Predictors of non-obstructive coronary slow flow in poorly controlled type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Coronary slow flow (CSF) can occur due to various factors, such as inflammation, small vessel disease, endothelial dysfunction, and inadequate glucose control. However, the exact pathological mechanisms behind CSF remain incompletely understood. The objective of this study was to identify the risk factors associated with slow coronary flow in individuals with Type 2 Diabetes Mellitus (T2DM) who have non-obstructive coronary artery disease (CAD) and experience CSF. METHODS: We conducted a prospective cohort study involving 120 patients with T2DM who were referred for invasive coronary angiography due to typical chest pain or inconclusive results from non-invasive tests for myocardial ischemia. Using a 2 × 2 design, we categorized patients into groups based on their glycemic control (adequate or poor) and the presence of CSF (yes or no), defined by a TIMI frame count > 27. All patients had non-obstructive CAD, characterized by diameter stenosis of less than 40%. We identified many variables associated with CSF. RESULTS: Our investigation revealed no significant differences in age, sex, family history of coronary artery disease, ECG ischemia abnormalities, or echocardiographic (ECHO) data between the groups. In patients with adequate glycemic control, hypertension increased the risk of CSF by 5.33 times, smoking by 3.2 times, while dyslipidemia decreased the risk by 0.142. Additionally, hematocrit increased the risk by 2.3, and the platelet-to-lymphocyte ratio (PLR) increased the risk by 1.053. Among patients with poor glycemic control, hematocrit increased the risk by 2.63, and the Neutrophil-to-Lymphocyte Ratio (NLR) by 24.6. Notably, NLR was positively correlated with glycemic control parameters in T2DM patients with CSF. CONCLUSIONS: In T2DM patients with CSF, various factors strongly correlate with glycemic control parameters and can be employed to predict the likelihood of CSF. These factors encompass hypertension, smoking, increased body mass index (BMI), elevated platelet count, hematocrit, NLR, PLR, and C-reactive protein (CRP). TRIAL REGISTRATION: Registry: ZU-IRB (ZU-IRB#9419-3-4-2022), Registered on: 3 April 2022, Email: IRB_123@medicine.zu.edu.eg.

Improved Survival for Patients with Systemic Sclerosis-associated Pulmonary Arterial Hypertension: The Johns Hopkins Registry.

Rationale: To date, it remains unclear whether recent changes in the management of patients with systemic sclerosis-associated pulmonary hypertension (SSc-PH) have improved survival. Objectives: To describe a cohort of patients with SSc-PH and compare their characteristics and survival between the last two decades. Methods: Patients with SSc-PH prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Center Registry were grouped into two cohorts based on the date of diagnostic right heart catheterization: cohort A included patients whose disease was diagnosed between 1999 and 2010, and cohort B included those whose disease was diagnosed between 2010 and 2021. Patients' characteristics were compared between the two cohorts. Measurements and Main Results: Of 504 patients with SSc-PH distributed almost equally between the two cohorts, 308 (61%) had World Symposium on Pulmonary Hypertension group 1, 43 (9%) had group 2, and 151 (30%) had group 3 disease. Patients with group 1 disease in cohort B had significantly better clinical and hemodynamic characteristics at diagnosis, were more likely to receive upfront combination pulmonary arterial hypertension therapy, and had a nearly 4-year increase in median transplant-free survival in univariable analysis than those in cohort A (P < 0.01). Improved transplant-free survival was still observed after adjusting for patients' baseline characteristics. In contrast, for group 2 or 3 patients with SSc-PH, there were no differences in baseline clinical, hemodynamic, or survival characteristics between the two cohorts. Conclusions: This is the largest single-center study that compares clinical characteristics of patients with SSc-PH between the last two decades. Transplant-free survival has improved significantly for those with group 1 disease over the last decade, possibly secondary to earlier detection and better therapeutic management. Conversely, those with group 2 or 3 disease continue to have dismal prognosis.

Relationship between inflammatory markers and coronary slow flow in type 2 diabetic patients.

