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Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys
No full textBackground: Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap. Methods: In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m2 or a BMI >25 kg/m2 among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models. Findings: Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5–19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8–79·2) were tested. 23·8% (23·4–24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7–46·2) were tested. Finally, 27·4% (26·3–28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1–2·4) were tested. Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education. Interpretation: Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested. Funding: Harvard McLennan Family Fund, the Alexander von Humboldt Foundation, and the National Heart, Lung, and Blood Institute of the US National Institutes of Health. © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens
Frizzy
Get PDFThe book tackles the importance of self love and acceptance through the journey of Reem, a little girl, accepting her curly hair. The illustrations are done by the Grade 5 students of the Amine Bayhom School Al Namouzajiyah
Suboptimal Chest Radiography and Artificial Intelligence: The Problem and the Solution
Get PDFChest radiographs (CXR) are the most performed imaging tests and rank high among the radiographic exams with suboptimal quality and high rejection rates. Suboptimal CXRs can cause delays in patient care and pitfalls in radiographic interpretation, given their ubiquitous use in the diagnosis and management of acute and chronic ailments. Suboptimal CXRs can also compound and lead to high inter-radiologist variations in CXR interpretation. While advances in radiography with transitions to computerized and digital radiography have reduced the prevalence of suboptimal exams, the problem persists. Advances in machine learning and artificial intelligence (AI), particularly in the radiographic acquisition, triage, and interpretation of CXRs, could offer a plausible solution for suboptimal CXRs. We review the literature on suboptimal CXRs and the potential use of AI to help reduce the prevalence of suboptimal CXRs. © 2023 by the authors
Carbonyl Emissions and Heating Temperatures across 75 Nominally Identical Electronic Nicotine Delivery System Products: Do Manufacturing Variations Drive Pulmonary Toxicant Exposure?
No full textStudies of factors that impact electronic nicotine delivery systems (ENDSs) carbonyl compound (CC) emissions have been hampered by wide within-condition variability. In this study, we examined whether this variability may be related to heating coil temperature variations stemming from manufacturing differences. We determined the mean peak temperature rise (ΔTmax) and CC emissions from 75 Subox ENDSs powered at 30 W. We found that ΔTmax and CC emissions varied widely, with greater ΔTmax resulting in exponentially higher CC emissions. Also, 12% of atomizers accounted for 85% of total formaldehyde emissions. These findings suggest that major reductions in toxicant exposure might be achieved through regulations focusing on limiting coil temperature. © 2023 The Authors. Published by American Chemical Society
Clinical predictors of mortality in patients with pseudomonas aeruginosa infection
Get PDFBackground Infections caused by Pseudomonas aeruginosa are difficult to treat with a significant cost and burden. In Lebanon, P. aeruginosa is one of the most common organisms in ventilator-associated pneumonia (VAP). P. aeruginosa has developed widespread resistance to multiple antimicrobial agents such as fluoroquinolones and carbapenems. We aimed at identifying risk factors associated for P. aeruginosa infections as well as identifying independent risk factors for developing septic shock and in-hospital mortality. Methods We used a cross-sectional study design where we included patients with documented P. aeruginosa cultures who developed an infection after obtaining written consent. Two multivariable regression models were used to determine independent predictors of septic shock and mortality. Results During the observed period of 30 months 196 patients were recruited. The most common predisposing factor was antibiotic use for more than 48 hours within 30 days (55%). The prevalence of multi-drug resistant (MDR) P. aeruginosa was 10%. The strongest predictors of mortality were steroid use (aOR = 3.4), respiratory failure (aOR = 7.3), identified respiratory cultures (aOR = 6.0), malignancy (aOR = 9.8), septic shock (aOR = 18.6), and hemodialysis (aOR = 30.9). Conclusion Understanding resistance patterns and risk factors associated with mortality is crucial to personalize treatment based on risk level and to decrease the emerging threat of antimicrobial resistance. © 2023 Frem 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
Quality of life and substance use in Lebanese medical students
Get PDFBackground: Substance use is prevalent among medical students and could affect their academic performance. This study aimed to determine whether a relationship exists between quality of life and substance use among medical students in Lebanon. Methods: This cross-sectional study was conducted on 465 medical students in Lebanon during the academic year 2022–2023. It was based on an online questionnaire about quality of life, and dependence on alcohol, nicotine, waterpipe, and cannabis. Results: Alcohol was the most used substance by medical students (83.2%) followed by cigarettes (27.5%), waterpipe (18.1%), and cannabis (16.1%). We reported alcohol dependence in 14%, cannabis use disorder in 4.1%, high nicotine dependence in 23.4%, and waterpipe dependence in 11% of students. Physical and mental health scores were below average. Poor physical health was associated with higher dependence on nicotine and waterpipe. Conclusion: Medical students in Lebanon have poor mental and physical health and engage in substance use. Awareness campaigns promoting better mental and physical quality of life are needed. © 2023 Taylor & Francis Group, LLC
Microaggressions as a Framework for Understanding Women’s STEM Career Experiences in Lebanon
Get PDFIn this paper, we draw on qualitative data from 21 women working in diverse Science, Technology, Engineering and Math (STEM) fields in Lebanon to explore how they experienced gendered microaggressions at work and how they navigated them. We use the subcategories of gendered microaggressions developed by Nadal (2010) to highlight the various micro aggressive behaviors the women faced including aspects of micro-assaults, microinsults, and microinvalidations. We then provide four navigation tactics the women adopted to address these microaggressions. This research on women in STEM careers in Lebanon extends and contributes to the gender and organization literature in multiple ways, and highlights implications for human resource management professionals and career counselors. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature
Role of preoperative bilirubin/albumin Ratio in prediction of sepsis and mortality in emergent colorectal surgery
No full textBACKGROUND: Sepsis comprises a spectrum of illnesses that confer great morbidity and mortality in surgical patients. Tremendous efforts are channeled towards timely diagnosis and control of sepsis. Few studies have reported on the independent association of bilirubin or albumin in the postoperative setting for prediction of complications. The purpose of this study was to assess the role of Bilirubin/Albumin Ratio (B-ARatio) in the preoperative prediction of postoperative sepsis and mortality in non-septic patients undergoing emergent colorectal surgery. METHODS: This is a retrospective study that used the NSQIP database for the years 2005-2017 to analyze data on patients who underwent emergent colorectal operations. Multivariate regression analysis was done to calculate the predictive utility of the B-ARatio for postoperative outcomes, namely sepsis and mortality. Cox regression was utilized to assess hazard ratio of mortality based on a cutoff value of 0.23 for the B-ARatio. RESULTS: We analyzed 23,822 patients with no identifiable preoperative sepsis who underwent emergent colorectal operations. We compared the basic demographic characteristics with respect to a cutoff value of 0.23 for B-ARatio. Using logistic regression, the adjusted Odds Ratio for sepsis and mortality based on the cutoff value of 0.23 for the B-ARatio was 1.26 (1.15-1.38) and 1.47 (1.32-1.66) respectively. In addition, respiratory and thromboembolic complications showed ORof 1.25 (1.14-1.37) and 1.20 (1.02-1.4), respectively. The Hazard Ratio for patients with Bilirubin/Albumin Ratio less than 0.23 was lower than those with a Bilirubin/Albumin Ratio greater than 0.23 (HR=1.31 P<0.0001). CONCLUSIONS: Patients with a B-ARatio more than 0.23 have an increase in the odds of sepsis, mortality and postoperative complications. The cumulative survival was higher for patients with a preoperative B-ARatio below the cutoff point. © 2023 Edizioni Minerva Medica. All rights reserved
STRESS DISTRIBUTION ON THE TEMPORO-MANDIBULAR JOINT (TMJ) IN UNILATERAL SAGITTAL SPLIT OSTEOTOMY (USSO): A FINITE ELEMENT ANALYSIS STUDY
Get PDFIntroduction:
Bilateral sagittal split osteotomy (BSSO) is a standard technique in mandibular orthognathic surgery to correct facial asymmetries. Unilateral SSO was introduced as a less aggressive alternative limited to only one side of the mandible and with a narrow range of movement. Stress distribution on the condyles in USSO has not been addressed to determine symmetry of balance in this asymmetric procedure. Hypothesis/aims:
The aims of this study are to evaluate: 1. the stress distribution on and displacement of the contralateral and ipsilateral neck of the condyles and menisci in simulated models of patients treated with USSO following graded movements of the mandible in advancement and setback; 2. the effect of condylar volume variation on stress distribution. The main hypothesis was that minimal stress would be registered on the operated condyle, and that a threshold should exist at which either advancement of setback mandibular movements should not be detrimental to condylar position and function.
Methods:
This retrospective study was conducted on 8 pretreatment CT scans of patients who presented for the surgical correction of mandibular asymmetry and who qualified for the USSO based on established inclusion criteria. USSO 3D movements (unilateral advancement and setback) in increments of 2 mm (from 4 to 12mm) were simulated in a finite element (FE) model and the corresponding stresses measured at the level of the temporomandibular structures (condyles and their respective discs and glenoid fossae). Stress distributions and displacements were analyzed for the different surgical movements through analyses of variance for group comparisons between advancement and setback and within the USSO variables, and correlation tests for associations among variables.
Results:
Stress and displacement at the condyle were higher on the non-operated than the operated side: highest on the anterior, posterior and lateral condylar surfaces, at the medial surface of the condylar neck, on the anterior condylar surface during setback, and posterior surface during advancement. The pattern of stress distribution suggested a lateral outward rotation of the condyle on the non-operated side. More displacement (up to 1.3mm) occurred at the non-operated than operated condyle. When condylar volume increased the displacement decreased. A balance of stress and displacement was observed at 6mm of advancement or setback before a new cycle of stress increase and decline. Increase in displacement was associated with increase in stress.
Conclusions:
1. This study was the first to contribute FE modeling and findings based on the individual variations among 8 human subjects who underwent USSO surgery.
2. With increased surgical movements, statistically significant increase in stress was observed at the level of the condyles, condylar necks, and menisci on the operated and non-operated sides.
3. The non-operated side disclosed most differences with incremental surgical movements.
4. Individual velocity changes suggested a balance of stress between operated and non-operated sides between 4 and 6 mm of mandibular advancement or setback, which corresponded to the actual amount of surgical movement in the 8 patients under study.
5. This research yielded a clinically testable hypothesis that should be explored in future FE models and direct clinical investigations.
Significance:
The significance of this research is the determination of the range of the surgical movements with the least and most stress on the temporomandibular structures thus the limits of mandibular displacement using the USSO
Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification
Get PDFObjective: To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients. Methods: Patients with LPR diagnosed by hypopharyngeal-esophageal impedance-pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3-to 9-month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated. Results: One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life-RSS (QoL-RSS) and RSS total scores were significantly higher in chronic LPR patients. The post-treatment decrease of QoL-RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL-RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL-RSS thresholds defined acute (QoL-RSS = 6–25), recurrent (QoL-RSS = 26–38), and chronic (QoL-RSS > 38) LPR. Conclusion: Baseline QoL-RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR. Level of Evidence: 3 Laryngoscope, 133:1073–1080, 2023. © 2022 The American Laryngological, Rhinological and Otological Society, Inc