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PubMed2002

Practice patterns of antiphospholipid syndrome at a tertiary teaching hospital in Lebanon.

The objective of the study was to describe the practice patterns of the antiphospholipid syndrome (APS) as compared with consensus guidelines for diagnosis and to determine whether practice patterns correlate with patient demographics and physician specialty. A retrospective medical chart review was conducted at the American University Hospital, in Beirut, Lebanon. All adult and pediatric patients admitted to the hospital between 1 January and 31 December 1998 who underwent either anticardiolipin antibodies (aCL) or lupus anticoagulant (LA) testing were included in the study. Work-up of APS syndrome was compared with: (a) the consensus guidelines for clinical diagnosis; (b) physician specialty; and (c) patient demographics (age, gender, ethnicity, health insurance status). Eighty-seven patients fulfilled at least one clinical criterion for APS; 92% were for work-up of thrombosis and 8% for pregnancy morbidities. Fifty-one percent underwent both aCL and LA. Overall 38% (33) of patients had an abnormal test result, however only 18% (6) underwent retesting, of whom only two satisfied a minimum of 6 weeks between test and retest TheAPS diagnostic work-up was requested by 11 different specialties. Rheumatologists were the most consistent in asking for both tests. APS is seen and diagnosed by a variety of medical specialties. Practice patterns as compared with the latest consensus are sub-optimal, and need to be improved. Interventions to help improve this have been discussed and are being implemented.

Adolescent↗
PubMed1999

Systemic lupus erythematosus in Lebanon.

The present study describes the clinical characteristics of patients with systemic lupus erythematosus (SLE) from the American University of Beirut Medical Center (AUBMC), one of the largest teaching hospitals in Lebanon. This is a retrospective chart review of 100 SLE patients seen over a 20 y period. There were 86 females and 14 males, with a median age of 26 y. 85 patients were Lebanese and 15 patients were Palestinians. The main clinical features were arthritis and/or arthralgias seen in 95% of our patients, followed by malar rash (52%), and renal involvement (50%). Of the hematological manifestations, thrombocytopenia was most commonly seen in 33% of patients, followed by leucopenia in 17% and hemolytic anemia in 10% Oral ulcers and serositis were both seen in 40% of patients. Less frequent manifestations included discoid lupus (19%), neuropsychiatric manifestations (19%), and photosensitivity (16%). Antinuclear antibodies were detected in 87% of patients, whereas anti-DNA antibodies were seen in 50% of cases. 25 patients (25%) had a false-positive VDRL. A comparison between our findings and 3 other Arab SLE groups revealed a higher incidence of oral ulcers, discoid lupus, articular manifestations, thrombocytopenia and false-positive VDRL, and a lower incidence of photosensitivity, leucopenia, neuropsychiatric manifestations, and anti-DNA antibodies.

Adult↗
PubMed2004

Middle Eastern masculinities in the age of new reproductive technologies: male infertility and stigma in Egypt and Lebanon.

Worldwide, male infertility contributes to more than half of all cases of childlessness; yet, it is a reproductive health problem that is poorly studied and understood. This article examines the problem of male infertility in two Middle Eastern locales, Cairo, Egypt, and Beirut, Lebanon, where men may be at increased risk of male infertility because of environmental and behavioral factors. It is argued that male infertility may be particularly problematic for Middle Eastern men in their pronatalist societies; there, both virility and fertility are typically tied to manhood. Thus, male infertility is a potentially emasculating condition, surrounded by secrecy and stigma. Furthermore, the new reproductive technology called intracytoplasmic sperm injection (ICSI), designed specifically to overcome male infertility, may paradoxically create additional layers of stigma and secrecy, due to the complex moral and marital dilemmas associated with Islamic restrictions on third-party donation of gametes.

Adult↗
PubMed1999

Emergence of Salmonella enteritidis outbreaks in broiler chickens in the Lebanon: epidemiological markers and competitive exclusion control.

