Epidemiology of Breast, Corpus Uteri, and Ovarian Cancers in Lebanon With Emphasis on Breast Cancer Incidence Trends and Risk Factors Compared to Regional and Global Rates.

OBJECTIVES: This study explores the incidence and trends of breast (Bca), corpus uteri (CUca), and ovarian (Oca) cancer in Lebanon, a Middle Eastern country. It compares the Bca rates to regional and global ones and discusses Bca risk factors in Lebanon. INTRODUCTION: Globally, Bca is the premier cause of cancer morbidity and mortality in women. METHODS: Data on female Bca, CUca, and Oca published by the Lebanese national cancer registry were obtained (ie, for the years of 2005 to 2016). The age-standardized incidence rates (ASIRw) and age-specific rates per 100,000 female population were computed. RESULTS: From 2005 to 2016, Bca, Oca, and CUca ranked first, sixth, and seventh, respectively, for cancer incidence among women in Lebanon. Bca alone accounted for 39.4% of all new female cancer cases. The ASIRw increased significantly for Bca and CUca (APC: 3.60 and 3.73, P < .05) but not for Oca (APC: 1.27, P > .05). The Bca ASIRw (per 100,000) increased significantly from 71.0 in 2005 to 115.6 in 2013 (P < .05), then decreased steadily but non-significantly to reach 96.8 in 2016 (P > .05). Lebanon's Bca ASIRw is comparable to developed countries. This may reflect altered sociological and reproductive patterns as the country transitions from regional to global trends. The five-year age-specific rates analysis revealed that Bca rates rose steeply from 35-39 to 50-54, dropped slightly between 55 and 64, then rose till 75+. The five-year age-specific rates between 35 and 54 among Lebanese women were amongst the highest worldwide from 2008 to 2012, even higher than the rates in Belgium, which had the highest ASIRw of Bca worldwide in 2020. CONCLUSION: Lebanon's Bca ASIRw is among the highest globally. It's important to investigate the contributing factors and develop a national Bca control strategy. This study supports the national recommendation in initiating Bca screening at age 40 for women.

E. coli, K. pneumoniae and K. oxytoca community-acquired infections susceptibility to cephalosporins and other antimicrobials in Lebanon.

OBJECTIVES: Cephalosporin resistance in Enterobacteriaceae has become an international concern. This article studies the distribution and trends of resistance of E. coli and Klebsiella species isolated from clinical specimens representing community-acquired infections. METHODS: E. coli, K. pneumoniae and K. oxytoca specimen strains were collected from patients presenting to three acute care hospitals in Lebanon. The study period extended from January 2010 to January 2011 and included patients presenting with community-acquired infections only. Automated microbiological system (VITEK 2) was used for identification and antimicrobial susceptibilities. RESULTS: Data from consecutive non-duplicate 589 E. coli, 54 K. pneumoniae and 40 K. oxytoca strains were collected of which 69.5%, 74.0% and 67.5% were susceptible to 3rd generation cephalosporins (3GC), respectively. Out of the 3GC-resistant E. coli strains, around 90% were susceptible to nitrofurantoin, 46% were susceptible to trimethoprim/sulfamethoxazole (TMP/SMX) and 53% to ciprofloxacin. The patterns of antimicrobial susceptibility in the two Klebsiella species did not parallel those in the E. coli strains. Yet, the number of Klebsiella strains was much lower than that of E. coli. Of note is that the 3GC-resistant strains of both Klebsiella species were less susceptible to nitrofurantoin compared to the overall groups reaching a maximum of 30%. However, susceptibility to TMP/SMX was much higher reaching 79% and that of ciprofloxacin reaching 86%. CONCLUSION: Clinical specimens of E. coli, Klebsiella pneumoniae and Klebsiella oxytoca, causing community-acquired infections in Lebanon showed that these organisms are significantly resistant to many antibiotics. These patterns of resistance were mainly to internationally recommended drugs for empiric treatment of community-acquired infections like community-acquired urinary tract infections (UTIs) and intra-abdominal infections. Therefore, continuous antimicrobial susceptibility surveillance is advisable to track emerging resistance in Enterobacteriaceae and national guidelines would be tailored accordingly.

Psychological distress and job stressors among Lebanese workers: experience from a private sector.

No published data exists on the prevalence of psychological distress (PD) among the Lebanese working population, and its association with job stressors. A cross-sectional study was conducted in 2003 among Lebanese employees in a private administrative company. All employees (n = 200) received an anonymous questionnaire by mail. The General Health Questionnaire (GHQ-28) was used to estimate the prevalence of PD. Multiple regression analyses were performed to evaluate the relationship between GHQ-28 Likert score (0-84) and job stressors and other covariates. The participation rate was 79.3%. PD was identified in 30.0% of the studied population. A significant association was found between PD and lack of moral support, a recent disturbing event, feeling of job insecurity, and inability to be proactive. The results showed a high prevalence of PD in the studied population with significant association with job stressors.

