This study assessed acrylamide (AA) content in breakfast cereals marketed in Lebanon and the United Arab Emirates (UAE) and examined the associated dietary, carcinogenic, and neurotoxic risks. Following a comprehensive market screening, a total of 21 stock keeping units (SKUs) from Lebanon and 76 from the UAE were identified, collected, and analyzed for AA using LC-MS/MS. At the same time, a food frequency questionnaire involved 845 participants gathered information on breakfast cereal consumption habits, body weight, and demographic details. AA was found in all samples, with average levels of 525.75 & micro;g/kg in Lebanon and 573.02 & micro;g/kg in the UAE, both exceeding many reported international levels. Estimated dietary exposures were 0.39 & micro;g/kgbw/day in Lebanon and 0.53 & micro;g/kg-bw/day in the UAE, accounting for about 25% of the WHO's maximum tolerable daily intake. Although neurotoxic risk assessments based on US-EPA reference values suggested low concern for average consumers, carcinogenic risk against NFCA and WHO limits indicated an increased risk for average and high consumers, particularly for products with above-average AA levels. Carcinogenic risk assessment showed that average acrylamide exposure from breakfast cereals reached 0.39 & micro;g/kg-bw/day in Lebanon and 0.53 & micro;g/kg-bw/day in the UAE, exceeding the NFCA and WHO reference values by 2.8-4.9 fold and 3.8-6.6 fold, respectively. Product origin, addition of chocolate or nuts, and processing methods significantly (p < 0.05) affected AA concentrations. The findings highlight the urgent need for strategies to reduce AA levels in breakfast cereal products and to improve regulatory control in developing countries to limit long-term health risks.

Chemical contamination of food products has become an increasing public health concern, particularly with the growing global demand for cereal-based foods. Cornflakes, widely consumed as a breakfast staple, may accumulate trace metals through environmental exposure, agricultural practices, processing, packaging, and transportation. In this study, thirteen essential and trace metals were quantified in 40 commercially available cornflake products collected from the United Arab Emirates market using Inductively Coupled Plasma Mass Spectrometry. The analyzed elements included Cr, Mn, Fe, Ni, Co, Cu, Zn, As, Mo, Cd, Sn, Hg, and Pb. The mean concentrations (µg/kg) ranged from 5.34 for Sn (1.2-17.3) and 5.00 for Hg (0.2-9.9) to 3350 for Fe (244.6-26,550.3) and 1500 for Zn (55.8-12,681.0). Intermediate levels were observed for Mn (mean 209; range 10.0-790.9), Cu (288.4; 25.2-1536.0), Ni (437.2; 316.2-718.7), Cr (109.6; 30.8-251.7), As (80.5; 11.9-573.0), Cd (35.2; 17.8-66.1), Mo (30.3; 4.42-99.0), and Co (22.0; 1.4-279.2). Particularly concerning were the toxic elements Pb and Hg, with mean concentrations of 353.4 µg/kg (range 296.6-563.7) and 5.0 µg/kg (range 0.2-9.9), respectively. A substantial proportion of samples exceeded regulatory limits, with 73.8% surpassing the permissible level for Pb and 76.0% for Hg, based on internationally recognized standards from the Codex Alimentarius Commission and the European Commission Regulation (EU) 2023/915. These findings highlight potential public health concerns associated with dietary exposure to toxic metals and emphasize the need for strengthened monitoring, improved manufacturing controls, and stricter regulatory enforcement to ensure food safety.