This study investigates the first emergence of Salmonella Enteritidis outbreaks among chickens in the Lebanon and identifies the epidemiological markers of selected recovered Enteritidis strains. In addition, the authors evaluate a competitive exclusion approach to control infection in broiler chickens by Enteritidis organisms which possess the prevalent identified markers. The basic procedure in this investigation involved recording signs and lesions in eleven broiler chicken flocks on eleven farms, and culturing livers, spleens, and caeca of ten randomly selected birds per flock for Salmonella isolation and serotyping. Furthermore, culturing for Salmonella and serotyping was attempted from the livers, spleens, caeca and oviduct swabs of ten hens in four broiler breeder flocks which provided hatching eggs for the broilers under study. The identification of epidemiological markers in recovered S. Enteritidis included the determination of drug-resistance patterns and plasmid profiling. The competitive exclusion was evaluated by spraying the microflora on day-old broilers in the hatchery, followed by a controlled oral challenge at three days of age, with 2.85 x 10(5) colony-forming units of S. Enteritidis organisms per bird. Exclusion was evaluated by culturing for S. Enteritidis in anal swabs, spleens, livers, and caeca of individual challenged birds treated with the microflora and in untreated challenged birds. A total of 112 invasive S. Enteritidis strains were recovered on eleven farms from individual organs of broiler chickens with typical signs and lesions of salmonellosis. The prevalent resistance to drugs in such strains was to furaltadone and gentamycin, a marker identified in 93 strains (83%), recovered from nine out of eleven farms. The same resistance pattern was present in S. Enteritidis strains recovered from breeders on one out of four farms. The prevalent plasmid profile in nine S. Enteritidis organisms selected randomly from a pool of 93 strains (one per each of the nine broiler farms) was 14.1 kilobases (kb) and approximately 50.0 kb, a typical pattern to that identified in S. Enteritidis organisms recovered from oviducts of breeders on one out of four breeder farms. The exclusion significantly reduced cumulative mortality in birds of up to 45 days of age by 3.93%, in comparison to that observed in untreated challenged birds (P < 0.05). At 45 days of age, exclusion resulted in a 15.6% reduction in the percentage infection rate by S. Enteritidis in spleens or livers and a 34.4% reduction in the percentage infection rate of the caeca (P < 0.05).

Animals↗
PubMedDate not supplied

Medical conditions affecting well-accommodated travelers in Lebanon.

There are no data on the prevalence of common diseases affecting travelers to Lebanon. Between 2001 and 2002, one among nine physicians was consulted on guests who needed medical attention in a five-star Beirut hotel. Physicians were consulted 114 times. The mean age of the patients was 36.6 years. Gastroenteritis (50.9%) followed by respiratory problems (25.4%) were the leading causes for consultation.

Adolescent↗
PubMed2003

The association of gynecological symptoms with psychological distress in women of reproductive age: a survey from gynecology clinics in Beirut, Lebanon.

To date there has been no previous research into a possible association between psychological distress and gynecologic symptoms in the Arab world. We hypothesized that psychological distress would be associated with specific gynecologic complaints as well as with psychosocial factors. We conducted a cross-sectional study of women attending gynecology clinics in Beirut, Lebanon. The study sample consisted of 355 women aged 18 to 49 years who were seeking healthcare from gynecologists affiliated with two general teaching hospitals in Beirut. Psychological distress was assessed using the General Health Questionnaire (GHQ). Gynecologic complaints were assessed by asking women about presenting gynecologic symptoms. Women who visited the gynecologists for specific complaints, for post-surgical follow-up, or for insertion of coils or other services were more likely to be distressed than women who were attending for a general checkup (chi 2 = 9.466, p = 0.024). About 50% of women who reported abdominal pain or breast pain also reported significant psychological distress. Only bleeding and infertility were not significantly associated with psychological distress. It is concluded that a high proportion of women who attend gynecology clinics with specific complaints report psychological distress. Our findings highlight the importance of considering the psychological component of gynecological morbidity.

Adolescent↗
PubMed2000

Beta-thalassemia mutations and haplotype analysis in Lebanon.

The molecular basis of beta-thalassemia in Lebanon reflects the heterogeneity of the Lebanese population. Eighteen different mutations were identified among a total of 277 chromosomes. There is evidence of clustering of some mutations in particular geographic regions or among specific religious groups. Haplotype analysis, using seven restriction sites was performed on a total of 110 samples and 11 different haplotypes were identified. The five most common mutations were each found on two different haplotypes, and most linkages were as previously reported in other Mediterranean populations, with a few exceptions, also showing some clustering.

