Evaluation of prophylactic dosages of Enoxaparin in non-surgical elderly patients with renal impairment

BACKGROUND: Thromboprophylaxis dosing strategies using enoxaparin in elderly patients with renal disease are limited, while dose adjustments or monitoring of anti-Xa levels are recommended. We sought to evaluate the efficacy and safety of enoxaparin 20 mg versus 30 mg subcutaneously daily by comparing anti-Xa levels, thrombosis and bleeding. METHODS: We conducted a prospective, single-blinded, single-center randomized clinical trial including non-surgical patients, 70 years of age or older, with renal disease requiring thromboprophylaxis. Patients were randomized to receive either 20 mg or 30 mg of enoxaparin. The primary endpoint was peak anti-Xa levels on day 3. Secondary endpoints included trough anti-Xa levels on day 3, achievement of within range prophylactic target peak anti-Xa levels and the occurrence of hemorrhage, thrombosis, thrombocytopenia or hyperkalemia during hospitalization. RESULTS: Thirty-two patients were recruited and sixteen patients were randomized to each arm. Mean peak anti-Xa level was significantly higher in 30 mg arm (n = 13) compared to the 20 mg arm (n = 11) 0.26 +/- 0.11, 95%CI (0.18-0.34), versus 0.14 +/- 0.09, 95CI (0.08-0.19) UI/ml, respectively; p = 0.004. Mean trough anti-Xa level was higher in 30 mg arm (n = 10) compared to the 20 mg arm (n = 16), 0.06 +/- 0.03, 95CI (0.04-0.08) versus 0.03 +/- 0.03, 95CI (0.01-0.05) UI/ml, respectively; p = 0.044. Bleeding events reported in the 30 mg arm were one retroperitoneal bleed requiring multiple transfusions, and in the 20 mg arm one hematuria. No thrombotic events were reported. CONCLUSION: Peak anti-Xa levels provided by enoxaparin 20 mg were lower than the desired range for thromboprophylaxis in comparison to enoxaparin 30 mg. TRIAL REGISTRATION: The trial was retrospectively registered on ClinicalTrials.gov identifier: NCT03158792 . Registered: May 18, 2017

von Willebrand factor levels in the diagnosis of von Willebrand disease: a systematic review and meta-analysis

Von Willebrand Disease (VWD) is associated with significant morbidity as a result of excessive mucocutaneous bleeding symptoms. Patients with VWD can experience easy bruising, epistaxis, gastrointestinal and oral cavity bleeding, as well as heavy menstrual bleeding and bleeding after dental work, surgical procedures, and childbirth. Early diagnosis and treatment is important to prevent and treat these symptoms. We systematically reviewed the accuracy of diagnostic tests using different cut-off values of VWF:Ag and platelet-dependent VWF activity assays in the diagnosis of VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies. Two investigators screened and abstracted data. Risk of bias was assessed using QUADAS-2 and certainty of evidence using the GRADE framework. We pooled estimates of sensitivity and specificity and reported patient important outcomes when relevant. This review included 21 studies that evaluated VWD diagnosis, including the approach to patients with VWF levels that have normalized with age (6 studies), VWF cut-off levels for the diagnosis of Type 1 VWD (9 studies), and platelet-dependent VWF activity/VWF:Ag ratio cut-off levels for the diagnosis of Type 2 VWD (6 studies). The results showed low certainty in the evidence for a net health benefit from reconsidering the diagnosis of VWD versus simply removing the disease in patients with VWF levels that have normalized with age. For the diagnosis of Type 1 VWD, in patients with VWF:A

Degradation-fragmentation of marine plastic waste and their environmental implications: A critical review

This review critically evaluates the plastic accumulation challenges and their environmental (primarily) and human (secondarily) impacts. It also emphasizes on their degradation and fragmentation phenomena under marine conditions. In addition, it takes into account the leachability of the various chemical substances (additives) embedded in plastic products to improve their polymeric properties and extend their life. Regardless of their effectiveness in enhancing the polymeric function of plastic products, these additives can potentially contaminate air, soil, food, and water. Several findings have shown that, regardless of their types and sizes, plastics can be degraded and/or fragmented under marine conditions. Therefore, the estimation of fragmentation and degradation rates via a reliable developed model is required to better understand the marine environmental status. The main parameter, which is responsible for initiating the fragmentation of plastics, is sunlight/UV radiation. Yet, UV- radiation alone is not enough to fragment some plastic polymer types under marine conditions, additional factors are needed such as mechanical abrasion. It should be also mentioned that most current studies on plastic degradation and fragmentation centered on the primary stages of degradation. Thus, further studies are needed to better understand these phenomena and to identify their fate and environmental effects.This paper was supported by Qatar University Internal Grant (No. QUCG-CAS-21/22-3). The findings achieved herein are solely the responsibility of the authors

