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Pregnancy Complications in COVID-19: A Retrospective Review of Medical Records
Get PDFBackground: The coronavirus 2019 (COVID 19) is a novel virus that led to a global public health emergency. Several case reports highlighted the severity of infection in pregnant women given their immunocompromised state. Nevertheless, the exact effect of COVID 19 on pregnancy and childbirth is unknown due to lack of sufficient studies and guidelines.
Aims: To evaluate the adverse effects and maternal-fetal outcomes that COVID-19 has on pregnancy in a sample of women who delivered at a tertiary medical center in 2021, compare the maternal and fetal outcomes of these women to a comparison group of healthy women matched by age and parity, and identify the predictors of select maternal and fetal outcomes.
Methods: This study used a retrospective descriptive comparative design. Data were collected through chart review on the maternal fetal outcomes of pregnant women that contracted COVID-19 throughout the course of their pregnancy, and delivered in the year of 2021 in Emirates Hospital Jumeirah, a tertiary healthcare center in Dubai, UAE and the comparison group. Women who contracted COVID-19 infection prior to their pregnancy were excluded from the study.
Results: From January to December 2021, 43 pregnant women contracted COVID-19 infection that were matched with 43 healthy pregnant women for a total sample of 86 with a mean age of 31 and parity 0.72. The incidence of preterm deliveries was significantly higher in the COVID-19 group, with a rate of 20.9% vs. 4.7% in the comparison group (p = 0.049). A higher number of premature rupture of membranes was notably observed with an incidence of 18.6% in the COVID-19 group versus none in the comparison group (p = 0.005). No significant difference was found in maternal outcomes; however, women who delivered prematurely were 46 times more likely to experience fetal distress (20.9% vs. 2.3%, p=0.015). While controlling for confounders, multivariable logistic regression showed that fetal distress was the only significant predictor of premature birth, whereas history of prior maternal complications and premature birth predicted fetal distress, with a positive trend for exposure to COVID-19.
Conclusion: The findings suggest that women who contract COVID-19 infection are more likely to deliver prematurely and experience fetal distress than those who do not. However, a limitation of the study was the small sample size that was recruited from one medical center. A comprehensive maternal-fetal assessment and monitoring is required in women exposed to COVID-19 until more evidence becomes available from rigorous studies
Exploring Visitor Perception and Botanical Learning Experience in Two Potential Ancillary Botanic Gardens (ABGs) Sites in Lebanon
Get PDFIn today's world, where society is increasingly disconnected from nature, botanic gardens have emerged as important urban venues for reestablishing this connection. The significance of botanical gardens lies beyond botanical learning and conservation, as these institutions contribute to wellbeing. Therefore, considering their role in fostering connections with plants and nature and their contribution to the well-being of residents, botanical gardens are indispensable today, particularly when more than half of the world's population resides in cities and leads stressful lives detached from nature. However, the number of botanic gardens in the world is low, and their distribution is skewed as they are mostly present in countries with a history of botanical explorations and advanced economies. To address this limitation, the development of ancillary botanic gardens (ABGs), a complementary category of botanic gardens that are created in established green spaces owned and run by various public or private institutions, was proposed. Despite the comprehensive nature of these guidelines, significant gaps in understanding remain. This study aims to investigate how visitors will perceive ABG in terms of botanical learning and wellbeing and to what extent this perception is influenced by different ABG typologies through focus group discussions in two different sites. Focus group discussions were conducted with youth scouts and analyzed through thematic analysis. The findings revealed favorable ABG experiences along two themes, namely knowledge experience and ABG site experience. Additionally, it revealed similar feedback despite the different ABG typologies. Overall, this study shows that while institutional green spaces may vary in typology, retrofitting these spaces into ABGs could provide educational and wellness benefits
In Vitro Assessment of the Radiosensitivity of Friedreich’s Ataxia Fibroblasts
No full textIntroduction: Friedreich’s Ataxia (FRDA) is a neurodegenerative disorder that stands as the most common form of inherited ataxia. FRDA affects 15,000 individuals worldwide, with approximately 250 documented cases in Lebanon. FRDA is an autosomal recessive disorder caused by a GAA triplet expansion on the FXN gene, that encodes for the protein Frataxin. The onset of symptoms typically manifests in childhood or early adolescence, Rare studies have shown that individuals with FRDA have an increased radiosensitivity compared to the normal population. In fact, radiation or exposure to any genotoxic stress induces different types of DNA damage, with double-strand breaks (DSBs) being the most lethal. Recent advancements in radiobiology have highlighted the importance of assessing the kinetics of the DSBs damage and repair pathway proteins in assessing radiosensitivity.
