DIABETES AND DEPRESSION: RELATION TO GLYCEMIC CONTROL

Diabetes mellitus is a worldwide highly prevalent chronic metabolic disorder, characterized by hyperglycemia, and is associated with significant complications, including the microvascular complications such as neuropathy, retinopathy and nephropathy and the macrovascular complications such as cardiovascular, cerebrovascular disease and peripheral vascular disease, thus leading to significant morbidity and mortality. Patients with diabetes were found to be 1.4-3 times more likely to suffer from comorbid depression when compared to non-diabetics, and depression in diabetes is usually persistent and/or recurrent. Depression was found to be increased among patients with type I and type II diabetes mellitus, which have higher glycosylated hemoglobin. Association was also found between diabetic complications and depression, and this relation is bidirectional since depression might be linked to poor glycemic control and complications lead to negative impact on patients’ physical and mental health and leads to worse quality of life, thus fostering the development of depression. The presence of depression by itself was found to be associated with significant negative impact in their diabetes self-care and having proper glycemic control, and led to worse health outcomes and quality of life. Thus, American Diabetes Association currently recommends that patients with diabetes mellitus, especially those with poor glycemic control, should be screened for depression

Prevalence of menopausal hot flashes in Lebanon: A cross-sectional study

Background: Menopausal hot flashes or vasomotor symptoms are prevalent and could be debilitating in postmenopausal women. There is controversy regarding the risk factors for hot flashes, some of which may vary from one country or culture to another. Objective: To shed light on this matter by assessing the prevalence of hot flashes, their effect on quality of life, and their association with certain factors such as physical exercise, caffeine, spicy food consumption, dietary intake, smoking, alcohol, etc. Materials and Methods: A large cross-sectional study was conducted among 627 Lebanese women, aged 45-67 yr using a well-developed and comprehensive questionnaire, in order to better assess the prevalence of hot flashes, focusing on their characteristics, association with various factors, severity, and effect on the women’s quality of life. Results: 62.5% of participants experienced hot flashes. A statistically significant difference was noted between women who experience hot flashes and their counterparts with respect to smoking, body mass index, spicy food consumption, education level, age, menstrual status, and parity. An association was not found with physical activity or other dietary factors. Conclusion: As an alternative for hormone therapy, clinicians should consider lifestyle changes to help manage hot flashes, which impose a tremendous physical and social toll on the women experiencing them. Key words: Menopause, Diet, Body mass index, Quality of life, Smoking

MEDICAL EDUCATION DURING COVID-19 PANDEMIC: THE EXPERIENCE OF FACULTY OF MEDICINE, BEIRUT ARAB UNIVERSITY (BAU): CHALLENGES, SUCCESSES AND LESSONS LEARNED

Background: The novel Coronavirus pandemic (COVID-19) has significantly disrupted and challenged medical education at the undergraduate and postgraduate levels. In this article, the experience at Beirut Arab University Faculty of Medicine (BAUFM), during the COVID-19 pandemic, is being shared with its challenges, successes and lessons learned. The program of BAUFM is divided into three phases: Pre-Clerkship (Semesters 1 to 6), Clerkship (Semesters 7 to 10), and Pre-internship (Semesters 11 and 12), it extends over six years duration, followed by one year of Internship. The curriculum is developed to be outcomes-based, and is composed from Phases and Modules. Methodology: In this study, Data was collected from interviews with members of Medical Education Department and Quality Assurance Unit, in addition to feedback questionnaire from students and instructors. Qualitative data was summarized, coded and sorted manually, while quantitative data was analyzed using Statistical Package of Social Science (IBM SPSS version 23.1). Results: Adherence to social distancing has eliminated all face-to-face activities, including in-person classes, in-person small group discussions and workshops, during which students used to interact with their peers and tutors in students-centered learning activities. Lectures were covered through help of virtual teaching platforms, online educational resources and audio-recorded Power-Points Presentations; whereby they were given to students in interactive (synchronous) sessions, or provided with audio support (asynchronous). Students’ satisfaction to online learning was 40%. While 54% of instructors believe that online learning should encompass less than 25% of the curriculum, 36% believe that it should cover 25-50%. Reflection and Discussion: The most important challenges that were faced, during the COVID-19 pandemic, were with the clinical rotations that used to take place during the Clerkship and Pre-internship phases. Decision was taken to ensure that all year six clinical rotations were to be completed which enabled their graduation on time. For the 4th and 5th year students, clinical rotations were resumed in Modules that included outpatient clinical exposure, while postponed for other Modules to the next academic year. A number of students (30%), regardless of their level of training, showed interest in community engagement and in volunteering community activities during the Coronavirus pandemic. Lessons Learned: BAUFM, while committed to its mission in graduating competent, humane, ethical, and socially accountable physicians, has to modify its learning strategy to comply with the recent international changes in medical education. Conclusion: Although COVID-19 pandemic has affected the educational program, BAUFM responded early by shifting to online education in the theoretical part of the curriculum. Meanwhile, the educational program and the curriculum learning objectives were maintained to comply with the accreditation standards. The impact of COVID-19 pandemic accelerated the transformation of education in BAUFM to the online and blended learning

