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Behçet's disease in Lebanon: report of 100 cases.

PURPOSE: To present clinical features of Behçet's disease in Lebanon and to evaluate the efficacy of treatment. PATIENTS AND METHODS: The 100 patients are seen at Hotel-Dieu de France Hospital of Beirut between 1980 and 1992. Diagnostic criteria are those of the Behçet Syndrome Research Committee of Japan. RESULTS: Recurrent oral ulcers are present in 95% of cases, genital ulcers in 78%, ocular manifestations are more frequent than those of several studies whereas skin lesions and vascular signs are less frequent. Joint involvement are recorded in 65% of cases and neurological one in 14%. The effectiveness of colchicine therapy is confirmed for mucocutaneous lesions and arthritis. Immunosuppressive agents are more beneficial than steroids alone on serious uveitis. An aggressive treatment with corticosteroids and immunosuppressive drugs improve the prognosis of meningoencephalitis. CONCLUSION: Behçet's disease doesn't have any specific characteristics in Lebanon despite some variation in the frequency of lesions.

Adolescent↗

The trimodal death distribution of trauma victims: military experience from the Lebanon War.

INTRODUCTION: Mortality in war is traditionally divided into two categories: killed in action and died of wounds. Mortality in civilian trauma is generally divided into three categories: immediate death (50%), early death (30%), and late death (20%). Can we identify a trimodal death distribution among war victims? METHODS: We analyzed data for casualties in the Lebanon War from June 6 to September 20, 1982. During this period a total of 1,950 soldiers were injured; 351 (18%) of them died. Time of injury and time of death of the victims was determined from real-time recordings during the battle and from hospital files. RESULTS: Analyzing the time of death revealed that 329 of the soldiers (93.7%) died within the first hour after injury, 7 soldiers died 1 to 4 hours after injury (2%), and 15 soldiers died 24 hours to 75 days after injury (4.3%). The most common causes of death during the first hour after injury were central nervous system (CNS) injuries 31%, exsanguination 30%, incineration 21%, and combined CNS injury and exsanguination 10.9%. Exsanguination was the leading cause of death 1 to 4 hours after injury (86%). CNS injury was the most common cause of late death (60%). Only 1.1% of the soldiers who reached the hospital alive died of their wounds. CONCLUSIONS: A trimodal mortality distribution with different causes of death in each peak can be identified in the mortality pattern of Israeli soldiers during the Lebanon War. The relative height of the different peaks and the causes of death in the third peak are different from those found in civilian trauma. We believe that prompt medical treatment and expeditious evacuation from the battle zone led to a very low death rate among the wounded soldiers who had reached the hospital alive. The same factors may have increased the relative portion of CNS injuries as a cause of late death.

Cause of Death↗

[Preliminary study on tuberculin sensitivity in north Lebanon].

Tuberculosis remains a severe public health problem, and is a major cause of infant disease in North Lebanon. We investigated tuberculin sensitivity in 1,405 school children (2 to 15 years old) not previously vaccinated with BCG in a deprived suburb of Tripoli (Lebanon). The Intra-Dermal Reaction (IDR) technique was used with 10 units of tuberculin (Pasteur-Mérieux, France). The prevalence was 4.3%. The score was higher in the lowest socio-economic group (5.7%) than in the middle socio-economic group (2.4%). No members of the upper socio-demographic group live in this area. There were no significant differences between the sexes. The diameter of induration was over 10 mm in 83.6% of cases (95.6% in the lower class and 46.6% in the middle class). The prevalence was higher among children over 10 years old. Chest X-rays were obtained for children with a positive reaction, and all were normal. Similarly, their sputum was tested for Acid Fast Bacilli (AFB) by a double staining technique (Ziehl-Nielsen and auramine), and all scored negative.

Adolescent↗

Prevalence and etiology of intestinal parasites in Lebanon.

