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Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon
Get PDFCardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases. © 2023 Al Daccache et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Deep Capillary Plexus as Biomarker of Peripheral Capillary Nonperfusion in Central Retinal Vein Occlusion
Get PDFPurpose: To identify the vascular biomarkers of peripheral capillary nonperfusion in patients affected by naive central retinal vein occlusion (CRVO), and to analyze their changes over the follow-up. Study Design: Consecutive prospective case series with a planned follow-up of 2 years. Participants: Thirty-five patients affected by CRVO and 35 healthy gender- and age-matched subjects were enrolled in the study. Methods: Ophthalmic examination included best corrected visual acuity (BCVA), ultrawidefield fluorescein angiography (UWFFA), OCT, and OCT angiography (OCTA). Main Outcome Measures: Vessel density (VD) at the superficial capillary plexus and deep capillary plexus (DCP) were calculated on OCTA images. The ischemic index (ISI) was calculated on UWFFA. Results: The mean baseline ISI was 37%, increasing to 40% at the end of the follow-up, whereas it was 4.9% in the patients’ fellow eyes and 4.5% in the control group with no change over the follow-up. OCT angiography revealed VD reduction in the DCP, considering both 3 × 3 mm and 12 × 12 mm scans. The correlation analyses revealed that DCP VD was the only parameter showing a statistically significant correlation with the foveal avascular zone (FAZ) area, BCVA, and ISI. Conclusions: Deep capillary plexus VD impairment is detectable in all CRVO cases, variably involving both the central retina (with enlarged FAZ) and the periphery (with VD reduction in the peripheral retina). The severity of DCP VD reduction has correlates with various clinical markers. Deep capillary plexus VD may represent a crucial biomarker to characterize CRVO, and further studies are necessary to identify the cutoff thresholds for the different clinical manifestations. © 2023 American Academy of Ophthalmolog
Pyrolysis of Waste Pharmaceuticals as a Novel Treatment for a Circular Economy: Analysis of Kinetics, Thermodynamics, and Products Characteristics.
No full textIn this expanding pharmaceutical market, the issue of drug pollution constitutes a significant concern that needs to be widely addressed because of its global relevance. Sustainable waste management requires that industries transition from the existing linear model to a circular economy; that incorporates wastes as raw materials for producing new products. In this study, pyrolysis was suggested as an economically and environmentally sustainable treatment for pharmaceutical waste within the context of circular economy. Fast pyrolysis was conducted at 500℃ on each of immediate release tablets of 500 mg paracetamol and 600 mg ibuprofen drug products, with the liquid and gas products analyzed using GC-MS (gas chromatography-mass spectroscopy) and micro GC-TCD (gas chromatography-thermal conductivity detector), respectively. The pyrolytic behavior of each pharmaceutical product was studied through kinetic and thermodynamic analysis. The data obtained by thermogravimetric analysis (TGA) were used to estimate the activation energy () through model-free isoconversional models of Kissenger-Akahira-Sunose (KAS) and Flynn-Wall-Ozawa (FWO). The pre-exponential factor () was evaluated using Kissinger model and followed by thermodynamic parameters determination.
