Spirituality among parents of children with cancer in a Middle Eastern country.

PURPOSE: Family caregivers of children with cancer face emotional, psychological, and spiritual challenges coping with their child's illness. For ensuring comprehensive multidisciplinary pediatric care, there is a need to understand and define what spirituality means for them in relation to their child's illness. The purpose of this study is to understand the meaning of spirituality for parents of cancer patients in Lebanon. METHODS: This qualitative study followed the Heideggerian interpretive phenomenological method. Through purposeful sampling, 11 parents (mother or father) of children with cancer receiving treatment at a tertiary care center in Beirut, Lebanon were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998). RESULTS: A constitutive pattern and overarching theme, "spirituality is a two-level relationship. It is a relation with God and with people. It is the act of receiving and giving back" and five major themes emerged from the data. These were "Being there for me; " "Connectedness with other parents is a blessing and a torment; " "The power of knowing; " "Communication with Unknown" and "Spirituality is not religiosity". CONCLUSION: Lebanese parents of children with cancer defined the elements of their own spirituality. Relational aspects dominated and communication was an important factor. IMPLICATIONS FOR PRACTICE: This is the first study in the Middle East to address the meaning of spirituality in this population, and would pave the way for a customized palliative care program and integrative approach to patient care.

The lived experience of parents of children admitted to the pediatric intensive care unit in Lebanon.

BACKGROUND: Family caregivers have a significant responsibility in the care of their child in the Pediatric Intensive Care Unit (PICU). Parents staying with their child in the PICU have particular needs that should be acknowledged and responded to by clinicians. Several studies have been conducted in the USA and Europe to try to understand the experience of family caregivers of children admitted to the Pediatric Intensive Care Unit. There are no such studies in Lebanon or the Middle East where the culture and support systems differ from other countries. OBJECTIVE: To understand the lived experience of Lebanese parents of children admitted to the PICU in a tertiary hospital in Beirut. DESIGN: Phenomenological study. METHODS: The study followed purposeful sampling in which 10 parents (mother or father) of children admitted to PICU were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998). RESULTS: A constitutive pattern "Journey into the unknown" which constitutes an overarching theme and four major themes with subthemes emerged from the data. These were: We are human beings with dignity "; "looking for a healthier environment"; Dependence on God and "The need to be in the loop" reveal the parents' journey into the unknown. CONCLUSION: This qualitative study adds to the knowledge that would help health care workers understand the experience of Lebanese parents with a child in PICU and to highlight the significance of this experience to them. The findings could be used to inform the development of a PICU parental satisfaction instrument for the sample group.

Profile of injured patients presenting to a tertiary hospital in a developing country.

BACKGROUND: In most developing countries including Lebanon, trauma research is lacking and warranted. Objectives of the current study were to describe trauma patients referred to a tertiary care center during one year and identify outcomes and patterns of injury. METHODS: Review of hospital charts of every 12th consecutive patient presenting to the emergency unit (ED) after a traumatic event during the year 2001-2002. Data collected include: demographics, injury description, and hospital data. RESULTS: A total of 736 patients were included, 212 pediatric, 455 young, and 62 geriatric patients. The most common body regions injured were the extremities followed by the face. The most encountered mechanism of injury was fall from less than 15 feet (38.2%) followed by penetrating/gunshot injury (14.8%), and road traffic accidents (11.8%). The rates of hospital admission and surgical intervention were highest among geriatric patients (p = 0.03 and p < 0.001). Most injuries occurred during the evening shift and the average time spent in the ED was 86 minutes. The police was informed in 6.6% of the cases. CONCLUSIONS: Falls represent a worrisome mechanism across all age groups. This may be an indication for unaddressed occupational hazards for the working young and lack of awareness about the need for more children supervision. More rigorous investigation of intentional and unintentional firearm injuries, and their predisposing factors are needed.

Common dermatologic diseases among students at a tertiary care center in Lebanon.

