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PubMedDate not supplied

Etiologic agents of dermatophyte infection in Lebanon.

BACKGROUND: Dermatophytes are common and cause important human fungal infections in many parts of the world, including Lebanon. The prevalence of these fungi, however, tends to vary with time and geographic location. In our region, studies on the prevalence of dermatophytoses and the distribution of the various dermatophyte species involved are rare. In Lebanon, only one study was published on this subject over the last forty years. OBJECTIVES: This study was undertaken to shed light on the types and prevalence of dermatophytes recovered at the American University of Beirut Medical Center (AUBMC), and to compare the findings with those of the only study from the same hospital published in the early 1960s. METHODS: Records from the clinical microbiology section were reviewed for the patients on whom dermatophyte cultures were requested between 1996 and 2002. All positive cultures were identified and analyzed. RESULTS: Among 1631 submitted specimens for culture (one per patient), 208 (12.7%) yielded 11 species of dermatophytes, dominated by Trichophyton spp. (89.9%), followed by Microsporum spp. (9.1%), Epidermophyton floccosum (0.4%) and Trichosporum beigelii (0.4%). The male to female ratio was almost 1:1, and the age range was 1 to 77 yrs for both sexes; 14% were children (< or = 15 yrs). The most commonly recovered species were: T. tonsurans (54.8%), T. mentagrophytes (24.5%), M. canis (7.7%), T. rubrum (5.3%) and T. verrucosum (4%). The distribution of infection according to body sites was : tinea unguium (44.2%), tinea corporis (43.2%), tinea capitis (7.7%) and tinea pedis (4.8%). Compared to the previous study from AUBMC in 1962, the current study showed an overall lower prevalence of dermatophytoses (12.7 vs 18.5%, p = 0.001) and variations in the prevalence rates of the dermatophyte species involved (dominated by T. tonsurans and T. mentagrophytes in the current study compared to E. floccosum and T. rubrum recovered in 1962). Based on the source of infection the current study showed higher transmission from human to human (anthropophylic) (86.5 vs 66.3%) and animal to human (zoophylic) (12.5 vs 1.1 %), but lower transmission from soil to human (geophylic) (1% vs 32.6%). CONCLUSIONS: The prevalence of dermatophytoses remains high in this country. The recognition of the changing prevalence in the causative dermatophyte species should help with the treatment approach and for potential implementation of control measures.

Adolescent↗
PubMedDate not supplied

Symptoms and acute pesticide intoxication among agricultural workers in Lebanon.

Pesticides are known for their toxicity and are still widely used, especially in agriculture. Increasing attention is being focused on the health effects affecting humans occupationally exposed to pesticides, particularly agricultural workers. The objective of this study was to assess the association between occupational exposure to pesticides with recurrent symptoms and acute intoxications, in comparison with other workers in Lebanon. A cross-sectional study was undertaken, where a standardized questionnaire was administered to 89 exposed and 88 non exposed workers. Subjects exposed to pesticides reported more upper respiratory tract infections (PR = 9.39 ; p < 10(-4)), anorexia (PR = 3.63 ; p = 0.03), epistaxis (PR = 2.97; p = 0.02), immunoallergic (PR = 1.58 ; p = 0.01) and gastrointestinal (PR = 2.13 ; p < 10(-4)) symptoms. Acute pesticide intoxications requiring hospitalization were also more common (PR = 4.26; p = 0.01). Adjustment over potential confounding did not change the results, except for the appearance of an association of central (PR = 1.50 ; p = 0.04) and autonomic nervous systems symptoms (PR = 3.92 ; p = 0.01) with agricultural work in Mount Lebanon. Our results suggest that agricultural workers have a higher prevalence of multiple symptoms, which may be due to subacute intoxications by pesticides that did not need hospitalization. In addition, these workers have a higher risk of having an acute intoxication due to pesticides, exposing them to life-threatening situations.

Acute Disease↗
PubMed2005

Hepatitis a in Lebanon: a changing epidemiological pattern.

In this multicenter study in Lebanon, hepatitis A virus (HAV) seroprevalence rates were surveyed by age, gender, and socioeconomic factors. Blood samples collected from 606 subjects aged 1 to 30 years were analyzed for anti-HAV IgG. Age was the most important factor influencing HAV seroprevalence. HAV seroprevalence rates in the current study were about 78% in the > or = 21 years age group, 28% in the 6-10 years age group, and 11% in the 1-5 years age group as compared with 97.7% in adults, 85% in children aged 6-12 years, and 40% in children aged 1 to 5 years in previous studies, demonstrating a shift in HAV seroprevalence from the younger to the higher age groups. In light of the severity of the disease in adults and availability of safe and effective vaccines against HAV infection, introduction of HAV vaccination into the national immunization schedule of Lebanon should be considered.

