A large family of small 18-25 nucleotide long non coding RNA molecules now known as microRNA (miRNA) was described two decades ago, and has been recently es- tablished as post-transcriptional gene regulators. miRNAs were shown to be involved in the regulation of diverse phys- iological and developmental processes. Moreover, dysregula- tion of specific miRNAs has been implicated later in several pathologies including cancer. Owing to their presence and stability in body fluids, miRNAs have been investigated as novel circulating non-invasive biomarkers. Accordingly, their role as potential diagnostic, prognostic or predictive biomark- ers for many cancer types has recently emerged. This review tackles the use of circulating miRNAs in cancer detection, diagnosis and prognosis, giving examples using common solid tumors and discussing the advantages of their use, the challenges facing this novel circulating biomarker and recorn- mendatidns to overcome them.
BACKGROUND:In the absence of surveillance data and consolidated information about tuberculosis (TB) and its drug resistance burden in Lebanon, this retrospective study was conducted to shed light on TB and its other relevant aspects over the last 15 years in this country.METHODS:To generate the TB data for this retrospective study, two main sources were used: 1) the records of patients in the National Tuberculosis Program (NTP); 2) the results of the Clinical Microbiology Laboratory (CML) at the American University of Beirut Medical Center (AUBMC). The TB data review pertained to its epidemiological aspect, implementation of the directly observed therapy strategy (DOTS) all over, the gender distribution, the impact of high risk groups (non-national population, Syrian refugees, patients with multi-drug resistance-TB [MDR-TB] and the inmate population) on the trend of TB in Lebanon between 1999 and 2013. Reviewed also are TB in children, extrapulmonary tuberculosis and the mycobacterium other than tuberculosis (MOTT).RESULTS:During the last 15 years, 7548 TB cases were diagnosed and evaluated at the NTP. After the decreasing of TB incidence from 13/100 000 population in 2001 to 9/100 000 in 2006, the incidence started to increase in 2007, reaching 20/100 000 in 2013, mostly due to increased cases among non-national population. Fluctuations in TB rates over the years were seen among children, inmates, MDR-TB, and HIV patients. MOTT isolates recovery rates also fluctuated during the study period, M. simiae being the most common.CONCLUSION:After the decreasing trends of TB incidence between 1999 and 2006, Lebanon has been experiencing an increasing incidence in tuberculosis population since 2007. This is mainly attributed to the dramatic increase of TB patients among non-nationals and the influx of Syrian refugees. The ongoing collaboration between the public and private sectors, improvements of the surveillance system and TB control are important factors for successful elimination of TB in this country.
Monitoring hospitals performance is evolving over time in search of more efficiency by integrating additional levels of care, reducing costs and keeping staff up-to-date. To fulfill these three potentially divergent aspects and to monitor performance, healthcare administrators are using dissimilar management control tools. To explain why, we suggest to go beyond traditional contingent factors to assess the role of the different stakeholders that are at the heart of any healthcare organization. We rely first on seminal studies to appraise the role of the main healthcare players and their influence on some organizational attributes. We then consider the managerial awareness and the perception of a suitable management system to promote a strategy-focused organization. Our methodology is based on a qualitative approach of twenty-two case studies, led in two heterogeneous environments (Belgium and Lebanon), comparing the managerial choice of a management system within three different healthcare organizational structures. Our findings allow us to illustrate, for each healthcare player, his positioning within the healthcare systems. Thus, we define how his role, perception and responsiveness manipulate the organization's internal climate and shape the design of the performance monitoring systems. In particular, we highlight the managerial role and influence on the choice of an adequate management system.
We report on an inflammatory pseudotumor of the spleen. A 72-year-old woman visited our hospital complaining of nausea. Physical examination and laboratory investigations were unremarkable. Ultrasonography, computed tomography, magnetic resonance imaging and angiography showed a hypovascular splenic mass measuring about 5 cm in diameter with a calcification in the center of the lesion. Splenectomy was performed. The removed spleen, weighing 145 g, contained a tan-white, circumscribed mass, measuring 6.2 x 5.5 x 5.3 cm. Histologically, the splenic mass was composed of an admixture of inflammatory cellular elements, predominantly plasma cells and lymphocytes with hyalinization, fibrosis, lymph follicles and multinuclear giant cells, suggestive of a inflammatory pseudotumor. The patient is currently alive and asymptomatic, 24 months after surgery. Inflammatory pseudotumors of the spleen are extremely rare and only 39 cases have been reported in the medical literature.
