Risk factors for asthma and allergic diseases in school children across Lebanon

Mirna Waked1, Pascale Salameh21Balamand University, Beirut, Lebanon; 2Lebanese University, Faculty of Public Health, Section II, Fanar, LebanonIntroduction: Childhood asthma is one of important diseases of childhood. There is no known prevalence of asthma and allergic diseases in Lebanon. This study was conducted with a secondary objective of finding the odds of exposure to asthma, allergic rhinitis and eczema potential risk factors in Lebanese children.Material and methods: It is a cross-sectional study on children in public and private schools. A sample of 22 schools participated, where standardized written core questionnaires were distributed. 5–12 year old students completed the questionnaires at home, while 13–14 year old students filled it in class.Results: 5522 children were evaluated for asthma, allergic rhinitis and atopic eczema prevalence and their associated factors. These diseases seem to be similarly affected by parental respiratory problems, parental smoking, infancy gastroesophageal reflux, recurrent otitis, and previous pertussis. Humidity on the bedroom walls is associated with both asthma and allergic rhinitis, a spongy pillow with both allergic rhinitis and eczema, animal possession with asthma, and noncotton mattress with atopic eczema. The adjusted odds ratios for significant associations varied between 1.25 and 3 (0.0001 < p-value < 0.01).Conclusion: These factors are preventable, thus permitting a possible reduction of the prevalence of these diseases.Keywords: asthma, eczema, rhinitis, allergic disease, risk factor

Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

Raghid Kreidy1, Elias Stephan2, Pascale Salameh3, Mirna Waked4 1Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 2Department of Geriatrics, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 3Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 4Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon Aim: The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10%–18%). Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied. Methods: Between July 2007 and January 2010, 95 consecutive Lebanese geriatric ($60 years of age) inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years). Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis. Results: Out of 95 patients, 33 patients (34.7%) were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal) using complete venous ultrasound. Nine of these 33 patients (27.2%) had a history of venous thromboembolism and eleven (33.3%) presented with edema of lower extremities. A total of 28 patients (84.8%) with positive duplex scan had associated risk factors for venous thromboembolism. Conclusion: Lower extremity venous color flow duplex scan appears to be a reasonable initial screening test in the diagnostic algorithm of pulmonary embolism in geriatric inpatients with clinically suspected pulmonary embolism. This is particularly true in patients with a history of venous thromboembolism, in patients with a clinical presentation suggesting venous thrombosis, in uremic patients and in patients with altered general and mental status who are not candidates for chest computed tomography. Keywords: venous thrombosis, lower extremities, geriatri

PSYCHOMETRIC EVALUATION OF THE ADHERENCE TO REFILLS AND MEDICATIONS SCALE (ARMS) AMONG ADULTS PATIENTS WITH CHRONIC DISEASE: THE LEBANESE VERSION

Background: Non-adherence to medications can lead to several consequences that range from waste of drugs to death. Consequently, a tool to assess the adherence to chronic medication is a necessity. Objectives: The purpose of this study was to conduct the translation and cross-cultural adaptation process of ARMS into the Lebanese Arabic version (ARMS-A) and to examine its psychometric properties (validity and reliability assessment). Design: The original English version of ARMS was translated into Arabic based on the established guidelines. Eight expert panels were involved in content validation, while face validation was conducted on twenty participants during pilot testing. A cross-sectional survey was used to evaluate the psychometric properties of ARMS-A on 135 participants. Participants: Adults patients on chronic medications were invited to be part of the study. Main outcome measures: Overall content and universal face validity indexes were determined in addition to the exploratory factors and Cronbach’s alpha. Key Results: The overall content validity index was 0.91, and the universal face validity index was also 0.91. For the exploratory factor analysis, two factors were extracted. The first one consisted of 6 items and explained 43.9% of the variance. The second one also comprised of 6 items with a variance of 9.59%. For internal consistency and reliability, the Cronbach’s alpha was 0.877. Conclusion: ARMS-A appears to be a valid and reliable medication adherence tool to assess the adherence of chronic medications among native Arabic speaking patient with chronic diseases

