Kidney cancer trends and risk factors in Lebanon: a 12-year epidemiological study.

PURPOSE: Lebanon has witnessed an increase in the rates of several cancer subtypes over the last years. The aim of this study is to examine the incidence rates of kidney cancer in Lebanon over 12 years and to compare them to other countries. METHODS: Data were collected from the Lebanese National Cancer Registry (NCR) for the time period 2005-2016 (inclusive). Data from other countries were retrieved from an online database "Cancer Incidence in Five Continents." The age specific and age-standardized rates (ASR) were calculated and analyzed using Joinpoint regression. RESULTS: Kidney cancer ranked as the 10th commonest cancer among men and the 19th among women. An age-standardized rate of 3.54 (per 100,000) was obtained. The average ASR was 4.80 for men and 2.27 for women. Kidney cancer showed a significantly rising trend for both genders. Lebanon had the highest ASR for kidney cancer in men and the third highest in women among regional countries. CONCLUSION: Lebanon presented an average-to-high ASR for kidney cancer compared to regional countries. However, compared to countries worldwide, Lebanon had a below-average ASR. Nonetheless, with the rising kidney cancer trends, it is important to study the associated risk factors in order to develop proper preventive and screening measures and therefore decrease the incidence rates.

Contribution of Arab countries to Behçet disease research: a PubMed-based bibliometric and altmetric analysis.

Behçet's disease (BD), a rare multisystemic disorder, has an unknown etiology. Interactions between genetic and environmental factors play a major role in this disorder. Human leukocyte antigen B51 allele is the strongest risk factor for the development of Behçet disease. The high prevalence of BD in the Arab world makes it necessary to undergo local research and publications, to target particular genetic, geographical, or even cultural risk factors. This study aims to assess the numerical contribution of the Arab world to research on Behçet disease. Using the PubMed platform, the number of BD-related publications from 2005 to 2019 was assessed for all 22 Arab countries, and countries having the highest prevalence of the disease. Number of publications on BD was normalized to the average population size and GDP for each Arab country. From 2005 to 2019, Arab countries published 198 articles related to BD. This accounts for 0.1% of the total number of BD-related articles published in this period (4170). A significant, positive correlation of moderate strength exists between the number of publications and the average population, while a non-significant, positive correlation of week strength exists between the number of publications and GDP. Concerning the top 15 countries according to Behçet disease prevalence, Turkey had the greatest number of articles, while the USA had the highest ratio of publications per prevalence. The high prevalence of BD in Arabic countries was faced by paradoxically low research activity in this field. Arab countries are lagging behind in the field of Behçet disease-related research, which highlights the need for improving research productivity.

Psoriasis: A bibliometric analysis in the Arab World (2004-2019).

BACKGROUND: Psoriasis is a relatively common inflammatory skin disease with systemic implications. Psoriasis data seem to arise from a select number of countries, while other areas in the world with different genetics and ethnicities, especially Arab countries have a questionable input. AIM: This study aims to quantitatively assess Arab countries contributions in psoriasis research. METHODS: The number of publications related to psoriasis for each of the 22 Arab countries was found on PubMed for every year between 2004 and 2019, and then, the total for each country was normalised according to three parameters: average population, Gross Domestic Product and psoriasis disability-adjusted life years. In addition, the number of psoriasis articles was also retrieved for 2 other groups: South America and Far East Asia, for comparison. RESULTS: Only 1.53% of all psoriasis research published between 2004 and 2019 originates from Arab countries (vs. 2.06% from South American countries and 13.2% from Far East Asian countries), and psoriasis articles make up only 0.15% of the total publications from Arab countries (vs. 0.10% for both South American and Far East Asian countries). Egypt scored the highest number of psoriasis-related articles and accounted on its own for almost half the number of psoriasis publications (47.9%) from Arab countries. When normalised according to the 3 parameters, other Arab countries also rose to prominence; Kuwait had the highest number of publications per million persons, and Tunisia had the highest number of publications per GDP. However, Egypt ranked once again first as having the highest number of publications per 1% psoriasis-related DALY. Among the three parameters, the average population size proved to be the most strongly correlated with the number of psoriasis publications in a given country. CONCLUSION: There is an incontestable need for more research related to psoriasis in Arab countries as the numbers are still very low reflecting many difficulties standing In the way of research in general in the Arab world.

Attitudes Towards Psychiatry in Lebanese Medical Students: What Are the Factors that Could Lead to a More Favorable Outlook?

OBJECTIVE: The authors aimed to assess the attitudes towards psychiatry of all Lebanese medical students, as well as the factors that could have led to these attitudes, whether favorable or not. METHODS: In this cross-sectional study, the authors ran a questionnaire among a sample of Lebanese medical students from all medical faculties, regions in Lebanon, and years of medical school, using the ATP-30 scale and the WHO-5 well-being index. The answers from the 607 participants were statistically analyzed on SPSS version 23.0. RESULTS: Among participants, 95.1% had a positive attitude towards psychiatry, reflecting a favorable outlook among Lebanese medical students overall. The average ATP-30 score in our sample was 111.95 out of 150 (SD = 12.55), which is in the range of countries of higher socio-economic level such as Germany and Switzerland. Also, 26.5% of participants reported that they consider psychiatry as a potential career choice. No demographic factor had any influence on the ATP-30 score. In the multivariate analysis, only two factors resulted in favorable attitudes: exposure to a patient with a diagnosed psychiatric illness in the student's surroundings and a lower WHO-5 well-being index. CONCLUSION: This study's results do not fit into the traditional "developed vs. developing countries" paradigm. However, Lebanon still has a lot of challenges to face in order to provide quality mental healthcare.

Competencies required for graduated physicians: the integration of Englander's common taxonomy in a validated scale for the assessment of competency acquiring in undergraduate medical education.

BACKGROUND: Competency-based medical education has been emerging as a new educational model for learning. The development of medical education in Middle Eastern countries lacks basic literature in the area of medical education, particularly competency-based medical education (CBME). AIM: Our objective is to validate a brief/rapid scale that informs us on the current perception of the acquiring of competencies of medical students and graduates from the Lebanese University, Lebanon. METHODS: A survey containing the Englander's common taxonomy for medical competencies-a set of 57 items-was distributed to medical students and graduates from the Lebanese University. Three parameters were used for the validation of this scale: construct validity using the principal component analysis technique, internal reliability using Cronbach alpha, and convergent validity using Pearson correlation. RESULTS: A total of 377 participants responded to the survey. Factor analysis, using Varimax rotation, showed appropriate loading of domains; loadings varied between 0.648 and 0.899. Construct validity showed for all competencies loaded appropriately in their respective domains; loadings ranged between 0.656 and 0.913. Cronbach alpha values were very good to excellent (0.868 to 0.932). Pearson correlation coefficients showed a good correlation with the total score and varied between 0.739 and 0.893 (p < 0.0001). CONCLUSION: The Englander's common taxonomy scale is valid and reliable among Lebanese medical students and could be used for concise assessment of current and past medical education in faculties among Lebanese medical students. Using such scales can be used in assessing the improvement of medical education towards CBME.

Epidemiology of Ocular Malignancies Among the Lebanese Population: A 12-Year Review.

Purpose Our article aims to assess the epidemiology of eye cancer in Lebanon and compare it with other regions worldwide and to study its future trends among Lebanese males and females. Methods Data on eye cancer cases from 2005 to 2016 were obtained from the Lebanese National Cancer Registry (NCR). Age-specific rates, crude rates, and age-standardized rates (ASRs) were subsequently calculated. Joinpoint was used to determine the changes in the slope of trends. A projection for the next 14 years was predicted using linear and logarithmic regression models. Results Among all tumors, eye cancer ranked 40 in females and 41 in males. The eye cancer ASR was 0.24 and 0.22 per 100,000 in males and females, respectively. However, the mean age of eye cancer was 31.94 years in males and 22.04 years in females. The cumulative risk between 0 and 74 years was 0.02%. From 2004 till 2016, a negative trend of eye cancer was observed, with a parallelism of trends between males and females. Age-specific rates showed a bimodal distribution in males. The first cluster was witnessed in the age group of 0-4 years and the second one in those above 50. An additional cluster of distribution was observed in females between 35 and 44 years of age. Forecasts for the next 14 years revealed a steady rate of eye cancer incidence of about 0.2 per 100,000. Moreover, Lebanon showed a relatively low eye cancer ASR compared to other regions worldwide, especially Zimbabwe with 5.8 and 4.8 per 100,000 in females and males, respectively. Conclusion Ocular malignancies showed a negative trend of incidence. A 14-year projection predicts a steady incidence rate in Lebanon and worldwide. Eye cancer seems to be affected by many risk factors. Future efforts are needed for a better understanding of the disease and a better outcome.

Assessment of gender gap in surgical specialties among Lebanese medical personnel: the need for involvement of women in surgery.

Background: Little is known about gender disparity in the surgery specialty in Lebanon. Aims: To assess the status of female surgeons and possible gender gaps in surgery specialty in Lebanon. Methods: The study was conducted in May 2021. Data were retrieved from the Lebanese Order of Physicians website, indicating the number of physicians in the different specialties, their gender, hospitals, and locations. The c2 test of homogeneity was used to establish whether the gender distribution was equal. Results: Women only accounted for 21.84% (3,370) of physicians in Lebanon, with surgery having the lowest number of female physicians in (n = 65; 2.30%). Women accounted for 1.63% of all surgeons in Lebanese hospitals, there were more female plastic and reconstructive surgeons (n = 12; 7.14%), while neurosurgery, oncological surgery and vascular surgery had no females. There was no significant difference in gender between academic and non-academic institutions (χ2 = 2.164, P = 0.149), or between public and private hospitals (χ2 = 1.277, P = 0.234). Conclusion: The surgical specialty had the widest gender gap among all the medical fields in Lebanon. Therefore, the healthcare systems, including public and private hospitals, have a long and difficult road in narrowing the gender gap. Different strategies to incorporate women into surgery should be explored to assure equitable opportunities for all physicians, based on competency rather than gender.

Complete recovery of complicated methotrexate-induced liver cirrhosis in a patient with psoriasis: A case report.

Cirrhosis is the most common indication for liver transplant. Literature addressing methotrexate (MTX)-induced liver cirrhosis in patients with psoriasis is sparse. We present a case of a nonalcoholic patient diagnosed with psoriasis that was treated with a weekly 5 mg dose of methotrexate, a chemotherapeutic and immunological modulator, for five years. The patient presented after five years with abdominal distension and lower limb edema along with ascites and esophageal varices and was diagnosed with liver cirrhosis. Upon the discontinuation of MTX, the patient showed clear regression of ascites and esophageal varices, and recovery of liver cirrhosis by de-escalating from Child-Pugh B to A. After five years of follow-up, Echography and Transient Elastography (Fibroscan) of the liver confirmed the full recovery of liver cirrhosis by the absence of steatosis and fibrosis. This study emphasizes the reversibility of MTX-induced liver cirrhosis: cirrhosis is not aggressive, can be reversible, and is dose- and duration-dependent.

Acute flaccid paralysis incidence rate and epidemiology in children in Lebanon: a rise in numbers in the post-vaccination and refugee crisis era.

Background: Acute flaccid paralysis (AFP) is a clinical syndrome characterized by the acute onset of weakness and paralysis with reduced muscle tone. This study explored the incidence and different aspects of AFP in Lebanese children between 2009 and 2019. Methods: AFP data were collected from the Lebanese Ministry of Public Health. Incidence rate according to year, age groups, clinical data, follow-up, diagnosis, and vaccination status was analyzed in the 11-years period. Results: AFP incidence rates increased importantly from 0.63 per 100,000 in 2009 till 4.96 per 100,000 in 2019. Most of the patients were children under ten years of age, 40.6% of all cases were under five years old, and 37.9% were between 5 and 9 years old. Follow-up revealed that approximately two out of five patients experienced residual weakness. As for the final diagnosis, around 30% of cases were diagnosed as Guillain-Barre Syndrome (GBS). Most cases were children having received between 3 and 5 doses of polio vaccine. Conclusions: The rise in cases coincided with the Syrian refugee crisis in Lebanon and the progressively deteriorating economy in the country; yet, incidence rates were in the lower margin compared with other countries.

Current state of clinical trials regarding liver transplant rejection.

BACKGROUND: Liver transplant (LT) is the second most common transplant intervention. The rate of acute cellular rejection (ACR) is 15-25% after LT, while being higher in chronic rejection (CR). Clinical trials had a major role in getting more potent and selective immunosuppressive medications. Our study plays an important role by evaluating and tracking clinical trials related to liver transplant rejection, focusing on interventional therapeutic trials. METHODS: On October 28, we searched Clinicaltrials.gov for interventional clinical trials related to liver transplant rejection. A total of 27 clinical trials included in this study. Characteristics on each trial were collected, and availability of linked publications was searched using Medline/PubMed and Embase/Scopus. Content of publications was reviewed and main findings were summarized. RESULTS: Majority of trials were completed (15 out of 27). Eleven trials had between 11 and 50 participants, and 10 had above 100. The study duration was between 1 and 4 years for the majority of trials (16 trials), with an average of 3.77 years. Most of the trials were done in Europe/UK/Russia (n = 12). The results were provided in 9 trials but published in 4, showing the possible tolerogenic efficacy of MSC in liver transplantation, increased success of immunosuppression (IS) withdrawal after sirolimus addition, efficacy of Alemtuzumab, normal graft function and stability within 1 year of immunosuppression withdrawal. CONCLUSION: This study revealed a low number of trials, lack of variety in location and low publishing rates. The focus of trials was mainly towards side effects and safety of immunosuppressants, and their withdrawal. These trials reached results that must be built on to reach definitive guidelines and treatment strategies. This highlights the need for better management of human and financial resources, in order to reach new and more effective therapeutic strategies, leading to the decrease in rate of LTR.

Effect of donor-to-recipient HLA matching in low-immunological risk kidney transplant recipients without induction therapy on acute rejection, graft survival, infections, and surgical complications at 3 years: The road towards new recommendations.

BACKGROUND: Donor-to-recipient human leukocyte antigen mismatching is considered one of the strongest determinants for graft and patient survival in kidney transplant recipients (KTR). OBJECTIVE: This retrospective study discusses the impact of HLA matching as low immunological risk KTR without induction therapy. MATERIAL AND METHODS: Records of 80 adult kidney transplant patients were reviewed with three years of the follow-up. All patients had panel reactive antibodies (PRA) < 20%, absence of donor-specific antibodies (DSA) and did not receive the induction therapy. These patients were divided into two groups according to their HLA matching between donor and recipient: 55 patients with ≥ 3 HLA matches (Group I; low immunogenicity) were compared to 25 patients with <3 HLA matches (Group II; high immunogenicity). The primary endpoints included the rate and severity of acute rejection (AR) episodes, graft function (creatinine level), and survival at 1, 3, 6, 12, and 36 months. Secondary endpoints include the rate and type of infections at one-year, surgical complications at one-year, and patient survival at 1, 6, 12, and 36 months after kidney transplantation. Baseline demographic characteristics were comparable between the two groups except for recipient age, donor gender, and pre-transplant dialysis time. RESULTS: There was no significant difference observed between two groups at one-year in infection rate, the length of hospital stay, AR severity, the rate of cytomegalovirus infection, and the occurrence of delayed graft function. However, the rate of AR, the graft function upon discharge, and the rate and type of surgical complications at one-year were significantly higher in Group II (high immunogenicity). The patient and graft survival at three years, the death-censored graft survival, and the serum creatinine levels at 1, 3, 6, 12, and 36 months were similar between two groups. Two deaths occurred in each group (NS). CONCLUSION: In our center, the donor-to-recipient HLA mismatch is not considered an immunological risk factor in low-risk kidney transplant recipients (PRA < 20% and absence of DSA).

Rapid clinical recovery of posterior reversible encephalopathy syndrome in two cases of IgA nephropathy disease and nephrotic syndrome type 9 post-renal transplant.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome often associated with immunosuppressant drug use, renal disease, and eclampsia and characterized by parieto-occipital vasogenic edema that usually resolves within days. Globally and in the settings of renal transplant, literature concerning PRES is very scattered. In this report, we provide two cases, one diagnosed with IgA nephropathy and another with nephrotic syndrome type 9 that developed episodes of tonic-clonic seizure immediately after renal transplant in case 1 and four days post-transplant in case 2. The two patients had a history of hypertension, renal disease, corticosteroid and immunosuppressant drug use. Neuro-imaging showed typical vasogenic edema involving the parieto-occipital areas. Therefore, the clinical-radiological presentation confirmed the diagnosis of PRES in both cases. Also, rapid neurologic recovery was witnessed upon administration of anti-epileptic and anti-hypertensive medications. Non-discontinuation of immunosuppressants, steroids, early symptomatic management, and blood pressure control are favorable factors that might explain the rapid recovery of these two patients.

The Arab Countries' Contribution to the Research of Neurodegenerative Disorders.

BACKGROUND: Neurodegenerative diseases are disorders in which nerve cells start to lose function due to different causes. Like many other illnesses, they are considered to be highly prevalent in the 22 Arabic-speaking countries known to constitute the Arab world. The two most prevalent neurodegenerative disorders are Alzheimer's disease and Parkinson's disease. AIM: The aim of this paper is to assess the amount of research dedicated to neurodegenerative diseases by the Arab countries during a 15-year period, between 2005 and 2019. METHODS: The number of publications by each Arab country as well as some non-Arab speaking countries was retrieved from PubMed. Publications in top 10 neuroscience journals were also tracked using the same method with each journal's name included. The numbers were then normalized with respect to the average population and average gross domestic product (GDP) in each country to eliminate bias. RESULTS: Arab countries were shown to contribute only 1,311 (0.774%) of the 169,330 articles published worldwide on neurodegenerative disorders. These 1,311 also constitute only 0.660% of the 198,869 Arab publications during the indicated period. Saudi Arabia had the highest contribution to these numbers with more than one-quarter the number of publications on neurodegenerative disorders. Approximately one-third of all neurodegenerative disease-related articles were associated with Alzheimer's disease, whereas one-fifth were related to Parkinson's disease. For the top 10 neuroscience journals, only a minimal contribution by Arab countries was noted. CONCLUSION: Although an increase in the number of articles by the Arab world was noted from 2013 onward, the contribution of the Arab countries on the subject to the number of publications still seems to be insufficient.

Distribution of Primary Brain Tumor Subtypes in Lebanon: A Multicenter Eleven-Year Study of 695 Patients.

Background Brain tumors are associated with relatively high mortality and morbidity in comparison with their low incidence. Little is known about primary brain tumors in Lebanon, as well as in the Arab world. This study aims to analyze the epidemiology of brain tumors across the Lebanese population. Methods Data from pathology reports of patients diagnosed with malignant and non-malignant primary brain tumors were collected retrospectively in an eleven-year period (2007-2017) from four medical centers in Lebanon. A total of 695 primary brain tumor cases (61% malignant and 39% non-malignant) were retrieved from different regions across the country. Results Meningiomas were the most common histology in this sample (29.6%), followed by glioblastomas (25.5%) and oligodendrogliomas (5.9%). Pituitary tumors were only 3.5% of brain tumors. Besides, the most common anatomical locations in malignant and non-malignant tumors were cerebral meninges (29.6%), the "other brain" category (21.3%), and the frontal lobe (11.2%). In children and adolescents, embryonal tumors (21%) were the most common histologies, while glioblastomas and meningiomas accounted for 14.8% and 13.6%, respectively. Conclusion Lebanon presented a low rate of pituitary tumors and an unusually high percentage of malignant tumors, as well as pediatric glioblastomas and meningiomas. This should raise major concerns for policymakers to detect the possible underlying causes.

Epidemiology and Incidence of Retinoblastoma in the Middle East: A Nationwide Study in Lebanon.

BACKGROUND: Retinoblastoma, although a rare pediatric cancer, can lead to disastrous outcomes if not managed early. This mishap often happens in developing countries. Conversely, early diagnosis and treatment of retinoblastoma in developed countries were associated with a surge in RB1 gene carriers. AIM: The authors aimed to evaluate the incidence of retinoblastoma in the Lebanese population aged between 0 and 19 years according to age, sex, and other variables and compare the age-standardized incidence rates with regional and worldwide countries. METHODS: Data were retrieved from the National Cancer Registry (NCR) of the Ministry of Public Health (MOPH). Subsequently, incidence rates, age-standardized rates, and fictional incidence rates excluding the emigrant population were calculated. Retinoblastoma trends were found using the Joinpoint regression program software. RESULTS: From the 38 cases of retinoblastoma recorded in the nine years cohort, 29 cases occurred in the 0-4 age group, and age-standardized rates were 2.8 and 3.6 per million person-years for the 0-19 and 0-14 age groups, respectively. When the refugee population was excluded, the ASR 0-19 almost doubled from 2.8 per million person-years to 5.16 per million person-years. Joinpoint regression revealed that retinoblastoma trends were divided into two segments showing a decrease from 2005 until 2011 and a rising trend in 2011-2015. When compared to other countries in the region, Lebanon had low-intermediate 0-19 ASRs. CONCLUSION: Retinoblastoma incidence in Lebanon is in the lower margin of the worldwide average and could be underestimated due to the underdiagnosis in the refugee population. Efforts are being deployed to overcome the financial barriers in the treatment of retinoblastoma by coordinating with neighboring Arab countries.

Insights in Neuropsychiatry: Suicide and Self-Mutilation in the Mena Region- a Bibliometric Quantitative and Co-occurrence Medline-Based Analysis.

Background  Little is known about self-mutilation and suicide-related research in the Arab world. Aim We aim to quantify research activity related to suicide and self-mutilation, according to socio-economic factors, and assess inter-regional collaborations and trends of topics in the Arab world in the last 16 years. Methods A search was conducted through the PubMed database to find articles related to suicide and self-mutilation, according to author affiliation in the 22 Arab countries between 2004 and 2019 (inclusive), and standardized according to mean population, suicide, and self-mutilation disability associated life years (DALY), and gross domestic product (GDP). VOS Viewer was used for keyword and organization co-occurrence analysis. Results Only 0.61% of articles related to suicide and self-mutilation published between 2004 and 2019 were of Arab origin, compared to 1.76% in South America and 7.94% in Far East Asia. Suicide and self-mutilation articles make up 0.09% of the total publications in the Arab region. Egypt, Saudi Arabia, and Lebanon had the highest number of published articles related to suicide and self-mutilation. When comparing publications per million persons, Lebanon and Kuwait ranked first with 5.15 and 3.40 publications per million persons. Lebanon showed the highest number of publications per USD billion GDP, with 0.75 publications. The highest number of publications per 1% self-injury-related DALY was recorded in Saudi Arabia, with 46.97 publications. In recent years, VOS Viewer revealed poor inter-regional collaborations and a modest but increasing trend towards depression, poisoning, and cross-sectional studies. Conclusion Despite increasing publications, the region still lags in terms of suicide and self-mutilation research activity. A pan-Arab strategy should be implemented to refine suicide-related research and increase mental health awareness.

Familial Mediterranean fever research activity in the Arab world: the need for regional and international collaborations.

BACKGROUND: Familial Mediterranean fever (FMF) is an autoinflammatory, multisystem disease affecting the populations of the Mediterranean basin. AIMS: The aim of this study was to assess the research input of Arab countries on FMF between 2004 and 2019. METHODS: The Medline database (PubMed) was accessed for FMF-related publications. The number of publications was normalized to average: population size, GDP and number of physicians for every country. VOSViewer was used to create a co-occurrence bibliographic map. RESULTS: Between 2004 and 2019, 69 articles relating to FMF were published in the Arab world, accounting for 0.03% of the total number of publications originating in Arab countries, and 3.60% of all articles relating to FMF worldwide. After normalizing to average population size, GDP and number of physicians, Lebanon ranked first with 4.44, 0.64 and 1.99 publications per million persons respectively. Moderate positive correlations were found between number of publications and average population size (r = 0.385) and average number of physicians (r = 0.513). Half of the articles were published in journals ranked Q1 and Q2. An abundance of keywords relating to genetics hint at a main focus on the genetic aspect of the disease. CONCLUSION: The low number of publications could be a result of the absence of research funding and the political and military instability in the Arab world. Given that many articles were published in high quality journals, Arab countries should focus on providing a clinical aspect to their studies and working on regional and international collaborations.

Severe Symptomatic Hypochloremia Associated with Rare Signet Ring Cell Carcinoma of the Ampulla of Vater: A Case Report.

Hypochloremia is an electrolyte disturbance characterized by low serum concentration of chloride ions, often occurring in acute illnesses and characterized by nonspecific signs and symptoms. It rarely results from decreased intake and is predominantly due to either renal or extra-renal losses. We report a case of severely worsening symptomatic hypochloremia resulting from an extra-renal loss of chloride ion in a 58-year-old female patient presenting for prolonged protracted vomiting. Chloremia reached a surprising level of 48 mEq/L, the lowest level reported in the literature. The patient was eventually diagnosed with a rare signet ring cell carcinoma that occurred in the ampulla of Vater, leading to a malignant gastric outlet obstruction and causing extra-renal loss of chloride.

Cytomegalovirus infection in kidney transplant patients: Prevalence, risk factors, and impact on outcome - A local multicentre experience.

BACKGROUND: CMV infection prevalence in kidney transplant recipients (KTR) is reported to be high in the literature, reaching rates of over 80%. OBJECTIVES: The primary endpoints were the evaluation of the prevalence, the risks factors, and the effects of CMV infection on graft function and survival, as well as patient survival at three years after kidney transplantation. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 288 kidney transplant patients operated in three Lebanese transplant centers between 1998 and 2017 with three years of follow-up. The patients were divided into two groups: those free of any CMV infection (271 patients (94%); Group I) and those who suffered from CMV infection (17 patients (6%); Group II). RESULTS: Baseline demographics of the two groups were similar, including recipient and donor gender and age, cause of renal disease, recipient body mass index, pre-transplant fasting blood sugar and dialysis duration, HLA matching between donor and recipient, degree of sensitization in the recipient, type of CMV prophylaxis, maintenance immunosuppression and immunological characteristics. The prevalence of CMV infection is 5.9% among KTR. There were significant differences between the two groups concerning the type of induction therapy and the duration of anti-CMV prophylaxis. The rate of infected patients and infectious episodes were significantly higher in Group II. At 3-years, graft function and survival, patient survival, and the rate of new-onset diabetes were similar between the two groups. CONCLUSION: The present study is the first to explore the incidence and risk factors of CMV in kidney transplant patients in Lebanon. Comprehensive nationwide studies are therefore necessary to determine the epidemiology and risk factors of CMV infection after kidney transplantation in Lebanon.

Contribution of Arab world in transplant research: A PubMed-based bibliometric analysis.

BACKGROUND: The Arab world consists of 22 countries situated in the Middle East and North Africa, tied together by linguistic and cultural bonds. Over numerous past decades, this region tended to fall behind regarding biomedical research. Organ, tissue, and cell transplantation are life-saving and life-improving treatments for various diseases. Given the positive correlation between research activity and the improvement of the clinical frame of transplantation, this article intended to examine the regional activity of transplantation research between 2005 and 2019. METHODS: Using the PubMed database, the number of transplantation-related articles published by each country, and regarding 26 different procedures, was assessed. The results were normalized with respect to each country's average population & average Gross Domestic Product (GDP). In addition, the co-occurrence of keywords and the co-authorships were analyzed by VOS Viewer. RESULTS: Arab countries contributed to 1.25% of total transplantation publications. The number of transplantation publications had an inflection in 2013, with the last six years alone contributing to 65.27% of the overall regional transplantation-related publications. Kuwait and Lebanon ranked first in terms of publications per million persons, while Egypt ranked first in terms of publications per national GDP. Stem cell, bone & kidney transplantations had the highest number of Arab transplantation-related publications. Low levels of collaboration between authors and organizations were observed, besides a modest but increasing trend towards experimental work on animals and newer therapies. CONCLUSION: Despite the increase in transplant-related research activity in recent years, the Arab world still lags behind in this field compared to the worldwide contribution.