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.

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.

Thermo-responsive adsorption-desorption of perfluoroorganics from water using PNIPAm hydrogels and pore functionalized membranes.

Perfluorochemicals (PFCs) are emerging contaminants in various water sources. Responsive polymers provide a new avenue for PFC adsorption/desorption from water. Poly-N-isopropylacrylamide's (PNIPAm's) temperature-responsive behavior and hydrophilic/hydrophobic transition is leveraged for reversible adsorption and desorption of PFCs. Adsorption of PFOA (perfluoro-octanoic acid) onto PNIPAm hydrogels yielded Freundlich distribution coefficients (Kd) of 0.073 L/g at 35 °C (above LCST) and 0.026 L/g at 22°C. Kinetic studies yielded second order rate constants (k2) of 0.012 g/mg/h for adsorption and 12.6 g/mg/h for desorption, with initial rates of 28 mg/g/h and 41 mg/g/h, respectively. Interaction parameters of PNIPAm's functional groups in its different conformational states, as well as the hydrophobic fluorinated carbon tails and hydrophilic head groups of PFOA are used to describe relative adsorption. Polyvinylidene difluoride (PVDF) provides a robust membrane structure for the commercial viability of polymeric adsorbents. Temperature swing adsorption of PFOA using PNIPAm functionalized PVDF membrane pores showed consistent adsorption and desorption capacity over 5 cycles. PFOA desorption percentage of 60% was obtained in pure water at temperatures below PNIPAm's lower critical solution temperature (LCST) while 13% desorption was obtained at temperatures above the LCST, thus showing the importance of the LCST on desorption performance.

Pore Functionalized PVDF Membranes with In-Situ Synthesized Metal Nanoparticles: Material Characterization, and Toxic Organic Degradation.

Functionalized PVDF membrane platforms were developed for environmentally benign in-situ nanostructured Fe/Pd synthesis and remediation of chlorinated organic compounds. To prevent leaching and aggregation, nanoparticle catalysts were integrated into membrane domains functionalized with poly (acrylic acid). Nanoparticles of 16-19 nm were observed inside the membrane pores by using focused ion beam (FIB). This technique prevents mechanical deformation of the membrane, compared to the normal SEM preparation methods, thus providing a clean, smooth surface for nanoparticles characterization. This allowed quantification of nanoparticle properties (size and distribution) versus depth underneath the membrane surface (0-20 µm). The results showed that nanoparticles were uniformly sized and evenly distributed inside the membrane pores. However, the size of nanoparticles inside the membrane pores was 13.9% smaller than those nanoparticles located on the membrane surface. Investigating nanoparticles inside membrane pores increases the accuracy of kinetic analysis and modeling aspects. Furthermore, the Fe/Pd immobilized membranes showed excellent performance in the degradation of chlorinated organics: Over 96% degradation of 3,3',4,4',5-pentachlorobiphenyl (PCB 126) was achieved in less than 15 s residence time in convective flow mode. The regeneration and reuse of this catalytic membrane system were also studied. Particles were examined in XRD upon formation, after deliberate oxidation, and after regeneration. The regenerated sample showed the same crystalline pattern as the original sample. Repeated degradation experiments demonstrated successful PCB 126 dechlorination with nanoparticles regenerated for four cycles with only a small loss in reactivity. It demonstrated that Fe/Pd immobilized membranes have the potential for large-scale remediation applications.

Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs.

There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different (P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

Incidence de la dilatation gastrique-volvulus après une splénectomie chez 238 chiens. Il existe des renseignements contradictoires dans la littérature vétérinaire concernant la splénectomie canine et le risque accru pour la dilatation gastrique-volvulus subséquente. Le but principal de cette étude consistait à déterminer le taux d'occurrence de la dilatation gastrique-volvulus après la splénectomie chez des chiens de race moyenne ou grande comparativement à un groupe témoin subissant d'autres interventions abdominales. Le suivi a été réalisé en examinant les dossiers médicaux et en réalisant des entrevues par téléphone. Le poids, le sexe et la présence d'un hémoabdomen au moment de la chirurgie n'étaient pas significativement associés à l'occurrence de la dilatation gastrique-volvulus, tandis que l'âge avancé l'était. Dix des 238 (4 %) chiens dans le groupe de splénectomie et 3/209 (1,4 %) des chiens dans le groupe témoin ont subséquemment développé la dilatation gastrique-volvulus, ce qui n'était pas significativement différent (P = 0,08). Bien que les résultats soient près du seuil significatif et supportent le besoin d'études supplémentaires, la recommandation actuelle pour la gastropexie au moment de l'enlèvement splénique devrait être faite au cas par cas et en tenant compte des facteurs de risque documentés antérieurement.(Traduit par Isabelle Vallières).

Development of Bench and Full-Scale Temperature and pH Responsive Functionalized PVDF Membranes with Tunable Properties.

Temperature and pH responsive polymers (poly(N-isopropylacrylamide) (PNIPAAm), and polyacrylic acid, PAA) were synthesized in one common macrofiltration PVDF membrane platform by pore-filling method. The microstructure and morphology of the PNIPAAm-PVDF, and PNIPAAm-FPAA-PVDF membranes were studied by attenuated total reflectance Fourier transform infrared (ATR-FTIR), thermogravimetric analysis (TGA), scanning electron microscopy (SEM) and atomic force microscopy (AFM). The membrane pore size was controlled by the swelling and shrinking of the PNIPAAm at the temperature around lower critical solution temperature (LCST). The composite membrane demonstrated a rapid and reversible swelling and deswelling change within a small temperature range. The controllable flux makes it possible to utilize this temperature responsive membrane as a valve to regulate filtration properties by temperature change. Dextran solution (Mw=2,000,000g/mol, 26 nm diameter) was used to evaluate the separation performance of the temperature responsive membranes. The ranges of dextran rejection are from 4% to 95% depending on the temperature, monomer amount and pressure. The full-scale membrane was also developed to confirm the feasibility of our bench-scale experimental results. The full-scale membrane also exhibited both temperature and pH responsivity. This system was also used for controlled nanoparticles synthesis and for dechlorination reaction.

