Makassed General Hospital Research Articles

Epidemiology Of Uterine Fibroid Disease In Lebanon: A Case-Control Study

Background: Uterine leiomyoma (UL) are women’s most common pelvic tumors, benign in nature, growing during reproductive age, and presenting with abnormal uterine bleeding or pelvic pain and pressure. Many risk factors may contribute to UL, such as family history, obesity, and early menarche. Despite the fact that UL symptoms may improve using many medical or surgical treatments, the health-related quality of life (HRQoL) is considerably affected by their presence. Based on all of the above, we conducted this study which is to the best of our knowledge, the first of its kind in Lebanon aiming to assess the risk factors of UL among the Lebanese population and provide an overview of the diagnostic methods, treatment modalities, and HRQoL among patients. Subjects & Methods: This is an epidemiologic case-control retrospective study, of 668 women of reproductive age, of different nationalities living in Lebanon, divided into 167 cases and 501 controls, conducted between January 2016 and February 2018, in Beirut, Lebanon, in Rafic Hariri University Hospital (RHUH) and Makassed General Hospital (MGH), using charts, questionnaires, and telephone calls. The statistical program Statistical Package for the Social Sciences 19 (SPSS-19) was used for data analysis. A multivariate analysis was also done. Two-sided data analysis was employed and statistical significance was considered for a p-value of ≤ 0.05. Results: Risk factors of UL were older age (>40), early menarche, family history, oral contraceptives (OCP) use, high body mass index (BMI) (>29), and chronic diseases. Smoking and sports were protective factors. The highest effectiveness in diagnosis was attributable to pelvic ultrasonography (94.8% of cases), magnetic resonance imaging (MRI) (85.2% of cases), and hysteroscopy (77.8% of cases). Hysterectomy was the most used treatment method (83.8% of cases), followed by hysteroscopy (77.8%) and uterine artery embolization (UAE) (72.7%). Women with leiomyoma reported that their HRQoL is negatively affected by this condition. Conclusion: This study showed many risk factors for UL, and the statistical significance of techniques for their diagnosis and treatment, in order to prevent their complications and decrease their impact on HRQoL.

Immunogenicity and reactogenicity of BNT162b2 booster in BBIBP-CorV-vaccinated individuals compared with homologous BNT162b2 vaccination: Results of a pilot prospective cohort study from Lebanon

Facing new COVID-19 waves, the effectiveness of BBIBP-CorV has been noted to be low in countries whose populations were already administered two doses of the vaccine. Heterologous vaccination using ChAdOx1-S/BNT162b2 elicited higher immunogenicity compared with homologous immunization. BBIBP-CorV/BNT162b2 combination is worth testing. In this pilot prospective cohort study conducted at Makassed General Hospital, Beirut, Lebanon, from February 17, 2021, to June 30, 2021, we tested the safety and immunogenicity of a BNT162b2 booster dose in COVID-19-naïve individuals who had received two doses of the BBIBP-CorV vaccine. Heterologous booster vaccination was found to be safe and well tolerated. It was significantly associated with higher anti-spike IgG geometric mean titers compared to that after homologous BNT162b2 immunization in COVID-19-naïve individuals [(8040BAU/mL, 95%confidence interval (CI), 4612–14016) vs (1384BAU/mL, 95%CI, 1063–1801), respectively, (P < 0.0001)]. In countries with limited access to mRNA vaccines and where populations have already received BBIBP-CorV, mixing BBIBP-CorV/BNT162b2 is seen to overcome the low immunogenicity induced by BBIBP-CorV alone, thus potentially providing protection against emerging variants.