Aim: To assess the in vitro radiosensitivity of FRDA fibroblasts.
Methods: Five human skin fibroblasts (three FRDA and two normal fibroblasts) were used in this study. Cells were exposed to a 2 Gy irradiation, and the DNA DSB signaling and repair pathways were analyzed by anti-pATM and anti-γH2AX immunofluorescence. The clonogenic assay was performed to characterize the cellular radiosensitivity.
Results: FRDA cell lines exhibited an impaired DSB repair mechanism when compared with the normal cell lines. Additionally, the post-irradiation pATM activity was significantly lower in FRDA cell lines than in normal fibroblasts.
Conclusion: Our results show that FRDA cells have a significant radiosensitivity caused by the impairment of their DNA DSB repair mechanism. These findings, if confirmed by other studies, will lead to the modification and development of FRDA treatment strategies that will take into account their increased radiosensitivity
Experimental Investigation on the Influence of Operation and Formation Parameters on Fracturing Fluid Flowback
No full textAdvancements in hydraulic fracturing stimulation, and lateral drilling lead to a commercial-scale exploitation of unconventional tight reservoirs. When the production of shale oil and gas took off, concerns addressing the safety of these operations rose to an alarming rate. Most of these concerns are related to the high pressures involved in hydraulic fracturing and the contamination caused by the fracturing fluid that might leak into nearby freshwater aquifers. A low fracturing fluid recovery can be an indication of environmental and health hazards. Despite the research conducted in the unconventional shale sector, there is no clear answer to why the percentage of fracturing fluid recovery is highly variable from one operation to the other, even for the same geological formations. Insights from the literature suggest that the flowback performance is affected by several parameters such as shut-in pressure, proppant pack conductivity, fracture network complexity, shut-in time, and having high permeability regions connected to the induced network. In this research, we designed and assembled an in-house experimental setup that mimics an actual hydraulic fracturing operation at a laboratory scale. The samples were designed using an innovative approach leveraging 3D printing, molding, and assembly techniques to investigate the impact of the aforementioned parameters on flowback percentages. Results indicate that increasing the shut-in pressure can have two opposing effects on the flowback percentage depending on the permeability of the matrix and that increasing the shut-in time will decrease the flowback percentage. Also, the flowback percentage drops for more complex fracture networks, and smaller proppant particle sizes. Moreover, having a hydraulic connection between the fracture network and a high permeability region will decrease the flowback percentage due to fluid losses. The work done in this research can be used as a reference to qualitatively predict the flowback performance of hydraulic fracturing operations
A Robust Pharmaceutical Supply Chain Solution – A Blockchain & Predictive Analytics Approach
No full textThe Lebanese pharmaceutical supply chain (PSC) suffers from two main challenges: drug shortages and the presence of illicit drugs in the market. To address these challenges, this research describes the creation of a blockchain application, integrated with a predictive model, to enhance the traceability of drugs in Lebanon and forecast pharmaceutical demand. This research represents the first study that integrates blockchain technology with predictive modeling for drug traceability in Lebanon. Solidity smart contracts have been employed on the Ethereum blockchain to create a traceable ledger of drugs in efforts to combat illicit drugs entering the market. Moreover, two predictive models – ARIMA and LSTM – have been implemented to forecast pharmaceutical demand and mitigate against drug shortages. While the ARIMA model performed poorly in demand prediction, the LSTM model showed great potential: it scored 21.63 RMSE on the test data and 103.3 RMSE on the train data. Further expansion of datasets and including external factors that affect demand should improve predictive accuracy in the future. This work seeks to provide a holistic approach toward improving the PSC in Lebanon to surmount drug shortages and illicit drugs, hence ensuring patient safety, improved inventory management and operational efficiency in the pharmaceutical industry
STRATEGIES TO OVERCOME IMPLEMENTATION BARRIERS OF URBAN NATURE-BASED SOLUTIONS FOR CLIMATE CHANGE ADAPTATION: A GLOBAL OVERVIEW FROM A CROSS COMPARATIVE STUDY
Get PDFUrban areas worldwide are increasingly facing intensifying climate change impacts like flooding, heatwaves, and droughts. In response, employing nature-based solutions (NBS) in cities has emerged as a promising adaptation strategy for counteracting these intensifying climate impacts. Specifically, NBS leverages sustainable, green infrastructure approaches inspired by natural processes to enhance climate resilience and adaptation of urban settlements. However, multiple systemic barriers have hindered the broader adoption and implementation of NBS interventions. This thesis sheds light on strategies for dismantling such barriers through an in-depth case study analysis.
