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The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study
No full textBackground: Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU. Methods: This is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes. Results: A total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08–2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03–5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00–5.31, p = 0.049). The association lost significance after adjustment. Conclusions: The increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed. © 2023, The Author(s)
Incidence of pediatric tonsillitis, otitis and upper respiratory infectious entities in the pre and post COVID-19 quarantine eras
Get PDFBackground: At this point of the COVID-19 pandemic, with the worldwide loosening of health restrictions, there has been an observed jump in infectious load especially of the upper airways. Aims/Objectives: To shed light on children’s immunity and potential health risks after the COVID-19 pandemic. Methods: A retrospective chart review from May 2019 to January 2022. Pediatric patients with a discharge diagnosis suggestive of an upper respiratory or ENT infection were included. The sample was divided into three groups according to the date of presentation. Results: A total 4356 patients were diagnosed with ENT infectious aetiology. The mean age was 4.69 years. The three periods studied were: Period-1 (May 2019–January 2020), period-2 (February 2020–April 2021) and period-3 (May 2021–January 2022). The distribution of adenoiditis and MEE is the same across all periods (p >.05). The incidence of URTI, AOM and tonsillitis were significantly highest during period-3 followed by period-1, which in turn was significantly higher than during period-2 (p <.05). The incidence of sinusitis was the highest during period-3 (p <.001). Conclusion: There seems to be a heightened susceptibility to acute infection in children after the pandemic. Significance: It is important to keep in mind the changes in microbiota and implement measures to promote healthy gut flora, timely vaccination, and prompt medical interventions. Summary Box: What is already known: We already know that quarantine has significantly decreased infectious load especially in children. This study adds an objective assessment of this decrease with an assessment of the infectious load post-quarantine. This study is a model for future pandemics on the importance of vaccinations and the importance of microbiota changes after pandemics. © 2023 Acta Oto-Laryngologica AB (Ltd)
In Vitro Evaluation of Biological and Anticancer Activities Exhibited by Five Varieties of Vitis vinifera L
Get PDFVitis vinifera commonly known as grapevine is one of the most important fruit crops worldwide. Its cultivation started more than 7000 years ago in the Near East, and over the millennia was followed by the development of thousands of cultivars that were further selected and characterized for specific purposes. Its important pharmacological value and its richness in phytoconstituents were the triggers to perform this project. Seven extracts were prepared from five different V. vinifera varieties (V. vinifera ‘Black Pearl’ (BP), V. vinifera ‘Red Glob’ (RG), V. vinifera ‘Crimson’ (CR), V. vinifera ‘Beitamouni’ (BE) and V. vinifera ‘Superior’ (SU)) by separating the pulp from the seeds, followed by methanolic extraction. The phytochemical analysis showed that red colored grapes (RE, BP and CR), the seeds from V. vinifera ‘Black Pearl’ and V. vinifera ‘Red Globe’ contain higher amounts of primary and secondary metabolites such as polyphenols, anthocyanins and reducing sugars. In addition to their richness in phytoconstituents, these varieties/seeds possess an important antioxidant activity. The results of the cell viability assays showed that the red varieties have a potential anticancer activity against Capan-2 pancreatic cancer and MDA-MB231(TNBC) breast cancer cell lines, with the greatest promise when combined with the seeds. © 2023 by the authors
Examining Physical and Cognitive Function in Chronic Low Back Pain Through the Use of a Multisystem Resilience Framework
No full textObjectives: Chronic pain results in significant impairment in older adults, yet some individuals maintain adaptive functioning. Limited research has considered the role of positive resources in promoting resilience among older adults. Likewise, these factors have largely been examined independently. We aimed to identify resilience domains based on biopsychosocial factors and explore whether resilience phenotypes vary across sleep disturbance, fatigue, and cognitive function. Methods: Sixty adults (ages ≥60 years) with chronic low back pain completed measures of psychological, health, and social functioning. On the basis of previously published analyses, principal-components analysis was conducted to create composite domains for these measures, followed by cluster analysis to identify phenotypes. Results: Four profiles emerged: Cluster 1, with high levels of psychosocial and health-related functioning; Cluster 2, with high health-related