The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study

Abstract Objective: To investigate the effects of spontaneous labor before elective repeat cesarean delivery (ERCD) on short-term maternal and neonatal outcomes. Methods: This was a prospective cohort study. All consecutive ERCDs, occurring at ≥37 weeks of gestation between July 1, 2017 and December 31, 2019 in Makassed General Hospital, were evaluated. The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery (URCD) group were compared with those of 204 women undergoing cesarean delivery (CD) without spontaneous labor (ERCD) group. Primary outcomes were “composite adverse maternal outcome” and “composite adverse neonatal outcome.” Fisher's exact and Student's t tests were used to assess the significance of differences in dichotomous and continuous variables, respectively. Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes. Results: “Composite adverse maternal outcome” was significantly more common in women who underwent spontaneous labor ((40/183) 21.9% vs. (19/204) 9.3%, P = 0.001, relative risk (RR): 2.7, 95% confidence interval (CI): 1.50–4.90). Similarly, “composite adverse neonatal outcome” was significantly increased in the URCD group ((24/183) 13.1% vs. (12/204) 5.9%, P = 0.014, RR: 2.4, 95% CI: 1.18–4.98). These adverse effects persisted after adjustment for confounders. Multivariate regression models revealed that, besides labor, CD-order impacted maternal outcome (RR: 1.5, 95%CI: 1.02–2.30, P = 0.036), while CD-order and teenage pregnancy influenced neonatal outcome (RR: 2.1, 95%CI: 1.29–3.38, P = 0.003, and RR: 16.5, 95%CI: 2.09–129.80, P = 0.008, respectively). Conclusion: In our study, spontaneous labor before ERCD, including deliveries at term, was associated with adverse maternal and neonatal outcomes, indicating that it is preferable to conduct ERCD before the onset of labor. Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier. Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.

Laparoscopic Sleeve Gastrectomy under Awake Paravertebral Blockade Versus General Anesthesia: Comparison of Short-Term Outcomes.

This study aimed at comparing the pre-, intra-, and early postoperative outcomes, between patients who underwent PVB vs general anesthesia (GA) during LSG. Follow-up of weight loss at least 1year postoperatively was also evaluated. A cohort study was conducted by selecting all patients who underwent LSG under PVB and GA at Makassed General Hospital between 2010 and 2016. Demographic, social, pre-op health status, body mass index (BMI), operative time, postoperative pain and pain medication consumption, postoperative complications and length of hospital stay, all were studied. Follow-up weight loss was collected up to 5years postoperatively. Data entry, management, and descriptive and inferential statistics were performed using SPSS. A total of 210 participants were included in this study of which 48 constituted the PVB group and 162 patients composed the GA group. Both groups were similar in baseline demographic factors, with patients in PVB suffering from higher number and advanced stage of comorbidities than the GA group. Mean operative time was similar in between the two groups with 80 ± 20min for PVB and 82 ± 18min for GA group. Intraoperative complications were scarce among both study groups. GA group requested a second dose of analgesia earlier than PVB group. After at least 1year postoperatively, the mean percentage of excess weight loss was 81.35 ± 15.5% and 77.89 ± 14.3% for the PVB and GA groups, respectively, P value 0.45. Outcomes of LSG under both types of anesthesia (PVB alone and GA alone) were found to be comparable. However, the need for analgesia was significantly less in the PVB group compared to GA group.

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

BackgroundA drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP.MethodsThis is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP].ResultsTigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001).ConclusionThe drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

Helicobacter pylori Infection: Clinical, Endoscopic, and Histological Findings in Lebanese Pediatric Patients.

Background Helicobacter pylori (H. pylori) is a common and universally distributed bacterial infection. However, in children, active gastritis and ulcer are rarely seen. Objectives The aims of this study were to establish the prevalence of H. pylori infection and to compare the clinical, endoscopic, and histopathological findings between infected and noninfected pediatric patients at Makassed General Hospital. Methods Patients aged between 1 month and 17 years who underwent upper gastrointestinal endoscopy from January 2011 to January 2017 were included. The diagnosis of H. pylori was confirmed by a CLO test and/or its presence on biopsy specimens. Demographic data, clinical characteristics, endoscopic and histopathological findings, and gastritis score were recorded retrospectively. Results During the study period, 651 children underwent upper gastrointestinal endoscopy. The main indication was abdominal pain (61%). The prevalence of H. pylori infection was 16.5%. The infection was most commonly seen among children aged between 6 and 10 years (43%). A large number of family members were associated with increased risk of infection (4.8 ± 1.5 versus 5.2 ± 1.8; p < 0.05). Epigastric pain was more associated with H. pylori (61.3% versus 14.6% in noninfected patients; p < 0.05). Nodular gastritis was commonly seen in infected patients (41.5% vs. 7.9%; p < 0.05). Mild and moderate gastritis was seen more in infected versus noninfected patients (mild: 53.8% vs. 14%; moderate: 27.4% vs. 2.4%, respectively). Conclusion Although epigastric pain was associated with H. pylori, other diagnoses should be considered since the infection are rarely symptomatic in children. Antral nodularity was associated with H. pylori infection; however, its absence does not preclude the diagnosis.

Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon.

Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital. This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks. One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29-11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27-120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05-10.98), P = 0.04]. The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death.

Efficacy and Safety of Laparoscopic Sleeve Gastrectomy in Adolescents

Background: Adolescent obesity is increasing worldwide, and the demand for bariatric surgery in this patient population is rising. This study assesses the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the adolescent (≤21 years) population in two University hospitals in Lebanon. Methods: We retrospectively reviewed a cohort of 121 adolescent patients who underwent LSG at the American University of Beirut Medical Center and at Makassed General Hospital between January 2011 and September 2014. Results: The study included 119 patients with a median age of 18.6 ± 2.1 years (range 11–21). Most patients were female (71.4%). Mean preoperative weight and body mass index were 117.9 ± 24.3 kg and 41.9 ± 6.6 kg/m2 (range 32.3–71.0 kg/m2), respectively. Follow-up was achieved in 90.6%, 65.9%, and 59.5% at 1, 2, and 3 years, respectively. Mean percentage of total weight loss was 31.5% ± 8.4%, 32.6% ± 10.4%, and 29.6% ± 13.7%, while mean percentage of excess weight loss was 90.1% ± 28.6%, 89.9% ± 32.0%, and 82.2% ± 38.6% at 1, 2, and 3 years, respectively. Diabetes, hypertension, and dyslipidemia resolved in 100%, 62.5%, and 83.3% of patients, respectively, at a mean follow-up of 13.8 ± 9.1 months. Gastroesophageal reflux disease was reported in 21% of patients followed up at 3 years. The most common long-term complication was symptomatic gallstones necessitating surgical intervention (10.1%). Conclusion: The study shows that LSG is an effective and safe weight loss procedure for morbidly obese adolescents, offering good medium-term weight loss outcomes and significant resolution of obesity-related comorbidities.

Management of gallbladder disease after sleeve gastrectomy in a selected Lebanese population

BackgroundPatients with morbid obesity are at a higher risk of developing gallstones after bariatric surgery. Studies on the incidence of symptomatic gallstones necessitating cholecystectomy after laparoscopic sleeve gastrectomy (LSG) are limited in the Middle East. ObjectivesThis study aims to assess the incidence of cholecystectomy after LSG during a 1-year follow-up and to evaluate potential risk factors and potential prophylactic measures. SettingTwo university hospitals in Lebanon. MethodsA prospectively maintained bariatric database of 361 patients who underwent primary LSG between January 2009 and December 2012 at the American University of Beirut Medical Center and Makassed General Hospital was reviewed. Data included demographics, preoperative weight, weight at 6 and 12 months postoperatively, and incidence of postoperative symptomatic cholelithiasis. ResultsA total of 319 patients (88.4%) were followed up at 1 year. Twenty-four (7.5%) had symptomatic gallstones and underwent cholecystectomy after LSG. Mean postoperative time for the development of symptomatic gallstones was 426 days (range, 91–1234 days). Patients who developed symptomatic gallstones were significantly younger (29.8 versus 34.8, P = 0.008) but comparable to patients who did not undergo cholecystectomy in terms of other baseline characteristics and weight loss results at 1 year. Out of the obesity-related co-morbidities, hypertension was the only co-morbidity associated with post-LSG cholecystectomy (OR = 3.35, P = 0.036) after multivariate adjustment. ConclusionThe incidence of symptomatic gallstones requiring cholecystectomy after LSG in our study cohort was higher than that of the general population (7.5%). This incidence does not warrant prophylactic cholecystectomy or routine pre- or postoperative ultrasounds.