BACKGROUND: Diabetes is a serious and quickly expanding global health problem. Cardiovascular disease is the leading cause of mortality in type 2 diabetes mellitus (T2DM) patients. Coronary slow flow (CSF) is characterised by delayed distal perfusion during coronary angiography with normal coronary arteries. This study aimed to investigate the correlation between CSF and inflammatory markers regarding glycemic status in T2DM. METHODS: This cross-sectional study included 120 patients who were divided equally into 4 groups according to their glycemic control and presence or absence of coronary slow flow: Group I included patients with T2DM with good glycemic control without CSF; Group II included patients with T2DM with good glycemic control and CSF; Group III included patients with T2DM with poor glycemic control without CSF; and Group IV included patients with T2DM with poor glycemic control and CSF. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), platelets, hematocrit, and haemoglobin were also evaluated as risk factors for coronary slow flow. RESULTS: This study showed that body mass index (BMI), hematocrit level, NLR, and CRP demonstrated a moderate but significant correlation (r = 0.53) with CSF in poorly controlled T2DM. NLR cutoff > 2.1 could predict CSF in poorly controlled T2DM with a modest sensitivity and specificity. A 1.9 increase in HbA1c increases the likelihood of coronary slow flow. Dylipidemia increases the likelihood of coronary slow flow by 0.18 times. Other predictors for coronary slow flow include NLR, PLR, CRP, platelets, hematocrit, and hemoglobin. The effect of the predictors is still statistically significant after being adjusted for glycemic status, age, and sex (p < 0.001). CONCLUSIONS: Poor glycemic control increases the incidence of CSF. This supports the hypothesis that CSF is related to endothelial dysfunction as poor glycemic control causes endothelial dysfunction due to inflammation. TRIAL REGISTRATION: ZU-IRB#9419-3-4-2022 Registered 3 April 2022, email.  IRB_123@medicine.zu.edu.eg .

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown.

OBJECTIVES: This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis. DESIGN: Cross-sectional study (June-July 2020); phone survey (thirty items). SETTING: Lebanon. PARTICIPANTS: Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households. RESULTS: FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels. CONCLUSIONS: Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Knowledge, attitudes, and perceptions of dairy farmers regarding antibiotic use: Lessons from a developing country.

In lower- and middle-income countries, uncontrolled use of antibiotics is causing antimicrobial resistance, affecting both animal welfare and public health. Meanwhile, studies on antibiotic use in these countries are limited. A crucial step to limit the spread of antimicrobial resistance (AMR) is to examine the use of these drugs and identify its determinants. The aim of our study, the first of its kind in Lebanon, was to assess dairy farmers' knowledge and awareness of antimicrobial use (AMU) and AMR. For this, 18 farmers from different regions, educational backgrounds, experience levels, and herd sizes were interviewed. Results showed that owners of larger farms were more aware of AMU and AMR, and trying to implement preventive actions, whereas nonsystematic antimicrobial use was prevalent among the smaller farms. Mastitis and laminitis were the most treated diseases, and antibiotics used were oxytetracycline, penicillin, streptomycin, and florfenicol. Overall, antibiotic use was found as a preventive measure and a treatment of nonbacterial diseases. Irregular uses were linked to easy access of farmers to antibiotics, interrupted relations with veterinary authorities, and lack of self-assessment and inspection. Lebanese dairy farmers and owners reported feeling disadvantaged in their local trade field, facing illegal competition and unauthorized farms and industries, and lacking support from the government. Training and awareness programs must be implemented, and policies and regulations must be set, to reduce antibiotic use and hinder the spread of AMR in Lebanon.

Spectrum Sensing for Cognitive Radio: Recent Advances and Future Challenge.

Spectrum Sensing (SS) plays an essential role in Cognitive Radio (CR) networks to diagnose the availability of frequency resources. In this paper, we aim to provide an in-depth survey on the most recent advances in SS for CR. We start by explaining the Half-Duplex and Full-Duplex paradigms, while focusing on the operating modes in the Full-Duplex. A thorough discussion of Full-Duplex operation modes from collision and throughput points of view is presented. Then, we discuss the use of learning techniques in enhancing the SS performance considering both local and cooperative sensing scenarios. In addition, recent SS applications for CR-based Internet of Things and Wireless Sensors Networks are presented. Furthermore, we survey the latest achievements in Spectrum Sensing as a Service, where the Internet of Things or the Wireless Sensor Networks may play an essential role in providing the CR network with the SS data. We also discuss the utilisation of CR for the 5th Generation and Beyond and its possible role in frequency allocation. With the advancement of telecommunication technologies, additional features should be ensured by SS such as the ability to explore different available channels and free space for transmission. As such, we highlight important future research axes and challenging points in SS for CR based on the current and emerging techniques in wireless communications.

Variations in the referral patterns to pharmacologic and exercise myocardial perfusion imaging.

