Loulou Kobeissi

Consanguinity and family clustering of male factor infertility in Lebanon

OBJECTIVE To investigate the influence of consanguineous marriage on male factor infertility in Lebanon, where rates of consanguineous marriage remain high (29.6% among Muslims, 16.5% among Christians). DESIGN Clinic-based, case-control study, using reproductive history, risk factor interview, and laboratory-based semen analysis. SETTING Two IVF clinics in Beirut, Lebanon, during an 8-month period (January-August 2003). PATIENT(S) One hundred twenty infertile male patients and 100 fertile male controls, distinguished by semen analysis and reproductive history. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Standard clinical semen analysis. RESULT(S) The rates of consanguineous marriage were relatively high among the study sample. Patients (46%) were more likely than controls (37%) to report first-degree (parental) and second-degree (grandparental) consanguinity. The study demonstrated a clear pattern of family clustering of male factor infertility, with patients significantly more likely than controls to report infertility among close male relatives (odds ratio = 2.58). Men with azoospermia and severe oligospermia showed high rates of both consanguinity (50%) and family clustering (41%). CONCLUSION(S) Consanguineous marriage is a socially supported institution throughout the Muslim world, yet its relationship to infertility is poorly understood. This study demonstrated a significant association between consanguinity and family clustering of male factor infertility cases, suggesting a strong genetic component.

N-Acetyltransferase 1 (NAT1) Genotype: A Risk Factor for Urinary Bladder Cancer in a Lebanese Population

In Lebanon, bladder cancer is the second most incident cancer among men. This study investigates a possible association between N-acetyltransferase 1 (NAT1) genotype, a drug-metabolizing enzyme coding gene, and bladder cancer in Lebanese men. A case-control study (54 cases and 105 hospital-based controls) was conducted in two major hospitals in Beirut. Cases were randomly selected from patients diagnosed in the period of 2002–2008. Controls were conveniently identified and selected from the same settings. Data was collected using interview questionnaire and blood analysis. NAT1 genotypes were determined by PCR-RFLP. Statistical analysis revolved around univariate, bivariate, and multivariate logistic regression models, along with checks for effect modification. Results showed NAT1∗14A allele, smoking, occupational exposure to combustion fumes, and prostate-related symptoms, to be risk factors for bladder cancer. The odds of carrying at least one NAT1∗14A allele are 7 times higher in cases compared to controls (OR = 7.86, 95% CI: 1.53–40.39). A gene-environment interaction was identified for NAT1∗14A allele with occupational exposure to combustion fumes. Among carriers of NAT1∗14A allele, the odds of bladder cancer dropped to 2.03 from 3.72. Our study suggests NAT1∗14A allele as a possible biomarker for bladder cancer. Further research is recommended to confirm this association.

Acute coronary syndromes: clinical characteristics, management, and outcomes at the American University of Beirut Medical Center, 2002-2005.

Data on acute coronary syndromes (ACS) in developing countries is scarce. In this report, we analyze the temporal trends in the management and outcomes of a large series of ACS patients hospitalized at the American University of Beirut Medical Center (AUBMC), a tertiary referral university hospital located in a middle income Middle Eastern developing country.

In‐hospital Neonatal Mortality and the Role of Consanguinity

BACKGROUND Consanguinity which increases the risk of genetic disorders has been implicated at times in infant mortality. The aim of this study was to determine the association between consanguinity and in-hospital mortality in newborns. METHODS Data was collected prospectively on all births from 26 hospitals in Lebanon from January 2004 to December 2008 and admitted to the National Collaborative Perinatal Neonatal Network. Secondary analysis was done on 65,402 singletons, after exclusion of stillbirths, infants of multiple gestation and infants of second cousin progeny. RESULTS In-hospital mortality was 6.7 per 1000 live births (439/65,402). The rate of first cousin marriage was 9.9%. Consanguinity was significantly associated with in-hospital mortality (odds ratio 2.4; 95% confidence interval (CI): 1.8, 3.1); consanguinity remained a significant predictor of mortality (odds ratio 1.8 [95% CI: 1.2, 2.9]) after adjusting for maternal age and education, crowding index, history of abortion, prenatal care, mode of delivery, gender, birthweight and apgar score at 5 minutes. CONCLUSIONS This association of consanguinity with in-hospital mortality points to potential genetic factors leading to this increased risk. Designing public health interventions, including raising the awareness and taking into consideration such risks in neonatal mortality studies are indicated.

