of daily living (ADL), length of stay, number of drugs at discharge and hospital readmission.The 123 included patients (60 in the first arm and 63 in the second arm) were 86.3 ± 6.6 years old, had 3.5 ± 1.7 diseases and were treated by 6.2 ± 2.7 drugs at admission. There was a significant decrease in PIPs in each arm, but no significant difference between arms. The deprescription of nervous system drugs was significantly higher with STOPP/START than with PIM-Check (Chi-square p = 0.025). ADL scores between home and discharge were significantly higher in the STOPP/START arm than in the PIM-Check arm (4.42 vs 3.77; p = 0.040). The predictors of ADL score improvement were the deprescription of nervous system drugs (β = 0.423; 95% CI 0.034-0.812; p = 0.033), the use of STOPP/START (β = 0.798, 95% CI 0.305-1.290; p = 0.002) and a shorter length of hospital stay (β = -0.033, 95% CI - 0.056 to - 0.010; p = 0.005).Although PIM-Check was non-inferior to STOPP/START in reducing the number of PIPs, STOPP/START had a significantly higher impact on ADL. The use of STOPP/START or the deprescription of two nervous system drugs would allow the patient to acquire almost one more basic function of living. On the other hand, a loss of one point on the ADL score was observed per month of hospitalization.NCT04028583.

People with epilepsy (PWE) face a variety of psychosocial challenges. A lack of knowledge of epilepsy, a high level of depression and anxiety and a low quality of life (QoL) are among the major problems that affect most PWE. The objective of this study was to examine the association of sociodemographic characteristics, clinical factors and knowledge of epilepsy with the level of QoL, and the presence of psychiatric comorbidities.A cross-sectional study was conducted in Lebanon. The PWE were recruited from neurologists' clinics in Beirut and its suburbs. A questionnaire translated into Arabic was used and composed of four parts: sociodemographic factors, clinical characteristics, psychosocial characteristics (QoL, psychiatric disorders), and knowledge epilepsy scale. Backward logistic regression models were developed, the associations were estimated by odds ratio (OR), and the level of significance was set at p ≤ 0.05.Four hundred and four PWE were recruited in this study. About a half of PWE had controlled epilepsy (46.3 %) and 40.3 % had epilepsy for less than 5 years. The QoL was low for 38.6 % of PWE and 30.2 % had psychiatric comorbidities. More than half of PWE had a good level of knowledge (71.5 %). Controlled epilepsy (OR = 1.8; 95 %CI: 1.2-2.9), and good knowledge about epilepsy (OR = 5.5; 95 %CI: 3.4-9.1) were associated with better QoL. Patients on polytherapy with anti-seizure drugs (OR = 0.6; 95 %CI: 0.4-0.9), experienced side effects of anti-seizure drugs (OR = 0.6; 95 %CI: 0.4-0.9) and with psychiatric comorbidities (OR = 0.6; 95 %CI: 0.3-0.9) had a lower QoL. A high number of nonpsychiatric comorbidities (OR = 2.5; 95 %CI: 2.0-3.1) and a polytherapy increased the risk of having psychiatric comorbidities (OR = 1.8; 95 %CI: 1.1-2.8).Good knowledge of epilepsy and the absence of psychiatric comorbidities are important predictors of good QoL in Lebanese PWE. Educational programs are needed to reduce misconceptions about epilepsy and improve mental health of PWE.

What is known and objective Many explicit tools have been developed to reduce prescribing errors and ensure patients' safety. The impact of explicit tools is not well studied. The objective of this study was (a) to conduct a systematic review of systematic reviews listing explicit tools developed to detect prescribing errors and (b) to assess their impact on clinical and economic outcomes. Methods This project includes two related parts. First, a systematic review of systematic reviews listing explicit tools dedicated to geriatrics or internal medicine was performed to develop an exhaustive list of explicit tools. Then, using the list compiled in the first step, a systematic review of randomized controlled trials (RCT) assessing clinical or economic impacts of tools was performed to evaluate their usefulness. Results and discussion The systematic review of systematic reviews identified 49 explicit tools. The systematic review of RCT, using one or more of the 49 explicit tools, identified 5 RCT using explicit tools as intervention (3 STOPP/START and 2 FORTA RCT). The 5 studies evaluated clinical impacts with 3 RCT identifying significant clinical impacts (falls, activities of daily living and/or adverse drug reactions) and 2 STOPP/START RCT identifying significant economic impacts. What is new and conclusion The systematic review of RCT showed that explicit tools can have some effect in improving patients' safety. Further studies are warranted to better characterize their clinical and economic impact.

