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Cherfane M, Boueri M, Issa E, Abdallah R, Hamam A, Sbeity K, Saad A, Abi-Gerges A. Unveiling the unseen toll: exploring the impact of the Lebanese economic crisis on the health-seeking behaviors in a sample of patients with diabetes and hypertension. BMC Public Health 2024; 24:628. [PMID: 38413883 PMCID: PMC10900622 DOI: 10.1186/s12889-024-18116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. METHODS An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. RESULTS The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). CONCLUSION Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.
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Affiliation(s)
- Michelle Cherfane
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie- Liban), Beirut, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Elio Issa
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Racha Abdallah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Ali Hamam
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Kassem Sbeity
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Anthony Saad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Aniella Abi-Gerges
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon.
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Sati H, Alzraikat N, Milan M, Saliba M, Fawaz A, Boueri M, Semaan S, Chedid ML, Yakdan S. Skin manifestations in children with MIS-C and COVID-19: a narrative review. Int J Dermatol 2024; 63:32-40. [PMID: 38018155 DOI: 10.1111/ijd.16912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023]
Abstract
This review aims to highlight the diverse skin manifestations in children and adolescents with COVID induced multisystem inflammatory syndrome in children (MIS-C). The symptoms of COVID-19 can vary greatly in severity between different age groups. Although most children infected with SARS-CoV-2 experience either no symptoms or only mild symptoms, some reported cases of severely affected children with a clinical presentation similar to incomplete Kawasaki disease have led to the definition of a new condition called MIS-C. MIS-C can involve multiple organs, including the skin, and may pose a life-threatening risk to affected children. Such cases highlight the need for continuous research into the possible skin manifestations associated with COVID-19 in pediatric populations to aid in early diagnosis and prompt treatment. We conducted a search of PubMed, Scopus, and ScienceDirect databases for studies published up until October 1, 2022. Three reviewers independently examined each study, and a fourth reviewer resolved any disagreements. A narrative review of all relevant papers was conducted. We present an overview of the clinical presentation, pathophysiology, diagnosis, and treatment of the various skin manifestations in children and adolescents with COVID-19 or MIS-C. The skin manifestations of COVID-19 and MIS-C can be diverse and are frequently overlooked. It is important to conduct further research to better understand the impact of this disease on children to provide appropriate care for these at-risk populations.
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Affiliation(s)
- Heba Sati
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | - Noor Alzraikat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Milanie Milan
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | - Marita Saliba
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | - Ala'a Fawaz
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Samar Semaan
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | | | - Salim Yakdan
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
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Zouein J, Boueri M, Kourie HR, Kattan J, Nemr E. Advanced bladder cancer management: history in the making. Future Oncol 2023; 19:2565-2567. [PMID: 38084488 DOI: 10.2217/fon-2023-0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Joseph Zouein
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Myriam Boueri
- Gilbert & Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Joseph Kattan
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Elie Nemr
- Urology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
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El Hayek P, Boueri M, Nasr L, Aoun C, Sayad E, Jallad K. Cholera Infection Risks and Cholera Vaccine Safety in Pregnancy. Infect Dis Obstet Gynecol 2023; 2023:4563797. [PMID: 37260611 PMCID: PMC10228220 DOI: 10.1155/2023/4563797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Discuss the impact of cholera infection on pregnant women, fetus, and neonates and review the safety of cholera vaccines in pregnancy. Methods This study was carried out as a narrative review during November 2022. A thorough literature review was conducted on the following databases: PubMed, Scopus, SciELO, CINAHL, Web of Science, and ScienceDirect. The following parameters were assessed from the included studies: type of cholera vaccine, cholera symptoms, cholera treatment, effect of cholera on pregnancy, effect of cholera treatment on pregnancy, effect of cholera vaccine on pregnancy, risk factors for fetuses and neonates, and prevention of cholera. The authors independently extracted data from the 24 included studies. Results Cholera infection is a serious threat on pregnancy as it could lead to increased stillbirths and neonatal death. Fetal death was shown to occur mainly in the third trimester as most of the pregnant women infected with cholera had spontaneous abortions even after controlling for other confounding variables such as maternal age, dehydration level, and vomiting. Neonatal death was attributed mainly to congenital malformations and low Apgar scores with no improvements. Besides, cholera vaccines have shown to be safe in pregnancy and have proven to lower fetal and neonatal malformations among vaccinated compared to nonvaccinated pregnant women. Conclusion This narrative summarizes the different complications due to cholera infection in pregnancy. It also reviews the safety of cholera vaccine administration in pregnant women.
