Rania A. Tohme

Intravitreal Bevacizumab in Inflammatory Ocular Neovascularization

PURPOSE To assess the role of bevacizumab in inflammatory ocular neovascularization. DESIGN Retrospective, multicenter, consecutive case series of inflammatory ocular neovascularization. METHODS Patients with inflammatory ocular neovascularization of varying causes for whom standard therapy failed were treated with intravitreal injection of bevacizumab. Main outcome measures included improvement of best-corrected visual acuity (BCVA) expressed in logarithm of minimum angle of resolution units, response of inflammatory ocular neovascularization by funduscopy and angiography, and decrease in central foveal thickness as measured by optical coherence tomography at the three-month follow-up. RESULTS At the three-month follow-up, 84 eyes of 79 patients had been treated with a mean of 1.3 injections (range, one to three). Thirty-four eyes showed juxtafoveal choroidal neovascularization (CNV), 34 eyes showed subfoveal CNV, eight eyes showed peripapillary CNV, and 11 eyes showed neovascularization of the disc (NVD) or neovascularization elsewhere (NVE). BCVA improved 2.4 lines from 0.68 (6/28 or 20/94) to 0.44 (6/17 or 20/55) (P < .001). BCVA improved by one to three lines in 34.5% of the eyes, by four to six lines in 16.7% of the eyes, and by more than six lines in 14.2% of the eyes. Function was unchanged in 23.8% of the eyes. BCVA worsened in 10.7% (zero to three lines in 7.1%, more than four lines in 3.6%). Central foveal thickness decreased from baseline 346 to 252 microm (P < .001). For CNV, 32 eyes (43.2%) had complete regression after the injection, 27 (36.5%) had partial regression, five (6.8%) had no response, and 10 eyes (13.5%) were not evaluated by the contributors. For NVD or NVE, seven eyes (63.6%) had complete regression of new vessels and four eyes (36.4%) had partial regression after the injection. CONCLUSIONS Intravitreal bevacizumab led to short-term significant visual improvement and regression of inflammatory ocular neovascularization in a wide variety of inflammatory ocular diseases.

The prevalence of hypertension and its association with other cardiovascular disease risk factors in a representative sample of the Lebanese population.

Hypertension is a well-known major risk factor for cardiovascular diseases. This study has been designed to assess the prevalence of hypertension, its co-occurrence with other cardiovascular risk factors and its association with cardiovascular diseases in a representative sample of Lebanese population. A pretested questionnaire was administered to 2125 adults aged equal or above 30 years old from all regions in Lebanon and proportionate with the respective population density. Data revealed that 23.1% of the respondents admitted being hypertensive, with no statistically significant difference between male and female patients. Prevalence of hypertension increased with age (P<0.01) and hypertension tended to occur more in the less educated and the unemployed (P<0.01). Only 45.7% of hypertensive patients followed a low fat diet while 14.7% exercised daily. The prevalence of hypertension increased significantly with an increase in body mass index particularly in female patients. Among the hypertensive respondents, 23.9% were diabetic, 38.1% were hyperlipidaemic and 9.1% were both diabetic and hyperlipidaemic. Co-occurrence of hypertension with diabetes, hyperlipidaemia or both was more common in female patients compared to male patients. In addition, stroke, myocardial infarction (MI) and atherothrombosis occurred in hypertensive respondents at rates of 2.4, 4.3 and 9.5%, respectively. Hypertensive female patients reported more stroke and atherothrombotic episodes compared to male patients, whereas hypertensive male patients had more MIs. Based on these results it is very important to address the issue of lifestyle modification for the prevention and treatment of hypertension and awareness campaigns should stress the fact that cardiovascular diseases are not only restricted to men.

Socioeconomic resources and living arrangements of older adults in Lebanon: who chooses to live alone?

ABSTRACT During recent decades, Lebanon has experienced demographic and social changes which, coupled with political instability, have led to waves of youth migration and a higher proportion of older adults living alone. This paper uses the 2004 data of the ‘Pan Arab Project for Family Health’ to assess the levels of various living arrangements and to examine the correlates of living alone, with a focus on economic resources. The findings reveal that 12 per cent of older adults in Lebanon lived alone (17.3 per cent of women and 6.2 per cent of men). Financially better-off older adults and those who reported being satisfied with their income were, respectively, 4.4 and 1.7 times significantly more likely to live alone than their counterparts. The incomes of Lebanese older adults were mainly provided by their children (74.8%) and a relatively small share derived from pension schemes. Contrary to findings from other Arab countries, variations in living arrangements among Lebanese older adults seem to follow the western model whereby wealthier older individuals are more likely to live alone and to be residentially independent. Further studies are warranted to examine to what extent this trend is the result of past migration of adult children who are now established elsewhere and sending remittances home.

