Awareness and Use of Folic Acid among Women of Childbearing Age

Folic acid (FA) given before and during pregnancy reduces the risk of several birth defects, including neurologic, cardiac, urinary and other congenital anomalies in the newborn. Several studies around the world showed less than satisfactory awareness and intake of this important vitamin. We undertook the task of exploring this question among Lebanese women of childbearing age. Between June and November 2014, we conducted this cross-sectional study on women aged 20 to 40 years. The subjects, who agreed to participate, completed a questionnaire, which included questions on sociodemographic characteristics, lifestyle, and knowledge about FA roles during pregnancy, as well as their babies’ health. Seventy-six percent reported having knowledge about FA during pregnancy, but only a small proportion knew the benefits for taking it. Also, 93.9% of women took FA supplements during pregnancy, however only 33.6% of the participants took FA before becoming aware of their pregnancy. Public health interventions to improve awareness of FA’s roles before and during pregnancy are crucial to curtail birth defects. It is our opinion that it is a very fruitful preventive medicine tool in which every community should invest

Glioblastoma and Increased Survival with Longer Chemotherapy Duration

Introduction The five-year survival rate for patients with glioblastoma (GBM) is low at approximately 4.7%. Radiotherapy plus concomitant and adjuvant temozolomide (TMZ) remains the standard of care. The optimal duration of therapy with TMZ is unknown. This study sought to evaluate the survival benefit of two years of treatment. Methods This was a retrospective chart review of all patients diagnosed with GBM and treated with TMZ for up to two years between January 1, 2002 and December 31, 2011. The Kaplan-Meier method with log-rank test was used to estimate the progression-free survival (PFS) and the overall survival (OS). The results were compared to historical controls and data from previous clinical trials of patients treated up to one year. Results Data from 56 patients with confirmed GBM were evaluated. The OS probability was 54% (SE = 0.068) at one year, 28.3% (SE = 0.064) at two years, 17.8% (SE = 0.059) at three years, and 4% (SE = 0.041) at five years. Seven patients (12.5%) were treated with TMZ for two years. Their median time-to-progression was 28 months (95% CI = 5.0 - 28.0), and they had an increased survival probability at three years compared to other patients (log-rank test χ2 (1, N = 56) = 19.2, p < 0.0001). Conclusions There may be an advantage for a longer duration of TMZ therapy among patients with GBM, but the sample size was too small for generalization. A multicenter prospective study is needed to dentify optimal duration of TMZ therapy

Vitamin B12 deficiency in diabetic subjects taking metformin: A cross sectional study in a Lebanese cohort

Metformin is the only biguanide derivative used to treat type 2 diabetes mellitus (T2D). Several studies documented that its use contributes to vitamin B12 deficiency in 10–30% of diabetics. The incidence of deficiency varies among populations and studies reported. There has been no reports documenting this incidence in the Middle East and Lebanon. The objectives of this study were to establish the incidence of vitamin B12 in our population, to investigate and characterize any specific associations between taking metformin and vitamin B12 deficiency to establish clear recommendations based on this data. During the first 6 months of 2015, we conducted a cross sectional study on 200 Lebanese individuals. The cohort consisted of subjects with an established diagnosis of T2D and who have been on metformin for at least three months. The patients were subjected to a questionnaire, medical record review, and vitamin B12 level measurement. Thirty three percent of the subjects were found to have borderline values of the serum vitamin B12 (148–220 pg/dl) while 22.5% had a clear, deficiency (levels less than 148 pg/dl). We found a highly significant inverse correlation between the dose and duration of metformin treatment and the serum levels of vitamin B12. Furthermore, both borderline and low levels of vitamin B12 were associated with the presence of different neuropathies and macrocytic anemia in a dose dependent manner. Based on our results, we strongly recommend the routine screening of subjects with T2D on metformin for vitamin B12 deficiency due to its high prevalence and the significant clinical effects it may result in. Furthermore, we recommend, based on our data, to start treating those subjects once a borderline or low level is detected