Background The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is commonly used to measure quality of life (QOL) in patients with heart failure (HF). We examined the psychometric properties and cultural validity of an Arabic version of the MLHFQ. Methods An observational cross-sectional study was conducted with 210 adult HF outpatients. Patients were interviewed with the Arabic MLHFQ and the Patient Health Questionnaire (PHQ-9). Cronbach's alpha coefficient and confirmatory factor analysis were conducted. Patients with different NYHA classes and HF-hospitalization histories were compared on QOL to test known-group validity. Results The confirmatory factor analysis yielded 3 factors: physical, emotional, and social. Three items (4, 8, and 15) had low loadings. The overall Cronbach's alpha coefficient was 0.92. There were significant differences in MLHFQ by PHQ-9 categories, NYHA class, and HF-hospitalization history. Conclusions This Arabic version of MLHFQ is valid and reliable and can be used in Arabic-speaking Lebanese HF populations.

Purpose Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. Methods First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. Results The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. Conclusions By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.

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

ObjectiveTo evaluate factors affecting adherence to oral antidiabetic treatment in the Lebanese population and to develop the Diabetes Medication Adherence Scale (DMAS) based on these factors.MethodsA cross-sectional study was conducted on a sample of Lebanese diabetic patients. Data were collected using a structured questionnaire. The level of adherence was measured using the Lebanese Medication Adherence Scale (LMAS-14). Bivariate analyses and multivariable analysis was done using SPSS. Psychometric evaluation of DMAS included an assessment of internal consistency, factor analysis, evaluation of sensitivity and specificity. Criterion-related validity was assessed by comparison with LMAS-14 measure of adherence.Key findingsA total of 500 patients were recruited. 39.2% were adherent to treatment. Long working hours, increased number of oral antidiabetic medication per day, drug discontinuation when travelling, longer duration of diabetes and treatment burden were among factors that decreased adherence. While understanding the treatment regimen, following up physician recommendations and following up the recommended diet contributed to good medication adherence. The final 7-item scale (DMAS) had a good internal consistency (Cronbach’s α = 0.612) and a good correlation and agreement with LMAS-14 (Spearman’s rho = 0.699, Cohen’s kappa = 0.566). Patients with high DMAS scores were significantly more likely to have controlled glycaemia (P < 0.05). Sensitivity and specificity reached 70.39% and 51.47%, respectively.ConclusionAdherence to oral antidiabetic treatment is suboptimal in Lebanon. The DMAS is a reliable instrument for assessing adherence and predicting poor glycaemic control in clinical practice, but requires further validation in other populations.

Stroke is a major cause of death and adult neurologic disability worldwide. Underdiagnosing a stroke at emergency may have devastating consequences on patients. We aim to develop a diagnosis score for stroke at emergency among the Lebanese population by using stroke risk factors and symptoms. A hospital-based case-control study was conducted for the score generation. Data were collected through a designed data collection sheet at two Lebanese tertiary hospitals between January 1st, 2012 and December 31st, 2014. A logistic regression determined the association of stroke risk factors and symptoms, and the rounded coefficients generated the Diagnosis Score for Stroke (DS-Stroke). Another case-control study was conducted for the score validation. Data were collected through a standardized questionnaire at five different Lebanese tertiary hospitals between January 1st, 2015 and December 31st, 2016. DS-Stroke was validated by comparing it to hospitals final diagnosis. DS-Stroke was constructed with good properties, comprising 7 items. The area under the curve was high at 0.980 (0.969–0.990; p