functioning and low psychosocial functioning; Cluster 3, with high psychosocial functioning and poorer health; and Cluster 4, with low levels of functioning across all domains. Significant differences across cluster membership emerged for sleep disturbance (ηp2 = 0.29), fatigue (ηp2 = 0.29), and cognitive abilities (ηp2 = 0.47). Individuals with the highest levels of resilience demonstrated more optimal outcomes in sleep and fatigue (P values ≤0.001) than did individuals with a less resilient phenotype. Furthermore, the High-Resilience group (Cluster 1) and the High Psychosocial / Low Health group (Cluster 3) had lower cognitive impairment than did the High Health / Low Psychosocial group (Cluster 2) and the Low-Resilience group (Cluster 4) (P values ≤0.009). Conclusions: A higher array of protective resources could buffer against the negative sequelae associated with chronic low back pain. These exploratory findings support the multidimensional nature of resilience and suggest that targeting resilience from a multisystem perspective might help to optimize interventions for older adults with chronic pain. © 2022 The Author(s)
Epithelial-to-Mesenchymal Transition-Related Markers in Prostate Cancer: From Bench to Bedside
Get PDFProstate cancer (PCa) is the second most frequent type of cancer in men worldwide, with 288,300 new cases and 34,700 deaths estimated in the United States in 2023. Treatment options for early-stage disease include external beam radiation therapy, brachytherapy, radical prostatectomy, active surveillance, or a combination of these. In advanced cases, androgen-deprivation therapy (ADT) is considered the first-line therapy; however, PCa in most patients eventually progresses to castration-resistant prostate cancer (CRPC) despite ADT. Nonetheless, the transition from androgen-dependent to androgen-independent tumors is not yet fully understood. The physiological processes of epithelial-to-non-epithelial (“mesenchymal”) transition (EMT) and mesenchymal-to-epithelial transition (MET) are essential for normal embryonic development; however, they have also been linked to higher tumor grade, metastatic progression, and treatment resistance. Due to this association, EMT and MET have been identified as important targets for novel cancer therapies, including CRPC. Here, we discuss the transcriptional factors and signaling pathways involved in EMT, in addition to the diagnostic and prognostic biomarkers that have been identified in these processes. We also tackle the various studies that have been conducted from bench to bedside and the current landscape of EMT-targeted therapies. © 2023 by the authors
Microvascular surgery training in a low volume setting: a single healthcare center experience
No full textBackground: Today, the surgical approach in the treatment of complex injuries is changing in that complex and intricate procedures, such as microvascular surgery, are no longer kept as a last resort. In Plastic and Reconstructive surgery, microvascular surgery has been described in the treatment of extensive tissue defects using free tissue transfer. This study discusses the incorporation of microvascular training in residency programs, as well as identifying the factors that influence residents’ confidence in performing microsurgery without supervision. Methods: This is a cross-sectional study conducted on thirteen current and former Plastic and Reconstructive surgery residents who practiced microsurgery during the past 8 years at the American University of Beirut Medical Center in Lebanon. Results: Nine residents (69.2%) started scrubbing in and became actively involved in microsurgery procedures at the PGY IV level with the majority being exposed to cases every 2–3 weeks (69.2%). Residents were mostly exposed to breast (100%) and orthopedic reconstruction (92.3%), and facial trauma reconstruction was the least practiced (46.2%). Eleven residents (84.6%) reported that music and choice of OR staff assisting in the operation significantly affected their speed and performance. Eleven residents (84.6%) were satisfied with the training program, and ten found the training program beneficial for their career (76.9%). Conclusion: Our findings suggest that residents who had a higher workload and were actively involved in microsurgery early during residency felt more confident in performing the procedure by themselves. The choice of operating staff, playing music, and the presence of different attendings in the operating room were found to affect the speed and performance of residents. Level of evidence: Level V, Risk/Prognostic. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature
Lebanon’s Economic and Financial Crises: Impact of the Current Account Deficit on Gross Fixed Capital Formation
No full textAfter the financial globalization, concerns rose over the dynamics of current account balance and its relationship with capital investments in developed and developing countries. Understanding the factors behind persistent current account deficits and their relationship with investments in emerging market countries would help policymakers in the economic decision-making process.
