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Georges Juvelekian,1 Waleed El-Sorougi,2 Chaicharn Pothirat,3 Faisal Yunus,4 Teresita De Guia,5 Han-Pin Kuo,6 Shalma Basu Patnaik,7 Virginia Pilipovic8 1St Georges Hospital University Medical Center, Ashrafieh, Beirut, Lebanon; 2Chest Department, Faculty of Medicine, Helwan University, Cairo, Egypt; 3Division of Pulmonary and Critical Care, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia, Persahabatan Hospital, Jakarta Timur, Indonesia; 5Department of Pulmonary Medicine, Philippine Heart Center, Quezon City, Philippines; 6Linkou Chang Gung Memorial Hospital, Taoyuan Hsien, Taiwan, ROC; 7Novartis Healthcare Pvt Ltd, Rangareddy, Telangana, India; 8Novartis Pharma AG, Basel, Switzerland Aim: INFLOW (INdacaterol eFfectiveness and utiLizatiOn in COPD: real World evaluation) was a prospective, noninterventional study assessing the effectiveness and safety of long-acting bronchodilators in patients with chronic obstructive pulmonary disease (COPD) from the Middle East, Asia, and South Africa.Methods: Patients newly prescribed or switched to indacaterol or other long-acting β2-agonist (LABA), or tiotropium (monotherapy or in combination) were evaluated over 6 months. The primary endpoint was the clinical COPD questionnaire overall score at the end of the study.Results: Data were analyzed from 1,710 patients (mean postbronchodilator forced expiratory volume in 1 second, 59% predicted) who received indacaterol (n=1,179), other LABA (n=68), tiotropium (n=271), indacaterol plus tiotropium (n=167), or other LABA plus tiotropium (n=25). Across treatments, clinical COPD questionnaire overall score improved from baseline by 0.81–1.26 points (all P

Objectives: This meta-analysis examined the effect of macrolides on resolution of community-acquired pneumonia (CAP) and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs)., Methods: This meta-analysis included 47 publications published between 1994 and 2022. Publications were analysed for 30-d mortality (58 759 patients) and resolution of CAP (6465 patients). A separate meta-analysis was done for the prevalence of respiratory pathogens in URCs., Results: Mortality after 30 d was reduced by the addition of macrolides (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.51-0.82). The OR for CAP resolution when macrolides were added to the treatment regimen was 1.23 (95% CI 1.00-1.52). In the CAP resolution analysis, the most prevalent pathogen was Streptococcus pneumoniae (12.68%; 95% CI 9.36-16.95%). Analysis of the pathogen epidemiology from the URCs included 12 publications. The most prevalent pathogens were S. pneumoniae (24.91%) and Klebsiella pneumoniae (12.90%)., Conclusion: The addition of macrolides to the treatment regimen led to 35% relative decrease of 30-d mortality and to 23% relative increase in resolution of CAP., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The prevalence of eosinophilic asthma in Lebanon, one of the most severe phenotypes among severe asthma, is not known. This study aimed at determining the prevalence of the eosinophilic phenotype defined as an eosinophil count ≥ 300 cells/mm 3 among severe asthma patients in Lebanon., Methods: The Lebanese Chapter of the PREPARE study was a national, multicenter, cross-sectional observational study. Patients aged ≥ 12 years with severe asthma were identified and prospectively enrolled during clinic visits and completed the Global Initiative for Asthma (GINA) assessment of asthma control questionnaire. Patients' health characteristics were collected from medical records and blood samples were obtained for measurement of serum IgE levels and blood eosinophils count., Results: Overall, 101 patients (with mean age of 46.3 ± 17.0 years and 73.27% females) with severe asthma were included and, among them, 37% had eosinophilic phenotype, 67.3% had atopic phenotype with IgE > 100 IU/mL and 25.7% patients had overlapping atopic and eosinophilic phenotypes. Close to 80% had late-onset asthma, beyond 12 years of age, and around 85% had at least one severe exacerbation in the 12 months prior to study enrolment. The majority of participants [64.4%] had uncontrolled asthma, 24.7% had partially controlled symptoms and 10.9% had controlled symptoms. 19.8% of participants were on chronic oral corticosteroids, 78.2% had short course treatment of corticosteroids and all were prescribed a combination of inhaled corticosteroids and long-acting beta-agonist., Conclusions: The majority of patients with severe asthma were uncontrolled of which 37% present with an eosinophilic phenotype, which should be taken into consideration for better management of these patients in view of the novel phenotype-specific therapeutic options., (© 2023. Canadian Society of Allergy & Clinical Immunology.)

Chronic obstructive pulmonary disease (COPD) has a significant impact on healthcare systems and health-related quality of life. Increased prevalence of smoking is an important factor contributing to high burden of COPD in the Middle East and Africa (MEA). Several other factors including sedentary lifestyle, urbanization, second-hand smoke, air pollution, and occupational exposure are also responsible for the upsurge of COPD in the MEA. Frequent COPD exacerbations accelerate disease progression, progressively deteriorate the lung function, and negatively affect quality of life. This consensus is based on review of the published evidence, international and regional guidelines, and insights provided by the expert committee members from the MEA region. Spirometry, though the gold standard for diagnosis, is often unavailable and/or underutilized leading to underdiagnosis of COPD in primary care settings. Low adherence to the treatment guidelines and delayed use of appropriate combination therapy including triple therapy are additional barriers in management of COPD in MEA. It is necessary to recognize COPD as a screenable condition and develop easy and simple screening tools to facilitate early diagnosis. Knowledge of the disease symptomatology at patient and physician level and adherence to the international or regional guidelines are important to create awareness about harmful effects of smoking and develop national guidelines to focus on prevention on COPD. Implementation of vaccination program and pulmonary rehabilitation are equally valuable to manage patients with COPD at local and regional level. We present recommendations made by the expert panel for improved screening, diagnosis, and management of COPD in MEA., (Copyright © 2021. Published by Elsevier Ltd.)

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of bla oxa-23 -carrying sequence type 2 clone over the 1-year study. Non-A. baumanii multidrug-resistant infections remained stable.

Introduction: In March 2009, a new influenza virus strain emerged, currently known as the 2009 pandemic H1N1 virus. The virus first appeared in Mexico and rapidly spread globally to reach a pandemic level in June of the same year. We describe here the experience of one major referral center in Beirut, Lebanon., Materials and Methods: The laboratory department at St. George Hospital University Medical Center received respiratory specimens from hospital wards, the emergency department, in addition to a considerable proportion collected directly from "outpatients" in the lab. We used the real time RT-PCR as our main diagnostic test. We collected data about the patients from the laboratory information system and from the hospital medical records department., Results: From mid-August 2009 till the end of January 2010, a total of 1771 specimens were analyzed, with 948 (53.5%) returning positive for influenza A (H1N1) by RT-PCR. Only 79 patients with H1N1 infection required hospitalization. Most of H1N1 confirmed patients were children and adolescents aged 5 to 17 years and young adults between 25 and 44 years. The most common symptoms at presentation were: fever, cough, shortness of breath, chills, rhinorrhea or nasal congestion, as well as gastrointestinal symptoms. Twenty-three patients required ICU care and eight patients died. The vast majority had an uncomplicated course of illness and was managed in an outpatient setting., Conclusion: The percentage of positive tests during the pandemia was significantly elevated, although few patients experienced drastic clinical outcomes.