Effect of Sleeping Disorders on the Growth Parameters of Lebanese Children.

Background: Sleep is a vital physiological function for the maintenance of health and quality of life by ensuring body rest and restoring its energy levels. Remarkably, some children have sleep disordered breathing (SDB) that can disturb their normal sleep and affect the quality of their lives. Objective: The aim of this study was to assess the correlation between SDB and growth impairments and wether the growth parameters vary among genders. Methods: This study was conducted in two steps: 1500 questionnaires were distributed to children aged 3 to 12 years. The questionnaire covered personal information, medical history, and the Pediatric Sleep Questionnaire. The latter was used to evaluate the incidence of sleep-disordered breathing and was completed by parents of the involved children. Growth assessment was then determined for the population to find the correlation between sleep disorders and growth impairments. Results: A total of 931 completed questionnaires were returned (70.7% response rate). Among the respondents, 56.3% were females whereas 43.3% were males. The mean age was 8 years. The result showed that 16.11% of children were at high risk of sleep-disordered breathing. A significant effect of SDB syndrome on growth parameters (weight-for-age parameter z-score and BMI for age z-score) was observed among males. Concerning the weight for age z-score, a significant difference was found between the means of control and SDB individuals (P = 0.0302). In male groups, the difference was significant (P=0.043), while non-significant difference was found in female groups (P = 0.69). Conclusion: This study highlights a significant effect of SDB on growth parameters among males aged between 3 and 12 years.

Maxillary dimensions and arch shape with palatally displaced canines.

BACKGROUND/OBJECTIVES: The aim of this study was to explore the effect of palatally displaced canines on maxillary dimensions and arch shape. METHODS: Occlusal and skeletal landmarks were plotted on cone beam computed tomography (CBCT) images of 156 orthodontic patients: 78 with palatally displaced canines (PDC) (27 left, 28 right, and 23 bilateral) and 78 controls using Mimics™ (Materialise, Belgium). Arch forms were created, and arch width, depth, and skeletal dimensions were measured. T-test (P < 0.05) was used to compare the groups. Geometric Morphometrics (GM) analysis was used to compare the groups and to explore the pattern of covariation between two sets of landmarks. RESULTS: The unilateral PDC group showed an increased first premolar, second premolar, molar widths, and an increased molar depth. No significant difference was found in arch form. The skeletal measurements were generally larger in the PDC group, but the transverse measurements were the most significant. Discriminant Function Analysis (DFA) with cross-validation allowed an accurate classification of 85.9% of the control group and 66.7% of the PDC group. The Mahalanobis distance displayed significant differences among three combinations of groups. Strong covariance was found between the second premolar and all other landmarks. LIMITATIONS: The small sample sizes of the stratified groups precluded recognition of statistical significance. CONCLUSIONS: Patients with unilateral PDC displayed significantly wider first, second premolar, and first molar widths, and increased first molar depths. There were no significant differences in arch form; however, GM showed significant differences between the groups and a prominent covariance function for the 2nd premolars.

Effect of septal deviation on nasomaxillary shape: A geometric morphometric study.

Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two-block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross-sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re-establish a good function of the nasomaxillary complex.

Spoligotyping of Mycobacterium tuberculosis isolates using Luminex®-based method in Lebanon.