As there are no studies done on the prevalence of intestinal parasites in Lebanon since 1967, this study was undertaken to reveal the current patterns of intestinal parasitic infestations in Lebanese patients from two geographic regions: Beirut and Tripoli. Analysis was based on 33,253 stool specimens examined at the American University of Beirut Medical Center (AUH) and 11,611 specimens examined at the Islamic Hospital (IH) in Tripoli over five and three years, respectively. The prevalence of intestinal parasites at AUH and IH were 8.47% and 45.35%, respectively (overall 18%). The prevalence in males vs females was almost the same; being 8.23% vs 8.74%, and 44.67% vs 45.88%, at AUH and IH, respectively. Multiple infections were noted in 8.8% and 3.5% of stool specimens at AUH and IH, respectively. Although 18 different types of parasites were encountered, the most common pathogenic parasites found at AUH vs IH were: Giardia lamblia (20.7% vs 10.5% of parasites found), Entamoeba histolytica (19.41% vs 1.25%), Taenia spp. (6.03% vs 4.08%) and Ascaris lumbricoides (2.09% vs 46.97%). The overall yearly or monthly prevalence of parasites recovered from both hospitals did not show clear seasonal patterns. Compared to developed countries, Lebanon still suffers from a high prevalence and a wide spectrum of intestinal parasites.

Animals↗

Validation of the European Spondylarthropathy Study Group and B. Amor criteria for spondylarthropathies in Lebanon.

OBJECTIVES: 1) To validate European Spondylarthropathy Study Group (ESSG) and B. Amor's criteria for spondylarthropathies in Lebanon. 2) To evaluate the frequency of spondylarthropathies in rheumatological practice in Lebanon. PATIENTS AND METHODS: Cases of definite and probable spondylarthropathy were diagnosed based on the clinical judgement of participating rheumatologists, without reference to the two criteria sets under study. The first two patients without spondylarthropathy seen after each spondylarthropathy case were included into the control group. Criteria in the ESSG and B. Amor sets were looked for in the patient and control groups. The frequency of spondylarthropathy meeting each criteria set was determined. RESULTS: Of the 841 patients evaluated during the study period, 68 met B. Amor's criteria and 72 met ESSG criteria. There were 29 cases of ankylosing spondylitis (40.3%), ten of peripheral psoriatic arthritis (13.8%), two of reactive arthritis (2.8%), two of enteropathic arthropathy (2.8%), and 29 of undifferentiated spondylarthropathy (40.3%). In the definite spondylarthropathy group, sensitivity and specificity were 77.19% and 97.55% for B. Amor's criteria versus 91.23% and 100% for ESSG criteria. The frequency of spondylarthropathy was 8.1% (95% confidence interval [CI], 6.3-9.9) or 8.56% (CI 6.6-10.5) according to B. Amor and ESSG criteria, respectively. CONCLUSION: Our data validate both criteria sets in the Lebanese population, demonstrating that they are useful in populations that are genetically different from the European populations used to develop them. Spondyloarthropathy is the most common in our rheumatology practice.

Adult↗

Drug resistance among Mycobacterium tuberculosis isolates in Lebanon.

OBJECTIVE: To determine the prevalence and patterns of drug resistance among Mycobacterium tuberculosis isolates recovered from tuberculosis (TB) cases in Lebanon. DESIGN: A total of 96 isolates were collected from the same number of TB cases between October 1994 and December 1995. These isolates were obtained from cases with newly diagnosed (81.3%) and previously treated (18.7%) cases of TB, and tested against isoniazid (INH), rifampicin (RIF), streptomycin (STM) and ethambutol (ETH), using the BACTEC-TB susceptibility procedure and system. RESULTS: The male to female ratio was 2:1 and the mean ages of males and females were almost similar, 34.1 and 32.7 years, respectively. Resistance to one or more drugs was found in 25 of 96 (26%) isolates. The overall percentages of single drug resistance against INH, RIF, STM and ETH were 23.9%, 12.5%, 7.3% and 3.1%, respectively. These percentages were higher, for all drugs, in isolates recovered from previously treated compared to new cases of TB: INH (50% vs 17.9%), RIF (33.3% vs 7.7%), STM (22.2% vs 3.8%) and ETH (11.1% vs 1.3%). Of the 25 resistant isolates, 11 were resistant to one drug only (10 to INH and 1 to STM), 10 were resistant to two drugs (7 to INH and RIF, 2 to INH and STM, 1 to STM and RIF), 2 were resistant to three drugs (1 to INH, RIF and ETH, 1 to INH, RIF and STM) and 2 were resistant to the four tested drugs. CONCLUSION: These data show that M. tuberculosis isolates in Lebanon have high rates of single and multidrug resistance, and speaks for the need to establish surveillance and monitoring programs in this country as part of the global effort to control TB.