Retrospective Analysis on the Use of Amphotericin B Lipid Complex in Neutropenic Cancer Patients with Suspected Fungal Infections in Lebanon, a Single Center Experience and Review of International Guidelines.

Immunocompromised patients carry a high risk for invasive fungal disease (IFD), which is associated with high mortality. This is a retrospective chart review of a 4-year experience of amphotericin B lipid complex (ABLC) utilization for the management of suspected IFD at the Hematology/Oncology and Bone Marrow Transplantation unit at Makassed General Hospital, Beirut, Lebanon between January 2011 and December 2014. We focused on treatment strategy, response rate, and adverse drug events associated with ABLC therapy. We also reviewed ABLC indications in international guidelines beyond its Food and Drug Administration approval. A total of 89 patients received ABLC therapy for suspected fungal infection. Forty-eight percent were treated for a possible fungal infection, 19% for a problable fungal infection, 12% based on hospital guidelines, and 20% based on treating physician's recommendations. The overall response rate was 71%. Nephrotoxicity occurred in 24% of patients and serum creatinine improved in 10% of these patients. Moderate hypokalemia was observed in 61% of the patients and severe hypokalemia in 10% but was corrected in both cases. Hepatotoxicity was observed in 12% of the patients throughout ABLC therapy. Infusion-related reactions were observed in 36% of the patients. There was a decrease in the incidence of these reactions upon using combination of premedication drugs. In this study, ABLC proved to be an effective and safe option in the management of suspected IFD in immunocompromised patients failing previous therapies.

Third generation cephalosporin resistant Enterobacteriaceae and multidrug resistant gram-negative bacteria causing bacteremia in febrile neutropenia adult cancer patients in Lebanon, broad spectrum antibiotics use as a major risk factor, and correlation with poor prognosis.

Introduction: Bacteremia remains a major cause of life-threatening complications in patients receiving anticancer chemotherapy. The spectrum and susceptibility profiles of causative microorganisms differ with time and place. Data from Lebanon are scarce. We aim at evaluating the epidemiology of bacteremia in cancer patients in a university hospital in Lebanon, emphasizing antibiotic resistance and risk factors of multi-drug resistant organism (MDRO)-associated bacteremia.Materials and Methods: This is a retrospective study of 75 episodes of bacteremia occurring in febrile neutropenic patients admitted to the hematology-oncology unit at Makassed General Hospital, Lebanon, from October 2009-January 2012. It corresponds to epidemiological data on bacteremia episodes in febrile neutropenic cancer patients including antimicrobial resistance and identification of risk factors associated with third generation cephalosporin resistance (3GCR) and MDRO-associated bacteremia.Results: Out of 75 bacteremias, 42.7% were gram-positive (GP), and 57.3% were gram-negative (GN). GP bacteremias were mostly due to methicillin-resistant coagulase negative staphylococci (28% of total bacteremias and 66% of GP bacteremias). Among the GN bacteremias, Escherichia coli (22.7% of total, 39.5% of GN organisms) and Klebsiella pneumoniae(13.3% of total, 23.3% of GN organisms) were the most important causative agents. GN bacteremia due to 3GC sensitive (3GCS) bacteria represented 28% of total bacteremias, while 29% were due to 3GCR bacteria and 9% were due to carbapenem-resistant organisms. There was a significant correlation between bacteremia with MDRO and subsequent intubation, sepsis and mortality. Among potential risk factors, only broad spectrum antibiotic intake >4 days before bacteremia was found to be statistically significant for acquisition of 3GCR bacteria. Using carbapenems or piperacillin/tazobactam>4 days before bacteremia was significantly associated with the emergence of MDRO (p < 0.05).Conclusion: Our findings have major implications for the management of febrile neutropenia, especially in breakthrough bacteremia and fever when patients are already on broadspectrum antibiotics. Emergence of resistance to 3GCs and, to a lesser extent, to carbapenems in GN isolates has to be considered seriously in our local guidelines for empiric treatment of febrile neutropenia, especially given that their occurrence was proven to be associated with poorer outcomes.

