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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.

Introduction: Post-operative pain management is crucial and patients can experience moderate to severe pain after surgery. The aims of this study were to assess the conformity to guidelines of analgesic prescription after major surgeries and evaluate the different predictors of non-conformity. Methods: A cross-sectional study was conducted on 497 hospitalized patients undergoing major surgeries between November 2018 and June 2019 using the data from their medical charts. Results: In total, 227 patients had a previous medical history. A significant relationship was noted between conformity, age, and length of stay where patients older than 65 had a higher degree of non-conformity compared to younger patients. Almost 90% of the analgesic were conforming in terms of dosage, treatment duration, choice and contraindication. Conclusion: This study highlights the importance of adequate pain management and its influence on the quality of life of patients, as well as the importance of age, comorbidities and pain intensity as predictors to reach a higher level of conformity., Анотація. У період з листопада 2018 року по вересень 2019 року було проведено обсерваційне перехресне дослідження, націлене на пацієнтів, які перенесли серйозні операції протягом вищезгаданого періоду. Дані були отримані з медичних карт пацієнтів за допомогою форми збору даних. Середній вік становив 49,3 року (SD = 19), причому 209 (42,1 %) пацієнтів віком від 41 до 65 років і лише 107 (21,5 %) старші, ніж 65 років. У більшості вибірки пацієнти проживали у Бейруті (39,4 %) і Гірському Лівані (49,3 %). Середній ІМТ становив 24,6 кг/м2 (SD = 4,81). Тривалість перебування в лікарні була різною у вибірці: 359 (72,2) пацієнтів були госпіталізовані від одного до п’яти днів, 92 (18,5 %) — від шести до десяти днів і 46 (9,3 %) — довше десяти днів. Майже 90 % анальгетиків відповідали за дозуванням, тривалістю лікування, вибором і протипоказаннями. При оцінці використання парацетамолу було повідомлено про майже 11 % випадків невідповідності щодо дозування, тривалості та протипоказань. Менша невідповідність була відзначена для нестероїдних протизапальних препаратів (НПЗП) (5 % для вибору та 2 % для протипоказань). Тим не менш, майже 14 % пацієнтів використовували трамадол для купірування болю, хоча його протипоказання та 9,7 % невідповідності були відзначені тривалістю лікування петидином.

Background: Studies addressing the oral health status among Lebanese school children are scarce. Aims: To assess the oral health status of Lebanese school children, and to provide epidemiological data for planning and evaluation of oral health care programmes. Methods: We selected 7902 schoolchildren aged 12–15 years from the 6 governorates of Lebanon, using a multistage probability sampling method. Data were obtained by self-administered structured questionnaires and clinical examinations (World Health Organization methodology and criteria). Dental caries was recorded using the Decayed, Missing, and Filled Teeth (DMFT) index. Periodontal status was evaluated using the Community Periodontal Index (CPI). Results: The mean (standard deviation) number of decayed, missing and filled teeth was 3.01 (2.927), 0.05 (0.245) and 2.14 (2.071), respectively, and the mean DMFT score was 5.20 (3.549). Among the whole tested population, the prevalence of caries was 89.5% and only 10.5% of the children were completely free of caries. Age, geographic location and school sector were the most significant risk factors for caries prevalence. Periodontal disease (CPI score > 0) was seen in 7633 participants (96.6%). In contrast to the shallow periodontal pockets that showed a low prevalence, calculus was the most frequently detected periodontal condition in both ages (50.9% at 12 years old and 50.2% at 15 years old). Age, sex, school sector and smoking status were significantly associated with occurrence of periodontal disease. Conclusion: Preventive and restorative public health campaigns are highly recommended to improve oral health status among Lebanese schoolchildren

