Salam Zein

Is oxidative stress induced by iron status associated with gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a common pregnancy complication in high risk populations, and is associated with increased perinatal and long term outcomes for both mothers and newborns. Both its prevention and early management can be reinforced by identifying risks factors, particularly those factors influencing glucose metabolism. On the other hand, several epidemiological studies have shown an increased oxidative stress (OS) in pregnant women with GDM. Elevated OS was also reported in pregnant women supplemented with iron, which can generate OS and may also influence insulin resistance. This review summarizes the current state of knowledge, highlighting the potential relationship between OS induced by iron status and the development of GDM.

Factors affecting medication adherence in Lebanese patients with chronic diseases

Background: Non-adherence to prescribed medications represents an obstacle toward achieving treatment goals. This problem is more pronounced in patients with chronic illness. Objective: To identify the extent of adherence in Lebanese outpatients with chronic diseases, and to suggest possible predictors of non-adherence in this population. The secondary objective was to assess if medication adherence affects patients’ quality of life. Methods: A questionnaire was administered face-to-face to a sample of Lebanese adults visiting the external clinics at two Tertiary Care Hospitals in Beirut. The level of adherence was assessed using the 8-item Morisky Medication Adherence Scale which was first validated. The health-related quality of life (HRQoL) of patients was measured using the EQ-5D. Linear regression and logistic regression analyses examined possible predictors of adherence. Results: Out of the 148 patients included in this study, 42.6% were classified as adherent. In the univariate analyses, statistically significant predictors of high adherence included good physician-patient relationship (p=0.029) and counseling (p=0.037), a high level of HRQoL (p<0.001), and a high level of perceived health (p<0.001). Predictors of low adherence included a declining memory (p<0.001), anxiety/depression (p=0.002), little drug knowledge (p<0.001), and postponing physician appointments (p<0.001). The multivariate analyses revealed similar results. In the linear regression, the most powerful predictor of non-adherence was the disbelief that the drug is ameliorating the disease (beta=0.279), however, in logistic regression, patient who were willing to skip or double doses in case of amelioration/deterioration were found to be 7.35 times more likely to be non-adherent than those who were not (aOR=0.136, 95% CI: 0.037-0.503). Conclusion: The findings of this study reassure the view that patients should be regarded as active decision makers. Patient education should be regarded as a cornerstone for treatment success. Additional studies as well are needed to test the practicability and effectiveness of interventions suggested to enhance adherence.

Risky substance exposure during pregnancy: a pilot study from Lebanese mothers.

Background The harmful effects of medication and licit substance use during pregnancy may potentially constitute a major public health concern. Our study aims to assess risky exposure of Lebanese pregnant women to drugs, tobacco, caffeine, and alcohol, and to determine their effect on postnatal outcomes. Methods Women at term were addressed after delivery in five university hospitals of Beirut and Mount Lebanon between February and June 2012. A standardized questionnaire was administered to them. Moreover, medical files of both mothers and their respective newborns were checked to confirm information given by mothers, and to assess the health outcome of the babies. Results Among the interviewed 350 women, active and passive smoking of tobacco (cigarette or water pipe), and consumption of category C, D, and X drugs were common during pregnancy in Lebanon; they were shown to negatively affect the neonatal outcome in multivariate analyses: they significantly decreased Apgar scores and increased the risk of underweight and medical complications of babies (P < 0.05). Conclusion Our study demonstrated that Lebanese women were exposed during pregnancy to multiple medications and licit substances that affected the neonates’ health. Our findings have implications for clinical obstetric practice and prevention programs in Lebanon. Efforts should be made to decrease exposure to harmful substances during pregnancy.

Evaluation of medication adherence in Lebanese hypertensive patients.

Controlling hypertension is essential in cardiovascular diseases. Poor medication adherence is associated with poor disease outcomes, waste of healthcare resources, and contributes to reduced blood pressure control. This study evaluates treatment adherence to antihypertensive therapy in Lebanese hypertensive patients by estimating the proportion of adherent hypertensive patients using a validated tool and investigates what factors predict this behavior. A questionnaire-based cross-sectional study was conducted on a random sample of 210 hypertensive outpatients selected from clinics located in tertiary-care hospitals and from private cardiology clinics located in Beirut. Adherence level was measured using a validated 8-item Modified Morisky Medication Adherence Scale (MMMAS). Among 210 patients, 50.5% showed high adherence, 27.1% medium adherence, and 22.4% low adherence to medication. Mean MMMAS score was 6.59 ± 2.0. In bivariate analyses, having controlled blood pressure (p = 0.003) and taking a combination drug (p = 0.023) were predictors of high adherence. Forgetfulness (p < 0.01), complicated drug regimen (p = 0.001), and side effects (p = 0.006) were predictors of low adherence after multiple liner regression. Logistic regression results showed that calcium channel blockers (p = 0.030) were associated with increased adherence levels. In conclusion, developing multidisciplinary intervention programs to address the factors identified, in addition to educational strategies targeting healthcare providers, are necessary to enhance patient adherence.