Allergic Rhinitis in Children with Asthma: A Questionnaire Based Study in Lebanon

ABSTRACT Introduction: Allergic rhinitis and asthma frequently coexist but has rarely been evaluated in Lebanese children. Aim: This prospective study aimed to estimate the prevalence of allergic rhinitis in asthmatic children in Lebanon, and to ascertain whether allergic rhinitis is a risk factor for the severity of asthma. Patients and Methods: Parents of 124 children aged 1-13 years admitted to the pediatric floor of the Makassed General Hospital between July 2008 and March 2009 and diagnosed as having asthma; parents were interviewed and followed up with a questionnaire concerning allergic rhinitis symptoms and signs with para-clinical data if available. The questionnaire was based on a study done in France by Hammouda et al. (2005). This was modified from an adult score for allergic rhinitis (SFAR). Results: This well recognized score defines the association of allergic rhinitis and asthma in children. A score of  9 out of 17 total score corresponds to the presence of allergic rhinitis in asthmatic children. The prevalence of allergic rhinitis was recognized in 67 patients out of 124 (54%). This prevalence was evident mainly in the age group 3-5 years. Original Research Article

Short-term neonatal outcome in singleton, late preterm deliveries: a three-year experience at a single Lebanese center.

There has been a decrease in the mean gestational age at delivery worldwide mostly due to an increase in deliveries occurring at late preterm period (LPP) with a concomitant rise in the rate of morbidities among newborns delivered at this period. To report the frequency of common short-term neonatal morbidities in infants born at LPP (between 34(0/7) and 36(6/7) weeks' gestation) and to compare these frequencies with those of full-term infants born at our institution. A descriptive cohort study (2008-2010) at Makassed General Hospital. All deliveries occurring at LPP constituted the study group (n = 361), while births at or beyond 37 weeks' gestation were considered as controls (n = 2814). The average rate of deliveries in LPP was 11.4% for the entire study period. The rate of Neonatal Intensive Care Unit admissions, respiratory morbidities, sepsis, jaundice, hypothermia, hypoglycemia and overall neonatal morbidity were all significantly higher in LPP infants when compared to those at term (p-value < 0.013). In our cohort of Lebanese newborns delivered at LPP, significantly higher morbidities were encountered when compared to full-term newborns. Every possible effort should be exerted to avoid elective deliveries during LPP in order to curb the incidence of neonatal morbidities.

Preventing Ventilator-Associated Pneumonia (VAP) in a Pediatric Intensive Care Unit using a Modified Ventilator-Associated Pneumonia Bundle: Pre-interventional and Post-interventional Trial

Background: Ventilator-associated pneumonia increases in-hospital stay, morbidity and mortality of ventilated pediatric patients. It prolongs time spent on the ventilator and length of Pediatric Intensive Care Unit stay. Methods: This is a pre-interventional and post-interventional trial of 57 and 50 pediatric patients, respectively, which started in March 2011 to decrease the rate of ventilator-associated pneumonia in Pediatric Intensive Care Unit after initiation of a modified pediatric VAP bundle compared with the ventilator-associated pneumonia rate for the preceding 12 months. The study was conducted at Makassed General Hospital in Beirut, Lebanon. It included pediatric patients that were on mechanical ventilation from March 2010 to March 2012. An interdisciplinary performance improvement team was formed, who implemented a modified pediatric VAP bundle. Results: The implementation of the pediatric VAP bundle resulted in the reduction of ventilator-associated pneumonia rates from 52% (March 2010-2011) to 6% (March 2011-2012) (P

Intestinal amebiasis: A concerning cause of acute gastroenteritis among hospitalized Lebanese children

Background:Intestinal amebiasis is an important public health problem worldwide. More severe disease is associated with young age, malnutrition and immunosuppression.Aim:The aim of this study is to evaluate the prevalence and characteristic nature of intestinal amebiasis among pediatric population, and compare it with other causes of gastroenteritis.Materials and Methods:This is a retrospective comparative study conducted at Makassed General Hospital between January 2008 and December 2012, including all pediatric patients between birth and 15 years of age, who presented with symptoms of acute gastroenteritis.Results:One thousand three hundred ninety-five patients were included in the study, and were divided into four groups: Group I (Entameba histolytica group = 311 cases, 22.3%), group II (Rotavirus group = 427 cases, 30.6%), group III (bacterial group = 107 cases, 7.7%), group IV (unidentified group = 550 cases, 39.4%). Significant leukocytosis, neutrophilia and positive C-reactive protein were found among more than 50% of admitted Entemaba histolytica cases with a picture of severe invasive disease in young infants.Conclusion:Entameba histolytica can be an emerging serious infection, especially when it finds suitable environmental conditions and host factors, so we should be ready to face it with effective preventive measures.