UNLABELLED: There are few publications on prevalence of skin diseases in Lebanon. OBJECTIVES: To find the prevalence of dermatologic diseases among students seen at the university health services of the American University of Beirut. PATIENTS & METHODS: Medical charts were retrospectively reviewed. Chi-square tests were used to assess any significant difference between male and female prevalence amongst all types of skin diseases met; p-value < 0.05 was considered significant. RESULTS: 2903 visits were reviewed, ages ranged from 16 to 33 years old, of whom 1688 were females (58.15%) and 1215 were males (41.85%). Acne vulgaris was the most prevalent, followed by hair problems and contact dermatitis. Acne vulgaris and hair problems were significantly higher among females, and verruca among males (p < 0.001 in all). CONCLUSIONS: Dermatologists must be aware of the psychological effects of skin diseases on their patients. Acne, hair problems, and contact dermatitis are the most common diseases seen. Patients seem to be more concerned about diseases that affect their image in society.

Approach to pediatric epilepsy surgery: State of the art, Part II: Approach to specific epilepsy syndromes and etiologies.

The second of this 2-part review depicts the specific approach to the common causes of pediatric refractory epilepsy amenable to surgery. These include tumors, malformations due to abnormal cortical development, vascular abnormalities and certain epileptic syndromes. Seizure freedom rates are high (usually 60-80%) following tailored focal resection, lesionectomy, and hemispherectomy. However, in patients in whom the epileptogenic zone overlaps with unresectable eloquent cortex, and in certain epileptic syndromes, seizure freedom may not be achievable. In such cases, palliative procedures such as callosotomy, multiple subpial transections and vagus nerve stimulation can achieve reduction in seizure severity but rarely seizure freedom. Integration of the new imaging techniques and the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones is an expanding and dynamic process that will allow us, in the future, to better decide on the surgical approach of choice and its timing.

Approach to pediatric epilepsy surgery: State of the art, Part I: General principles and presurgical workup.

In 1990, the National Institute of Health adopted epilepsy surgery in children as an option when medications fail. In the past few years several concepts have become increasingly recognized as key to a successful approach to epilepsy surgery in children. These include the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones. In addition, several techniques have increasingly been utilized to delineate the above areas in an attempt to determine, in each patient, the epileptogenic zone, defined as the zone the resection of which leads to seizure freedom. When seizure semiology (which defines the symptomatogenic zone), ictal EEG (which identifies the ictal onset zone), and structural imaging (which identifies the epileptogenic lesion) can be reconciled to infer the location of the epileptogenic zone, surgery is usually, subsequently, undertaken. When these diagnostic modalities are discordant, not definitive, or when the epileptogenic zone is close to eloquent cortex, invasive EEG, complemented by other imaging techniques may be needed. These include magnetoencephalography, single photon emission tomography, various types of positron emission tomography, various magnetic resonance imaging modalities (functional, diffusion weighted, other) and other emerging and experimental techniques. While MRI, video-EEG, and neuropsychological assessments are well established components of the presurgical evaluation, the use of the new emerging imaging technologies is dictated by the degree of anatomo-electro-clinical correlations, and, awaiting multicentric studies and more detailed guidelines, remains center-dependent.

Determinants of university students physical exercise: a study from Lebanon.

BACKGROUND: Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise. METHODS: In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: "No"" (< 0.5 h) and "Yes" (> 0.5 h) per week. Chi-square tests and binary regression were conducted to determine the predictors of performing physical exercise. RESULTS: Of 2,013 students, only 26.4% engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control. CONCLUSION: The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females.

Health care workers' exposure to blood-borne pathogens in Lebanon.

BACKGROUND: Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). AIM: To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. METHODS: This study reports a 17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. RESULTS: A total of 1,590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). CONCLUSIONS: The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.

Novel mutation causing partial biotinidase deficiency in a Syrian boy with infantile spasms and retardation.

We report a case of partial biotinidase deficiency (plasma biotinidase levels: 1.30 nm/minute/mL) in a 7-month-old boy who presented with evidence of perinatal distress followed by developmental delay, hypotonia, seizures, and infantile spasms without alopecia or dermatitis. His neurologic symptoms improved markedly on biotin supplementation and antiepileptic drug therapy. DNA mutational analysis revealed that the patient was homozygous for a novel E64K mutation and his parents were heterozygous for the same mutation. Whereas preexisting perinatal distress probably contributed to the severity of the patient's symptoms, the described mutation is novel and is possibly responsible for at least some of his clinical manifestations.

Sickness-related absence among employees at a tertiary care center in Lebanon.