Family physicians beliefs and attitudes regarding adult pneumococcal and influenza immunization in Lebanon.

BACKGROUND: Influenza and pneumococcal diseases are responsible for more deaths than all other vaccine-preventable diseases combined. Despite all efforts, the vaccination rate is below target. OBJECTIVES: To assess knowledge and beliefs of family physicians in Lebanon regarding influenza and pneumococcal vaccines, to identify adult immunization barriers, to assess physicians' use of evidence-based strategies to improve adult immunization and identify barriers to implementation of such strategies. METHODS: All 52 Lebanese family physicians attending the annual family medicine conference in Beirut in November 2009 were asked to fill a self-administered questionnaire that included items inquiring about knowledge, beliefs, attitudes, barriers to these vaccines and their opinions regarding strategies to improve immunization rate. RESULTS: Response rate was 82.7%. Accurate knowledge of influenza and pneumococcal vaccination guidelines was 58.1% and 53.5%, respectively. Thirty-eight physicians (88.4%) believe that influenza and pneumococcal vaccines are important, while 36 (83.7%) recommend influenza vaccine and 33 (76.7%) pneumococcal vaccine. Barriers for recommending vaccines were reported by 14 participants (32.5%). Concerning the influenza vaccine, the most commonly reported barriers were patient's refusal and non-availability of the vaccine, followed by physicians' concerns about efficacy and safety. As for the pneumococcal vaccine, the most frequently reported barriers were patient's refusal, cost and physicians concerns about efficacy. Insufficient time and unknown immunization status were reported to be barriers of lesser importance. Twenty-six physicians (61%) reported physicians' reminders as the most important intervention to promote adult immunization, followed by patient education (48%). Lack of time and availability of electronic medical record were cited as important strategies to increase adult immunization rate. CONCLUSIONS: Education and intervention efforts are needed to overcome barriers faced by practitioners and to define the most effective strategies to overcoming these barriers.

Trends and prevalence of intestinal parasites at a tertiary care center in Lebanon over a decade.

Intestinal parasitic infections or infestation are amongst the most prevalent infections worldwide. This study aimed at revealing the changing trends over a decade duration of intestinal parasites identified at a major tertiary care center in Lebanon between 1997-1998 and 2007-2008. The total number of specimens tested were 14,771 for 1997-1998 vs 7477 for 2007-2008. The positive findings for parasites were 2077 (14%) vs 1047 (14%), respectively. The majority of recovered parasites in both study periods belonged to intestinal protozoa (91% and 95%), followed by cestodes (6% and 3%), and nematodes (3% and 2%), while trematodes were negligible in both periods. The highest prevalence occurred among ages 16 to 35 years for 1997-1998, and without age predominance in the second period. The detected parasites from 1686 individuals (11.4%) in the first period vs 904 (12.1%) in the second period encompassed 18 species. The most common "pathogenic" parasite in both periods were: Entamoeba histolytica (14% vs 12%), Giardia lamblia (16% vs 6%), Taenia spp. (6% vs 3%), and Ascaris lumbricoides (2% vs 1%). Generally, these were detected more in males than females, in adults than in children, and during the summer (= 30%) and autumn (= 26%) than winter (= 20%) seasons for both periods. Despite some observable decrease in prevalence among the two study periods, sustainability of substantial intestinal parasites detection continues to exist. The latter is a valuable indicator for a state of collective ill-health, warranting more attention and efforts for public health awareness to improve hygiene and sanitation in order to minimize the prevalence of these parasites in this country.

Common dermatologic diseases among students at a tertiary care center in Lebanon.

UNLABELLED: There are few publications on prevalence of skin diseases in Lebanon. OBJECTIVES: To find the prevalence of dermatologic diseases among students seen at the university health services of the American University of Beirut. PATIENTS & METHODS: Medical charts were retrospectively reviewed. Chi-square tests were used to assess any significant difference between male and female prevalence amongst all types of skin diseases met; p-value < 0.05 was considered significant. RESULTS: 2903 visits were reviewed, ages ranged from 16 to 33 years old, of whom 1688 were females (58.15%) and 1215 were males (41.85%). Acne vulgaris was the most prevalent, followed by hair problems and contact dermatitis. Acne vulgaris and hair problems were significantly higher among females, and verruca among males (p < 0.001 in all). CONCLUSIONS: Dermatologists must be aware of the psychological effects of skin diseases on their patients. Acne, hair problems, and contact dermatitis are the most common diseases seen. Patients seem to be more concerned about diseases that affect their image in society.

