Amal Rahi

To identify risk factors for subclinical hypothyroidism (SCH) (thyroid-stimulating hormone levels >5 mIU/mL) in patients receiving valproate (VPA) therapy. During a period of 2 years, consecutive patients with epilepsy receiving VPA and a control group of patients with diseases other than epilepsy attending a tertiary care neurology clinic were screened for SCH. The 2 groups were compared. The association between SCH and specific risk factors was investigated with bivariate and multivariate analyses. Thirty-six of 143 patients receiving VPA (25.2%, mean age +/- SD: 8.5 +/- 6.6 years) and none of the 35 control subjects had SCH (P < .001). Predictors of SCH were younger age (OR: 1.15, cutoff age 3.9 years); duration of treatment between 6 and 24 months versus <6 months (OR: 2.98) and >24 months (OR: 2.66); VPA polytherapy with enzyme-inducing agents (OR: 6.08), or polytherapy with non-enzyme-inducing agents (OR: 3.34) compared with VPA monotherapy. Most (88.2%) patients with duration of therapy >2 years were older than 3.9 years. Risk factors for SCH were young age, co-medication with antiepileptic drugs, and duration of therapy between 6 and 24 months. Screening patients with these risk factors may be warranted.

Febrile seizures occur between the age of 3 months and 5 years with a temperature of 38°C or higher, and are either simple or complex. Eight gene loci have been identified to be associated with certain cases of autosomal dominant familial febrile seizures, and 12 genes have been associated with some of the familial epilepsy syndromes that can start with febrile seizures. The mutations and the protein products are known for only some of these 20 genes. The risk of recurrence of convulsions in a further febrile illness is on average 30%, and of developing epilepsy is on average 6%, but both vary depending on the presence and number of risk factors in any given patient. The immediate treatment of a febrile convulsion is intravenous or rectal diazepam, but febrile status epilepticus requires intravenous Phenobarbital and possibly other medications. Long-term antiepileptic drugs are not recommended in most patients with febrile seizures. However, exceptions should be considered on an individual basis in patients with complex febrile seizures with multiple risk factors for development of later epilepsy.

Background Sustainability of hand hygiene is challenging in low resource settings. Adding ownership and goal setting to the WHO-5 multimodal intervention may help sustain high compliance. Aim To increase and sustain compliance of nursing and medical staff with hand hygiene in a tertiary referral center with limited resources. Methods A quality improvement initiative was conducted over two years (2016–2018). After determining baseline compliance rates, the WHO-5 multimodal intervention was implemented with staff education and training, system change, hospital reminders, direct observation and feedback, and hospital safety climate. Additionally, the medical staff was responsible for continuous surveillance of compliance (ownership) until rates above 90% were achieved and sustained (goal setting). Results Of 2987 observations collected between August 2016 and April 2018, 1630 (54.5%) were before, and 1357 (45.5%) were after patient encounters. The average overall compliance with hand h...

There are few publications on prevalence of skin diseases in Lebanon. To find the prevalence of dermatologic diseases among students seen at the university health services of the American University of Beirut. 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. 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). 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 disea...

Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise. In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: "No" (< 0.5 h) and "Yes" (> 0.5 h) per week. Chi-square tests and binary regression were conducted to determine the predictors of performing physical exercise. Of 2,013 students, only 26.4% engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control. The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females.

Objective:To identify the source of an epidemic ofBurkholderia cepaciabloodstream infections during 7 years (411 episodes in 361 patients).Design:Outbreak investigation.Setting:A 250-bed university hospital in Beirut, Lebanon.Methods:Matched case-control and retrospective cohort studies, and microbiological surveillance and polymerase chain reaction–restriction fragment length ascertainment were employed. Special media and filtration techniques were used to isolate organisms from water and diluted alcohol solutions.Results:In a group of 50 randomly selected case-matched patients from 1999, the positive blood cultures were concomitant with fever in 98%, intravenous phlebitis in 44%, and recurrent bacteremia in 20%. Fever disappeared approximately 6 hours after intravenous catheter removal. Polymerase chain reaction–restriction fragment length polymorphism revealed strain homogeneity in patient, water, and alcohol isolates. Contaminated tap water had been used to dilute alcohol for sk...

We present our 10-year experience and preoperative predictors of outcome in 93 adults and children who underwent epilepsy surgery at the American University of Beirut. Presurgical evaluation included video-EEG monitoring, MRI, neuropsychological assessment with invasive monitoring, and other tests (PET, SPECT, Wada). Surgeries included temporal (54%), extratemporal (22%), and multilobar resections (13%), hemispherectomy (4%), vagal nerve stimulation (6%), and corpus callosotomy (1%). Mesial temporal sclerosis was the most common aetiology (37%). After resective surgery, 70% had Engel class I, 9% class II, 14% class III, and 7% class IV. The number of antiepileptic drugs before surgery was the only preoperative factor associated with Engel class I (p=0.005). Despite the presence of financial and philanthropic aid, many patients could not be operated on for financial reasons. We conclude that advanced epilepsy presurgical workups, surgical procedures, and favourable outcomes, comparab...

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.

Methods: Twenty consecutive TLE patients who underwent temporal lobectomy 3 years previously were matched in the following variables: age, sex, seizure frequency, seizure duration, age at onset of epilepsy, duration of epilepsy, and number of medications, with 17 TLE patients ...