Adolescent↗
PubMed2004

[Prevalence of infection by intestinal parasites in north Lebanon: 1997-2001].

We determined the prevalence of intestinal parasites in the north of Lebanon between 1997 and 2001. We analysed the parasitology records of 17126 patients and evidence of parasitic infections was found in 5 713 (33.35%) cases. There was no significant difference in prevalence for males or females for any of the parasites. The most prevalent parasites were Entamoeba coli (38.45%), Ascaris lumbricoides (37.14%), Giardia lamblia (15.39%), Ent. histolytica (4.57%) and Taenia sp. (3.3%). A comparison between our data and results of previous studies in Lebanon in 1937, 1939, 1956, 1967 and 1993 showed an increase in the prevalence of A. lumbricoides and G. lamblia in the period 1997-2001, with less marked changes in the prevalence of the other parasites.

Animals↗
PubMedDate not supplied

[Human brucellosis in Lebanon. Clinical features and therapeutic responses in 88 patients].

OBJECTIVES: Present clinical features of brucellosis in Lebanon. METHODS: Eighty-eight patients were seen at Hotel-Dieu de France Hospital of Beirut between 1994 and 2002. Diagnostic criteria were brucellar agglutinins at a titer; 1/160 with symptoms suggestive of brucellosis in the absence of other diagnosis and a therapeutic response. RESULTS: Out of the 88 hospitalized patients, 11 pediatric cases are noted. The disease is acute in 58 (66%), subacute in 28 (32%) and chronic in 2. The main presenting symptoms are fever, sweating, easy fatigability and diffuse aches. Osteoarticular involvement is the most prevalent complication (28%) and spondylitis is seen in 44% of these cases. Meningoencephalitis is the most frequent neurological manifestation. Among the haematological tests, relative lymphocytosis is significantly more frequent in children than adults (73% vs 19% ; p < 0,001) and in the acute form than the subacute (36% vs 7%; p < 0,001) whereas leucocytosis is more frequent in the subacute form (21% vs 7%; p < 0,01). CONCLUSION: Brucellosis is still an endemic disease in Lebanon and should be systematically evoked in the case of prolonged fever, articular and neurological manifestations.

Adolescent↗
PubMed1990

[Mental health and war in Lebanon].

This paper studies the effects of the war on the civilian and military lebanese populations from 1975 to 1987. A review of the literature on war psychiatry is presented as an introduction in order to estimate its applicability to Lebanon, and it seems that all the morbid conditions described in the different wars are to be found in Lebanon. A study on the military population was undertaken, focusing on the comparison of the morbid conditions before and during the war. It shows that war has led to a decrease of malingering and generalized anxiety disorders but to an increase of neurotic and psychotic reactions. A comparison of these conditions with those found in Vietnam shows a greater proportion of generalized anxiety and post-traumatic stress disorders among Marines in Vietnam. The milicians of the Lebanese Forces differ from the Lebanese Army soldiers by a higher proportion of antisocial personality disorders and anxiety neuroses. Among the civilian population war does not seem to have significantly modified in-patient morbidity in the main psychotic, affective and neurotic diagnostic categories. Drug abuse whose frequency has considerably increased during the war is studied in detail. In conclusion, the author analyzes the factors having contributed to the relative psychological resistance of the Lebanese population.

Humans↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. I: Penetrating craniocerebral injuries.

The present report analyzes 116 penetrating wounds of the brain sustained during warfare in Lebanon during 1982-85. Two basic mechanisms of injury were encountered: high-velocity bullets, and shrapnel and stones from explosive devices; and in one case a radio antenna penetrated the head through the orbit. The site of impact was at the convexity in 87% of cases and at the base of the skull in the remaining 13%. Surgery was performed in 83% of the patients: debridement-craniotomy in 73%, burr hole for intracranial pressure monitoring only in 6% and scalp closure only in 4%. The remaining 17% did not require surgery because of transbasal penetration without intracranial mass (10%) or due to moribundity. Indriven bone or foreign body fragments were removed only if readily accessible. The mortality rate was highest among patients with a Glasgow Coma Scale of less than or equal to 4 on arrival, after high-velocity bullet wounds, when the intracranial path was multilobar or transventricular, and when associated lesions were accompanied by shock. A follow-up study of the 49 Israeli survivors for almost 6 years revealed intracerebral-retained bone fragments in 48%, but these did not result in increased immediate or late complications (e.g., infection, epilepsy). These results support our conservative approach. Since all victims of penetrating head injuries were evacuated from Lebanon to Rambam Medical Center, Haifa, our report can serve as an estimation of the incidence of penetrating brain wounds and their burden on a front-line hospital.