The study analytically examines 103 successfully implemented NBS initiatives across diverse global cities to elucidate real-world strategies for overcoming implementation barriers. The cases unveiled interconnected barriers spanning four key dimensions – policy, knowledge, collaboration, and financial. Outdated regulations and institutional resistance frequently obstruct NBS uptake, coupled with gaps in technical capacity and multi-stakeholder coordination.
To overcome the uncovered systemic barriers, the case studies revealed that it is important to employ implementation strategies including participatory policymaking; strengthening collaborative abilities by facilitating diverse partnerships; fostering robust knowledge networks for technical assistance; generating evidence of effectiveness via pilot demonstrations; and enhanced financing access through creative models. Specific enablers like communication campaigns, knowledge sharing platforms, regulatory reforms and technical training also prove impactful for mainstreaming NBS.
As urban settlements worldwide face mounting threats from climate change, adopting holistic implementation perspectives becomes imperative. This research also provides guidance for decision-makers on implementing NBS to systematically dismantle existing sustainability adoption barriers. The developed framework lays implementable roadmaps for mainstreaming nature-based approaches to enhance urban adaptation globally. Enabling broad NBS integration through combinations of social, institutional, knowledge and economic interventions constitutes a pathway for building climate-resilient, sustainable cities globally. With intensifying climate impacts, these findings can facilitate urgent green transformations worldwide
The Effect of Thapsigargin-Induced ER Stress on the Expression of Different Proteins(Structural and Functional) and Transporters (OCTN2 and OAT2) in HCT-116 and Caco-2 Cells
No full textIntroduction: Colorectal cancer (CRC) remains one of the most lethal cancers worldwide, necessitating a comprehensive understanding of its underlying molecular mechanisms to develop more effective therapeutic strategies. Interestingly, among the various risk factors, inflammatory bowel disease (IBD) has been strongly associated with an increased risk of CRC. The chronic inflammation observed in IBD contributes to CRC through several mechanisms, including disrupting junctional proteins that maintain the intestinal epithelial barrier. This disruption compromises the barrier's integrity, facilitating inflammation and promoting tumorigenesis. Junctional proteins, crucial for maintaining epithelial homeostasis, are thus a focal point in understanding how IBD contributes to CRC development. In IBD, chronic inflammation can be exacerbated by endoplasmic reticulum (ER) stress, which can be induced by many factors, among which is calcium depletion. The ER, the calcium store, is the milieu where protein synthesis occurs, and many chaperons responsible for properly folding the proteins are calcium-dependent. It is thus not surprising that ER stress induced by calcium depletion would affect the synthesis of many essential structural and functional proteins that are important for the proper function of the cells. Additionally, the SLC22A family transporters, particularly the organic cation transporters 2 (OCTN2) and organic anion transporters 2 (OAT2), are known for their involvement in cellular transport mechanisms and the pathophysiology of several diseases, including CRC. These transporters play a significant role in the uptake of chemotherapeutic agents, and their differential expression in CRC cell lines versus normal colon cells suggests they may be critical players in cancer progression and treatment resistance. Yet, nothing is known about their expression levels under inflammatory conditions or ER stress and whether their expression profile is compromised in ER stress conditions as observed in IBD, similar