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[Multicenter study of children with terminal renal failure in Lebanon].

A retrospective study was conducted in June 1997 concerning all Lebanese children with end stage renal failure. This study was able to recognize 20 children and infants (age less than 15) dialysed regularly in 8 hemodialysis centers. The other 23 centers are not following children. Thirteen children are dialysed on bicarbonate and seven on acetate. Children receive erythropoietin occasionally; 30% of them are polytransfused, 60% of them suffer from anemia. Four children have never received immunization against hepatitis B and three are seropositive for hepatitis C. None of these children has regular school attendance and psychological support for the child and his family do not exist. We conclude that the situation of children on hemodialysis in Lebanon is alarming. Solutions are possible and available; they need to be undertaken urgently.

Adolescent↗

Comparative performance of PCR-based assay versus microscopy and culture for the direct detection of Mycobacterium tuberculosis in clinical respiratory specimens in Lebanon.

SETTING: American University of Beirut Medical Center, Lebanon. OBJECTIVE: To assess the performance of a polymerase chain reaction (PCR) using primers that flank 542 bp within IS6110 in Mycobacterium tuberculosis (TB) vs. microscopy and BACTEC culture, in the diagnosis of tuberculosis. DESIGN: A total of 82 clinical respiratory pulmonary specimens and 73 samples from BACTEC vials were tested by the three methods. RESULTS: Of 24 smear-positive culture-positive (SP-CP) and 11 smear-negative culture-positive (SN-CP) TB specimens, PCR detected 83% and 64%, respectively. Among 17 specimens yielding mycobacteria other than tuberculosis (MOTT), the PCR was positive in 33% SP-CP and 14% SN-CP specimens. Among the 73 BACTEC vials, PCR was positive in 36 of 38 (95%) yielding culture-positive TB, and in one of 20 (5%) yielding culture positive MOTT. None of the 30 smear-negative culture-negative (SN-CN) clinical specimens and 15 of the CN vials were positive by PCR. The overall sensitivity of PCR was 77% and 95% for TB detection in respiratory specimens and BACTEC vials, respectively, and the specificity was 94% in both. CONCLUSIONS: Because a substantial number of TB cases are missed, especially in SN-CP specimens, a PCR-based assay utilizing these primers cannot be used reliably, alone, in clinical laboratory diagnosis of mycobacterial respiratory infections.

Bacteriological Techniques↗

[Dental surgery in Lebanon: studies and professional demography].

Lebanon (about 4,000,000 inhabitants) shows us a surprising dental professional demography. University diplomas to practice dentistry come from 73 different foreign countries. The concentration of dental offices in and around Beirut explains disharmonies of the sanitary map. The studies of these particularities set up the frame of this work. Some answers are proposed.

Demography↗

[Chapters in the history of psychiatry in Israel and its surroundings: B). The Asfouriyeh hospital for the insane in Lebanon].

This is the second of a series of articles dealing with the history of psychiatry in Eretz-Israel and its surroundings. After a brief survey of the Ottoman medicine and Islamic hospitals, this article presents a short description of the treatment for mentally ill patients in the Ottoman Empire. We describe the historical background and the establishment of the Asfouriyeh hospital for the insane in Lebanon towards the end of 19th century, as well as other mental hospitals in this land. We outline some similarities in initiative and administration during the foundation of Ezrath-Nashim hospital in Jerusalem at that time.

History, 15th Century↗

Management of diabetes mellitus and hypertension at UNRWA primary health care facilities in Lebanon.

A cross-sectional descriptive study was conducted at all UNRWA primary health care facilities in Lebanon Field, to assess the quality of care of diabetes mellitus and hypertension. The study reviewed 2202 records of diabetic and hypertensive patients. Both diseases were present at an early age (< 40 years), with family history, obesity and sedentary lifestyle being the main risk factors. The major complication was cardiovascular disease followed by retinopathy. Action-oriented measures to improve the organization and management of the health care services were identified.

Adolescent↗

Transboundary movement of hazardous wastes into Lebanon: Part 2. Environmental impacts and the need for remedial actions.

This paper discusses the transboundary movement of hazardous wastes (the "silent trade") into Lebanon in terms of environmental impacts and remedial actions. It highlights the projected impacts on potable-water quality, the exposure of the groundwater aquifer, and the status of quality control programs. The public responses to these problems are presented and characterized in terms of mistrust and rejection. The constraints developing countries face in handling environmental impacts and undertaking remedial actions are emphasized. The vision derived from the decade covered (1990-2000) emphasizes the need for international collaboration, through Basel Convention efforts, to control the transboundary movement of hazardous wastes and the disposal of such wastes. The need for "global harmonization" should be given serious consideration.

Developing Countries↗

Transboundary movement of hazardous wastes into Lebanon: Part 1. The silent trade.