Brain↗
PubMed1989

The incidence of congenital abnormalities of the kidney and urogenital system in Lebanon.

In an attempt to define the incidence of congenital abnormalities of the kidney and urogenital system in Lebanon, 37,500 consecutive hospital records of newborn infant delivered at the American University of Beirut Medical Center from 1975 to 1985 were reviewed. The study revealed 6.32 abnormalities per 1000 newborns. These figures are lower than those reported in the literature, because of the very small number of autopsies performed in this country. A prospective, cooperative study by major nurseries in the country, performing fetal ultrasonography on every at-risk pregnancy, and the performance of more autopsies are needed to come out with more accurate figures on the incidence of these abnormalities in Lebanon. Early detection of congenital abnormalities of the kidney and urinary tract is of vital importance to institute early treatment to decrease the occurrence of end-stage renal disease.

Academic Medical Centers↗
PubMed1989

Seroepidemiology of the human immunodeficiency virus in Lebanon. Preliminary evaluation.

In order to evaluate the prevalence of infection with the human immunodeficiency virus in Lebanon, serologic studies were performed in a group of 1406 individuals, of whom 397 belonged to high risk groups. There were 7 seropositive individuals in the high risk population. One additional patient who was known to have the acquired immunodeficiency syndrome was also positive. It appeared that among these eight persons, the virus was acquired either through sexual activity outside Lebanon or through transfusion of foreign blood products.

Blood Transfusion↗
PubMed1984

Trichinosis in southern Lebanon.

An outbreak of trichinosis in two villages in southern Lebanon affected over 100 patients, aged 3 to 70 years, who celebrated Christmas and New Year's of 1981 by feasting on rare pork. Six were hospitalized in Israel. The diagnosis was made on clinical and histological grounds. The clinical picture included the classical features, but was unusual in that rarely reported pedal or pretibial edema, pruritus and vertigo, were prominent. There was one case with suspected myocarditis. Two women in the first trimester of pregnancy had miscarriages. All patients recovered. With the unstable political situation in Lebanon in recent years, veterinary and sanitary supervision has deteriorated, and most pigpens are infected with trichinosis.

Abortion, Spontaneous↗
PubMed1984

Burn injury and prevention in the Lebanon War, 1982.

Measures taken during the Lebanon War, 1982, to prevent and minimize the extent and severity of tank-crew combat burns proved to be of value. Since 98% of tank crewmen who were burned were wearing fireproof suits at the time, only 12% sustained abdominal burns; 77% had facial burns, as none of them were wearing fireproof masks. Only 9% of the burned soldiers who wore fireproof gloves sustained hand burns, compared with 75% who did not wear the gloves. A comparison of the extent of tank-crew burns in the Lebanon War and the October 1973 War revealed that 51% of the burns in 1982 were minor, compared with 21% in 1973. Of the burns sustained in 1973, 29% covered greater than 40% of the body surface area, compared with 18% in 1982.

Burns↗
PubMed1984

Treatment of liver trauma in the Lebanon War, 1982.

During the Lebanon War, 1982, 37 laparotomies were performed in our ward, mostly for penetrating abdominal trauma. The liver was injured in 11 of these patients and was bleeding at the time of laparotomy in all cases. Liver sutures were restricted to superficial wounds only. In deep lacerations, all devitalized liver tissue was removed by anatomic segmentectomy or lobectomy. Patients who had segmentectomies had a rapid and uneventful recovery, with the exception of one who developed jaundice but later recovered. In one case, the intrahepatic left main branch of the portal vein was repaired. Two soldiers died during surgery. We report our experience in liver surgery during the Lebanon War.

Abdominal Injuries↗
PubMed1984

Eye injuries and ocular protection in the Lebanon War, 1982.

There was a high incidence of ocular trauma (6.8% of all casualties) in the Lebanon War, 1982, which is similar to the rates in previous Arab-Israeli wars. Combat in the Lebanon War consisted of both armored warfare and infantry operations, with much of the fighting taking place in built-up areas. Consequently, there were two main types of ocular injuries: perforating eye injuries caused by the small high-velocity missiles that characterize armored combat, and a wide range of injuries to the eye caused by ricochets during combat in built-up areas. The latter injuries varied in severity from complete destruction of the eye to minor corneal erosions. Not a single eye was injured in soldiers who had ballistic protective goggles properly placed over the eyes at the time of injury. Most of the ocular trauma could have been prevented had the goggles been in universal use. A considerable degree of eye protection is also afforded by ordinary ophthalmic eyeglasses.

