Lebanese Family Research Articles

The Spectrum of β-Thalassemia Mutations in the Population Migration in Lebanon: A 6-Year Retrospective Study

β-Thalassemia (β-thal) is highly prevalent among the Mediterranean populations. In Lebanon, the carrier rate of the disease is estimated to be around 2.0–3.0%. In this retrospective study, we determined the spectrum of β-thal mutations in a total of 170 individuals from a sample of 140 Lebanese, Iraqi and Syrian refugee families in Lebanon, over a period from 2012 to 2018. Twenty-eight different β-globin gene mutations were identified. The most prevalent mutations were IVS-I-110 (G>A) (HBB: c.93-21G>A), IVS-II-1 (G>A) (HBB: c.315+1G>A), IVS-I-6 (T>C) (HBB: c.92+6T>C) and IVS-I-1 (G>A) (HBB: c.92+1G>A), accounting for the majority of mutations found in HBB mutations analysed in 250 alleles. Ten different β-globin gene mutations that were not previously described in Lebanon were identified in our study. These mutations include the IVS-II-848 (C>A) (HBB: c.316–3C>A), codons 9/10 (+T) (HBB: c.30_31insT), codon 15 (–T) (HBB: c.46delT), −86 (C>G) (HBB: c.-136C>G), Cap +22 (G>A) (HBB: c.-29G>A), −28 (A>C) (HBB: c.−78A>C), codon 7 (GAG>TAG) (HBB: c.22G>T), codon 26 (GAG>TAG) (HBB: c.79G>T), codons 41/42 (–TTCT) (HBB: c.126_129delCTTT), and codons 82/83 (–G) (HBB: c.250delG). Of these, six mutations [codons 9/10, codon 15 (–T), −86, codon 7, codon 26, codons 82/83) were identified in Lebanese samples only; one mutation (IVS-II-848) was identified in both Lebanese and Iraqis; and three mutations (Cap +22, −28, codons 41/42) were identified in Iraqi samples only. Further studies will help better delineate the spectrum of β-thal mutations among different ethnic groups, and provide crucial prevention strategies.

Family business, strategic planning and corporate entrepreneurship

The aim of this paper is to examine whether willingness to change, generational involvement, perceived technological opportunities, and competitive aggressiveness, in addition to strategic planning, affect the corporate entrepreneurship of family firms in Lebanon. Using a sample of 85 Lebanese family firms, our results suggest that family-business-related characteristics and strategic planning have a positive relationship with corporate entrepreneurship. Our study provides important insights to regulators and practitioners interested in enhancing governance practices in family firms in Lebanon based on the impact of family-business-related characteristics and strategic planning on corporate entrepreneurship. More importantly, our paper helps understand how corporate entrepreneurship in a Middle Eastern country can be affected by willingness to change, generational involvement, perceived technological opportunities, and competitive aggressiveness.

A homozygous stop gain mutation in BOD1 gene in a Lebanese patient with syndromic intellectual disability.

Intellectual disability (ID) is a neurodevelopmental disorder characterized by limitations in both intellectual and behavioral functioning. It can occur in non-syndromic and syndromic forms involving multiple organs. While the majority of genetic variants linked to ID are de novo, inherited variants are also detected in some forms. Here, we report a consanguineous Lebanese family presenting with an autosomal recessive syndromic ID characterized by neurodevelopmental delay, mild dysmorphic features, hearing impairment and endocrine dysfunction. Whole exome sequencing enabled the detection of the homozygous nonsense mutation in BOD1, p.R151X, in the proband. BOD1 is required for chromosomes biorientation during cell division. It also contributes to the regulation of cell survival and to the modulation of fatty acid metabolism. Another nonsense mutation in BOD1 was linked to ID in a consanguineous Iranian family. This is the second report of BOD1 mutations in humans and the first in a syndromic ID including gonadal dysfunction and high-frequency hearing impairment. Our findings confirm the involvement of BOD1 in cognitive functioning and expand the clinical spectrum of BOD1 deficiency.

