Unveiling the unseen toll: exploring the impact of the Lebanese economic crisis on the health-seeking behaviors in a sample of patients with diabetes and hypertension.

BACKGROUND: Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. METHODS: An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. RESULTS: The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). CONCLUSION: Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.

Skin manifestations in children with MIS-C and COVID-19: a narrative review.

This review aims to highlight the diverse skin manifestations in children and adolescents with COVID induced multisystem inflammatory syndrome in children (MIS-C). The symptoms of COVID-19 can vary greatly in severity between different age groups. Although most children infected with SARS-CoV-2 experience either no symptoms or only mild symptoms, some reported cases of severely affected children with a clinical presentation similar to incomplete Kawasaki disease have led to the definition of a new condition called MIS-C. MIS-C can involve multiple organs, including the skin, and may pose a life-threatening risk to affected children. Such cases highlight the need for continuous research into the possible skin manifestations associated with COVID-19 in pediatric populations to aid in early diagnosis and prompt treatment. We conducted a search of PubMed, Scopus, and ScienceDirect databases for studies published up until October 1, 2022. Three reviewers independently examined each study, and a fourth reviewer resolved any disagreements. A narrative review of all relevant papers was conducted. We present an overview of the clinical presentation, pathophysiology, diagnosis, and treatment of the various skin manifestations in children and adolescents with COVID-19 or MIS-C. The skin manifestations of COVID-19 and MIS-C can be diverse and are frequently overlooked. It is important to conduct further research to better understand the impact of this disease on children to provide appropriate care for these at-risk populations.

Cholera Infection Risks and Cholera Vaccine Safety in Pregnancy.

Introduction: Discuss the impact of cholera infection on pregnant women, fetus, and neonates and review the safety of cholera vaccines in pregnancy. Methods: This study was carried out as a narrative review during November 2022. A thorough literature review was conducted on the following databases: PubMed, Scopus, SciELO, CINAHL, Web of Science, and ScienceDirect. The following parameters were assessed from the included studies: type of cholera vaccine, cholera symptoms, cholera treatment, effect of cholera on pregnancy, effect of cholera treatment on pregnancy, effect of cholera vaccine on pregnancy, risk factors for fetuses and neonates, and prevention of cholera. The authors independently extracted data from the 24 included studies. Results: Cholera infection is a serious threat on pregnancy as it could lead to increased stillbirths and neonatal death. Fetal death was shown to occur mainly in the third trimester as most of the pregnant women infected with cholera had spontaneous abortions even after controlling for other confounding variables such as maternal age, dehydration level, and vomiting. Neonatal death was attributed mainly to congenital malformations and low Apgar scores with no improvements. Besides, cholera vaccines have shown to be safe in pregnancy and have proven to lower fetal and neonatal malformations among vaccinated compared to nonvaccinated pregnant women. Conclusion: This narrative summarizes the different complications due to cholera infection in pregnancy. It also reviews the safety of cholera vaccine administration in pregnant women.

Effect of COVID-19 vaccinations on menstrual cycle and postmenopausal bleeding among health care workers: A cross-sectional study.

OBJECTIVE: To determine the effect of coronavirus disease 2019 (COVID-19) vaccination and its association with sociodemographic factors on the menstrual cycle in premenopausal women and on postmenopausal bleeding. METHODS: This is a retrospective cross-sectional study conducted between September 22, 2022, and November 30, 2022, via a questionnaire distributed to 359 health care workers (HCWs) at Lebanese American University Medical Center-Rizk Hospital and St John's Hospital. Inclusion criteria included female Lebanese HCWs who were vaccinated and aged 18 to 65 years. RESULTS: Change in cycle length was significantly associated with age (P = 0.025 after the first dose and P = 0.017 after the second dose), level of education (P = 0.013 after the first dose and P = 0.012 after the second dose), and fibroids (P = 0.006 after the second dose and P = 0.003 after the third dose). The change in cycle flow was significantly associated with age (P = 0.028), fibroids (P = 0.002 after the second dose and P = 0.002 after the third dose), bleeding disorders (P = 0.000), and chronic medications (P = 0.007). The change in symptoms was associated with polycystic ovary syndrome (P = 0.021), chronic medications (P = 0.019 after the second dose and P = 0.045 after the third dose), and fibroids (P = 0.000). CONCLUSION: COVID-19 vaccination can influence the menstrual cycle. Age, body mass index, level of education, underlying comorbidities, and use of chronic medications are significantly associated with changes in menstrual length, flow, and symptoms following vaccination.

Direct and indirect cardiovascular and cardiometabolic sequelae of the combined anti-retroviral therapy on people living with HIV.