OBJECTIVES:The objective of this study was to examine the impact of multidisciplinary team meetings on the management decisions for urological cancers. A pro- spective study was conducted.METHODS:The study popu- lation is cases presented to multidisciplinary teams at Notre- Dame de Secours University Medical Center between July 2012 and July 2014. Data was collected by a standard pro forma.RESULTS:189 cases were presented in multidisci- plinary meetings during the study period. Results of this study showed that multidisciplinary team meetings change management decisions in 40.7% of cases. Change in man- agement decisions was mainly significant in testicular can- cer (57.1%), prostate cancer (42.7%) and bladder cancer (38.2%), with less important changes in renal cancer (33.3%). Prostate cancer cases with Gleason score 7 (51.7%) and bladder tumors with TNM ;t T2 (85.7%) were the most mod- ified in their respective groups.CONCLUSION:Multidiscipli- nary team meetings have a major impact in therapeutic de- cisions taken by urologists for newly diagnosed urological cancers.
BACKGROUND:Medical conditions and depen- dency levels of the elderly in the Lebanese long-term care institutions have not been described. This may undermine care commissioning and development to institutionalized elderly. Data to inform policy and practice are needed.OBJECTIVE:To identify clinical diagnoses and dependency levels among elderly residents in long-term care institutions in Lebanon.METHODS:Cross-sectional survey of long-term care institutions throughout Lebanon as identified by the Mihistry of Social Affairs.RESULTS:Thirty-one out of 42 long- term care institutions have been included in this survey. Among them, 1371 elderly subjects were included in the analysis; 75.6% were over the age of 75, and female repre- sented 67%. Medical morbidities and associated disabilities have driven admission in 70.5% of residents; 45.6% of resi- dents reported dernentia, stroke or other neurodegenerativb disease. Overall, 60% of residents required locomotor assis- tance.CONCLUSIONS:Elderly residents in long-term carb institutions are predominantly females, with mental and/or locomotor disabilities resulting fror neurological and ar- thritic conditions. Targeting healthcare for such health condi- tions remains a challenge for the institutions.
INTRODUCTION:25 (OH) vitamin D plays an important role in many places through the body. Its deficien- cy can cause rickets or osteomalacia. This is particularly im- portant in hemodialysis (HD) patients who are at icreased risk due to decreased sunlight exposure and deterioration of their mineral homeostasis.OBJECTIVES:To determine the prevalence of 25 (OH) vitamin D deficiency in HD patients at Rafic Hariri University Hospital (RHUH), compared to a sample of the general population matched for gender and age, and to evaluate the effectiveness of 25 (OH) vitamin D supplementation in HD deficient group.METHODS:This is a cross sectional study conducted since December 2012, comparing the prevalence of 25 (OH) vitamin D deficiency in HD patients in the dialysis center at RHUH, with patients from the general population who sought medical attention at RHUH for purposes other than HD, matched for age and gender. 25 (OH) vitamin D levels were measured with radio- immunoassay method (LOINC) at CIC European Lab, Bar- celona, Spain. A pilot study was conducted with the 34 HD patients who turned out to be deficient or insufficient in 25 (OH) vitamin D. We supplemented them with cholecalciferol over 6 months. We then assessed their vitamin D levels, and biochemistry parameters.RESULTS:The prevalence of 25 (OH) vitamin D deficiency in the sample of HD patients at baseline was 32% while that of insufficiency was 36%. The prevalence of 25 (OH) vitamin D deficiency in the sample of general population was 67%. No correlation was found be- tween 25 (OH) vitamin D levels and the studied parameters. In the pilot study, after six months of cholecalciferol supple- mentation, there was a significant improvement in 25 (OH) vitamin D levels in the deficient and insufficient groups.CONCLUSION:The sample studied in the general population showed high prevalence of 25 (OH) vitamin D deficiency (67%). The sample studied in HD patients showed a preva- lence of 25 (OH) vitamin D deficiency of 32% and insuffi- ciency of 36%. The pilot study showed that 25 (OH) vitamin D supplementation in the form of cholecalciferol is beneficial in HD patients.
This phenoMenon of early and transitory increase of CA 19-9 in APC could reflect the high efficacy of FOLFIRINOX and could predict better out- come in these patients.