This paper discusses the transboundary movement of hazardous wastes into developing countries, frequently referred to as the "silent trade," and the new efforts by the Basel Convention to control the international movement of hazardous wastes. The importation of hazardous wastes into Lebanon is examined in terms of waste trade activities (e.g., types, quantities, and management responses) as of 1987. The focus is on the national response, the roles played by different parties (e.g., politicians, expert groups, nongovernmental organizations, international organizations, and mass media) and their impact on the current status of events. Key challenges facing developing countries in managing silent-trade activity are identified in terms of environmental health and safety implications.

Developing Countries↗

[Oral health in school children in Lebanon].

This survey is the first epidemiological investigation to be carried out at the national level in Lebanon. It provides a first series of basic data indicative of the present oral health situation in the country. The results of this survey should contribute to the elaboration of a National Oral Health Plan and to the development of a broad strategy for the implementation of preventive measures [8]. Indeed, experience clearly indicates that dental caries cannot be successfully eradicated nation-wide through curative measures only and that preventive measures must also be implemented. The main effort in the field of oral health care should mainly focus on health promotion and education, leading in turn to improved oral hygiene.

Adolescent↗

[Oral health behavior in students in north Lebanon].

We conducted a study of the state of oral health among 600 twelve-year-old schoolchildren in North Lebanon. We assessed the range of behaviours linked to dental health: dental hygiene, eating habits, use of fluoride and use of dental health services. Half of the students brushed their teeth at least once a day. For 74% of the children, it was mainly their mothers who taught them how to brush their teeth. Toothbrushes and toothpaste were used by 75% of the children. About 82% had heard of fluoride but only 58% understood its usefulness. Four out of five children drank sugared drinks on a daily basis and 83% said that they had never been to the dentist. The information can serve as a basis for the development and implementation of health promotion and education programmes for oral health within schools.

Child↗

List of essential drugs for primary care in Lebanon.

In 1966, Lebanon had around 19,000 drug formulations registered in the Ministry of Public Health. The government decreased that number to 5400 in 1992 through numerous interventions. In 1995 and in an effort to rationalize drug prescribing, the Lebanese government organized an ad hoc committee of medical and pharmaceutical experts to review the 1992 list and create a list of essential drugs for primary care (LEDPC). This report describes the process and the studies used to update the 1992 list by the ad hoc committee.

Drug Prescriptions↗

Infant and child mortality in Palestinian camps in Lebanon.

"This study aims at producing acceptable estimates of a number of indicators of infant and child mortality in Palestinian camps in Lebanon by using the Brass technique. The study utilized data provided by two comprehensive surveys...carried out in 1979 and 1989." Results are provided on the decline in infant mortality between 1977 and 1989; the reduction in the probability of dying between ages one and five; life expectancy at birth; sex differences in infant mortality; and changes in death rates and life expectancy by mother's educational level.

Asia↗

Cardiac disease in children in Lebanon: the AUB-MC Children's Cardiac Registry experience.

OBJECTIVE: To study the epidemiology of cardiac disease in children and their outcome in Lebanon, we established a Children's Cardiac Registry Center (CCRC) at the American University of Beirut-Medical Center. DESIGN/METHODS: The CCRC included prospectively all pediatric patients with congenital heart disease (CHD) and/or acquired heart disease (AHD) who were evaluated at our center, between March 1, 1997 and July 31, 2000. RESULTS: Out of the 1000 patients with cardiac anomalies enrolled in the CCRC, 917 (91.7%) had CHD and the rest had AHD. Ventricular septal defect was the most common cardiac malformation with a relative frequency of 25.3%, followed by pulmonary stenosis (14.6%), aortic anomalies (8%), ASD (8%) and tetralogy of Fallot (7.8%). Complex cardiac lesions like HLHS, TGA and AVC had lower frequencies at 0.4%, 3.7% and 3.5% respectively. The most common AHD was rheumatic heart disease (42.2%). 34.9% of the registry patients with CHD and 10.8% with AHD underwent surgical intervention. There were 4.8% and 2.4% mortality rates in the CHD and AHD groups, respectively during the 40-month study period. CONCLUSION: The prevalence of many of the cardiac malformations in the CCRC was similar to that reported in the literature. However, some of the complex cardiac lesions were less common. The outcome of the two groups of patients is comparable to the outcome of children with cardiac malformation from developed countries. The establishment of a registry at the national level is important. Appropriate identification of the cardiac disease, its epidemiology, and outcome is of utmost importance in guiding adequate care.

Female↗

[Prevalence and susceptibility patterns of extended-spectrum betalactamase-producing Escherichia coli and Klebsiella pneumoniae in a general university hospital in Beirut, Lebanon].