Self-medications with potential abuse in the Middle East: a systematic literature review

Self-medication (SM) is highly prevalent in the Middle East. However, regulations in the Middle East are not always enforced and therefore many prescription medicines can be purchased as SM, resulting in potential abuse of many medicines. The aim of this article, therefore, was to undertake a comprehensive review to identify the different types of self-medications involved in abuse in the Middle East and to identify harms related to SM abuse. An extensive review of the published literature pertaining to the subject (1990–2015) was conducted using PubMed, Web of Science, Cochrane and Google Scholar databases for OTC medication abuse in the Middle East. Twenty two papers were identified. Medications involved in SM abuse included: psychoactive prescription-only medicines, codeine-containing products, tramadol, anabolic steroids, sedative antihistamines, decongestants and laxatives. Moreover, studies in the region rarely reported harms related to SM abuse and strategies to limit this abuse. Potential SM abuse involving a range of medicines is a public health problem in the Middle East. Future interventions and regulations should be applied to limit the expansion of SM use and potential abuse

Effective components of self-management programs for chronic obstructive pulmonary disease patients: scoping review

Introduction: To date, little guidance is available to support the development of effective programs for improving self-management in chronic obstructive pulmonary disease (COPD) patients. Yet, given the global burden of this disease, it seems important to identify the components of a self-management program that are effective in terms of health outcomes for COPD patients. Objectives: This review aims to identify effective elements of a self-management program for COPD patients, the ones that may impact quality of life, emergency visits, and rehospitalization rates.Material and methods: A systematic literature search of three databases (Medline, Cochrane, and CINHAL) was conducted to identify studies on self-management of COPD, with three limiting parameters: published in twelve years prior to November 2019, in English or French, and including patients over 40 years old. Prisma was used to guide the work process. Results: The search yielded 361 studies from the three electronic databases by applying limiting criteria, and after removing duplicates. Sixty-five articles were identified as relevant based on their titles and abstracts. However, 16 documents were retained after full reading. The analysis of the included articles identified 4 components in self-management programs for COPD patients: initiation stage of the intervention, educational sessions, support and monitoring methods. Conclusions: Although the combination of self-management program initiation, educational sessions, support and monitoring methods were effective, further research is needed to identify the components that have better impact on COPD patients’ skills and quality of life

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

Acute flaccid paralysis incidence rate and epidemiology in children in Lebanon: a rise in numbers in the post-vaccination and refugee crisis era

Background: Acute flaccid paralysis (AFP) is a clinical syndrome characterized by the acute onset of weakness and paralysis with reduced muscle tone. This study explored the incidence and different aspects of AFP in Lebanese children between 2009 and 2019. Methods: AFP data were collected from the Lebanese Ministry of Public Health. Incidence rate according to year, age groups, clinical data, follow-up, diagnosis, and vaccination status was analyzed in the 11-years period. Results: AFP incidence rates increased importantly from 0.63 per 100,000 in 2009 till 4.96 per 100,000 in 2019. Most of the patients were children under ten years of age, 40.6% of all cases were under five years old, and 37.9% were between 5 and 9 years old. Follow-up revealed that approximately two out of five patients experienced residual weakness. As for the final diagnosis, around 30% of cases were diagnosed as Guillain-Barre Syndrome (GBS). Most cases were children having received between 3 and 5 doses of polio vaccine. Conclusions: The rise in cases coincided with the Syrian refugee crisis in Lebanon and the progressively deteriorating economy in the country; yet, incidence rates were in the lower margin compared with other countries. Keywords: Acute flaccid paralysis; Epidemiology; Guillain-Barré Syndrome; Lebanon; Pediatrics

Root and Root Canal Morphology of Premolars in a Sample of the Lebanese Population: Clinical Considerations

