Highly Sensitive SPAD-Based Receiver for Dimming Control in LiFi Networks.

Visible light communication (VLC) is an emerging mode of wireless communication that supports both illumination and communication. One essential function of VLC systems is the dimming control, which requires a sensitive receiver for low-light conditions. The use of an array of single-photon avalanche diodes (SPADs) is one promising approach to enhancing receivers' sensitivity in a VLC system. However, because of the non-linear effects brought on by the SPAD dead time, an increase in the brightness of the light might degrade its performance. In this paper, an adaptive SPAD receiver is proposed for VLC systems to ensure reliable operation under various dimming levels. In the proposed receiver, a variable optical attenuator (VOA) is used to adaptively control the SPAD's incident photon rate according to the instantaneous received optical power so that SPAD operates in its optimal conditions. The application of the proposed receiver in systems with various modulation schemes is investigated. When binary on-off keying (OOK) modulation is employed due to its good power efficiency, two dimming control methods of the IEEE 802.15.7 standard based on analogue and digital dimming are considered. We also investigate the application of the proposed receiver in the spectral efficient VLC systems with multi-carrier modulation schemes, i.e., direct current (DCO) and asymmetrically clipped optical (ACO) orthogonal frequency division multiplexing (OFDM). Through extensive numerical results, it is demonstrated that the suggested adaptive receiver outperforms the conventional PIN PD and SPAD array receivers in terms of bit error rate (BER) and achievable data rate.

Repurposing of Chronically Used Drugs in Cancer Therapy: A Chance to Grasp.

Despite the advancement in drug discovery for cancer therapy, drug repurposing remains an exceptional opportunistic strategy. This approach offers many advantages (faster, safer, and cheaper drugs) typically needed to overcome increased challenges, i.e., side effects, resistance, and costs associated with cancer therapy. However, not all drug classes suit a patient's condition or long-time use. For that, repurposing chronically used medications is more appealing. This review highlights the importance of repurposing anti-diabetic and anti-hypertensive drugs in the global fight against human malignancies. Extensive searches of all available evidence (up to 30 March 2023) on the anti-cancer activities of anti-diabetic and anti-hypertensive agents are obtained from multiple resources (PubMed, Google Scholar, ClinicalTrials.gov, Drug Bank database, ReDo database, and the National Institutes of Health). Interestingly, more than 92 clinical trials are evaluating the anti-cancer activity of 14 anti-diabetic and anti-hypertensive drugs against more than 15 cancer types. Moreover, some of these agents have reached Phase IV evaluations, suggesting promising official release as anti-cancer medications. This comprehensive review provides current updates on different anti-diabetic and anti-hypertensive classes possessing anti-cancer activities with the available evidence about their mechanism(s) and stage of development and evaluation. Hence, it serves researchers and clinicians interested in anti-cancer drug discovery and cancer management.

Complementary and alternative medicine use during the COVID-19 pandemic: Community pharmacists' knowledge, attitudes, and practices.

BACKGROUND: The challenges in COVID-19 treatment have driven patients to seek Complementary and Alternative Medicine (CAM) for the prevention and/or treatment of the disease. Pharmacists are uniquely positioned to promote the effective and safe use of CAM. OBJECTIVE: Assess the beliefs, practices, and knowledge of community pharmacists in Lebanon about existing evidence for the use of CAM for the prevention and/or treatment of COVID-19. METHODS: A national cross-sectional survey was conducted among community pharmacists during the COVID-19 pandemic in Lebanon (n = 310 respondents). Participants completed an online questionnaire addressing, in addition to the socio-demographic characteristics; the beliefs, practices, and knowledge of pharmacists regarding the existing evidence of CAM use for COVID-19 prevention and/or treatment. RESULTS: Pharmacists (70%) received frequent inquiries about CAM for COVID-19 prevention or treatment. Only 25.5% of the pharmacists reported having enough time to get information about CAM and COVID-19. Almost all participants believed that pharmacists have a major role in the fight against COVID-19 (98%) and that they have enough information to counsel patients in that regard (75%). For practices, the majority of pharmacists reported counseling their patients on proper use (98%) and possible adverse reactions (93%) of CAM, but only 51% reported toxic or undesirable effects. Regarding knowledge, although most pharmacists answered correctly the questions on the role of CAM in preventing COVID-19, few knew about its role in treating the infection. Pharmacists who trust the WHO website as a credible source had a higher knowledge score (ß = 0.52, 95%CI: 0.05-0.986). CONCLUSIONS: The positive beliefs and practices of pharmacists towards CAM during the pandemic were coupled with a few gaps, especially in their knowledge about existing evidence for CAM use. Concerted efforts ought to be dedicated to supporting pharmacists in playing a more prominent role during health crises such as the COVID-19 pandemic.

