Osteoporotic hip and vertebral fractures in the Arab region: a systematic review.

Asia is projected to account for the largest proportion of the rising burden of osteoporotic fractures worldwide. Data from the Middle East is scarce. We performed a systematic review on the epidemiology of vertebral and hip osteoporotic fractures in 22 Arab League countries, using Scopus, PubMed, and Embase. We identified 67 relevant publications, 28 on hip and 39 on vertebral fractures. The mean age of patients was 70-74 years, female to male ratio 1.2:2.1. Age-standardized incidence rates, to the UN 2010 population, were 236 to 290/100,000 for women from Kuwait and Lebanon, lower in Morocco. Risk factors for hip fractures included lower BMD or BMI, taller stature, anxiolytics, and sleeping pills. Most patients were not tested nor treated. Mortality derived from retrospective studies ranged between 10 and 20% at 1 year, and between 25 and 30% at 2-3 years. Among 39 studies on vertebral fractures, 18 described prevalence of morphometric fractures. Excluding grade 1 fractures, 13.3-20.2% of women, mean age 58-74 years, had prevalent vertebral fractures, as did 10-14% of men, mean age 62-74 years. Risk factors included age, gender, smoking, multiparity, years since menopause, low BMD, bone markers, high sclerostin, low IgF1, hypovitaminosis D, abdominal aortic calcification score, and VDR polymorphisms. Vertebral fracture incidence in women from Saudi Arabia, mean age 61, was 6.2% at 5 years, including grade 1 fractures. Prospective population-based fracture registries, prevalence studies, predictive models, fracture outcomes, and fracture liaison services from Arab countries are still lacking today. They are the pillars to closing the care gap of this morbid disease.

Reproducibilidad, correlación y concordancia de un cuestionario abreviado del Dietary Score / Reproducibility, correlation and concordance of the Abbreviated Dietary Score questionnaire

OBJETIVO: El objetivo de este estudio es evaluar la reproducibilidad, la correlación y la concordancia del Dietary Score abreviado (DSa) utilizado en el estudio IBERICAN. MATERIAL Y MÉTODOS: Estudio transversal. Se evaluó la reproducibilidad del DSa mediante una prueba test-retest, evaluando su consistencia interna mediante alfa de Cronbach y la fiabilidad de las mediciones mediante el coeficiente de correlación intraclase (CCI). A partir del cuestionario de frecuencia alimentaria (CFA) del estudio PREDIMED-Plus se evaluó la adherencia a un patrón de dieta mediterránea mediante el DS, valorándose su correlación y concordancia con el DSa. En ambos casos se utilizaron técnicas de regresión lineal, de Bland-Altman e índice de kappa. RESULTADOS: Participaron 142 sujetos, mayoritariamente hombres (56,3%), con una media de edad de 64,6+/-4,9 años. En términos de reproducibilidad, se obtuvo un coeficiente de correlación de Pearson de 0,538; una media de las diferencias de 2,03 puntos y un índice kappa ponderado de 0,400 (IC del 95%=0,295-0,577). El instrumento tuvo buena consistencia interna (alfa de Cronbach=0,699), así como buena fiabilidad (CCI=0,931). El DSa presentó un coeficiente de correlación con el DS de 0,517; una media de las diferencias de 1,19 puntos y un índice kappa ponderado de 0,450 (IC del 95%=0,366-0,532). CONCLUSIONES: El DSa presenta una moderada reproductibilidad y una buena correlación y concordancia con el DS, por lo que puede ser una herramienta útil en Atención Primaria para valorar la adherencia a la dieta mediterránea

