Hotel-Dieu De France Hospital Research Articles

Management of the 4th of August explosion in an orthopedics department

Abstract Mass casualty incidents (MCI) are rare, large-scale events that result in heavy damage to people and infrastructure. These types of incidents result in a high influx of patients in local hospitals. In Beirut, this was witnessed on the 4th of August. A massive explosion took place in Lebanon’s capital city Beirut. Although Hotel-Dieu de France Hospital was damaged, it played a crucial role in the management of numerous injured, especially in the orthopedics department. Six months later, the hospital contacted all patients that had been hospitalized during that night and the following 2 days for musculoskeletal injuries. The contact was done for feedback purposes as the event was considered one of the largest non-nuclear explosions in international history. Accordingly, most of the patients that were contacted gave a credible and positive rating. There were few who had suggestions for management improvement. MCIs are rare, but it is crucial to be prepared to face any edging situation. Having effective communication and an organized plan in any risk management process are essential tools to foster for the well of the community and to scale down the losses of the locals in the area.

Genetic susceptibility of bladder cancer in the Lebanese population

BackgroundBladder cancer (BC) is the 10th most frequent tumor worldwide. Evidence shows an association between elevated risk of BC and various single nucleotide polymorphisms (SNP). BC incidence was the highest in Lebanon according to Globocan 2018 report, but little is known about the genetic susceptibility of Lebanese people to this disease. We aim to evaluate whether this prominent incidence of BC in Lebanon is attributable to known coding genetic variants.MethodsA case-control study was conducted at Hotel-Dieu de France Hospital, Beirut. A cohort of 51 Lebanese patients with BC were recruited between 2017 and 2020. Whole Exome Sequencing (WES) was performed on peripheral blood samples to detect coding genetic variants in the patients. An in-house database including WES data from 472 Lebanese individuals served as control. Literature review of the genetic predisposition to BC was conducted to establish a database of variants known to influence the risk of BC. In-common SNPs were identified between cases and the aforecited database, and their allelic frequencies was quantified in the former and in controls. Comparative analysis of the allelic frequencies of each in-common SNP was carried out between cases, controls, and the genome aggregation database (gnomAD). Analysis was performed by applying the binomial law and setting the p-value to 10− 10.Results484 polymorphisms associated with BC were extracted from the literature review ;151 of which were in-common with the 206 939 variations detected by WES in our cases. Statistically significant differences (p-value < 10− 10) in allelic frequencies was seen in 11 of the 151 in-common SNPs, but none of which corresponds with a higher BC risk. Moreover, rs4986782 variant in the NAT1 gene is not associated with BC in the Lebanese population. `.ConclusionThis is the first next-generation sequencing (NGS)- based study investigating BC risk in a Lebanese cohort of 51 patients. The majority of known exonic variants in the literature were not associated with BC in our patients. Further studies with larger sample sizes are warranted to explore the association of BC in our population with known non-coding genetic variants, and the remainder of WES-generated private Lebanese variants.

Validation of an Arabic version of the Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome.

To validate an Arabic version of the short form of the Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome (CH-RLSq13). The Arabic version was created using a standard forward-backward translation method. A pre-final Arabic version was administered with the original English version to a group of bilingual subjects as a pretest. The inter-rater agreement between these two versions was measured. A finalized Arabic version was obtained. For the validation, the Arabic version of the CH-RLSq13 was administered to Lebanese subjects, above 18years old, selected upon a clinical interview. The diagnosis provided by the Arabic version of the CH-RLSq13 was compared to the clinical diagnosis made by a neurologist at Hotel-Dieu de France hospital. Inter-rater agreement was assessed using Cohen's kappa coefficient. Sensitivity, specificity, and positive and negative predictive values of the translated questionnaire were calculated. Inter-rater agreement, between the 2 versions, for the entire questionnaire, was excellent (κ = 0.950). All items showed a substantial level of agreement between the two versions. In the validation process, 91 participants were included (17 patients diagnosed with RLS and 74 control subjects). The mean age was 40years, with female predominance. The final Arabic version of the CH-RLSq13 had a sensitivity of 71%, a specificity of 100%, and with negative and positive predictive values of 94% and 100% respectively. The Arabic version of the CH-RLSq13 is a reliable tool for the screening and diagnosis of RLS in Lebanese and Arabic-speaking populations.