INTRODUCTION: Data about the genotypes of circulating Mycobacterium tuberculosis isolates (MTB) in Lebanon are scarce. This study was undertaken to reveal the spoligotypes of MTB isolates recovered from patients in Lebanon. METHODOLOGY: MTB isolates from 49 patients living in Lebanon were recovered and identified. The samples were heat killed and subjected to DNA extraction. Spoligotyping was performed using microbeads from TB-SPOL Kit and the fluorescence intensity was measured using Luminex 200®. Generated patterns were assigned to families using the SITVIT2 international database of the Pasteur Institute of Guadeloupe and compared. RESULTS: The spoligotyping of the 49 MTB isolates revealed that 31 isolates belonged to Lineage 4 (Euro-American, 63.3%), 12 to Lineage 3 (East- African Indian, 24.5%), 3 to Lineage 2 (East Asian, 6%) and 2 were unknown. Over half of the genotypes (16 of 30) harbored SIT127 supposed to belong to the L4.5 sublineage. One isolate belonging to the rare Manu-Ancestor SIT523 was recovered for the first time in Lebanon, being associated with highly virulent extensively drug-resistant (XDR) MTB phenotype. CONCLUSION: The application of the Spoligotyping Multiplex Luminex® method is an efficient, discriminatory and rapid method to use for first-lane genotyping of MTB isolates. Though humble numbers were tested, this study is one of the first to describe the genomic diversity and epidemiology of MTB isolates of Lebanon, and suggests an increasing prevalence of SIT127 in the country.

BioAlder: a tool for assessing chronological age based on two radiological methods.

We have created the tool BioAlder as an age prediction model based on the systems Greulich and Pyle (hand) and the Demirjian's grading of the third molar tooth. The model compiles information from studies representing a total of 17,151 individuals from several parts of the world. The model offers a solution where issues as group-wise data format and age mimicry bias are bypassed. The model also provides a solution for combining the two grading systems, hand and tooth, to one combined age prediction result assuming independency. We have tested our model of age prediction and the independency assumption on a separate data set from Lebanon with 254 young individuals. The prediction intervals of BioAlder covered most of the data points; however, we observed some outliers. Our analyses indicate at least a weak dependency between the two methods.

Genotyping of Mycobacterium tuberculosis in Lebanon using a novel rapid spoligotyping multiplex luminex method.

INTRODUCTION: Incidence of Tuberculosis (TB) in Lebanon, according to the WHO, is estimated to be 35 cases per 100,000 people. However, data about the genotypes of circulating Mycobacterium tuberculosis isolates (MTB) in this country is lacking. This study aims to reveal the genotypes of TB isolates recovered from patients in Lebanon. METHODOLOGY: Fifty M. tuberculosis isolates from patients in Lebanon were recovered and identified at the reference TB center of the Ministry of Public Health. All isolates were heat killed and subjected to DNA extraction. Spoligotyping method (TB-Spol, Beamedex, France) was used to identify the presence of 43 spacers via a multi-analyte profiling system (Luminex, Bio-Rad). Generated patterns were assigned to families using the SITVIT2 international database of the Pasteur Institute of Guadeloupe. RESULTS: The spoligotyping of the 50 MTB isolates revealed 13 lineages, one being novel. The most frequent shared-types (SIT) identified lineage was the Ural (34%), followed by the Central Asian lineage (10%) and a single isolate (2%) belonging to the rare Manu-Ancestor SIT523 lineage, associated with a highly virulent XDR MTB phenotype. The rest of the SIT isolates (18%) were equally distributed along 9 different lineages. The 13th non-SIT lineage is a novel one constituting 36% of the total isolates. CONCLUSION:  The application of Spoligotyping Multiplex Luminex method is a novel, discriminatory and rapid method to use for genotyping of MTB isolates employing the multi-spacer analysis system. Our study showed genomic diversification of MTB isolates from Lebanon.

Predictability of Craniofacial Skeletal Age with Geometric Morphometries.

AIM: This study aims to estimate skeletal age of craniofacial shape obtained from cone beam computed tomography (CBCT)-defined facial and basicranial landmarks using geometric morphometrics method in a random sample of growing patients, and explore the correlation between craniofacial shape and skeletal age as determined from hand and wrist radiograph. MATERIALS AND METHODS: Generalized Procrustes analysis (GPA) of craniofacial shape with estimation of centroid size was performed on CBCTs of 48 growing patients (mean age 11.7 ± 1.5 years). Greulich and Pyle method for skeletal age assessment were used for correlation with centroid size. Correlation among the variables relied on Pearson's coefficient and its 95% confidence interval was estimated. The model's R2 was calculated, (Cook's distances, Mahalanobis distances, leverage values, and studentized residuals) and multiple regression analysis performed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: Mean skeletal age was 11.9 ± 2.4 years. Centroid size (151.5 ± 7.2) was significantly correlated with chronological age (R = 0.616, 95% CI 0.355-0.789, p < 0.01) and skeletal age (R = 0.605, 95 % CI 0.331-0.794, p < 0.01). CONCLUSION: A new equation for determining craniofacial skeletal age was developed, using the centroid size of the craniofacial frame, gender, and the known chronological age. CLINICAL SIGNIFICANCE: A CBCT may be used for skeletal age assessment without additional hand wrist radiograph.