Genetic Linkage↗
PubMed2005

Family functioning, cultural orientation, and psychological well-being among university students in Lebanon.

The author examined the relationship between perceived family functioning, the cultural orientations of horizontal and vertical individualism and collectivism, and psychological well-being in a group of 182 university students in Lebanon. Factor analysis of the present data from the 12-item General Functioning Scale of the Family Assessment Device (GF-FAD) resulted in the extraction of one general factor, accounting for 43% of the variance. On the basis of North American cutoff values, the author found that 60.5% of the university students perceived their family as healthy and that 39.5% perceived their family as unhealthy. Male students perceived their families as somewhat more dysfunctional than did female students. Muslim students perceived their families as more dysfunctional than did Christian students. As the author expected, family functioning was associated with the culture-related personality dimension of horizontal collectivism and with perceived psychological well-being. Overall, the findings supported the structure and usefulness of the GF-FAD in the Lebanese context and the importance of viewing family functioning from the perspective of individual cultural orientation.

Adult↗
PubMed2003

Endemic gastrointestinal anthrax in 1960s Lebanon: clinical manifestations and surgical findings.

Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment.

Adolescent↗
PubMedDate not supplied

Cigarette and nargileh smoking practices among school students in Beirut, Lebanon.

OBJECTIVES: To determine the prevalence and predictors of smoking nargileh and/or cigarettes among school students in Greater Beirut, Lebanon. METHODS: A proportionate random sample of 2443 students from 13 public and private schools was selected and asked to complete self-administered anonymous questionnaires. RESULTS: The prevalence of smoking cigarettes only, nargileh only, and both was 2.5%, 25.6%, and 6.3%, respectively. Stepwise regression analyses revealed that the predictors of smoking for either type are different, whereby nargileh smoking is more culturally accepted than cigarette smoking. CONCLUSIONS: Design interventions to increase awareness towards the hazards of the misconceived harmless effects of nargileh smoking.

Adolescent↗
PubMedDate not supplied

[Hepatitis E virus: detection of antibodies in blood donors in Lebanon].

One hundred Lebanese volunteers blood donors were tested for the qualitative detection of antibodies against hepatitis E virus (HEV) by an immunoenzymatic method. The results showed 4% of positivity. This figure allows us to confirm the presence of infection due to HEV in Lebanon. More studies on a larger panel are necessary to confirm this result. This study leads us to suspect an HEV infection in front of an acute non A, non B, non C hepatitis even if the patients have not lived in an endemic area.

Adult↗
PubMedDate not supplied

[Lung cancer in Lebanon. Experience at the l'Hôtel-Dieu de France in Beirut].

All lung cancer cases admitted in our hospital from the 1st of January 1979 to the 31st of December 1995 were reviewed to allow for the study of the "behaviour" of the disease in Lebanon. A total of 386 cases included 87.5% males and 12.5% females. Mean age was 60 years. 87.3% were smokers. Squamous cell carcinoma was the most frequent histologic type (37.3%) and predominant in men. Adenocarcinoma was more frequent in women (50% v/s 29.9%). Patients often consulted their physician after delays of several months. Diagnosis is commonly confirmed by bronchoscopy. Transthoracic needle aspiration has become, since 1990, a very useful procedure for diagnosis of peripheral lesions with a sensitivity of 90.6%. Metastases are recorded in 30.9% of cases. Histological type distribution and advanced cancer stages found in our study are similar to that encountered in extensive international studies over the last few decades.

Adenocarcinoma↗
PubMedDate not supplied

[Health financing in Lebanon. I. Organization of health care services, coverage system and contribution of the Ministry of Public Health].

