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El Chamieh C, El Haddad C, El Khatib K, Jalkh E, Al Karaki V, Zeineddine J, Assaf A, Harb T, Sanayeh EB. River water pollution in Lebanon: the country's most underestimated public health challenge. East Mediterr Health J 2024; 30:136-144. [PMID: 38491899 DOI: 10.26719/emhj.24.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/18/2023] [Indexed: 03/18/2024]
Abstract
Background Due to the several interconnected crises that Lebanon has been facing for the past 4 years, many important social and environmental issues have been overlooked until more "pressing" ones are dealt with. Consequently, water pollution in Lebanon continues to worsen. Aim This study aimed to describe the microbiological and chemical properties of the 10 main rivers in Lebanon and to assess their suitability for irrigation, while exploring some of the solutions to the problem. Methods This cross-sectional study evaluated the pollution level of water from 10 rivers in Lebanon in June 2023 and their suitability for irrigation. Samples were collected at 3°C and their quality parameters were measured. Statistical analysis was conducted using R statistical software version 4.0.2. Results Compared to the Food and Agriculture Organization (FAO) guidelines for safe irrigation water use, 4 out of the 10 samples had pH levels exceeding the permissible threshold, resulting in severe limitations on their usability. Three rivers had nitrate concentrations that exceeded the approved range, thus constraining their severe usage. Among the rivers, 60% had Escherichia coli levels higher than the permissible spectrum and 40% had faecal coliform counts exceeding FAO's upper limit recommendation. All water sources, however, had total dissolved solid levels that were within the recommended range. Conclusions Polluted water can have a negative impact on human, wildlife and ecosystem health. Most of the assessed rivers in our study contained bacterial colonies, above the maximum recommended internationally. There is therefore an urgent need to address pollution issues in Lebanese waters to make them suitable for irrigation and other uses.
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Affiliation(s)
| | - Claudia El Haddad
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khaled El Khatib
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Edmond Jalkh
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon
| | - Victoria Al Karaki
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Zeineddine
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Antoine Assaf
- Department of Emergency Medicine, Notre Dame des Secours University Hospital, Jbeil, Lebanon
| | - Tania Harb
- Department of Radiology, Notre Dame des Secours University Hospital, Jbeil, Lebanon
| | - Elie Bou Sanayeh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Jammoul M, Naddour J, Madi A, Reslan MA, Hatoum F, Zeineddine J, Abou-Kheir W, Lawand N. Investigating the possible mechanisms of autonomic dysfunction post-COVID-19. Auton Neurosci 2023; 245:103071. [PMID: 36580747 PMCID: PMC9789535 DOI: 10.1016/j.autneu.2022.103071] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 12/10/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Patients with long COVID suffer from many neurological manifestations that persist for 3 months following infection by SARS-CoV-2. Autonomic dysfunction (AD) or dysautonomia is one complication of long COVID that causes patients to experience fatigue, dizziness, syncope, dyspnea, orthostatic intolerance, nausea, vomiting, and heart palpitations. The pathophysiology behind AD onset post-COVID is largely unknown. As such, this review aims to highlight the potential mechanisms by which AD occurs in patients with long COVID. The first proposed mechanism includes the direct invasion of the hypothalamus or the medulla by SARS-CoV-2. Entry to these autonomic centers may occur through the neuronal or hematogenous routes. However, evidence so far indicates that neurological manifestations such as AD are caused indirectly. Another mechanism is autoimmunity whereby autoantibodies against different receptors and glycoproteins expressed on cellular membranes are produced. Additionally, persistent inflammation and hypoxia can work separately or together to promote sympathetic overactivation in a bidirectional interaction. Renin-angiotensin system imbalance can also drive AD in long COVID through the downregulation of relevant receptors and formation of autoantibodies. Understanding the pathophysiology of AD post-COVID-19 may help provide early diagnosis and better therapy for patients.
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Affiliation(s)
- Maya Jammoul
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Lebanon
| | - Judith Naddour
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Lebanon
| | - Amir Madi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, 90127 Palermo, Italy
| | - Mohammad Amine Reslan
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Hatoum
- Faculty of Medicine, American University of Beirut, Lebanon
| | | | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Lebanon
| | - Nada Lawand
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Lebanon; Department of Neurology, Faculty of Medicine, American University of Beirut, Lebanon.
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Zeineddine J, El Chamieh C, Bou Sanayeh E. The lack of specialized pediatric cardiac surgeons in Lebanon: a humanitarian catastrophe. Health Econ Rev 2023; 13:10. [PMID: 36765022 PMCID: PMC9921605 DOI: 10.1186/s13561-023-00424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Congenital heart disease (CHD) is a major public health concern, as it is the most common birth defect and the leading cause of death in the first year of life if adequate surgical interventions were not provided. Unfortunately, in Lebanon, a country that has been assailed by devastating social and economic crises, many specialized Lebanese pediatric heart surgeons fled abroad to secure more stable careers. This has led to the death of many newborns with CHDs. Public health authorities must find urgent solutions for this national tragedy that is projected to last for years.