Dental and Skeletal Age Estimations in Lebanese Children: A Retrospective Cross-sectional Study.

AIMS AND OBJECTIVES: Assessing dental and bone ages is frequently required in a wide range of fields such as odontology, forensic science, as well as orthopedics. The aim of this study was to evaluate applicability of two methods of bone age assessment and two methods of dental age (DA) assessment for Lebanese children. MATERIALS AND METHODS: Skeletal age (SA) of 260 orthodontic patients (124 males, 136 females divided into four groups each) was consecutively assessed using Greulich and Pyle and Fishman's SMI methods. DA was evaluated using both Demirjian's and Willem's methods. Mean age was 11.89 ± 1.38 years for males and 11.75 ± 1.58 years for females. Data were collected and statistically analyzed using the SPSS software (IBM SPSS Statistics, version 21, USA). The differences between estimated DA, estimated SA, and chronological age (CA) were compared by gender and age group. RESULTS: Greulich and Pyle method showed nonsignificant difference with CA in male sample, while in both assessment methods, the difference between skeletal and CAs is significant in female sample. Results of Willem's method in the whole sample suggested a statistically nonsignificant difference, when compared to CA. Demirjian's method delivered higher mean value than Willem's assessment in both genders. CONCLUSIONS: Greulich and Pyle method is accurate for SA assessment in males and only in one group of females, while it significantly overestimates age in all other female groups. Willem's method is more suitable to assess DA in both genders. A strong correlation exists between both dental and skeletal assessment methods and CA.

TUBERCULOSIS BURDEN IN LEBANON: EVOLUTION AND CURRENT STATUS.

BACKGROUND: In the absence of surveillance data and consolidated information about tuberculosis (TB) and its drug resistance burden in Lebanon, this retrospective study was conducted to shed light on TB and its other relevant aspects over the last 15 years in this country. METHODS: To generate the TB data for this retrospective study, two main sources were used: 1) the records of patients in the National Tuberculosis Program (NTP); 2) the results of the Clinical Microbiology Laboratory (CML) at the American University of Beirut Medical Center (AUBMC). The TB data review pertained to its epidemiological aspect, implementation of the directly observed therapy strategy (DOTS) all over, the gender distribution, the impact of high risk groups (non-national population, Syrian refugees, patients with multi-drug resistance-TB [MDR-TB] and the inmate population) on the trend of TB in Lebanon between 1999 and 2013. Reviewed also are TB in children, extrapulmonary tuberculosis and the mycobacterium other than tuberculosis (MOTT). RESULTS: During the last 15 years, 7548 TB cases were diagnosed and evaluated at the NTP. After the decreasing of TB incidence from 13/100 000 population in 2001 to 9/100 000 in 2006, the incidence started to increase in 2007, reaching 20/100 000 in 2013, mostly due to increased cases among non-national population. Fluctuations in TB rates over the years were seen among children, inmates, MDR-TB, and HIV patients. MOTT isolates recovery rates also fluctuated during the study period, M. simiae being the most common. CONCLUSION: After the decreasing trends of TB incidence between 1999 and 2006, Lebanon has been experiencing an increasing incidence in tuberculosis population since 2007. This is mainly attributed to the dramatic increase of TB patients among non-nationals and the influx of Syrian refugees. The ongoing collaboration between the public and private sectors, improvements of the surveillance system and TB control are important factors for successful elimination of TB in this country.