The relaxation exercise and social support trial- resst: study protocol for a randomized community based trial

BackgroundStudies suggests a possible link between vaginal discharge and common mental distress, as well as highlight the implications of the subjective burden of disease and its link with mental health.Methods/DesignThis is a community-based intervention trial that aims to evaluate the impact of a psycho-social intervention on medically unexplained vaginal discharge (MUVD) in a group of married, low-income Lebanese women, aged 18-49, and suffering from low to moderate levels of anxiety and/or depression. The intervention consisted of 12 sessions of structured social support, problem solving techniques, group discussions and trainer-supervised relaxation exercises (twice per week over six weeks). Women were recruited from Hey el Selloum, a southern disadvantaged suburb of Beirut, Lebanon, during an open recruitment campaign. The primary outcome was self-reported MUVD, upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Intent to treat analysis will be used.DiscussionThe results will indicate whether the proposed psychosocial intervention was effective in reducing MUVD (possibly mediated by common mental distress).Trial RegistrationThe trial is registered at the Wellcome Trust Registry, ISRCTN assigned: ISRCTN: ISRCTN98441241

HIV/AIDS-related knowledge and its association with socioeconomic status among women: results of Lebanese Survey for Family Health (PAPFAM) 2004.

This article assesses the association of women’s HIV/AIDS knowledge of transmission and prevention with socioeconomic status (SES). Data from the 2004 Lebanese PAPFAM (Pan-Arab Project for Family Health) survey were used. The survey was based on a representative household sample (n = 5532 households; n = 3315 women) of ever-married women aged 15 to 55 years. Adjusted analysis revolved around multivariate logistic regression models. 18% of women were knowledgeable of HIV/AIDS transmission methods and 21% of prevention methods. Income and education were significantly related to women’s transmission and prevention knowledge. Significant differences were also found by region and media exposure. Women in the richest income quintile were 4 times (95% confidence interval [CI] = 2.43-6.42) more likely to be knowledgeable than those in the poorest. Women with the highest education were 2.57 times more likely (95% CI = 1.98-3.34) to be knowledgeable than those with elementary education or less. These results suggest the need for incorporating contextual regional and population differences for more effective HIV/AIDS awareness campaigns in Lebanon.

The 2009 Lebanese National Mammography Campaign: Results and Assessment Using a Survey Design

Background: Breast cancer screening and early detection lead to better prognosis, survival rates and quality of life. The Lebanese Ministry of Public Health (MoPH) organizes yearly national-subsidized mammography campaigns in October, since 2002. This paper describes the characteristics of women attending the 2009 MoPH mammography campaign and explores factors influencing their first-time participation. Materials and Methods: Data from 83 mammography centers on 10,953 women (gathered during October- December 2009) were analyzed. The data were collected by the radiology technicians at the centers, using a closedended questionnaire. Data management and analysis was done using SPSS. Analysis included descriptive, bi-variate statistics and backward logistic regression. Results: The mean age of women attending the campaign was 49 (SD 9.67) years. 84.1% of the women were married, 13.6% had some form of university education, and 40.7% were current smokers. 82.9% indicated to have ever breast fed, and 36.9% were current or ever users of OCP. As for family history, 8.9% indicated to have an aunt on the mother’s side with breast cancer, 8.8% have a sister, 7.5% an aunt on the father’s side, and 7.3% have a mother. 68.2% of the women participated in the campaign for the first time. 97.8% indicated they would repeat the exam next year. 88.8% considered the price acceptable. 51.6% had normal diagnosis. Television messages and a friend were the two most common routes via which the woman heard of the campaign. Women who participated in the campaign before compared to those participating for the first time: were more likely to be independently-significantly: older, of higher educational levels, non-smokers, and with a family history of breast cancer. Conclusion: Such an assessment is important in order to enhance outreach as well as identify factors that could contribute to better service delivery, capacity and quality.