OBJECTIVE: The objective of this study was to evaluate the reproducibility, correlation and concordance of the abbreviated Dietary Score (aDS) used in the IBERICAN study. MATERIAL AND METHODS: A cross-sectional study was performed in order to assess the reproducibility of the aDS using a test-retest. Its internal consistency was evaluated using Cronbach's alpha, and reliability of the measurements using the intraclass correlation coefficient (ICC). From the food frequency questionnaire (FFQ) of the PREDIMED-Plus study, adherence to a Mediterranean diet pattern was evaluated using DS, and its correlation and agreement with aDS was assessed. In both cases the lineal regression, Bland-Altman, and kappa index techniques were used. RESULTS: A total of 142 subjects participated, mostly men (56.3%), with a mean age of 64.6+/-4.9 years. In terms of reproducibility, a Pearson correlation coefficient of 0.538 was obtained; a mean of the differences of 2.03 points, and a weighted kappa index of 0.400 (95% CI=0.295-0.577). The instrument had good internal consistency (Cronbach's alpha=0.699), as well as good reliability (CCI=0.931). The aDS had a correlation coefficient with the DS of 0.517, a mean difference of 1.19 points, and a weighted kappa index of 0.450 (95% CI=0.366-0.532). CONCLUSIONS: The aDS has moderate reproducibility and a good correlation and agreement with the DS, so it can be a useful tool in Primary Care to assess adherence to the Mediterranean diet

Cardiovascular disease research in the Arab world: a scoping review from seven Arab countries (2000-2018).

OBJECTIVES: The objective of this study is to map cardiovascular disease (CVD) research productivity in Arab countries and identify gaps and opportunities that would inform future research agenda. STUDY DESIGN: This is a scoping review. METHODS: A review of research output between January 2000 and December 2018 in seven Arab countries, selected to represent various economies and epidemiological transitions, was conducted. Data on quantity and quality, study design, setting and focus were extracted and analysed for trends by time and place. RESULTS: Over the study period, a total of 794 articles were published, with an average of 7.3 publications per million population. While time trends showed a 6-fold increase in the number of publications over the study period, a decreasing trend in mean journal impact factor was noted (from 2.3 in 2000 to 1.5 in 2018). Most studies (71%) were observational, 56% were conducted in medical facilities (hospitals or clinics) and most of the experimental studies (10%) were based in laboratory settings. Behavioural risk factors were addressed in 52% of the studies, and there was a dearth of studies examining associations with diet, physical inactivity or family history. CONCLUSIONS: Findings from this review indicate gaps in robust methods and pertinent themes in CVD research in the Arab region. Greater attention should be paid to high-quality evidence and implementation research. Also, there is a need for a more targeted CVD research agenda that is responsive to local and regional health burden and needs.

[Reproducibility, correlation and concordance of the Abbreviated Dietary Score questionnaire]. / Reproducibilidad, correlación y concordancia de un cuestionario abreviado del Dietary Score.

OBJECTIVE: The objective of this study was to evaluate the reproducibility, correlation and concordance of the abbreviated Dietary Score (aDS) used in the IBERICAN study. MATERIAL AND METHODS: A cross-sectional study was performed in order to assess the reproducibility of the aDS using a test-retest. Its internal consistency was evaluated using Cronbach's alpha, and reliability of the measurements using the intraclass correlation coefficient (ICC). From the food frequency questionnaire (FFQ) of the PREDIMED-Plus study, adherence to a Mediterranean diet pattern was evaluated using DS, and its correlation and agreement with aDS was assessed. In both cases the lineal regression, Bland-Altman, and kappa index techniques were used. RESULTS: A total of 142 subjects participated, mostly men (56.3%), with a mean age of 64.6±4.9 years. In terms of reproducibility, a Pearson correlation coefficient of 0.538 was obtained; a mean of the differences of 2.03 points, and a weighted kappa index of 0.400 (95% CI=0.295-0.577). The instrument had good internal consistency (Cronbach's alpha=0.699), as well as good reliability (CCI=0.931). The aDS had a correlation coefficient with the DS of 0.517, a mean difference of 1.19 points, and a weighted kappa index of 0.450 (95% CI=0.366-0.532). CONCLUSIONS: The aDS has moderate reproducibility and a good correlation and agreement with the DS, so it can be a useful tool in Primary Care to assess adherence to the Mediterranean diet.

Adolescents' self-perceived and actual weight: Which plays a dominant role in weight loss behaviour in Lebanon?

BACKGROUND: The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. METHODS: Data on 278 adolescents aged 13-17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with "effort to lose weight" as the outcome variable, controlling for a number of potential confounders. RESULTS: Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). CONCLUSION: Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents.

