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Abstract Introduction The view that spirits may possess humans is found in 90% of the world population, including Arab/Islamic societies. Despite the association between possessive states and various neurological and psychiatric disorders, the available literature has yet to correlate possessive states with functional brain imaging modalities such as single-photon-emission computed tomography. Case presentation This paper describes the clinical case of a 22-year-old male Omani patient who presented to us with an altered state of consciousness that his caregiver attributed to possession. We examined whether the patient's mental state correlated with neuro-imaging data. The patient's distress was invariably associated with specific perfusion in the left temporal lobe and structural abnormality in the left basal ganglia. Conclusion We discuss the case in the context of possession as a culturally sanctioned idiom of distress, and highlight the importance of studying cross-cultural presentations of altered states of consciousness within biomedical models.

The present study was undertaken to determine the antimicrobial resistance patterns and plasmid fingerprints of commensal Escherichia coli isolated from Lebanese broiler chickens. To that end, a total of 30 E. coli isolates were collected from 15 semi-open broiler farms from North Lebanon and Bekaa Valley. Results showed that all the isolates were resistant to at least nine out of 18 evaluated antimicrobial agents. The best-performing antibiotic families were Carbapenems (Imipenem) and Quinolones (Ciprofloxacin and Norfloxacin) to which only 0.0 and 8.3% of the isolates were resistant, respectively. Fifteen various plasmid profiles were depicted, and all the isolates were found to possess one or multiple plasmids. The plasmid sizes varied from 1.2 to 21.0 kbp, and the most commonly detected plasmid had a size of 5.7 kbp (23.3% of the isolates). There was no significant association between the number of plasmids per isolate and resistance to a particular drug. Nevertheless, the presence of specific plasmids, namely, the 2.2 or 7.7 kbp sized ones, was strongly correlated to Quinolones or Trimethoprim resistance, respectively. Both the 7.7 and 6.8 kbp plasmids showed mild correlation to Amikacin resistance, and the 5.7 kbp plasmid was mildly correlated to Piperacillin-Tazobactam resistance. Our findings highlight the need to revise the list of antimicrobials currently used in Lebanese poultry and associate the presence of specific plasmids to antimicrobial resistance patterns in E. coli isolates. The revealed plasmid profiles could also serve any future epidemiological investigation of poultry disease outbreaks in the country., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2023 Houssam Shaib et al.)

This study aims at the identification of endo- and ectoparasites in broiler farms while assessing their prevalence in semi-open and closed rearing systems in Lebanon. Seventeen semi-open and six closed broiler farms were investigated in various Lebanese provinces between March and September 2020 and 2021. Intestinal and composite litter samples were collected and observed for morphological identification of prevalent parasites. Results notably revealed the prevalence of mites in all of the surveyed farms. Moreover, mixed mite-helminth infestation was recorded in 100% of the semi-open farms and 50% of the closed ones. The northern fowl mite Ornithonyssus sylviarum was the predominant chicken parasitic mite in both systems. The poultry red mite Dermanyssus gallinae, was present in 6% of the semi-open farms and was not detected in closed farms. The mammalian itching mite Sarcoptes scabiei and the grain mite Acarus siro were also identified and had similar prevalence pattern as the red poultry mite. Eggs and/or larvae stages of one parasitic helminth species, Ascaridia galli, were detected in half of the semi-open and closed farms while adult worms were not present. This study documents for the first time the prevalence of specific endo- and ectoparasites in Lebanese broiler farms, reflecting managerial problems and poor biosecurity practices. Nevertheless, the identification of specific parasites in this work paves the way towards implementing proper control methods against these overlooked, yet devastating, organisms.

