Umayya Musharrafieh

Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak

BACKGROUND Leishmaniasis is a neglected tropical disease, endemic in many worldwide foci including the Middle East. Several outbreaks have occurred in the Middle East over the past decades, mostly related to war-associated population migration. With the start of the Syrian war, the frequency and magnitude of these outbreaks increased alarmingly. We describe the epidemiology of Leishmania infection in Lebanon and the most recent outbreak relevant to the Syrian war. METHODS We reviewed all leishmaniasis cases reported to the Epidemiologic Surveillance Department at the Lebanese Ministry of Public Health between 2001 and the first quarter of 2014. The demographics and distribution of Syrian refugees in Lebanon were linked to reports of new Leishmania cases. RESULTS In total, 1033 new cases of leishmaniasis were reported in 2013 compared to a previous annual number in the range of 0-6 cases. The majority of cases reported in 2013 involved Syrian refugees and their relevant areas of concentration. CONCLUSIONS This new outbreak of leishmaniasis in Lebanon is the first of its kind for more than a decade. The sudden increase in Leishmania cases in Lebanon in 2013 is attributed to the increasing numbers and wide distribution of Syrian refugees in Lebanon. This serves as an example of the risks associated with military conflicts and the ability of communicable diseases to cross borders.

Topical zinc oxide vs. salicylic acid–lactic acid combination in the treatment of warts

Background  Warts are a common dermatologic problem. Treatment is painful, prolonged, and can cause scarring.

Revisiting Down syndrome from the ENT perspective: review of literature and recommendations.

Down syndrome is the most common chromosomal abnormality among live born infants reaching up to 1 in 700 births and is characterized by a variety of dysmorphic features and medical conditions. The potential to reach their full developmental capacities can be hindered by ear, nose, and throat problems. Hence, knowledge of the various anatomic peculiarities that predispose them to various medical conditions is fundamental. The medical states resulting from these variations and suggested treatment options are reviewed. Such conditions include refractory otitis, eustachian tube dysfunction, laryngomalacia, tracheal stenosis, obstructive sleep apnea, hearing loss, and voice and articulatory impairments. This review revisits besides the otolaryngeal pathologies, special medical considerations in Down’s syndrome patients that might affect surgical outcomes used in the management of the above pathologies.

Weight Control Measures among University Students in a Developing Country: A Cultural Association or a Risk Behavior

Objective: The purpose of the study was to determine the prevalence of university students, in Lebanon, trying to lose weight and assess the relation of trying to lose weight with demographic, scholastic and health behavioral factors. Methods: The study was cross-sectional conducted in the academic year 2000–2001. A proportionate random sample of 2,013 students was selected among five public and private universities in Beirut. Participants completed a self-administered anonymous questionnaire that included questions on trying to lose weight, demographic, scholastic, and health behavioral factors including smoking, alcohol, and seat belt use. Bivariate and stepwise logistic regression analyses were performed to examine the association between trying to lose weight and the above-mentioned characteristics. Results: The overall prevalence of students trying to lose weight was 30%, with 71% of them being under weight or normal weight. Use of medications and inducement of vomiting constituted 12% and 11%, respectively. Stepwise logistic regression analysis showed that the variables significantly associated with trying to lose weight were socio-economical factors rather than risky behaviors. Students who were at increased odds of performing such methods were females OR = (2.08, 95% CI = 1.6–2.5), employed (OR = 1.36, 95% CI = 1.01–1.8), and registered in a private university (OR = 1.69, 95% CI = 1.25–2.0). The major of students was also a significant predictor. Conclusion: In Lebanon, weight reduction could be re-enforced by socio-economical factors and not necessarily be an adolescent risk behavior.