Reparación endovascular de seudoaneurisma en aorta infrarrenal / Endovascular treatment of infrarenal aortic pseudoaneurysm

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Prevalence and correlates of metabolic syndrome in pre-crisis Syria: call for current relief efforts.

This study aimed to assess the prevalence, components and correlates of metabolic syndrome (MetS) in adults in pre-crisis Aleppo, Syrian Arab Republic. We used a population-based, 2-stage cluster sampling method in a population of 557 men and 611 women, randomly selected from 83 residential neighbourhoods including many rural settlers. Sociodemographic and lifestyle characteristics, comorbidity, anthropometry and biochemical indices were measured. Prevalence of MetS was estimated at 39.6%, with comparable rates in men and women. Hypertension was the most prevalent component (56.6%), followed by central obesity (51.4%). Among women, education (12 years) was inversely associated with risk of MetS, while family history of obesity and diabetes was associated with an increased risk. The high prevalence of MetS and its components emphasizes the burden of cardiovascular diseases among adults in pre-crisis Aleppo. A system of surveillance and management for cardiovascular diseases needs to be incorporated into the current humanitarian response.

Prevalence and correlates of metabolic syndrome in pre-crisis Syria: call for current relief efforts

This study aimed to assess the prevalence, components and correlates of metabolic syndrome [MetS] in adults in pre-crisis Aleppo, Syrian Arab Republic. We used a population-based, 2-stage cluster sampling method in a population of 557 men and 611 women, randomly selected from 83 residential neighbourhoods including many rural settlers. Sociodemographic and lifestyle characteristics, comorbidity, anthropometry and biochemical indices were measured. Prevalence of MetS was estimated at 39.6%, with comparable rates in men and women. Hypertension was the most prevalent component [56.6%], followed by central obesity [51.4%]. Among women, education [12 years] was inversely associated with risk of MetS, while family history of obesity and diabetes was associated with an increased risk. The high prevalence of MetS and its components emphasizes the burden of cardiovascular diseases among adults in pre-crisis Aleppo. A system of surveillance and management for cardiovascular diseases needs to be incorporated into the current humanitarian response

La présente étude avait pour objectif d'évaluer la prévalence, les composantes et les corrélats du syndrome métabolique chez l'adulte à Alep avant la crise, en République arabe syrienne. Nous avons utilisé une méthode d'échantillonnage en grappe à deux degrés basée sur une population de 557 hommes et 611 femmes, choisis de manière aléatoire dans 83 zones résidentielles, comprenant de nombreux habitants de zones rurales. Les caractéristiques socio-démographiques et relatives au mode de vie, les comorbidités, l'anthropométrie et les indices biochimiques ont été évaluées. La prévalence du syndrome métabolique a été estimée à 39,6%, avec des taux comparables entre hommes et femmes. L'hypertension était la composante la plus prévalente [56,6%], suivie par l'obésité centrale [51,4%]. Parmi les femmes, l'éducation était inversement associée au risque de syndrome métabolique, alors que des antécédents familiaux d'obésité et de diabète étaient associés à un risque accru. La forte prévalence du syndrome métabolique et de ses composantes met en évidence la charge des maladies cardio-vasculaires chez l'adulte à Alep avant la crise. Un système de surveillance et de prise en charge des maladies cardio-vasculaires doit être incorporé à la riposte humanitaire actuelle

Ageing and intergenerational family ties in Arab countries.

This paper explores the dominant issues in intergenerational ties in Arab countries with a view to highlighting patterns, trends and challenges as well as policy implications. The data were drawn from a review of scholarly work and published literature in Arab countries and from a regional mapping of ageing policies and programmes in 2012. Social and health ageing policies in the region have been set with the premise that the family represents the core safety net for older Arabs. Yet demographic, sociocultural and economic transitions, as well as political conflict in the Arab world, are bringing profound changes to familial structures. This review feeds into efforts to promote health and social reforms that approach intergenerational solidarity from several fronts: providing equitable old-age income security, fostering cross-generational interactions, embracing caregivers and home-based care, promoting age-responsive actions in emergencies and conflicts, and prioritizing context- and country-specific research on the levels, types and trends in intergenerational and familial support.

