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The incidence of female infertility is growing worldwide and its rate varies across countries. . The goal of this study is to assess the rate of female infertility and identify its associated factors among Lebanese women. This cross-sectional study was conducted between January to May 2019, enrolling a total of 952 females. The mean age was 34.8 ± 8 years and the rate of infertility was 34.3%. The multivariable analysis taking presence vs absence of infertility as the dependent variable, showed that patients with advanced age (aOR = 1.04), endometriosis (aOR = 2.175) and polycystic ovarian syndrome (aOR = 1.41) were significantly associated with higher rate of infertility. On the other hand, having a college level of education compared to a school level was significantly associated with lower odds of infertility (aOR = 0.511). The study highlights that the rate of infertility is high in Lebanon and is mainly associated with various sociodemographic factors and disease states. The findings raise the need to establish awareness campaigns that focus on early diagnosis of infertility, control the associated factors, and treat underlying comorbid conditions.

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BACKGROUND: Febrile neutropenia is a prevalent oncologic complication. Initiating rapid treatment with empirical antimicrobials in febrile neutropenia patients reduces mortality due to infections. OBJECTIVES: The study aims to evaluate antimicrobial utilization among FN patients in Lebanon in terms of drug choice, dose, and duration of the treatment. This is a retrospective, multicenter, observational study conducted at three different Lebanese university hospitals (in which the Infectious Diseases Society of America (IDSA) guidelines are adopted), between February 2014 and May 2017. METHODS: Adult cancer patients aged 18 years and older with febrile neutropenia were included in the study. Using the IDSA guidelines as a reference, patients were assessed whether they received the antimicrobial regimen inconsistent with the IDSA reference or not. Statistical analysis was performed using the Statistical Package for the Social Science software (SPSS version 22.0). The adherence to guidelines for the indication and doses of antibiotics and anti-fungal in patients with febrile neutropenia. RESULTS: A total of 124 patients with a mean age of 54.43 ± 17.86 years were enrolled in the study. Leukemia (29.7%) was the most prevalent cancer and the most common infection was sepsis (20.2%). Combination antibiotic lactams are the most prescribed antibiotics (86.8%). Only 94 (86.23%) patients were given the antibiotic therapy appropriate for choice, dose, and duration. Empirical antifungal therapy was initiated in 63.7% of the patients and fluconazole was the most used antifungal (36.3%). In contrast to antibiotics, the majority of antifungal choices were not selected according to the recommendations and they were considered inappropriate for doses and the required treatment duration as proposed by (IDSA). Fifty-eight percent of patients received antivirals, even though it is not recommended as empirical treatment. CONCLUSION: In conclusion, this study reveals a non-consistent antimicrobial utilization practice at the involved sites concerning FN treatment. Inappropriateness was encountered in drug selection, dose, and duration of treatment with antifungals and antivirals.

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Diabetes is considered one of the major causes of chronic kidney disease (CKD), affecting renal blood vessels and nerves. Diagnosis of CKD by traditional biochemical serum and blood analyses is insufficient and insensitive, thus requiring the development of a more robust technique. This novel study aims to propose a new method for the accurate diagnosis of CKD, quantification of kidney damage, and its prognosis by physicians by measuring the kidney volume on computed tomography (CT). In total, 251 patients were enrolled in this retrospective study. They were divided into four groups: control, patients having diabetes, patients having CKD, and patients having both diabetes and CKD. Results showed that kidney volume correlated negatively with both GFR and HbA1C on CT images, in addition to decreasing faster in males than females. Moreover, HbA1C was shown to correlate positively with creatinine and negatively with GFR. Finally, GFR was more robust than creatinine when correlated with age. The association between kidney volume with GFR and HbA1c can be used to accurately anticipate kidney volume in established CKD on CT scan, especially in resource-poor settings. Furthermore, HbA1C can serve as a powerful biomarker for studying renal function in diabetic CKD patients as it correlates with creatinine and GFR.

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Objective: The aim of this study was to elucidate the relationship between the mother’s use of over-the-counter (OTC) medications during pregnancy and asthma in Lebanese children. Methods: A cross-sectional study was conducted on Lebanese students in both public and private schools, between January and September 2017, involving 1000 children aged between 4 and 17 years. Results: The intake of any medication as an independent variable throughout pregnancy reveals that being in a public school compared to a private one (Beta = 0.344) and breastfeeding (Beta = 0.51) were highly associated with lower odds of asthma, while having a positive family of allergic rhinitis (Beta = 2.129) and the intake of any medication during pregnancy (Beta = 7.052) were highly associated with higher odds of asthma. A second logistic regression, taking as the dependent variable asthmatic versus healthy children and taking each OTC drug as an independent variable, showed that taking paracetamol once per week during pregnancy (Beta = 4.66) and proton pump inhibitors (PPIs) once per month (Beta = 3.498) compared to no intake were significantly correlated with higher probability of asthma. Conclusion: Our findings showed that the intake of paracetamol, vitamin C, and PPIs during pregnancy is strongly correlated with asthma in the offspring. Since these factors are avoidable, it is necessary to raise awareness among healthcare professionals to reduce the prevalence of asthma in children (AU)

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OBJECTIVE: The aim of this study was to elucidate the relationship between the mother's use of over-the-counter (OTC) medications during pregnancy and asthma in Lebanese children. METHODS: A cross-sectional study was conducted on Lebanese students in both public and private schools, between January and September 2017, involving 1000 children aged between 4 and 17 years. RESULTS: The intake of any medication as an independent variable throughout pregnancy reveals that being in a public school compared to a private one (Beta = 0.344) and breastfeeding (Beta = 0.51) were highly associated with lower odds of asthma, while having a positive family of allergic rhinitis (Beta = 2.129) and the intake of any medication during pregnancy (Beta = 7.052) were highly associated with higher odds of asthma.A second logistic regression, taking as the dependent variable asthmatic versus healthy children and taking each OTC drug as an independent variable, showed that taking paracetamol once per week during pregnancy (Beta = 4.66) and proton pump inhibitors (PPIs) once per month (Beta = 3.498) compared to no intake were significantly correlated with higher probability of asthma. CONCLUSION: Our findings showed that the intake of paracetamol, vitamin C, and PPIs during pregnancy is strongly correlated with asthma in the offspring. Since these factors are avoidable, it is necessary to raise awareness among healthcare professionals to reduce the prevalence of asthma in children.