Febrile seizures occur between the age of 3 months and 5 years with a temperature of 38 degrees C or higher, and are either simple or complex. Eight gene loci have been identified to be associated with certain cases of autosomal dominant familial febrile seizures, and 12 genes have been associated with some of the familial epilepsy syndromes that can start with febrile seizures. The mutations and the protein products are known for only some of these 20 genes. The risk of recurrence of convulsions in a further febrile illness is on average 30%, and of developing epilepsy is on average 6%, but both vary depending on the presence and number of risk factors in any given patient. The immediate treatment of a febrile convulsion is intravenous or rectal diazepam, but febrile status epilepticus requires intravenous Phenobarbital and possibly other medications. Long-term antiepileptic drugs are not recommended in most patients with febrile seizures. However, exceptions should be considered on an individual basis in patients with complex febrile seizures with multiple risk factors for development of later epilepsy.

In most developing countries including Lebanon, trauma research is lacking and warranted. Objectives of the current study were to describe trauma patients referred to a tertiary care center during one year and identify outcomes and patterns of injury. Review of hospital charts of every 12th consecutive patient presenting to the emergency unit (ED) after a traumatic event during the year 2001-2002. Data collected include: demographics, injury description, and hospital data. A total of 736 patients were included, 212 pediatric, 455 young, and 62 geriatric patients. The most common body regions injured were the extremities followed by the face. The most encountered mechanism of injury was fall from less than 15 feet (38.2%) followed by penetrating/gunshot injury (14.8%), and road traffic accidents (11.8%). The rates of hospital admission and surgical intervention were highest among geriatric patients (p = 0.03 and p < 0.001). Most injuries occurred during the evening shift and the a...

Pyridoxine-dependent epilepsy (PDE) is a rare disease, of which the EEG manifestations are only partially characterised. We report our observations of EEG recordings in four patients with PDE. EEG tracings from four patients fulfilling the clinical criteria for PDE were reviewed. Relative to the time of treatment with pyridoxine, EEG recordings were available before treatment in two patients (at ages four and 10 months), immediately after treatment in two patients and during long-term follow-up with treatment in all four patients. Pre-pyridoxine interictal EEG findings included: diffuse slowing, bilateral independent multifocal epileptiform discharges, generalized bursts of polyspike slow waves and focal or generalized sharp waves. In addition, the EEG was often asymmetrical and included: generalized semi-rhythmic sharp and slow waves, a burst suppression pattern and continuous generalized spike and slow waves. In one patient, who was followed subsequently, a decrease in multifocal ...

The objectives of the current study were to investigate risky weight control measures (vomiting or pills) among university students in Lebanon and to assess their relation to demographic, scholastic, and health risk behavioral characteristics. The study used a cross-sectional design. A proportionate random sample of 2,013 students was selected from public and private universities in Greater Beirut. Each participant completed a self-administered anonymous questionnaire. Among participating students, 123 (6.1%) reported practicing risky weight control measures. Multivariate analysis indicated that younger females, cigarette smokers, engaged/married students, and those with a higher body mass index (BMI) were at increased odds of performing risky weight control measures. Health awareness measures need to be proposed and, if possible, implemented to better define the motives and methods of weight reduction among Lebanese youth.

From the Department of Pediatrics (Drs. Ziad, Rahi, Hamdan, and Mikati) and Adult and Pediatric Epilepsy Program (Dr. Mikati), American University of Beirut Medical Center, Beirut, Lebanon. ... To determine the risk of occurrence of hyperthermia during topiramate ...

We report a case of partial biotinidase deficiency (plasma biotinidase levels: 1.30 nm/minute/mL) in a 7-month-old boy who presented with evidence of perinatal distress followed by developmental delay, hypotonia, seizures, and infantile spasms without alopecia or dermatitis. His neurologic symptoms improved markedly on biotin supplementation and antiepileptic drug therapy. DNA mutational analysis revealed that the patient was homozygous for a novel E64K mutation and his parents were heterozygous for the same mutation. Whereas preexisting perinatal distress probably contributed to the severity of the patient's symptoms, the described mutation is novel and is possibly responsible for at least some of his clinical manifestations.

Chronic nasal obstruction in children is a very common disorder. Obstructing adenoid is usually the first to blame. Though the clinical assessment is essential, it is often considered unreliable or insufficient. We conducted a prospective clinical study to validate a clinical score predicting the severity of adenoid obstruction in symptomatic children. The clinical score (CS) included mouth breathing, snoring, restless sleep, frequent waking-up at night and obstructive breathing during sleep. Each item received a score of 0 or 1. The palatal airway was evaluated on a lateral nasopharyngeal x-ray. The degree of obstruction was assessed intra-operatively by a laryngeal mirror using a 3-grade scale. The volume of each adenoid specimen was measured. Eighty-six patients were enrolled, 51 boys and 35 girls, aged 13-181 months (mean 52, median 45). The CS correlated very well with the intra-operative findings (p < 0.01) and with the degree of palatal airway obstruction (p < 0.05) but not with the volume of the adenoid removed (p > 0.05). The CS was higher in children younger than 3 years (CS > 3 in 85.7% vs. 29.2%), having more frequent obstructive breathing during sleep (71.43% vs. 21.54%). A CS of three or higher, predicted severe obstruction in 96.5% of patients, as detected intra-operatively. The suggested CS is simple to use and is highly reliable in identifying children in need for adenoidectomy, in the context of normal anterior rhinoscopy and tonsils less than grade three.