Podocyte infolding glomerulopathy after 25 years of clinical remission of lupus nephritis in a patient with systemic lupus erythematosus: A case report and review of literature.

Podocyte infolding glomerulopathy (PIG) is a rare pathological finding that has gained more recognition recently. Most of the reported cases have been associated with connective tissue diseases especially systemic lupus erythematosus (SLE). Here we report the first case of Infolding Glomerulopathy associated with SLE in the Middle East.

Markedly elevated procalcitonin due to anaphylactic shock, a case report.

Procalcitonin (PCT) is a well-known biomarker that is directly connected to bacterial infection especially when it reaches significantly high levels. It is extremely rare to be witnessed in non-bacterial infections such as viral or parasitic. It may be elevated in other conditions such as trauma and autoimmune diseases. We present a rare case of a young gentleman, who had an extremely high PCT level that appeared to be a result of anaphylaxis due to worm infestation.

Malaria causing post-infectious cerebellitis, a case report and literature review.

Background: Malaria is a common parasitic infection with a wide range of clinical presentations. Thus, it should be suspected for any symptomatic patient with a recent travel history to a malaria-endemic area. Case presentation: In this case report, we will present a previously healthy 28-year-old patient who developed cerebellar signs that were attributed to infectious etiology later on proven to be a malaria-related complication that responded well to anti-malarial medications. Discussion: The classical presentation of malaria with attacks of fever is noticed only in around 60% of the patients. The development of immunity, the increasing resistance to anti-malarial drugs, and the indiscriminate use of anti-malarial drugs have led to malaria presenting unusual characteristics. Cerebellar ataxia, extrapyramidal signs, and various psychiatric manifestations have been described as early presentations of cerebral malaria or as a part of the post-malaria neurological syndrome. Other neurological syndromes like peripheral neuropathies, movement disorders, myelopathies, and stroke-like syndrome have also been described. Conclusion: Malaria should be included as a differential diagnosis in a patient presenting with cerebellar signs as its devastating if left untreated. However, it responds well to anti-malarial regimens if started early during the course.

A national study on the resilience of community pharmacists in Lebanon: a cross-sectional survey.

BACKGROUND: Community pharmacists are among the most accessible healthcare professionals and are likely to experience the full brunt of public health crises. In Lebanon, the COVID-19 pandemic, added to a severe economic meltdown, have significantly disrupted an already suffering profession. METHODS: The objective of this study was to determine the level of resilience and its relationship to burnout, job satisfaction, intention to quit, and changes in practice. The study utilized a cross-sectional design to survey community pharmacists using an online questionnaire that included the Connor-Davidson Resilience Scale and the Copenhagen Burnout Inventory. All community pharmacists were invited to participate. Multiple logistic regression identified variables significantly associated with the resilience of pharmacists. RESULTS: A total of 459 community pharmacists completed the questionnaire. Respondents had a relatively low resilience level (68.0 ± 13.37). They also had higher scores on the client-related burnout (58.06 ± 17.46), followed by the personal burnout (56.51 ± 16.68) and the work-related burnout (55.75 ± 13.82). In this sample, 52.3% of pharmacists indicated that they are dissatisfied with their job and 41.1% indicated an intention to quit in the coming year. According to multivariate analysis, marital status (ß = 0.38; 95% CI 0.16-0.91; p = 0.03), intention to quit (ß = 0.384; 95% CI 0.149-0.987; p = 0.047), workload (ß = 0.275; 95% CI 0.096-0.783; p = 0.016), perception of safety (ß = 0.267; 95% CI 0.078-0.909; p = 0.035), and personal burnout (ß = 0.321; 95% CI 0.152-0.677; p = 0.003) were independent influencing factors for resilience. CONCLUSIONS: Multiple challenges and crises have culminated to the low job satisfaction, high burnout, and high the intention to quit of community pharmacists. This seriously destabilized the labor market of pharmacists which could negatively affect public safety. Effective interventions are essential to enhance the well-being and job satisfaction of pharmacists during public health crisis.