Extended-spectrum betalactamases (ESBLs) are recognized worldwide as a problem in hospitalized patients. Their prevalence among clinical isolates of Enterobacteriaceae varies between countries and institutions. We studied the evolution of ESBL production by clinical isolates of Escherichia coli and Klebsiella pneumoniae and analyzed the patterns of susceptibility of these isolates to different antimicrobial agents in a general university hospital in Beirut. Of the 4299 isolates of E. coli and 1248 isolates of K. pneumoniae tested over the five years, 2.0% of the E. coli and 20.0% of K. pneumoniae were ESBL producing. A clear decrease in the susceptibility to all antibiotics was observed between 1999 and 2001, and no resistance to imipenem was detected. The isolates were distributed between the Intensive Care Unit (ICU), medical wards, outpatients, and other origins. The highest numbers were found in the ICU (E. coli 28.1% and K. pneumoniae 34.8%). Three phenotypes of resistance to cefotaxime and ceftazidime were observed on the basis of microbiological results. The present study was the first to assess the occurrence and susceptibility patterns of extended-spectrum betalactamase-producing Enterobacteriaceae in Lebanon.

Cross Infection↗

Bilharziasis survey in south-western Asia; covering Iraq, Israel, Jordan, Lebanon, Sa'udi Arabia, and Syria: 1950-51.

This paper describes a limited survey of bilharziasis and its vectors carried out during 1950 and 1951 in some countries of south-western Asia. Lack of time and of full facilities prevented the survey from being as comprehensive and systematic as would have been wished, but enough data were obtained to provide a general estimate of the situation.Information already available from the literature was supplemented by collecting unpublished records, questioning the inhabitants, examining random samples of stools and urine, and investigating rivers, wells, and springs. Bilharziasis haematobia is already heavily endemic in the irrigated areas of Iraq and is also present, in comparatively smaller foci, in northern Syria, Israel, and Sa'udi Arabia. In the opinion of the senior author (M. A. A.), the envisaged extension of irrigation is likely to create a serious health problem in Mesopotamia and to introduce the disease into the Jordan region unless the spread of the molluscan vector, Bulinus sp., is checked. Intensification of infection and further spread are possible in Israel and in the Syrian Jezire, while the remainder of Syria and Lebanon are not considered to be endangered. Bilharziasis mansoni is widespread in the fertile areas of Sa'udi Arabia and also occurs in one minor focus in Israel. The industrialization of Sa'udi Arabia which is planned to exploit its oil resources, with its inevitable concentration of population, equally presents a danger in the intensification of bilharziasis. It is considered that, unless prompt measures are undertaken to break the link between the agricultural and industrial expansion and the spread of the disease, the debilitation of large groups of the population and the economic loss which may well result over most of the inhabited parts of the area discussed will be significant.

Arabia↗

[The estimation of the prevalence of diabetes mellitus in Lebanon].

A sample of 436 persons of both sexes, all ages and being from all over the Lebanese territory, was analysed as part of a survey on the prevention of cardiovascular diseases. Our results gave an estimation of the prevalence of diabetes mellitus in Lebanon being at 7-8% and that of impaired glucose tolerance being at 10-11%. 50% of diabetics were previously unknown; this percentage rose up to 89% in people aged less than 40 years. The male preponderance was not statistically significant. The prevalence of diabetes mellitus increased steadily with age.

Adult↗

Laparoscopic cholecystectomy: initial experience in Lebanon.

Laparoscopic Cholecystectomy became very rapidly the procedure of choice for dealing with gallstones. We present our initial experience in Lebanon with 45 cases. All patients referred for cholelithiasis without any exception had a laparoscopic procedure. The conversion, mortality and morbidity rates were 0%. Post-operative hospital stay was 24 hours in the majority of the cases. The results clearly demonstrates the major advantages this procedure has over the conventional cholecystectomy and we believe it should be the procedure of choice for cholelithiasis.

Adult↗

Family medicine in Lebanon: the 10th anniversary.

Developing a family practice residency program was a logical step in addressing the needs for primary care in Lebanon. The American University of Beirut initiated a family practice residency program in 1979. The curriculum was structured following the guidelines of the American Academy of Family Physicians. Since its establishment, the program has participated in the design, launching, and maintenance of the family practice residency in Bahrain. Future plans include establishing other programs in the region and increasing community participation.

Delivery of Health Care↗

Medication use, gender, and socio-economic status in Lebanon: analysis of a national survey.

From data collected in Lebanon by the 1999 National Household Health Expenditures and Utilization Survey an analysis was made of reported medication use (n = 14,142). Seventy-two percent of the population aged 25-64 reported taking a medication in the month preceding the survey. Medications with high frequencies of reported use were analgesics, psychotropics, antibiotics and vitamins. Women were more than one and a half times more likely than men to report taking any medication (OR = 1.6), and significantly more likely to report taking eight of the 19 medication types analyzed. Analyses of the association of medication use with socio-economic variables show different effects for education and employment (inversely correlated with higher use), and higher socio-economic status (positively correlated with higher use). Multivariate analyses were carried out on two of the frequently used medications, antibiotic and prescription psychotropic use, to further explore the simultaneous effects of socio-economic variables The results of the analysis high-light a number of potential areas which may be targeted for intervention, in particular the higher use of antibiotics in rural areas, the greater use of psychotropics by women, and the possible obstacles to obtaining needed medications for those with lower incomes.

Adult↗