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Alam W, Mobayed T, Younis N, Zarif R, Bizri N, Tamim H, Musharrafieh U, Bizri AR. Neglected Tropical Diseases in Lebanon. Acta Parasitol 2022; 67:809-819. [PMID: 35113340 PMCID: PMC8811347 DOI: 10.1007/s11686-021-00510-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) are highly endemic and distributed within the Middle East and North Africa (MENA) region, affecting an estimated 65 million people. Lebanon suffers from several NTDs as they are either endemic in the country or imported via expats residing in endemic regions, refugees, and foreign labor force. The Syrian crisis and the displacement of refugees to Lebanon have made the country the largest host of refugees per capita right after the Syrian crisis in 2011, peaking in the year of 2013. Additionally, foreign labor in Lebanon come from different countries in Africa and Asia that are endemic with certain NTDs. The Lebanese diaspora is approximately twice the number of those residing in the country and is distributed throughout the continents carrying the risk of importing new NTDs. MATERIALS AND METHODS A descriptive study about the prevalence of NTDs in Lebanon, their distribution, and factors contributing to spread was performed. The Lebanese Ministry of Public Health (LMPH) database regarding reportable transmissible diseases was reviewed for reportable NTDs between 2002 and 2020 in relation to age, gender, prevalence, and geographical distribution. The medical literature was searched using several engines looking for all reports about NTDs in Lebanon, those relevant to regions hosting Lebanese diaspora, and countries where the refugees and migrant workers came from. RESULTS Only leishmaniasis, leprosy, echinococcosis, schistosomiasis, and rabies are mandatorily reportable NTDs by the LMPH. Additionally, case reports about fasciolosis, ascaridiosis, and Dengue were reported from Lebanon. The presence of the Syrian refugees in the country affected the prevalence of leishmaniasis and rabies. The most prevalent NTD in Lebanon is cutaneous leishmaniasis. The Lebanese diaspora reside mainly in South America, Africa, and in some Arab states known to be endemic with certain NTDs. CONCLUSION Little information is known about NTDs in Lebanon. The country is at an increased risk of experiencing several new NTDs due to refugee influx, foreign labor, economic crisis, and ever-growing number of Lebanese seeking work opportunities abroad. More information is needed to assess the true burden of NTDs in Lebanon and the future steps to contain and mitigate their effects.
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Affiliation(s)
- Walid Alam
- Department of Oncology, Maidstone Hospital, Maidstone, Kent UK
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tala Mobayed
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Younis
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Rana Zarif
- Faculty of Medicine, American University of Beirut, Hamra, Beirut, Lebanon
| | - Nazih Bizri
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Department of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Umayya Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Moghnieh R, Khalil A, Bizri N, Francis N, Imad S, Mezher M, Mrad Z, Ibrahim J, Zahran K, Farroukh F, Itani M, Assaad A, Sinno L, Abdallah D, Ibrahim A. QTc prolongation during levofloxacin and triazole combination chemoprophylaxis: Prevalence and predisposing risk factors in a cohort of hematopoietic cell transplantation recipients. J Oncol Pharm Pract 2022; 29:534-542. [PMID: 35075933 DOI: 10.1177/10781552221074016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND QTc interval prolongation has been reported when combining fluoroquinolones and triazoles for chemoprophylaxis in cancer patients. Herein, we aimed to identify the prevalence and contributing factors to QTc prolongation in hematopoietic cell transplantation (HCT) recipients who received these agents during the neutropenic phase. METHODS This is a retrospective medical chart review conducted at a university hospital in Lebanon from 2017 to 2020. It included all adult HCT inpatients on antimicrobial prophylaxis with fluoroquinolones and triazoles and whose baseline ECG monitoring done prior to chemoprophylaxis administration, then on day-3 and day-6 of therapy, were available. RESULTS Overall, 68 HCT recipients met our inclusion criteria, of which 22% developed QTc prolongation. Based on bivariate analysis, female gender contributed to QTc prolongation (P = 0.001). There was a trend to QTc prolongation in patients with predisposing thyroid disease (P = 0.12), grade 2 vomiting and diarrhea (P = 0.16, P = 0.46, respectively), baseline hypokalemia (P = 0.18) and hypocalcemia (P = 0.3), hypomagnesemia on day-3 (P = 0.21) and day-6 hyponatremia (P = 0.36). Patients receiving two or more drugs with a known or probable risk of QTc prolongation (other than the fluoroquinolone/ triazole combination) were more prone to experience a prolonged QTc interval (P = 0.09). None of the patients that had QTc prolongation died or developed serious arrhythmias. CONCLUSION The prevalence of QTc prolongation was 22% among HCT recipients on fluoroquinolone and triazole prophylaxis, yet we did not identify any independent risk factors for this issue. None of the patients that had QTc interval prolongation died or developed serious arrhythmias.
