Factors associated with infertility among the Lebanese population: a cross-sectional study.

The incidence of female infertility is growing worldwide and its rate varies across countries. . The goal of this study is to assess the rate of female infertility and identify its associated factors among Lebanese women. This cross-sectional study was conducted between January to May 2019, enrolling a total of 952 females. The mean age was 34.8 ± 8 years and the rate of infertility was 34.3%. The multivariable analysis taking presence vs absence of infertility as the dependent variable, showed that patients with advanced age (aOR = 1.04), endometriosis (aOR = 2.175) and polycystic ovarian syndrome (aOR = 1.41) were significantly associated with higher rate of infertility. On the other hand, having a college level of education compared to a school level was significantly associated with lower odds of infertility (aOR = 0.511). The study highlights that the rate of infertility is high in Lebanon and is mainly associated with various sociodemographic factors and disease states. The findings raise the need to establish awareness campaigns that focus on early diagnosis of infertility, control the associated factors, and treat underlying comorbid conditions.

The socio-demographic and lifestyle characteristics associated with quality of life among diabetic patients in Lebanon: a cross-sectional study.

Objective: Diabetes mellitus (DM) is a chronic non-communicable endocrine disease that has a considerable impact on both the health and quality of life (QoL) of patients. This study aimed to investigate the sociodemographic factors associated with the quality of life among the Lebanese population with DM. Methods: A cross-sectional study that enrolled 125 diabetic patients aged ≥18, was conducted between January and June of 2021. The validated Arabic version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire is utilized by all patients to measure the quality of life (QoL). A logistic regression was then performed. Results: The life domains "freedom to eat" and "freedom to drink", were the most negatively impacted by diabetes. According to the multivariate analysis monthly income OR 3.4, 95 % CIs 1.25 -9.6, P = 0.017, educational level (OR) 0.2, 95 % CIs 0.07 -0.89, HbA1c (OR) 7, 95 % CIs 1.5 -32.35, and FBG [odds ratio (OR) 1.01, 95 % (CIs) 1.004 -1.021, P = 0.005] were independently associated with impaired QOL. Conclusion: The study showed that diabetes generally had a negative impact on QoL. The findings also suggest that certain sociodemographic factors, such as monthly income and educational level along with clinical parameters like HbA1c, might be associated with a lower quality of life among Lebanese diabetic patients.

Insights into the Pharmacokinetics and Pharmacodynamics of Direct Oral Anticoagulants in Older Adults with Atrial Fibrillation: A Structured Narrative Review.

Older adults, the fastest growing population, represent almost 50% of all users of direct oral anticoagulants (DOACs). Unfortunately, we have very little relevant pharmacological and clinical data on DOACs, especially in older adults with geriatric profiles. This is highly relevant as pharmacokinetics and pharmacodynamics (PK/PD) often differ substantially in this population. Hence, we need to obtain a better understanding of the PK/PD of DOACs in older adults, to ensure appropriate treatment. This review summarises the current insights into PK/PD of DOACs in older adults. A search was undertaken up to October 2022 to identify PK/PD studies of apixaban, dabigatran, edoxaban, and rivaroxaban, that included older adults aged ≥ 75 years. This review identified 44 articles. Older age alone did not influence exposure of edoxaban, rivaroxaban and dabigatran, while apixaban peak concentrations were 40% higher in older adults than in young volunteers. Nevertheless, high interindividual variability in DOAC exposure in older adults was noted, which can be explained by distinctive older patient characteristics, such as kidney function, changes in body composition (especially reduced muscle mass), and co-medication with P-gp inhibitors, which is in line with the current dosing reduction criteria of apixaban, edoxaban, and rivaroxaban. Dabigatran had the largest interindividual variability among all DOACs since its dose adjustment criterion is only age, and thus it is not a preferable option. Additionally, DOAC exposure, which fell outside of on-therapy ranges, was significantly related to stroke and bleeding events. No definite thresholds linked to these outcomes in older adults have been established.