Non-adherence to medication schedules by patients with chronic illnesses can have serious consequences, including poor clinical outcomes, higher hospitalization rates, and increased healthcare costs. Hypothyroidism is a chronic illness with simple treatment, yet non-compliance is common.This study aimed to evaluate treatment adherence to levothyroxine therapy in Lebanese population by estimating the proportion of adherent hypothyroidism patients and assess factors affecting the adherence to treatment.A cross-sectional survey between May and July 2015 included 337 patients. Patients were approached by a community pharmacist during their visit to buy their levothyroxine drug and were asked to fill the questionnaire.Among these patients, 14.5% showed high adherence, 30.6% medium adherence, and 54.9% low adherence to medication. The mean adherence score was 5.53 ± 1.86 points. The results of a logistic regression showed that age (ORa=1.036), visiting the endocrinologist once every month (ORa=27.77), and the fact that the physician gave the patient information about the disease (ORa=2.898) would significantly increase the adherence to the medication. In addition, having one (ORa=0.365) or two comorbidities (ORa=0.232) in addition to hypothyroidism, postponing/cancelling medical appointments at the last minute (ORa=0.358), the number of waterpipe smoked per week (ORa=0.621) and the number of alcohol glasses drunk per week (ORa=0.631) would significantly decrease the adherence score.Educational programmes should be implemented, doctor-patient and pharmacist-patient relationship could be improved and new treatment regimens be considered in order to enhance patient adherence.الالتزام بتناول ليفوثيروكسين بين المرضى المصابين بقصور الغدة الدرقية في لبنان.سارة الحلو، سهيل هلّيط، سناء عواضة، أمل الحاج، سمر رشيدي، وفاء بواب، باسكال سلامة، سلام زين.يؤدِّي عدم التزام المرضى الذين يعانون من أمراض مزمنة بمواعيد الأدوية إلى عواقب خطيرة، بما في ذلك ضعف المخرجات السريرية ومعدلات أعلى للدخول إلى المستشفى، وارتفاع تكاليف الرعاية الصحية. ويُعَدُّ قصور الغدة الدرقية مرضًا مزمنًا وعلاجه بسيط، ولكن يشيع عدم الالتزام بتناوله.هدفت هذه الدراسة إلى تقييم الالتزام بتناول دواء ليفوثيروكسين بين السكان اللبنانيِّين من خلال تقدير نسبة المرضى بقصور الغدة الدرقية الملتزمين وتقييم العوامل المؤثرة في الالتزام بالعلاج.أُجري استطلاع مقطعي في الفترة بين مايو/أيار ويوليو/تموز 2015 وشمل 337 مريضًا، حيث تحدث الصيادلة المجتمعيون مع المرضى أثناء زيارتهم لشراء دواء ليفوثيروكسين، وطُلب منهم ملء الاستبيان.من بين هؤلاء المرضى، أظهر 14.5 % التزامًا كبيرًا، وأظهر 30.6 % التزامًا متوسطًا، وأظهر 54.9 % التزامًا منخفضًا بتناول الدواء. وكان متوسط درجات الالتزام هو 1.86 ± 5.53 نقطة. وأظهرت نتائج الارتباط المنطقي أن العمر (1.036 = ORa) ، وزيارة أخصائي الغدد الصماء مرة واحدة شهريًا (27.77 = ORa) ، وحقيقة أن الطبيب أعطى المريض معلومات حول المرض (2.898 = ORa) تزيد بشكل كبير من الالتزام بتناول الدواء. إضافة إلى ذلك، الإصابة بحالة مرضية مصاحبة واحدة (0.365 = ORa) أو حالتين (0.232 = ORa) بالإضافة إلى قصور الغدة الدرقية، وتأجيل/إلغاء مواعيد الزيارات الطبية في اللحظة الأخيرة (0.358 = ORa) ، وعدد مرات تدخين النرجيلة (الشيشة) التي تم تدخينها في الأسبوع (0.621 = ORa) ، وعدد كؤوس الكحوليات التي تم شربها في الأسبوع (0.631 = ORa) يؤدي إلى تقليل درجة الالتزام بشكل كبير.يجب تطبيق برامج للتوعية، ويمكن تحسين العلاقة بين الطبيب والمريض وبين الصيدلي والمريض، كما يمكن البحث في نُظُم علاج جديدة لتحسين التزام المرضى بتناول الدواء.Observance du traitement par lévothyroxine chez des patients atteints d’hypothyroïdie au Liban.La non-observance des horaires de prises médicamenteuses par les patients atteints de maladies chroniques peut avoir de graves conséquences, tels que de mauvais résultats cliniques, des taux d’hospitalisation plus élevés et une augmentation des coûts de santé. L’hypothyroïdie est une maladie chronique dont le traitement est simple. Pourtant, la non-observance médicamenteuse est courante.La présente étude avait pour objectif de déterminer l’observance du traitement par lévothyroxine dans la population libanaise en estimant la proportion de patients qui respectent le traitement et en évaluant les facteurs qui affectent l’observance thérapeutique.Une étude transversale conduite entre mai et juillet 2015 incluait 337 patients. Des patients ont été contactés par un pharmacien communautaire lors de leur visite pour acheter leur traitement et il leur a été demandé de remplir un questionnaire.Parmi ces patients, 14,5 % ont montré une observance élevée, 30,6 % une observance moyenne et 54,9 % une faible observance médicamenteuse. Le score moyen d'observance était de 5,53 ± 1,86 points. Les résultats de la régression logistique ont montré que l'âge (ORa =1,036), la visite chez un endocrinologue une fois par mois (ORa=27,77) et le fait que le médecin ait informé le patient de la maladie (ORa=2,898) augmenteraient considérablement l'observance médicamenteuse. De plus, le fait d’avoir une (ORa=0,365) ou deux comorbidités (ORa=0,232) en plus de l'hypothyroïdie, de reporter/d’annuler les rendez-vous médicaux à la dernière minute (ORa=0,358), le nombre de pipes à eau fumées par semaine (ORa=0,621) et le nombre de verres d’alcool consommés par semaine (ORa=0,631) réduiraient considérablement le score d’observance.Des programmes éducatifs devraient être mis en oeuvre, la relation médecin-patient et pharmacien-patient pourrait être améliorée et de nouveaux schémas thérapeutiques devraient être envisagés afin d'améliorer l’observance du patient.