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Affiliation(s)
- Pamela El Hayek
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
- Department of Obstetrics and Gynecology, Lebanese American University School of Medicine, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
| | - Leah Nasr
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
| | - Christine Aoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
| | - Edouard Sayad
- Department of Pediatrics, Division of General Pediatrics, Division of Pediatric Pulmonology, Lebanese American University Medical Center LAUMCRH, Beirut, Lebanon
| | - Karl Jallad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
- Department of Obstetrics and Gynecology, Lebanese American University School of Medicine, Lebanon
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Farah S, Hijazi M, Aoun E, Boueri M, Nasr E, Chlala W, Salem MJ, Moufawad G, Farah D, El Hayek P, Jallad K, Ghaname W, Ziadeh H. Effect of COVID-19 vaccinations on menstrual cycle and postmenopausal bleeding among health care workers: A cross-sectional study. Int J Gynaecol Obstet 2023. [PMID: 37132636 DOI: 10.1002/ijgo.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine the effect of coronavirus disease 2019 (COVID-19) vaccination and its association with sociodemographic factors on the menstrual cycle in premenopausal women and on postmenopausal bleeding. METHODS This is a retrospective cross-sectional study conducted between September 22, 2022, and November 30, 2022, via a questionnaire distributed to 359 health care workers (HCWs) at Lebanese American University Medical Center-Rizk Hospital and St John's Hospital. Inclusion criteria included female Lebanese HCWs who were vaccinated and aged 18 to 65 years. RESULTS Change in cycle length was significantly associated with age (P = 0.025 after the first dose and P = 0.017 after the second dose), level of education (P = 0.013 after the first dose and P = 0.012 after the second dose), and fibroids (P = 0.006 after the second dose and P = 0.003 after the third dose). The change in cycle flow was significantly associated with age (P = 0.028), fibroids (P = 0.002 after the second dose and P = 0.002 after the third dose), bleeding disorders (P = 0.000), and chronic medications (P = 0.007). The change in symptoms was associated with polycystic ovary syndrome (P = 0.021), chronic medications (P = 0.019 after the second dose and P = 0.045 after the third dose), and fibroids (P = 0.000). CONCLUSION COVID-19 vaccination can influence the menstrual cycle. Age, body mass index, level of education, underlying comorbidities, and use of chronic medications are significantly associated with changes in menstrual length, flow, and symptoms following vaccination.
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Affiliation(s)
- Stephanie Farah
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Mariam Hijazi
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Eliane Aoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Elena Nasr
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Walid Chlala
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Marie Josee Salem
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Graziella Moufawad
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dany Farah
- Department of Research, University of Sainte Famille, Batroun, Lebanon
| | - Pamela El Hayek
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Karl Jallad
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Batta Y, King C, Johnson J, Haddad N, Boueri M, Haddad G. Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems. Front Physiol 2022; 12:748972. [PMID: 35095546 PMCID: PMC8795698 DOI: 10.3389/fphys.2021.748972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients’ prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.
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Affiliation(s)
- Yashvardhan Batta
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Cody King
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - John Johnson
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Natasha Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | | | - Georges Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
- *Correspondence: Georges Haddad,
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Boueri M, Motto-Ros V, Lei WQ, Ma QL, Zheng LJ, Zeng HP, Yu J. Identification of polymer materials using laser-induced breakdown spectroscopy combined with artificial neural networks. Appl Spectrosc 2011; 65:307-314. [PMID: 21352651 DOI: 10.1366/10-06079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A combination of laser-induced breakdown spectroscopy (LIBS) and artificial neural networks (ANNs) has been used for the identification of polymer materials, including polypropylene (PP), polyvinyl chloride (PVC), polytetrafluoroethylene (PTFE), polyoxymethylene (POM), polyethylene (PE), polyamide or nylon (PA), polycarbonate (PC) and poly(methyl methacrylate) (PMMA). After optimization of the experimental setup and the spectrum acquisition protocol, successful identification rates between 81 and 100% were achieved using spectral features gathered from single spectra without averaging (1 second acquisition time) over a wide spectral range (240-820 nm). Furthermore, ten different materials based on PVC were tested using the identification procedure. Correct identifications were obtained as well. Sorting of the materials into sub-categories of PVC materials according to their charges (concentration in trace elements such as Ca) was performed. The demonstrated capacities fit, in practice, the needs of plastic-waste sorting and of producing high-grade recycled plastic materials.
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