Post-graduation migration intentions of students of Lebanese medical schools: a survey study

<p>Abstract</p> <p>Background</p> <p>The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.</p> <p>Methods</p> <p>Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon.</p> <p>Results</p> <p>Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2^ndcitizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty.</p> <p>Conclusion</p> <p>An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.</p

Contribution of copy number variants (CNVs) to congenital, unexplained intellectual and developmental disabilities in Lebanese patients

International audienceBackground: Chromosomal microarray analysis (CMA) is currently the most widely adopted clinical test for patients with unexplained intellectual disability (ID), developmental delay (DD), and congenital anomalies. Its use has revealed the capacity to detect copy number variants (CNVs), as well as regions of homozygosity, that, based on their distribution on chromosomes, indicate uniparental disomy or parental consanguinity that is suggestive of an increased probability of recessive disease. Results: We screened 149 Lebanese probands with ID/DD and 99 healthy controls using the Affymetrix Cyto 2.7 M and SNP6.0 arrays. We report all identified CNVs, which we divided into groups. Pathogenic CNVs were identified in 12.1% of the patients. We review the genotype/phenotype correlation in a patient with a 1q44 microdeletion and refine the minimal critical regions responsible for the 10q26 and 16q monosomy syndromes. Several likely causative CNVs were also detected, including new homozygous microdeletions (9p23p24.1, 10q25.2, and 8p23.1) in 3 patients born to consanguineous parents, involving potential candidate genes. However, the clinical interpretation of several other CNVs remains uncertain, including a microdeletion affecting ATRNL1. This CNV of unknown significance was inherited from the patient's unaffected-mother; therefore, additional ethnically matched controls must be screened to obtain enough evidence for classification of this CNV. Conclusion: This study has provided supporting evidence that whole-genome analysis is a powerful method for uncovering chromosomal imbalances, regardless of consanguinity in the parents of patients and despite the challenge presented by analyzing some CNVs

Chromosomal microarray analysis of a cohort of 185 Lebanese patients with unexplained intellectual disability

La déficience intellectuelle (DI) est une affection fréquente à causes multiples et souvent inconnues. Durant les 30 dernières années, l’examen utilisé pour l’exploration des anomalies chromosomiques chez des patients libanais présentant une DI était le caryotype standard. Le but de ce projet de thèse était d'appliquer pour la 1ère fois au Liban les technologies d'hybridation sur puces à ADN dans la recherche de nouveaux microremaniements (CNV) impliquant des gènes susceptibles d'engendrer une DI.Ainsi, les ADNs de 99 contrôles et de 185 patients libanais présentant une DI inexpliquée ont été hybridés sur des puces à ADN. Nous avons, par la suite, classé les CNVs identifiés en groupes selon leur transmission, leur contenu en gènes et leur localisation.Nous avons identifié 29 CNVs pathogènes associés à des syndromes ou gènes morbides responsables du phénotype recherché et 90 variants de signification inconnue dont 25 ont été investigués. On a retrouvé 18 de ces derniers comme probablement bénins, 5 comme probablement pathogènes, et 2 à investiguer puisqu'ils sont rapportés comme pathogènes dans la littérature mais hérités d’un parent sain dans l’étude. Nous avons élaboré 4 cas des CNVs pathogènes, 3 des CNVs probablement pathogènes qui sont des microdélétions à l'état homozygote chez des sujets issus de mariages consanguins; et les 2 CNVs à investiguer.Finalement, nous avons discuté les avantages de cette technique permettant l'identification chez 8% des patients ayant une DI inexpliquée, des microremaniements non identifiables par caryotype standard. Cependant nous avons aussi souligné la complexité, les limites et certaines incertitudes d’interprétation des résultats.Chromosomal imbalances are the most frequent cause of intellectual disability (ID). In Lebanon, during the past 30 years, screening of these imbalances was done using standard karyotyping. However, the resolution of this test was insufficient to detect submicroscopic chromosomal imbalances (CNV). The aim of this thesis was to apply, for the first time in Lebanon, advanced techniques like the chromosomal microarray analysis (CMA), capable of detecting CNVs. Therefore, we screened the DNAs of 185 Lebanese subjects having unexplained ID and those of 99 healthy controls.CNVs identified were classified into groups upon their inheritance status, gene/microRNA content, and their localization.We identified 29 pathogenic CNVs associated to known syndromes or to morbid genes responsible for the patient's phenotype. We also found 90 variants of unknown significance of which 25 were investigated. 18 of the latter were likely benign, 5 were considered as probably pathogenic, and 2 needed future investigations to be classified, as they were considered as pathogenic in the literature but were inherited from a normal parent in this study.We discussed interesting cases by developing 4 pathogenic CNVs, 3 probably pathogenic that were homozygous microdeletions found in patients issued from consanguineous parents, and the 2 CNVs that required further investigations.Finally, we discussed the advantage of this CMA technique that lead to the identification of microimbalances unseen by a standard karyotype in 8% (14/174) of the patients with unexplained ID. Moreover, we mentioned the complexity, limitation and difficulty of interpretation of some results