A generalization of the space of complete quadrics

To any homogeneous polynomial h we naturally associate a variety Ωh which maps birationally onto the graph Γh of the gradient map ∇h and which agrees with the space of complete quadrics when h is the determinant of the generic symmetric matrix. We give a sufficient criterion for Ωh being smooth which applies for example when h is an elementary symmetric polynomial. In this case Ωh is a smooth toric variety associated to a certain generalized permutohedron. We also give examples when Ωh is not smooth

Elliptic membership functions and the modeling uncertainty in type-2 fuzzy logic systems as applied to time series prediction

In this paper, our aim is to compare and contrast various ways of modeling uncertainty by using different type-2 fuzzy membership functions available in literature. In particular we focus on a novel type-2 fuzzy membership function–”Elliptic membership function”. After briefly explaining the motivation behind the suggestion of the elliptic membership function, we analyse the uncertainty distribution along its support, and we compare its uncertainty modeling capability with the existing membership functions. We also show how the elliptic membership functions perform in fuzzy arithmetic. In addition to its extra advantages over the existing type-2 fuzzy membership functions such as having decoupled parameters for its support and width, this novel membership function has some similar features to the Gaussian and triangular membership functions in addition and multiplication operations. Finally, we have tested the prediction capability of elliptic membership functions using interval type-2 fuzzy logic systems on US Dollar/Euro exchange rate prediction problem. Throughout the simulation studies, an extreme learning machine is used to train the interval type-2 fuzzy logic system. The prediction results show that, in addition to their various advantages mentioned above, elliptic membership functions have comparable prediction results when compared to Gaussian and triangular membership functions

Intravitreal Expansile Gas and Bevacizumab Injection for Submacular Hemorrhage Due to Neovascular Age-related Macular Degeneration

Purpose: To evaluate the results of intravitreal expansile gas injection, with or without recombinant tissue plasminogen activator (rtPA), followed by intravitreal bevacizumab injection for treatment of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (AMD). Methods: In this interventional case series, 5 eyes of 5 patients with SMH secondary to choroidal neovascularization (CNV) due to neovascular AMD were treated with 0.3 cc intravitreal SF6 (and 50 μg of rtPA in two eyes), followed by face-down positioning; 24 hours later, 1.25 mg of bevacizumab was injected intravitreally. Main outcome measures included displacement of SMH and best corrected visual acuity (BCVA). Results: Mean patient age was 75.6±9.2 (range, 60-83) years, mean duration of symptoms was 6.4±3.2 (range, 3-10) days, and mean number of bevacizumab injections was 1.8 (range, 1-3). Mean preoperative BCVA was 1.28±0.27 logMAR which improved significantly to 0.57±0.33 logMAR at 12 months (P=0.042). SMH displacement occurred in all eyes, and visual acuity improved and remained stable during the follow-up period of 12 months. Conclusion: Intravitreal expansile gas injection, with or without rtPA, followed by intravitreal bevacizumab injection, seems to be an effective modality for SMH displacement and treatment of the underlying CNV in neovascular AMD

PERCEPTION OF NARRATIVE MEDICINE AMONG MEDICAL STUDENTS IN LEBANON

The physician-patient relationship has evolved over the years. A good relationship necessitates mutual commitment from both parties, and narrative medicine can be considered as a tool that can aid in improving this relationship, as it helps to improve listening to patients’ stories and turning the patients’ subjective words into objective information, which help physicians to understand the nature of patients’ illnesses, improve the quality of patient care and leads to a better therapeutic effect. A descriptive cross-sectional study was planned. Data collection was done via convenience sampling. Beirut Arab University medical students were asked to fill a paper-based questionnaire between ­­­­­August 2019 and February 2020. The study collected demographic information about the participants including the age, the gender, current academic year, and the cumulative grade point average, and assessed their knowledge about narrative medicine and its importance to be implemented in the medical school curriculum. Data were collected, entered, and analyzed on SPSS software version 23.1. 361 medical students participated. Around 60% thought that narrative medicine helps to promote reflection and empathy, and 80% thought that narrative medicine is essential for enhancing the quality of patient care and that listening to patients’ stories would enhance physician-patient communication. Females tended to have a better understanding of narrative medicine’s importance. The majority agreed that narrative medicine should be an integral part of the medical school curriculum. Medical students were found to be lacking adequate knowledge about narrative medicine. However, the majority agreed on the need for implementation of humanity courses in the current curriculum