CRP Marker Adds a Risk Factor for Lebanese Obese Children and Adolescents

Abstract INTRODUCTION: Obesity in children and adolescents is increasingly recognized as a major health concern. It is actually a pandemic disease by itself. Several cytokines and inflammatory mediators are induced in obesity and they may trigger atherosclerosis, coronary disease and heart failure. It is reported that increased high sensitivity CRP was an independent predictor of cardiovascular events in adults and this relation is less clear in pediatrics age group. OBJECTIVES: 1) To Measure the high sensitivity C - Reactive Protein (CRP) level in children and adolescents who are obese or normal weight (control group) with no known history of associated co morbidities and define the abnormality in CRP level among obese children and adolescent in Lebanese population. 2) To prove that the increase in CRP among obese children could be as early as 2 years of age. 3) Follow up the obese children and adolescents who had positive CRP with scheduled diet regimen by help of the nutritionist and seek the effect of diet on CRP level. METHOD: This is a prospective case control study, collecting children and adolescents between 2 and 15 years of age and determining the obese group according to definition of obesity which refers to BMI that vary with age and sex. Obese group selected if BMI > 95th percentile and normal weight (control group) selected if BMI < 85th percentile for age and sex respectively. This was achieved by using document analysis, paper based questionnaire, interviews, complete physical examination, direct measurement of weight and height. Then after justification for the inclusion criteria, CRP level done at Makassed General Hospital laboratory. RESULTS: CRP level was significantly different between obese and control group (normal weight). All subjects of control group had negative CRP value with mean result of 0.08, while 33 subjects (57.9%) of obese group had positive CRP value with a mean of 0.83 that has statistically significant P value of 0.003. This relation was observed among obese children as young as 2 years of age. For All members who had weight reduction the CRP decreased, while only one subject who lost the dietary control had elevation in CRP level. CONCLUSIONS: We conclude that obesity in children and adolescents with no comorbidities is strongly associated with elevated CRP level (a high sensitivity inflammatory marker) which may reflect a future increase in the risk of developing atherosclerosis process. This relation was observed among obese children as young as 2 years of age. Changing life style according to diet regimen lowered CRP level in direct correlation to the weight reduction.

The use of C-reactive protein in predicting bacterial co-Infection in children with bronchiolitis.

Background:Bronchiolitis is a potentially life-threatening respiratory illness commonly affecting children who are less than two years of age. Patients with viral lower respiratory tract infection are at risk for co-bacterial infection.Aim:The aim of our study was to evaluate the use of C-reactive protein (CRP) in predicting bacterial co-infection in patients hospitalized for bronchiolitis and to correlate the results with the use of antibiotics.Patients and Methods:This is a prospective study that included patients diagnosed with bronchiolitis admitted to Makassed General Hospital in Beirut from October 2008 to April 2009. A tracheal aspirate culture was taken from all patients with bronchiolitis on admission to the hospital. Blood was drawn to test C-reactive protein level, white cell count, transaminases level, and blood sugar level.Results:Forty-nine patients were enrolled in the study and were divided into two groups. Group 1 included patients with positive tracheal aspirate culture and Group 2 included those with negative culture. All patients with a CRP level ≥2 mg/dL have had bacterial co-infection. White cell count, transaminases and blood sugar levels were not predictive for bacterial co-infection. The presence of bacterial co-infection increased the length of hospital stay in the first group by 2 days compared to those in the second group.Conclusion:Bacterial co-infection is frequent in infants with moderate to severe bronchiolitis and requires admission. Our data showed that a CRP level greater than 1.1 mg/dL raised suspicion for bacterial co-infection. Thus, a tracheal aspirate should be investigated microbiologically in all hospitalized patients in order to avoid unnecessary antimicrobial therapy and to shorten the duration of the hospital stay.