Background/Aims As in all developing countries, there could be a large number of stroke cases that can be prevented provided that individuals at risk are recognized. We aim to develop a score for screening individuals at risk of stroke in the Lebanese population. Methods A hospital-based case-control study was conducted for the score generation. Data were collected through a designed data collection sheet at two Lebanese tertiary hospitals between January 1st, 2012 and December 31st, 2014. A logistic regression determined the association of stroke risk factors with stroke, and the rounded coefficients generated the Risk of Stroke Score (ROSS). Another case-control study was conducted for the score validation. Data were collected through a standardized questionnaire at five different Lebanese tertiary hospitals between January 1st, 2015 and December 31st, 2016. ROSS was validated by comparing it to hospitals final diagnosis. Results ROSS was constructed with good properties, comprising 10 items. The area under the curve was high at 0.869 (0.838–0.899; p 10 points had more than 85.4% positive predictive value of stroke. In the validation study, ROSS had an area under the curve of 0.826 (0.790–0.863; p Conclusion It is highly recommended to use the ROSS, particularly in the primary care setting, as a good assessment tool to predict stroke among high-risk people and encourage them to get involved in intervention programs to prevent this disease.

Objective: The objective of this study was to assess adherence to the Mediterranean diet (MeD) and the risk of stroke in the Lebanese population. Methods: A hospital based case-control study was conducted in Lebanon between January 1st, 2015 and December 31st, 2016. Data were collected prospectively using a standardized questionnaire. Adherence to the MeD was assessed based on the total number of points a patient can have on the MeD scale. Data were analysed using SPSS version 24. The strength of association between the risk of stroke and adherence to MeD was expressed in odds ratio (OR) through 95% confidence interval. P-value

Summary Introduction Since the majority of cancers occur as a result of modifiable risk factors, cancer is being seen more as a preventable disease. The primary objective of our study was to assess the level of awareness of environmental risk factors of cancer among the Lebanese general population. The secondary objective focused on identifying the predictors of the preventability of the disease. Methods We conducted a cross-sectional study between June and July 2020. An online questionnaire was used to collect data pertaining to the knowledge of environmental risk factors of cancer, source of information and personal practice of the participants. Bivariate and multivariate analyzes were performed. Results About 387 respondents agreed to participate in the study. The study showed low awareness regarding infectious agents, lifestyle, diet and many work exposures. The predictors of the attitude of respondents regarding the preventability of cancer were: believing that cancer has an environmental cause (p=.014), not having a healthy lifestyle (p = 0.004), not smoking waterpipe (p = 0.023), being single (p = 0.013), and having a university degree (p = 0.049). Conclusions Efforts should be made to improve awareness of the cancer risk factors regarding infectious agents, lifestyle, diet and many work exposures. This can also be followed by further studies assessing the impact of these community and governmental cancer prevention initiatives on cancer risk factors level of awareness.