A novel TRAF3IP2 variant causing familial scarring alopecia with mixed features of discoid lupus erythematosus and folliculitis decalvans.

Discoid lupus erythematosus (DLE) is an autoimmune disorder with a poorly defined etiology. Despite epidemiologic gender and ethnic biases, a clear genetic basis for DLE remains elusive. In this study, we used exome and RNA sequencing technologies to characterize a consanguineous Lebanese family with four affected individuals who presented with classical scalp DLE and generalized folliculitis. Our results unraveled a novel biallelic variant c.1313C > A leading to a missense substitution p.(Thr438Asn) in TRAF3IP2(NM_147200.3). Expression studies in cultured cells revealed mis-localization of the mutated protein. Functional characterization of the mutated protein showed significant reduction in the physical interaction with the interleukin 17-A receptor (IL17RA), while interaction with TRAF6 was unaffected. By conducting a differential genome-wide transcriptomics analysis between affected and non-affected individuals, we showed that the hair follicle differentiation pathway is drastically suppressed, whereas cytokine and inflammation responses are significantly upregulated. Furthermore, our results were highly concordant with molecular signatures in patients with DLE from a public dataset. In conclusion, this is the first report on a new putative role for TRAF3IP2 in the etiology of DLE. The identified molecular features associated with this gene could pave the way for better DLE-targeted treatment.

Aesthetic Anxieties in the Migrant House: The Case of the Lebanese in Australia

ABSTRACT Migrants’ houses not only offer shelter and a setting for everyday life, but a platform from which to maintain a migrant identity. Migrants’ efforts to express their culture can be reflected in the appearance of their houses, where aesthetic differences spark “aesthetic anxieties” towards an ethnic-looking artefact from non-migrant neighbours. In this paper, we extend the category of “aesthetic anxieties” to include the migrants’ own experiences within their Australian houses, rather than the reactions of mainstream society. The settings provoking such anxieties are often not visible from the street but are experienced by migrants within the house in response to a lack of housing diversity to accommodate their cultural needs. This study aims to provide insights into the experience of Lebanese migrants in Australian houses, and to reflect their responses to the spatial organisation of their houses, considering changing factors such as household occupants’ age, marital status, and household dynamics over time. We use in-depth interview data from three Lebanese families to reflect on their behaviour within, and emotional and physical relationship to, their houses. We find the spatial organisation of mainstream Australian housing may clash with residents’ cultural values affecting whether they are able to comfortably occupy their houses, or not.

DNMT3B deficiency presenting as severe combined immune deficiency: A case report

Immunodeficiency, Centromeric instability and Facial anomalies (ICF) syndrome is a group of rare autosomal recessive disorders. The immune disease in the ICF syndrome consists mainly of humoral immunodeficiency. T-cell dysfunction has previously been suspected to be part of the syndrome's spectrum. However, patients with ICF display, at a young age, a normal number of T cells that tend to decline throughout disease progression due to apoptosis. Biallelic mutations in the DNMT3B gene account for around 50% of ICF cases (ICF type 1). The remaining half may be linked to ZBTB24, CDCA7 or HELLS. Here we report a novel homozygous DNMT3B mutation (NM_ 006892; p.R826H) in a Lebanese family presenting in early infancy with severe combined immune deficiency (SCID). This work expands the clinical spectrum of the ICF syndrome and confirms the importance of tailoring therapeutic approaches for each patient with ICF syndrome, according to the clinical manifestations of his disease.