BACKGROUND: Myocardial perfusion imaging (MPI) is commonly utilized for the non-invasive evaluation of patients with suspected coronary artery disease (CAD). It is either performed with exercise or pharmacologic stress. The objective of this study is to compare the referral patterns and diagnostic findings in patients referred for pharmacologic vs exercise MPI. METHODS AND RESULTS: This was a prospective study of 429 consecutive patients who were referred for MPI at the American University of Beirut Medical Center (23% had pharmacologic stress with dipyridamole and 77% had exercise stress testing). Patients referred to pharmacologic stress were older, had a higher percentage of women, and a higher prevalence of diabetes and hypertension. There were more abnormal scans in the pharmacologic stress group (38% vs 20%, P < 0.001), as well as a higher prevalence of ischemia (21% vs 13%, P < 0.001) and impaired left ventricular function with an ejection fraction < 50% (19% vs 7.9%, P < 0.001). The significant predictors for referral to pharmacologic stress by multivariable logistic regression analysis were older age (OR = 2.01 (1.57-2.57), P < 0.001) and diabetes (OR = 2.04 (1.19-3.49), P = 0.009). CONCLUSION: Patients referred for pharmacologic stress MPI are at a higher risk than those referred for exercise stress MPI with more CAD risk factors, older age, and a higher prevalence of abnormal MPI findings.

Mortality rate of ICU patients with the Middle East Respiratory Syndrome - Coronavirus infection at King Fahad Hospital, Jeddah, Saudi Arabia.

OBJECTIVE: The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a novel coronavirus circulating in the Arabian Peninsula since September 2012. It leads to significant respiratory disease and among patients with co-morbidities is associated with high mortality. This research studied the mortality rate of MERS-CoV among intensive care unit (ICU) patients and the correlation of mortality with different co-morbidities. METHODS: This was a retrospective observational study conducted at the Intensive Care Unit of the King Fahad Hospital, Jeddah, Saudi Arabia. Data was obtained through patient chart review. RESULTS: The total sample consisted of 52 laboratory-confirmed MERS-CoV infection patients. 39 patients died, with a 75% case-fatality rate. Many patients had underlying co-morbidities, including diabetes mellitus (51.9%), hypertension (46.2%), and chronic renal disease (21.2%). CONCLUSIONS: MERS-CoV ICU mortality remains markedly high due to a combination of factors; the disease process of MERS-CoV leads to multiple organ failure, particularly respiratory and renal failure.

Epidemiology of Measles Cases in South Darfur State, Sudan, 2011-2015.

Case-based surveillance measles data was defined according to World Health Organization (WHO) guidelines. A total of 511 measles cases were studied from 2011 to 2015 in Southern Darfur State, Sudan and 58.1% of cases were confirmed from Nyala city. About 43.4% of cases were males, 56.6% of cases were female, and 47.7% were children under five years old. Similarity, within February to June, the cases increased by 8.0% in children vaccinated through measles campaign, and 5.3% in children that used child vaccination card and 78.7% in unvaccinated one. The epidemiologically linked (EPI-Linked) measles cases declined from 2011 to 2015; consequently, Measles still remain to be a significant challenge in south Darfur state, Sudan.

Evaluation of gluten in gluten-free-labeled foods and assessment of exposure level to gluten among celiac patients in Lebanon.

The aim of the study was to evaluate gluten contamination in all the gluten-free (GF)-labeled food products sold in Lebanon. Over a 2-year period, a total of 173 food samples collected from 135 brand names were analyzed. Gluten contamination was detected in 33 of 173 (19%) samples, and its content ranged between 2.5 and >80 mg kg-1. In 10 of the 173 samples (6%), the quantity of gluten exceeded the upper limit of 20 mg kg-1. Out of the 10 contaminated products, eight (80%) were locally manufactured. Among these 10 products, eight (80%) were wheat-starch-based foods. Of the 40 brand names tested twice in 2014 and 2015, 15 (38%) showed significantly (p < .05) different gluten content between the 2 years. Using a food frequency questionnaire, exposure level to gluten through the contaminated products was evaluated among 15 celiac patients. Two patients reported consuming these products more than twice per week.

Microbial assessment of commercial pet foods marketed in the United Arab Emirates.