This paper intends to analyze the health care system in Lebanon from the organizational and financial points of view. It allows for an understanding of the health services' market by tackling it from different angles: supply versus demand, private versus public sectors, curative versus preventive services, hospital versus ambulatory care. This study necessitated a review of all previous surveys made in this field, during the after-war period. It also needed the daily collection and follow-up of pertinent data with all private and public agencies and concerned ministries, over a one-year period. In addition, a critical analysis has been made to the survey Conditions de vie des ménages, en 1997, that was carried out by the Central Administration of Statistics, that came to complete the missing data concerning household expenditures on insurance and health services. Especially that this survey covered the same period (1997), subject of this study. The paper reveals that, although the private sector is the main provider of both hospital and ambulatory care, private hospitals are flourishing on public money, whereas outpatients care is mainly financed by the households. Evidence shows that the Lebanese health care system succeeded in resolving the problem of accessibility to primary, secondary and tertiary health care, responding thus to the value of equity. But, at the price of an ever escalating cost, threatening the sustainability of the system. This is what is attained in this paper, as it shows clearly that expenditures on health have reached an alarming level of the GDP share. Our purpose being providing solid arguments in favor of reforming the health system.

Budgets↗
PubMed1987

The impact of civil disturbances on the migration of physicians: the case of Lebanon.

During the 1970s, the migratory flow of physicians was an issue of major concern to the world medical community. Numerous publications have focused on the issue of the foreign medical graduates in the United States the impact of the "brain drain" on developing countries, and the various related issues of licensure, quality of medical care, "reverse" foreign aid, and ways and means to stem the tide of migration. Of the numerous studies on this subject, however, few have focused on the impact of civil disturbances and political instability on the decision of physicians to emigrate, even though this type of migration has been known to occur during or subsequent to political crises. Examples include the large-scale emigration of Hungarian, Cuban, and Czechoslovakian physicians to the United States in the late 1950s and 1960s. Mejia refers to this type of migration and characterizes it as "... likely to be sudden, to reach a high peak within a short period of time and to decline almost as rapidly...." This description fits closely the definition of a "point epidemic"--a condition wherein the political events that led to the outflow of these physicians constituted a one-time event, limited in time and duration. Lebanon presents a different picture: ever-raging civil disturbances have plagued that country continuously for the past 11 years. The epidemiologic analogy is more akin to an "endemic" situation, with point exacerbations and remissions between ferocious fighting and relative peace leading to situations of acute, subacute, and chronic civil instability.(ABSTRACT TRUNCATED AT 250 WORDS)

Civil Disorders↗
PubMed1999

Congenital heart disease at a tertiary care center in Lebanon.

OBJECTIVE AND METHODS: To study the epidemiology of congenital heart disease (CHD) at the American University of Beirut-Medical Center, we reviewed the medical records of all cardiac patients seen at our outpatient cardiology clinic (OPD) between 1980 and 1995. The charts of all patients with CHD seen as inpatients and/or outpatients at our center during the year 1995 were also reviewed. A cardiologist evaluated all patients and the diagnosis was confirmed at least by echocardiography. The frequency of CHD was reported among three groups: 1980-1995 OPD groups (Group A); the group with CHD seen during the year 1995 (Group B); and (Group C), a subgroup of group B, included all newborns with CHD born at our hospital during the year 1995. Stillbirth and premature infants with the diagnosis of patent ductus arteriosus were excluded from the study. RESULTS: Group A included 883 patients. 344 patients were evaluated in Group B, with a mean age of 3.8 years. The incidence of CHD was 11.5/1,000 live births at our center. There was a relatively low prevalence of complex lesions (i.e., hypoplastic left heart syndrome, transposition of the great arteries) and a relatively high prevalence of the simpler cardiac malformation (i.e., ventricular and atrial septal defects, pulmonary stenosis) in Groups A and B. CONCLUSION: The relatively low prevalence of complex cardiac lesions in our study is probably related to the age of the studied patients, and reflects the high mortality of these complex lesions in our country early in life. The incidence of CHD of 11.5/1,000 live births at our center is higher than that reported in the literature, with evidence of more frequent ventricular septal defects and pulmonary atresia lesions. This may be related to high rate of consanguinity in our population. This review underscores the need for a national cardiac registry center for children in a developing country like Lebanon. Such a database will allow referral and care of complex cardiac lesions.

