Comparison of cytologic accuracy of endobronchial ultrasound transbronchial needle aspiration using needle suction versus no suction

BACKGROUND AND OBJECTIVES: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively new procedure initially used for lung cancer diagnosis, staging and re-staging and extended to benign diseases such as sarcoidosis and other mediastinal lesions. Previously, multiple studies evaluated the use of needle biopsy with no aspiration that did not change the diagnostic accuracy compared with needle biopsy aspiration. MATERIALS AND METHODS: All adult subjects who were scheduled to undergo EBUS-TBNA to sample mediastinal lesions were eligible. We evaluated two methods of sampling mediastinal lesions. The first method was the application of negative pressure syringe for needle suction aspiration. The second was with no suction. For every patient and every biopsy site in the same patient, we had two samples using each method. RESULTS: Among the 26 participants, 24 patients had adequate tissue using both methods (92.3%, P = 1.00). Among the 24 patients with adequate tissue using both methods, 14 patients (58.3%) had benign pathology using both methods, whereas ten patients (41.7%) had malignant pathology using both methods (P = 1.00). Among the 32 sites that were sampled, 30 sites had adequate tissue using both methods (93.8%, P = 1.00). Among the thirty sites with adequate tissue using both methods, 17 (56.7%) had benign pathology using both methods; 12 (40.0%) had malignant pathology using both methods; and one site (3.3%) had malignant pathology using suction, but benign pathology using no suction (P = 1.00). CONCLUSION: In patients undergoing EBUS-TBNA to sample mediastinal lesions, the diagnostic yield with the application of suction to needle biopsy was not statistically significant compared to no suction

Environmental health risks in disadvantaged urban slums

Meeting: 6th International Perspective on Water Resources and the Environment, Izmir, Turkey, January 7-9, 2013This paper assesses diarrhea occurrence in two urban slums to identify salient factors influencing case prevalence. Rapid urbanization in settings of poor economic performance and governance has increased the number of people living in urban slums to about 1 billion people worldwide. In this study, water quality analysis showed contamination at the household level due primarily to the location of water storage tanks. Significant difference in diarrhea cases in both study areas correlated with the educational level of household head, financial status, type of water storage tank and cleaning frequency, along with adoption of measures to treat water, or use bottled water

The chromatin remodeling factor ISW-1 integrates organismal responses against nuclear and mitochondrial stress

Age-associated changes in chromatin structure have a major impact on organismal longevity. Despite being a central part of the ageing process, the organismal responses to the changes in chromatin organization remain unclear. Here we show that moderate disturbance of histone balance during C. elegans development alters histone levels and triggers a stress response associated with increased expression of cytosolic small heat-shock proteins. This stress response is dependent on the transcription factor, HSF-1, and the chromatin remodeling factor, ISW-1. In addition, we show that mitochondrial stress during developmental stages also modulates histone levels, thereby activating a cytosolic stress response similar to that caused by changes in histone balance. These data indicate that histone and mitochondrial perturbations are both monitored through chromatin remodeling and involve the activation of a cytosolic response that affects organismal longevity. HSF-1 and ISW-1 hence emerge as a central mediator of this multi-compartment proteostatic response regulating longevity.Peer reviewe

Did the post war repatriation of Lebanese physicians drive recent Lebanese medical graduates to emigrate? An observational study

<p>Abstract</p> <p>Background</p> <p>A significant number of Lebanese medical graduates have emigrated from Lebanon. The objective of this study was to evaluate the hypothesis that the repatriation of Lebanese physicians educated abroad has contributed to the international emigration of recent Lebanese medical graduates.</p> <p>Methods</p> <p>We analyzed the demographic and educational characteristics and the year of registration of physicians registered with the two physician associations in Lebanon as of 2007. We then analyzed the number of new and total registrants and the physician density for the years 1977–2006. Finally we calculated the percentage of Lebanese graduates of the years 1977–2006 registered as of 2007.</p> <p>Results</p> <p>As of 2007, 10,918 physicians were registered in Lebanon. Most were male (80.4%) and graduated from either Lebanese (36.4%) or Eastern European (30.6%) medical schools. The top three regions of specialty training were Western Europe (31.8%), Eastern Europe (28.4%) and Lebanon (25.7%). About half the physicians registered with the Lebanese Order of Physicians as of 2007 joined during the 1990s decade; only 26.2% of these graduated from Lebanese medical schools during that decade. The number of new registrants increased dramatically in the early 1990s and started decreasing in the early 2000s. About 60% of Lebanese medical graduates of the years 1977–2006 were registered in Lebanon as of 2007. Categorizing Lebanese medical graduates by their year of graduation, the percentage registered in Lebanon as of 2007 showed a "dip" for those who graduated in the early 1990s.</p> <p>Conclusion</p> <p>The high number of physicians educated abroad returning to Lebanon after the end of the civil war may have driven recent Lebanese medical graduates to emigrate.</p

An analysis of inpatient pediatric sickle cell disease: Incidence, costs, and outcomes