Examining the microbiological characteristics of pet food is imperative to safeguard the health and well-being of companion animals, pet owners, and the surrounding environment. Domestic animals, known for carrying harmful microorganisms, pose a significant health risk, especially in close proximity to people and children. Notably, no studies have previously investigated pet food quality in the Gulf Cooperation Council countries, in particular, the United Arab Emirates (UAE). This study examined the microbiological quality of all stock keeping units (SKUs) of pet foods marketed in UAE (n = 118). Parameters assessed include Total Aerobic Microbial Count (TAMC), Enterobacteriaceae, Total Yeast and Mold Count (TYMC), Salmonella, Listeria monocytogenes, and Clostridium species. Among the 118 samples, 33 (28%) exceeded the acceptable TAMC limit of 106 CFU/g, highlighting significant variations based on manufacturers and ingredients. Eight samples (7%) surpassed the maximum Enterobacteriaceae limit of 3 × 102 CFU/g. TYMC levels exhibited variation, with 33 (28%) exceeding the limit of 104 CFU/g. L. monocytogenes was identified in 44 (37%) of the samples, while Salmonella was not detected. Clostridium contamination was observed in 28 (24%) of the samples. Statistical analyses revealed associations between pet food characteristics and microbial quality, underscoring the imperative for international standards to ensure the safety of pet food. These findings carry significant implications for pet owners, regulatory bodies, and the pet food industry, emphasizing the need for ongoing efforts to enhance the overall quality and safety of pet food products.

Association Between Smoking Habits and Body Weight Among General Population in Saudi Arabia.

BACKGROUND: Smoking is a significant cause of mortality and is strongly associated with the development of morbid diseases, such as obesity. There is a considerable interest in understanding the impact of smoking on body weight. The exact nature remains unclear due to the mixed results observed in the literature review. The aim of this study is to evaluate the association between smoking and body weight concerning demographic characteristics in the western region of Saudi Arabia. METHODS: This cross-sectional study was carried out in the western region of Saudi Arabia from November 15, 2022 to July 15, 2023. To collect data, an online survey was utilized, and the survey link was shared across various social media platforms. The survey was completed by a total of 744 individuals who were at least 18 years old and answered a self-reported questionnaire on the web. RESULTS: Analysis showed that (39%) of participants lead a sedentary lifestyle, and (58.8%) have an abnormal BMI. Among them approximately 25% are overweight, 12.4% are obese, and 7.4% are extremely obese. Moreover, a greater number of them were traditional smokers. Our study reported that individuals who had quit smoking were more likely to be overweight. Regarding self-perception of their weight, almost half of the participants consider themselves overweight and they're more likely to smoke, whether it be traditional or electronic cigarettes. CONCLUSION: This study revealed a strong link between smoking habits and increased weight status, as measured by body mass indexes. These findings have important implications for public health interventions aimed at reducing smoking rates and obesity levels. By recognizing the potential connection between these two risk factors, experts in public health can develop more effective strategies to promote healthy behaviors and prevent chronic diseases among young individuals.

Attitudes and practices on antibiotic use and its emerging threats among Lebanese dairy veterinarians: a case study from a developing country.

Introduction: This study aimed to explore how veterinarians (vets) rationalized their prescribing decisions for antimicrobial (AM) uses, the barriers they perceived to implement proper farm management in Lebanon, and the consecutive threats that might arise concerning the emergent spread of antimicrobial resistance in animals and the population. Methods: Amid the COVID-19 pandemic, phone call interviews were conducted with 34 veterinarians working in different demographic regions across the country. Data were analyzed qualitatively using an inductive thematic analysis. Results and discussion: The majority of veterinarians called for responsible antibiotic use. The prescribing decision of veterinarians was based mainly on suspected disease from field examination, farmer's reports via phone calls, and the ability of the farmer to cover antibiotic costs. Very few veterinarians referred to laboratory diagnosis before prescribing a specific AM due to many obstacles. This study uncovered the absence of a trust relationship between veterinarians and farmers in Lebanon. Veterinarians provided different insights into farming practices, reflecting that farmers, in general, lack proper knowledge and implementation of farm management and that they mainly treat the herd on their own, especially in light of the current unprecedented economic crisis that Lebanon has been facing in the last three years. Above all, veterinarians revealed that AM resistance in Lebanon is markedly spreading, which calls for a serious and instantaneous set of governmental policies and regulations.

Food allergies and allergens in Lebanon: Characterization and perceptions toward labeling.