BACKGROUND:Head-to-head randomised trials or real-world studies comparing the safety and efficacy of natalizumab and anti-CD20 monoclonal antibodies are limited. This study aimed to compare the effectiveness and safety of natalizumab versus ocrelizumab/rituximab in a real-world cohort of relapsing-remitting multiple sclerosis (RRMS) patients using data from the Middle East and North Africa Committee for the Treatment and Research in Multiple Sclerosis (MENACTRIMS) registry. METHODS:This registry-based, retrospective, multicentre study was carried out in seven Middle Eastern countries by analysing data from the MENACTRIMS registry. All adults RRMS patients treated with natalizumab, rituximab or ocrelizumab and maintained on treatment for at least 12 months were included. Patients were matched using propensity scores. Primary outcomes were annualised relapse rate (ARR), confirmed disability progression and improvement and MRI activity. RESULTS:A total of 1954 patients met the inclusion criteria, with 1277 receiving anti-CD20 therapy (768 on rituximab and 509 on ocrelizumab) and 677 natalizumab. Natalizumab significantly reduced ARR compared with anti-CD20 therapies (0.062 vs 0.092, p=0.001). Confirmed disability progression rates, MRI outcomes and no evidence of disease activity (NEDA-3) were similar between the two groups. However, natalizumab demonstrated higher rates of disability improvement compared with anti-CD20 therapies (9.3% vs 5.5%, p=0.03). Adverse events were more frequent in the anti-CD20 group (36.4% vs 27.5% for natalizumab, p=0.001). CONCLUSION:In this large, real-world cohort, natalizumab was associated with lower ARR, greater likelihood of disability improvement, lesser adverse events, but lower persistence compared with anti-CD20 therapies. These findings provide valuable insights into the comparative efficacy and safety of these RRMS therapies, aiding clinicians in personalised treatment decisions.

Genetically modified foods (GMFs) have garnered significant attention due to their implications for health, agriculture, and food security. Understanding knowledge and perceptions of GMFs is essential, as these factors influence acceptance and attitudes. This study, the first of its kind in Lebanon, aimed to assess the knowledge, attitudes, and perceptions regarding GMFs and to explore their association with socio-demographic characteristics. A cross-sectional study was conducted with 1,001 participants who completed a 50-item questionnaire, followed by a 15-minute educational session on GMFs. Statistical analysis was performed using SPSS. Prior to the educational session, participants had an average knowledge score of 60.3 ± 17.4%, which significantly increased to 83.0 ± 15.8% afterward. Attitude and perception scores improved from an average of 30.3 ± 25.1% pre-intervention to 38.9 ± 12.4% post-intervention. Females demonstrated significantly higher knowledge scores, and educational attainment was positively correlated with knowledge levels both pre- and post-intervention. Younger participants and those in health-related fields scored higher before the intervention, while unemployed individuals scored lower. Additionally, higher educational levels and health-related educational backgrounds were linked to better attitudes and perceptions pre-intervention, while unemployment correlated with lower scores. Interestingly, multivariate regression analysis indicated that being under 35 years of age, having a health-related educational background, and holding a university degree were predictors of higher GMF knowledge. Consequently, individuals with initially lower knowledge level benefited the most from the educational intervention, exhibiting the greatest knowledge increases post-education. Our findings underscore the importance of targeted educational initiatives to bridge knowledge gaps and address misconceptions regarding GMFs.

BackgroundCOVID-19 has worsened burnout, marked by exhaustion, cynicism, and reduced professional efficacy. In Lebanon, economic collapse, political instability, the Beirut Port explosion, and social unrest have compounded this, with limited gender-specific data. This study evaluates burnout levels in Lebanese women and men during COVID-19, exploring gender differences and related factors, including burnout mitigation strategies.MethodsA cross-sectional survey included 423 adult participants aged 18 or older from Lebanon, recruited via online snowball sampling during July 2021 to August 2022. Utilizing the Maslach Burnout Inventory-General Survey (MBI-GS), participants reported exhaustion (≥ 12), cynicism (≥ 11), and low professional efficacy (≤ 21). Burnout was defined as exhaustion with either cynicism or low efficacy. The survey gathered demographic, family, and professional data, stressors, and burnout mitigation strategies. Analyses were gender-stratified, using descriptive statistics and Pearson’s chi-squared test. Bivariate associations between burnout indicators and sample characteristics were tested using Pearson’s chi-square. Odds ratios (OR) and adjusted ORs for burnout were estimated via logistic regressions.ResultsLebanese women experienced higher rates of burnout compared to men during the pandemic, with significant differences observed in emotional exhaustion (p = 0.006). Factors associated with burnout varied between genders, with women more likely to exhibit exhaustion when residing in the Beqaa, Mount or North Lebanon governorates, being single, having children aged 10–15 years, and most interestingly when lacking support from their boss/institution. Stressors such as the Lebanese economic crisis and the Beirut Port Explosion were significantly linked to burnout in both genders, with the economic crisis particularly associated with higher levels of exhaustion in men (p = 0.011) and cynicism in both genders (p = 0.001 for men, p = 0.039 for women). Coping strategies, including COVID-19 precautions, social activities, and religious practices, were effective in reducing burnout among both women and men who experienced burnout (p = 0.039 and 0.03, respectively).ConclusionThe study contributes to public health efforts, emphasizing the importance of recognizing gender dimensions in addressing burnout during the pandemic, designing targeted interventions and fostering supportive, inclusive environments for collective resilience namely for women at the workplace.