Family business, strategic planning and corporate entrepreneurship

The aim of this paper is to examine whether willingness to change, generational involvement, perceived technological opportunities, and competitive aggressiveness, in addition to strategic planning, affect the corporate entrepreneurship of family firms in Lebanon. Using a sample of 85 Lebanese family firms, our results suggest that family-business-related characteristics and strategic planning have a positive relationship with corporate entrepreneurship. Our study provides important insights to regulators and practitioners interested in enhancing governance practices in family firms in Lebanon based on the impact of family-business-related characteristics and strategic planning on corporate entrepreneurship. More importantly, our paper helps understand how corporate entrepreneurship in a Middle Eastern country can be affected by willingness to change, generational involvement, perceived technological opportunities, and competitive aggressiveness.

Ten Ways to Hear Snow by Cathy Camper

Reviewed by: Ten Ways to Hear Snow by Cathy Camper Deborah Stevenson, Editor Camper, Cathy Ten Ways to Hear Snow; illus. by Kenard Pak. Kokila/Penguin, 2020 [32p] Trade ed. ISBN 9780399186332 $17.99 E-book ed. ISBN 9780593111239 $10.99 Reviewed from digital galleys R 4-8 yrs A snow has blanketed the city, but Lina still decides to bundle up and head out to her grandmother's, since it's "grape leaf day," when they make the Lebanese dish of warak enab together. On the way over, Lina considers the neighborhood from her grandmother's viewpoint; since Sitti's eyesight is failing, she interprets the world through her ears, and Lina notices the different sounds, from the scrape of snow shovels to the giggle of friends planning to throw a snowball. Upon arrival at Sitti's home (an apartment in a retirement community), she starts cooking with her grandmother and learns a tenth way to hear snow, from the quiet it makes: "No noise is the sound that means it's snowing." Camper, inspired by her own Lebanese family, makes Lina a staunch heroine as she plows through the snow; the sounds she hears (such as "Ploompf!" and "Swish-wish, swish-wish") make for inviting and performative reading aloud. Pak's watercoloresque digital art is solid and accessible even in the snowy scenes, and it makes the most of Lina's fond family at both ends, especially in Lina and Sitti's playful visit. This cries out for a choral performance of the snow sounds, and it might prompt librarians to bring out Perkins' classic Snow Music (BCCB 12/03). Copyright © 2020 The Board of Trustees of the University of Illinois

Next Generation Sequencing Identifies Five Novel Mutations in Lebanese Patients with Bardet–Biedl and Usher Syndromes

Aim: To identify disease-causing mutations in four Lebanese families: three families with Bardet–Biedl and one family with Usher syndrome (BBS and USH respectively), using next generation sequencing (NGS). Methods: We applied targeted NGS in two families and whole exome sequencing (WES) in two other families. Pathogenicity of candidate mutations was evaluated according to frequency, conservation, in silico prediction tools, segregation with disease, and compatibility with inheritance pattern. The presence of pathogenic variants was confirmed via Sanger sequencing followed by segregation analysis. Results: Most likely disease-causing mutations were identified in all included patients. In BBS patients, we found (M1): c.2258A > T, p. (Glu753Val) in BBS9, (M2): c.68T > C; p. (Leu23Pro) in ARL6, (M3): c.265_266delTT; p. (Leu89Valfs*11) and (M4): c.880T > G; p. (Tyr294Asp) in BBS12. A previously known variant (M5): c.551A > G; p. (Asp184Ser) was also detected in BBS5. In the USH patient, we found (M6): c.188A > C, p. (Tyr63Ser) in CLRN1. M2, M3, M4, and M6 were novel. All of the candidate mutations were shown to be likely disease-causing through our bioinformatic analysis. They also segregated with the corresponding phenotype in available family members. Conclusion: This study expanded the mutational spectrum and showed the genetic diversity of BBS and USH. It also spotlighted the efficiency of NGS techniques in revealing mutations underlying clinically and genetically heterogeneous disorders.

A novel homozygous RTEL1 variant in a consanguineous Lebanese family: phenotypic heterogeneity and disease anticipation.

