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In August 2021, the Centers for Disease Control and Prevention (CDC) released a health alert following the rapid increase in ivermectin prescriptions and reports of severe illness associated with use of products containing ivermectin for the prevention or treatment of COVID-19 infections. The United States Food and Drug Administration (FDA) and the CDC have explicitly discouraged the use of ivermectin in the prevention or treatment of COVID-19 outside of clinical trials. The study aims to describe the adverse events (AEs) related to ivermectin use for the prevention or treatment of COVID-19.This is a prospective case series of adverse events related to therapeutics used in the prevention or treatment of COVID-19 submitted to the FDA ACMT COVID-19 ToxIC (FACT) Pharmacovigilance Project sub-registry between October 2020 and December 2021. This is an ongoing toxico-surveillance system at 15 major academic medical centers in 12 states. Data collected included sociodemographics, exposure related information including dose, frequency, route, duration, and reason for taking ivermectin as well as a clinical description of the adverse event and the outcome.A total of 40 patients who developed AEs following ivermectin use were reported to FACT over 15 months. Self-medication with veterinary formulations were reported in 18/40 patients Thirty-three patients presented to emergency departments and nineteen patients were admitted to the hospital. Patients reported using ivermectin for prevention (24/40), treatment of symptoms (19/40), and for treatment of documented COVID-19 (8/40). Neurological toxicity was the most frequent finding. Fifteen patients had minor symptoms while 25 developed severe toxicity.Ivermectin use for the attempted treatment of COVID-19 has potential adverse health effects primarily related to neurological function. This is especially true when patients are self-treating with this medication and when they are using formulations intended for non-human use.

Background No national research has yet explored the prevalence of asthma among adults in Lebanon. This study aims to evaluate the prevalence of physician-diagnosed asthma and current asthma, and their determinants among Lebanese adults 16 years old or above. Methods A cross-sectional study was carried out using a multistage cluster sampling. The questionnaire used collected information on asthma, respiratory symptoms, and risk factors. Results The prevalence of physician-diagnosed asthma was 6.7% (95% CI 5–8.7%), and that of current asthma was 5% (95% CI 3.6–6.9%). Chronic symptoms such as cough, wheezing, and shortness of breath were worst at night. Factors positively associated with physician-diagnosed asthma were a secondary educational level (adjusted OR, aOR = 4.45), a family history of chronic respiratory diseases (aOR = 2.78), lung problems during childhood (15.9), and allergic rhinitis (4.19). Additionally, consuming fruits and vegetables less than once per week (3.36), a family history of chronic respiratory diseases (3.92), lung problems during childhood (9.43), and allergic rhinitis (8.12) were positively associated with current asthma. Conclusions The prevalence of asthma was within the range reported from surrounding countries. However, repeated cross-sectional studies are necessary to evaluate trends in asthma prevalence in the Lebanese population.

Background and Aim of this Study: Patients presenting with aortic stenosis are offered surgical aortic valve (SAVR) or transcatheter aortic valve replacement (TAVR) as therapeutic options. However, both techniques are associated with postoperative conduction abnormalities necessitating PPMI. We evaluate in this paper the impact of a modified technique of SAVR- which aims to decrease the stress on the conduction system- on the incidence of PPMI for a 24 months period post-surgery. Methods: The perioperative course of 184 patients who underwent SAVR in Saint George Hospital University Medical center between January 2016 and June 2019 was assessed. The study compares the incidence of PPMI between two groups of patients. In group A, 92 patients underwent the classic SAVR and in-group B, and 92 patients underwent a modified SAVR. Results: The results revealed a significant decrease of PPMI from 12 to 2.2% during a two-year period follow up. A multi variate analysis showed that the modified technique was a strong predictor for PPMI post SAVR. In addition, this rate (2.2%) was lower than the ones reported after TAVR. Conclusion: This reproducible and reliable technique should be recommended whenever SAVR is performed. On the other hand, the low incidence observed may be adopted as a benchmark whenever TAVR is offered as a therapeutic option specially to intermediate and low risk patients. Moreover, this less traumatic technique should be retained whenever stent design modifications for TAVR are considered.

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.