Adult↗

Therapeutic play for hospitalized preschoolers in Lebanon.

Therapeutic play in the form of an interactive puppet show was administered to 50 preschool children one day before surgery in a hospital in Lebanon. A control group of 50 preschool children received routine care but no therapeutic play. Physiological and behavioral measures were assessed on admission, at the time of a stressful procedure (preoperative injection), after surgery, and after discharge. Although on admission there had been on significant differences between the means on physiological measures for the two groups, the children who received the therapeutic play intervention manifested markedly less anxiety and more cooperation and had significantly lower mean blood pressures and pulse rates during the injection than the control group. Following surgery, the experimental group took less time to void their bladders, another physiological indication of lower stress level. After hospital discharge, the children who had received therapeutic play had significantly lower scores on all six factors of the Post Hospital Behavior Questionnaire. This study demonstrates that therapeutic play is a valid means of reducing stressful responses to hospitalization and surgery among children in Lebanon.

Anxiety↗

Childhood blindness in Lebanon.

A survey in the Lebanese schools for the blind revealed that 77% of childhood blindness in the country was genetically determined. Two thirds of the hereditary blindness cases were due to autosomal recessive conditions; the high frequency of consanguineous marriages in Lebanon was the underlying cause of this finding. There is marked similarity in the etiology of childhood blindness in Cyprus and Lebanon, for both countries are somewhere between the highly developed countries.

Adolescent↗

Antimicrobial susceptibility patterns of bacteria at the Makassed General Hospital in Lebanon.

Bacterial resistance to various antimicrobial agents is most common in areas with high usage of antibiotics such as in countries where over-the-counter availability promotes usage. In Lebanon, information about bacterial resistance to antimicrobial agents is limited. In this study, data on the antimicrobial susceptibility patterns have been collected for the last 7 years in addition to the first 6 months of 1996 at the Makassed General Hospital in Lebanon. Enterobacteriaceae and Pseudomonas species proved to have high but variable rates of multidrug resistance. Among Staphylococcus aureus isolates, 17% were resistant to methicillin. A high percentage of resistance to penicillin (76-88%) was noted among Streptococcus pneumoniae. These resistance patterns were generally comparable with those of other medical centres.

Anti-Bacterial Agents↗

Occupational Health in Lebanon: Overview and Challenges.

This paper discusses the challenges facing the field of occupational health in Lebanon following 15 years of war. It examines the opportunities for advancing this field and for bringing Lebanese standards up to par with international ones. Challenges include the minor contribution of industry to the overall economy, its perception as nonhazardous, the lack of standards and enforcement, the scarcity of data, and the obscurity of occupational health on the national agenda. Opportunities, on the other hand, have arisen from the need to rebuild the infrastructure and revive tourism, public awareness of the potential hazards of industries in densely populated areas, international pressure, and the return of professionals in occupational health. The safety and salubriousness of workplaces are perceived as minor concerns in Lebanon, yet desire for economic recovery may prove to be an incentive for increased action on this issue. Three potential approaches for action are presented.

Journal Article↗

Evaluation of some competition indices for the construction of Lebanon cedar (Cedrus libani A. Rich.) stand models.