Association between dietary patterns and the risk of metabolic syndrome among Lebanese adults.

PURPOSE: The main objective of this study was to evaluate the association between dietary patterns and the metabolic syndrome (MetS) and its metabolic abnormalities among Lebanese adults, using data from a national nutrition survey. METHODS: A cross-sectional analysis involving adults aged ≥ 18 years (n = 323) with no prior history of chronic diseases was conducted. Participants completed a brief sociodemographic and 61-item food frequency questionnaire. Anthropometric measurements and fasting blood samples were also obtained. The International Diabetes Federation criteria were used to classify study participants with the metabolic syndrome. Dietary patterns were identified by factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of extracted patterns with MetS and its metabolic abnormalities. RESULTS: Out of 323 participants, 112 (34.6%) were classified as having MetS. Three dietary patterns were identified: "Fast Food/Dessert," "Traditional Lebanese," and "High Protein." Compared with participants in the lowest quintile of the Fast Food/Dessert pattern, those in the highest quintile had significantly higher odds for MetS (OR, 3.13; 95% CI: 1.36-7.22) and hyperglycemia (OR, 3.81; 95% CI: 159-9.14). Subjects with the highest intake of the High Protein pattern had an increased risk for hypertension (OR, 2.98; 95% CI: 1.26-7.02). The Traditional Lebanese pattern showed no association with MetS or its components. CONCLUSIONS: The findings of this study demonstrate a positive association of the Fast Food/Dessert pattern with MetS and hyperglycemia among Lebanese adults. These results may guide the development of improved preventive nutrition interventions in this adult population.

Living arrangements of older adults in Lebanon: correlates of living with married children.

Rapid increases in the proportion of older adults in the population present major challenges to policy-makers worldwide. Using a nationally representative sample from the PAPFAM survey in Lebanon, this study examined the living arrangements of older adults (aged > or = 65 years), and their correlates, with a focus on co-residence with married children. Of 1774 older adults 17.1% co-resided with their married children: 28.1% of the 559 unmarried (widowed/divorced/single) and 11.3% of the 1071 married older adults. Among both the married and unmarried, the likelihood of co-residence was significantly lower in regions outside the capital and decreased with increasing socioeconomic status. Among the unmarried elderly, co-residence with a married child was also significantly associated with increasing age and availability of sons, as well as presence of a vascular disorder and speech problems. While solitary living has traditionally been the focus for policy-makers, older people living with a married child may also be a vulnerable group.

PP179. The influence of prior abortion on rates of gestational hypertension/pre-eclampsia and spontaneous preterm delivery in nulliparous women.

INTRODUCTION: Gestational hypertension/preeclampsia (GH) is clearly a heterogeneous condition of which the pathogenesis could be different in women with various risk factors. Nulliparity is a known risk factor for GH, however a previous abortion (spontaneous or induced) may be associated with a lower risk of GH. OBJECTIVES: To examine the effect of abortion history on rates of GH and spontaneous preterm delivery (SPTD) and in nulliparous women. METHODS: Nulliparous women with an initial prenatal screening at <13 weeks' gestation and a current singleton gestation delivering between 6/2006 and 6/2011 that voluntarily enrolled for risk assessment-case management services were identified from a database of clinical information. Excluded were women reporting a history of both spontaneous (SAB) and induced (IAB) abortions, or with a priori diagnosis of diabetes. Rates of SPTD and GH were compared between women with SAB or IAB history (AB group) and a reference group of primigravid women using Pearson's chi-square, Student's t, Kruskal-Wallis H, and Mann-Whitney U statistics. RESULTS: Of the 75,487 women studied, 5.7% (n=4288) reported a history of IAB and 24.3% (n=18,328) reported a history of SAB. Overall, 301 women (0.4%) experienced a SAB at <20 weeks in the index pregnancy. Of those 75,186 with delivery ⩾20 weeks, the incidence of SPTD was 6.1% in controls vs. 6.0% in the IAB/SAB group (p=0.550). Rates of GH were 10.2% in controls vs. 8.0% (p<0.001) in the AB group despite the AB group having significantly (p<0.001) higher rates of women of African-American race (8.5% vs. 5.5%); age >34years (23.9% vs. 10.0%); and obesity (19.6% vs. 16.6%). For women with >2 AB's significant differences were observed in rates of SPTD vs. controls (8.2% vs. 6.0%, p<0.001), but rates of GH were similar (9.2% vs. 10.2%, p=0.188). (1)p<0.001 vs. 0 AB group. CONCLUSION: In nulliparous women, prior AB is associated with a reduction in risk for GH. Risk for SPTD increases only in those with >2 prior AB's.