Toxicogenetic Profile and Cancer Risk in Lebanese

An increasing number of genetic polymorphisms in drug-metabolizing enzymes (DME) were identified among different ethnic groups. Some of these polymorphisms are associated with an increased cancer risk, while others remain equivocal. However, there is sufficient evidence that these associations become significant in populations overexposed to environmental carcinogens. Hence, genetic differences in expression activity of both Phase I and Phase II enzymes may affect cancer risk in exposed populations. In Lebanon, there has been a marked rise in reported cancer incidence since the 1990s. There are also indicators of exposure to unusually high levels of environmental pollutants and carcinogens in the country. This review considers this high cancer incidence by exploring a potential gene–environment model based on available DME polymorphism prevalence, and their impact on bladder, colorectal, prostate, breast, and lung cancer in the Lebanese population. The examined DME include glutathione S-transferases (GST), N-acetyltransferases (NAT), and cytochromes P-450 (CYP). Data suggest that these DME influence bladder cancer risk in the Lebanese population. Evidence indicates that identification of a gene–environment interaction model may help in defining future research priorities and preventive cancer control strategies in this country, particularly for breast and lung cancer.

Management of acute coronary syndromes in developing countries: Are we complying with practice guidelines?

Abstract Comparative clinical data on acute coronary syndromes (ACS) in developing countries to those from international registries are non-existing, particularly regarding adherence to practice guidelines and its association with clinical outcomes. In this report, we compare the management and in-hospital outcomes of 1025 patients hospitalized with ACS at the American University of Beirut Medical Center (AUBMC) to recent data from the GRACE registry. The overall revascularization rate was similar between AUBMC and GRACE (48% vs 49%), but the utilization rates of reperfusion therapy, glycoprotein IIb/IIIa inhibitors, aspirin, clopidogrel, beta blockers, ACE/ARB, and statins were consistently lower than those reported in GRACE ( p p

Process evaluation of a psychosocial intervention addressing women in a disadvantaged setting

Objectives: This paper presents the process evaluation of a community-based randomized psycho-social trial aimed to enhance reproductive and mental health outcomes of disadvantaged women living in the southern suburb of Beirut-Lebanon. Process evaluation of public health interventions involves the monitoring and documentation of interventions’ implementation to allow for better understanding of planned outcomes and of intervention effectiveness. Methods: A community-based randomized trial was conducted. The intervention consisted of 12 sessions (of combined 30 minutes of relaxation exercises and 75 minutes of structured support groups) delivered twice per week over a period of six-weeks. A process evaluation was conducted during the implementation of the intervention. This process evaluation aimed to ensure that the intervention was delivered and implemented as planned, as well as to monitor women’s satisfaction and attendance. The main components of the process evaluation included: dose delivered, dose received, and reach. Closed ended questionnaires were administered before/after/during each intervention session. Data was entered and analyzed using SPSS. Analysis revolved around simple frequency distribution for categorical variables and means (SD) for continuous variables. Limited bivariate analysis (using CHI Square and Anova) was done. Results: Results indicated that the delivery, implementation, and reach of the intervention were favorable. Participation was acceptable and satisfaction rates were very high. Conclusion: These favorable findings pertaining to intervention satisfaction, reach and participation highlight a number of lessons for future intervention studies in the context of disadvantaged settings. They also support the importance of involving the local community members in intervention planning, implementation and evaluation early on. We believe that the community involvement in this trial directly and significantly contributed to the results of this process evaluation.