The average values for the pyrolysis of the paracetamol drug product using KAS and FWO methods were found to be 125.9 and 128.8 .−1, respectively. For ibuprofen drug product pyrolysis, the average values were 77.9 and 82.0 .−1 for the first decomposition stage, and were found to be 136.0 and 138.9 .−1 for the second decomposition stage, using KAS and FWO models, respectively. The small difference between and Δ values (~5 .−1) indicated the small energy barrier to overcome. The results showed that the pyrolysis liquids consisted of the active pharmaceutical ingredient, along with other compounds of commercial importance, while pyrolysis gas from both drugs consisted of carbon monoxide, methane, and ethylene. Methane was the most abundant in the pyrolysis gas of paracetamol drug product (39.16 mol%), while ethylene was the most prominent in that of ibuprofen drug product (49.99 mol%). Both pyrolysis liquid and gas products were high-value products that may be repurposed, as the active pharmaceutical ingredient (API) may be recycled to produce new tablets, and the other compounds may be utilized as fuels or chemical feedstocks
The 5-item frailty index predicts 30-day morbidity and mortality in radical nephrectomy patients: A propensity matched analysis
Get PDFPurpose: To assess the ability of the 5-item frailty index (5-IFi) score to predict 30-day morbidity and mortality post-radical nephrectomy (RN). Methods: ACS-NSQIP database was used to select patients who underwent RN from 2011 to 2020. 5-IFi score was calculated by assigning a point for each of the following comorbidities: chronic obstructive pulmonary disease or pneumonia, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were divided into 3 frailty groups 0, 1, and ≥2. Patient demographics, medical comorbidities, prolonged length of stay, and prolonged operative time were compared between different groups; mortality and morbidity using the Clavien-Dindo classification (CVD). Multivariable logistic regression models and propensity score matching were performed as a sensitivity analysis to control for possible confounders. Results: Cohort consisted of 36,682 patients whereby 5-IFi class 0, 1, and ≥2 included 11,564 (31.5%), 16,571 (45.2%), and 8,547 (25.3%) patients respectively. A multivariable analysis and propensity score matching revealed that patients with 5-IFi classes 1 and ≥ 2 were more likely to have a prolonged length of stay (OR = 1.11, 1.3, respectively) and to mortality (OR = 1.85 for frailty class ≥2); in addition to CVD class 1 & 2 (OR = 1.51, OR = 1.13, respectively), and CVD ≥ 4 (OR = 1.41, 1.86, respectively) as compared to 5-IFi class 0 (P < 0.001). Conclusion: The 5-IFi score was found to be an independent predictor of prolonged length of stay, morbidity, and mortality after RN. This tool can play a major role in preoperative risk assessment and patient counseling based on individualized risks. © 2023 Elsevier Inc
Dermatological manifestations associated with COVID-19 and COVID-19 vaccination: results from the Lebanese COVID registry
Get PDFBackground: A number of cutaneous manifestations and adverse cutaneous reactions have been associated with COVID-19 infection and vaccine. Objectives: A Lebanese national registry was established to characterize the dermatologic manifestations and adverse cutaneous reactions associated with COVID-19 infection and vaccination in a sample of the Lebanese population. Methods: An observational cross-sectional study was conducted via a web-based clinical form distributed to physicians wishing to report their cases from May 2021 till May 2022. Results: In total, 142 patients were entered in the registry, of which 133 were adults and nine were pediatric patients. The main dermatological manifestations reported with COVID-19 infection in the adult group were urticaria (32.9%), telogen effluvium (21.4%), morbilliform (10%), and papulosquamous (8.6%) eruptions. Urticaria was the most common adverse cutaneous reaction to the vaccine (33%). Interestingly, herpes zoster was triggered in 12 patients post vaccination in our series with this finding more frequently seen in patients above the age of 41 (P = 0.013). In the pediatric group, the most reported dermatological findings associated with COVID-19 infection were malar erythema (25%) and telogen effluvium (25%). One 16-year-old patient developed lichen planus after one dose of a COVID-19 vaccine. No deaths were reported in both age groups. Conclusion: This Lebanese registry adds more robust evidence that clinical manifestations of the COVID-19 virus and vaccine are diverse. More studies are necessary to establish the pathophysiology of these dermatological findings in the context of COVID-19 infection and vaccination. © 2023 the International Society of Dermatology
BEYOND THE SHELF: DVD CULTURE IN LEBANON IN THE DIGITAL AGE
Get PDFWith digital technologies creating new updated and trendier ways for people to consume media, DVDs remain essential to this provision. Throughout the first chapter, we get an understanding of the distribution process of DVDs in Lebanon and its role in providing content throughout the years. In the second chapter, we understand how important the role of DVDs was during the pandemic in enabling people to reach media content when formal entities and other internet technologies were not easily accessible. The third chapter explains the ongoing effect of the financial crisis and the ways DVDs continue to survive even with the reopening of formal entities. This chapter permits us to see that DVD artefacts were capable of adapting to new trends to ensure a longer existence. All three chapters help readers understand why DVDs should not be underestimated nor understudied when one wishes to understand how people in Lebanon reach global media. This thesis is especially important because it opposes popular beliefs that DVD artefacts are considered as “old media” and that they will eventually be ultimately forgotte