The Socio-Demographic and Lifestyle Characteristics Associated with Quality of Life Among Diabetic Patients in Lebanon: A Crosssectional Study

Objective: Diabetes mellitus (DM) is a chronic non-communicable endocrine disease that has a considerable impact on both the health and quality of life (QoL) of patients. This study aimed to investigate the sociodemographic factors associated with the quality of life among the Lebanese population with DM. Methods: A cross-sectional study that enrolled 125 diabetic patients aged ≥18, was conducted between January and June of 2021. The validated Arabic version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire is utilized by all patients to measure the quality of life (QoL). A logistic regression was then performed. Results: The life domains “freedom to eat” and “freedom to drink”, were the most negatively impacted by diabetes. According to the multivariate analysis monthly income OR 3.4, 95 % CIs 1.25 –9.6, P = 0.017, educational level (OR) 0.2, 95 % CIs 0.07 –0.89, HbA1c (OR) 7, 95 % CIs 1.5 –32.35, and FBG [odds ratio (OR) 1.01, 95 % (CIs) 1.004 -1.021, P = 0.005] were independently associated with impaired QOL. Conclusion: The study showed that diabetes generally had a negative impact on QoL. The findings also suggest that certain sociodemographic factors, such as monthly income and educational level along with clinical parameters like HbA1c, might be associated with a lower quality of life among Lebanese diabetic patients. (AU)

Factors associated with knowledge and awareness of stroke among the Lebanese population: A cross-sectional study.

Background: Evaluation of the knowledge about stroke in the general population is extremely vital as it prevents stroke development, limits complications, and achieves better quality of life.  We assume that the general Lebanese population lacks awareness about stroke and its associated complications. This study aims to evaluate stroke knowledge and determine the factors associated with stroke awareness among the general Lebanese population. Methods: This cross-sectional study assessed respondents' sociodemographic characteristics and the identification of risk factors, warning signs, stroke consequences, and early response to stroke symptoms. A total of 551 Lebanese adults without a history of stroke filled in an online self-reported questionnaire publicly shared on social applications. Logistic regression analysis was performed to identify the factors associated with poor knowledge of stroke.  Results: Among the 551 participants enrolled, 403 (74.2%) were females and 312 (56.7%) were under 30 years of age. Females compared to males and employed compared to unemployed had significantly higher odds of identifying at least one risk factor (OR=4.3 [95%CI=1.1;16.8] and 6 [95%CI=1.2;29.6], respectively). Also, when compared to unemployed, employed participants had significantly higher odds of recognizing at least one of the early stroke symptoms (OR=3.3 [95%CI=1.2;8.9]) and identifying at least one of the stroke consequences (OR=5.3 [95%CI=1.1;25.9]). Reaching a university level of education compared to a school level was associated with significantly higher odds (OR=2.3 [95%CI=1.1;4.8]) of taking a patient to a hospital. Conclusion: Well-educated, employed, and female participants were more knowledgeable about stroke. Tailored interventions focusing on individuals with inadequate stroke literacy are needed. Further studies, more representative of the general Lebanese population with a larger sample size, are necessary to confirm our findings.

Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults.

We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treated with either intermittent or continuous vancomycin infusions. Each patient provided two randomly selected pairs of two consecutive vancomycin concentrations. A web-based precision dosing software, TDMx, was used to evaluate the model-based approaches. In total, 154 patients contributed 308 pairs. With standard TDM-based dosing, only 48.1% (148/308) of all of the second concentrations were within the therapeutic range. Across the model-based approaches we investigated, the mean relative bias and relative root mean square error varied from -5.36% to 3.18% and from 24.8% to 28.1%, respectively. The model averaging approach according to the squared prediction errors showed an acceptable bias and was the most precise. According to this approach, the median (interquartile range) differences between the model-predicted and prescribed doses, expressed as mg every 12 h, were 113 [-69; 427] mg, -70 [-208; 120], mg and 40 [-84; 197] mg in the case of subtherapeutic, supratherapeutic, and therapeutic exposure at the second concentration, respectively. These dose differences, along with poor target attainment, suggest a large window of opportunity for the model-based TDM compared with the standard TDM-based vancomycin dosing. Implementation studies of model-based TDM in routine care are warranted.

Knowledge, attitude, and practice of patients with diabetes towards diabetic nephropathy, neuropathy and retinopathy.

Background: Epidemiological and knowledge, attitude and practice (KAP) studies about diabetic microvascular complications are lacking. The goals of this study are: determining 1) the prevalence of diabetes mellitus subtypes and microvascular complications, 2) the KAP towards the complications and 3) health-seeking behavior, barriers to follow-up, stigma and sources of information. Methods: A cross-sectional study was conducted from January to October 2020 enrolling 380 Lebanese patients with diabetes asked about socio-demographic and lifestyle characteristics, medical, therapeutic, supplement, and dietary history, KAP scores, health-seeking behavior, stigma, barriers to compliance, and sources of information. Results: The prevalence of diabetes type II, type I, gestational, and the microvascular complications was 82.23%, 15.65%, 2.12%, and 33.07% respectively. Factors with significant association were: 1) good quality of life (ß=-0.03; p=0.005) and presence of microvascular complications (ß=3.58; p=0.001) with knowledge score, 2) good quality of life (ß=-0.01; p=0.02) and absence of the complications (ß=-0.33; p=0.001) with attitude score, 3) advanced age (ß=0.01; p=0.01), no metformin (ß=-0.39; p=0.005), and low-protein diet (ß=0.6; p=0.02) with practice score. Patients visited community pharmacies (41.84%) and clinics (46.32%). Barriers were costs (33.42%) and time (30.53%). Few talked about the complications to the family (19.74%). Sources of information were healthcare workers. Conclusion: Awareness campaigns should be tailored accordingly to retard the microvascular complications.