Eye Foreign Bodies↗
PubMed1984

Surgery in the field during the Lebanon War, 1982: doctrine, experience and prospects for future changes.

During the Lebanon War, 1982, the Medical Corps of the Israel Defense Forces provided its mobile surgical units with sophisticated equipment, enabling them to perform advanced resuscitation and lifesaving surgical procedures, as well as pre- and postoperative intensive care, under conditions similar to those in rear hospitals. The surgical theaters and the intensive care units were deployed in spacious, mobile, expandable, environmentally controlled shelters. Primary medical treatment was provided to the wounded, followed by prompt evacuation to rear hospitals whenever possible. In addition, the best possible medical equipment was provided to competent medical personnel located in close proximity to the combat zone. This combination proved to be highly efficient in saving lives as well as cost effective. The lessons learned from deploying the surgical units in Lebanon have been evaluated and analyzed, resulting in updated concepts and doctrines that will optimize the medical support to combat units in the future.

Equipment and Supplies↗
PubMed1984

Primary health care for a civilian population: the experience of the Israel Defense Forces in southern Lebanon.

Since May 1976, the Medical Corps of the Israel Defense Forces has provided primary medical care for a population of more than 100,000 in southern Lebanon. The project of the "Good Fence" clinics is discussed in relation to primary health care problems encountered in rural southern Lebanon during the period of the Lebanese civil war and the Litani Operation.

Hospitals, Public↗
PubMed1984

Mental health care in the Lebanon War, 1982.

Lessons in mental health care learned from the October 1973 War were applied in the Lebanon War 1982. A three-echelon system of management was followed according to the practices prevalent in Western armies. The clinical pictures were essentially similar to those observed in other wars. Combat stress reactions (CSR) comprised 15 to 20% of the total casualties during the active phase of the war; the rate of late reactions was 30 to 40% of the total CSR. Treatment on the battlefield was more effective than treatment following airlift to the rear, in returning soldiers to their units. The role of stress in causing CSR, and the importance of leadership and cohesion in its prevention were evident. The important lessons learned from the Lebanon War are discussed and include: 1) the need for a broad definition of CSR; 2) the importance of forward unit intervention; 3) the necessity of mobility and divisibility of mental health treatment units; 4) fighting units should not be dispersed immediately after combat; and 5) the management of stress reactions to be the responsibility not only of the mental health services, but of all sections of the medical corps, both in treatment and prevention.

Combat Disorders↗
PubMed1993

[Smoking habits among Norwegian soldiers in Lebanon 1986].

The smoking habits in 287 Norwegian soldiers, mean age 24 years, who served for six months in the United Nations' peace-keeping forces in Lebanon was studied by self-administered questionnaire and determination of serum-thiocyanate. According to the questionnaires and verified by serum thiocyanate 42% were non-smokers at departure, 88% of them were still non-smokers at return. 7% of the smokers quit smoking while in Lebanon. The other smokers increased the consumption of cigarettes. The study indicates that campaigns against smoking should preferably be directed toward the youngsters since success among them will have long lasting effect.

Adult↗
PubMed1995

Most common diseases treated in primary health care facilities in Lebanon.

The Lebanese Ministry of Health has requested public health experts to assess the most common health problems seen in Primary Health Care (PHC) facilities. This paper presents the results of this assessment conducted in a convenience sample of PHC centers. The assessment aimed at identifying areas of strength and gaps in the current system. Data were drawn from 23 PHC centers in various regions of Lebanon, in addition to an 8-year review of the experience of the Department of Family Medicine at the American University Hospital. In general, 46% of all visits to PHC centers did not include any kind of diagnosis. Most centers provided data on large categories of diseases without breakdown into specific entities. The most commonly identified health problems were hypertension, diabetes and asthma, in addition to eye and ear diseases, cardiologic conditions, and dermatologic problems. Other health problems included ill-defined signs and symptoms associated most likely with mental distress. Dental caries, skin and hair parasites, and respiratory tract infections topped the health problems among children. A qualitative synopsis of all data is presented. The paper highlights the limitations of the current health information system in Lebanon, and suggests corrective measures. It also presents a number of recommendations regarding the optimal use of PHC centers for health education and promotion and for disease prevention.

Adult↗