Souheil Hallit

Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study

Environmental factors, pesticides, alcohol and smoking are linked to asthma in children. The association of toxic substances exposure with asthma has not been evaluated. Our objective is to assess such associations among children aged less than 16 years old. This is a cross-sectional study, conducted between January and May 2015, using a sample of Lebanese students from private schools in Beirut and Mount Lebanon. Out of 700 distributed questionnaires, 527 (75.2%) were returned to us. Verbal informed consent was also obtained from all parents prior to participating in the study. A significant association was found between waterpipe smoking and diagnosed asthma (p = 0.003; ORa = 13.25; 95% CI 2.472–71.026). Alcohol during pregnancy, waterpipe smoking during pregnancy and parents respiratory problems significantly increased the risk of respiratory problems by approximately 5 times, 6 times and 2 times respectively (p = 0.016; ORa = 4.889; 95% CI 1.339–17.844, p = 0.021; ORa = 6.083; 95% CI 1.314–28.172, p = 0.004; ORa = 1.748; 95% CI 1.197–2.554 respectively). Waterpipe smoking, alcohol during pregnancy, recurrent otitis and humidity at home seem to be significantly correlated with asthma in children. Spreading awareness by health care professionals is needed to permit a reduction of the prevalence of these allergic diseases, especially asthma, in children.

Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study

ObjectiveSpiritual well-being was found to have some protective effect against end-of life despair in cancer patients. We aimed at assessing the impact of spirituality on the quality of life, depression, and anxiety of Lebanese cancer patients.MethodsOur observational transversal monocentric study was conducted between January and April 2016 among a convenient sample of 115 Lebanese cancer patients admitted to Hôtel-Dieu de France Hospital (HDF), Beirut—Lebanon. In addition to socio-demographic and clinical data, three questionnaires were used: EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 3rd version), FACIT-Sp-12 (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; The 12-item Spiritual Well-Being Scale, 4th version), and HADS (Hospital Anxiety and Depression Scale). Eighteen patients taking anxiolytic and/or antidepressants were not included in the analysis. The remaining 97 patients were analyzed.ResultsBetter emotional and cognitive functioning was seen in patients with higher meaning, peace, faith, and total FACIT scores. Meaning, peace, and total FACIT scores were also higher among patients with better global health status and quality of life. Anxiety as well as depression was significantly associated to all spiritual well-being factors.ConclusionSpirituality can improve quality of life and decrease the incidence of anxiety and depression in cancer patients. Our results highlight the need to incorporate spiritual care in healthcare systems.

Correlation of Types of Food and Asthma Diagnosis in Childhood: A Case-Control Study

ABSTRACT Objective: Studies concerning asthma in Lebanon investigated environmental and personal factors but none of them took into account the effect of nutritional habits. Our objective is to assess the effect of nutritional habits on asthma and allergies in Lebanese children aged 3–16 years old. Methods: This is a case–control study, conducted between December 2015 and April 2016. The Food Frequency Questionnaire was composed of 16 semi-quantitative questions covering different food categories. Results: This study included 1,276 children (976 healthy and 300 asthmatic children). Eating dairy products less than twice a week, 3–6 times per week and daily were significantly and inversely associated with asthma, as compared to never eating dairy products (p = 0.02, ORa = 0.285, CI 0.099–0.821; p < 0.001, ORa = 0.140, CI 0.052–0.378 and p < 0.001, ORa = 0.161, CI 0.061–0.422), whereas eating red meat daily compared to never was associated with asthma significantly (p = 0.037, ORa = 2.051, CI 1.046–4.024). Eating nuts less than twice weekly as compared to never was significantly and inversely associated with asthma (p = 0.035, ORa = 0.597, CI 0.369–0.965). The age categories 7–10 and 11–13 years were significantly associated with asthma as compared to the 3–6 years category (p < 0.001, ORa = 3.359, CI 1.869–6.038 and p = 0.008, ORa = 2.191, CI 1.228–3.909, respectively), while male gender was significantly more prone to asthma (p = 0.014, ORa = 0.686, CI 0.507–0.926). Conclusions: Knowing the correlation between nutritional habits and asthma is important to promote healthy eating. Educational programs for parents about healthy food and breastfeeding encouragement is warranted.