Hemoglobin level as a risk factor for lower respiratory tract infections in Lebanese children.

Background:Pneumonia is the biggest single cause of childhood death under the age of 5 years, and anemia affects approximately 30% of infants and children all over the world.Aim:Determination of the relationship between anemia and lower respiratory tract infection as a risk factor in Lebanese children.Patients and Methods:A total number of two hundred infants and children aged nine months to twelve years were included; One hundred cases were hospitalized for lower respiratory tract infection in Department of Pediatrics, Makassed General Hospital, and one hundred healthy, age and sex matched controls, were selected from outpatient department. Complete blood count, iron level, ferritin level, and total iron binding capacity were taken if hemoglobin level less than eleven gram per deci-liter. In addition peripheral blood smear, chest radiograph and C-reactive protein were done to hospitalized cases. Definition of iron deficiency anemia and normal laboratory values were predetermined.Results:Anemia was found in 32% of hospitalized cases and 16% of healthy controls. Mean hemoglobin level was 9.99 ± 0.62 gram per deci-liter and 11.99 ± 0.92 gram per deci-liter in anemic and non-anemic group respectively with a significant P-value of 0.001. C-reactive protein levels and number hospitalization days were similar among the anemic and non-anemic group. History of recurrent chest infections was significantly higher in both anemic group and hospitalized cases compared to non-anemic group and healthy controls. Low hemoglobin level was a risk factor for lower respiratory tract infection with a P-value of 0.008.Conclusion:Anemic children were two times more susceptible to lower respiratory tract infection compared to the control group, and iron deficiency anemia was predominating. Accurate diagnosis and prevention of anemia, whatever its etiology, is essential.

The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients

Background:The treatment of unstable intertrochanteric fracture in the elderly patient is still controversial. Traditionally, internal fixation using a dynamic hip screw was of choice. Recently, some authors advocated the use of cemented bipolar arthroplasty or hemiarthroplasty which results in better functional outcome.Aim:The aim of this study is to find out which of these treatment options can lead to the best clinical and functional outcomes.Patients and Methods:One hundred and two patients admitted to Makassed General Hospital between 2002 and 2007 with a diagnosis of unstable intertrochanteric fracture of femur were selected. Preoperative and operative data was retrieved from inpatient hospital files. Postoperative radio clinical data at follow up visits was collected from outpatient department files. Functional outcomes were assessed with use of Harris hip score. The main clinical measures were early postoperative full weight bearing, postoperative complications and functional outcome.Results:The time to full weight bearing, the rate of postoperative complications, and the functional outcomes was significantly better in the cemented bipolar arthroplasty group.Conclusion:According to our results, we believe that cemented bipolar hemiarthroplasty is of choice in freely mobile elderly patients above seventy years of age with an intertrochanteric femoral fracture.

Retrospective evaluation of bipolar hip arthroplasty in fractures of the proximal femur

Background:There is still controversy about the choice of treatment of displaced fractures of the neck of femur which leads the best clinical and functional outcomes. Treatment options include internal fixation, unipolar or bipolar hemiarthroplasty, or total hip replacement.Aim:The aim of this study is to find out which treatment option can lead to the best clinical and functional outcomes.Patients and Methods:Fifty one consecutive patients admitted to Makassed General Hospital with a diagnosis of a displaced fracture of the femoral neck during the year 2006 were selected. Preoperative and operative data was retrieved from inpatient hospital files. The patients then were interviewed to fill a questionnaire form. Radiological data was retrieved from inpatient hospital files and outpatient files upon latest follow up visit in clinic. Functional outcomes were assessed with use of Harris hip score. The main clinical measures were mortality and a reoperation.Results:Postoperatively, Thirty three patients (89.2%) either returned to the functional level that they had had before the fracture or used only a cane, which they had not needed before.Conclusion:In our study, the bipolar hemiarthroplasty has served us well. Two-year results of total hip replacement appeared to be better than those of bipolar hemiarthroplasty, but this finding was based on relatively small numbers of patients.