Background: Food allergy is a life-threatening medical condition of public health concern. The aim of our study was to characterize food allergies, in terms of sources, symptoms, severity, and history, as well as to assess the knowledge, practices, and attitudes towards food allergens and allergies, in addition to food allergen labeling, in Lebanon. Methods: For this, 1100 participants filled over the phone a comprehensive valid questionnaire composed of 41 questions. Results: Fruits were reported as top food allergens (29.6%), while itching and rash were the most reported symptoms (9.6% and 8.0%, respectively). In terms of knowledge, participants scored on average 67.9 ± 16.2%. Participants who identified as females, below 35 years, highly educated, and from health backgrounds had a significantly higher score (p < 0.05), while area of residence did not have any significant effect (p > 0.05). Participants who are medically diagnosed with allergies and those with health background were found to check the ingredients list and read nutritional claims significantly more frequently than those from a non-health background and who are non-medically diagnosed, respectively, while females were found to check ingredients list and read nutritional claims significantly more frequently (p < 0.05). The majority reported that ingredients are easy to understand (63.2%) and simple to read (61.3%), while allergic individuals agreed that the font size of the ingredients list is not big enough (56.8%) and that E-code numbers are not understood (68.7%). The majority considered it "important" to have the label writings larger and bolded (85.7%), to use simple language (95.5%), to place allergen warning (82.2%), and to use a striking allergen symbol (93.5%). Conclusions: Our results emphasize the need for national awareness campaigns to improve knowledge and practices, and to lobby policymakers for appropriate management of food allergies and allergens in Lebanon.

Fecal prevalence of Campylobacter spp. in house dogs in Lebanon: A pilot study.

Background and Aim: Campylobacter spp. are Gram-negative bacilli that are widely recognized as a primary cause of bacterial gastroenteritis worldwide. Campylobacteriosis is the disease caused by this pathogen. Recently, greater attention has been given to the prevalence of campylobacteriosis in different animals, including pets. These animals are considered to be significant reservoirs for this zoonosis. In Lebanon, the occurrence of Campylobacter infection is high. Our first-of-its-kind pilot study in Lebanon aimed to estimate the fecal prevalence of Campylobacter species in house dogs. Materials and Methods: Thirty-five rectal swabs were collected from male and female house dogs of different ages, both with or without diarrhea. Samples obtained from the dogs were subjected to qualitative microbiological culture testing and molecular diagnosis by polymerase chain reaction assays after bacterial DNA extraction. Results: Fecal prevalence of Campylobacter spp. in house dogs in this study was 17%. There was a relatively higher prevalence among young females and a significant difference between healthy dogs and those suffering from diarrhea. Conclusion: Campylobacteriosis was found to be prevalent among house dogs in Lebanon, making them potential carriers of Campylobacter species.

Perfluorooctanoic Acid and Perfluorooctane Sulfonate in Human Milk: First Survey from Lebanon.

Human milk is the primary source of nutrition for infants in their first year of life. Its potential contamination with perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), a group of toxic man-made chemicals, is a health concern that may threatens infants' health. Our study aims to assess the levels of PFOA and PFOS in the breast milk of Lebanese lactating mothers and the maternal factors associated with their presence. High-performance liquid chromatography (HPLC) coupled with a Micromass Quattro micro API triple quadrupole mass spectrometer was used to detect the level of contamination in 57 collected human milk samples. PFOA and PFOS were present in 82.5% and 85.7% of the samples, respectively, while PFOA levels ranged between 120 and 247 pg/mL with a median of 147 pg/mL, and those of PFOS ranged between 12 and 86 pg/mL with a median of 27.5 pg/mL. The median contamination for PFOA exceeded the threshold set by the European Food Safety Authority (EFSA) (60 pg/mL); however, that of PFOS was below the threshold (73 pg/mL). The consumption of bread, pasta, meat, and chicken more than twice per week and that of white tubers and roots at least once per week was significantly associated with higher levels of PFOA (p < 0.05). No significant association was found between maternal age, BMI, parity, level of education, place of residence, source of water used, and smoking with the levels of PFOA and PFOS in the human milk. Additionally, the consumption of cereals at least twice per week was significantly associated with higher levels of PFOS. These findings call for actions to improve the local environmental and agricultural practices, and the regulations and standards for inspecting imported food. It is important to highlight that the benefits of breastfeeding outweigh the reported contamination with PFOS and PFOA in our study.

Prevalence of Campylobacter spp. in broilers in North Lebanon.