Critical Care Nurses' Experiences During the Illness of Family Members: A Qualitative Study.

IntroductionA loved one's hospitalization in a critical care unit is a traumatic experience for families. However, because of their status and professional competence, a family member who is also a critical care nurse has additional obstacles and often long-term consequences.ObjectivesTo describe the experiences of critical care nurse-family members when a loved one is admitted to a critical care unit at the Hotel-Dieu de France hospital.MethodsA qualitative path based on van Manen's hermeneutic phenomenology combining both descriptive and interpretive models were adopted.ResultsThe lived experience of critical care nurses in providing care for their family members admitted into the same critical care were summarized in five themes. Nurses were torn between roles, consisting of confounding roles, their registered nurse status, and watchfulness. The lived experience of critical care nurses in providing care for their family members admitted into the same critical care was summarized into specialized knowledge that included a double-edged sword of seeking information and difficulty delivering the information. Critical nurses compete for expectations, including those placed on self and family members, resulting in emotional and personal sacrifice while gaining insight into the experiences.ConclusionsCritical care nurse-family members have a unique experience compared to the rest of the family, necessitating specialized care and attention. Increased awareness among healthcare providers could be a start in the right direction.

CML-296: First-Line Treatment Outcomes of CML Patients in a Real-World Data Setting in Lebanon

Context: BCR–ABL-targeting tyrosine kinase inhibitors (TKIs) constitute the cornerstone of treatment for CML, leading to a life expectancy that is currently very close to that of age-matched individuals in the general population. Objective: To describe aspects of CML in a real-world data setting in Lebanon, including responses to first-line treatment with the first-generation TKI imatinib compared to those with the second-generation TKIs dasatinib and nilotinib. To evaluate the proportion of patients eligible for an attempt to stop TKI treatment. Design: Medical charts of patients diagnosed with CML between 2003 and 2019 were reviewed and updated in January 2020. Settings: Lebanese patients from two university medical centers in Beirut, Mount Lebanon Hospital and Hotel-Dieu de France Hospital, were included. Patients: The registry covered 70 patients, of which 54 patients were included. Inclusion criteria were patients older than 18 years, confirmed diagnosis with CML based on BCR-ABL PCR, and available follow-up data in the clinical chart for at least 2 years. Outcomes: Major and deep molecular responses were based on BCR-ABL1 levels; time of attaining these responses and duration of sustained responses were measured. The reason for switching to another TKI was noted (‘treatment failure’ or ‘intolerance’). Eligibility criteria for an attempt to stop TKI were based on the EURO-SKI trial. Modality of Treatment: Imatinib was given at a dose of 400 mg once daily, nilotinib 300 mg twice daily, and dasatinib 100 mg once daily. Results: 70% of patients were treated with imatinib and 30% with a second-generation TKI. 14% of patients discontinued their first-line treatment, mainly due to intolerance (10%) or treatment failure (5%). At 24 months, deep molecular response (MR4.0 and MR4.5) was achieved, at 15.3% and 40.3%, respectively, for imatinib, and 22% and 33.5%, respectively, for second-generation (p=1). The 5-year cumulative incidence of eligibility for TKI cessation attempt was 37%. Conclusion: We report the experience in CML from two health care institutions in Beirut, Lebanon. There was no statistically significant difference in response between the first- and second-generation TKIs. The criteria for an attempt to stop TKI therapy were met by one-third of patients.

Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage.