Metabolic Effects of D-Chiro-Inositol and Myo-Inositol in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age.&nbsp; The&nbsp; pathogenesis&nbsp; has&nbsp; not&nbsp; been&nbsp; fully&nbsp; deciphered.&nbsp; PCOS&nbsp; is&nbsp; associated&nbsp; with&nbsp; insulin&nbsp; resistance&nbsp; (IR), menstrual irregularities, cardiovascular disease, obesity, hirsutism, infertility, and endometrial cancer. The use&nbsp; of&nbsp; D-chiro-inositol&nbsp; (DCI)&nbsp; for&nbsp; the&nbsp; treatment&nbsp; of&nbsp; IR&nbsp; in&nbsp; PCOS&nbsp; has&nbsp; been&nbsp; controversial&nbsp; with&nbsp; contradictory data being published. Our objective is to evaluate the effect of DCI combined with myo-inositol (MI), and metformin on the metabolic outcomes of PCOS in a Lebanese women cohort. This is a prospective study of 150 Lebanese women diagnosed with PCOS and treated with Ovacure® (DCI+MI+folic&nbsp; acid),&nbsp; or&nbsp; a&nbsp; combination&nbsp; of&nbsp; Ovacure®&nbsp; and&nbsp; metformin.&nbsp; Patients&nbsp; aged&nbsp; 13&nbsp; to&nbsp; 55&nbsp; years&nbsp; were randomly&nbsp; selected&nbsp; from&nbsp; different&nbsp; clinics&nbsp; in&nbsp; Beirut&nbsp; and&nbsp; Mount&nbsp; Lebanon.&nbsp; A&nbsp; questionnaire&nbsp; covering&nbsp; the personal&nbsp; and&nbsp; health&nbsp; status,&nbsp; physical&nbsp; activity,&nbsp; medications&nbsp; and&nbsp; anthropometrics&nbsp; was&nbsp; completed&nbsp; before enrolment. The prevalence of obesity in our population was 35.3%. Although IR was more prevalent among obese women&nbsp; with&nbsp; PCOS,&nbsp; non-obese&nbsp; subjects&nbsp; were&nbsp; also&nbsp; found&nbsp; to&nbsp; have&nbsp; a&nbsp; significant&nbsp; incidence&nbsp; of&nbsp; IR.&nbsp; After&nbsp; a&nbsp; 6 months course of treatment with Ovacure®, a significant decrease in fasting glucose, HOMA-IR, Glycated Hemoglobin&nbsp; (HbA1c),&nbsp; Low&nbsp; Density&nbsp; Lipoprotein&nbsp; (LDL),&nbsp; Triglycerides&nbsp; (TG),&nbsp; weight&nbsp; and&nbsp; Body&nbsp; mass&nbsp; index (BMI)&nbsp; levels&nbsp; were&nbsp; noted.&nbsp; Furthermore,&nbsp; adding&nbsp; metformin&nbsp; to&nbsp; Ovacure®,&nbsp; lowered&nbsp; weight&nbsp; and&nbsp; BMI&nbsp; further but not IR.In this study, we show that the combination of MI and DCI may improve the metabolic profile in PCOS.The addition of metformin may help control overweight further but not IR.</p

Uric Acid Association with the Metabolic Syndrome and Type 2 Diabetes

Introduction and Objectives: The metabolic syndrome (MetS) consists of a group of cardiovascular risk factors, highly prevalent worldwide, afflicting an estimated 20 to 25% of the world’s population. There is a probable relationship between serum uric acid (SUA), Type 2 diabetes (T2D) and the MetS but the literature presents conflicting data. Our primary objective was to assess any association between SUA, T2D, MetS, the lipid profile and pre-diabetes (PD).Materials and Methods: We conducted a prospective study on 116 patients with T2D, PD or MetS. Patients aged between 18 and 89 years were chosen randomly from private clinics. Data covering personal, socio-economic, health and dietary habits, lab tests, anthropometric measures and medications were collected.Results: The prevalence of T2D and MetS in our group was 74% and 85.9% respectively. The mean SUA level was 4.95 mg/dL±1.45 with males having a higher mean (5.28 mg/dL ±1.26) compared to females (4.56 mg/dL ±1.57). The highest association was found between SUA levels, obesity and insulin levels. No association was found between the levels of SUA and Triglycerides (TG), High Density Lipoproteins (HDL), the Systolic or Diastolic Blood Pressures (BP). The fasting glucose levels were found to be inversely associated with SUA among subjects with the MetS. Fish and shellfish and soft drinks were the food items most associated with SUA levels.Conclusion: In conclusion, we found no direct association between SUA and T2D, the MetS, BP, TG, and HDL. SUA levels were associated with obesity, insulin levels, male gender, and the consumption of fish and shellfish and soft drinks

Implementing and evaluating group interpersonal therapy for postnatal depression in Lebanon and Kenya-individually randomised superiority trial

BACKGROUND: Depression ranks as the foremost mental health concern among childbearing women. Within low- and middle-income countries (LMICs), between 20 and 25% of women encounter depression during pregnancy or soon after delivery. This condition impacts not only the mothers but also their offspring. Offspring of women suffering from postnatal depression (PND) exhibit suboptimal cognitive development and increased emotional and behavioural issues throughout their growth. This scenario becomes more pronounced in LMICs, where numerous adversities further jeopardise children's developmental progress. Despite antenatal services providing a pivotal platform to address women's mental health needs, PND treatment remains inaccessible in many LMICs. The World Health Organization advocates interpersonal psychotherapy (IPT) for treating depression. While research from high-income countries has established the efficacy of IPT and group-IPT (g-IPT) for PND, its effectiveness within the LMIC context and its potential benefits for child development remain uncharted. This study seeks to gauge the potency of g-IPT for women with PND in two LMICs. METHODS: This multi-site randomised controlled trial is a continuation of two preceding phases-conceptual mapping and a feasibility study executed in Lebanon and Kenya. Insights gleaned from these phases underpin this comprehensive RCT, which contrasts the efficacy and cost-effectiveness of high-quality standard care (HQ-SC) augmented with g-IPT against HQ-SC in isolation. The trial, characterised as an individually randomised superiority assessment, targets women with postnatal depression in Beirut, Lebanon, and Nairobi, Kenya. It aims to determine if culturally tailored g-IPT, administered within community settings in both countries, outperforms HQ-SC in influencing child developmental outcomes, maternal depression, and the quality of the mother-child bond. DISCUSSION: The SUMMIT trial, designed with pragmatism, possesses the magnitude to evaluate g-IPT within two LMIC frameworks. It seeks to enlighten policymakers, service commissioners, professionals, and users about g-IPT's potential to alleviate maternal PND and bolster child developmental outcomes in LMICs. Additionally, the trial will generate valuable data on the clinical and economic merits of high-quality standard care. TRIAL REGISTRATION: ISRCTN, ISRCTN15154316. Registered on 27 September 2023, https://doi.org/10.1186/ISRCTN15154316