With reports of its emergence as far back as the early 1900s, human immunodeficiency virus (HIV) has become one of the deadliest and most difficult viruses to treat in the era of modern medicine. Although not always effective, HIV treatment has evolved and improved substantially over the past few decades. Despite the major advancements in the efficacy of HIV therapy, there are mounting concerns about the physiological, cardiovascular, and neurological sequelae of current treatments. The objective of this review is to (Blattner et al., Cancer Res., 1985, 45(9 Suppl), 4598s-601s) highlight the different forms of antiretroviral therapy, how they work, and any effects that they may have on the cardiovascular health of patients living with HIV, and to (Mann et al., J Infect Dis, 1992, 165(2), 245-50) explore the new, more common therapeutic combinations currently available and their effects on cardiovascular and neurological health. We executed a computer-based literature search using databases such as PubMed to look for relevant, original articles that were published after 1998 to current year. Articles that had relevance, in any capacity, to the field of HIV therapy and its intersection with cardiovascular and neurological health were included. Amongst currently used classes of HIV therapies, protease inhibitors (PIs) and combined anti-retroviral therapy (cART) were found to have an overall negative effect on the cardiovascular system related to increased cardiac apoptosis, reduced repair mechanisms, block hyperplasia/hypertrophy, decreased ATP production in the heart tissue, increased total cholesterol, low-density lipoproteins, triglycerides, and gross endothelial dysfunction. The review of Integrase Strand Transfer Inhibitors (INSTI), Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) revealed mixed results, in which both positive and negative effects on cardiovascular health were observed. In parallel, studies suggest that autonomic dysfunction caused by these drugs is a frequent and significant occurrence that needs to be closely monitored in all HIV + patients. While still a relatively nascent field, more research on the cardiovascular and neurological implications of HIV therapy is crucial to accurately evaluate patient risk.

Duodenal Exclusion in the Regulation of Glycemia in Type 2 Diabetic Patients Submitted to Gastrectomy with Roux-en-Y by Gastric Cancer: Cohort Study / Exclusión duodenal en la regulación de la glucemia en pacientes diabéticos tipo 2 sometidos a gastrectomía con en Y de Roux por cáncer gástrico: estudio de cohorte / Exclusão Duodenal na Regulação da Glicemia em Diabéticos Tipo 2 Submetidos a Gastrectomia com Y-de-Roux por Câncer Gástrico: Estudo de Coorte

Background: The effect of the duodenal exclusion in glycemic regulation has yet to be defined. Individuals with type 2 Diabetes Mellitus (T2DM) operated for other reasons than obesity, represent an adequate model to analyze clinical outcomes of duodenal exclusion.   Objective: To analyze the changes in glycemia and pharmacotherapy for T2DM in patients undergoing gastrectomy with Roux-in-Y derivation for gastric cancer.  Methods: An observational study was conducted in 2018 on patients who were submitted to surgery from 2001 to 2016. Medical records of 129 patients' cohort operated in two public hospitals were analyzed retrospectively before the surgery (T0) and one year after (T1). The research protocol was approved by the ethics committee. The final sample was mainly represented by women (50.5%) with a mean age of 65.5 years, and a mean body mass index of 26.5 kg/m2 SD 4.30.   Results: One year later, mean glucose levels of the entire sample decreased (p=0.046), but 70% of patients with glycemia> 100 at T0, remained with the same value in T1. Glycated hemoglobin had no significant change (p=0.988). Regarding the pharmacotherapy for T2DM, 60.7% of the sample had no change. However, 6.7% had discontinuation of the medication with the improvement of T2DM. The multivariate model by classification and decision tree method (CART) found as predictors of change in DM2 medication, age (<62.5 years) and a body mass index (> 30.2 kg/m2) with a predictive value of 71.4%.  Conclusion: There was no improvement of glycemia and pharmacotherapy in patients with T2DM who underwent gastrectomy with Roux-en-Y reconstruction, with a body mass index below 30 kg/m2

Antecedentes: Aún no se ha definido el efecto de la exclusión duodenal en la regulación glucémica. Individuos con Diabetes Mellitus tipo 2 (DM2) operados por otras razones distintas a la obesidad, representan un modelo adecuado para analizar los resultados clínicos de la exclusión duodenal. Objetivo: Analizar los cambios en la glucemia y la farmacoterapia para la DM2 en pacientes sometidos a gastrectomía con derivación en Y de Roux por cáncer gástrico. Métodos: se realizó un estudio observacional en 2018 en pacientes que fueron sometidos a cirugía entre 2001 y 2016. Se analizaron retrospectivamente las historias clínicas de una cohorte de 129 pacientes operados en dos hospitales públicos antes de la cirugía (T0) y un año después (T1). El protocolo de investigación fue aprobado por el comité de ética. La muestra final estuvo representada mayoritariamente por mujeres (50,5 %) con una edad media de 65,5 años y un índice de masa corporal medio de 26,5 kg/m2 SD 4,30. Resultados: Un año después, los niveles medios de glucosa de toda la muestra disminuyeron (p=0,046), pero el 70% de los pacientes con glucemia > 100 en T0, permanecieron con el mismo valor en T1. La hemoglobina glicosilada no tuvo cambios significativos (p=0,988). En cuanto a la farmacoterapia para la DM2, el 60,7% de la muestra no presentó cambios. Sin embargo, el 6,7% tuvo suspensión de la medicación con la mejoría de la DM2. El modelo multivariante por método de clasificación y árbol de decisión (CART) encontró como predictores de cambio de medicación en DM2 la edad (< 62,5 años) y el índice de masa corporal (> 30,2 kg/m2) con un valor predictivo del 71,4%. Conclusión: No hubo mejoría de la glucemia y la farmacoterapia en pacientes con DM2 que se sometieron a gastrectomía con reconstrucción en Y de Roux, con un índice de masa corporal por debajo de 30 kg/m2