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.

International audience; Background: Epilepsy is among the more stigmatising diseases, leading to a negative impact on the quality of life (QoL) of people with epilepsy (PWE). Assessment of the QoL and stigma in PWE reflects the outcome of their disease, and the findings can be used to improve the management of epilepsy. To fill a gap in the literature, our primary aim is to evaluate the QoL and stigma in Lebanese PWE, and our secondary aim is to identify factors affecting these parameters.Material and methods: A cross-sectional study was conducted for 1 year in Greater Beirut. PWE were interviewed by using a standardised questionnaire. QoL was evaluated by the QoL in Epilepsy Inventory-10 (QOLIE-10), and the stigma was evaluated by the Jacoby scale. Multivariate analyses were used to identify the factors associated with QoL and stigma.Results: The sample was 404 PWE. More than half of the PWE (61.4 %) had a better QoL than the other PWE (mean QOLIE-10 score of 26.9 ± 11.3), and 47.8 % of PWE felt stigmatised. Linear regression showed that presence of psychiatric comorbidities (p = 0.03), stigma (p < 0.001), experiencing side effects (p = 0.001), polytherapy (p = 0.002), living in a northern area (p = 0.003), and older age (p = 0.004) were the major factorsassociated with a poor QoL. Logistic regression showed that a low level of QoL (p = 0.005) and experiencing side effects (p = 0.045) were associated with a high level of stigma.Conclusions: An appropriate treatment based on a monotherapy can reduce the risk of side effects, improving QoL of PWE, and decreasing stigma. Furthermore, the management of depression by specialists is an essential step to improve the QoL of Lebanese PWE. Education programmes and information on epilepsy and treatment also play a major role in reducing stigma.

The aim of the Lebanese hospital-based Rheumatoid Arthritis (RA) registry, initiated in 2011, is to evaluate the safety and efficacy of biologic agents among patients seeking care at the American University of Beirut Medical Center (AUBMC). We aimed to characterize the demographic and clinical profile of RA patients included in the Lebanese registry. We compared our results with those issued from Middle Eastern and non-Middle Eastern registries.195 Patients enrolled in the RA registry from 2011 to 2018 were considered in this study. Patients enrolled in the registry were eligible to be treated with biologics, but 56 patients remained biologics naïve. Patients were reassessed every six months.The highest proportion of patients were female (81%). The mean age was 55.53±15 years, and the disease duration was 11.38±7.7 years. RA was diagnosed at a mean age of 44.13±16 years. Almost one-third of RA patients were smokers (29.2%) and 15% consumed alcohol. Comorbidities included cardiac diseases (30.8%), hypertension (24.6%), hyperlipidemia (11.8%), diabetes mellitus (9.2%), and Hypothyroidism (6.2%). Three cases of cancer and seven cases of tuberculosis were reported. The mean of the Disease Activity Score (DAS28) was 3.75 ± 2.28 with no difference according to gender; the mean of the Health Assessment Questionnaire (HAQ) score showed a significant difference between females and males (1.02 ± 0.84 and 0.61 ± 0.7 respectively). Methotrexate was the most commonly used medication. There was non-significant difference in taking biologics according to gender.Our findings are similar to other studies in terms of gender distribution. The higher mean age at diagnosis compared to other populations could indicate a delay in seeking appropriate care. The Lebanese RA registry provides valuable data on pharmacological interventions used and an opportunity to follow up to examine the effectiveness of different therapeutics and to monitor their side effects.