The purpose of this research is to test the precision of some published competition indices of Lebanon cedar (Cedrus libani A. Rich.) for the estimation of future periodic diameter increment of individual trees. Twenty- nine published competition indices were tested, using fifteen separate sets of data and their pooled values, collected from various stand age and site quality classes Lebanon cedar at Antalya. Temporary sample plots were taken in Elmali-Qamkuyusu (9 sample plots) and Finike-Pinarcik (6 sample plots) in 2001. Every plot was stem mapped (x and y coordinate system), diameter (dbh), total height, crown length, crown diameter and 10-year radial increment were recorded for trees greater than 4 cm in dbh. Then, in order to evaluate these competition indices for the prediction of the periodic diameter increment of the individual trees. Three linear models have been constructed for each competition index. It was found that the competition indices (Daniels et al., 1986; Biging and Dobbertin, 1995; Pukkala and Kolström, 1987; Hegyi, 1974) with larger influence-zone areas produce better results.

Cedrus↗

Acceptance of first-trimester prenatal diagnosis for the haemoglobinopathies in Lebanon.

We have interviewed 83 couples at risk for a haemoglobin disorder, mostly beta-thalassaemia, in an effort to evaluate their attitude towards first-trimester prenatal diagnosis. Most of the families had received poor education and were of low socio-economic status and more than half of the couples were not properly aware of their genetic risk. Fifty-nine per cent of the couples were definitely in favour of prenatal diagnosis, 23 per cent were uncertain at the time of the interview, and 18 per cent were opposed to such testing, because of their religious conviction against termination of a pregnancy. Another important factor which seems to influence choice was the cost of the test. Essential issues that arise from this study include the importance of a control programme adapted to particular populations, proper information and counselling, and the need for financial support in countries such as Lebanon.

Chorionic Villi Sampling↗

Genetic diseases in Lebanon.

Lebanon has a high incidence of common and rare genetic diseases, due probably to the mosaic different ethnic origins and the high rate of consanguineous marriages in certain communities. Two major investigations, exploring the genetic structure of the Lebanese population, indicated the population to be caucasiods (though Oriental traits were found). These investigations involved studies of dermatoglyphics, and type and distribution of genetic markers and protein variants. Recorded genetic diseases, some characteristic of ethnic group or particular to a geographic region include familial paroxysmal polyserositis, familial hypercholesterolemia, hypothroidism, the Dyggve-Melchoir-Clausen syndrome, Sandhoff disease, and various genetic hematologic diseases. Genetic counseling and care to patients with genetic diseases is available in Beirut from the Faculty of Medicine at American University and St. Joseph University. Also, the Lebanese National Council for Scientific Research initiates and finances medical genetics programs.

Consanguinity↗

Attitudes towards prenatal diagnosis and termination of pregnancy among health professionals in Lebanon.

OBJECTIVES: To assess the attitudes of health professionals in Lebanon towards prenatal diagnosis and termination of pregnancy, for a series of genetic, non-genetic and non-medical conditions. METHODS: A total of 158 questionnaires were sent to geneticists, family doctors, pediatricians and obstetricians/gynecologists, that included information on sociodemographic variables and sets of questions and case scenarios, to which participants were asked to reply anonymously. RESULTS: Responses from the 75 participants revealed that the type of specialty did not significantly influence their attitude. However, acceptance of termination of pregnancy was influenced by gender, age, marital status, religion and its importance in their daily life. In general, acceptance of termination of pregnancy in the case of mild or severe clinical conditions was comparable to that reported from European countries, but more favorable in the case of sex chromosome abnormalities. Acceptance of prenatal diagnosis for non-clinical conditions was, however, lower than that reported in Western nations. CONCLUSION: The study provides a good basis for further studies with a larger number of respondents representing various geographical regions of the country.

Abortion, Induced↗

Industrial-waste management in developing countries: the case of Lebanon.

