Evaluation of medication adherence among Lebanese diabetic patients

Background: Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications. Objectives: The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence. Methods: A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20. Results: Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively). Conclusions: Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence

Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer

Cancer was recently annexed to diabetic complications. Furthermore, recent studies suggest that cancer can increase the risk of diabetes. Consequently, diabetes and cancer share many risk factors, but the cellular and molecular pathways correlating diabetes and colon and rectal cancer (CRC) remain far from understood. In this study, we assess the effect of hyperglycemia on cancer cell aggressiveness in human colon epithelial adenocarcinoma cells in vitro and in an experimental animal model of CRC. Our results show that Nox (NADPH oxidase enzyme) 4-induced reactive oxygen species (ROS) production is deregulated in both diabetes and CRC. This is paralleled by inactivation of the AMPK and activation of the mammalian target of rapamycin (mTOR) C1 signaling pathways, resulting in 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) accumulation, induction of DNA damage, and exacerbation of cancer cell aggressiveness, thus contributing to the genomic instability and predisposition to increased tumorigenesis in the diabetic milieu. Pharmacologic activation of AMPK, inhibition of mTORC1, or blockade of Nox4 reduce ROS production, restore the homeostatic signaling of 8-oxoguanine DNA glycosylase/8-oxodG, and lessen the progression of CRC malignancy in a diabetic milieu. Taken together, our results identify the AMPK/mTORC1/Nox4 signaling axis as a molecular switch correlating diabetes and CRC. Modulating this pathway may be a strategic target of therapeutic potential aimed at reversing or slowing the progression of CRC in patients with or without diabetes.-Mroueh, F. M., Noureldein, M., Zeidan, Y. H., Boutary, S., Irani, S. A. M., Eid, S., Haddad, M., Barakat, R., Harb, F., Costantine, J., Kanj, R., Sauleau, E.-A., Ouhtit, A., Azar, S. T., Eid, A. H., Eid, A. A. Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer.Scopu

Modélisation numérique des mouvements de sol induits par des excavations

La modélisation numérique des mouvements de sol induits par des excavations soutenues reste un problème complexe où de multiples paramètres peuvent avoir une réelle influence sur le résultat final. Cet article propose dans un premier temps d’étudier l’influence de l’état initial des contraintes en modélisant le phasage de réalisation de différents panneaux d’une paroi moulée. Différents calculs, en deux et trois dimensions, intégrant ou pas ce phasage, sont réalisés afin de mettre en évidence les effets de l’état initial des contraintes sur les mécanismes de déformation induits par l’excavation. Au préalable, une étude précise des mouvements de sol générés lors de la réalisation des parois est réalisée pour identifier les variations de la contrainte horizontale en arrière de l’écran. Dans un second temps, une étude relative aux effets des non-linéarités élastiques dans les lois de comportement comprenant un critère de rupture de type Mohr-Coulomb est effectuée. Elle permet d’identifier les liens entre les paramètres des parties élastiques des lois de comportement et les mouvements calculés lors d’une excavation

An advanced t-z curves method using cyclic shaft friction degradation for the design of piles in sand

International audienc

Effect of a diesel engine ban on asthma-related morbidity in Beirut

Background: Diesel emissions contain smaller amounts of CO, CO2 and hydrocarbons than gasoline, but their content in nitrogen oxides and particulate matter is significantly higher. Some of this particulate matter is of the respirable size and penetrates deep into the tracheobronchial tree. Exposure to diesel emissions is associated with respiratory disease.In Lebanon, a rapid expansion in the transportation sector allowed a gradual introduction of diesel fuel-operated vehicles, which had been banned till 1977. Fuel was being imported with little control over its quality. A ban was imposed on light and medium-duty diesel engine on the Lebanese territory as of July 1, 2002.Objective: To determine the effect of the diesel ban on the air concentration of particulate matter and on asthma-related morbidity in children admitted to the emergency room (ER) of the American University of Beirut Medical Center (AUBMC).Methods: Air samples were collected at multiple large intersections of Beirut before and after the ban. Each sample was collected over a period of 30 minutes and analyzed for particulate matter. Air sampling was done during summer, at which time the concentration of particulate matter is at its peak. The average of all the concentrations was computed.The records of all visits to AUBMC-ER were reviewed over a two-year period: Period 1 (Pre-ban: July 1, 2001 to June 30, 2002) and Period 2 (Post-ban: July 1, 2002 to June 30, 2003). All patients 0-15 years of age presenting with acute asthma were identified.Results: The average concentration of particulate matter was 181.3 µg/m3 and 97.1 µg/m3 before and after the ban respectively. The total numbers of ER visits for pediatric patients were 6453 and 6865 in period 1 and period 2, respectively. Of those, 313 were due to asthma in period 1 and 223 in period 2. The number of asthma-related visits was significantly reduced during period 2. Asthma-related visits were significantly reduced during October, November and December of period 2 compared to the same months of period 1, while it was significantly increased during the month of June.Discussion: This study shows that a ban on diesel engine resulted in a decrease in the air concentration of particulate matter and was associated with a reduction in the number of emergency room visits for acute asthma. This reduction was most marked during the season of viral respiratory infections. We postulate that a reduction in the concentration of air pollutants was protective against viral-induced asthma exacerbations