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OBJECTIVES: The causes of the global increase in asthma in children are unknown. It has been hypothesized that diet is an important factor that may play a role in the pathogenesis of the disease. The objective was to evaluate the association between diet and current asthma among Lebanese children. METHODS: A cross-sectional study was conducted on 1000 children recruited from public and private schools in Lebanon. Of the total enrolled participants, 107 children were diagnosed with current asthma and were analyzed. The food frequency questionnaire was used to assess participants' dietary habits. RESULTS: The consumption of sweets ≥3 times weekly (ORa = 5.42), white bread ≥3 times weekly (ORa = 26.38), and olive oil daily (ORa = 9.80) were associated with higher odds of current asthma. Drinking carbonated beverages occasionally (ORa = 0.25) and ≥3 times per week (ORa = 0.03) was significantly associated with lower odds of current asthma. Adhering to Mediterranean diet (occasional, >3 times weekly and daily) was significantly associated with lower odds of current asthma compared to never consuming Mediterranean diet (ORa = 0.23 and ORa = 0.22, respectively). The occasional consumption of bread was significantly associated with higher odds of current asthma (ORa = 8.2), whereas daily consumption was significantly associated with lower odds (ORa = 0.336). Moreover, the occasional, ≥3 times weekly and daily consumption of meat were significantly associated with higher odds of current asthma (ORa = 9.6; ORa = 5.1 and ORa = 4.5), respectively. An occasional consumption of junk food was significantly associated with lower odds of current asthma (ORa = 0.044), whereas a daily consumption was associated with higher odds. CONCLUSION: Adhering to certain diets might be associated with higher odds of current asthma.

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Background: Attaining therapeutic goals in diabetes mellitus (DM) is often suboptimal due to disease complexity, poor adherence and inadequate patient counseling. Aim: This study evaluated the effectiveness of the collaboration between the physicians and pharmacists in DM management. Design and setting: A pilot study was conducted between January 2015 and December 2015 in diabetic patients from four districts of Lebanon. Methods: A total of 200 patients with type 2 DM were recruited with 12 months of follow-up. A range of clinical measures, including medication adherence and self-care activities, were assessed over a period of 12 months. The protocol consisted of primary care physicians referring patients to community pharmacies. The participants were attended for 30 min in the pharmacy. They were asked to complete a questionnaire and then received counseling on their illness and their medication in an organized manner by the pharmacist once every month for 12 consecutive months. The primary outcome was the change in fasting blood glucose (FBG) after 12 months of follow-up. Results: A total of 200 patients completed the study. The primary endpoint decreased significantly from the baseline after 12 months of follow-up (mean difference: 30 mg/dl; 95% CI, 28-32; p < .001). The secondary endpoints, such as glycated hemoglobin, also showed an improvement after 12 months of follow-up. Conclusion: Collaborative care between the physician and the pharmacist was successful in reducing FBG and improving patient satisfaction and quality of care over 12 months of follow-up.

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BACKGROUND: Health care professionals (HCP) are known key elements of effective patient's counselling and education. For patients taking warfarin, education about the dose, side effects, and toxicity is clearly identified as a cornerstone of achieving improved health and quality of life. The study objective was to evaluate the patients' knowledge about warfarin and assess the impact of the health care professionals' counselling in enhancing patients' knowledge in achieving warfarin therapeutic outcomes. METHOD: A six-month prospective multicentered study was conducted in three hospitals, enrolling 300 patients admitted to the cardiac care unit and internal medicine departments. Patients' warfarin knowledge and INR levels were assessed before and after the clinical pharmacist counselling. The main therapeutic outcome was the impact of the clinical pharmacist-physician counselling on improving patient's education and achieving therapeutic INR level. RESULTS: A higher mean knowledge about warfarin score was found after counselling as compared to before counselling (4.82 vs 13.2; p < 0.001). Likewise, the drug dose (1.05 vs 1.88), drug toxicity (0.41 vs 1.92), drug-drug and food-drug interactions (0.02 vs 1.89), therapeutic INR and general drug knowledge scores (2.66 vs 4.68) were significantly higher after as compared to before counselling (p < 0.001 for all variables). The percentages of patients who achieved therapeutic INR levels pre/post counselling was 37.2% and 74.4% respectively (p < 0.001). CONCLUSION: Based on the study findings, HCP play a major role in enhancing patients' knowledge about the factors that affect warfarin therapeutic outcomes. This study highlights the need to establish and develop strategies for appropriate warfarin utilization in Lebanon.

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This is a report of a 32-year-old man who presented with dyspnea upon micturition. He was found to have hematuria. Pelvic ultrasound and CT scan of the abdomen and pelvis revealed a left bladder wall polyp confirmed by cystoscopy to be a submucosal pulsating mass. Plasma free metanephrines were elevated in favor of a bladder paraganlioma while urinary metanephrines, catecholamines and MIBG scan were normal. Patient was managed by partial cystectomy with disappearance of symptoms thereafter. Pathology showed a completely excised paraganglioma. The assessment, diagnosis and treatment are illustrated.

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