Toward Optimal DoF Maximization With Interference Categorization Using TIM and SIC
Get PDFIn this paper, a novel topological interference management (TIM) framework, combined with the successive interference cancellation (SIC) technique, is proposed for Device-to-Device (D2D) networks. While the TIM problem was originally studied in a partially connected network, the main contribution appears here in proposing a novel design that allows some interfering links to be very high so that SIC can be used to handle them efficiently. More specifically, this inter-twinning between the two techniques (TIM and SIC) is based on the design of the precoding and decoding vectors used by the transmitters and receivers, respectively. This scenario of having very strong interference may occur in crowded D2D networks, such as malls, concerts or stadiums, where D2D communications take place in very close proximity. The problem is formulated as a rank minimization framework and solved by building on the characteristic polynomial function (CPF) of the adjacency matrix of the network interference graph. Numerical results show the effectiveness of our approach by achieving promising gains in terms of degrees-of-freedom (DoF), as compared to existing solutions, with a polynomial complexity. © 2013 IEEE
Curvature tensor in discrete gravity
Get PDFWe study numerically the curvature tensor in a three-dimensional discrete space. Starting from the continuous metric of a three-sphere, we transformed it into a discrete space using three integers n1, n2 , and n3 . The numerical results are compared with the expected values in the continuous limit. We show that as the number of cells in the lattice increases, the continuous limit is recovered. © 2023, The Author(s)
Recommendations for Early and Comprehensive Management of Type 2 Diabetes and Its Related Cardio-Renal Complications
Get PDFType 2 diabetes (T2D) is a global health problem accompanied by an elevated risk of complications, the most common being cardiac and renal diseases. In Lebanon, the prevalence of T2D is estimated at 8–13%. Local medical practice generally suffers from clinical inertia, with gaps in the yearly assessment of clinical manifestations and suboptimal screening for major complications. The joint statement presented here, endorsed by five Lebanese scientific medical societies, aims at providing physicians in Lebanon with a tool for early, effective, and comprehensive care of patients with T2D. Findings from major randomized clinical trials of antidiabetic medications with cardio-renal benefits are presented, together with recommendations from international medical societies. Optimal care should be multidisciplinary and should include a multifactorial risk assessment, lifestyle modifications, and a regular evaluation of risks, including the risks for cardiovascular (CV) and renal complications. With international guidelines supporting a shift in T2D management from glucose-lowering agents to disease-modifying drugs, the present statement recommends treatment initiation with metformin, followed by the addition of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists due to their CV and renal protection properties, whenever possible. In addition to the selection of the most appropriate pharmacological therapy, efforts should be made to provide continuous education to patients about their disease, with the aim to achieve a patient-centered approach and to foster self-management and adherence to the medical plan. Increasing the level of patient engagement is expected to be associated with favorable health outcomes. Finally, this statement recommends setting an achievable individualized management plan and conducting regular follow-ups to monitor the patients’ glycemic status and assess their risks every 3–6 months. © 2022, The Author(s)
EVALUATION OF DIFFERENT OSTEOTOMUES IN SURGICALLY ASSISTED RAPID PALATAL EXPANSION: A FINITE ELEMENT ANALYSIS STUDY
Get PDFBackground: The management of transverse maxillary deficiency may require adjunct surgical osteotomies such as the surgically assisted rapid palatal expansion (SARPE) in patients with skeletally mature craniofacial morphology. Aims: evaluate a mid-palatal sagittal osteotomy as a minimally invasive surgery in reducing stress and allowing adequate expansion. Methods: Finite element (FE) modeling was applied to five expansion setups: 1. Control model with no surgical cuts; 2. Bone-anchored expander with mid-palatal osteotomy; 3. Setup 2 + osteotomy at the level of the anterior nasal spine ; 4. Setup 3 + lateral supra-apical cuts (5mm above apices of maxillary canine to second molar); 5. SARPE cuts: setup 3 + Lefort 1 osteotomy with pterygomaxillary disjunction. Von mises stresses and displacement were measured through FE analysis. Results: Stress at the mid-palatal area was highest in the control (32006.54 ± 2984.55 MPa) then in setup 2 (16331.88 ± 2207.93 MPa), in which the lowest stress was recorded. Stresses palatal to the molars and buccal to the incisors were statistically significantly different between the control and experimental setups, the highest in setup 5 (3091.89 ± 991.22 MPa buccal to incisors; 3091.89 ± 991.22 MPa palatal to molars). Expansion increased significantly incrementally from setups 1 to 5, except between setups 3 and 4 (p>0.005). The amount of expansion obtained was mostly affected by cortical bone thickness in setup 5. Conclusion: The minimally invasive mid-palatal cut was the most efficient at reducing stress near the mid-palatal suture. Clinical research parallel to a time-dependent FE analysis is needed