Evidence that homozygous PTPRD gene microdeletion causes trigonocephaly, hearing loss, and intellectual disability

International audienceBackground: The premature fusion of metopic sutures results in the clinical phenotype of trigonocephaly. An association of this characteristic with the monosomy 9p syndrome is well established and the receptor-type protein tyrosine phosphatase gene (PTPRD), located in the 9p24.1p23 region and encoding a major component of the excitatory and inhibitory synaptic organization, is considered as a good candidate to be responsible for this form of craniosynostosis. Moreover PTPRD is known to recruit multiple postsynaptic partners such as IL1RAPL1 which gene alterations lead to non syndromic intellectual disability (ID). Results: We describe a 30 month old boy with severe intellectual disability, trigonocephaly and dysmorphic facial features such as a midface hypoplasia, a flat nose, a depressed nasal bridge, hypertelorism, a long philtrum and a drooping mouth. Microarray chromosomal analysis revealed the presence of a homozygous deletion involving the PTPRD gene, located on chromosome 9p22.3. Reverse Transcription PCR (RT- PCR) amplifications all along the gene failed to amplify the patient's cDNA in fibroblasts, indicating the presence of two null PTPRD alleles. Synaptic PTPRD interacts with IL1RAPL1 which defects have been associated with intellectual disability (ID) and autism spectrum disorder. The absence of the PTPRD transcript leads to a decrease in the expression of IL1RAPL1. These results suggest the direct involvement of PTPRD in ID, which is consistent with the PTPRD -/- mice phenotype. Deletions of PTPRD have been previously suggested as a cause of trigonocephaly in patients with monosomy 9p and genome-wide association study suggested variations in PTPRD are associated with hearing loss. Conclusions: The deletion identified in the reported patient supports previous hypotheses on its function in ID and hearing loss. However, its involvement in the occurrence of metopic synostosis is still to be discussed as more investigation of patients with the 9p monosomy syndrome is required

Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate

In the context of a worldwide physician brain drain phenomenon, Lebanon has the highest emigration factor in the Middle East and North Africa. In this manuscript we aim to identify and develop a conceptual framework for the factors underlying the decisions of graduating Lebanese medical students to train abroad. We conducted two focus groups and seven semi-structured individual interviews with 23 students. In the deductive analysis (based on the push-pull theory), students reported push factors in Lebanon and pull factors abroad related to five dimensions. They focused predominantly on how training abroad provides them with a competitive advantage in an oversaturated Lebanese job market. An inductive analysis revealed the following emerging concepts: repel factors abroad and retain factors locally; societal expectations that students should train abroad; marketing of abroad training; and an established culture of migration. The marketing of abroad training and the culture of migration are prevalent in the academic institutions.Lebanon Middle east Brain drain Migration Physicians Medical students