Musculoskeletal disorders remain a major problem in hemodialysis patients. The aim of the study was to estimate the prevalence of musculoskeletal manifestations in hemodialysis patients and identify disease cluster profiles. We performed a cross-sectional study including all adult patients in the hemodialysis unit at Hotel-Dieu de France Hospital. We collected demographic characteristics, musculoskeletal symptoms, biologic parameters, and treatments. Musculoskeletal disorders were classified by a rheumatologist into predefined diagnostic categories. Prevalence was presented, and a cluster analysis was performed. Eighty-nine patients were included, mean age was 67.5 ± 12years, and 43.8% were female. Dialysis vintage was 5.7 ± 5.37years. Musculoskeletal symptoms were reported by 76.4% of the patients. Pain was the most frequent symptom (44.9%). The main diagnoses were osteoarthritis (53.9%) and fracture (27%). Musculoskeletal symptoms and disorders were significantly associated with dialysis vintage and age. Cluster analysis identified three patient profiles: younger with low calcium levels, younger but long dialysis vintage with osteoarthritis and carpal tunnel syndrome, and older with long dialysis vintage and fractures. The prevalence of musculoskeletal manifestations is high in the hemodialysis population and increases with dialysis vintage. Musculoskeletal disorders cluster according to age and dialysis vintage. Key Points• Musculoskeletal symptoms are highly prevalent among hemodialysis patients (76.4%).• All musculoskeletal disorders are associated with dialysis vintage and age.• Three clusters are identified among hemodialysis patients: young with low calcium levels, young but long dialysis vintage with osteoarthritis and carpal tunnel syndrome and old with long dialysis vintage with fractures.

Seizures in Cancer Patients: a Vast Spectrum of Etiologies

Aim: This study aims to recognize the distribution of different seizures etiologies in cancer patients, the most common primary tumors responsible for brain metastases, the most epileptogenic primary tumors and the therapeutic modalities. Methods: A retrospective study was conducted at Hotel-Dieu de France Hospital targeting patients admitted to hematology–oncology department between 2005 and 2016 who presented a seizure. Results: Of the 153 included patients, mean age was 57 years (standard deviation = 16 years) and a male predominance (66%). The majority of seizures were due to a primary tumor (49%) or brain metastases (32%). Other reversible (metabolic and drug) or nonreversible causes (carcinomatous meningitis, radiation and cardiovascular complications) formed the remaining causes. Regarding antiepileptic treatments, sodium valproate was mostly used, followed by levetiracetam and phenytoin. Conclusion: Numerous reversible causes are involved in the onset of epileptic seizures, including metabolic disorders, antibiotics and chemotherapies.

Chronic urticaria in most patients is poorly controlled. Results of the development, validation, and real life application of the arabic urticaria control test.

Objectives:To translate and linguistically validate the urticaria control test (UCT) to/for Arabic speakers. No Arabic version of the UCT is available to assess disease control in patients with chronic urticaria (CU). Secondary objectives were to assess disease control in Lebanese CU patients and determine influence factors.Methods:This is a prospective observational study of 178 CU patients diagnosed during their first visit to a private Allergy/Immunology Clinic, Hotel Dieu de France Hospital, Beirut, Lebanon between January and December 2014.Results:Factor analysis showed that all 4 UCT items on the Arabic version converged over a solution of one factor. A high internal consistency was found with a Cronbach’s alpha of 0.824. Most patients in this study had chronic spontaneous urticaria (96%), of which 19% also had inducible urticaria. The majority was <40 years (67.4%), with disease duration of <2 years (70.8%). Most patients used H1-antihistamines, but unfortunately, 34.3% used systemic glucocorticosteroids, of which 24.7% also used H1-antihistamines. The disease was poorly controlled in most patients (79.2%, UCT <12). Age, gender, duration, diagnosis, triggers, and/or history of atopy had no influence.Conclusion:We developed the first linguistically validated Arabic UCT to improve CU management in Arabic speaking patients. We also found that disease control was poor in most CU patients, and is unaffected by age, disease duration, gender, subtype, triggers, history of atopy, and/or previous treatments.

Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution.

Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured.

Primary neuroendocrine tumors of the ear, nose and throat: A report of three cases and a review of the literature.

The aim of the present study was to review all cases of neuroendocrine tumors of the ear, nose and throat in a tertiary care center, as well as the data published in the literature. The study presents all the cases of neuroendocrine tumors (NETs) in the Hotel Dieu De France Hospital (Beirut, Lebanon) between January 2004 and January 2014. The data reported in the English and French literature is also reviewed with regard to the typical clinical presentation and management of these tumors. Three cases of NETs presented to the Department of Otolaryngology-Head and Neck Surgery during the study period. One case was of an atypical carcinoid (AC) tumor of the larynx, one case was of a typical carcinoid tumor in the middle ear and the third case was, to the best of our knowledge, the first reported case of an AC tumor of the nasopharynx. Overall, NETs are rare in the head and neck. The clinical presentation can mimic any other tumor in the same localization in the absence of a carcinoid syndrome. Management of these tumors remains controversial, but a complete excision of the tumor is crucial, followed by possible adjuvant treatment.