Phenotypic heterogeneity is often observed in patients with telomeropathies caused by pathogenic variants in telomere biology genes. However, the roles of recessive variants in these different phenotypes are not fully characterized. Our goal is to describe the biological roles of a novel homozygous RTEL1 variant identified in a consanguineous Lebanese family with unusual presentation of telomeropathies. A proband was screened for germline variants in telomere biology genes by whole exome sequencing. Leukocytes' telomere length was measured in the proband and eight relatives. We identified a novel homozygous p.E665K RTEL1 variant in the proband, his mother, and seven siblings that associated with telomere shortening and a broad spectrum of clinical manifestations, ranging from mild unspecific findings to severe phenotypes. Consanguinity in at least three family generations led to increased frequency of the homozygous p.E665K variant in the youngest generation and progressive telomere shortening. The increased frequency of the homozygous RTEL1 variant due to consanguinity in this Lebanese family allowed us to infer novel behaviors of recessive RTEL1 variants, as the expressivity and penetrance of this gene are very heterogenous between inter- and intra-generations. Progressive telomere shortening was associated with disease anticipation, first reported in recessive autosomal telomeropathies. Both genetic testing and telomere length measurement were critical for the clinical diagnosis of this family with telomere diseases marked by phenotypic heterogeneity.

Loss of Cajal bodies in motor neurons from patients with novel mutations in VRK1

Distal hereditary motor neuropathies (dHMNs) are a heterogeneous group of diseases, resembling Charcot-Marie-Tooth syndromes, but characterized by an exclusive involvement of the motor part of the peripheral nervous system. Here, we describe two new compound heterozygous mutations in VRK1, the vaccinia-related kinase 1 gene, in two siblings from a Lebanese family, affected with dHMN associated with upper motor neurons (MNs) signs. The mutations lead to severely reduced levels of VRK1 by impairing its stability, and to a shift of nuclear VRK1 to cytoplasm. Depletion of VRK1 from the nucleus alters the dynamics of coilin, a phosphorylation target of VRK1, by reducing its stability through increased proteasomal degradation. In human-induced pluripotent stem cell-derived MNs from patients, we demonstrate that this drop in VRK1 levels leads to Cajal bodies (CBs) disassembly and to defects in neurite outgrowth and branching. Mutations in VRK1 have been previously reported in several neurological diseases affecting lower or both upper and lower MNs. Here, we describe a new phenotype linked to VRK1 mutations, presenting as a classical slowly progressive motor neuropathy, beginning in the second decade of life, with associated upper MN signs. We provide, for the first time, evidence for a role of VRK1 in regulating CB assembly in MNs. The observed MN defects are consistent with a length dependent axonopathy affecting lower and upper MNs, and we propose that diseases due to mutations in VRK1 should be grouped under a unique entity named `VRK1-related motor neuron disease'.

