CORRELATES OF SELF-ESTEEM AMONG THE LEBANESE POPULATION: A CROSS-SECTIONAL STUDY

Background: To the best of our knowledge, no studies have been conducted in order to assess the correlation of these factors with the self-esteem in Lebanon. Therefore, this study aims to assess risk factors associated with self- esteem among a representative sample of the Lebanese population. Subjects and methods: A cross-sectional, conducted between November 2017 and March 2018, enrolled 789 participants. Selfesteem was measured using the Rosenberg scale. An exploratory factor analysis was executed to detect patterns of risk factors associated with self-esteem from our sample. A cluster analysis was then performed with the identified factor scores to identify the different profiles of the participants. Results: Relationship management (Beta=0.117), emotional awareness(Beta=0.074) and personal accomplishment (Beta=0.064)were associated with a higher self-esteem, whereas high depression (Beta=-0.102), alexithymia (Beta=-0.077), burnout depersonalization(Beta=-0.078), suicidal ideation (Beta=-0.391) were associated with a lower self-esteem. Factor 1 (High emotional intelligence & low depersonalization) (Beta=1.819) was associated with increased self-esteem, whereas Factor 2 (High suicidal ideation, high alcohol dependence, high depression and anxiety) and Factor 3 (Highburnout, high stress and high alexithymia) were associated with decreased self-esteem (Beta=-1.380 and Beta=-0.751) respectively. Being widowed (Beta=-2.332), belonging to cluster 1 (People with emotional dysregulation) (Beta=-2.850) and cluster 2 (People in distress) (Beta=-3.660) were significantly associated with decreased self-esteem. Conclusions: Depression, anxiety, burnout, stress, low emotional intelligence, alexithymia, suicide ideation, alcohol dependence and many other factors can be prevented, or reduced, by interventions that improve self-esteem

Prevalence of Chlamydia trachomatis infection in the general population of women in Qatar

Objectives The Arabian Gulf region has limited epidemiological data related to sexually transmitted infections. The objective of this study was to estimate the prevalence of Chlamydia trachomatis infection among general population women in Doha, Qatar. Methods Endocervical swabs were collected from healthy women attending primary healthcare centres in Doha, June–December 2008. The specimens were tested for C trachomatis by a commercially available PCR-based assay. Data on basic socio-demographic characteristics, medical history and sexual behaviour were obtained using self-administered questionnaires. The prevalence of C trachomatis and of background variables were stratified by nationality, Qatari nationals versus non-Qatari residents. Results A total of 377 women were enrolled in the study, out of whom 351 (37.9% Qataris, 62.1% non- Qataris) were tested for the presence of C trachomatis in their specimens. The mean age of participants was 41.2 years, and the vast majority (93%, 95% CI 90.3 to 95.7) were married. The mean age at sexual debut was significantly lower among Qatari women compared with non-Qatari women (19.2 vs 22.2 years, respectively p<0.001), but the mean number of reported lifetime sexual partners (1.1 partner) was nearly the same in both groups (p=0.110). The prevalence of C trachomatis infection was 5.3% among Qatari women and 5.5% among non-Qatari women, with no statistically significant difference between both groups ( p=0.923). Conclusions The prevalence of C trachomatis among women was higher than expected, with no significant difference between Qatari nationals and expatriate residents. The higher prevalence may reflect, in part, the limited access to and use of chlamydia screening and management.Research Committee of the College of Arts and Sciences, Qatar University (QUUG-CAS-DHS-10/11-6); Qatar National Research Fund (NPRP 4-924-3-251); The Biostatistics, Epidemiology, and Biomathematics Research Core at the Weill Cornell Medical Colleg

COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm. Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection

Molecular epidemiology and genotype distribution of Human Papillomavirus (HPV) among Arab women in the state of Qatar

Background: Human Papilloma Virus (HPV) infection is the major cause of cervical cancer worldwide. With limited data available on HPV prevalence in the Arab countries, this study aimed to identify the prevalence and genotypic distribution of HPV in the State of Qatar. Methods: 3008 cervical samples, exclusively of women with Arabic origin residing in Qatar were collected from the Women’s Hospital and Primary Health Care Corporation in Doha, State of Qatar. HPV DNA detection was done using GP5+/6+ primers based real time-polymerase chain reaction (RT-PCR) assay followed by the usage of HPV type specific primers based RT- PCR reactions and Sanger sequencing for genotype identification. Results: Similar prevalence rates of HPV infection was identified in both Qatari and non-Qatari women at 6.2% and 5.9% respectively. HPV prevalence rate of 5.8% and 18.4% was identified in women with normal cytology and in women with abnormal cytology respectively. HPV 81, 11 and 16, in decreasing order were the most commonly identified genotypes. HPV 81 was the most frequent low-risk genotype among women with both normal (74.0%) and abnormal (33.3%) cytology. HPV 16 (4.6%) was identified as the predominant high-risk HPV genotype among women with normal cytology and HPV 16, HPV 18, and HPV 56 (22.2% each) were the most common identified high-risk genotypes in women with abnormal cytology Conclusions: The overall HPV prevalence in Arab women in Qatar was identified as 6.1% with an increased HPV prevalence seen in women with abnormal cytology results and no significant trends seen with age. In contrast to Western countries, we report a varied genotypic profile of HPV with a high prevalence of low-risk HPV genotype 81 among the Arab women residing in Qatar.Weill Cornell Medical College in Qatar; and by a grant from the Qatar National Research Fund (NPRP- 09-344-3-082)