Experience of morning reports in the emergency department

Morning report in the emergency medicine departments is an emerging teaching modality in the medicine curriculum. Our institution, Hotel-Dieu de France hospital, a multidisciplinary tertiary care university hospital affiliated to the Saint Joseph University of Medical Sciences, is the only hospital in Middle East to hold morning reports in the emergency department (ED). We evaluate the usefulness of the morning report as a pedagogic tool as it assesses the content, quality of the discussions, professionalism, leadership, participation and duration of the morning report. The particularity of this paper is that it takes into consideration the interns' input often under-recognised in the studies. An anonymous questionnaire was diffused to the residents and interns that rotated in the ED during the previous year. It consisted of seven multiple-choice questions to evaluate the quality of the presentations, targeted discussions, ethics and professionalism, evidence-based medicine, clinical reasoning, relation of cases to discussions and implication of the ED physician. Overall, of the 63 patients who answered the survey, 65.1% were satisfied by the content. The majority considered the quality of the discussions acceptable and the leadership and participation satisfactory, professionalism was judged poor. Both residents and interns were satisfied of the teaching point of the morning reports. The only fail back observed was professionalism and pathophysiological discussions that require to be added to the sessions, whereas clinical management, teaching points, leadership and time management were completely satisfactory.

Distribution of testicular tumors in Lebanon: a single institution overview.

Testicular tumors constitute a rare type of cancer affecting adolescents and young adults with recent reports confirming an increase in incidence worldwide. The purpose of this study was to estimate the epidemiological characteristics and histological subtypes of testicular tumors in the Lebanese population according to the WHO classification of testicular and paratesticular tumors. In this single institutional retrospective study, all patients diagnosed with a testicular tumor in Hotel-Dieu de France Hospital University in Beirut between 1992 and 2014 were enrolled. The age, subtype based on the 2004 WHO classification and body side of tumor were analyzed. A total of two hundred and forty-four (244) patients diagnosed with a testicular tumor in our institution were included in the study. Two hundred and one patients (82.4% of all testicular tumors) had germ cell tumors (TGCT). Among TGCT, 50% were seminomatous tumors, 48% non-seminomatous tumors (NST) and 2% were spermatocytic seminomas. The NST were further divided into mixed germ cell tumors (63.9%), embryonic carcinomas (18.6%), teratomas (15.4%) and yolk sac tumors (2.1%). The mean age for testicular tumors was 32 years. The mean age for germ cell tumors was 31 years and further subtypes such as seminomatous tumors had a mean age of 34 years, 28 years in non-seminomatous tumors and 56 years in spermatocytic seminoma. Patients with right testicular tumor were the predominant group with 55% of patients. Three patients (1.2%) presented with bilateral tumors. The distribution of different subgroups and the mean age for testicular tumors proved comparable to most countries of the world except for some Asian countries. Germ cell tumors are the most common subtype of testicular tumors with seminomatous tumors being slightly more prevalent than non-seminomatous tumors in Lebanese patients.

Characteristics of incident female breast cancer in Lebanon, 1990–2013: Descriptive study of 612 cases from a hospital tumor registry

Despite the fact that breast cancer is a major health issue, very few studies describe its characteristics in the Arab world or the Middle East, particularly in Lebanon. We report in this article a retrospective pilot study of the characteristics of breast cancer in Lebanon. The pathological characteristics of 624 patients diagnosed between 1990 and 2013 randomly chosen from the archives of an oncology clinic affiliated to Hotel Dieu de France Hospital are analyzed. The mean age at diagnosis is 54.6±13.4 years with 43% diagnosed before the age of 50 years. The infiltrative ductal carcinoma represents the major pathological subtype. One third of the tumors had a size of more than 2cm at diagnosis. Estrogen-receptors are positive in more than 50% of our patients and Her2-neu is overexpresssed in 30%. Luminal A represents 45.5% and the triple negative subgroup constitutes only 8.3%. Breast cancer in Lebanon is evolving to a more indolent disease. Therefore, public awareness and institution of screening programs are required. These programs should be based on national epidemiological data and necessitate the activation of the national cancer registry.