Short term effect of hubble-bubble smoking on voice.

OBJECTIVE: To investigate the short term effect of hubble-bubble smoking on voice. STUDY DESIGN: Prospective study. MATERIAL: Eighteen non-dysphonic subjects (seven men and 11 women) with a history of hubble-bubble smoking and no history of cigarette smoking underwent acoustic analysis and laryngeal video-stroboscopic examination before and 30 minutes after hubble-bubble smoking. RESULTS: On laryngeal video-stroboscopy, none of the subjects had vocal fold erythema either before or after smoking. Five patients had mild vocal fold oedema both before and after smoking. After smoking, there was a slight increase in the number of subjects with thick mucus between the vocal folds (six, vs four before smoking) and with vocal fold vessel dilation (two, vs one before smoking). Acoustic analysis indicated a drop in habitual pitch, fundamental frequency and voice turbulence index after smoking, and an increase in noise-to-harmonics ratio. CONCLUSION: Even 30 minutes of hubble-bubble smoking can cause a drop in vocal pitch and an increase in laryngeal secretions and vocal fold vasodilation.

Hip fracture incidence in Lebanon: a national registry-based study with reference to standardized rates worldwide.

UNLABELLED: Crude incidence rates for hip fractures in individuals aged 50 and above in Lebanon were determined using data from the national hip fracture registry. For the years 2006-2008, crude rates varied between 164 and 188/100,000 for females and between 88 and 106 per 100,000 for males. Using the US 2000 white population as a reference, the calculated age-standardized rates were closest to rates derived for southern Europe. INTRODUCTION: Owing to the demographic explosion, it is projected that the rates of hip fractures would increase the most in the Middle East and Asia. Few are the population-based studies investigating the incidence of hip fractures in the region. METHODS: Using the Ministry of Health registry data, this population-based study evaluated the incidence of hip fractures in individuals aged 50 and above in Lebanon for the years 2006, 2007, and 2008. RESULTS: Hip fracture crude incidence rates varied across the years between 164 and 188 per 100,000 for females and between 88 and 106 per 100,000 for males, with a female/male ratio of 1.6-2.1. The overall mean age (SD) for hip fractures was 75.9 (9.2), 76.8 (9.0), and 77.0 (9.9) years in females in 2006, 2007, and 2008, respectively, and 74.4 (11.6), 76.3 (10.3), and 74.0 (12.1) years in males, respectively. Using the US 2000 white population as a reference, the age-standardized rates were 370.4, 335.1, and 329.0 for females and 109.7, 134.1, and 128.7 for males, for the years 2006, 2007, and 2008, respectively. CONCLUSIONS: The hip fracture age-standardized incidence rates in the Lebanese subjects receiving Ministry of Health coverage were lower than those found in northern Europe and the US and closest to rates derived for southern Europe.

Prevalence of arytenoid asymmetry in relation to vocal symptoms.