Professional Notes and Research Sources

Professional Notes and Research Sources Megan Connor and Katherine A. Johnson Megan Connor and Katherine A. Johnson Several influential critics and filmmakers have died in the past year. In their memory and contributions to African and African American cinema, we take note and salute their passing. Med Hondo, 1936–2019 Med Hondo, a French-Mauritanian filmmaker born Abid Mohamed Medoun Hondo, died in Paris at age 82 in March. Hondo was among the founding fathers of African cinema, given his career-long dedication to making films that explored the history of colonialism and postcoloniality in metropolitan France and the African continent, such as his award-winning debut feature, Soleil O (1967), which screened at the 1970 Cannes Film Festival, and was awarded the Golden Leopard at the Locarno International Film Festival. Beyond his directorial efforts, including Soleil O, West Indies (1979)—widely considered to be Africa's first musical and at the time, the most expensive African film production in history—Sarraounia (1986), and his last film, Fatima, I'Algerienne de Dakar (2004), Hondo also acted throughout his career, originally studying under French actress Francoise Rosay and forming his own theater company, Shango (named for the Yoruba god of Thunder) which toured France featuring plays by African and diaspora writers. Additionally, Hondo was known for his voice dubbing work of Hollywood films, especially dubbing Eddie Murphy in roles like The Nutty Professor (1996) and the Shrek franchise. For more on Hondo see: https://www.indiewire.com/2019/03/med-hondo-dead-african-cinema-1202048352/. S. Pierre Yameogo, 1955–2019 Following a long illness, influential Burkinabe filmmaker S. Pierre Yameogo passed away in April at age 63. Yameogo, known for his passionate and politically engaged work that focused on his home country of Burkina Faso, directed six films, beginning in 1987. Yameogo's often controversial subject matter was the subject of censorship, most notably for Silmande—Tourbillon (1998), which critiqued economic and political corruption through the tale of a Lebanese family in Burkina Faso and was boycotted and banned [End Page 462] by Lebanese and Cote d'Ivoire theaters. In addition, several of Yameogo's films were screened at the Cannes Film Festival, including Laafi—Tout va bien (1991), Wendemi (1993), and Delwende (2005), which was awarded the Prize of Hope at the 2005 edition of the festival. John Singleton, 1968–2019 The first African American nominated for an Oscar for best director for his first feature film Boyz N the Hood (1991), John Singleton died at the age of 51 after having suffered a stroke. Like Spike Lee, Leslie Harris, Julie Dash, et al, Singleton was a filmmaker who gave audiences of the 1990s stories about characters they recognized, but had not seen yet in the movies. Singleton's success allowed him to do more than tell the stories of black people, it also allowed him to help other black stars, like Tupac Shakur and Ice Cube, navigate predominantly white media industries. He graduated from USC in 1990 and released Boyz N the Hood only a year later. Less than a decade after that, he directed several more features, including Poetic Justice (1993), with Janet Jackson and Shakur, and Shaft (2000), starring Samuel L. Jackson. Throughout his career, Singleton encouraged and supported black communities, their representation, and the work of black filmmakers and musicians. Up until his death, he was directing for television shows like, Empire (2015-) and Snowfall (2017-). He will be remembered as a significant figure in the pursuit of representational diversity. For more on Singleton, see his New York Times obituary: https://www.nytimes.com/2019/04/29/obituaries/john-singleton-dead.html. Camille Billops, 1933–2019 A significant figure in the film and art world, Camille Billops is best remembered for her documentary films, especially Finding Christa (1991) where she details her own story of reconnecting with the daughter she gave up as a toddler so that she could become an artist. Billops made a number of documentaries through her production company, Mom and Pop Productions, which she created alongside her husband, James Hatch. Her films were typically about difficult social issues, such as Suzanne, Suzanne (1982), a documentary about a substance-abusing teenage girl who...

Novel pleiotropic BRCA2 pathogenic variants in Lebanese families

BRCA1 and BRCA2 associated pathogenic variants are the major cause of familial cases of early onset breast and ovarian cancers. Here we report two novel heterozygous pathogenic variants in exons 18 and 11 of the BRCA2 gene in two Lebanese families. The double nucleotide insertion c.8052_8053dupAA was identified in a 38-year-old Lebanese woman diagnosed with a breast cancer. The patient had a family history of affected first degree relatives. The double nucleotide deletion c.4342_4343delAA was identified in a 67-year-old woman with ovarian cancer. The patient came from a family marked by the occurrence of variable cancers. Her two daughters were also found to carry the deleterious variant. Both genetic aberrations result in a framing error that leads to a premature stop codon giving rise to unstable or truncated proteins. We further discuss two non-mutually exclusive potential scenarios related to the resulting haploinsufficiency and variant-specific dominant negative phenotype that might explain, at least in part, the variable expressivity associated with BRCA2 pathogenic variants.