to CRC. Aim: Thapsigargin (TG), a potent inhibitor of the Sarco/endoplasmic reticulum Ca²⁺-ATPase (SERCA), induces ER stress by disrupting calcium homeostasis. Therefore, under TG-induced ER stress, this study aims to evaluate the expression profile of different junctional proteins responsible for cell integrity alongside the expression of calcium transporters responsible for calcium homeostasis and transporters (OCTN2 and OAT2) involved in many physiological and pathophysiological episodes. The ultimate aim is to uncover potential links between ER stress, calcium regulation, and protein expression regulation in CRC cell lines under ER stress, as observed in IBD/CRC. Methods: HCT-116 and Caco-2 cells were used for all experiments. MTT and Trypan blue assays were used to determine the effect of different concentrations of TG, known to induce calcium depletion, on cell proliferation. Furthermore, western blot analysis was performed to evaluate the expression levels of OCTN2, OAT2, calcium signaling proteins, and junctional proteins in HCT-116 and Caco-2 cells in response to 1 μM TG for 4, 8, and 24h. At each time point, proteins were extracted, quantified using the BCA assay, separated by SDS-PAGE, and detected using specific antibodies. Following western blot analysis, densitometry quantification of the protein bands was conducted using ImageJ to assess relative protein expression levels. The intensity of the bands was normalized against GAPDH to ensure accurate quantification. These normalized values were used to determine the fold change in expression of OCTN2, OAT2, calcium signaling proteins, and junctional proteins under ER stress conditions induced by TG treatment. Results: MTT and trypan blue assays demonstrated that HCT-116 cells are more sensitive to TG-induced-ER stress than Caco-2 cells, as indicated by a more pronounced reduction in cell viability and metabolic activity in response to TG. 1 μM TG, known to induce calcium depletion, was then selected to perform the additional experiments. TG-induced ER stress was confirmed by the significant increase in the ER stress markers BIP and CHOP in both cell lines. Caco-2 cells exhibited a rapid disruption of junctional proteins (ZO-1, CX-43, and ECAD), while HCT-116 cells showed a delayed disruption, highlighting differences in cellular responses between the two CRC cell lines. This is because CX-43 in HCT-116 showed a considerable decrease at 24h-post treatment with TG, while it showed a significant reduction at all time points in Caco-2 cells. However, ECAD showed no change at early time points in HCT-116 with a substantial increase at later time points, while in Caco-2, it showed a significant decrease at early time points with a remarkable increase at 24h. Moreover, the different studied calcium transporters and channels (TRPV6, PMCA1, PMCA4, PMCAT, NCX-1, SERCA2, SERCA3, Orai-1, STIM1, STIM2, ITPR2, ITPR3, RYR1, and RYR3) were significantly disrupted in both cell lines due to calcium depletion induced by TG, reflecting the critical role of calcium homeostasis in ER function. Starting with TRPV6, its expression in HCT-116 at 4h after treatment with TG showed no change; however, it was reduced in Caco-2 cells. On the other hand, PMCA1, PMCA4, and NCX-1 showed a significant decrease in HCT-116 at all time points post-treatment with TG, while no detectable expression was observed in Caco-2 cells at any time point. Nevertheless, ORAI-1 showed no observable expression in HCT-116 at 4h, with a significant reduction at later time points following treatment with TG, while in Caco-2, ORAI-1 expression showed a slight decrease at 4h with no change in its expression at later time points. Besides, SERCA 2 expression in HCT-116 showed a notable increase at 4 and 8h with a critical decrease at 24h; however, in Caco-2 it showed an increase at 8h, followed by a decrease at 24h. Notably, ER stress did not significantly affect the expression of OCTN2 and OAT2 transporters.