Background and Aim: Great attention has been given recently to the prevalence of different Campylobacter spp. in poultry since the latter are considered the major contributing reservoir of human campylobacteriosis. In Lebanon, the occurrence of campylobacteriosis in humans is high. The aim of our first-of-its-kind study in the country was to estimate the prevalence of Campylobacter spp. in broilers from a convenient sample of farms in North Lebanon. Materials and Methods: One hundred twenty-five fecal samples were collected from 25 broiler farms, which were selected, examined, and classified according to their biosecurity level and rearing system. All samples were subjected to qualitative microbiological culture testing and polymerase chain reaction (PCR) assays to detect Campylobacter spp. Results: Despite the reported use of antibiotics, cell culture and PCR were positive for 44% and 88%, respectively. This implies that this bacterium is resistant to antibiotics used on the farms. Furthermore, Campylobacter infection rate was higher in open (92%) than in closed (85%) system farms. All farms with poor biosecurity measures, and 82% of farms with good biosecurity measures had Campylobacter infections, and the difference was significant (p < 0.05). Conclusion: Our results show that campylobacteriosis was found prevalent among broilers in North Lebanon, making them potential carriers of Campylobacter spp. Future studies should include antibiotic susceptibility testing to check the susceptibility pattern of isolates.

Aflatoxins and Ochratoxin A in Tea Sold in Lebanon: Effects of Type, Packaging, and Origin.

Tea is among the oldest and most-known beverages around the world, and it has many flavors and types. Tea can be easily contaminated in any of its production steps, especially with mycotoxins that are produced particularly in humid and warm environments. This study aims to examine the level of ochratoxin A (OTA) and total aflatoxin (AF) contamination in black and green tea sold in Lebanon, evaluate its safety compared to international standards, and assess the effect of different variables on the levels of OTA and AFs. For this, the Lebanese market was screened and all tea brands (n = 37; 24 black and 13 green) were collected twice. The Enzyme-Linked Immunoassay (ELISA) method was used to determine OTA and AFs in the samples. AFs and OTA were detected in 28 (75.7%) and 31 (88.6%) samples, respectively. The average of AFs in the positive (above detection limit: 1.75 µg/kg) samples was 2.66 ± 0.15 µg/kg, while the average of OTA in the positive (above detection limit: 1.6 µg/kg) samples was 3.74 ± 0.72 µg/kg. The mean AFs in black and green tea were 2.65 ± 0.55 and 2.54 ± 0.40 µg/kg, respectively, while for OTA, the mean levels were 3.67 ± 0.96 and 3.46 ± 1.09 µg/kg in black and green tea samples, respectively. Four brands (10.8%) contained total aflatoxin levels above the EU limit (4 µg/kg). As for OTA, all samples had OTA levels below the Chinese limit (5 µg/kg). No significant association (p > 0.05) was found between OTA and tea type, level of packaging, country of origin, country of packing, and country of distribution. However, AF contamination was significantly (p < 0.05) higher in unpacked tea, and in brands where the country of origin, packing, and distributor was in Asia. The results showed that the tea brands in Lebanon are relatively safe in terms of AFs and OTA.

Assessment of mycotoxins in cornflakes marketed in Lebanon.

Cornflakes are a popular and convenient breakfast cereal made from corn and widely consumed worldwide, including in Lebanon. However, they are susceptible to mycotoxin contamination, which can have harmful effects on human health. Our study evaluated the occurrence of five mycotoxins (AFB1, OTA, FUM, ZEA, DON) levels in packed cornflakes marketed in Lebanon. A market screening identified 35 different cornflake stock-keeping units (SKU) in the Lebanese market, originating from 10 different brands and having different tastes and shapes. SKUs were collected and tested for five mycotoxins in triplicates using enzyme-linked immunosorbent assay technique. The results showed the presence of the five mycotoxins in the samples. The average levels of AFB1, OTA, ZEA and FUM among positive samples (above limit of detection) were 1.58, 1.2, 15.1 and 774.1 µg/kg, respectively, and were below the EU limits. On the other hand, the average level of DON was 1206.7 µg/kg, exceeding the EU limit. Furthermore, out of the positive samples, 60%, 17%, 9%, 14%, and 6% exceeded the EU limits for DON, OTA, AFB1, FUM, and ZEA, respectively. Notably, SKUs made in Lebanon had significantly (p < 0.05) higher levels of AFB1 and FUM. The packing size of the cornflakes had no significant (p > 0.05) effect on the levels of the five mycotoxins detected in the samples. AFB1, FUM and ZEA levels differed significantly among SKUs (p > 0.05). Considering these findings, further studies should be conducted to assess the exposure to mycotoxins from the consumption of cornflakes in Lebanon, especially among children.