OBJECTIVES: (1) To assess the prevalence of arytenoid asymmetry during adduction, and (2) to correlate arytenoid asymmetry with vocal symptoms. MATERIALS AND METHOD: The medical records and video recordings of 116 patients who presented to the voice clinic were reviewed for the presence of arytenoid asymmetry, as regards sharpening of the aryepiglottic fold angle and altered positioning of the cuneiform and corniculate cartilages. RESULTS: There were 61 males and 55 females, with a mean age of 39 years and a standard deviation of 15 years. Almost one-third had a history of reflux, 25 per cent had a history of smoking and 9.6 per cent had a history of allergy. Hoarseness was the most common symptom, occurring in 42.2 per cent of patients, followed by vocal fatigue (25 per cent) and inability to project the voice. The most common type of asymmetry was corniculate asymmetry, present in 27.6 per cent of the cases and accounting for 74.39 per cent of cases. This was followed by cuneiform cartilage asymmetry, present in 15.5 per cent of cases. There was no correlation between arytenoid asymmetry and vocal symptoms, except for vocal fatigue (p = 0.038). CONCLUSION: The prevalence of arytenoid asymmetry during adduction is common. The presence of vocal symptoms such as hoarseness, breathiness, inability to project the voice and straining does not generally seem to correlate with the prevalence of arytenoid asymmetry. However, subjects with vocal fatigue are more likely to have cuneiform asymmetry.

Adolescent obesity in Syria: prevalence and associated factors.

Abstract Background Data on the prevalence of overweight and obesity in Eastern Mediterranean countries remain scarce, particularly for children and adolescents. The objective of this study is to estimate the prevalence of obesity and examine associated factors and covariates amongst school adolescents in Syria. Methods A cross-sectional survey of a representative sample of 776 adolescents (386 males and 390 females), aged 15-18 years, was conducted in six randomly chosen secondary schools in Damascus, the capital city of Syria. Anthropometric measurements and dietary assessment data were collected using standard methods and techniques. Overweight and obesity were defined according to World Health Organization 2007 child growth standards. Results The prevalence rates of overweight and obesity were estimated at 18.9 and 8.6%, respectively. Carbohydrate and saturated fatty acid intakes were significantly higher amongst overweight and obese (250.66 and 32.82 g/day, respectively) as compared with normal weight adolescents (218.12 and 26.10 g/day, respectively). Regression analysis showed that the likelihood of obesity was significantly greater amongst adolescent boys than girls (OR = 2.30, P < 0.05) and amongst subjects reporting family history of obesity (OR = 2.98, P < 0.05). The odds of obesity increased consistently with increasing educational attainment of both parents and was higher (OR = 1.63) amongst adolescents reporting lower crowding index than their counterparts. Conclusion Our findings of a positive association between obesity and socio-economic status measured by parental education and crowding index call for intervention strategies for the promotion of healthy dietary practices not only amongst school adolescents but also parents, targeting families as the unit of intervention. Further studies are needed to examine nutritional habits and food choices amongst families of different socio-economic strata.

Clinical characteristics of multiple sclerosis in Lebanon.

The epidemiologic, clinical, radiological and laboratory characterization of multiple sclerosis (MS) is very well documented in Caucasian and Japanese populations, but very little is known about MS in the Arab world. Such knowledge is becoming of paramount importance, with the recent advances in therapies, MRI techniques and other diagnostic procedures. We report a cohort of Lebanese MS patients, including details of their clinical and laboratory characteristics. The medical records of 202 patients fulfilling the Mc Donald's diagnostic criteria, and followed in our tertiary care center were reviewed. This cohort is highly representative of the disease in Lebanon where the number of MS patients is estimated to be between 1200 and 1700. The peak age of onset of MS in our cohort was in the third decade with 62.4% of patients developing their first symptoms between 20 and 39 years. The female/male ratio was 1.8/1.0. A positive family history for MS was present in 5% of patients. The most frequent presenting symptoms were brainstem-cerebellar (46.2%) followed by sensory (42.5%), motor (33.9%) and visual (29.6%). Of the total number of patients, 85.1% had relapsing remitting MS at onset, and 7.9% primary progressive MS. Benign MS defined as EDSS<=2.0 after 10 years from onset was present in 20% of patients. The mean time from onset to secondary progressive MS was around 9 years. Visual, brainstem, and somatosensory evoked potentials were abnormal in 65.6%, 27.8%, and 50.7% of patients tested respectively. Cerebrospinal fluid showed pleocytosis in 32.6%, increased IgG synthesis in 45.2%, positive oligoclonal bands in 40%, and elevated protein in 34% of patients tested. Although some of the clinical characteristics of our MS population were different compared to western series, the natural history of the disease was similar.