Aim To assess schoolchildren's feelings and attitudes towards dentists and their potential impact on oral health. Materials and methods 7902 schoolchildren (12 and 15 years old) attending public and private schools completed a questionnaire that assessed their feeling and attitude toward dentists. DMFT and CPI indices were used to assess dental caries and periodontal diseases respectively according to the World Health Organization method and criteria. Results 79.7% of all schoolchildren who participated in this study had been to the dentist. 24.7% reported that they are afraid of dental visits, pain being the main reason for this disturbing feeling (88, 2%). Of the children, 81.4% preferred a female dentist; 82.3% preferred a dentist with a colored coat and 80.3% favored a renovated dental facility. 91.1% of the children are irritated by the noises in the dental clinic. The mean DMFT and CPI scores were significantly higher in patients with dental fear, and in patients who never had a dental visit. Conclusion Meeting patient's perceptions and preferences regarding their dentist may help to reduce the potential dental anxiety and thus ensure the delivery of a high-quality dental treatment leading to better oral health status. Clinical relevance Patient perception about dentists is affected by a series of factors related to the dentist, the patient, and the dental clinic. Patients who experience the worst perceptions of dental professional tend not to seek dental care, which leads to a bad oral health status, hence the importance of further studies in this area to improve such perceptions, and promote attitudinal changes toward positive health-seeking behavior.

Background: Despite the efforts of the health system to improve access to medications during the coronavirus disease of 2019 (COVID-19) pandemic, such as online consultations, encouraging generic prescriptions, and other measures to limit the storage of medication, psychotropic patients faced significant challenges in accessing their medications. Objectives: This study aimed (1) to compare the consumption of psychotropics before and during the pandemic, (2) to assess the association between having difficulties finding the medications and the general characteristics of the patients, and (3) to assess the predictors of these difficulties. Design: A case–control study was performed in which 128 patients (cases) were recruited during the pandemic (July–October 2021), and 256 patients (controls) using psychotropics before the pandemic were matched for age and sex. Methods: Data were collected using a uniform survey given to patients using psychotropics and filled out at their time and place preferences. Results: More patients used antipsychotics and anti-anxiety medications before the pandemic, while antidepressants were used more during the pandemic. Almost half of the patients reported facing difficulties finding their medications in both time frames. Before the pandemic, these difficulties were noted per increase in age and being employed and were less faced if patients had medical assistance or lived in the north of Lebanon. However, more patients reported having difficulties accessing their medication during the pandemic, with no significant differences. Conclusion: The consumption of psychotropic drugs was higher among cases. All patients faced challenges in accessing their medication throughout the pandemic, while older and employed patients had more limitations before the pandemic. Further investigations exploring viable solutions are recommended in order to maintain sustainable access to treatment.

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.

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

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.

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.

Purpose The purpose of this paper is to review and synthesize data from different countries in the Middle East on stroke and its potential risk factors. Method A systematic review of all published stroke articles in the Middle East between 1980 and May 2015 was conducted. Findings Sixty-four papers were included in the review. The incidence rate for all strokes ranged between 22.7 and 250 per 100,000 population per year. The prevalence rate for stroke ranged between 508 and 777 per 100,000 population. Among studies reporting gender differences, 75% reported a high male-to-female ratio among stroke patients. The mean age of stroke was within the sixth and the seventh decade. Ischemic stroke was the most reported type followed by intracerebral hemorrhage and subarachnoid hemorrhage. Hypertension was the most reported risk factor followed by diabetes. The overall case-fatality rate within one month was 12–32%. Discussion During the last decades, there was an increase in stroke incidence and mortality rates in the Middle East. The Middle East faces low rates of self-awareness and control of noncommunicable diseases and also lacks knowledge for stroke risk factors, awareness, causes, and symptoms. Conclusion There is an urgent need to develop more efficient and accurate methods to measure stroke in the Middle East. There is also a significant call to increase public awareness and implement interventions on stroke and its risk factors and symptoms to help people understand the negative impact of stroke on quality of life and potentially prevent this disease.

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.

Gestational diabetes mellitus (GDM) is a common pregnancy complication in high risk populations, and is associated with increased perinatal and long term outcomes for both mothers and newborns. Both its prevention and early management can be reinforced by identifying risks factors, particularly those factors influencing glucose metabolism. On the other hand, several epidemiological studies have shown an increased oxidative stress (OS) in pregnant women with GDM. Elevated OS was also reported in pregnant women supplemented with iron, which can generate OS and may also influence insulin resistance. This review summarizes the current state of knowledge, highlighting the potential relationship between OS induced by iron status and the development of GDM.