Rheumatoid Arthritis (RA) is a chronic inflammatory disabling disease with significant impact on the Quality of Life (QOL) of patients. Information on the effects of RA on Health-related Quality of Life (HRQoL) is lacking in the Lebanese population. The objective of this study was to evaluate QOL of RA patients compared with non-RA subjects and to suggest possible predictors of their QOL in Lebanon. We conducted a case-control observational study among individuals visiting the external clinics at three hospitals and different private clinics; the QOL was measured using the SF-36 questionnaire administered face to face to the study population, applied to RA (N = 90) and non-RA (N = 180) groups. RA presented lower Physical Component Scores (PCS) and Mental Component Scores (MCS) as well as overall QOL scores. Among RA patients, MCS and QOL were significantly decreased with morning stiffness duration (β = -9.211, p = 0.013 and β = -9.190, p = 0.009, respectively). The frequency of practicing sport per week increases PCS and QOL (β = 6.692, p = 0.002 and β = 6.148, p = 0.003, respectively). Workability has a positive effect on PCS (β = 5.546, p = 0.022) and time between blood transfusion and the onset of the disease has a positive impact on MCS (β = 8.415, p = 0.007). To improve QOL of patients with RA, health professionals have to take these results into consideration while treating their patients.

Background Epilepsy is a common worldwide neurological disorder. For people with epilepsy (PWE), adherence and attitudes towards medication is a crucial step to improve efficacy of prescribed treatment and to prevent seizures. Objectives The first aim of this study was to evaluate attitudes towards antiepileptic medications in Lebanese population. Secondary aims were to assess factors affecting attitudes and associated with epilepsy control. Material and methods A cross-sectional study was conducted in outpatient neurology clinics located in Beirut-Lebanon. Data were collected using a structured questionnaire. Self-report of medication taking behaviors were assessed using the abbreviated (4 items) Morisky Medication Adherence Scale (MMAS-4). Epilepsy was considered as controlled if the patient had no seizures in the last 6 months. Results Among 250 PWE recruited in this study, male-to-female ratio was 0.87 (116/134), and 50.8% were married. Mean duration of epilepsy was 13.7 ± 12.8 years. Valproate was the most common antiepileptic drug (AED) used followed by levetiracetam and carbamazepine. About 60.8% of the population presented partial epilepsy. Uncontrolled epilepsy was present in more than half of participants (55.2%), with only 32.4% had positive attitudes to their medication. Positive attitudes towards antiepileptic increased in people who found that their treatment was efficacious (odds ratio (OR) = 4.9; 95% confidence interval (CI): 1.2–20.0; p = 0.03), who had controlled epilepsy (OR = 3.4; 95%CI 1.6–7.1; p = 0.001), and who were diagnosed as PWE between the age of 12–20 years (OR = 3.1; 95%CI 1.1–8.4; p = 0.03). Oppositely, these attitudes decreased in participants who felt their treatment as an economic burden (OR = 0.2; 95%CI 0.1–0.4; p ≪ 0.001), and in people with depression (OR = 0.4; 95%CI 0.2–0.9; p = 0.04). Controlled epilepsy was higher in people who contacted a neurologist if seizure occurred, in people with positive attitudes, and after a long duration of disease, but it decreased if patient did not follow neurologist's instructions in fasting period. Conclusions Lebanese PWE were less likely to have positive attitudes towards medication, which may lead to poor epilepsy control. Depression and economic burden were the major factors that decreased these attitudes. Identifying factors affecting attitudes to medication and leading to controlled epilepsy may help clinicians to elaborate educational programs to optimize medication adherence.

Cigarette and waterpipe (shisha and hookah) smoking are main public health concerns in Lebanon. We aim to assess the relationship between smoking and stroke, mainly waterpipe smoking, to better apply preventive and therapeutic interventions. A case-control study was conducted at five tertiary private and governmental hospitals in Lebanon between January 1st, 2015 and December 31st, 2016, using a standardized questionnaire. A stepwise ascending logistic regression was conducted. Odds ratio through 95% confidence interval (CI) expressed the degree of association among variables. In total, 650 patients were involved in the study with 205 stroke cases and 445 stroke-free normal individuals considered as controls. The risk of stroke was found to increase significantly among current cigarette smokers; total stroke Odds ratio (OR) = 2.79 (95% CI, 1.72–4.54), ischemic stroke OR = 2.59 (95% CI, 1.46–4.59), and hemorrhagic stroke OR = 4.25 (95% CI, 1.33–13.59). The risk of total and ischemic stroke was also found to increase significantly among current waterpipe smokers; OR 4.99 (95% CI, 2.07–11.99) and 6.25 (95% CI, 2.26–17.39), respectively. Moreover, waterpipe smoking was observed to have a stronger association with stroke in current cigarette smokers than non-smokers. Waterpipe smoking was found to be associated with stroke in this study. Moreover, this association is stronger among cigarette smokers, demonstrating a quantitative interaction between waterpipe and cigarette smoking.