Contexto: O efeito da exclusão duodenal na regulação glicêmica ainda não foi definido. Indivíduos com Diabetes Mellitus tipo 2 (T2DM) operados por outros motivos que não obesidade, representam um modelo adequado para analisar os resultados clínicos da exclusão duodenal. Objetivo: Analisar as alterações da glicemia e da farmacoterapia para DM2 em pacientes submetidos à gastrectomia com derivação em Y de Roux para câncer gástrico. Métodos: Foi realizado um estudo observacional em 2018 em pacientes operados de 2001 a 2016. Os prontuários de uma coorte de 129 pacientes operados em dois hospitais públicos foram analisados ​​retrospectivamente antes da cirurgia (T0) e um ano após (T1). O protocolo de pesquisa foi aprovado pelo comitê de ética. A amostra final foi representada principalmente por mulheres (50,5%) com idade média de 65,5 anos e índice de massa corporal médio de 26,5 kg/m2 SD 4,30. Resultados: Um ano depois, os níveis médios de glicose de toda a amostra diminuíram (p=0,046), mas 70% dos pacientes com glicemia > 100 em T0, permaneceram com o mesmo valor em T1. A hemoglobina glicada não apresentou alteração significativa (p=0,988). Em relação à farmacoterapia para DM2, 60,7% da amostra não apresentou alteração. No entanto, 6,7% tiveram descontinuação da medicação com melhora do DM2. O modelo multivariado pelo método de classificação e árvore de decisão (CART) encontrou como preditores de mudança na medicação para DM2, idade (<62,5 anos) e índice de massa corporal (> 30,2 kg/m2) com valor preditivo de 71,4%. Conclusão: Não houve melhora da glicemia e farmacoterapia em pacientes com DM2 submetidos à gastrectomia com reconstrução em Y de Roux, com índice de massa corporal abaixo de 30 kg/m2

Could "cellular exercise" be the missing ingredient in a healthy life? Diets, caloric restriction, and exercise-induced hormesis.

Overnutrition is a poor dietary habit that has been correlated with increased health risks, especially in the developed world. This leads to an imbalance between energy storage and energy breakdown. Many biochemical processes involving hormones are involved in conveying the excess of energy into pathologic states, mainly atherosclerosis, hypertension, cardiovascular diseases, and diabetes. Diverse modalities of regular exercise have been shown to be beneficial, to varying extents, in overcoming the overnutrition comorbidities. Cellular exercises and hormesis are triggered by dietary protocols that could underlie the cellular mechanisms involved in modulating the deleterious effects of overnutrition through activation of specific cellular signal pathways. Of interest are the oxidative stress signaling, nuclear factor erythroid-2, insulin-like growth factor-1, AMP-activated protein kinase as well as sirtuins and nuclear factor-κB. Therefore, the value of intermittent fasting diets as well as different diet regimens inducing hormesis are evaluated in terms of their beneficial effects on health and longevity. In parallel, important effects of diets on the immune system are explored as essential components that can undermine the overall health outcome. Additionally, the subtle but relevant relation between diet and sleep is investigated for its impact on the cardiovascular system and quality of life. The aim of this review is to focus on how calorie restriction triggers multiple molecular pathways that ultimately lead to hormetic effects resulting in cell longevity and resistance to cardiovascular disease, stroke, and cancer.

Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems.

COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients' prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.

Identification of polymer materials using laser-induced breakdown spectroscopy combined with artificial neural networks.

A combination of laser-induced breakdown spectroscopy (LIBS) and artificial neural networks (ANNs) has been used for the identification of polymer materials, including polypropylene (PP), polyvinyl chloride (PVC), polytetrafluoroethylene (PTFE), polyoxymethylene (POM), polyethylene (PE), polyamide or nylon (PA), polycarbonate (PC) and poly(methyl methacrylate) (PMMA). After optimization of the experimental setup and the spectrum acquisition protocol, successful identification rates between 81 and 100% were achieved using spectral features gathered from single spectra without averaging (1 second acquisition time) over a wide spectral range (240-820 nm). Furthermore, ten different materials based on PVC were tested using the identification procedure. Correct identifications were obtained as well. Sorting of the materials into sub-categories of PVC materials according to their charges (concentration in trace elements such as Ca) was performed. The demonstrated capacities fit, in practice, the needs of plastic-waste sorting and of producing high-grade recycled plastic materials.