Background: Lebanon is part of the global DISCOVER study, a global, noninterventional, multicentre, prospective study with 3-years of follow-up., Aims: The aim of this study is to describe real-world clinical practice in terms of type 2 diabetes mellitus (T2DM) disease management and treatment patterns within Lebanon., Methods: Baseline demographic and clinical parameters were captured on a standardized case report form, according to routine clinical practice at each clinical site., Results: We recruited 348 patients. At the initiation of second-line therapy, mean duration of diabetes was 6.7 [standard deviation (SD) 6.5] years; mean HbA1c and fasting plasma glucose levels were 8.5% (SD 1.6%) and 178.7 (SD 56.5) mg/dL respectively. Almost half the patients were hypertensive (45.1%) or had dyslipidaemia (48.6%). Metformin monotherapy was used as first-line therapy in 56.9% of the patients and upfront dual therapy in 25%. The primary reason for changing firstline therapy was poor glycaemic control. The main factors in choosing the second-line therapy were efficacy, tolerability and hypoglycaemia., Conclusion: Clinical inertia was evident in this cohort of patients as they had suboptimal glycaemic control at the time of enrolment and the initiation of second-line therapy. Treatment intensification is required to reduce diabetes-related adverse outcomes., (Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Objective: The American Diabetes Association and the European Association for the Study of Diabetes guidelines recommend to individualize treatment targets/strategies in inadequately controlled patients by lifestyle management and glucose-lowering drugs to decrease the burden of diabetes-related complications. This real-world practice study aimed to assess predictive factors for achieving the glycemic hemoglobin A1c (HbA1c) at 6 months as targeted by the treating physician in adults with type 2 diabetes who required initiation of basal insulin, initiation of bolus insulin, or modification from basal or premixed insulin to new insulin regimen containing insulin glargine and/or insulin glulisine., Research Design and Methods: This was an international, multicenter, observational survey with 12-month follow-up time in adults with type 2 diabetes inadequately controlled conducted in 10 developing countries., Results: Overall, 2704 patients (mean age: 54.6 years, body mass index: 28.7 kg/m 2 ; Caucasian: 46.1%, type 2 diabetes duration: 10.1 years) with poor glycemic control (mean HbA1c: 9.7% (83 mmol/mol), fasting blood glucose: 196.8 mg/dL) were eligible. At 6 months, advanced age, Caucasian ethnicity, shorter type 2 diabetes duration (>10 vs 1 year, p<0.0001), lower baseline HbA1c (≥ 8.5% vs <7%, p<0.0001) and no intake of oral antidiabetic drug (OAD) (none vs 2, p=0.02) were predictive factors for achieving glycemic goal as targeted by the treating physician. Absolute changes in the mean HbA1c of -1.7% and -2% were observed from baseline to 6 and 12 months, respectively., Conclusions: Along with some well-known predictive factors, this study suggested that early insulin regimen treatment initiation and/or intensification allowed patients to promote glycemic control., Competing Interests: Competing interests: KD is employee at Sanofi. MF, YO, AAIM, AH and DD were national investigators for the study in their respective countries. AAIM, YO, NI, MF, AH, MM, TC received support from Sanofi to discuss the design, analysis, and interpretation of the study.

Background: There is an increasing concern about methicillin-resistant Staphylococcus aureus (MRSA) infections in the community. This study aimed to evaluate the rate of S aureus nasopharyngeal colonization in outpatients as the primary endpoint, and also to study the impact of several possible risk factors, including recent hospitalization, recent surgical procedures, and antibiotic intake., Methods: A total of 1,526 consecutive outpatients underwent surveillance cultures after completing a questionnaire. Isolated S aureus strains were tested for antibiotic susceptibility. The Pearson χ(2) test was used for statistical analysis. The differences were considered to be statistically significant at a P value <.05., Results: Out of the 1,526 outpatients tested, 133 (8.7%) carried S aureus in the nose and/or throat. Only 2 of those cases were MRSA, and both were isolated from the nose. One hundred thirty-one patients had methicillin-sensitive S aureus, 13 with simultaneous carriage in the nose and throat. Among the risk factors, a relative working in health care, presence of an intravascular device, recent dental procedure, and health club use were significantly associated with an increased risk of S aureus colonization, with P values of .00, .02, .04, and .00, respectively, calculated by the χ(2) test., Conclusions: The prevalence of MRSA is still low in our study population within the Lebanese community. The only significant risk factors playing a role in increasing the carriage of S aureus were related to health care exposure., (Published by Mosby, Inc.)

A technique is described to help ensure the accurate reproduction of rigid implant components and the edentulous soft tissue. Splinted implant impression copings are luted together with resin to a specially designed custom tray.