Epidemiological Study of Thyroid Pathology in a University Hospital

Objectives: The incidence of papillary thyroid carcinoma increased in several countries. The purpose of this study was to quantify the changes in thyroid carcinomas in our University Hospital. Study Design: Retrospective study.Methods: All 1.927 thyroidectomy cases studied in the Pathology Department of Hotel-Dieu de France Hospital (Beirut, Lebanon), between 2003 and 2013, were included.Results : The Female/Male Sex Ratio of the studied population was 3.7/1. The mean age of female patients was significantly lower than that of male patients. The most frequent diagnoses were multinodular goiter (78%) and papillary carcinoma (26%). 337 cases had a single lesion on gross examination. 21 of them were diagnosed with follicular carcinoma and 59 with follicular adenoma. A statistically significant correlation was found between the unicity of the lesion on gross examination and the final diagnosis of a follicular neoplasm. Thyroid carcinoma was multifocal in 33% of the cases and bilateral in 24%. A statistically significant increase in thyroid carcinoma proportion (from 15% in 2003 to 44% in 2013) was found. Among all thyroid carcinomas, the proportion of papillary type increased from 65% in 2003 to 94% in 2013; this increase remained statistically significant after the exclusion of papillary micro-carcinomas, whose proportion was stable throughout the 11 years.Conclusions : In this study, we noted a statistically significant increase in the frequency of thyroid carcinoma, especially of the papillary type. The unicity of the lesion on gross examination is significantly associated with a follicular neoplasm.

High-dose sublingual immunotherapy in patients with uncontrolled allergic rhinitis sensitized to pollen: a real-life clinical study.

High-dose pollen sublingual immunotherapy (SLIT) is indicated in patients with moderate to severe allergic rhinitis (AR), especially those who are unable to control their disease with pharmacotherapy. We explore the use of high-dose SLIT in patients with severe AR and sensitized to pollen, in real-life clinical practice. We also analyzed the effect on asthma. This was a prospective observational study conducted at the Allergy outpatient clinic at Hotel Dieu de France Hospital (HDF), Beirut, Lebanon. The cohort, composed of 118 patients between 7 and 55 years old, was regularly evaluated at inclusion, at 12 months, and at 36 months. Fifty-five percent of AR patients had associated controlled asthma. Patients received a standardized pollen extract (Staloral 300IR). The pollen combination was 1 to 3 pollens, the most commonly used were Parietaria judaica, Cupressaceae, 5grasses, and Oleaceae. In a previous study, those were the main allergenic pollens correlated to AR in the same population. Global assessment of the effect of SLIT was measured using a rhinitis total symptom score (RTSS), a rhinitis medication consumption score (RMCS), a global asthma score (ASS), and an asthma medication consumption score (AMCS). Using a t test we found that the average scores at inclusion, 12 months, and 36 months, respectively, were as follows: RTSS: 31.32, 16.39 (p < 0.041), and 13.35 (p < 0.041); RMCS: 6.96, 1.96 (p < 0.0162), and 1.61 (p < 0.0162); ASS: 4.62, 1.96 (p < 0.0005), and 1.33 (p < 0.0005); and AMCS: 2.35, 0.78 (p < 0.0005), and 0.7 (p < 0.0005). Our study showed favorable results of SLIT to aeroallergens in patients with uncontrolled AR. The effect is also applicable to the subgroup of patients suffering from concomitant, controlled asthma.