Self-medication (SM), practiced globally, is an important public health problem. This is the first study aiming to determine the prevalence of inappropriate usage of drugs among Lebanese patients, assess their knowledge, and identify predicting factors of potentially inappropriate drug intake. This cross-sectional prospective survey was carried out in five Lebanese governorates. A structured interview was done with patients who visited pharmacies. Data were analyzed using SPSS version 21 (SPSS Inc., Chicago, IL, USA). A multivariate logistic regression was performed to investigate factors associated with SM, which was reported by 79.1% of 930 interviewed cases. The most common symptoms warranting SM were symptoms relating to ear, nose, and throat diseases (99.0%), gastrointestinal symptoms including nausea and vomiting (75.6%), and cold and flu symptoms (60.1%). Age [adjusted odds ratio (ORa) = 1.44; 95% confidence interval (CI), 1.15–1.80; p = 0.002] and sex (ORa = 1.60; CI, 1.16–2.21; p = 0.004) significantly increased the odds of SM. Medication classes commonly consumed by respondents for SM included acetaminophen-based analgesics (48.7%) and nonsteroidal anti-inflammatory drugs (24.6%). Moreover, 83.7% of respondents thought they were knowledgeable about proper dosing of the self-medicated drug (in fact, only 69.0% had adequate knowledge), and 35.5% thought they knew about side effects (assessment showed only 59.5% of them were right). Our study shows that SM is common among Lebanese adults. Hence, reinforcement of laws is necessary to improve access to adequate health care; efforts are needed to increase patients’ education regarding the health risk related to inappropriate consumption of medication.

Scientific research on use and misuse of substances in Lebanon is scarce. This study aimed to evaluate the rate of use and abuse of substances among Lebanese youth and identify the determinants and risk factors behind these behaviours. An observational survey was conducted on 1945 university students selected from the different faculties of the Lebanese University and other private universities. A self-administered questionnaire based on ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) was administered. The prevalence of ever consuming alcohol was 20.9%. Cannabis (12.3%) and tranquilizers (11%) had the highest rates of ever use among the drugs, whereas cocaine (3.3%) and hallucinogens (3.6%) had the lowest rates. Smoking cigarettes and waterpipes, going out at night, peer pressure and having no specific leisure time activity were associated with problematic substance use, while a better relationship with parents, reading and working were inversely associated with use. There is a high prevalence of substance use among university students in Lebanon. Multidisciplinary support for addicted students is needed to meet their diverse needs.

The main objective of this study was to identify the risk factors of dyslipidemia and measure its impact on patients’ quality of life (QOL). Secondary objectives were to determine the percentage of dyslipidemia and assess the predictive factors affecting patients’ QOL. A cross-sectional study was conducted in a sample of Lebanese population. A standardized questionnaire was developed to assess the QOL using the Short form-36 (SF-36) score. A total of 452 individuals were interviewed, of which 59.5% were females. The mean age was 43.3 ± 15.6 years, and 24.8% had dyslipidemia. The results show a lower overall QOL score among dyslipidemic patients compared with controls (57.9% and 76.5%, respectively; p < 0.001). Waterpipe smoking [adjusted odds ratio (ORa) = 4.113, 95% confidence interval (CI): 1.696–9.971, p = 0.002], hypertension (ORa = 3.597, 95% CI: 1.818–7.116, p < 0.001), diabetes (ORa = 3.441, 95% CI: 1.587–7.462, p = 0.002), cigarette smoking (ORa = 2.966, 95% CI: 1.516–5.804, p = 0.001), and passive smoking (ORa = 2.716, 95% CI: 1.376–5.358, p = 0.004) were significantly associated with dyslipidemia in individuals older than 30 years. A higher overall QOL score (p = 0.013) was observed in patients treated with statins in comparison with other lipid-lowering medications. In addition to clinical and economical consequences, dyslipidemia may have a significant impact on patients’ QOL. Further research is needed to confirm the impact of treatment on dyslipidemic patients’ QOL in order to maximize the overall benefits of therapy.