AIDS-Related Lymphoma: Resolution with Antiretroviral Therapy Alone

Patients with HIV are at increased risk of malignancy, particularly lymphoma, which is the most common malignancy leading to death. With the advent of highly active antiretroviral therapy (HAART), patients live longer but have a longer duration of antigenic stimulation, increasing the prevalence of AIDS-related lymphoma (ARL) in the population living with HIV. Highly active antiretroviral therapy plays a direct role in preserving the immune system, helping to decrease the incidence of ARL. We present a case of a female patient with HIV (CD4 count of 576 cells/mm3) diagnosed with a stage III-B non-Hodgkin lymphoma in 2009 while off HAART. She was subsequently started on HAART, leading to full resolution of her lymphoma without any chemotherapeutic intervention. She was last seen in the clinic in December 2013 without any evidence of recurrence of her lymphoma. To our knowledge, this is the first case report of a stage III-B non-Hodgkin lymphoma in an HIV-infected patient, which resolved with only HAART.

An Arabic Version of the Geriatric Depression Scale (30 Items): Psychometric Properties and Some Findings in a Lebanese Elderly Sample

Background/Aim: Although the rates of depression and anxiety disorders have been shown to be higher in older people, especially those living in institutional settings, most of this population remains undiagnosed and untreated. The objective is to translate the full-scale Geriatric Depression Scale (30 items, GDS) into Arabic for use in elderly patients in Lebanon, to check its validity and reproducibility in comparison to the original version of the questionnaire, and assess the risk factors associated with depression in the Lebanese geriatric population. Methods: This case-control study was conducted between June and August 2016 and included 500 patients aged more than 60 years (250 living inside and 250 outside a nursing home). Results: Strongly positive correlations (p < 0.001 for all items of the scale) were found between each item of the scale and the total scale. The mean inter-item correlation for our scale was 0.51, higher than that of the original scale (0.36), with an excellent internal consistency (Cronbach α = 0.901). Living in a nursing home, stress, anxiety, being married, age, and the primary level of education would significantly increase depression (β = 2.211, β = 0.223, β = 0.041, β = 0.902, β = 0.118, and β = 3.533, respectively). A normal nutritional status and a university level of education would significantly decrease depression (β = –0.732; β = –1.961). Conclusion: The Arabic version of the GDS can be used to estimate the severity of depression in the Lebanese elderly population. Periodic screening for anxiety, nutritional status, and stress is also recommended among geriatric people living in Lebanon.

Neurological soft signs in bipolar and unipolar disorder: A case-control study

Neuropsychiatric disorders are associated with neurological soft signs (NSS), including motor, sensory, and inhibitory dysfunction. The present study aims at determining the prevalence of NSS and explore the association of sociodemographic characteristics with the occurrence of NSS in patients with bipolar disorder and unipolar depression compared to healthy controls. A case-control study included a sample of 50 bipolar and unipolar patients and 50 healthy controls. NSS subscales of the Neurological Evaluation Scale (NES) were administered to each participant. Significant differences were found in the total NES score, motor coordination, sensory integration, sequence of complex motor act and other subscales among the three groups. Compared with healthy controls, patients with bipolar disorder showed significantly more total NSS signs, motor coordination signs and sensory-integration signs. When compared with patients with unipolar disorder, patients with bipolar disorder showed significantly more sensory integration signs and a trend of difference in the sequencing of complex motor acts and other subscales. Our findings suggest that NSS may be specifically associated with bipolar disorder but not unipolar depression. The specificity of NSS expression has the potential to help the discrimination of bipolar disorder from disorders less likely to have a neurodevelopmental component such as major depression.

Wheezing phenotypes and risk factors in early life: The ELFE cohort

Objective Different phenotypes of wheezing have been described to date but not in early life. We aim to describe wheezing phenotypes between the ages of two months and one year, and assess risk factors associated with these wheezing phenotypes in a large birth cohort. Methods We studied 18,041 infants from the ELFE (French Longitudinal Study of Children) birth cohort. Parents reported wheezing and respiratory symptoms at two and 12 months, and answered a complete questionnaire (exposure during pregnancy, parental allergy). Results Children with no symptoms (controls) accounted for 77.2%, 2.1% had had wheezing at two months but no wheezing at one year (intermittent), 2.4% had persistent wheezing, while 18.3% had incident wheezing at one year. Comparing persistent wheezing to controls showed that having one sibling (ORa = 2.19) or 2 siblings (ORa = 2.23) compared to none, nocturnal cough (OR = 5.2), respiratory distress (OR = 4.1) and excess bronchial secretions (OR = 3.47) at two months, reflux in the child at 2 months (OR = 1.55), maternal history of asthma (OR = 1.46) and maternal smoking during pregnancy (OR = 1.57) were significantly associated with persistent wheezing. These same factors, along with cutaneous rash in the child at 2 months (OR = 1.13) and paternal history of asthma (OR = 1.32) were significantly associated with increased odds of incident wheezing. Having one sibling (ORa = 1.9) compared to none, nocturnal cough at 2 months (OR = 1.76) and excess bronchial secretions at 2 months (OR = 1.65) were significantly associated with persistent compared to intermittent wheezing. Conclusion Respiratory symptoms (cough, respiratory distress, and excessive bronchial secretion) were significantly associated with a high risk of persistent wheezing at one year. Smoking exposure during pregnancy was also a risk factor for persistent and incident wheezing.