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Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Division of Infectious Diseases, Middle East Institute of Health University Hospital, Bsalim, Lebanon.,Department of Internal Medicine, Division of Infectious Diseases, 36696Makassed General Hospital, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Ahmad Khalil
- Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Nazih Bizri
- Faculty of Medicine and Medical Sciences, 54686Universityof Balamand, Koura, Lebanon
| | - Nadine Francis
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Sabine Imad
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Maria Mezher
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Zahraa Mrad
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Jad Ibrahim
- Faculty of Sciences, 11238American University of Beirut, Beirut, Lebanon
| | - Kamal Zahran
- Hematology, Oncology and Bone Marrow Transplantation Unit, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Farah Farroukh
- Hematology, Oncology and Bone Marrow Transplantation Unit, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Malak Itani
- Hematology, Oncology and Bone Marrow Transplantation Unit, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Amani Assaad
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Loubna Sinno
- Department of Medical Research, 36696Makassed General Hospital, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, 36696Makassed General Hospital, Beirut, Lebanon
| | - Ahmad Ibrahim
- Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, Middle East Institute of Health University Hospital, Bsalim, Lebanon.,Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, 36696Makassed General Hospital, Beirut, Lebanon
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El Zarif T, Kassir MF, Bizri N, Kassir G, Musharrafieh U, Bizri AR. Measles and mumps outbreaks in Lebanon: trends and links. BMC Infect Dis 2020; 20:244. [PMID: 32216754 PMCID: PMC7098136 DOI: 10.1186/s12879-020-04956-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Lebanon has experienced several measles and mumps outbreaks in the past 20 years. In this article, a case-based surveillance of both measles and mumps outbreaks in Lebanon was carried out in an attempt to outline factors contributing to the failure of elimination plans and to provide potential solutions. The relationship between the outbreaks of both diseases was described and explored. METHODS A retrospective descriptive study of confirmed cases of measles and mumps in Lebanon between 2003 and 2018 collected from the Lebanese Ministry of Public Health Epidemiological Surveillance Unit public database was carried out. The information collected was graphically represented taking into consideration dates of reported cases, age groups affected, and vaccination status. RESULTS The mean number of measles cases was 150.25 cases/year in the 1-4 years age group, 87 cases/year in individuals aging between 5 and 14, and 63.68 cases/year in those > 14 years old. In the latter group, only 18.05% were unvaccinated. The mean number of mumps cases was 30.4 cases/year in the < 4 year age group and 53.8 cases/year in the 10-19 years age group. During the study period, every spike in measles cases was followed by a similar spike in mumps. 9.66% of measles cases occurred in individuals who received at least 2 doses of the vaccine, 52.26% in the unvaccinated, and 38% in those whose vaccination status was undetermined. CONCLUSIONS Measles in Lebanon is a disease of the pediatric population, but adults remain at risk. Outbreaks of mumps followed those of measles and were mainly among adolescents. Presence of a large number of Syrian refugees in the country may further complicate the situation. Vaccination activities need to be intensified.
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Affiliation(s)
- Talal El Zarif
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | | | - Nazih Bizri
- Faculty of Medicine, University of Balamand, Koura, Lebanon
| | - Ghida Kassir
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Umayya Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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