Conclusion: The obtained findings underscore the complexity of the cellular stress response in CRC, providing insights into the roles of calcium signaling, junctional integrity, and transporters in ER stress. Calcium transporters were significantly modulated in both cell lines, although to a different extent, due to calcium depletion induced by TG, reflecting the critical role of calcium homeostasis in ER function. Moreover, junctional proteins were affected by ER stress, which affects cell-cell contact. These differential expressions observed between HCT-116 and Caco-2 cells may be attributed to genetic factors, particularly the tumor suppressor gene p53 status. HCT-116 cells express wild-type p53, which may contribute to their heightened sensitivity to ER stress, whereas Caco-2 cells carry a mutated version of the gene p53, potentially influencing their adaptive responses to TG-induced stress. Notably, the unchanged expression of OCTN2 and OAT2 in the two cell lines could be due to their roles in ionic transport, suggesting that their translation might be deprioritized under ER stress conditions, possibly as a strategy to avoid exacerbating ER stress due to further disruption in ions. Another possibility is that the unfolded protein response prioritizes synthesizing ER chaperones and components of the ER-associated degradation pathway over these transporters to maintain cellular homeostasis. Likewise, it is possible that factors other than excessive ER stress and calcium disturbance could contribute to their observed differential expression in different CRC cells. Finally, ER stress, as observed in IBD, could further disrupt junctions; hence, it might contribute to IBD-CRC progression. Nevertheless, future studies are warranted to explore the therapeutic implications of targeting these pathways in IBD-CRC progression
Drug and Heat Resistance of Escherichia Coli and Staphylococcus Aureus Isolated from Dairy Products from Lebanon
No full textWith the ongoing economical-political crisis that Lebanon has been going through and the reflecting effect on the food security and safety sectors on one hand, and with the expansion of heat and drug-resistant bacteria worldwide on the other hand, this study aimed to examine the behavior of microorganisms isolated from Lebanese dairy products towards heat treatments and antibiotics. A sampling of various dairy products of which Halloum, Akkawi, Kashta, Karishe, and raw milk and more were gathered from different Lebanese areas to be screened for microbial contamination. Microorganisms such as Escherichia coli, Staphylococcus aureus, Salmonella were isolated from the samples, of which 38.33% were found contaminated. The isolates were tested for their heat tolerance. Salmonella isolate was sensitive to heat, however, E. coli and S. aureus isolates showed resistance with a prevalence of 68.4% and 50% respectively at 65C/30 min and 47.4% and 25% respectively at 75C/15s. Meanwhile eight E.coli and one S. aureus isolates tolerated both heating methods of 75C for 15 seconds and 65C for 30 minutes. A variety of antimicrobial agents of Amikacin (AKN30), Cefepime (FEP30), Cefuroxime, (CXM 30), Chloramphenicol (CHL30), Fosfomycin (FOS200), Gentamicin (GMN10), Levofloxacin (LVX5), Meropenem (MEM10), Nutrofurantoin (FTN300), Piperacillin + Tazobactam (TZP110), Streptomycin (SMN10), Tetracycline (TET30), Trimethoprim + sulfamethoxazole (SXT25), Amoxicillin + Clavulanic Acid (AMC30), Ciprofloxacin (CIP5), Clindamycin (CMN2), Erythromycin (ERY15) and Penicillin (PEN6) were used to test the resistance of the isolates. 52.6% of the E.coli isolates exhibited resistance to one or more antimicrobials and 21% were multidrug resistant while only one S. aureus was resistant to PEN6 and none was multidrug resistant
DEVELOPING A FRAMEWORK TO PRIORITIZE AND ASSESS THE TRAFFIC IMPACTS OF LOW TRAFFIC NEIGHBORHOODS: A CASE STUDY IN BEIRUT
No full textFor the better part of the past century, streets have been designed with the private vehicle in mind. It is not until relatively recently that a surge in design ideas putting humans and their social and physical health as priority was observed in many cities around the world. One scheme that aims at reducing the harms of private vehicle dependence, especially on urban residential neighborhoods, is the Low Traffic Neighborhood (LTN). It is a simple idea based on preventing through-traffic from passing in predominantly residential neighborhoods and prioritizing pedestrian and soft mobility movement within their boundaries by using simple tools like modal filters, bollards, and street direction reassignment. Vehicular traffic can always reach any destination within the neighborhood, but it cannot cut through it to reach a parallel main road.