OBJECTIVES To analyze clinical and immuno- logic manifestations of Lebanese patients with the antiphos- pholipid syndrome (APS). PATIENTS AND METHODS Our study was retrospective and was done on hospitalized patients be- tween 2001 and 2013. All these patients fulfilled the interna- tional criteria for diagnosis (Sydney criteria). RESULTS Of the 30 patients selected, we noticed a female predominance (sex ratio: 2.75). The age at diagnosis ranged between 9 and 72 years with a mean age of 43 - 17 years. "Primary" APS was present in 70% of patients; APS was associated with systemic lupus erythematosus (SLE) in 23% of patients, with a mixed connective tissue disease in 3% and systemic vasculitis in 3%. A catastrophic APS occurred in 3 cases (10%). The most com- mon presenting manifestations were deep venous thrombosis (53%), pulmonary embolism (33%) and stroke (13%). Eleven patients (37%) had venous thrombosis, 7 (23%) had arterial thrombosis alone and 7 (23%) both arterial and venous throm- bosis. Deep venous thrombosis occurred mostly in the lower limbs (70%) whereas arterial thrombosis occurred in cerebral arteries in 50% of cases. The most common fetal complica- tions were early fetal loss (62.5%). Anticardiolipin antibodies were the most frequently identified antibodies (83%), followed by anti-p2GPI (70%) and anticoagulant lupus (11%). An effec- tive anticoagulation by anti-vitamin K was performed in 29 pa- tients. Corticosteroids were prescribed in 13 cases and were associated to immunosuppressant drugs in 6 cases of second- ary APS and the 3 catastrophic APS. The patients with cat- astrophic APS received also intravenous immunoglobulin. Response to treatment was favorable in 86% of patients with a mean follow up of 6 4 years. We deplored 4 deaths, 2 with- in the catastrophic APS. CONCLUSION The APS does not seem to have particular features in Lebanon. The primary form seems to be the most common. It is important to diagnose this syn- drome earlier before the onset of serious complications.
Autism spectrum disorders are a group of neurodevelopmental disorders characterized by impaired verbal and/or nonverbal communication in addition to repeti- tive stereotypical behaviors. We present a review article on this topic. Criteria for diagnosis are defined by the Diagnos- tic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5). Abnormalities at the level of synapses, including newly described genetic perturbations, have been implicated in the pathogenesis of autism. Non-invasive modalities like Diffusion Tensor Magnetic Resonance Imaging have identi- fied white matter tract involvemeht in the brains of autistic in- dividuals. Early and intensive intervention impact prognosis. Risperidone and aripiprazole are FDA approved for irritability in autism although no known medication relieves core symp- toms of social and communication impairment. Fluoxetine is used to decrease anxiety in autistic patients.
BACKGROUND:The objective was to highlight the profile of Eysenck Personality Questionnaire traits of a sample of Arab college students, and assess the relationship of trait scores with gender, age and symptoms of anxiety, depression, PTSD and grade point average (GPA) score. Similar reports from the Arab world were restricted to neuroticism/extraversion and rarely involved traumatic experience and psychosocial performance.METHODS:Participants (N = 624) were Kuwaiti national college students who completed, in class, the EPQ- 90, Hopkins Symptoms Checklist, and the PTSD Checklist.RESULTS:Men had higher psychoticism (p < 0.004) and extra- version (p <0.03) scores, while women had higher neuroticism (p < 0.001) and lie scale scores (p < 0.001). Students with the lowest GPA had the highest scores for psychoticism (p< 0.01). Psychoticism and neuroticism were significantly correlated with each other, but negatively with extraversion and lie scale. The correlations of psychopathology were strongest with neu- roticism and psychoticism; and negative with extraversion and the lie scale. In regression analyses, the dominant predictor of psychopathology was neuroticism. With neuroticism as covari- ate, the sex difference in depression scores was no longer sig- nificant.CONCLUSIONS:Our findings support the usefulness of neuroticism as reflecting characteristic level of distress; and a combination of high neuroticism and low extraversion as vul- nerability marker for psychopathology. Psychoticism needs further study as a marker of psychosocial underachievement.
The dacryoscanner is the imaging technique of choice in case of persistent tearing. It allows the opacification of nasolacrimal system, and thus determines the site and the origin of obstruction. The site could be the lacrimal canaliculus, the lacrimal sac, or the nasolacrimal duct. The origin could be an idiopathic or a sequellar stenosis, a dacryolithiases, a bony malformation, or a tumor. This is a technique done by the radiologist under aseptic conditions, and easily tolerated by the patient. Many technical variants exist for an optimal opacification of the nasolacrimal system.