Nosocomial infections are a significant problem and hospitals need to be aware of their nosocomial infection status. This retrospective study aimed to identify nosocomial bacterial infections in patients admitted to the Lebanese Hospital Center from January 2006 to January 2008 and determine the causative micro-organisms, the antibiotic sensitivity of the micro-organisms and evaluate the hospital treatment. In total 96 patients with nosocomial infection were included. Urinary infections were the commonest nosocomial infections (42%) followed by pulmonary infections (28%). Gram-negative bacteria were responsible for 89% of nosocomial infections and staphylococci for 7%, with Escherichia coli and Pseudomonas aeruginosa being the most common (46% and 26% respectively). The organisms were resistant to multiples antibiotics and 18% of the patients were treated with imipenem, 7% with vancomycin, 42% with third-generation cephalosporins and 24% with amikacin. Hospital hygiene measures and antibiotic prescription policies are required to fight nosocomial infections and reduce antibiotic resistance among organisms.

The variation of the polysaccharide composition of the brown alga Padina pavonica from the Mediterranean Sea was studied as a function of the collection season (April–July). It was shown that the principal polysaccharide (8.0-13.3% of dry alga weight) was alginic acid. Its content did not undergo significant changes from April to July. The content of water-soluble polysaccharides (laminarans and fucoidans) was low (

Objectives: to assess the knowledge of both parents and community pharmacists regarding antibiotics use and resistance in pediatrics in Lebanon. Methods: A cross-sectional study was conducted between June and August 2017 in community pharmacies. A pre-established questionnaire targeting knowledge of parents and pharmacists regarding antibiotics use/misuse was carried out. An index of knowledge was computed to assess factors associated with good knowledge on antibiotics use/misuse. Results: The study showed that 28.7% of pharmacists did not know which factors may contribute to antimicrobial resistance. Concerning the misuse of antibiotics, pharmacists blamed at first parents (90.1%), at second level physicians (72.8%), and third themselves (59.4%). Furthermore, pharmacists believed that the socioeconomic problems of the country (86.1%), the level of resistance to the molecule of choice (80.8%), the lack of consultation time (71.2%) and the lack of national guidelines/recommendations (66.3%) might be additional factors contributing to antimicrobial resistance. In case of acute otitis media, the majority of pharmacists chose the correct treatment, dose and duration according to international guidelines; this was in contrast to the results obtained in case of pharyngitis. Female pharmacists had a significantly higher knowledge score compared to their male counterparts (ORa=2.51). Half of parents (42.6%) declared that antibiotics act against both viruses and bacteria, 55.9% still believe that the presence of fever requires the administration of antibiotics, 50% didn’t know the consequences of antibiotics misuse, 58.4% said that it is okay to give their child antibiotics without a physician’s advice or based on a pharmacist’s recommendation, and 66.7% trusted the pharmacist in the antibiotic prescription. Parents with a university level of education or a master’s degree had significantly better knowledge compared to illiterate ones (ORa=9.04 and ORa=16.46, respectively). Conclusions: Based on the results obtained, it would be necessary to implement educational campaigns in order to increase awareness on antibiotics misuse and resistance in pediatrics.

Background: Non-adherence to prescribed medications represents an obstacle toward achieving treatment goals. This problem is more pronounced in patients with chronic illness. Objective: To identify the extent of adherence in Lebanese outpatients with chronic diseases, and to suggest possible predictors of non-adherence in this population. The secondary objective was to assess if medication adherence affects patients' quality of life. Methods: A questionnaire was administered face-to-face to a sample of Lebanese adults visiting the external clinics at two Tertiary Care Hospitals in Beirut. The level of adherence was assessed using the 8-item Morisky Medication Adherence Scale which was first validated. The health-related quality of life (HRQoL) of patients was measured using the EQ-5D. Linear regression and logistic regression analyses examined possible predictors of adherence. Results: Out of the 148 patients included in this study, 42.6% were classified as adherent. In the univariate analyses, statistically significant predictors of high adherence included good physician-patient relationship (p=0.029) and counseling (p=0.037), a high level of HRQoL (p