This thesis aims to assess the impact of the current account deficit on gross fixed capital formation in Lebanon, a developing country that has recently experienced an economic and financial crisis. Using annual data from 1990 to 2021, the study employs Vector Autoregression (VAR) econometric technique to analyze the relationship between these variables over time. We use the Granger Causality test to investigate the causal relationship between them. The results suggest that there is no proof of any impact of the current account deficit on gross fixed capital formation in Lebanon. However, the opposite is true; such that gross fixed capital formation Granger causes the current account deficit. The findings of this study have important implications for policymakers to stimulate economic growth and development in the country
Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review)
Get PDFProper management of stage III non‑small cell lung cancer (NSCLC) might result in a cure or patient long‑term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncolo‑ gists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scan‑ ning remains a cornerstone in the discovery of a lung lesion, a positron‑emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case‑by‑case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncolo‑ gist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unre‑ sectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physi‑ cian panel, available literature and evidence governing the treatment, management and follow‑up of patients with stage III NSCLC. © 2023 Spandidos Publications. All rights reserved
DATA-DRIVEN RECOVERY OF TIME-EVOLVING CAUSAL INTERACTION NETWORKS AND STOCHASTIC DYNAMICS IN ZEBRAFISH GROUPS
Get PDFThis thesis explores the collective behavior and dynamics of juvenile zebrafish (Danio
rerio) shoals of varying group sizes, employing a multifaceted approach grounded in
physics, information theory, graph theory, and stochastic analysis. We look at how
groups of 4, 10, 60, 80, and 100 zebrafish interact.
We examine two key behavioral metrics: rotation and polarization order parameters,
and observe that the decay times derived from the autocorrelation functions of
these metrics’ time series increase considerably as group size grows. This signals a
heightened level of coordination that arises with increased density, with decay rates
of the rotation order parameter in the largest group exhibiting a ten-fold difference
compared to the smallest group.
To learn more about how coordination and density work together, we used the Optimal Causation Entropy principle (oCSE) to build dynamic, time-evolving, causally-
weighted networks that show how zebrafish shoals of sizes 4, 10, and 60 interact with
each other. By leveraging these networks, and exploring them using graph theory,
we relate the increase in coordination within denser systems to a more consistent,
and less volatile causal structure. Within the context of network science, we measure the average number of interacting neighbors, then look at the emergence of
leadership, provide a way to quantify it, and compare that across the three different
groups.
In the concluding part of this study, we use the Kramers-Moyal equation to com-
bine Kramers-Moyal coefficients with Sparse Regression techniques, also known as
equation learning, to derive interpretable, analytical expressions of stochastic differential equations describing the evolution of the rotation and polarization order parameters for the different group sizes, as well as the coupled differential equation
that describes the concurrent evolution of these order parameters.
Collectively, our findings cast light on the intricate relationships between collective
behavior, emergent sustained coordination, information sharing, and stochastic dynamics in animal groups, providing a holistic framework for studying such systems
FROM FRAGMENTED LANDSCAPE TO GREEN-BLUE NETWORK: SUSTAINABLE GREENING OF TYRE
Get PDFThe rapid urban growth is reshaping the Lebanese coastal cities and their surrounding hinterlands, by, introducing major challenges for the preservation and conservation of open/green landscapes. Besides, "Political instability is partly responsible but also collapse of the welfare state, economic liberalization and partial integration into global systems” (Makhzoumi, 2015). As Lebanon faces an unprecedented economic and financial crisis, the privatization of state lands has been suggested as a silver bullet solution by the government. As a result, in Lebanon’s fourth largest coastal city - Tyre, state lands that constitute 63% of the city’s area are threatened.
The repercussions of privatizing Tyre’s state lands leave severe concerns that the southern area of the city that hosts large areas of agricultural and natural landscapes will be disfigured. The current urban planning approaches failed to accommodate sustainable urban development and green urban strategies. Therefore, this thesis adopts the ecological landscape methodology to propose a strategic design and conceptual approach that first, protects the ecological and cultural character of these threatened lands and second, connects the fragmented landscapes of municipal Tyre taking into consideration the complementarity between city and its periphery.The rapid urban growth is reshaping the Lebanese coastal cities and their surrounding
hinterlands, by, introducing major challenges for the preservation and conservation of
open/green landscapes. Besides, "Political instability is partly responsible but also
collapse of the welfare state, economic liberalization and partial integration into global
systems” (Makhzoumi, 2015). As Lebanon faces an unprecedented economic and
financial crisis, the privatization of state lands has been suggested as a silver bullet
solution by the government. As a result, in Lebanon’s fourth largest coastal city - Tyre,
state lands that constitute 63% of the city’s area are threatened.
The repercussions of privatizing Tyre’s state lands leave severe concerns that the
southern area of the city that hosts large areas of agricultural and natural landscapes will
be disfigured. The current urban planning approaches failed to accommodate
sustainable urban development and green urban strategies. Therefore, this thesis adopts
the ecological landscape methodology to propose a strategic design and conceptual
approach that first, protects the ecological and cultural character of these threatened
lands and second, connects the fragmented landscapes of municipal Tyre taking into
consideration the complementarity between city and its periphery