Context Hip fractures incur high morbidity and mortality. Data on secular trends in mortality from hip fractures and risk predictive models are scarce. Objective We aim to describe secular trends in 30-day mortality after hip fracture surgery from the 2011-2017 National Surgical Quality Improvement Program database, identify preoperative and on-discharge predictors of 30-day mortality, and develop risk calculators. Methods We calculated yearly proportions of deaths and examined survival using Kaplan-Meier curves. We implemented logistic regressions models, using SPSS and created calculators using Excel. Results In 84 824 cases of hip fracture surgery, the overall 30-day mortality was 6.8%. It decreased from 8.1% to 6.5% between 2011 and 2017 (P < .001). Significant preoperative predictors of 30-day mortality on admission were male gender, age, lower body mass index, White race, poorer functional health status, higher creatinine, lower hematocrit, >10% weight loss in the past 6 months, congestive heart failure within 30 days before surgery, and chronic obstructive pulmonary disease. Predictors on discharge included preoperative predictors with the exception of White race, hematocrit, and >10% weight loss in the past 6 months, and the addition of unplanned intubation, cerebrovascular accident, myocardial infarction, and pneumonia. The parsimonious preoperative risk calculator for mortality had 10 variables, an area under the curve (AUC) of 0.739, and a model fit R2 of 0.9716. The on-discharge calculator had 11 variables, an AUC of 0.800, and an R2 of 0.9924. Conclusion Thirty-day mortality after hip fracture surgery decreased significantly from 2011 to 2017. Readily available clinical risk factors predict mortality preoperatively and on discharge. While most predictors are nonmodifiable, the calculators may better inform clinical decision-making.

This study aimed to assess health literacy (HL) levels among inpatients and evaluate its association with health-related quality of life (HRQoL), antibiotic use and knowledge, health services need, adverse drug events (ADEs), and sociodemographic factors. The cross-sectional study was conducted at a major teaching hospital from October 2022 to April 2023, recruiting 135 inpatients aged 18 and older. Data were collected through face-to-face interviews using validated questionnaires including the HLS-EU-Q16 for HL and EQ-5D-5 L for HRQoL assessment. Results showed sufficient HL among 64.4% of the participants, which was associated with gender, marital status, and occupation. Patients with sufficient HL demonstrated higher HRQoL measures and better antibiotic knowledge. Those with insufficient HL were more likely to engage in risky medication practices and hold misconceptions about antibiotic use. No significant link was found between HL and healthcare utilization or ADEs. The findings underscore HL’s critical impact on inpatient healthcare outcomes. By integrating HL assessment into clinical practice and implementing targeted educational initiatives, particularly on antibiotic use, healthcare providers can empower patients to make informed decisions and enhance health outcomes.