Introduction The percentage of demented elderly is increasing worldwide and in Lebanon. Improvement in nutritional status would improve cognition in elderly. The purpose of this work is to investigate the presence of an association between nutritional status and cognitive function in elderly living in Lebanese institutions. Materials and methods This is a cross-sectional study performed in three long-stay elderly institutions in Beirut. Subjects who met the inclusion criteria filled out a questionnaire consisting of nutritional status scale (Mini Nutritional Assessment: MNA), cognitive function (Mini Mental State Evaluation: MMSE) and other parts (demographic, self-assessment of the state health, smoking and alcohol, physical dependence, quality of life, frailty, depression, social isolation and loneliness). Results Among 111 elderly (55 men and 56 women), 14(12.6%) elderly are malnourished, 54(48.7%) are at risk of malnutrition and 43(38.7%) had adequate nutrition. The majority of malnourished elderly (71.43%) showed a cognitive function deterioration (MMSE Conclusion Nutritional status is associated with cognitive function. Monitoring the status of elderly can help in preventing malnutrition and possibly their cognitive impairment.

Resume L’augmentation de l’insulinoresistance dans le monde est un sujet preoccupant en termes de sante publique, en raison des risques associes de diabete de type 2, de maladies cardiovasculaires, de cancers et, plus recemment, d’augmentation du risque de declin cognitif. Au cours de la gestation, l’insulinoresistance est un phenomene physiologique qui, lorsqu’elle n’est pas « maitrisee », peut devenir pathologique, on parle alors de diabete gestationnel (DG). Le lien etroit entre stress oxydant, diabete et DG est clairement admis, resultant d’une hyperproduction radicalaire associee a l’hyperglycemie et a une diminution des defenses antioxydantes. Au cours de cette derniere decennie, une controverse est nee sur les risques associes a des apports eleves en fer, en raison de son role pro-oxydant et du risque de diabete associe a une ferritinemie elevee. Une relation qui est egalement decrite dans l’augmentation du risque de DG, et qui doit inciter a evaluer le benefice/risque en cas de supplementation martiale. En effet, un diagnostic biologique fonde uniquement sur une ferritine basse, et en l’absence d’anemie, conduit encore trop souvent a une supplementation preventive qui ne serait pas denuee de risque sur l’incidence de DG. Un risque qui justifie que la supplementation martiale ne soit proposee qu’en cas d’anemie, alors, qu’a l’avenir, le dosage de la ferritine en debut de grossesse pourrait devenir un marqueur de risque de DG.

International audience; Elevated circulating ferritin has been reported to increase the risk of gestational diabetes mellitus (GDM). When high ferritin translates into high iron stores, iron excess is also a condition leading to free radical damage. We aimed to evaluate the relationship between oxidative stress (OS) induced by iron status and GDM risk in non iron-supplemented pregnant women. Methods: This was a pilot observational study conducted on 93 non-anemic pregnant women. Iron status was assessed at the first trimester of gestation. Blood sampling was done at 24–28 weeks' gestation for oral glucose tolerance test (OGTT), insulin and biological markers of oxidative damage tests. Results: A significant increase in DNA damage was found in patients who developed GDM. Women with elevated DNA damage had a six-fold increased risk of developing GDM (Exp (B) = 6.851, P = 0.038; 95% CI [1.108–42.375]). The serum ferritin levels at first trimester were significantly correlated to lipid per-oxidation (rho = 0.24, p = 0.012). The stratified analysis suggests that ferritin is a modifying factor for the correlation of oxidative stress (OS) and glucose intolerance. Conclusion: Moderate ferritin levels due to iron intake without iron-supplement, at early pregnancy is a modifying factor for the correlation of oxidative damage and glucose intolerance in pregnant women. Larger studies to evaluate the risk of food iron intake induced increased oxidative damage in offspring are warranted to propose nutrition advice regarding iron intake in women with a high risk of GDM.