Knowledge, Attitude, and Practice of Patients with Diabetes towards Diabetic Nephropathy, Neuropathy and Retinopathy

Background: Epidemiological and knowledge, attitude and practice (KAP) studies about diabetic microvascular complications are lacking. The goals of this study are: determining 1) the prevalence of diabetes mellitus subtypes and microvascular complications, 2) the KAP towards the complications and 3) health-seeking behavior, barriers to follow-up, stigma and sources of information. Methods: A cross-sectional study was conducted from January to October 2020 enrolling 380 Lebanese patients with diabetes asked about socio-demographic and lifestyle characteristics, medical, therapeutic, supplement, and dietary history, KAP scores, health-seeking behavior, stigma, barriers to compliance, and sources of information. Results: The prevalence of diabetes type II, type I, gestational, and the microvascular complications was 82.23%, 15.65%, 2.12%, and 33.07% respectively. Factors with significant association were: 1) good quality of life (β=-0.03; p=0.005) and presence of microvascular complications (β=3.58; p=0.001) with knowledge score, 2) good quality of life (β=-0.01; p=0.02) and absence of the complications (β=-0.33; p=0.001) with attitude score, 3) advanced age (β=0.01; p=0.01), no metformin (β=-0.39; p=0.005), and low-protein diet (β=0.6; p=0.02) with practice score. Patients visited community pharmacies (41.84%) and clinics (46.32%). Barriers were costs (33.42%) and time (30.53%). Few talked about the complications to the family (19.74%). Sources of information were healthcare workers. Conclusion: Awareness campaigns should be tailored accordingly to retard the microvascular complications. (AU)

Effects of sociodemographic and socioeconomic factors on stroke development in Lebanese patients with atrial fibrillation: a cross-sectional study.

Background: Non-communicable diseases, the major cause of death and disability, are susceptible to modifiable and non-modifiable risk factors. Atrial fibrillation (AF) increases the risk of stroke by 4 to 5 times and can lead to cardiovascular mortality. This study was conducted to assess the effects of different sociodemographic and socioeconomic factors on stroke development in patients with AF. Methods: A cross-sectional study was conducted between January and June 2018 on patients recruited from Lebanese community pharmacies. The CHA 2DS 2-VASc scoring system is utilized as a stroke risk stratification tool in AF patients. Participants with a previous physician diagnosis of AF, documented on medical records, were included in this study. Data was collected through a survey that was distributed to all eligible patients. Results: A total of 524 patients were enrolled in the study with a mean age (± SD) of 58.75 ± 13.59 years with hypertension (78.4%) being the most predominant disease. The results showed that obesity (Beta=0.61, p-value =0.011), retirement and unemployment compared to employment (Beta=1.44 and 1.44, p-value=0.001 respectively), divorced/widow compared to married (Beta=1.38, p-value =0.001) were significantly associated with higher CHA 2DS 2-VASc scores whereas high versus low socio-economic status (Beta=-1.03, p=0.009) and high school education versus primary education level (Beta=-0.49, p-value=0.025) were significantly associated with lower CHA 2DS 2-VASc scores. Conclusions: The study highlights that the CHA 2DS 2-VASc score is affected by the presence of various sociodemographic and socioeconomic characteristics in patients with AF. Thus, screening for those factors may predict the progression of cardiovascular disease and may provide an optimal intervention.

Photoswitchable 11 nm CsCoFe Prussian Blue Analogue Nanocrystals with High Relaxation Temperature.

Photoswitchable 11 nm nanocrystals with the coordination network Cs{Co[Fe(CN)6]} were obtained using a template-free method. The nanocrystals were recovered from the colloidal solutions as solid materials surrounded by cetyltrimethylammonium (CTA) cations or embedded in the organic polymer polyvinylpyrrolidone (PVP). Complementary magnetic, spectroscopic, and structural techniques, including EPR spectroscopy, reveal a majority (∼70%) of the low-spin and photoactive diamagnetic CoIIIFeII pairs located in the core of the nanocrystals and a mixture of CoIIFeII and CoIIFeIII species present mainly within the shell of the objects. While bulk compounds with similar vacancy concentration do not exhibit noticeable photoinduced charge transfer, the observed photoactivity of the nanocrystals is ascribed to their nanometric size. The relaxation temperature of the photoinduced state shifts upward by ∼55 K when PVP is replaced by CTA. This is ascribed to the larger rigidity of the dense CsCoFe_CTA material, whose metastable state is lower than that for CsCoFe_PVP, leading to a larger relaxation energy barrier and, therefore, to a higher relaxation temperature.

Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature.

BACKGROUND: Pharmacokinetics (PK) are severely altered in critically ill patients due to changes in volume of distribution (Vd) and/or drug clearance (Cl). This affects the target attainment of antibiotics in critically ill children. We aimed to identify gaps in current knowledge and to compare published PK parameters and target attainment of antibiotics in critically ill children to healthy children and critically ill adults. METHODS: Systematic literature search in PubMed, EMBASE and Web of Science. Articles were labelled as relevant when they included information on PK of antibiotics in critically ill, non-neonatal, pediatric patients. Extracted PK-parameters included Vd, Cl, (trough) concentrations, AUC, probability of target attainment, and elimination half-life. RESULTS: 50 relevant articles were identified. Studies focusing on vancomycin were most prevalent (17/50). Other studies included data on penicillins, cephalosporins, carbapenems and aminoglycosides, but data on ceftriaxone, ceftazidime, penicillin and metronidazole could not be found. Critically ill children generally show a higher Cl and larger Vd than healthy children and critically ill adults. Reduced target-attainment was described in critically ill children for multiple antibiotics, including amoxicillin, piperacillin, cefotaxime, vancomycin, gentamicin, teicoplanin, amikacin and daptomycin. 38/50 articles included information on both Vd and Cl, but a dosing advice was given in only 22 articles. CONCLUSION: The majority of studies focus on agents where TDM is applied, while other antibiotics lack data altogether. The larger Vd and higher Cl in critically ill children might warrant a higher dose or extended infusions of antibiotics in this patient population to increase target-attainment. Studies frequently fail to provide a dosing advice for this patient population, even if the necessary information is available. Our study shows gaps in current knowledge and encourages future researchers to provide dosing advice for special populations whenever possible.

Mn(II)-containing coordination nanoparticles as highly efficient T(1) contrast agents for magnetic resonance imaging.

Large longitudinal relaxivities were observed in Mn(II)-containing Prussian blue analogue nanoparticles. At low concentrations and high field (7 T), a remarkable positive contrast enhancement was seen which exceeded that of clinical contrast agents and was attributed to the very large proportion of surface atoms of these coordination nanoparticles.

Synergy in photomagnetic/ferromagnetic sub-50 nm core-multishell nanoparticles.

Based on nickel hexacyanidochromate and cobalt hexacyanidoferrate Prussian blue analogues, two series of photomagnetic/ferromagnetic sub-50 nm core multishell coordination nanoparticles have been synthesized in a surfactant-free one-pot multistep procedure with good control over the dispersity (10% standard deviation) and good agreement with the targeted size at each step. The composition and the valence state of each shell have been probed by different techniques that have revealed the predominance of Co(II)-NC-Fe(III) pairs in a series synthesized without alkali while Co(III)-NC-Fe(II) photoswitchable pairs have been successfully obtained in the photoactive coordination nanoparticles by control of Cs(+) insertion. When compared, the photoinduced behavior of the latter compound is in good agreement with that of the model one. Exchange coupling favors a uniform reversal of the magnetization of the heterostructured nanoparticles, with a large magnetization brought by a soft ferromagnetic shell and a large coercivity due to a harder photomagnetic shell. Moreover, a persistent increase of the photoinduced magnetization is observed for the first time up to the ordering temperature (60 K) of the ferromagnetic component because of a unique synergy.

Tuning the magnetic anisotropy in coordination nanoparticles: random distribution versus core-shell architecture.

Core-shell magnetic coordination nanoparticles made of a soft core and a hard magnetic shell, containing anisotropic Co(II) ions, display a dramatic increase in their average blocking temperature with a coercive field value 25 times larger than that of the soft core, due to a large enhancement of the magnetic anisotropy.

Tailored coordination nanoparticles: assessing the magnetic single-domain critical size.

Negatively charged nanocrystals of the magnetic coordination network CsNiCr(CN)(6) were prepared in water through a seed-mediated growth with a few atomic layers accuracy and final sizes tailored from 6 to 30 nm. A lower limit of the magnetic single-domain critical size was determined to be around 15 nm possessing a blocking temperature above 20 K.