In this position statement, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) highlights the evaluation of ring-augmented procedures in Metabolic Bariatric Surgery (MBS). A GRADE-based systematic review and meta-analysis were conducted to assess their effectiveness and safety. The analysis included 28 studies with 6939 patients. The findings demonstrated that ring augmentation in bariatric procedures may provide superior or comparable weight loss outcomes compared to standard procedures, although results were heterogenous and evidence quality varied. Ring-related complications and removal rates were generally low. While further high-quality, long-term studies are needed, current evidence cautiously supports selective use of ring augmentation in both primary and revisional MBS, particularly for Roux-en-Y Gastric Bypass (raRYGB).
Colorectal serrated polyps are now recognized as an important pathway in colorectal carcinogenesis. An association between serrated polyposis syndrome (SPS) and duodenal serrated lesions sharing a similar immunophenotype in both the colon and duodenum has been reported in the literature. We present a case of a 38-year-old male who presented in June 2023 with abdominal pain and fever. Initial investigations, including multiple computed tomography scans of the abdomen and pelvis, revealed an appendiceal abscess and small bowel intussusception involving two segments of the jejunum without evidence of obstruction, along with multiple polyps throughout the small and large bowel suggestive of an intestinal polyposis syndrome. Further evaluation with colonoscopy, esophagogastroduodenoscopy, and magnetic resonance enterography confirmed the presence of numerous polyps of varying sizes involving the duodenum, jejunum, ileum, and all segments of the colon. The initial differential diagnosis included familial adenomatous polyposis, Peutz-Jeghers syndrome, and PTEN hamartoma tumor syndrome. The patient subsequently developed complicated small bowel obstruction due to intussusception and underwent open small bowel resection. Multiple intestinal polyps were identified, and histopathological examination confirmed the diagnosis of SPS. At a later stage, the patient was planned for subtotal colectomy, preceded by elective endoscopic polypectomy, which achieved clearance of the left colon up to 20 cm from the anal verge. Gross examination of the colectomy specimen revealed more than 20 large polyps measuring up to 4 cm. Histopathological analysis demonstrated colonic serrated polyposis without evidence of invasive malignancy, wall infiltration, or lymph node involvement, with clear surgical margins.
Globally, the trajectory of COVID-19 has been shaped by viral evolution, widespread vaccination and immunity from prior infections. We assessed the epidemiological and clinical patterns of COVID-19 in Lebanon between 2020 and 2024, identified the predominant SARS-CoV-2 clades and evaluated risk factors for COVID-19 associated mortality. This multicenter prospective study enrolled 1302 patients hospitalized with COVID-19 in Lebanon between November 2020 and October 2024. Multivariate logistic regression was used to determine predictors of COVID-19 associated mortality. Whole genome sequencing (WGS) was utilized to investigate the genomic epidemiology of SARS-CoV-2 and infer viral interactions between Lebanon and other countries. Multiple sequence alignment and phylogenetic analysis were conducted using the augur pipeline. A progressive and significant reduction in severe outcomes, including pneumonia and mortality was observed throughout the study period. Pneumonia (AOR, 6.714; CI, 4.140–10.888; p < 0.0001) and age ≥ 60 years (AOR, 6.051; CI, 2.190–16.723; p = 0.001) were identified as independent predictors of COVID-19 mortality. Moreover, receiving 3 doses of a COVID-19 vaccine significantly reduced the odds of mortality (AOR, 0.229; CI, 0.108–0.486; p < 0.0001). Genomic analysis revealed multiple introductions of the same SARS-CoV-2 clades into Lebanon, which seeded local transmission chains. The transition of COVID-19 from pandemic to endemic in Lebanon was associated with reduced disease severity. Vaccination remains essential, particularly in older adult patients who are at high risk of mortality. Moreover, early diagnosis and management of pneumonia are crucial, given its association with COVID-19 mortality. Furthermore, WGS has proven valuable in tracking the local evolution of SARS-CoV-2 and its impact on clinical outcomes.