The role of pharmacists in complementary and alternative medicine in Lebanon: users' perspectives.

BACKGROUND: Customers' expectations and satisfaction are critical to ensure a more effective role of the community pharmacists in promoting the safe use of Complementary and Alternative Medicine (CAM). The aim of this study is to examine the perceptions and practices of customers buying their CAM products from pharmacies and explore their satisfaction with CAM-related services offered by the community pharmacists in Lebanon. METHODS: A national cross-sectional study was conducted among users of CAM (age > =18 years) who obtained their CAM from community pharmacies in Lebanon (n = 832). Within the proximity of the pharmacy, subjects were invited to complete a multi-component questionnaire. The latter consisted of four sections related to CAM: general beliefs, perception of pharmacists' role, practices, satisfaction with services offered by the pharmacists. In addition, the questionnaire included questions about sociodemographic characteristics of participants. RESULTS: The majority of participants agreed to an active role of the pharmacists' in guiding CAM use, however over half of the participants (61.3%) did not agree that the pharmacist is more knowledgeable in this field than other healthcare providers. As for practices, one in two surveyed customers (47%) did not always give feedback to their pharmacists about the outcomes after using CAM, 20% did not often ask the pharmacists about the safe and effective mode of use of the products and 28.1% did not discuss their medical history. For services offered by the pharmacist, the majority of participants reported receiving good education about the CAM product (87.1%), its side effects (87.1%) and mode of use (93.4%), while significant proportions of participants reported that pharmacists were not asking questions about their medical history before dispensing CAM products (22%) nor were they providing information on CAM-drug interactions (30%). CONCLUSIONS: The results of this study highlighted important gaps between the perceptions of customers and the services they received from the pharmacists about CAM use. These findings could be used by concerned stakeholders, including public health authorities and educational bodies, to develop evidence-based interventions aimed at promoting the role of pharmacists in ensuring a safe and effective CAM use Lebanon.

A profession in danger: Stakeholders' perspectives on supporting the pharmacy profession in Lebanon.

BACKGROUND: Lebanon boosts one of the highest pharmacists to population ratios globally (20.3/10,000). Yet, workforce analysis elicited serious concerns with the distribution, practice environments and regulation of Lebanese pharmacists. Recent workforce data shows that the profession has been majorly destabilized with hundreds of pharmacists closing their pharmacies or losing their employment. Proper planning for the future of the pharmacy profession in Lebanon necessitates a deeper understanding of the current challenges and the necessary policy and practice recommendations. The aim of this study is to examine stakeholders' perspectives on the current pharmacist workforce challenges and the necessary measures to support the profession. METHODS: The research team carried out a series of semi-structured interviews with twenty-one key stakeholders within the pharmacy profession in Lebanon. We categorized stakeholders according to their experience as policy makers, practitioners, academicians, and media experts. The interview guide included questions about workforce trends, labor market challenges and recommendations for improvement. Interviews were transcribed and analyzed thematically. RESULTS: Four major themes emerged from this study: the oversupply of pharmacists in Lebanon, the demand supply imbalance, poor regulation of the pharmacy practice, and the difficult practice environment. There was a consensus among interviewees that the oversupply of pharmacists is due to the poor workforce planning and weak regulatory framework, combined with the easy integration of foreign-trained pharmacists into the labor market. The lack of coordination between the educational and practice sectors is further widening the demand-supply gap. Interviewees further revealed that the regulatory policies on pharmacy practice were outdated and/or weakly enforced which increases the risk of unethical practices and erodes the image of pharmacists in the society. With respect to the practice environment, there is an ongoing struggle by Lebanese pharmacists to maintain profitability and exercise their full scope of practice. CONCLUSION: The poor pharmacy workforce planning and regulation is significantly weakening the pharmacy profession in Lebanon. A concerted effort between the various stakeholders is necessary to enhance workforce planning, regulate supply, optimize the integration of pharmacists into work sectors of need, and improve the financial and professional wellbeing of pharmacists in Lebanon.

Role of community pharmacists in weight management: results of a national study in Lebanon.