Experiential Education in Pharmacy Curriculum: The Lebanese International University Model

Experiential education is an essential component of pharmacy education in order to allow intern students to experience real conditions and training opportunities in different inpatient and outpatient settings. This paper provides a description of the pharmacy practice experiences (PPEs) in the Lebanese International University (LIU) 5-year bachelor of pharmacy (BPharm) and postgraduate doctor of pharmacy (PharmD) programs; focuses on the opportunities and challenges encountered; and presents a model for experiential education in Lebanon. Learning outcomes and thus students’ acquisition of predefined competencies are evaluated in actual practice settings through assessment tools. Our experiential education program aligns with the accreditation/certification criteria set by the Accreditation Council for Pharmacy Education (ACPE) and equips future pharmacists with the knowledge and skills to become major components in the healthcare team

Smoking Behavior among Adolescents: The Lebanese Experience with Cigarette Smoking and Waterpipe Use

International audienceBackground: The study aims to assess cigarette smoking and waterpipe experimentation among Lebanese adolescent school students with respect to their gender, region, age, and socioeconomic status.Methods: This is a cross-sectional study, where students between 11 to 18 years of age were included from all over Lebanon.Results: A total of 1133 students were interviewed. The total proportion of adolescents who ever experimented with cigarette smoking was 24.5%. Males experimented with cigarette smoking more commonly than females (31.9% vs. 19.1%; p < 0.001). Cigarette smoking experimentation was higher among students from the Beirut area (33.6%; p < 0.001) in comparison to other regions, and among those with poor health perception (29.1% vs. 19.8%; p < 0.001) compared to students with excellent health perception. The total proportion of adolescents who ever used a waterpipe was 33.9%. Waterpipes were significantly more experimented with among males than females (40.3% vs. 29.8%; p < 0.001), and among students with bad perception about their health (39.4% vs. 28.9%; p < 0.001). Adolescents who experimented with both cigarettes and waterpipes constitute 22.2% of the studied sample.Conclusions: The rate of tobacco product use is alarming and constitutes a major public health issue for adolescents that urgently needs intervention. The findings raise important policy implications for the development of cigarette smoking prevention programs for youth

Insights into the degradation mechanism of PET and PP under marine conditions using FTIR

Plastics possess diverse functional properties that have made them extremely desirable. However, due to poor waste management practices, large quantities eventually end up in the oceans where their degradation begins. Hence, it is imperative to understand and further investigate the dynamics of this process. Currently, most relevant studies have been carried out under benign and/or controlled weather conditions. This study investigates the natural degradation of polypropylene (PP) and polyethylene terephthalate (PET) in more extreme environments. Simulated and real marine conditions, both in the laboratory (indoors) and outdoors were applied for a duration of 140 days and results were assessed using Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) with energy dispersive X-ray analysis. SEM micrographs revealed variations in the morphologies of both plastic types. Degradation signs were shown in both plastic types, under all conditions. Findings indicated that microplastics (MPs) degraded faster than macroplastics, with PP MPs having higher weight loss (49%) than PET MPs (1%) when exposed to outdoor marine conditions. Additionally, the degradation rates of MPs-PP were higher than MPs-PET for outdoor and indoor treatments, with 1.07 ×10-6g/d and 4.41 ×10-7g/d, respectively. FTIR combined with PCA was efficient in determining the most degraded plastic types.This paper was supported by Qatar University Internal Grant (No. QUCG-CAS-21/22-3). The findings achieved herein are solely the responsibility of the authors. The SEM-EDX, DSC, and FTIR analyses were accomplished in the Central Laboratories unit, Qatar University

Effect of temperature and sunlight on the leachability potential of BPA and phthalates from plastic litter under marine conditions