Background/Objectives: In Lebanon, the economic crisis since 2019 has severely strained healthcare infrastructure, yet its impact on cancer treatment adherence remains incompletely characterized. This study assessed factors associated with treatment delay and regimen modification to identify barriers to optimal cancer care among Lebanese patients. Methods: This multicenter, cross-sectional study was conducted in five tertiary hospitals in Beirut, Lebanon, between 13 June 2024, and 27 June 2025. Demographic, clinical and treatment data were collected via a structured questionnaire. Bivariate and multivariable binary logistic regression analyses were performed to identify independent predictors of treatment delay (>2 weeks) and incomplete treatment regimens. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are reported. Results: A total of 244 patients were enrolled in the study. The study population was predominantly female (59.0%) and aged ≥60 years (60.2%). Advanced disease was common, with 50.4% of patients presenting with stage IV disease. Financial vulnerability was widespread: 72.6% reported monthly household incomes below USD 1000, 88.1% reported a decline in income due to the economic crisis, and 39.3% relied on unstable income sources. Overall, 52.5% of patients experienced treatment initiation delays, and 9.0% received incomplete or dose-reduced regimens. On multivariable analysis, reliance on unfixed income independently predicted treatment delay (aOR 2.55, 95% CI 1.42–4.59; p = 0.002), lack of health insurance (aOR 1.91, 95% CI 1.08–3.39; p = 0.026) and pre-treatment surgical costs also increased the odds of delay (aOR 9.03, 95% CI 2.57–31.7; p = 0.001). For incomplete treatment, unfixed income remained an independent predictor (aOR 2.09, 95% CI 1.16–5.79; p = 0.015). A lack of insurance (aOR 5.62, 95% CI 1.22–25.9; p = 0.027) and high laboratory costs (>USD 150 per session) were also associated with incomplete regimens (aOR 1.62, 95% CI 1.02–2.57; p = 0.041). Conclusions: In Lebanon’s crisis context, financial instability was a key factor associated with deviations in cancer treatment. These findings highlight the need for strengthened insurance coverage and subsidization of diagnostic and treatment-related costs to ensure timely and continuous oncologic care.
Hepatitis E virus (HEV) is an emerging transfusion-transmissible pathogen, yet epidemiological data from the Middle East remain limited, and differences in serological assay performance complicate interpretation of seroprevalence. Lebanon lacks national HEV surveillance data and has no blood donor screening policy. In this cross-sectional national study, 3000 blood donors from all Lebanese governorates (July 2023-August 2024) were screened for anti-HEV IgG and IgM using two commercial platforms: Euroimmun ELISA and Roche Elecsys electrochemiluminescence immunoassay (ECLIA). This study represents the first large-scale, peer-reviewed evaluation of the Roche Elecsys Anti-HEV assays in a national blood donor population. All samples that were positive or borderline by either serological assay were tested for HEV RNA using real-time RT-PCR (Altona RealStar® and Roche Cobas®). Anti-HEV IgG seroprevalence differed significantly between assays (Euroimmun: 1.13% vs. Roche Elecsys: 1.93%; p < 0.001). IgM prevalence was 0.07% and 0.33%, respectively. Overall agreement between assays was high (IgG: 98.7%; IgM: 99.7%), although Cohen's κ indicated limited concordance, with Roche Elecsys identifying additional low-reactivity seropositive donors. Seropositivity varied across regions, with higher rates observed in South Lebanon (4.0%) and North Lebanon (3.1%). HEV RNA was not detected in any tested donor. HEV exposure among Lebanese blood donors is low but geographically distributed. Seroprevalence estimates were strongly assay-dependent, indicating that HEV burden may be underestimated when lower-sensitivity platforms are used. These findings highlight the importance of assay selection in HEV epidemiological studies and support consideration of selective HEV nucleic acid testing for high-risk recipients to inform evidence-based blood safety policy in Lebanon.