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Affiliation(s)
- Jana Zeineddine
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Elie Bou Sanayeh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Faculty of Medicine, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Thomas J, Riaz IB, Freeman D, Adib E, Nuzzo PV, El Zarif T, Davidsohn M, McClure H, Curran C, Ravi P, Yadav R, Kalluri U, Zeineddine J, Matar A, McGregor BA, Mantia C, Sonpavde GP. Early changes in peripheral blood neutrophil-lymphocyte ratio (NLR) to predict outcomes with immune checkpoint inhibitors (ICIs) for metastatic urothelial carcinoma (mUC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
449 Background: ICIs have provided advances in the therapy of mUC. However, the objective determination of benefit from ICIs determined by radiographic imaging may take months and may be confounded by pseudoprogression. Peripheral blood cells appear to reflect tumor microenvironment immune infiltrating cells. Given the known prognostic impact of baseline peripheral blood NLR, we aimed to investigate dynamic early changes in NLR as a biomarker of benefit in patients (pts) with mUC. Methods: Deidentified data from mUC pts who were treated with ICIs at Dana Farber Cancer Institute from 2015 to 2020 were reviewed retrospectively. Demographic data (age, gender), setting (untreated vs. post-platinum), sites of metastasis, performance status (PS), platelet count, and NLR at baseline and 3-4 weeks after initiating the ICI were collected. We assessed the association of NLR at baseline and 3-4 weeks after starting the ICI with any regression of tumor (ART) and overall survival (OS). A multivariable logistic regression model and Cox proportional-hazards model was employed to identify the association of NLR changes with ART and OS, respectively, using backward selection. Results: A total of 144 pts were included. The median age was 76 years and 100 (69.3%) were male. Overall, 54.8% (n=79) had ART and the median OS was 15.2 (12.2-23.5) months. 37.5% (n=54) were platinum naive and the remaining received post-platinum ICI therapy. In the multivariable models (Table), an increase in NLR, defined as an increase in NLR by ≥1.0 from baseline at 3-4 weeks was significantly associated with lower odds of ART (Odds Ratio (OR)= 0.80; 95% CI = 0.70-0.90; p = 0.0004) and worse OS (HR = 1.08; 95% CI = 1.05-1.11; p < 0.0001). The presence of liver metastasis was associated with lower odds of ART (OR = 0.30; 95% CI = 0.13-0.70; p = 0.006) and OS (HR 2.73; 95% CI 1.71 - 4.36; p<0.0001). Conclusions: Change in NLR in the first 4 weeks after initiating ICI for mUC was associated with tumor regression and survival in pts with mUC. Change in NLR may assist in early identification of benefit as well as identification of pts who may have progression of disease. Further validation is warranted to facilitate the early discrimination of benefit from ICIs in pts with mUC.[Table: see text]
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Affiliation(s)
| | | | | | - Elio Adib
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Heather McClure
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Ritu Yadav
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Ayah Matar
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Guru P. Sonpavde
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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Gebran A, Abou Khalil E, El Moheb M, Albaini O, El Warea M, Ibrahim R, Karam K, El Helou MO, Ramly EP, El Hechi M, Matar A, Zeineddine J, Dabar G, Al Hajj A, Abi Saad G, Hoballah J, Safadi B, Kaafarani HMA. The Beirut Port Explosion Injuries and Lessons Learned: Results of the Beirut Blast Assessment for Surgical Services (BASS) Multicenter Study. Ann Surg 2022; 275:398-405. [PMID: 34967201 DOI: 10.1097/sla.0000000000005322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This multicenter study aims to describe the injury patterns, emergency management and outcomes of the blast victims, recognize the gaps in hospital disaster preparedness, and identify lessons to be learned. SUMMARY BACKGROUND DATA On August 4th, 2020, the city of Beirut, Lebanon suffered the largest urban explosion since Hiroshima and Nagasaki, resulting in hundreds of deaths and thousands of injuries. METHODS All injured patients admitted to four of the largest Beirut hospitals within 72 hours of the blast, including those who died on arrival or in the emergency department (ED), were included. Medical records were systematically reviewed for: patient demographics and comorbidities; injury severity and characteristics; prehospital, ED, operative, and inpatient interventions; and outcomes at hospital discharge. Lessons learned are also shared. RESULTS An estimated total of 1818 patients were included, of which 30 died on arrival or in the ED and 315 were admitted to the hospital. Among admitted patients, the mean age was 44.7 years (range: 1 week-93 years), 44.4% were female, and the median injury severity score (ISS) was 10 (5, 17). ISS was inversely related to the distance from the blast epicenter (r = --0.18, P = 0.035). Most injuries involved the upper extremities (53.7%), face (42.2%), and head (40.3%). Mildly injured (ISS <9) patients overwhelmed the ED in the first 2 hours; from hour 2 to hour 8 post-injury, the number of moderately, severely, and profoundly injured patients increased by 127%, 25% and 17%, respectively. A total of 475 operative procedures were performed in 239 patients, most commonly soft tissue debridement or repair (119 patients, 49.8%), limb fracture fixation (107, 44.8%), and tendon repair (56, 23.4%). A total of 11 patients (3.5%) died during the hospitalization, 56 (17.8%) developed at least 1 complication, and 51 (16.2%) were discharged with documented long-term disability. Main lessons learned included: the importance of having key hospital functions (eg, laboratory, operating room) underground; the nonadaptability of electronic medical records to disasters; the ED overwhelming with mild injuries, delay in arrival of the severely injured; and the need for realistic disaster drills. CONCLUSIONS We, therefore, describe the injury patterns, emergency flow and trauma outcome of patients injured in the Beirut port explosion. The clinical and system-level lessons learned can help prepare for the next disaster.
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Affiliation(s)
- Anthony Gebran
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
| | - Elissa Abou Khalil
- Division of Pulmonary and Critical Care, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Mohamad El Moheb
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
| | - Obey Albaini
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | | | - Rand Ibrahim
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karin Karam
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Mohamad Othman El Helou
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Elie P Ramly
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Majed El Hechi
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
| | - Ayah Matar
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Zeineddine
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - George Dabar
- Division of Pulmonary and Critical Care, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | | | - George Abi Saad
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal Hoballah
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Safadi
- Lebanese American University Gilbert and Rose Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA
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