Background Disease-related knowledge of people with multiple sclerosis (MS) can influence self-management, coping, treatment adherence, and clinical health outcomes. Studies assessing MS patients' knowledge are scarce. Objectives The aim of this study was to evaluate the awareness and knowledge of Lebanese MS patients regarding their disease and identify the factors associated with poor knowledge. Methods This cross-sectional, multicenter, survey-based study was conducted between June and September 2023 among Lebanese MS patients with confirmed diagnosis. MS knowledge was assessed using the validated MS knowledge questionnaire (MSKQ-25). Results A total of 350 patients were included. Most (92.3%) were diagnosed with relapsing-remitting MS, and 65.1% were female with a mean age of 39.4 ± 11.4 years. The mean MSKQ-25 score was 15.1 ± 3.9. The mean percentage of correct answers was 60.4% ± 15.9, with 65.1% scoring ≥60%. Multivariate analysis identified higher education (p=0.004) and residence in Beirut (p=0.025) as significant predictors of increased knowledge levels. Conclusion Lebanese MS patients demonstrated adequate disease knowledge. Higher education and residing in the capital Beirut were key contributors to improved knowledge.

This study investigates the occurrence of toxic metals in cornflakes marketed in Lebanon and the associated health risks from their consumption. Following a market screening, 21 stock-keeping units (SKUs) of cornflakes from different manufacturers and countries of origin were identified and collected across two production periods (n = 42). The samples were analyzed using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Arsenic (As), cadmium (Cd), chromium (Cr), mercury (Hg), and lead (Pb) were quantified and compared against both international and Lebanese regulatory standards. All samples exceeded international limits for Cr. Most samples surpassed permissible levels for Pb (73.8%) and Hg (76.2%), while a smaller proportion (19%) exceeded the limits of As. However, the concentrations of all toxic metals remained below the Lebanese national limits. The analysis indicated that the brand of the cornflakes did not exert a significant influence on metal concentrations (p ≥ 0.05), whereas statistically significant differences (p ≤ 0.05) were observed in the levels of Cr and Pb when comparing Lebanese to imported products. Estimated Daily Intake (EDI) and Hazard Quotient (HQ) calculations indicated no significant health risk for adults. Nevertheless, the frequent detection of contaminated samples and the increasing consumption of ready-to-eat cereals raise concerns about cumulative exposure, particularly among children. This research underscores the urgent need for updated national food safety regulations, strengthened food surveillance systems, and immediate public health interventions to reduce toxic metal exposure in the Lebanese population.

Our study investigates the presence of toxic metals in pet food stock keeping units (SKUs) marketed in Lebanon (n = 75) and the United Arab Emirates (UAE) (n = 121) using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The study quantified nine metals: chromium (Cr), cobalt (Co), copper (Cu), zinc (Zn), arsenic (As), molybdenum (Mo), cadmium (Cd), mercury (Hg), and lead (Pb). Dry pet food exhibited higher concentrations compared to wet pet food, particularly for Cu (30.302 mg kg-1 vs. 4.861 mg kg-1, p < 0.001), Zn (350.223 mg kg-1 vs. 35.965 mg kg-1, p < 0.001), and Pb (0.981 mg kg-1 vs. 0.421 mg kg-1, p < 0.039). This suggests that moisture content affects metal retention. Notably, Cd concentrations were higher in wet food (0.296 mg kg-1 vs. 0.102 mg kg-1, p < 0.045), indicating differential metal solubility and retention mechanisms. Cat food samples contained higher Cd levels than dog food (0.251 mg kg-1 vs. 0.112 mg kg-1), whereas Zn and Cu concentrations were significantly higher in dog food. Pb and As exceeded safety thresholds, raising concerns about contamination sources and health risks for pets. These findings highlight the need for stringent monitoring of toxic metals in pet food and further research into contamination sources and their potential health impacts for pets.