ObjectiveTo identify characteristics of pediatric sickle cell disease (SCD) hospitalizations and to examine admission demographics and medical expenditures.MethodsAdmissions with SCD were identified from the 2009 and 2012 releases of the Healthcare and Cost Utilization Project’s Kids Inpatient Database. Diseaseâ specific secondary diagnoses including acute chest syndrome (ACS), vasoâ occlusive pain crisis (VOC), splenic sequestration, and stroke/transient ischemic attack were analyzed for patient and hospital demographics. Analytical endpoints included total healthcare expenditures and mortality.ResultsWe reviewed 75,234 inpatient hospitalizations with a diagnosis of SCD. Over $900,000,000 was spent annually in associated healthcare expenditure. The median length of hospitalization stay (LOS) for all admissions was 3 days (interquartile range [IQR] 2â 5 days). VOC was the most frequent secondary diagnosis, recording 48,698 total hospitalizations and a median LOS of 3 days (IQR 2â 6 days). Of the 8,490 hospitalizations with ACS, the infant population had a significantly higher mortality rate compared to other age groups (2$18,956), behind ACS ($22,631). A high proportion of Caucasian patients died during hospitalization for VOC (0.4% vs. 0.1%, P = 0.014) and ACS (4% vs. 0.2%, P < 0.001) when compared to nonâ Caucasians.ConclusionInpatient hospitalizations for secondary manifestations of pediatric SCD were associated with significant healthcare expenditures. Patients with an increased statistical risk for death during hospitalization included Caucasians with SCD complications of ACS and VOC, and patients <1â yearâ old with ACS. Further research is needed to substantiate the associated clinical significance of these findings.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140014/1/pbc26758.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140014/2/pbc26758_am.pd

Social cost benefit analysis of water and sanitation improvement in a poor urban slum

A health-based socio-economic assessment as well as side-by-side social cost benefit analysis is depicted in this visual synopsis of research carried out in a suburban slum in Tripoli, Lebanon. 88% of reported diarrheal cases are attributed to unsafe water supply, inadequate sanitation and hygiene, with cases distributed uniformly throughout the year. The poster includes field observations, and a selection of alternative interventions with estimated costs. Installing rooftop tanks and replacing water piping at the household level are the most economically viable interventions

Valorization of wine‐making by‐products’ extracts in cosmetics

The increased demand for conscious, sustainable and beneficial products by the consumers has pushed researchers from both industries and universities worldwide to search for smart strategies capable of reducing the environmental footprint, especially the ones connected with industrial wastes. Among various by-products, generally considered as waste, those obtained by winemaking industries have attracted the attention of a wide variety of companies, other than the vineries. In particular, grape pomaces are considered of interest due to their high content in bioactive molecules, especially phenolic compounds. The latter can be recovered from grape pomace and used as active ingredients in easily marketable cosmetic products. Indeed, phenolic compounds are well known for their remarkable beneficial properties at the skin level, such as antioxidant, antiaging, anti-hyperpigmentation and photoprotective effects. The exploitation of the bioactives contained in grape pomaces to obtain high value cosmetics may support the growing of innovative start-ups and expand the value chain of grapes. This review aims to describe the strategies for recovery of polyphenols from grape pomace, to highlight the beneficial potential of these extracts, both in vitro and in vivo, and their potential utilization as active ingredients in cosmetic products

Stability and Antioxidant Activity of Hydro-Glyceric Extracts Obtained from Different Grape Seed Varieties Incorporated in Cosmetic Creams

Grape seeds are agro-industrial by-products, which if improperly managed, may be responsible for socioeconomic and environmental problems. Nevertheless, it is possible to effectively valorize them by means of extraction of the bioactive compounds, especially the antioxidant phenolic molecules, using a safe, green, and environmentally-friendly extractive medium (i.e., hydro-glyceric solution). In the present study, the extraction was performed using seeds from two Lebanese varieties, Obeidi and Asswad Karech, and three international varieties, Marselan, Syrah, and Cabernet Franc. The type and amount of phenolic compounds were identified by High-Performance Liquid Chromatography (HPLC). Marselan was the extract richer in catechins (132.99 +/- 9.81 mu g/g of dried matter), and it also contained a higher amount of phenolic compounds (49.08 +/- 0.03 mg of gallic acid equivalent/g of dry matter and 10.02 +/- 0.24 mg of proanthocyanidin content/g of dry matter). The antioxidant capacity of the extracts was assessed using three different colorimetric assays including 2,2-DiPhenyl-1-PicrylHydrazyl (DPPH), CUPRIC ion Reducing Antioxidant Capacity (CUPRAC), and Ferric Reducing Antioxidant Power (FRAP). As expected, Marselan exhibited the highest antioxidant activity; as well, the total phenolic and proanthocyanidin content were the highest. The stability of the Marselan extract incorporated into a commercial cream, was performed at three different temperatures (4, 25, and 50 degrees C), and four different concentrations (5, 4, 3, 2%), over a period of 4 months, using different methods such as centrifugation, Heat-Shock Cycles, pH, and viscosity. All Marselan hydro-glyceric extract formulations were proven to be stable over the entire 4 months, where the highest stability was achieved at 4 degrees C and the least at 50 degrees C. This study supports the suitability of the incorporation of phenolic extracts into commercial creams to enrich the cosmetic industry with effective, natural, and safe skincare products