This paper presents a critical assessment of the existing Lebanese industrial sector, namely the current status and classification of industrial establishments based on a comparative synthesis and analysis of recent nationwide surveys and studies pertaining to industrial-waste management. Characterisation of solid and liquid industrial wastes generated, including hazardous wastes, is presented together with current and projected waste loads, recycling opportunities, and export/import practices. Institutional capacity and needs pertaining to the enforcement of relevant environmental legislation, staffing and resources, monitoring schemes, and public participation are critically evaluated. Finally, realistic options for industrial-waste management in the context of country-specific institutional economic and technical limitations are outlined. The industrial sector in Lebanon consists of small-scale industries (84% employ less than 10 persons), primarily involved in light manufacturing (96%). These industries which are distributed among 41 ill-defined zones and deficient in appropriate physical infrastructure, generate solid, liquid, and hazardous waste estimated at 346,730 tons/year, 20,169,600 m3/year and between 3000 to 15,000 tons/year, respectively. Although the growth of this sector contributes significantly to the socio-economic development of the country (industry accounts for 17% of the gross domestic product), in the absence of a comprehensive environmental management plan, this expansion may not be sustained into the coming millennium. The anticipated expansion will inevitably amplify adverse environmental impacts associated with industrial activities due to rising waste volumes and improper waste handling and disposal practices. These impacts are further aggravated by a deficient institutional framework, a lack of adequate environmental laws, and lax enforcement of regulations governing industrial-waste management.

Environmental Pollution↗

Prevalence of antimicrobial resistance in Haemophilus influenzae in Greece, Israel, Lebanon and Morocco.

Between 40 and 43 Haemophilus influenzae isolates obtained from Greece, Lebanon, Israel and Morocco respectively (a total of 167 strains) were analysed for prevalence of resistance to six different drugs. Of these isolates 12.6% produced beta-lactamase and were resistant to ampicillin. All isolates, except a single strain from Greece, were susceptible to cefaclor. The frequency of resistance to chloramphenicol and tetracycline was below 2%. The frequency of isolates susceptible and resistant to erythromycin and cotrimoxazole varied from country to country.

Ampicillin Resistance↗

Major depression and external stressors: the Lebanon Wars.

This article examines the effect of war events and pre-war depression on the prevalence of major depression during war. A total of 658 subjects aged 18-65 years were randomly selected from four Lebanese communities differentially exposed to the Lebanon Wars and were interviewed using the Diagnostic Interview Schedule (Arabic version). The individual levels of exposure to war events were assessed through a War Events Questionnaire. The lifetime prevalence of the DSM-III-R-defined major depression varied across the four communities from 16.3 to 41.9%; the final parameters predicting major depression since the onset of the wars were: depression before the wars and exposure to the wars. Both, individual levels of exposure to war and a history of pre-war depression, predict the development of depression during war.

Adult↗

Cystic fibrosis in Lebanon: distribution of CFTR mutations among Arab communities.

Cystic fibrosis (CF) is thought to be rare among the Arab populations from the Middle East and little data have been reported so far. We have studied a sample of 20 families living in Lebanon for several generations and who have at least one child with CF. These families are mainly from the Maronite, Greek Catholic, Greek Orthodox. Shiite or Sunnite groups. We found a 50% rate of consanguineous marriage, independent of the community of origin. The distribution of CF genotypes was determined through the screening of all exons of the CFTR (cystic fibrosis transmembrane conductance regulator) gene by the technique of denaturing gradient gel electrophoresis combined with asymmetric amplification DNA sequencing. A total of ten different mutations accounting for 87.5% of 32 unrelated CF alleles was identified, including two novel putative mutations (E672del and IVS21-28G-->A). Three mutations, delta F508 (37.5%), W1282X (15.6%), and N1303K (9.4%) accounted for 62.5% of CF alleles. Interestingly, in the Maronite group, 66.7% of the delta F508 chromosomes were found to be associated with allele 7 of the IVS8(T)tract, contrasting with the absolute linkage disequilibrium between European delta F508 chromosomes and allele 9. During this study, two previously undescribed polymorphisms (IVS14a + 17del5 and 2691T/C) were also identified.

Arabs↗