Identification of the first Tangier disease patient in Lebanon carrying a new pathogenic variant in ABCA1

The Middle East region is characterized by low levels of high-density lipoprotein cholesterol (HDL-C). To date, no genetic study has investigated the cause of low HDL-C in the Lebanese population. Our objective was to study the genetic causes for hypoalphalipoproteinemia in a Lebanese family with extremely low HDL-C levels. We sequenced the ABCA1 gene and evaluated cholesterol efflux, inflammatory, and metabolic profiles in the proband and his family. We identified the first Lebanese pathogenic variant in ABCA1 gene causing Tangier disease in a consanguineous family. The proband carried a novel homozygous pathogenic variant p.Gly592Asp in exon 14 of ABCA1, which segregated with the disease in the family. Functional study of the p.Gly592Asp pathogenic variant revealed that lipid-free apolipoprotein A-I-dependent cholesterol efflux was completely abolished in cholesterol-loaded human monocytes-derived macrophages isolated from the proband when compared to controls. Systemic inflammatory and metabolic assessments showed that plasma cytokines (MCP-1, MIP-1α, IL-6, CRP, TNF-α), adhesion molecules (ICAM-1, VCAM-1, E-selectin), inflammatory soluble receptors (sIL-6r, sTNFRI, sTNFRII), and metabolic markers (Insulin, C-peptide) were elevated in the proband when compared to controls. Noninvasive cardiovascular investigation revealed the presence of premature artery lesions in the proband. It is the first case of Tangier disease reported in Lebanon harboring a novel pathogenic variant in ABCA1. Further genetic research is needed in the Middle East where the consanguinity rate is elevated, to understand the cause of the highly prevalent dyslipidemia. This will help guiding the early diagnosis, management, and prevention of cardiovascular complications.

Emotional Intelligence and Immigrant Entrepreneurship Development: A Correlation Analysis of the Lebanese Family Entrepreneurships in Nigeria

The arrival of the first Lebanese immigrant in Lagos in 1890 has been followed by increase in the number of Lebanese immigrants in Nigeria. The immigrants get attached to their families on arrival. This is owing to the instrumental, financial, psychological and emotional supports they receive from their families to enable them assimilate into the Nigerian community. In spite of their contributions to the economic and infrastructural development of Nigeria through the family-owned immigrant entrepreneurships they have developed, no study seems to have been conducted in this area. Consequently, based on data from selected Lebanese family-owned entrepreneurships, this study examines the relationship between emotional intelligence and immigrant entrepreneurship development. The study adopted mail questionnaire survey design. The generated data through questionnaire were analyzed using Pearson’s correlation. It was found that emotional intelligence is significantly related to the dimensions of immigrant entrepreneurship development, that is, entrepreneurial intention, entrepreneurial capabilities, entrepreneurial networking and entrepreneurial success. Based on the results, the study recommends exposing new immigrants and immigrant entrepreneurs to trainings and programs that will improve their emotional intelligence, entrepreneurial behaviour, capabilities, networking attitude and success mindset. The ultimate effect of these trainings and programs is increase in the development of immigrant entrepreneurships.

PR083A: Prevalence of periodontal destruction and putative periodontal pathogens in the same lebanese family

PR083A: Prevalence of periodontal destruction and putative periodontal pathogens in the same lebanese family

Adoption of positive health behaviour among primary care physicians: a cross-sectional pilot study from Lebanon