Statins decrease mortality in Lebanese patients with sepsis: A multicenter study

Background Sepsis is a significant public health concern. The clinical response to statins is variable among sepsis patients. Objective The aim of the study was to determinate the effect of statin-treatment on mortality in Lebanese patients with sepsis. Methods A retrospective multicenter study on Lebanese patients with sepsis between January 2008 and March 2012 was conducted. Patients with a primary diagnosis of sepsis admitted to the intensive care unit of two tertiary care hospitals in Beirut were included. Patients who continued to receive statin therapy for dyslipidemia during the hospital course were included in the statin treatment group. The control group consisted of patients not taking statin. Demographic characteristics, clinical signs, standard laboratory test and treatment received were compared between these two groups using univariate analysis. Logistic regression and survival analysis were performed by SPSS. Results Three hundred fifty one Lebanese patients were included (age: 71.33 SD=14.97 years; Male: 56%). Among them, 30% took a statin at the doses recommended for dyslipidemia. The comparison of the two groups showed that in the statin treatment group: The mean serum level of C-reactive protein at the time of sepsis was significantly decreased (P=0.050), the length-stay at ICU significantly increased (P=0.047) and mortality significantly reduced (P<0.001). Results were confirmed by logistic regression, particularly for mortality. In the Cox regression analysis, hypothermia and shock were significantly associated with high mortality while statin treatment decreased mortality (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037). Conclusions At usual doses for dyslipidemia, statin treatment decreased incidence of mortality related to sepsis and improved the survival in this Lebanese septic population. Large randomized controlled clinical trials must be realized to give conclusive results about the potential beneficial effect of statins in sepsis.

Middle Iron-Enriched Fructose Diet on Gestational Diabetes Risk and on Oxidative Stress in Offspring Rats.

Gestational diabetes mellitus (GDM) is associated with increased insulin resistance and a heightened level of oxidative stress (OS). Additionally, high iron consumption could also increase insulin resistance and OS, which could aggravate GDM risk. The aim of this study is to evaluate a high fructose diet (F) as an alternative experimental model of GDM on rats. We also have evaluated the worst effect of a fructose iron-enriched diet (FI) on glucose tolerance and OS status during pregnancy. Anthropometric parameters, plasma glucose levels, insulin, and lipid profile were assessed after delivery in rats fed an F diet. The effects observed in mothers (hyperglycemia, and hyperlipidemia) and on pups (macrosomia and hypoglycemia) are similar to those observed in women with GDM. Therefore, the fructose diet could be proposed as an experimental model of GDM. In this way, we can compare the effect of an iron-enriched diet on the metabolic and redox status of mother rats and their pups. The mothers’ glycemic was similar in the F and FI groups, whereas the glycemic was significantly different in the newborn. In rat pups born to mothers fed on an FI diet, the activities of the antioxidant enzyme glutathione peroxidase (GPx) and glutathione-S-transferase in livers and GPx in brains were altered and the gender analysis showed significant differences. Thus, alterations in the glycemic and redox status in newborns suggest that fetuses are more sensitive than their mothers to the effect of an iron-enriched diet in the case of GDM pregnancy. This study proposed a novel experimental model for GDM and provided insights on the effect of a moderate iron intake in adding to the risk of glucose disorder and oxidative damage on newborns.

Risk factors and quality of life of dyslipidemic patients in Lebanon: A cross-sectional study

The main objective of this study was to identify the risk factors of dyslipidemia and measure its impact on patients’ quality of life (QOL). Secondary objectives were to determine the percentage of dyslipidemia and assess the predictive factors affecting patients’ QOL. A cross-sectional study was conducted in a sample of Lebanese population. A standardized questionnaire was developed to assess the QOL using the Short form-36 (SF-36) score. A total of 452 individuals were interviewed, of which 59.5% were females. The mean age was 43.3 ± 15.6 years, and 24.8% had dyslipidemia. The results show a lower overall QOL score among dyslipidemic patients compared with controls (57.9% and 76.5%, respectively; p < 0.001). Waterpipe smoking [adjusted odds ratio (ORa) = 4.113, 95% confidence interval (CI): 1.696–9.971, p = 0.002], hypertension (ORa = 3.597, 95% CI: 1.818–7.116, p < 0.001), diabetes (ORa = 3.441, 95% CI: 1.587–7.462, p = 0.002), cigarette smoking (ORa = 2.966, 95% CI: 1.516–5.804, p = 0.001), and passive smoking (ORa = 2.716, 95% CI: 1.376–5.358, p = 0.004) were significantly associated with dyslipidemia in individuals older than 30 years. A higher overall QOL score (p = 0.013) was observed in patients treated with statins in comparison with other lipid-lowering medications. In addition to clinical and economical consequences, dyslipidemia may have a significant impact on patients’ QOL. Further research is needed to confirm the impact of treatment on dyslipidemic patients’ QOL in order to maximize the overall benefits of therapy.