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

Purpose: Surgical treatments such as tendon transfers and muscle lengthening play a significant role in cerebral palsy management,but timing of upper extremity cerebral palsy surgery remains controversial. This study systematically reviews the current literature and investigates the correlation between age at surgery and follow-up time with surgical outcomes in pediatric upper extremity cerebral palsy patients. Methods: A comprehensive search of PubMed, Cochrane, Web of Science, and CINAHL databases was performed from inception to July 2020 and articles were screened using PRISMA guidelines to include full-text, English papers. Data analysis was performed using itemized data points for age at surgery, follow-up length, and surgery outcomes, reported as changes in active forearm and wrist motion. A 3D linear model was performed, to analyze the relationship between age, follow-up length, and surgery outcomes. Results: A total of 3,855 papers were identified using the search terms and a total of 8 studies with itemized patient data (n=126) were included in the study. The studies overall possessed moderate bias according to the ROBINS-I scale. Regression analysis showed that age is a significant predictor of change (|t| > 2) in active forearm supination (Estimate = -2.3465, Std. Error = 1.0938, t-value= -2.145) and wrist flexion (Estimate = -2.8474, Std. Error = 1.0771, t-value = -2.643) post-intervention, with older individuals showing lesser improvements. The duration of follow-up is a significant predictor of improvement in forearm supination (Estimate = 0.3664, Std. Error = 0.1797, t-value = 2.039) and wrist extension (Estimate = 0.7747, Std. Error = 0.2750, t-value = 2.817). In contrast, forearm pronation (Estimate = -0.23756, Std. Error = 0.09648, t-value = -2.462) and wrist flexion (Estimate = -0.4243, Std. Error=0.1859, t-value = -2.282) have a significant negative association with follow-up time. Conclusion: These results suggest that there is significant correlation between the age and follow up after surgery with range of motion gains. Most notably, increased age at surgery had a significant negative correlation with select active range of motion postoperative outcomes. Future research should focus on identifying other factors that could affect results of surgical treatment in upper extremity.

Forearm and elbow secondary surgical procedures in neonatal brachial plexus palsy: a systematic scoping review.

Background: Neonatal Brachial plexus palsy is an injury during delivery that can lead to loss of motor function and limited range of motion in patients due to damage of nerves in the brachial plexus. This scoping review aims to explore types of procedures performed and assess outcomes of forearm and elbow secondary surgery in pediatric patients. Methods: Searches of PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Web of Sciences, and Scopus were completed to obtain studies describing surgical treatment of elbow and forearm in pediatric patients with neonatal Brachial plexus palsy. 865 abstracts and titles were screened by two independent reviewers resulting in 295 full text papers; after applying of inclusion and exclusion criteria 18 articles were included. The level of evidence of this study is level IV. Results: Ten main procedures were performed to regain function of the forearm and elbow in neonatal brachial plexus birth palsy patients. Procedures had different aims, with supination contracture (6) and elbow flexion restoration (5) being the most prevalent. The variance between preoperative and postoperative soft tissue and bony procedures outcomes decreased and showed improvement with respect to the aim of each procedure category. For soft tissue procedures, a statistically significant increase was found between preoperative and postoperative values for active elbow flexion, passive supination, and active supination. For bony procedures, there was a statistically significant decrease between preoperative and postoperative values of passive and active supination. Conclusion: Overall, all procedures completed in the assessed articles of this study were successful in their aim. Bony procedures, specifically osteotomies, were found to have a wider range of results, whereas soft tissue procedures were found to be more consistent and reproducible with respect to their outcomes. Bony and soft tissue procedures were found vary in their aims and outcomes. This study indicates the need for further research to augment knowledge about indications and long-term benefits to each procedure.

Outcomes of humeral osteotomies versus soft-tissue procedures in secondary surgical procedures for neonatal brachial plexus palsy: a meta-analysis.

Secondary surgical procedures can be used in brachial plexus birth injury to correct shoulder movement imbalances. This study compares outcomes of the two secondary surgical procedure types: humeral osteotomies and soft tissue procedures. Outcome measures assessed included active and passive internal and external rotation, active and passive abduction and adduction, active and passive flexion and extension, percentage of the humeral head anterior to the middle glenoid fossa, glenoid version, and Mallet Score. Nineteen full-text articles were included in the analysis. Humeral osteotomies resulted in a loss of internal rotation postoperatively (-15.94°). Active internal rotation was not evaluated for soft tissue procedures. All other assessed outcomes were improved postoperatively for bony and soft tissue procedures. Bony procedures exhibited a greater degree of active external rotation postoperatively when compared to soft tissue procedures (+67° vs. +40°). Both bony and soft tissue procedures Improve shoulder function in children with neonatal brachial plexus palsy, however, soft tissue procedures showed greater consistency in outcomes. Level of Evidence: IV.

Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review.

BACKGROUND: Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. OBJECTIVE: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient's or at the technology's end), so the patients can implement them without any support. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. RESULTS: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. CONCLUSIONS: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates.