First data on latent tuberculosis infection in Syrian refugees with diabetes in Lebanon.

OBJECTIVE: The association between diabetes mellitus and tuberculosis is a health-threatening double trouble. Vulnerable populations such as refugees and conflict-displaced populations may be at higher risk of both diseases. Here, we examined the prevalence of latent tuberculosis infection (LTBI) and its associated risk factors in a population of Syrian refugees with diabetes in North Lebanon. STUDY DESIGN: This is a cross-sectional study. METHODS: A total of 87 Syrian refugees with diabetes were enrolled. Demographic and clinical data were collected using a structured questionnaire, and a blood sample was obtained from each patient. LTBI was examined using the last generation QuantiFERON-TB Gold Plus assay. RESULTS: The mean age of the study population was 54.1 ± 10.5 years, and the majority were women (79.3%). LTBI was found in 1 in 5 (17/87; 19.5%) enrolled patients, with the majority being originated from Aleppo (47.05%). Infection was significantly associated only with age (P = 0.009), and its risk was 4-fold higher in patients aged ≥60 years (odds ratio: 4.1, confidence interval: 1.4-12.5, P = 0.018). CONCLUSION: This study highlights the need to implement effective tuberculosis control strategies among refugees with diabetes, with particular attention to those at older age.

e-Assessment in a Limited-Resources Dental School Using an Open-Source Learning Management System.

e-Assessment provides solutions to some problems encountered in dental students' evaluation. The aim of this study was to evaluate the experience of a limited-resources dental school with e-assessment provided through an open-source learning management system (LMS). Data about users' access and types of e-assessment activities at the Faculty of Dentistry, Alexandria University, Egypt, were obtained from the web-based LMS Moodle. A questionnaire developed to assess students' perceptions of the e-assessment was also sent to students registered in two courses (undergraduate and postgraduate) with the same instructor. The results showed that most e-courses at the school had one form of e-assessment (82%) and, of these, 16.7% had summative assessment activities. There were significant differences among departments in the number of e-courses with e-assessment. One-quarter of e-courses with e-assessment used Moodle quizzes. Of 285 students registered in the two courses that included the questionnaire, 170 responded (response rate=59.6%). The responding students positively perceived the impact of e-assessment on learning and its reliability and security, whereas technical issues and related stresses were negatively perceived. This study suggests that e-assessment can be used at minimal cost in dental schools with limited resources and large class sizes with the least demands on faculty members and teaching staff time. For these schools, an open-source LMS such as Moodle provides formative e-assessment not available otherwise and accommodates various question formats and varying levels of instructors' technical skills. These students seemed to have a positive impression of the e-assessment although technical problems and related stresses are issues that need to be addressed.

Pyrosequencing for rapid detection of tuberculosis resistance to Rifampicin and Isoniazid in Syrian and Lebanese clinical isolates.

BACKGROUND: Rapid and accurate techniques are always welcomed for the detection of resistant strains of Mycobacterium tuberculosis MTB. OBJECTIVES: The objective of this study is to evaluate the pyrosequencing technology for the detection of MTB resistance to Rifampicin (RIF) and Isoniazid (INH) in Syrian and Lebanese clinical strains; 66 strains resistant to INH, among them 56 resistant also to RIF, were tested. METHODS: Four pyrosequencing assays were optimized and applied to the following loci: rpoBrpoB RIF resistance-determining region, katG, the promoter regions of inhA and ahpC-oxyR intergenic region. RESULTS: The prevalence of mutations on codon 315 of the katG gene, inhA and ahpc-oxyR were 42.4%, 21.2% and 9.0%, respectively, which make an overall sensitivity of 72.6% for INH resistance. All RIF-resistant strains contained at least one non-synonymous codon change in the sequenced rpoB region (507-533) relative to the ATCC reference strain. The RIF drug resistance region (RRDR) sequencing identified 96 modified codons representing 34 different mutations. CONCLUSIONS: The high sensitivity and the short turnaround time combined with multilocus sequencing of several isolates in parallel make pyrosequencing an attractive method for drug resistance screening for MTB.

Air quality in Malaysia: impacts, management issues and future challenges.

OBJECTIVE: Observations have been made on the long-term trends of major air pollutants in Malaysia including nitrogen dioxide, carbon monoxide, the ozone and total suspended particulate matter (particularly PM10), and sulfur dioxide, emitted from industrial and urban areas from early 1970s until late 1998. METHODOLOGY: The data show that the status of atmospheric environment in Malaysia, in particular in highly industrialized areas such as Klang Valley, was determined both by local and transboundary emissions and could be described as haze and non-haze periods. RESULTS: During the non-haze periods, vehicular emissions accounted for more than 70% of the total emissions in the urban areas and have demonstrated two peaks in the diurnal variations of the aforementioned air pollutants, except ozone. The morning 'rush-hour' peak was mainly due to vehicle emissions, while the late evening peak was mainly attributed to meteorological conditions, particularly atmospheric stability and wind speed. Total suspended particulate matter was the main pollutant with its concentrations at few sites often exceeding the Recommended Malaysia Air Quality Guidelines. The levels of other pollutants were generally within the guidelines. Since 1980, six major haze episodes were officially reported in Malaysia: April 1983, August 1990, June 1991, October 1991, August to October 1994, and July to October 1997. The 1997 haze episode was the worst ever experienced by the country. Short-term observations using continuous monitoring systems during the haze episodes during these periods clearly showed that suspended particulate matter (PM10) was the main cause of haze and was transboundary in nature. Large forest fires in parts of Sumatra and Kalimantan during the haze period, clearly evident in satellite images, were identified as the probable key sources of the widespread heavy haze that extended across Southeast Asia from Indonesia to Singapore, Malaysia and Brunei. The results of several studies have also provided strong evidence that biomass burning is the dominating source of particulate matter. The severity and extent of 1997's haze pollution was unprecedented, affecting some 300 million people across the region. The amount of economic costs suffered by Southeast Asian countries during this environmental disaster was enormous and is yet to be fully determined. Among the important sectors severely affected were air and land transport, shipping, construction, tourism and agro-based industries. The economic cost of the haze-related damage to Malaysia presented in this study include short-term health costs, production losses, tourism-related losses and the cost of avertive action. Although the cost reported here is likely to be underestimated, they are nevertheless significant (roughly RM1 billion). CONCLUSIONS: The general air quality of Malaysia since 1970 has deteriorated. Studies have shown that should no effective countermeasures be introduced, the emissions of sulfur dioxide, nitrogen oxides, particulate matter, hydrocarbons and carbon monoxide in the year 2005 would increase by 1.4, 2.12, 1.47 and 2.27 times, respectively, from the 1992 levels.

Teratoma of the heart. A case report and review of the literature.

The clinical manifestations and pathological features of an extremely rare cardiac tumour, a mature (benign) teratoma, in a 6 year-old girl are described. These are compared with those reported in the literature.

Surgical treatment for a complicated congenital aortic stenosis. The association of a three-level obstruction of the left ventricular outflow tract with mitral incompetence, coarctation of the aorta, and the Wolff-Parkinson-White syndrome.

We report a case of complex congenital aortic stenosis with obstruction at all three levels of the left ventricular outflow tract (subaortic, aortic, and supravalvular aortic stenoses) associated with a mitral malformation, coarctation of the aorta, and the Wolff-Parkinson-White syndrome. The subaortic stenosis was corrected by excision and myotomy, and the supravalvular stenosis by a widening prosthetic operation with a Dacron patch extending as far as the aortic ring, at which level a Björk-Shiley No. 17 aortic prosthesis was inserted. The mitral valve was replaced by a Lillehei-Kaster prosthesis. The coarctation of the aorta was not significant and was left alone. Permanent pacing was needed because of peroperative surgical section of the bundle of His. Reviews of the literature and the various techniques used to widen the left ventricular outflow tract are included.

[Valvular prosthesis and anticoagulant treatment]. / Prothéses valvulaires et traitement anticoagulant

67 patients with prosthetic valvular replacement have been followed up for a period ranging from 6 months to 9 1/2 years; the overall number of valves was: 53 mitral, 24 aortic, 10 tricuspid valves. The average age of our patients was young (23.6 years). Many patients, because of their age or by lack of discipline or because of their social condition, had an inefficient anticoagulant treatment; they were subdivided into three groups. Those who stopped their anticoagulant treatment 6, those treatment was inefficient 25; in these two groups, no thrombo-embolic accident was noted, those whose treatment was efficient with a prothrombin time permanently lower than or equal to 40%: 36. It is in this very series that three cases of thrombosis occurred, two of which were lethal. Thus, although the indication for an anticoagulant treatment in patients with prosthetic valvar replacement remains indisputable, one may wonder, in front of such results, if there are not other factors, besides anticoagulant treatment, that result in thrombo-embolic accidents.