International audience; Gestational diabetes mellitus (GDM) is associated with increased insulin resistance and a heightened level of oxidative stress (OS). Additionally, high iron consumption could also increase insulin resistance and OS, which could aggravate GDM risk. The aim of this study is to evaluate a high fructose diet (F) as an alternative experimental model of GDM on rats. We also have evaluated the worst effect of a fructose iron-enriched diet (FI) on glucose tolerance and OS status during pregnancy. Anthropometric parameters, plasma glucose levels, insulin, and lipid profile were assessed after delivery in rats fed an F diet. The effects observed in mothers (hyperglycemia, and hyperlipidemia) and on pups (macrosomia and hypoglycemia) are similar to those observed in women with GDM. Therefore, the fructose diet could be proposed as an experimental model of GDM. In this way, we can compare the effect of an iron-enriched diet on the metabolic and redox status of mother rats and their pups. The mothers' glycemic was similar in the F and FI groups, whereas the glycemic was significantly different in the newborn. In rat pups born to mothers fed on an FI diet, the activities of the antioxidant enzyme glutathione peroxidase (GPx) and glutathione-S-transferase in livers and GPx in brains were altered and the gender analysis showed significant differences. Thus, alterations in the glycemic and redox status in newborns suggest that fetuses are more sensitive than their mothers to the effect of an iron-enriched diet in the case of GDM pregnancy. This study proposed a novel experimental model for GDM and provided insights on the effect of a moderate iron intake in adding to the risk of glucose disorder and oxidative damage on newborns.

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 (

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

Smoking is known to have physiological effects on biological systems. The purpose of this study is to evaluate acute and chronic effects on pulmonary functions and cardiovascular indices of waterpipe (WP) smoking in real life circumstances.Three groups were included in the study: non-smokers (N = 42), WP smokers (N = 42) and cigarette smokers (N = 48). A questionnaire was completed for each participant, in addition to pulmonary function [forced expiratory volume at 1 s (FEV1), 6 s (FEV6), percentage of FEV1/FEV6], and cardiovascular [diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR)] measures, taken before and after smoking.Mean values of FEV1, FEV6, FEV1/FEV6, DBP and SBP in WP and cigarette smokers were very close. However, WP smoking significantly increased HR compared to cigarette smokers (p = 0.007); duration of smoking, age at first WP and quantity of smoking affected pulmonary function and cardiovascular values. In the subgroup of WP smokers, DBP was acutely increased by a larger WP size (p = 0.011), while the FEV6 was acutely increased by a smaller WP size (p = 0.045).WP smoking affected the cardiovascular system more than cigarette smoking, while it had similar effects on pulmonary function.

High iron stores in pregnancy are essential in preventing negative outcomes for both infants and mothers; however the risk of gestational diabetes mellitus (GDM) might also be increased. We intend to study the relationship between increased iron stores in early pregnancy and the risk of glucose intolerance and GDM. This prospective, observational, single-hospital study involved 104 non-anemic pregnant women, divided into 4 groups based on the quartile values for ferritin at the first trimester of pregnancy. All participants were screened for GDM with 75-g oral glucose tolerance test (OGTT) at 24-28 weeks' gestation. We observed that ferritin levels at early pregnancy were significantly correlated to glucose level after OGTT at 1-h and 2-h (rho=0.21, p0.05; rho=0.43, p0.001 respectively). Furthermore, in the higher quartile for ferritin (38.8μg/L) glycemia at 2-h OGTT was significantly higher than in the others quartiles (p=0.002). In multivariate regression analysis, serum ferritin was a significant determinant of glycemia at 2-h OGTT. Although we did not find a significant association in the incidence of GDM in women with higher serum ferritin levels, probably in reason to the limit power of our study, our data demonstrated that the role of iron excess is tightly involved in the pathogenesis of glucose intolerance. We report for the first time that high ferritin values in early pregnancy are predictors of impaired glucose tolerance in non-anemic women. Individual iron supplementation should be evaluated in order to minimize glucose impairment risk in women with high risk of diabetes.