In Lebanon, primary care physicians (PCPs), including family doctors and GPs, are the main healthcare providers at the primary care level. The difference between the two is that GPs practice medicine directly after medical school without additional specialisation, while family physicians complete a family medicine residency before starting practice. PCPs have an essential role in counselling and providing health education, which are integral components of comprehensive care. Health behaviour includes practices, actions, and habits that positively or negatively affect one’s health status.1 In Lebanon, there is a high prevalence of risky health behaviour. Among the adult population, 38.5% are smokers, 45.8% do not have adequate physical activity, 13.8% have hypertension, 5.9% have diabetes mellitus (DM), 38.0% are overweight, and 27.4% are obese.2 Studies have shown better counselling of patients when the doctors themselves have a healthy lifestyle.3–7 The issue of whether or not doctors themselves adopt positive health behaviour has been studied in some countries, with mixed results. However, no such studies were done in Lebanon or the Arab region. This article presents the results of a preliminary study in Lebanon, which assesses the level of PCPs’ adherence to positive health behaviour, including the implementation of preventive recommendations. A cross-sectional questionnaire-based survey was conducted among a convenience sample of 227 PCPs attending the Annual Lebanese Family Medicine Conference, held in Beirut in 2014. A 22-item-survey was used, with questions about physicians' demographics and adherence to different components of health behaviour, covering such topics as smoking status, exercise habits, cancer screening, and immunisation compliance. ### Sociodemographic characteristics The response …

A complete, homozygous CRX deletion causing nullizygosity is a new genetic mechanism for Leber congenital amaurosis

CRX is a transcription factor required for activating the expression of many photoreceptor-neuron genes. CRX may be mutated in three forms of human blindness; Leber congenital amaurosis (LCA), cone-rod degeneration (CRD) and retinitis pigmentosa (RP). The pathogenic mechanism in most cases is likely dominant negative, with gain of function. We report a novel, complete homozygous CRX deletion in LCA. We identified a Lebanese family with 3 affected LCA cases. The proband was sequenced by NGS. Quantitative PCR, array comparative genomic hybridization, and long range PCR were performed. Full eye examinations, OCT and photography were performed. We identified a homozygous 56,000 bp deletion of CRX, which co-segregates and is heterozygous in four parents, who report normal vision. The blind children with LCA manifest severe retinal degeneration, a phenotype typical for CRX and LCA. We hypothesized that a single copy of CRX (haplo-insufficiency) in the causes mild abnormal foveal development, but not LCA. Two parents had significant inner and outer foveal and photoreceptor abnormalities. This is the first reported case of a homozygous, complete CRX deletion. Nullizygosity of CRX thus causes LCA while haplo-insufficiency of CRX causes abnormal foveal development, but not LCA. Our data suggest a new disease mechanism for CRX.

Impact of Diabetes Mellitus Type 1 on Lebanese Families' Quality of Life.

IntroductionDiabetes mellitus type 1 (DM1) markedly alters the lives of individuals and their families. Family members can be affected by diabetes and its treatment, causing burden, distress, and reduced quality of life (QOL).ObjectiveThe aim of this research is to study the relationship between the diabetic child and the family members, to evaluate the stress and emotional issues between siblings, and to weigh in on the psychological, affective, and financial burden that parents have to deal with in their daily life.Materials and methodsA total of 37 diabetic Lebanese families recruited from the Chronic Care Center (CCC) answered two questionnaires, one about general information and the other related to psychological and financial impact of DM1 and its oral complications on the families.ResultsAbout 56.8% have monthly income below $1,000; 16.2% of parents have an educational upper limit of college degree; 83.8% of the mothers are housewives; 75.7% of parents feel guilty about their child’s condition; 89.2% feel that their diabetic child is frustrated with their diet. For 78.4%, the siblings are jealous of the diabetic child; 13.5% of parents are well aware of the oral complications of diabetes and 86.5% think that treating the diabetic child’s teeth is more important than the siblings’ ones; 91.9% assist their diabetic child’s toothbrushing, but 81.1% of family members do not visit the dentist regularly. A total of 100% allocate special budget for the diabetic child’s diet and 59.4% have an additional budget dedicated to the diabetic child’s treatment; 81.1% declared that their career is affected by their child’s illness.ConclusionThe diabetic child expressed frustration with their diet. The child’s siblings are jealous as they feel left behind. The parents experienced guilt feeling and psychological stress. They have social restriction and financial problems. The QOL of families living with a diabetic child is altered negatively.How to cite this article: Noueiri B, Nassif N. Impact of Diabetes Mellitus Type 1 on Lebanese Families’ Quality of Life. Int J Clin Pediatr Dent 2018;11(2):61-65.