BACKGROUND: Ideally situated within the community, pharmacists can be involved in a broad range of health promotion campaigns including prevention of obesity. Limited evidence is available regarding their involvement in weight management in Lebanon, a country with escalating prevalence rate of obesity. OBJECTIVE: To examine the role of community pharmacists in weight management in Lebanon, specifically studying their beliefs, current practices, services, and knowledge. METHODS: Using a stratified random sampling approach, a cross sectional national survey of community pharmacists was conducted (n = 341, response rate 89%). At the pharmacy, and through a face-to-face interview, pharmacists completed a multi-component questionnaire that addressed, in addition to socio-demographic and work characteristics, their beliefs, practices, knowledge in relation to weight management. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analyses were used to examine the determinants of knowledge in the study population. RESULTS: Over 80% of study participants agreed that they have an important role to play in weight management. However, 50% of pharmacists did not agree that weight loss products are well regulated and 81.1% thought that companies marketing weight loss products are making false promises. The majority of pharmacists always/often sold weight loss products (84.7%) and counseled their patients for diet (86.3%) and physical activity (91.7%). Despite taking weight and height measurements, 50% of pharmacists rarely/never calculated BMI. Among the pharmacists who reported side effects of weight loss products (46.5%), the majority (91.3%) did so to the pharmaceutical company. The knowledge of pharmacists was better for the use of weight loss products as opposed to their side effects and interactions. Significant predictors of knowledge were holding a Masters/ PhD degree in Pharmacy, graduating from a university inside Lebanon, obtaining weight management training within the academic degree, and receiving inquiries about weight management in the pharmacy more than once daily. CONCLUSIONS: The results of the study provided important insights on the beliefs, practices and knowledge of community pharmacists in weight management in Lebanon. These findings could be used to inform the development of future evidence-based community pharmacists led weight management service provision nationally and internationally.

Upscaling the pharmacy profession in Lebanon: workforce distribution and key improvement opportunities.

BACKGROUND: The critical role pharmacists play in the healthcare system necessitates close monitoring of their supply, distribution, and competencies. This is especially relevant considering the global increase in the demand for pharmacists. In Lebanon, the pharmacy profession is facing several challenges related to the unplanned supply of pharmacists. The aim of the study is to analyze the Order of Pharmacists registration database and generate workforce distribution over the last six decades. METHODS: This study entailed a detailed database analysis of a deidentified subset of the Order of Pharmacists in Lebanon registration records for years 1954-2018. The analysis generated workforce distribution in terms of growth in number, distribution by gender, age distribution, geographic location, workforce status, sector of employment, and employment position. A descriptive analysis was carried out with cross-tabulations to identify distribution across selected variables. RESULTS: The pharmacy profession in Lebanon witnessed significant growth over the period of analysis. The "Community" was the most common employment sector (63%), followed by "Pharmaceutical Sector" (24%) and "Hospitals" (5%). The high ratio of pharmacists to 10 000 population (20.3) was contrasted by a low ratio of hospital pharmacist per hospital and per 100 hospital beds (1.9 and 1.7, respectively). The high pharmacist to population ratio is indicative of an oversupply of pharmacists precipitated by poor workforce planning. While oversupply did not result in high unemployment, it may have negatively affected the income of pharmacists and their adherence to the professional and ethical requirements of their job. Despite the large number of pharmacists in Lebanon, findings elicit concerns over the adequacy and safety of pharmacists' services in hospitals with a low ratio of hospital pharmacists to 100 hospital beds. CONCLUSION: This study unearthed several opportunities and concerns related to planning the supply, distribution, regulation, and the professional scope of practice of pharmacists in Lebanon. A concerted multi-stakeholder effort to address some of the identified challenges will not only improve the professional status of pharmacists but will also enhance the safety and efficiency of pharmaceutical care in the country.

Beliefs, practices and knowledge of community pharmacists regarding complementary and alternative medicine: national cross-sectional study in Lebanon.