Validation of the Arabic version of the 5‐item WHO well being index in elderly population

Bonsignore M, 2001, EUR ARCH PSYCHIAT S2, V251, pII27; Chaaya M, 2008, INT PSYCHOGERIATR, V20, P571, DOI 10.1017-S1041610208006741; Chaaya M, 2007, AGING MENT HEALTH, V11, P37, DOI 10.1080-13607860600735812; Heun R, 1999, ACTA PSYCHIAT SCAND, V99, P171, DOI 10.1111-j.1600-0447.1999.tb00973.x; Karam EG, 2006, LANCET, V367, P1000, DOI 10.1016-S0140-6736(06)68427-4

Violent behavior among adolescents in post-war Lebanon: the role of personal factors and correlation with other problem behaviors

BACKGROUND Adolescent violence is a significant public health problem. The primary objective of this study is to assess the prevalence and correlates of violent behavior among adolescent students in Lebanon. METHODS A cross-sectional study was conducted among a representative sample of 827 secondary students enrolled in public and private schools in Beirut. Using a series of multiple logistic regression techniques, socio-demographic variables which significantly associated with violent behavior were included as potential confounders in building the models for risk behavior. RESULTS Nearly 42 and 17% of adolescents reported being involved in physical fights and weapon carrying, respectively. Boys were significantly more likely to use violence than girls. Whereas associations with physical fights were stronger for socio-economic variables and perceived rank in class, weapon carrying was significantly associated with problem behaviors, such as unintentional injury, substance abuse and sexual activity, with effect measures being stronger than those estimated for physical fighting. CONCLUSION Compared with other countries, the rates of violent behavior in Lebanon are relatively high. The results from this study are discussed in light of the political ecology of Lebanon which may contribute to a culture that perpetrates violent behavior and may have influenced the clustering pattern of risk behaviors.

The appropriateness of use of coronary angiography in Lebanon: implications for health policy

BACKGROUND Lebanon, characterized by a free-market health care system, has one of the highest reported per capita rates of cardiac catheterization facilities and coronary angiographies in the world. The aim of this study is to evaluate the appropriateness of performance of coronary angiography procedures in Lebanon. METHODS Data derived from the 2004 Lebanese Interventional Coronary Registry (LICOR) included 5418 patients aged 30 years and older who had not undergone prior percutaneous coronary intervention or coronary artery bypass grafting. Appropriateness was evaluated based on the Class I indications of the ACC/AHA guidelines for coronary angiography. FINDINGS The overall rate of appropriate procedures was 54.7% (95% CI 53.3-56.0%). Appropriateness varied significantly by gender and across administrative regions. Compared with females, males were more likely to be referred appropriately for coronary angiography (OR = 1.28, 95% CI = 1.15-1.44). Appropriateness was lowest (OR = 0.89, 95% CI = 0.71-1.12) in the region where the per capita density of cardiac catheterization labs increased by six-fold in the latter 2 years. The majority of the patients (84.3%) were not evaluated by any of the non-invasive tests prior to angiography, with only 10.8%, 4% and 1.5% of the patients referred for an exercise stress test, stress echocardiography and thallium stress tests, respectively. DISCUSSION Findings indicate a high rate of procedures conducted without appropriate indications and a low utilization rate of pre-interventional non-invasive testing. This may be attributed to three factors: a surplus of catheterization facilities in certain regions, the insignificant cost gradient between non-invasive testing and coronary angiography, and the wide case-based reimbursement of coronary angiography, unlike non-invasive testing, by public insurance schemes.

Vocal Technique in a Group of Middle Eastern Singers

Objective: We aimed to report on the vocal technique in a group of Middle Eastern singers. Subjects and Method: A total of 78 Middle Eastern singers were assessed. Demographic data included age, gender, training status and number of years of singing. All singers had laryngeal videoendostroboscopy. Description and grading of posture, tension, type of breathing, type of phonation, resonance and tone quality are reported. Proportions and means (± SD) were used to describe the sample for categorical and continuous variables respectively. Associations between endostroboscopy and voice technique were determined by χ2 or Fisher’s exact test. Results:There were 43 males and 35 females with an age ranging between 16 and 32 years and a mean of 23 ± 4 years. Of these, 88.5% were nontrained singers and 50% had more than 3 years of singing experience. Around 80% of Middle Eastern singers rely on either thoracic or clavicular breathing. Posture was average in 68% and moderate tension was present in 63% of the cases. Two thirds had a bright voice, 61% were hypernasal and almost 46% had a strained phonation. There was a significant correlation between posture and tension. Conclusion: Middle Eastern singing relies more on thoracic breathing and is characterized by tension.