Adolescent↗
PubMedDate not supplied

[Nitrate contamination of the groundwater of the Akkar Plain in northern Lebanon].

The Akkar Plain in northern Lebanon covers an area of 130 km2 and is the second largest agricultural region in the country. It also borders the Mediterranean Sea (Figure 1). Groundwater supplies are the only source of drinking water in this region and there is no public drinking water network. This area has a population of about 75,000 inhabitants, who have depended on and used the water from these aquifers for many years, with no treatment, filtration or monitoring system in place. The inhabitants and farmers depend on groundwater supplies for crop irrigation and other uses. The plain provides ideal conditions for agriculture and the use of chemical fertilizers has been increasing. Over-fertilization, resulting in the application of excess nitrogen, and the lack of vegetation during the winter have disturbed the nitrogen cycle, leading to the pollution of groundwater supplies with high concentrations of nitrate. Nitrates seep slowly into the soil at a rate of about 0.5 to 1 meter per year until they reach the water table. However, tons of nitrogen are carried into the groundwater each year by runoff and infiltration. If a water source is found to be heavily contaminated with nitrate, it is probably too late and too difficult to correct the problem within a short period of time. Corrective measures may not be effective, as shown by current high nitrate concentrations despite previous efforts to resolve the problem. Therefore, we must try to keep nitrate levels within acceptable limits. If action is not taken now, future generations will pay the price of current bad practice in agriculture. International water quality guidelines permit a maximum of 50 mg nitrates/l for adults and of 25 mg/l for infants and pregnant women. The intake of nitrates in drinking water by humans is currently one of the major environmental problems associated with agricultural practice. Nitrate is itself inert but concern arises due to its possible conversion into nitrite, which is highly toxic. We analyzed the nitrate content of water samples from 15 private wells currently used for human consumption and agricultural in an effort to deal with the nitrate pollution of groundwater supplies in the Akkar Plain. We found that 14 of the 15 wells had a nitrate concentration above 50 mg/l, with a maximum of 163 mg/l. In addition, salt water was found to have contaminated groundwater supplies in some of the villages along the coastline in the north. Our results indicate that the groundwater is seriously contaminated with nitrates, to the extent that it does not meet international drinking water standards. These high nitrate levels may have adverse effects and cause disease. The toxic effects of nitrate contamination are most severe in individuals with weak immune systems, such as the elderly and children. We are currently developing solutions and preventive measures for this extremely worrying situation, based on these data.

Adult↗
PubMedDate not supplied

Recommendations for the school health physical examination in Lebanon.

School health developed gradually over the years; starting with efforts to keep contagion out of schools to global programs of comprehensive services. One of its components, school medicine, covers screening examinations, record maintenance, emergency care, immunization monitoring and health counseling. This paper proposes the essential health activities to be performed during a screening school examination in Lebanon. The recommendations are based on a combination of international literature review of evidence and the existence of Lebanese epidemiological reports identifying specific problems. Vaccination record review, tuberculin testing, vision, hearing, dental and skin disorders screening procedures are proposed as essential activities of the school physical examination.

Child↗
PubMedDate not supplied

[++Helicobacter pylori infection in North Lebanon].

The aim of this study was to determine the prevalence of Helicobacter pylori (HP) infection in North Lebanon and to compare it with published figures. The study period was from September 1 1996 to March 31 1998. We tested 349 patients for HP, using biopsy tissue obtained by esophagoduodenoscopy and the modified urease technique. One hundred and seventy-nine of these patients were men and 170 were women. The mean age of the subjects was 39.3 years (range: 20 to 78 years). The prevalence of HP was 25.9% in individuals with normal endoscopy results (n = 104), 60.8% in patients with duodenal ulcer and 72% in patients with congestive antritis. The prevalence of HP in patients with erosive antritis was similar to that in individuals with normal endoscopy results. The prevalence of HP increased with age in the individuals with pathological endoscopic results but no such relationship was observed in individuals with normal endoscopy results. Our results show that the prevalence of HP in our patients is similar to that of industrialized countries. As age affected the prevalence of HP only in subjects with pathological endoscopy results, it is probably the extent of lesions caused by HP, rather than the infection itself, that increases with age.

Adult↗