Health care workers' exposure to blood-borne pathogens in Lebanon.

BACKGROUND: Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). AIM: To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. METHODS: This study reports a 17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. RESULTS: A total of 1,590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). CONCLUSIONS: The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.

Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts.

BACKGROUND: Warts are a common dermatologic problem. Treatment is painful, prolonged, and can cause scarring. OBJECTIVE: To evaluate topical zinc oxide for the treatment of warts. METHODS: This was a randomized, double-blind controlled trial of 44 patients. Twenty-two patients were given topical zinc oxide 20% ointment, and the other 22 received salicylic acid 15% + lactic acid 15% ointment twice daily. All patients were followed up for 3 months or until cure, whichever occurred first. All patients were observed for side-effects. RESULTS: Sixteen patients in the zinc group and 19 in the salicylic acid-lactic acid group completed the study. In the zinc oxide-treated group, 50% of the patients showed complete cure and 18.7% failed to respond, compared with 42% and 26%, respectively, in the salicylic acid-lactic acid-treated group. No patients developed serious side-effects. CONCLUSION: Topical zinc oxide is an efficacious, painless, and safe therapeutic option for wart treatment.

Association between hepatitis A virus and Helicobacter pylori in a developing country: the saga continues.

BACKGROUND: The epidemiologic association between Helicobacter pylori and hepatitis A virus (HAV) has been evaluated by various different groups with conflicting conclusions. The aim of the present study was to determine the prevalence of HAV and H. pylori infection among adolescents attending high schools in Lebanon, and to identify the sociodemographic factors associated with their prevalence, individually and concurrently. METHODS: Nine hundred and two school students 14-18 years of age were selected randomly from 30 schools scattered all over Lebanon and tested for IgG antibodies against hepatitis A and H. pylori. Each student received a copy of a self-administered questionnaire to be completed by his/her parents inquiring about demographics, history of immunization, and prior viral hepatitis illness in the student. Bivariate analysis examined the association between different sociodemographic variables and prior HAV or H. pylori infection, and multivariate regression analysis was done to determine the factors independently associated with prior infection. RESULTS: Using ELISA the seroprevalence of antibodies against HAV was 71.3% as compared to 61.6% for anti-H. pylori. A total of 9.1% of those tested were negative for both agents. A multinomial regression analysis revealed that place of residence in relation to district or urban versus rural areas, in addition to mothers' education, were important determinants for the incidence of both agents. CONCLUSION: The low number of subjects negative for both H. pylori and HAV antibodies in Lebanon is indicative of their high prevalence in the country. It is possible that this high prevalence reflects an age-specific prevalence rather than a true association.

Sickness-related absence among employees at a tertiary care center in Lebanon.

The authors studied the rate of sickness-related absence of employees at a tertiary care center. They examined sickness-related absence records of employees, including nurses, food service workers, housekeeping, and security personnel, in a university teaching hospital in Lebanon over a period of 1 year. These departments included 1,010 employees, of which 47% took sickness absences during the study period. In all, 49.02% of the nursing employees, 43.67% of the food service workers, 37.79% of the housekeeping employees, and 47.5% of the protection/security workers took sickness-related absences. Employees in younger age groups took the majority of sicknessrelated absences; in general, these constituted short-duration sickness-related absences (relative to those taken by emploees in older age groups; dietary personnel were the exception to this pattern). Principal causes of sickness-related absences were respiratory illness and musculoskeletal problems. The authors observed that distribution of sickness-related absences among the departments studied was similar to the actual distribution of employees. They considered reasons for sicknessrelated absences as pertinent to each category.

Tuberculosis of the knee.

Tuberculosis is a worldwide problem that has persisted in developing countries and is re-emerging in developed ones. Infectious complications with Mycobacterium tuberculosis have also been reported with increasing frequency. Among these, skeletal and intra-articular infections continue to affect patients and pose a difficult diagnostic problem to physicians and orthopedic surgeons. This is so, as the non-specific clinical presentation which, overlaps with several infectious and non-infectious diseases, and the latency period of this bacteria that can persist up to several years after the initial infection, contribute to diagnosis and management delay. Thus due to the paucity of the disease, physicians should heighten their index of suspicion for diagnosing tuberculosis of the joints especially when faced with recurrent symptoms of what they think is a common problem. In this context, we present a case of a protracted recurrent illness of a knee joint, which was proved by culture to be due to M. tuberculosis. Moreover, the aspects of this disease entity that poses a diagnostic challenge to the treating physician are highlighted together with those that differentiate it from other overlapping diseases such as brucellosis, especially in endemic areas.