This thesis develops a framework that defines the boundaries, prioritizes implementation, and assesses the traffic impact of LTN schemes. The boundaries are placed based on a set of criteria and assessed by locals and experts to fine tune them. Then the LTNs are ranked in terms of priority of implementation relating to each LTN’s likelihood to succeed and expected impact level. After that, implementation is usually done gradually with local feedback improving every iteration. The implementabilty is assessed qualitatively by interviewing stakeholders, experts, and locals. The traffic impact is assessed using an EMME traffic model. The model is set up by defining the suggested LTNs as new traffic analysis zones and then using Institution of Transportation Engineers (ITE) trip generation rates and traffic counts to calibrate and update the model. The model is run with current conditions and later with the implemented interventions. Before and after percentages of through-traffic on identified through-streets and total traffic on boundary streets of the LTNs are compared.
This thesis also investigates a case study of implementing the framework of proposed LTNs within the context of a developing country, and specifically within the challenges presented in Beirut, Lebanon. The chosen area that lies at the east of municipal Beirut is characterized by an existing urban landscape that is too dependent on private vehicles. The results show that implementing LTNs decreases the through-traffic by 33% on average on internal streets but increases traffic by 9% on average on boundary roads as expected. However, after implementing a 15% reduction in trip demand from and to the implemented LTNs to simulate mid to long-term effects, the traffic on boundary roads decreased again: in some cases, less than the base conditions. The traffic reduction effect on higher ranked implemented LTNs was found to be higher than on the lower ranked ones which corroborates the results of the prioritization framework presented by this research. More intrusive interventions were considered favoring complete through-traffic prevention over maintaining easy access to commuters reaching destinations within the LTN with the effect on travel time being minimal when compared to the less intrusive intervention. The framework presented by this research may be used as a tool by cities that are considering implementing LTNs
Trends and Correlates of Occupational Injuries among Healthcare Workers at a Tertiary Care Center in Lebanon
No full textHealthcare workers (HCWs) are at an increased risk of occupational injuries due to exposure to a multitude of hazards at work. During the COVID-19 pandemic, hospital employees worldwide worked in increasingly demand environments and often times under stressful conditions. In Lebanon, over the past five years, several events have occurred, including an unprecedented socio-economic crisis, a hospital workforce shrinkage, and the COVID-19 pandemic, that severely affected the level of hospital activity at a tertiary hospital. The study aims to determine the trends and correlates of HCWs occupational injuries and identify whether the fluctuations in levels of hospital activity affected injury rates.
This is a retrospective longitudinal study that examines monthly injuries sustained by all HCWs at a tertiary hospital, the American University of Beirut medical center (AUBMC), over a period of 5 years from January 2018 to December 2022. The study examined incident report forms completed by HCWs and submitted to the Environmental Health, Safety, and Risk Management department (EHSRM) at AUB. The data was complemented by monthly objective workload measures and absenteeism data. Occupied beds, clinic visits and ED visits were excluded from the analysis for reasons related to the goodness-of-fit of the regression model. Admissions and procedures were included in the analysis.
The total number of injuries reported was 2,291. The mean monthly injury rate was 1.68 per 100 EFTE, with an increased yearly trend. The findings showed that with each 1,000 additional procedures performed each month, the mean injury rate increases by 0.1081 or 6.34% (p-value = 0.002). Admissions were not statistically significant, despite a positive correlation with injury rate. The study provides an in depth understanding of the social factors and the changes in the workload in relation with injury trends. It offers valuable insights into suitable staffing and workload levels during times of crises, and can inform policies