Open Reduction with Internal Fixation of Proximal Humeral Fractures with Plates: Results of 20 Operated Patients

Introduction: This study evaluates the functional and radiological results of surgical treatment with plate and screws of proximal humeral fractures focusing on short and longterm complications. Materials and Methods: This retrospective study was conducted at Hotel Dieu de France Hospital in Beirut. Inclusion criteria were: (1) Age >18 years old and (2) proximal humeral fracture operated on with the use of a plate (DCP (Dynamic compression plate) or LCP (Locking compression plate). Only 45 patients met these criteria since more than 70% of patients operated on were treated by other methods or dead. 20 patients presented to last follow up. Data collection included: Fracture type (using 2 classification: Codman/Neer and Hertel), early complications (infection, implant failure, stress riser fracture...), functional evaluation of the patient (using the “simple shoulder test”), and late complications (necrosis of the humeral head (NHH), malunion, osteoarthritis...) evaluated on x-rays by 2 independent physicians. Results: Analysis of the 20 patients revealed 9 males and 11 females; with the mean age of 68 years and a mean follow up of 45 months. The most frequent type (60%) was a three-part fracture involving the great tuberosity. A standard 3,5 plate was used in 6 patients and a proximal humeral locking plate in 14, through a deltopectoral approach. Original Research Article British Journal of Medicine & Medical Research, 4(14): 2750-2756, 2014 2751 There was neither early superficial nor deep infection. No vascular or neurological complications were noted. Mean SST score was 9.95. No differences between DCP and LCP fixation was noted (P=.27). Fixing tuberosities was not correlated with the SST (Simple Shoulder Test) score (P=.73). Latest x-ray evaluation showed 4 NHH. No correlation was found between functional outcome and the development of NHH (P=.18). Malunion was found in 6 patients (3 varus, 3 valgus). Perforation of the articular surface from long screws was noted in 3 patients. Intraarticular screw had no effect on functional outcome (P=.3). Conclusion: With a careful preoperative patient’s selection and a good surgical technique, ORIF with both conventional and locking plates gives satisfactory functional results. AVN of the humeral head, when present, does not affect the shoulder’s function.

Anxiety, Depression and Suicidal Ideation in Lebanese Patients Undergoing Hemodialysis

Anxiety, depression and suicidal thoughts are highly prevalent comorbidities of end-stage-renal-disease (ESRD). There are no studies in Lebanon on the prevalence of these symptoms in Lebanese end-stage-renal-disease patients. Moreover, the association between ESRD on one hand, and anxiety, depression and suicidal ideation on the other has never been established in Lebanon. Groups of patients at a high-risk of development of these symptoms are not determined. The Hospital Anxiety and Depression Score and M.I.N.I (module C) were used to measure the prevalence of anxiety, depression and suicidal ideation in 51 patients from the dialysis center of Hotel-Dieu de France Hospital in Lebanon. In our sample, 45% of included patients suffered from symptoms of anxiety and 50% presented symptoms of depression.The prevalence of suicidal ideation as detected by the M.I.N.I. is at 37%. No patients presented with a high risk of suicide. There was a statistically significant correlation between the existence of organic comorbidities and the presence of symptoms of depression and suicidal ideation. As for anxiety, the association was marginally significant. The results obtained by our study are consistent with those found in studies performed in other societies. The profile of depression- and suicidal ideation-prone patients has been determined. It consists of patients with at least one medical comorbidity to the ESRD. This, in turn, should lead to increased awareness and better treatment of these psychiatric ailments, considering their impact on morbidity and mortality in ESRD.

The Immunoglobulin Diagnosis, Evaluation, and Key Learnings (IDEaL) Patient Registry: An Initial Two-Year Data Survey From a Longitudinal Registry of Patients On Immunoglobulin Replacement Therapy in an Alternate Care Setting