Objectives:1) To document quality of life (QOL) changes in type 2 diabetes (T2D) and at-risk individuals who took part in the DiabetAction program and 2) to determine if changes in the QOL were associated with program attendance.Methods:QOL (SF-36 questionnaire), physical activity (PA) level, body weight, skinfold thickness, aerobic capacity and handgrip strength were measured before and after the 10-week intervention in 15 T2D and 14 at-risk individuals.Results:Physical and mental components of QOL and 6 out of 8 domains of QOL were significantly improved in T2D and at-risk individuals after the intervention. Four significant correlations were identified: physical functioning domain with skinfolds (r = – 0.56) and aerobic capacity (r = 0.49), social functioning domain with handgrip strength (r = 0.43) and the physical health summary measure with body weight (r = – 0.45).Conclusion:QOL was significantly improved after the DiabetAction program. Also, PA intervention appears to impact QOL to a larger extent when participants experience changes in body composition and fitness.
Background:Proper approach to symptom control in cancer patients requires a good understanding of the prevalence of the various symptoms these patients have.Aim:This study aims at assessing the Lebanese oncologists’ point of view concerning the symptom burden among cancer patients of Lebanon and comparing their opinions to the real complaints of patients themselves.Methods:A cross-sectional study was conducted among a representative sample of the Lebanese medical oncologists. Thirty-six physicians filled out a questionnaire regarding their demographics as well as the symptom profile of their patients. Those results were compared to the ones obtained from our previous study about symptom profile as reported by patients.Results:Fatigue was the symptom most our patients suffered from according to their physicians (64.167%). Also, a good percentage of physicians agreed that patients suffer from appetite loss, pain, weight loss, and nausea. When compared to the patients’ reports of their own symptoms, a statistically significant difference existed between the two profiles for the majority of symptoms (14 out of 19). Also, for the majority of symptoms, physicians were found to underestimate the percentage of patients suffering from each symptom.Conclusion:This study shows that there is a statistically significant difference between the physicians’ and the patients’ perspectives on most of the common distressing symptoms. This entails more detailed questioning of the cancer patients about their distressing symptoms.
Bisphosphonates have been proven to be effective and safe to millions of osteoporotic and cancer patients but were associated with multiple complications. The most prevalent and well established are upper gastrointestinal discomfort for oral bisphosphonates and acute phase reactions for intravenous forms. Although rare, hypocalcaemia and renal injury could be potentially serious. Severe musculoskeletal pain and ocular events may be ignored by physicians, which delay their diagnosis and management. Recently there are growing concerns over two long-term and emerging adverse effects, which are still of unclear pathophysiology and unproven causality. Osteonecrosis of the jaw is more common in cancer sufferers who receive high doses of intravenous bisphosphonates. Atypical femoral fractures are very rare compared with osteoporotic fractures that bisphosphonates prevent. Based on current data, the association of bisphosphonates with esophageal cancer, hepatotoxicity and atrial fibrillation remains doubtful. Overall, the adverse effect profile of these drugs is still unclear. Physicians must be vigilant to bisphosphonate-reported side effects and recognize the level of evidence supporting them, to better communicate the balance between benefits and potential risks to patients.
In contrast to the vast majority of cases that present with nasal complaints, the clinical presentation of an inverted papilloma confined to the ethmoid sinus was incidental. Radiologic findings are nonspecific. Functional endoscopic sinus surgery with total removal of the mass is the therapy of choice to reach a final pathologic diagnosis, prevent recurrence and other sequelae.
There has been a pedagogic shift in higher education from the traditional teacher centered to the student centered approach in teaching, necessitating a change in the role of the teacher from a supplier of information to passive receptive students into a more facilitative role. Active learning activities are based on various learning theories such as self-directed learning, cooperative learning and adult learning. There exist many instructional activities that enhance active and collaborative learning. The aim of this manuscript is to describe two methods of interactive and collaborative learning in the classroom, automated response systems (ARS) and team-based learning (TBL), and to list some of their applications and advantages. The success of these innovative teaching and learning methods at a large scale depends on few elements, probably the most important of which is the support of the higher administration and leadership in addition to the availability of “champions” who are committed to lead the change.
Intramuscular myxoma is a rare entity in itself, and while it has been described in several locations in the body, its presence in the tibialis anterior muscle has only been reported once in the literature. In this case report, we present, to our knowledge, the first case of an intramuscular myxoma in the tibialis anterior muscle in the English literature, which was successfully managed with wide surgical resection.