Immediate post-operative vocal changes in patients using laryngeal mask airway versus endotracheal tube.

OBJECTIVE AND HYPOTHESIS: (1) To examine the vocal symptoms and acoustic changes perceived in the short period immediately after laryngeal mask airway, and (2) to compare these findings in patients using laryngeal mask airway and endotracheal tube. MATERIALS AND METHODS: A total of 27 patients were enrolled. They were evaluated pre-operatively and then at 2 and 24 hours post-operatively. Patients were divided into two subgroups, laryngeal mask airway and endotracheal tube. Patients were asked about the presence or absence of the following: hoarseness, vocal fatigue, loss of voice, throat-clearing sensation, globus pharyngeus and throat pain. Patients then underwent acoustic analysis of their voice, measuring the average fundamental frequency, relative average perturbation, shimmer, noise to harmony ratio, voice turbulence index, habitual pitch and maximum phonation time. RESULTS: In the laryngeal mask airway group, there was an increase in the incidence of all vocal symptoms two hours post-operatively, except for globus pharyngeus. The increase was statistically significant for vocal fatigue, loss of voice and throat pain. All the symptoms had reverted back to a normal baseline level by 24 hours. There was a decrease in the maximum phonation time and habitual pitch, with an increase in all the perturbation parameters, two hours post-operatively. At 24 hours, an increase was still present for shimmer, noise to harmony ratio and voice turbulence index. The maximum phonation time and habitual pitch reverted back to normal values. In the endotracheal tube group, there was a significant increase two hours post-operatively in the incidence of hoarseness, loss of voice and throat pain. At 24 hours, all the symptoms reverted to baseline, except for vocal fatigue and throat pain. Two hours post-operatively, there was a significant decrease in maximum phonation time and an increase in all other parameters (however, the latter was significant only for relative average perturbation and noise to harmony ratio). At 24 hours, there was a significant increase in the maximum phonation time and a persistent (but statistically insignificant) increase in the average fundamental frequency, habitual pitch, noise to harmony ratio and voice turbulence index. At two hours, there was more loss of voice and vocal fatigue in the laryngeal mask airway group, compared with the endotracheal tube group. At 24 hours, these symptoms were comparable in both groups. Comparing changes in acoustic parameters to baseline values in both groups, there were no statistically significant changes. CONCLUSION: Shortly after reversal of anaesthesia, laryngeal symptoms following laryngeal mask airway are no less significant than those experienced following endotracheal tube anaesthesia. Both methods can be regarded as nontraumatic, in view of the lack of significant vocal symptoms and acoustic changes 24 hours after anaesthesia.

Older adult care in Lebanon: towards stronger and sustainable reforms.

We assessed elderly care in Lebanon through direct observation and review of the literature and legislation with the aim of drawing attention to the current situation and the need for improvement, and providing suggestions to address the problems. The weaknesses of elderly care in Lebanon and obstacles to reform include the stigma of age, an inefficient health care system, a lack of geriatric specialists and social/volunteer services, and inadequacies in nursing homes. Countering the negative perception of ageing, promoting social welfare, refurbishing nursing homes and empowering volunteer services are needed to improve the lives and care of the elderly. Sustained initiatives by governmental agencies, physicians, volunteer services and the community are essential. Adequate funding is also imperative.

Older adult care in Lebanon: towards stronger and sustainable reforms

We assessed elderly care in Lebanon through direct observation and review of the literature and legislation with the aim of drawing attention to the current situation and the need for improvement, and providing suggestions to address the problems. The weaknesses of elderly care in Lebanon and obstacles to reform include the stigma of age, an inefficient health care system, a lack of geriatric specialists and social/volunteer services, and inadequacies in nursing homes. Countering the negative perception of ageing, promoting social welfare, refurbishing nursing homes and empowering volunteer services are needed to improve the lives and care of the elderly. Sustained initiatives by governmental agencies, physicians, volunteer services and the community are essential. Adequate funding is also imperative