Adverse drug events associated with vitamin K antagonists: factors of therapeutic imbalance

Background Adverse drug events (ADE) occur frequently during treatment with vitamin K antagonists (AVK) and contribute to increase hemorrhagic risks. Methods A retrospective study was conducted over a period of 2 years. Patients treated with AVK and admitted to the emergency room of a tertiary care hospital in Beirut were included. The aim of the study was to identify ADE characterized by a high international normalized ratio (INR) and to determine the predictive factors responsible for these events. Statistical analysis was performed with the SPSS statistical package. Results We included 148 patients. Sixty-seven patients (47.3%) with an INR above the therapeutic range were identified as cases. The control group consisted of 81 patients (54.7%) with an INR within the therapeutic range. Hemorrhagic complications were observed in 53.7% of cases versus 6.2% of controls (P < 0.0001). No significant difference was noticed between cases and controls regarding the indication and the dose of AVK. Patients aged over 75 years were more likely to present an INR above the therapeutic range (58.2%, P = 0.049). Recent infection was present in 40.3% of cases versus 6.2% of controls (P < 0.0001) and hypoalbuminemia in 37.3% of cases versus 6.1% of controls (P < 0.0001). Treatment with antibiotics, amiodarone, and anti-inflammatory drugs were also factors of imbalance (P < 0.0001). Conclusion Many factors may be associated with ADE related to AVK. Monitoring of INR and its stabilization in the therapeutic range are important for preventing these events.

Fer, stress oxydant et diabète gestationnel

Resume L’augmentation de l’insulinoresistance dans le monde est un sujet preoccupant en termes de sante publique, en raison des risques associes de diabete de type 2, de maladies cardiovasculaires, de cancers et, plus recemment, d’augmentation du risque de declin cognitif. Au cours de la gestation, l’insulinoresistance est un phenomene physiologique qui, lorsqu’elle n’est pas « maitrisee », peut devenir pathologique, on parle alors de diabete gestationnel (DG). Le lien etroit entre stress oxydant, diabete et DG est clairement admis, resultant d’une hyperproduction radicalaire associee a l’hyperglycemie et a une diminution des defenses antioxydantes. Au cours de cette derniere decennie, une controverse est nee sur les risques associes a des apports eleves en fer, en raison de son role pro-oxydant et du risque de diabete associe a une ferritinemie elevee. Une relation qui est egalement decrite dans l’augmentation du risque de DG, et qui doit inciter a evaluer le benefice/risque en cas de supplementation martiale. En effet, un diagnostic biologique fonde uniquement sur une ferritine basse, et en l’absence d’anemie, conduit encore trop souvent a une supplementation preventive qui ne serait pas denuee de risque sur l’incidence de DG. Un risque qui justifie que la supplementation martiale ne soit proposee qu’en cas d’anemie, alors, qu’a l’avenir, le dosage de la ferritine en debut de grossesse pourrait devenir un marqueur de risque de DG.

Aspects actuels des infections nosocomiales au Centre Hospitalier Libanais de Beyrouth

Nosocomial infections are a significant problem and hospitals need to be aware of their nosocomial infection status. This retrospective study aimed to identify nosocomial bacterial infections in patients admitted to the Lebanese Hospital Center from January 2006 to January 2008 and determine the causative micro-organisms, the antibiotic sensitivity of the micro-organisms and evaluate the hospital treatment. In total 96 patients with nosocomial infection were included. Urinary infections were the commonest nosocomial infections (42%) followed by pulmonary infections (28%). Gram-negative bacteria were responsible for 89% of nosocomial infections and staphylococci for 7%, with Escherichia coli and Pseudomonas aeruginosa being the most common (46% and 26% respectively). The organisms were resistant to multiples antibiotics and 18% of the patients were treated with imipenem, 7% with vancomycin, 42% with third-generation cephalosporins and 24% with amikacin. Hospital hygiene measures and antibiotic prescription policies are required to fight nosocomial infections and reduce antibiotic resistance among organisms.