Background: The new millennium has been together with a variety of synthetic and caffeinated high-energy drinks targeting the youth market. Energy drinks raise the level of energy and their consumption has been increased significantly worldwide. Objectives: This research aimed to determine patterns of energy drink consumption and to assess the prevalence of adverse side effects among energy drink users. Patients and Methods: A pilot cross-sectional study survey was undertaken on students aged between 13 and 30 years in private and public schools and universities in Lebanon over 5 months. A self-administered questionnaire was used inquiring about sociodemographic characteristics, consumption patterns, attitudes and beliefs about energy drinks. Bivariate and multivariate analyses were conducted. Data was analyzed using SPSS 17. Results: We studied 1500 students (mean age: 18.92 ± 1.85; 51.3% were males). The overall prevalence of energy drinks consumption was 63.6% (60.5% were males), among which 50.5% used alcoholic energy drinks. Respondents indicated that most consumed energy drinks were “Red Bull” and “Boom Boom” (70.9% and 51.5% respectively). In total, 64.5% of participants believed the effect of these drinks in energizing the body, and 72.7% believed that they can stimulate intellectual capacities. In addition, 29.6% of consumers experienced at least one adverse effect, where tachycardia was reported in 21.1% of cases. On the other hand, desired effects felt after consumption were mostly pleasure (33.8%). Males had a 3-time more risk of consuming such drinks compared to females (OR: 0.381, P < 0.001; 95% CI: 0.300-0.484). Additionally, this analysis demonstrated a significant association between energy drinks consumption and regions outside Beirut (OR: 1.401, P: 0.006; 95% CI: 1.103-1.781), medical field of work (OR: 0.376, P: 0.010; 95% CI: 0.179-0.790) and higher personal income (OR: 1.317, P < 0.001; 95% CI: 1.117-1.553). Conclusions: This study showed a high prevalence of energy drinks consumption among youth. The current results highlight the importance of education to prevent the consumption of energy drinks in excessive quantities and modifying some wrong perceptions regarding the benefits of energy drinks in youth.

Hip fractures are serious fall injuries that often result in long-term functional impairment and increased mortality. As the population ages, the number of hip fractures is likely to increase worldwide. The main objective of this pilot study was to evaluate the risk factors of hip fracture among the older adults in the Lebanese population.This pilot epidemiological, prospective, and case-control study was performed in 6 hospitals in Great Beirut and South Lebanon. Subjects who met the inclusion criteria filled out a questionnaire consisting on the socio- demographic characteristics, health status, drugs intake and cigarette smoking.Overall, 195 subjects were recruited, with 65 cases of hip fracture and 130 controls all aged over 50 yr. Females represented around two third of the studied population. The logistic regression, using adjusted odds ratio (ORa), showed a significant relationship between hip fracture and chronic diseases (ORa=3.02; 95% CI: 1.63, 6.66), antihypertensive drugs intake (ORa=2.72; 95% CI: 1.56, 6.42), fall (ORa=2.79; 95% CI: 1.82, 7.06) previous fracture (ORa=3.80; 95% CI: 1.57, 9.23) and family history of fracture (ORa=4.82; 95% CI: (2.29, 10.86). Besides, smoking increased the risk of hip fracture (ORa=2.55; 95% CI: (1.96, 5.80). Having a bow was associated with the highest risk for hip fracture (ORa=5.18; 95% CI: 2.30, 12.24).Elderly people in Lebanon are exposed to many risk factors contributing to hip fracture. Our finding has implication in geriatric health improvement by preventing hip fracture in the Lebanese population.