Traumatic brain injury (TBI) is the leading cause of death among trauma patients. Identifying preoperative factors that predict postoperative outcomes in such patients can guide surgical decision-making. The aim of this study was to develop a predictive model using preoperative variables that predicts 30-day mortality and morbidity in patients undergoing neurosurgery following TBI. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried between 2005 and 2017 for patients aged 18 years or older who underwent TBI-specific surgery. The primary outcome was 30-day mortality, and the secondary outcome was a composite morbidity score. Significant variables on univariate analysis with Chi-squared test were used to compute multivariable logistic regression models for both outcomes, and Hosmer-Lemeshow test was used. A total of 1634 patients met the inclusion criteria. Most patients were elderly aged >60 years (74.48%), male (63.59%), of White race (73.62%), and non-Hispanic ethnicity (82.44%). The overall 30-day mortality rate was 20.3%. Using multivariate logistic regression, 11 preoperative variables were significantly associated with 30-day mortality, including (aOR, 95% CI) age 70-79 years (3.38, 2.03-5.62) and age >80 years (7.70, 4.74-12.51), ventilator dependency (6.04, 4.21-8.67), receiving dialysis (4.97, 2.43-10.18), disseminated cancer (4.42, 1.50-13.0), and coma >24 hours (3.30, 1.40-7.80), among others. Similarly, 12 preoperative variables were found to be significantly associated with 30-day morbidity, including acute renal failure (7.10, 1.91-26.32), return to OR (3.82, 2.77-5.27), sepsis (3.27, 1.11-9.66), prior operation within 30 days (2.55, 1.06-4.95), and insulin-dependent diabetes (1.60, 1.06-2.40), among others. After constructing receiver operating characteristic curve, the model for mortality had an area under the curve (AUC) of 0.843, whereas composite morbidity had an AUC of 0.716. This model can aid in clinical decision-making for triaging patients based on prognosis in cases of mass casualty events.

Abstract Background Following the Beirut explosion, our university hospital received at least 350 casualties. Subsequently, infection control standard practices were compromised. Concerns for Multi-Drug Resistant Organisms (MDROs) infections in injured patients and a resulting hospital outbreak were raised. The objectives of the study were to compare the rate of hospital growing MDROs 6 months before and 6 months after the Beirut explosion, to identify emerging microorganisms and to evaluate the change in surgical infection prevention practices. Methods This is a retrospective chart review of patients with hospital acquired infections (HAI) admitted to the hospital before and after the Beirut explosion. The study was conducted between February 4, 2020 and January 4, 2021. Excluded patients were those transferred from other hospitals and those with community acquired infections. The primary outcome was to identify the rate of growing MDROs post explosion. The secondary outcomes were identifying antibiotics used for surgical prophylaxis in patients requiring surgeries and patients diagnosed with a HAI. Therefore, patients were divided in three groups. Control group included patients admitted with explosion-related injuries on that same day. Patients admitted and between February 4 and August 4 and diagnosed with HAI were compared to those admitted post August 4 with explosion-related HAI and to patients diagnosed with non-explosion-related HAI between August 4 and January 4, 2021. An estimated rate of 18-22% MDRO was needed to achieve a statistical significance with 80% power and 0.05 α. Pearson Chi square test was used to analyze the primary outcome. Results A total of 82 patients with 150 cultures were included in this study. Data showed an increase in the rate of MDRO after the explosion with 37.1% of the cultures taken before the explosion and 53.1% after the explosion (p = 0.05). When comparing the types of HAI in both groups, culture sites were significantly different between pre- and post-explosion patients (p = 0.013). However, both groups had similar types of microbes (p = 0.996) with an increase in candida related infections. Conclusion These findings confirmed that the Beirut explosion impact on antimicrobial resistance was similar to combat zone incidence, where an increase in MDROs rate such as Escherichia coli (E.Coli) and Stenotrophomonas maltophilia, in addition to the increase in candida related infections.