Background Community pharmacists provide an essential service by promoting, maintaining and improving the health of the community. However, factors affecting community pharmacists' work productivity remain poorly studied. Objective Our study aimed to assess, on a national level, work productivity components and its correlates among Lebanese community pharmacists. Methods: The study was carried out between March and July 2018, using a representative sample of community pharmacies from all districts of Lebanon. Main outcome measure: The work productivity components were assessed using the Work Productivity and Activity Impairment questionnaire. Results The study included 435 community pharmacists, the prevalence of sickness presenteeism and sickness absenteeism reached 91% and 45%, respectively. Presenteeism was positively associated with reporting higher depression score (β = 0.26) and insomnia (β = 0.20) whereas better mental (β = - 0.35) and physical health (β = - 0.38) were negatively associated with presenteeism. Absenteeism was positively associated with male gender (adjusted OR 2.05, 95% CI 1.14-3.70), reporting higher depression score (adjusted OR = 1.07, 95% CI 1.02-1.11) and negatively associated with better mental and physical health (adjusted OR = 0.93, 95% CI 0.90-0.96 and adjusted OR = 0.96, 95% CI 0.93-0.99; respectively). Activity impairment was positively associated with depression (β = 0.16) and insomnia (β = 0.12) and negatively associated with better mental (β = - 0.22) and physical health (β = - 0.015). Conclusion This is the first study assessing work productivity and activity impairment among Lebanese community pharmacists. Further research is needed to predict sickness absenteeism and presenteeism and this information will be useful to ensure quality of care is delivered.

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.

Background: Many governments encouraged generic use to enhance health equality and minimise health expenditure. The lack of knowledge and acceptance of generic medicines are the main barriers to their use. Objectives: This study aimed to assess population knowledge and perception towards generic drugs, identify their primary sources of information and examine which variables are independently related to their acceptance. Design: An observational cross-sectional study was performed targeting the Lebanese adult population. Methods: Overall, 385 patients participated in the study. Data were collected using a uniform survey from six public healthcare centres. Results: The participants reported a distrust towards generic drugs; they either said that they were not as effective as the brand (36.9%), were of less quality than the brand (38.5%) or had more side effects than the brand (38.4%). Around 52% said they would never buy a generic drug, and two-thirds (68.6%) preferred using a brand drug over a generic one. After adjusting for socio-demographics, a high income (odds ratio (OR) = 3.7), knowing that brands and generics have the same active ingredients (OR = 2.28) and that brands and generics were equally effective (OR = 6.46) were the strongest independent predictors for the willingness to buy generic drugs. Conclusion: A lack of knowledge and misperceptions about generic drugs limited the use of generic drugs, and therefore must be addressed.

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

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.