Prevalence of Asthma, Allergic Rhinitis and Eczema among Lebanese Adolescents

Objective. Studies on allergic diseases remain scarce in Lebanon. The aim of the present study was to determine prevalence and characteristics of asthma, allergic rhinitis and eczema among Lebanese school children. Methods. The study was cross-sectional in design performed on a convenient sample of 3,115 students (13–14 yr) selected from 13 schools in 5 Lebanese provinces. Students were asked to complete the Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire. Logistic regression was performed to assess the characteristics of having asthma, allergic rhinitis and eczema in the past year. Results. The prevalence of ever having asthma, rhinitis and eczema was 8.3%, 45.2% and 12.8% respectively, while the prevalence of the symptoms of these diseases in the past year was 24.1%, 38.6% and 20.9%, respectively. Residing in the South and the North provinces of Lebanon and living in a busy area increased the likelihood of developing asthma and rhinitis. Higher rates of asthma and eczema, however, was noted among students going to private schools (Odds Ratio (OR) = 1.6, 95% confidence interval (CI): 1.3–2.1 and OR = 1.3, 95% CI: 1.0–1.7, respectively). Passive smoking was significantly associated with asthma only (OR = 1.3, 95% CI: 1.1–1.7). In addition to the above, the odds of having any of the three outcomes increases to at least 2.4-fold when accompanied by another allergic disease. Conclusions. Allergic diseases are highly prevalent in Lebanon and are catching up with the rates of developed countries. Moreover, the role of each of the three diseases in the existence of the other two had the greatest impact on their prevalence.

Prevalence of burnout syndrome among medical residents: experience of a developing country

Background It has been well established that burnout, defined as emotional exhaustion (EE), de-personalisation (DP), and a ‘decreased sense of personal accomplishment (PA) due to work related stress’, is prevalent to a great extent among medical residents. This has been implicated in the delivery of suboptimal patient care. Residents in developing countries work under difficult working and social conditions and therefore examining burnout is important when addressing quality of care and working conditions. Objectives The objectives of the study were to assess the point prevalence of burnout among residents in Lebanon and investigate some of the work and non-work related factors associated with burnout. Methods A cross sectional study of all medical residents was carried out in two major hospitals in the capital city. A total of 155 residents responded, representing all specialities. Maslach Burnout Inventory for Health Services Workers (MBI-HSS) was used. Burnout in three domains was dichotomised into high versus not high burnout. Results The prevalence of burnout was high in all the domains with the highest in the domain of emotional exhaustion (67.7%). 80% of the sample had a high level of burnout in at least one domain. Being female, experiencing a major stress, working for more than 80 h per week, and having more than eight calls per month increased the odds of burnout in at least one domain. Conclusions The high burnout level calls for action. This could be addressed by re-examining workload and other working conditions of residents as well as attending to their psychological wellbeing. The limitations of the study are also discussed.

Determinants of university students physical exercise: a study from Lebanon

SummaryBackground:Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise.Methods:In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: “No”” (<0.5 h) and “Yes” (>0.5 h) per week. Chisquare tests and binary regression were conducted to determine the predictors of performing physical exercise.Results:Of 2,013 students, only 26.4 % engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control.Conclusion:The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females.

Health care workers' exposure to blood-borne pathogens in Lebanon

BACKGROUND Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). AIM To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. METHODS This study reports a 17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. RESULTS A total of 1,590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). CONCLUSIONS The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.

Association between hepatitis A virus and Helicobacter pylori in a developing country: The saga continues

Background:   The epidemiologic association between Helicobacter pylori and hepatitis A virus (HAV) has been evaluated by various different groups with conflicting conclusions. The aim of the present study was to determine the prevalence of HAV and H. pylori infection among adolescents attending high schools in Lebanon, and to identify the sociodemographic factors associated with their prevalence, individually and concurrently.

Immunity to chickenpox among school adolescents in Lebanon and options for vaccination

Varicella infections cause substantial morbidity and mortality in adolescents and adults. The primary infection, chickenpox, results in lifelong immunity to chickenpox. A seroprevalence study carried on adolescents 15-18 years of age attending schools in Lebanon showed 96.6% immunity to varicella. The positive predictive value for immunity to chickenpox based on history alone was 97.4%, whereas the negative predictive value was 4.5%. Coming from a bigger family was a statistically significant predictor of immunity to chickenpox. In a developing country like Lebanon the merits and limitations of implementing universal varicella vaccination is discussed in relation to seroprevalence and socioeconomic factors.