ABSTRACT Objectives: The aim of this study was to investigate the anatomy of the maxillary and mandibular premolars among a sample of the Lebanese population and to explore their incidence by sex and the symmetry between the left and right sides. Materials and Methods: This retrospective analysis of 250 cone-beam computed tomography (CBCT) scans consisted of 960 maxillary and 972 mandibular premolars. Roots, canals, and morphology types were recorded. Vertucci’s classification was used to categorize the canal morphologies. Fisher’s exact and chi-square tests (P≤.05) were applied. Results: The majority of maxillary first premolars had two roots (85.3%) with two canals (91.3%). Most of the maxillary second premolars showed one root (79.8%). Two-root canals (53.55%) were more common than one canal (44.2%). The three-root, three-canal morphology was rarely spotted in the maxillary first (0.4%) and second premolars (2.3%). The one-root (99.2%) and one-canal (84.5%) morphologies were most frequently located in the mandibular first and second premolars (100%, 88.6%), and two canals being less common (15.5%, 11.4%) correct same as before. The total prevalence of premolars with a complex root canal morphology was 62.4%, found in types II, III, and V to VIII. Men had significantly more roots and root canals in their maxillary first premolars than women (P≤.05). No significant differences were observed between the contralateral premolars (P\u3e.05). Conclusions: Premolars displayed wide variations in root and root canal morphology and symmetry between the contralateral premolars. Keywords: cone-beam computed tomography (CBCT), mandibular premolars, maxillary premolars, root canal anatomy, root canal configuration, sex distribution, symmetry. Objectif Cette étude vise à examiner le nombre de racines, les canaux radiculaires et la morphologie des canaux des prémolaires maxillaires et mandibulaires, au sein d’une population libanaise. Matériels et méthodes 250 images CBCT de 960 prémolaires maxillaires et 972 prémolaires mandibulaires ont été analysées rétrospectivement. Les tests de Fisher Exact et du Chi-Carré (P \u3c 0,05) ont été appliqués pour évaluer le nombre de racines et de canaux radiculaires, la fréquence et la symétrie entre les côtés gauche et droit, ainsi que l’incidence au sein du sexe. La classification de Vertucci a été utilisée pour classer les morphologies des canaux. Résultats Les premières prémolaires maxillaires étaient principalement caractérisées par deux racines (1 racine : 14,4%, 2 racines: 85,3% et 3 racines: 0,4%), avec deux canaux (91,3%). Une racine a été observée dans de nombreuses deuxièmes prémolaires maxillaires (79,8 %). Cependant, deux canaux radiculaires (53,55 %) étaient plus fréquents qu’un canal (44,2 %). Trois racines et trois canaux ont rarement été repérés dans les premières (0,4 %, 0,4 %) et les deuxièmes prémolaires maxillaires (2,3 %, 2,3 %). Une racine avec un canal était localisée respectivement le plus fréquemment dans la première (99,2 %, 84,5 %) et la deuxième prémolaire mandibulaire (100 %, 88,6 %), bien que deux canaux soient moins fréquents (15,5 %, 11,4 %). Des prémolaires avec une anatomie complexe du canal radiculaire ont été trouvées avec une prévalence de 16,2% allant du type II, III et de V à VIII. Les résultats ont également montré des différences entre les sexes : les hommes avaient remarquablement plus de racines et de canaux radiculaires dans leurs premières prémolaires maxillaires que les femmes (P \u3c 0,05). Aucune différence statistique n’a été observée entre les paires prémolaires controlatérales (P ³ .5). Conclusion Au sein de cette sous-population libanaise, les prémolaires maxillaires et mandibulaires présentaient de grandes variations dans la morphologie des racines et des canaux radiculaires, et une symétrie entre les paires controlatérales. Ces résultats susciteraient un intérêt clinique pour les praticiens et les chercheurs. Mots-clés : CBCT, prémolaires mandibulaires, prémolaires maxillaires, anatomie canalaire, configuration canalaire, symétrie, sexe