Using a pharmacist-led educational tool to teach elementary and middle-school students in Lebanon about microbes, antibiotic use and antimicrobial resistance: A pilot study

Background: Teaching school students about antibiotic use and antimicrobial resistance (AMR) can shape their future behaviour to become antibiotic guardians. This study aims to assess the impact of a pharmacist-led educational tool in boosting knowledge of these topics at elementary and middle school educational stages. Methods: A prospective web-based cross-sectional pre-post study was conducted in Lebanese private schools from April 2020 to December 2021. Results: The results showed that the pharmacist-led intervention increased the general knowledge (p = 0.01) and understanding of microbes (junior versus senior, p = 0.003 versus p = 0.004). In middle school, the spread of infection (p < 0.001) and the AMR concept (p = 0.001) significantly changed post-test, while antibiotics use and AMR concept remained unchanged in elementary students. Conclusion: The successful learning impact of the educational tool designed and led by pharmacists shows their importance as antibiotic experts in influencing early pedagogic learning about antibiotics and AMR starting at the middle-school stage.Scopu

Management of patients at the hepatopancreatobiliary unit of a London teaching hospital during the COVID-19 pandemic

To mitigate COVID-19-related shortage of treatment capacity, the hepatopancreatobiliary (HPB) unit of the Royal Free Hospital London (RFHL) transferred its practice to independent hospitals in Central London through the North Central London Cancer Alliance. The aim of this study was to critically assess this strategy and evaluate perioperative outcomes. Prospectively collected data were reviewed on all patients who were treated under the RFHL HPB unit in six hospitals between November 2020 and October 2021. A total of 1541 patients were included, as follows: 1246 (81%) at the RFHL, 41 (3%) at the Chase Farm Hospital, 23 (2%) at the Whittington Hospital, 207 (13%) at the Princess Grace Hospital, 12 (1%) at the Wellington Hospital and 12 (1%) at the Lister Hospital, Chelsea. Across all institutions, overall complication rate were 40%, major complication (Clavien-Dindo grade ≥ 3a) rate were 11% and mortality rates were 1.4%, respectively. In COVID-19-positive patients (n = 28), compared with negative patients, complication rate and mortality rates were increased tenfold. Outsourcing HPB patients, including their specialist care, to surrounding institutions was safe and ensured ongoing treatment with comparable outcomes among the institutions during the COVID-19 pandemic. Due to the lack of direct comparison with a non-pandemic cohort, these results can strictly only be applied within a pandemic setting

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

BACKGROUND: Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. METHODS: A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. RESULTS: 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. CONCLUSIONS: Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Long-Term Exposure to Traffic-Related Air Pollution and Diabetes: A Systematic Review and Meta-Analysis

Objectives: We report results of a systematic review on the health effects of long-term traffic-related air pollution (TRAP) and diabetes in the adult population.Methods: An expert Panel appointed by the Health Effects Institute conducted this systematic review. We searched the PubMed and LUDOK databases for epidemiological studies from 1980 to July 2019. TRAP was defined based on a comprehensive protocol. Random-effects meta-analyses were performed. Confidence assessments were based on a modified Office for Health Assessment and Translation (OHAT) approach, complemented with a broader narrative synthesis. We extended our interpretation to include evidence published up to May 2022.Results: We considered 21 studies on diabetes. All meta-analytic estimates indicated higher diabetes risks with higher exposure. Exposure to NO2 was associated with higher diabetes prevalence (RR 1.09; 95% CI: 1.02; 1.17 per 10 μg/m3), but less pronounced for diabetes incidence (RR 1.04; 95% CI: 0.96; 1.13 per 10 μg/m3). The overall confidence in the evidence was rated moderate, strengthened by the addition of 5 recently published studies.Conclusion: There was moderate evidence for an association of long-term TRAP exposure with diabetes

rs5888 Variant of SCARB1 Gene Is a Possible Susceptibility Factor for Age-Related Macular Degeneration

Major genetic factors for age-related macular degeneration (AMD) have recently been identified as susceptibility risk factors, including variants in the CFH gene and the ARMS2 LOC387715/HTRA1locus. Our purpose was to perform a case-control study in two populations among individuals who did not carry risk variants for CFHY402H and LOC387715 A69S (ARMS2), called “study” individuals, in order to identify new genetic risk factors. Based on a candidate gene approach, we analyzed SNP rs5888 of the SCARB1 gene, coding for SRBI, which is involved in the lipid and lutein pathways. This study was conducted in a French series of 1241 AMD patients and 297 controls, and in a North American series of 1257 patients with advanced AMD and 1732 controls. Among these individuals, we identified 61 French patients, 77 French controls, 85 North American patients and 338 North American controls who did not carry the CFH nor ARMS2 polymorphisms. An association between AMD and the SCARB1 gene was seen among the study subjects. The genotypic distribution of the rs5888 polymorphism was significantly different between cases and controls in the French population (p<0.006). Heterozygosity at the rs5888 SNP increased risk of AMD compared to the CC genotypes in the French study population (odds ratio (OR) = 3.5, CI95%: 1.4–8.9, p<0.01) and after pooling the 2 populations (OR = 2.9, 95% CI: 1.6–5.3, p<0.002). Subgroup analysis in exudative forms of AMD revealed a pooled OR of 3.6 for individuals heterozygous for rs5888 (95% CI: 1.7–7.6, p<0.0015). These results suggest the possible contribution of SCARB1, a new genetic factor in AMD, and implicate a role for cholesterol and antioxidant micronutrient (lutein and vitamin E) metabolism in AMD