Objectives: Studies have correlated second hand smoke (SHS) with many diseases, especially respiratory effects. The goal of this study was to measure the impact of SHS on the respiratory symptoms and exhaled carbon monoxide. Material and Methods: The study population consisted of 50 young workers in restaurants serving waterpipes, 48 university students who sit frequently in the university cafeteria where cigarette smoking is allowed and 49 university students spending time in places where smoking is not allowed. Subjects completed questionnaires on socio-demographic characteristics, respiratory symptoms and exposure to SHS. Exhaled carbon monoxide levels were measured. ANOVA and Chi-square tests were used when applicable as well as linear and logistic regression analysis. Results: Exposure to cigarette smoke in university (adjusted odds ratio (ORa) = 6.06) and occupational exposure to waterpipe smoke (ORa = 7.08) were predictors of chronic cough. Being married (ORa = 6.40), living near a heavy traffic road (ORa = 9.49) or near a local power generator (ORa = 7.54) appeared responsible for chronic sputum production. Moreover, predictors of chronic allergies were: being male (ORa = 7.81), living near a local power generator (ORa = 5.52) and having a family history of chronic respiratory diseases (ORa = 17.01). Carbon monoxide levels were augmented by the number of weekly hours of occupational exposure to waterpipe smoke (β = 1.46) and the number of daily hours of exposure to cigarette smoke (β = 1.14). Conclusions: In summary, young non-smoker subjects demonstrated more chronic cough and elevated carbon monoxide levels when exposed to SHS while the effect of waterpipe was even more evident.

Malnutrition represents an important issue in older adults; unfortunately, there is lack of data concerning this topic in Lebanon. This paper aims to provide a description of nutritional status and its correlates in older adults living in long stay institutions situated in Beirut.This cross-sectional study was conducted in three long stay institutions in Beirut in 2012. The study population was composed of people aged 65 years and above, having a score of Folstein Mini Mental State Examination (MMSE) greater than 14 and without renal failure requiring dialysis. Subjects meeting inclusion criteria filled out a questionnaire consisting of nutritional status scale (Mini Nutritional Assessment: MNA) and several other parts (demographic, self-assessment of the state health, smoking and alcohol, physical dependence, quality of life, frailty, depression, social isolation and loneliness). Data were entered and analyzed using the statistical software SPSS (Statistical Package for Social Sciences), version 17.0 (Chicago, IL, USA).Among 111 older adults (55 men and 56 women), 14 (12.6%) were malnourished, 54 (48.7%) were at risk of malnutrition and 43 (38.7%) had an adequate nutritional status. Multivariate analysis showed that physical exercise, depression, frailty and cognitive function were independent correlates of nutritional status of older adults. This model explained 42.2% (adjusted R2 = 0.422) of the older adults nutritional status variability.We found a moderate percentage of malnutrition in older adults living in long stay institutions situated in Beirut, and the correlates of malnutrition in older adults were low physical exercise, depression, frailty and low cognitive function.

Samar Rachidi,1 Sanaa Awada,1 Amal Al-Hajje,1 Wafaa Bawab,1 Salam Zein,1 Nadine Saleh,1,2 Pascale Salameh1,21Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon; 2Faculty of Public Health Labanese University, Beirut, LebanonBackground: The harmful effects of medication and licit substance use during pregnancy may potentially constitute a major public health concern. Our study aims to assess risky exposure of Lebanese pregnant women to drugs, tobacco, caffeine, and alcohol, and to determine their effect on postnatal outcomes.Methods: Women at term were addressed after delivery in five university hospitals of Beirut and Mount Lebanon between February and June 2012. A standardized questionnaire was administered to them. Moreover, medical files of both mothers and their respective newborns were checked to confirm information given by mothers, and to assess the health outcome of the babies.Results: Among the interviewed 350 women, active and passive smoking of tobacco (cigarette or water pipe), and consumption of category C, D, and X drugs were common during pregnancy in Lebanon; they were shown to negatively affect the neonatal outcome in multivariate analyses: they significantly decreased Apgar scores and increased the risk of underweight and medical complications of babies (P < 0.05).Conclusion: Our study demonstrated that Lebanese women were exposed during pregnancy to multiple medications and licit substances that affected the neonates' health. Our findings have implications for clinical obstetric practice and prevention programs in Lebanon. Efforts should be made to decrease exposure to harmful substances during pregnancy.Keywords: pregnancy, smoking, cigarette, water pipe, caffeine, alcohol, drugs, Apgar score