“Why Do Arabs Own Grocery Stores?” Arabic-Speaking Merchants in Flint, Michigan

The Michigan Historical Review 44:2 (Fall 2018): 67-96©2018 Central Michigan University. ISSN 0890-1686 All Rights Reserved “Why Do Arabs Own Grocery Stores?” Arabic-Speaking Merchants in Flint, Michigan By Hani J. Bawardi In October of 1996, I volunteered to talk about the influence of Arabic civilization on Spanish culture to a class of children at Northern High School in Flint, Michigan. When it was time for questions, a student asked: “Why do Arabs own grocery stores?” A classmate answered: “Because the government gives them money, so they open stores.” Another said: “And they don’t pay taxes for seven years.” Then a third responded: “They [Arabs] sell the store to their relatives, so they don’t pay no taxes.” A few months earlier, and half a world away in East Jerusalem, a Palestinian I met at a gathering at the Mount Olive Hotel wondered about the same phenomenon: “How come so many of you [Palestinian immigrants and expatriates] own stores in America?” He used the English word “stores” although the question was asked in Arabic, suggesting his impression that the “store” was not so much an occupation as it was an experience for immigrant countrymen. These are valid questions, given that 104 out of Flint’s 108 convenience stores and supermarkets were owned and operated by Arabic-speaking immigrants in 1997. This overwhelming representation in grocery retail should not obscure the fact that Arab Americans overall have made substantial strides in a variety of businesses and professions. The descendants of those who migrated during the past century, and indeed the majority of the relatively recent immigrants who arrived after 1965 seeking education, are well represented in every conceivable profession. Among them there are artists, doctors, lawyers, educators, authors, and athletes, including many luminaries who made an indelible mark on popular culture in the United States.1 Today’s merchants in Flint 1 Habib Ibrahim Katibah (in collaboration with Farhat Ziadeh), Arabic-Speaking Americans, Pamphlet no 2 (New York: Institute of Arab American Affairs, 1946). In addition to this rich resource on the accomplishments of Arab immigrants, published over seventy years ago, the websites of the Institute of Arab American Affairs, the American Ara Anti-Discrimination Committee, and the Arab American National Museum teem with similar examples. 68 The Michigan Historical Review are three generations removed from those predecessors who charted a path for them, and who also influenced their choice of location. Almost all are relatively recent arrivals. Many are either migrants from Palestinianoccupied territories or Palestinian population centers inside Israel, or Chaldeans (a Catholic ethnic group) mostly from the Iraqi city of Telkeif (Tal Kaif, a town near Mosul in the Ninawa District of northern Iraq). There are also some Jordanians and a few Lebanese families. Few of their businesses still bear the names of retail grocery dynasties, among them Farah-Khouri, Mansour, Zerka, and, for a short while, a single location under the once wildly successful Hamady name. These names trace to the first decade of the twentieth century. In fact, many of the most prosperous and prominent older Arab immigrant families in Flint made their fortunes in grocery retailing, and most of the Syrian immigrants first engaged in peddling before transitioning to owning stationary general stores by the 1910s. Between 1994 and 1997, I conducted several oral history interviews and collected a range of archival material related to the history of Arab Americans in Flint, some of which is now housed in the Hani Bawardi Collection at the University of Michigan-Flint.2 It became evident over the course of my initial research that the question of why so many immigrants still owned grocery stores in 1996 was part of a narrative worthy of investigation. In addition, such an inquiry proposes new questions about how business life enhanced intra-communal social cohesion and, ultimately, the characteristics and functions of business patrons in other social spheres. What follows is a brief background on Arab immigration to Flint, including early migrants who peddled wares and trinkets door-to-door, a practice that ran its course by the first decade of the twentieth century.3 Next, in order to understand the persistence of grocery retailing over...