Learning Control of Fixed-Wing Unmanned Aerial Vehicles Using Fuzzy Neural Networks

A learning control strategy is preferred for the control and guidance of a fixed-wing unmanned aerial vehicle to deal with lack of modeling and flight uncertainties. For learning the plant model as well as changing working conditions online, a fuzzy neural network (FNN) is used in parallel with a conventional P (proportional) controller. Among the learning algorithms in the literature, a derivative-free one, sliding mode control (SMC) theory-based learning algorithm, is preferred as it has been proved to be computationally efficient in real-time applications. Its proven robustness and finite time converging nature make the learning algorithm appropriate for controlling an unmanned aerial vehicle as the computational power is always limited in unmanned aerial vehicles (UAVs). The parameter update rules and stability conditions of the learning are derived, and the proof of the stability of the learning algorithm is shown by using a candidate Lyapunov function. Intensive simulations are performed to illustrate the applicability of the proposed controller which includes the tracking of a three-dimensional trajectory by the UAV subject to time-varying wind conditions. The simulation results show the efficiency of the proposed control algorithm, especially in real-time control systems because of its computational efficiency

The role of religious and ethnic diversity of Iraq in the U.S. administration's decision to overthrow Saddam Hussein in the years 1991-2003

Bachelor thesis "The role of religious and ethnic diversity of Iraq in the U.S. administration's decision to overthrow Saddam Hussein in the years 1991-2003" deals with the issue of American foreign policy making regarding the Iraq regime of Saddam Hussein from the first Gulf war in 1990-1991 to the second Gulf war in 2003. The thesis concentrates on what was the role of ethnic and religious diversity of Iraq in the decision making process, precisely did this crucial factor influence the decision. Although during the first Gulf war the aspect of religious and ethnic diversity was very much taken into account, and was in fact one of the reasons for the decision not to overthrow Hussein's regime, during the second Gulf war the factor had been totally ignored which led to an afterwar violence which cost tens of thousands of casualties. The thesis concentrates on what was the reason to ignore this risk in the second Gulf war when it was taken into consideration during the first one, regarding the fact that both administrations had very similar personal and political basis.Bakalářská práce "Úloha etnické a náboženské rozmanitosti Iráku při rozhodování americké administrativy o svržení Saddáma Husajna v letech 1991-2003" pojednává o tvorbě zahraniční politiky USA ve vztahu k iráckému režimu Saddáma Husajna v období od první války v Zálivu v letech 1990-1991 do druhé války v zálivu v roce 2003. Konkrétně se zaměřuje na aspekt etnické a náboženské rozmanitosti Iráku v rámci tohoto rozhodovacího procesu, přesněji do jaké míry tento klíčový faktor rozhodování ovlivňoval. Zatímco během první války byl tento faktor zohledněn velmi výrazně a hrál značnou roli v rozhodnutí ponechat Husajna u moci, v případě druhé války byl naopak zcela ignorován, následkem čehož se Irák propadl do sektářského násilí, které si vyžádalo desetitisíce obětí. Práce se zabývá tím, co bylo důvodem jednak k zohlednění těchto rizik v prvním případě, a jednak k ignorování těchto rizik v případě druhém, a to i přesto, že obě administrativy měly velmi podobný jak politický, tak personální základ.Department of North American StudiesKatedra severoamerických studiíFaculty of Social SciencesFakulta sociálních vě

Impact of Antimicrobials use in chickens on emergence of drug-resistant Campylobacter organisms in humans

The objective of this review is to present the impact of uncontrolled use of antimicrobialagents in chicken husbandry on emergence of drug-resistant Campylobacterin humans. The absence of an Antimicrobial Resistance Monitoring System(ARMS) in most developing countries of the world, amidst trade’s globalization ofanimals and animal products, helped in the recent decade in spreading of drugresistantorganisms across the world’s food chains.The emergence of drug resistance in Campylobacter organisms was associated withtheir transmission from animals and their products to humans. This transmissionof drug-resistant Campylobacter resulted in serious failure of treatment regimensprescribed to infected humans