Validation of the mini pediatric asthma quality of life questionnaire and identification of risk factors affecting quality of life among Lebanese children

ABSTRACT Background: Few studies used various scales to assess the QOL in Lebanon in general but none was specific to asthma. Our objective was to assess the asthma-related quality of life, using the mini Pediatric Asthma Quality of Life Questionnaire (PAQLQ), in Lebanese asthmatic children, check its validity compared to the original version, and identify clinical and sociodemographic risk factors that might affect these childrens QOL. Methods: This retrospective study included 300 children aged between 7–16 years (51.6% boys and 48.4% girls). To confirm the mini-PAQLQ questionnaire construct validity in the Lebanese population, an exploratory factor analysis was launched for the 13 items of the questionnaire, using the principal component analysis technique. Cronbachs alpha was recorded for reliability analysis. A multivariate analysis linear regression was carried out, taking the QOL score as the dependent variable. Results: The correlation coefficients for factors 1 (symptoms and emotions) and 2 (activities) were similar to that of the original scale. High Cronbachs alphas were found for factor 1 (0.914), factor 2 (0.888), and the full scale (0.921). Uncontrolled asthma, the childs respiratory problems before the age of 2 years, and the presence of pets at home significantly decreased the childrens asthma-related quality of life (Beta = −1.541; Beta = −6.846, and Beta = −5.364, respectively). Conclusion: We were able to validate the mini-PAQLQ among the Lebanese population. The identification of risk factors, some of which are amenable to intervention, especially uncontrolled asthma, could lead to an improvement in the asthmatic childrens QOL.

Medication safety knowledge, attitudes and practices among community pharmacists in Lebanon

Abstract Background: The effectiveness of a national post-marketing surveillance program depends directly on the active participation of all health professionals. There is no current comprehensive and active pharmacovigilance program available in Lebanon. Objectives: To assess the knowledge, attitudes, and practices (KAP) among community pharmacists in Lebanon with respect to potential pharmacovigilance and adverse-drug-reaction reporting in Lebanon. Methods: A cross-sectional descriptive study, using a self-administered KAP questionnaire and conducted between March and July 2016, included 1857 pharmacists practicing in community settings. Statistical analysis included χ2 test for dichotomous or multinomial qualitative variables, and Wilcoxon test for quantitative variables with non-homogeneous variances or non-normal distribution. Results: The majority of responders had good knowledge concerning the concept and purpose of pharmacovigilance as well as adverse drug reactions (how to report these/the importance of reporting adverse events/the definition of an adverse event and pharmacovigilance). Concerning community pharmacists’ attitudes and practice towards pharmacovigilance, the majority described having a positive attitude towards their role in adverse drug reaction reporting and this activity was even seen as one of their core duties. The questionnaire revealed a lack of practice and training regarding pharmacovigilance. Nonetheless, the pharmacists agreed on the Order of Pharmacists in Lebanon and the Ministry of Health’s role in promoting this practice and helping them be more involved in reporting adverse drug reactions (ADRs). The pharmacists thought that they are well positioned regarding patient-safety practice in their pharmacies and the results were not statistically different between pharmacy employers and employees. Conclusion: Lebanese pharmacists have the required knowledge and positive attitude to start reporting ADRs, were aware of ADRs occurring with various medicines post-marketing, yet were currently not able to disseminate this information widely or to record it centrally, emphasizing the importance of establishing a national ADR reporting system.

Hypertension prevalence and living conditions related to air pollution: results of a national epidemiological study in Lebanon

Hypertension is a risk factor of several diseases, linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution exposure items to hypertension, but results were inconsistent. Our objective was to assess the association of living conditions related to air pollution to hypertension in Lebanon, a Middle Eastern country. A national cross-sectional study was conducted all over Lebanon. Blood pressure and its related medications were assessed to be able to classify participants as hypertensive or not. Moreover, in addition to living conditions related to air pollution exposure, we assessed potential predictors of hypertension, including sociodemographic characteristics, self-reported health information and biological measurements. Furthermore, we assessed dose-effect relationship of air pollution items in relation with hypertension. Living conditions related to indoor and outdoor air pollution exposures were associated with hypertension, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (15% increase in risk of disease for every additional pollution exposure item), after adjustment for sociodemographics and biological characteristics (Ora = 1.15 [1.03–1.28]). Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of air pollution on chronic diseases. The work on reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.