PURPOSE:Exposure to traumatic events may lead to the development of Acute Stress Disorder (ASD) within the first month post-trauma in some individuals, while others may not exhibit ASD symptoms. ASD was introduced as a potential early indicator to identify those at higher risk of developing Posttraumatic Stress Disorder (PTSD), however, PTSD can occur in some individuals even without prior ASD. Assessing ASD post-trauma can assist in identifying those who would most benefit from intervention to prevent later PTSD, yet the predictive power of ASD varies across studies, with intensity of ASD symptoms and subthreshold PTSD often less considered. METHODS:A prospective cohort study on 426 health workers exposed to the Beirut Port Blast assessed DSM-5 ASD and symptom intensity using self-report questionnaire at two distinct time points: 9-15 and 21-27 days post blast. DSM-5 PTSD was assessed afterwards at 6-7 months via self-report questionnaire post-exposure. Probit models predicted full and subthreshold PTSD. RESULTS:Using ASD diagnosis alone, the sensitivity 9-15 days after trauma was better than 21-27 days after trauma (75.68% vs. 58.06%); when stratified by intensity, however, sensitivity increased from 41.66% among those with low intensity to 92% among those with high intensity. Specificity, however, was better 21-27 days after trauma (77.82%) compared with 9-15 days (60.98%). Positive Predictive Value of ASD increased, and Negative Predictive Value decreased, with time since exposure and when adding intensity with diagnosis. ASD diagnosis plus intensity achieved better prediction of PTSD and subthreshold PTSD. CONCLUSION:Screening for PTSD should include ASD and its intensity, improving predictive ability for later PTSD, incorporatingfull threshold and subthreshold PTSD. Specificity increases with time since exposure, suggesting a high rate of false positives when assessing ASD soon after trauma. This highlights the need to prioritize individuals for early preventive measures after trauma.

Introduction: One strategy to mitigate progressive multifocal leukoencephalopathy (PML) risk is to switch to other highly effective disease-modifying therapies (DMTs). However, the optimal switch DMT following natalizumab (NTZ) discontinuation is yet to be determined. Objective: The objective of the study is to determine the most effective and tolerable DMTs to switch to following NTZ discontinuation due to John Cunningham virus (JCV) antibody positivity. Methods: This is a multicenter observational cohort study that included all stable relapsing-remitting multiple sclerosis (MS) patients who were treated with NTZ for at least 6 months before switching therapy due to JCV antibody positivity. Results: Of 321 patients, 255 switched from NTZ to rituximab/ocrelizumab, 52 to fingolimod, and 14 to alemtuzumab, with higher annualized relapse rate (ARR) in fingolimod switchers (0.193) compared with rituximab/ocrelizumab or alemtuzumab (0.028 and 0.032, respectively). Fingolimod switchers also had increased disability progression (p = 0.014) and a higher proportion developed magnetic resonance imaging (MRI) lesions compared with rituximab/ocrelizumab (62.9% vs. 13.0%, p < 0.001, and 66.6% vs. 24.0%, p < 0.001, respectively). Mean drug survival favored rituximab/ocrelizumab or alemtuzumab over fingolimod (p < 0.001). Conclusion: Our study shows superior effectiveness of rituximab/ocrelizumab and alemtuzumab compared with fingolimod in stable patients switching from NTZ due to JC virus antibody positivity.

Examining the microbiological characteristics of pet food is imperative to safeguard the health and well-being of companion animals, pet owners, and the surrounding environment. Domestic animals, known for carrying harmful microorganisms, pose a significant health risk, especially in close proximity to people and children. Notably, no studies have previously investigated pet food quality in the Gulf Cooperation Council countries, in particular, the United Arab Emirates (UAE). This study examined the microbiological quality of all stock keeping units (SKUs) of pet foods marketed in UAE (n = 118). Parameters assessed include Total Aerobic Microbial Count (TAMC), Enterobacteriaceae, Total Yeast and Mold Count (TYMC), Salmonella, Listeria monocytogenes, and Clostridium species. Among the 118 samples, 33 (28%) exceeded the acceptable TAMC limit of 106 CFU/g, highlighting significant variations based on manufacturers and ingredients. Eight samples (7%) surpassed the maximum Enterobacteriaceae limit of 3 × 102 CFU/g. TYMC levels exhibited variation, with 33 (28%) exceeding the limit of 104 CFU/g. L. monocytogenes was identified in 44 (37%) of the samples, while Salmonella was not detected. Clostridium contamination was observed in 28 (24%) of the samples. Statistical analyses revealed associations between pet food characteristics and microbial quality, underscoring the imperative for international standards to ensure the safety of pet food. These findings carry significant implications for pet owners, regulatory bodies, and the pet food industry, emphasizing the need for ongoing efforts to enhance the overall quality and safety of pet food products.