FEBRUARY 2013 AB36 Abstracts S A T U R D A Y 131 The Hygiene Hypothesis : Aeroallergen Sensitization in Allergic Rhinitis Patients Living in Rural and Urban Areas of Lebanon Carla Irani, MD, FAAAAI, Maya Mouzannar; Hotel Dieu de France hospital, Beirut, Lebanon, University of Alberta, Edmonton, Canada. RATIONALE: The hygiene hypothesis suggests that in some rural areas,overcrowding, unhygienic conditions and larger family size were associated with a lower prevalence of allergic rhinitis and asthma. The primary objective of this study is to compare aeroallergen sensitization in patients with allergic rhinitis living in urban Beirut, and rural South of Lebanon. METHODS: It is a retrospective study observational, multivarite of allergic rhinitis patients treated between 2002 and 2010 in Beirut and the South of Lebanon. One hundred patients of each area were included in the study. RESULTS: 200 patients divided in two equal groupswere evaluatedwith a sex-ratio 1-1. Mean age of allergic rhinitis patients was 14,2 years in the South of Lebanon, and 23.4 years in Beirut. The 2 groups were statistically equivalent concerning tobacco exposure, exposure to dust mites and antibiotic intake in childhood. Patients with allergic rhinitis living in Beirut were more sensitized to pollen with a significant p50.036. There was no significant difference regarding sensitization to dust mites although the number was higher for those living in Beirut. CONCLUSIONS: Differences in the prevalence of allergic disease between urban and rural areas have been observed in many parts of the world. Our study, the first of its kind in Lebanon, showed pollen sensitization to be higher in urban than rural areas. Therewas no significant difference regarding dust mites sensitization in both groups, maybe due to environmental factors or lower age. Asthma prevalence was similar in both groups.

Chronic obstructive pulmonary disease prevalence in Lebanon: a cross-sectional descriptive study

BackgroundChronic obstructive pulmonary disease (COPD) continues to increase worldwide. The objective of this study was to determine the prevalence of COPD in Lebanese adults.MethodsA cross-sectional study was carried out using a multistage cluster sample from all over Lebanon. Residents aged 40 years and over were enrolled. Subjects underwent baseline spirometry and answered a questionnaire. After an albuterol + ipratropium bromide bronchodilator, a posttest was performed.ResultsOf 2201 individuals, only 33.3% had never smoked. The prevalence of COPD by the Global Initiative for Chronic Obstructive Lung Disease definition, was 9.7% (95% confidence interval [CI]: 8.5%–10.9%). According to the 5% lower limit of normal definition of COPD, the prevalence was 12.5% (95% CI: 11.2%–13.9%). A total of 20.2% were already diagnosed by a physician. No differences in symptoms across stages of COPD were found, but there was a significant trend for a higher number of visits to the emergency room and to the doctor (P < 0.001), and a higher number of hospitalizations (P < 0.001). Older individuals had an increased risk of COPD (adjusted odds ratio [ORa] = 1.05); so did “ever” cigarette smokers (ORa = 4.88) and water-pipe smokers (ORa = 2.53).ConclusionThis is the first epidemiological study in Lebanon that determined COPD prevalence and the link with water-pipe smoking.

A 5-year survey of biopsy proven kidney diseases in Lebanon: significant variation in prevalence of primary glomerular diseases by age, population structure and consanguinity

Differences in epidemiology of kidney disease across the Middle East may arise from variations in indication for biopsy, environmental exposure and socio-economic status. The Lebanese population is composed of different ethnicities, with distinct ancestry and religion, enabling comparison of their effect on the prevalence of kidney disease within a confined geographic setting and uniform practices. Here we report 5 years' detailed epidemiology of renal diseases, based on histological diagnosis, in a sample from three large pathology centres in Lebanon. Records of renal biopsies analysed at the American University of Beirut Medical Center, Hotel Dieu de France Hospital and the Institut National de Pathologie from January 2003 till December 2007 were retrospectively examined. We recorded the following data for each patient: age, gender, indication for renal biopsy and histopathological diagnosis. Religious affiliation and parents' consanguinity were recorded when feasible. The mean age at renal biopsy was 36.76 ± 20 years (range 1-84). The most common diagnosis was mesangioproliferative glomerulonephritis (GN; 20%), followed by focal segmental glomerulosclerosis (13.2%). While there were no differences in age, gender or indications for biopsy among different religious affiliations, mesangioproliferative GN was significantly more frequent among Muslims (P = 0.039) and offspring of consanguineous unions (P = 0.036). On the other hand, focal segmental glomerulosclerosis was most prevalent in Christians (P < 0.001). Variation in the distribution of diagnoses between Muslim and Christian groups likely reflects differences in population structure and ancestry. In particular, the increased prevalence of mesangioproliferative GN among offspring of consanguineous unions in Muslims suggests a recessive genetic component to this disease which may be identified via homozygosity mapping. These findings have important implications for formulating renal health policies and designing research studies in this population.