This study investigates the leaching potential of several additives embedded in six different plastic types when exposed to extreme simulated marine conditions for 140 days. The findings achieved herein contribute to a better understanding of the impact of macro- and microplastics leaching harmful compounds (bisphenol A (BPA) and phthalates) in the marine environment when exposed to harsh climatic conditions. Leachability experiments showed that bis(2-ethylhexyl) phthalate (DEHP), dibutyl phthalate (DBP), and BPA were detected in seawater (SW) samples. Furthermore, while analysing 100 mL of SW per each sample, the total leachate concentrations of the identified compounds ranged from 5 μg/L to 123 μg/L, after 140 days of exposing a total of 120 plastic samples (96 samples micro- and 24 macro-plastics) to SW conditions It was observed that the leaching of DEHP was promoted by wave abrasion, high temperature and sunlight, while the leaching of DBP was favoured by wave abrasion. Findings showed that polypropylene (PP) was the most attributable plastic type in the leaching of DBP with an average concentration of 5.3 μg/L, whereas high-density polyethylene (HDPE) was the most responsible plastic-type for the leaching of DEHP, with an average concentration of 123 μg/L. Our results suggest that most of the phthalates and BPA will, ultimately, leach out to the SW environment after a longer period.This paper was supported by Qatar University Internal Grants (No. QUCG-CAS-21/22-3 & M-QJRC-2020-3). The findings achieved herein are solely the responsibility of the authors. The GC–MS analysis was accomplished in the Central Laboratories unit, Qatar University

A cross-sectional survey on community pharmacists readiness to fight COVID-19 in a developing country: knowledge, attitude, and practice in Lebanon

Abstract Background Lebanon, a developing Middle Eastern country, was hit by the COVID-19 pandemic that occurred amid a severe national economic crisis. Community pharmacists are responsible for dispensing appropriate medications and products in addition to counseling, informing and educating the public, and promoting disease prevention and infection control. Objective This study aimed to assess community pharmacists' knowledge, attitude, and practice towards the COVID-19 pandemic and evaluate behavior changes and safety measures. Methods An anonymous and standardized online questionnaire in English was disseminated via social media platforms to Lebanese community pharmacists. The questionnaire consisted of 95 items designed as Likert-scales and multiple-choice questions divided into four different sections: socio-demographic characteristics, knowledge-based, attitude-based, and pharmacy practice questions. Descriptive statistical analysis was used to summarize the demographic characteristics, and indices were created for knowledge, attitude, and practice by computing the correct answers for each section. Results A total of 310 questionnaires were completed. Around 61% have expressed their fear of getting infected with COVID-19 due to occupational exposure. The respondents were able to answer 80–90% of the knowledge-based questions of the survey. A more careful/anxious attitude, but not knowledge, was associated with overall better practice (p = 0.03). Also, respondents stated that they are dispensing protective equipment items such as masks (87%), gloves (60%), and sanitizers (77%) in small quantities due to limited availability. Conclusion Our findings revealed an adequate level of knowledge and good practice towards COVID-19 among Lebanese community pharmacists. Their fears of contracting the virus and compromising the safety of those around them are justified. However, their supply of protective equipment is limited

S1 Data -

BackgroundCOVID-19 infection in patients with type 2 diabetes mellitus (T2DM) -a chronic illness in Lebanon–is not well described.MethodsThis was a single-centre retrospective observational study of 491 patients, including 152 patients with T2DM, who were hospitalised for COVID-19 between 20 August 2020 and 21 April 2021. Data on clinical characteristics, laboratory and radiological findings and outcomes were collected from the electronic medical records. Clinical characteristics and in-hospital mortality between patients with and without T2DM infected with COVID-19 using multivariate analysis were compared.ResultsPatients with T2DM were significantly older than those without T2DM (mean age, 68.7 vs. 60.3 years). Patients with T2DM were more likely to present with a body temperature of ConclusionAmong patients hospitalised for COVID-19, those with T2DM were older, presented with milder symptoms and had more comorbidities and higher troponin T levels compared with those without T2DM. Despite the worse clinical course, the patients with T2DM had lower odds of mortality than those without T2DM.</div

Laboratory findings of diabetic and non-diabetic patients admitted for COVID-19 infection.

Laboratory findings of diabetic and non-diabetic patients admitted for COVID-19 infection.</p