INTRODUCTION: Pharmacists are uniquely positioned to provide patients with evidence-based information in order to ensure effective and safe use of Complementary and alternative medicine (CAM) products. OBJECTIVE: Assess beliefs, practices and knowledge related to CAM products among community pharmacists in Lebanon. DESIGN, METHODS AND SETTING: Using stratified random sampling, a nationally representative survey was conducted among community pharmacists in Lebanon. Through face-to-face interviews, pharmacists completed a multicomponent questionnaire consisting of four sections: (1) sociodemographic characteristics; (2) beliefs related to regulation of CAM products, role of media in promoting their safe use, availability of resources and continuing education; (3) practices including selling CAM products, providing advice for patients and reporting adverse effects and (4) knowledge about specific CAM products, their uses, side effects and interactions. RESULTS: A total of 341 pharmacists agreed to participate (response rate: 86%). Only pharmacists with complete data were included in this study (n=310). Pharmacists agreed that CAM products are effective (63.8%) and that they should be exclusively sold in pharmacies (80.3%), but disagreed that commercially marketed CAM products are well regulated (63.5%) and that media plays a positive role in educating users about these products (55.8%). As for practices, 64.5% of pharmacists were always or often advising patients on safe use; however, 74.2% of participants rarely or never reported adverse effects. Regarding knowledge, although the majority of pharmacists were aware of the uses of CAM products, fewer knew about their side effects and their interactions with drugs. After adjustment for covariates, receiving education/training on CAM products during university was the sole predictor of higher knowledge score (ß=0.68, 95% CI 0.29 to 1.07). CONCLUSIONS: This study revealed positive beliefs of pharmacists in Lebanon towards CAM products and indicated important gaps in their practice and knowledge. Deliberate efforts to enhance the education of pharmacists are warranted to ensure the safe integration and use of CAM products in Lebanon.

Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation.

BACKGROUND: Tricuspid regurgitation (TR), if untreated, is associated with an adverse impact on long-term outcomes. In recent years, there has been an increasing enthusiasm about surgical and transcatheter treatment of patients with severe TR. We aim to evaluate the contemporary trends in the use and outcomes of tricuspid valve (TV) surgery for TR using the National Inpatient Sample. METHODS AND RESULTS: Between January 1, 2003 and December 31, 2014, an estimated 45 477 patients underwent TV surgery for TR in the United States, of whom 15% had isolated TV surgery and 85% had TV surgery concomitant with other cardiac surgery. There was a temporal upward trend to treat sicker patients during the study period. Patients who underwent isolated TV repair or replacement had a distinctly different clinical risk profile than those patients who underwent TV surgery simultaneous with other surgery. Isolated TV replacement was associated with high in-hospital mortality (10.9%) and high rates of permanent pacemaker implantation (34.1%) and acute kidney injury requiring dialysis (5.5%). Similarly, isolated TV repair was also associated with high in-hospital mortality (8.1%) and significant rates of permanent pacemaker implantation (10.9%) and new dialysis (4.4%). Isolated TV repair and TV replacement were both associated with protracted hospitalizations and substantial cost. CONCLUSIONS: In contemporary practice, surgical treatment of TR remains underused and is associated with high operative morbidity and mortality, prolonged hospitalizations, and considerable cost.

Iatrogenic Circumflex Artery Stenosis Following Mitral Valve Repair.

Injury of the left circumflex coronary artery is a potentially serious complication of mitral valve surgery due to the proximity of the vessel to the posterior segment of the mitral annulus. Suture-related distortion of the artery with partial or subtotal occlusion is the most commonly implicated mechanism. Herein, we present a case of symptomatic iatrogenic circumflex coronary artery stenosis following mitral valve annuloplasty for degenerative mitral valve regurgitation.

Evaluation of Analgesic Activity of Papaver libanoticum Extract in Mice: Involvement of Opioids Receptors.

Papaver libanoticum is an endemic plant to Lebanese region (family Papaveraceae) that has not been investigated before. The present study aimed to explore the analgesic activity of dried ethanolic extract of Papaver libanoticum (PLE) using tail flick, hot plate, and acetic acid induced writhing models in mice. The involvement of opioid receptors in the analgesic mechanism was investigated using naloxone antagonism. Results demonstrated that PLE exhibited a potent dose dependent analgesic activity in all tested models for analgesia. The analgesic effect involved activation of opioid receptors in the central nervous system, where both spinal and supraspinal components might be involved. The time course for analgesia revealed maximum activity after three hours in both tail flick and hot plate methods, which was prolonged to 24 hours. Metabolites of PLE could be responsible for activation of opioid receptors. The EC50 of PLE was 79 and 50 mg/kg in tail flick and hot plate tests, respectively. The total coverage of analgesia by PLE was double that of morphine in both tests. In conclusion, PLE proved to have opioid agonistic activity with a novel feature of slow and prolonged effect. The present study could add a potential tool in the armaments of opioid drugs as a natural potent analgesic and for treatment of opioid withdrawal syndrome.