The authors studied the rate of sickness-related absence of employees at a tertiary care center. They examined sickness-related absence records of employees, including nurses, food service workers, housekeeping, and security personnel, in a university teaching hospital in Lebanon over a period of 1 year. These departments included 1,010 employees, of which 47% took sickness absences during the study period. In all, 49.02% of the nursing employees, 43.67% of the food service workers, 37.79% of the housekeeping employees, and 47.5% of the protection/security workers took sickness-related absences. Employees in younger age groups took the majority of sicknessrelated absences; in general, these constituted short-duration sickness-related absences (relative to those taken by emploees in older age groups; dietary personnel were the exception to this pattern). Principal causes of sickness-related absences were respiratory illness and musculoskeletal problems. The authors observed that distribution of sickness-related absences among the departments studied was similar to the actual distribution of employees. They considered reasons for sicknessrelated absences as pertinent to each category.

Febrile seizures. From molecular biology to clinical practice.

Febrile seizures occur between the age of 3 months and 5 years with a temperature of 38 degrees C or higher, and are either simple or complex. Eight gene loci have been identified to be associated with certain cases of autosomal dominant familial febrile seizures, and 12 genes have been associated with some of the familial epilepsy syndromes that can start with febrile seizures. The mutations and the protein products are known for only some of these 20 genes. The risk of recurrence of convulsions in a further febrile illness is on average 30%, and of developing epilepsy is on average 6%, but both vary depending on the presence and number of risk factors in any given patient. The immediate treatment of a febrile convulsion is intravenous or rectal diazepam, but febrile status epilepticus requires intravenous Phenobarbital and possibly other medications. Long-term antiepileptic drugs are not recommended in most patients with febrile seizures. However, exceptions should be considered on an individual basis in patients with complex febrile seizures with multiple risk factors for development of later epilepsy.

Outbreak of Burkholderia cepacia bacteremia traced to contaminated hospital water used for dilution of an alcohol skin antiseptic.

OBJECTIVE: To identify the source of an epidemic of Burkholderia cepacia bloodstream infections during 7 years (411 episodes in 361 patients). DESIGN: Outbreak investigation. SETTING: A 250-bed university hospital in Beirut, Lebanon. METHODS: Matched case-control and retrospective cohort studies, and microbiological surveillance and polymerase chain reaction-restriction fragment length ascertainment were employed. Special media and filtration techniques were used to isolate organisms from water and diluted alcohol solutions. RESULTS: In a group of 50 randomly selected case-matched patients from 1999, the positive blood cultures were concomitant with fever in 98%, intravenous phlebitis in 44%, and recurrent bacteremia in 20%. Fever disappeared approximately 6 hours after intravenous catheter removal. Polymerase chain reaction-restriction fragment length polymorphism revealed strain homogeneity in patient, water, and alcohol isolates. Contaminated tap water had been used to dilute alcohol for skin antisepsis and for decontamination of the caps of heparin vials. Only sporadic cases directly attributable to breach of protocol were reported after single-use alcohol swabs were substituted. CONCLUSION: This is potentially the largest single-source nosocomial bloodstream infection outbreak ever reported, and the first report of an alcohol skin antiseptic contaminated by tap water as a source for nosocomial bacteremia.

Effects of epilepsy surgery on quality of life: a controlled study in a Middle Eastern population.

The purpose of this study was to investigate which areas of quality of life (QOL) change after epilepsy surgery and generate QOL data specific to the Lebanese population. The QOL of 20 consecutive patients 1 year after surgery was compared (using the ESI-55 scale) with that of 20 matched patients who underwent the same presurgical evaluation, but no surgery. Overall QOL improved in both groups, but was greater in the surgery group (85% seizure free as compared to 0% in nonsurgery group). Significant differences were noted within the "well-being" domain including health perception (5/9 items), energy-fatigue (2/4), and emotional well-being (2/5). Differences were less common in the "functioning" domain including physical (1/10 items), social (1/2), and cognitive (0/5) functioning scales, and in the role limitation domain (1/17 items). Our patients experienced, 1 year after epilepsy surgery, improvements similar to those reported in Western populations after a similar period: they had marked improvements in overall QOL, health perception, well-being, and cognitive functioning areas. They had less remarkable improvements in social functioning and role limitation areas.