Sleep problems in teenagers seriously disturb the active process of learning. Given the absence of sleep data from Lebanon, a study to determine sleep quality among adolescents is vital.To understand sleep habits and patterns that affect sleep quality, and assess the amplitude of possible sleep problems in Lebanese adolescents, raising awareness of the effects of good sleep hygiene on general health in adolescents.A cross-sectional survey of 500 high-school students in Beirut was conducted using a self-filled questionnaire inquiring about sociodemographics, health-risk behaviour and sleep quality. The effect of several factors related to sleep habits of the students was investigated using bivariate analysis and logistic regression.We found that 76.5% of teenagers were not satisfied with their sleep quality; 56% did not have the appropriate amount of sleep (8 hours); and 82.4% used mobile phones and electronic devices in bed before falling asleep. Moreover, 3.2% faced a real problem with sleep initiation, 11.3% with sleep maintenance and 8.7% with early awakening.A large proportion of high-school students in Beirut have poor sleep patterns. It is therefore necessary to increase awareness of the problem in education in order to prevent its escalation.تقييم جودة النوم لدى طلاب المدارس الثانوية اللبنانية وعلاقته بنمط الحياة: دراسة ارتيادية في بيروت.رامز شاهين، ريتا فرح، ميشيل شحود، آلان حرب، رامي طراباي، إيريك سولو، روجر غودبوت.تسبب مشاكل النوم عند المراهقين اضطراباً خطيراً في عملية التعلم الفعَّالة. ونظراً لغياب البيانات الواردة من لبنان حول النوم، تعد دراسة تحديد جودة النوم بين المراهقين أمراً حيوياً.فهم عادات النوم وأنماطه التي تؤثر على جودة النوم، وتقييم مدى مشاكل النوم المحتملة لدى المراهقين اللبنانيين، ورفع مستوى الوعي بالآثار الصحية الجيدة للنوم على الصحة العامة لدى المراهقين.أجريت دراسة مسح مقطعي شملت 500 طالباً في المدارس الثانوية في بيروت باستخدام استبيان يُمْلَ ذاتياً حول السلوك الاجتماعي السكاني والسلوك المعرّض للمخاطر الصحية وجودة النوم. وتمت دراسة تأثير العديد من العوامل المتعلقة بعادات النوم لدى الطلاب باستخدام التحليل الثنائي المتغيرات والتَّحَوُّف اللوجستي.وجدنا أن 76.5 % من المراهقين غير راضين عن جودة نومهم؛ وأن 56 % منهم لم يحصلوا على القدر المناسب من النوم (أقل من 8 ساعات)؛ وأن 82.4 % منهم يستخدمون الهواتف المحمولة والأجهزة الإلكترونية في السرير قبل الدخول في النوم. علاوة على ذلك، واجه 3.2 % مشكلة حقيقية في بدء النوم، وواجه 11.3 % مشكلة الاستمرار في النوم وواجه 8.7 % مشكلة اليقظة المبكرة.تعاني نسبة كبيرة من طلاب المدارس الثانوية في بيروت من سوء أنماط النوم. لذلك من الضروري زيادة الوعي بالمشكلة أثناء التعليم من أجل منع تفاقمها.Évaluer la qualité du sommeil des élèves du secondaire au Liban en fonction de leur mode de vie : étude pilote à Beyrouth.Les troubles du sommeil chez les adolescents perturbent gravement l’activité du processus d’apprentissage. Étant donné l’absence de données concernant le sommeil au Liban, il est essentiel de mener une étude sur la qualité du sommeil chez les adolescents.Comprendre les habitudes et les tendances qui perturbent la qualité du sommeil et évaluer l’importance des éventuels problèmes chez les adolescents libanais, alerter l’opinion sur les effets d’une bonne hygiène de sommeil sur l’état de santé général des adolescents.Une étude transversale a été conduite auprès de 500 élèves du secondaire à Beyrouth à l’aide d’un questionnaire d’auto-évaluation. Les thèmes recouvraient les caractéristiques sociodémographiques, les comportements à haut risque et la qualité du sommeil. Une analyse bivariée et la régression logistique ont été utilisées pour examiner l’effet que pouvaient avoir divers facteurs associés aux habitudes de sommeil.L’étude a révélé que 76,5 % des adolescents n’étaient pas satisfaits de la qualité de leur sommeil, 56 % ne dormant pas un nombre suffisant d’heures (8 heures) ; et que 82,4 % utilisaient leur téléphone mobile ou des appareils électroniques dans leur lit avant de dormir. De plus, 3,2 % éprouvaient de réelles difficultés pour s’endormir, 11,3 % au niveau du maintien du sommeil et 8,7 % se réveillaient tôt.Une grande partie des élèves du secondaire à Beyrouth présentent de mauvaises habitudes de sommeil. Il est donc nécessaire de sensibiliser davantage la population dans le cadre de l’enseignement afin d’éviter toute aggravation de ce problème.

Smoking prevalence in Lebanon was reported by the World Health Organization to be 43%, which is among the highest rates in the Arab nation. The objectives of this study were to assess cigarette smoking knowledge and attitude among smokers and non-smokers using validated scales in the Lebanese general population and evaluate their association with current cigarette smoking; a secondary objective is to assess the dose effect relationship of knowledge and attitude with cumulative smoking. This cross-sectional took place between May and December 2018, and enrolled a sample of 2623 participants, representative from all Lebanese governorates. A questionnaire about knowledge of the harmful effects of tobacco and attitude toward smoking bans retrieved from other studies was used to collect data. Male gender (ORa = 0.75), having a low monthly income (ORa = 1.56) and a higher passive smoking score (ORa = 1.25), were significantly associated with higher odds of being current smokers. Higher knowledge score (ORa = 0.97) and positive attitude toward smoking ban score (ORa = 0.94) were significantly associated with lower odds of being current smokers. In addition, increased age (s = 15.21) and higher passive smoking score (s = 26.58) were significantly associated with higher cumulative cigarette smoking. More positive attitude toward smoking ban score (s = − 6.51) and having a university degree (s = − 68.35) were significantly associated with lower cumulative cigarette smoking. Higher knowledge about the smoking-related health problems and better attitudes toward smoking ban were observed among non-smokers compared to smokers. It is important to increase awareness campaigns and to propose effective interventions to put in place an adequate culture of smoking cessation among the general population.

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.

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.