Marie-Hélène Gannagé-Yared

Introduction: Pediatric dyslipidemia is common worldwide, especially in Lebanon, and is associated with increased long-term cardiovascular risk. However, international screening recommendations are still controversial. In Lebanon, no study has assessed physicians’ knowledge, attitudes, and practices (KAPs) about this screening. Methods: A cross-sectional online questionnaire-based study was conducted among pediatricians, family medicine physicians, and endocrinologists practicing in Lebanon. The questionnaire assessed knowledge, attitudes, screening practices, and perceived barriers regarding pediatric dyslipidemia. Associations between variables were examined using univariate and multivariable analyses. Results: A total of 245 physicians participated in the study. Performance on the nine selected knowledge items was low (mean score of 53.2 ± 22.1 out of 100, median 55.6), with gaps mainly related to the prevalence of pediatric dyslipidemia in Lebanon and familiarity with international recommendations. Attitudes toward screening were generally favorable (mean score of 77.8 ± 14.2 out of 100, median 80), although 56.3% of participants reported concerns about family anxiety. Screening practices were heterogeneous and primarily relied on targeted screening when risk factors were present. Screening in adolescents was performed (always or most of the time) by 40.3% of endocrinologists, 32.6% of family medicine physicians, and 19.3% of pediatricians, with laboratory test costs and parental consent being the main obstacles (49.8% and 33.9%, respectively). The score based on the nine selected knowledge items showed a weak positive correlation with the attitude score (Spearman’s ρ = 0.135, p = 0.035). Attitude scores differed significantly across reported screening-frequency categories (p<0.001). In multivariable analysis, female sex, family medicine practice, and practice in Beirut/Mount Lebanon (BML) were independently associated with higher score on the nine selected knowledge items (p=0.015, p<0.001, and p=0.005, respectively). Conclusion: Despite favorable attitudes, insufficient knowledge and contextual barriers limit the systematic implementation of pediatric dyslipidemia screening in Lebanon. Actions that combine training, harmonization of recommendations, and improved access to screening could strengthen pediatric cardiovascular prevention.

Background: Pediatric dyslipidemia is a common metabolic disorder worldwide, especially in Lebanon, and is an early risk factor for cardiovascular disease. Parents play a crucial role in prevention, screening, and management, but their knowledge and practices remain poorly studied. Methods: A cross-sectional questionnaire-based study was conducted between March and November 2025 among parents of school-aged children from eight schools in Greater Beirut and Mount Lebanon. An electronic questionnaire was used to collect sociodemographic data and to assess parents’ knowledge (using a composite score) and practices regarding dyslipidemia. Factors associated with knowledge levels and their relationship with parental practices were also examined. Results: A total of 946 parents were included (861 women and 85 men) with a mean age of 43.9 ± 6.2 years, 94.1% had a university education, and 11.6% were healthcare professionals. Among them, 42.4% had heard of pediatric dyslipidemia, mainly through the media (25.2%) and healthcare professionals (24.4%). The mean knowledge score was 14.1 ± 4.4 out of 23. Blood test-based lipid screening for dyslipidemia in children had been performed by only 6.7% of parents. The independent determinants of a higher knowledge score were female gender, university education, healthcare professional status, and having heard of pediatric dyslipidemia ( p < 0.001, p = 0.007, p < 0.001, p < 0.001, respectively). In addition, higher knowledge scores were significantly associated with favorable preventive practices, including implementation of healthy eating habits ( p = 0.02) and lipid screening in children ( p < 0.001). Conclusion: Parents demonstrated moderate knowledge levels. The association between knowledge level and the adoption of favorable preventive measures suggests that educational campaigns targeting parents and health care professionals could play a role in promoting healthier practices.

The impact of COVID-19 pandemic on diabetes management and control is controversial and has never been studied in Middle Eastern countries. The aim of this study is to assess recent trends in HbA1c and fasting blood glucose (FBG) in Lebanon. Data related to all the HbA1c tests performed between 2018 and 2022 were extracted from the large laboratory database of our hospital. Data related to fasting plasma glucose when measured at the same time then HbA1c were also collected. The variation in the number and values of HbA1c and FBG were analyzed according to age, gender, pandemic, sampling year and patient status (in/outpatient). The total number of HbA1c and FBG tests performed was 44,043 and 37,193 respectively. The median (interquartile) values for HbA1c and FBG were 5.55% (IQR:5.24–6.02) and 5.4 mmol/L (IQR:4.98–6.13) respectively. During the pandemic, a significant decrease in the number of HbA1c tests by 26.2% and FBG tests by 25.6% was noted, as well as a significant increase in their values (from 5.53%–5.56% and from 5.35 mmol/L to 5.43 mmol/L respectively). Median HbA1c values were higher in men than in women (5.61% vs 5.5%), in elderly subjects (5.86%) than in adults and children (5.42%, 5.16% respectively), and in inpatient than in outpatient settings (5.98% vs 5.53%), P < .001, for all comparisons. During the COVID-19 outbreak, the number of HbA1c and FBG tests performed decreased, but their values increased. Further studies are needed to look if this trend will last and to assess the long-term impact of these changes.

Background and objectives: Stress-induced hyperglycemia is common in intensive care units (ICUs) and has been linked to adverse outcomes. Although mean glycemia (MG) has been extensively studied, the benefits of strict glycemic control remain controversial, and the impact of glycemic variability (GV) is less clearly defined. No consensus currently exists regarding GV thresholds, and limited evidence is available across different ICU settings, with data from the Middle East region particularly lacking. This study aimed to assess the relationship between MG and GV with key clinical outcomes, including hospital and ICU length of stay (LOS), renal function, and in-hospital mortality, among patients admitted to three ICUs at a Lebanese tertiary care center.Methods: We retrospectively reviewed the medical records of patients admitted during July and August 2024 to the surgical, medical, and cardiovascular ICUs at the Hôtel-Dieu de France Hospital. Baseline characteristics, MG, GV, total hospital/ICU LOS, in-hospital mortality, and glomerular filtration rates (GFR) were analyzed.Results: GV was significantly associated with prolonged total and ICU LOS, reduced GFR, and increased in-hospital mortality. Patients with GV >30% had a markedly higher risk of death. In contrast, no significant association was found between MG and said outcomes. MG differed across ICU subunits, reaching its highest levels in the cardiovascular ICU, while GV did not vary significantly between units.Conclusion: GV, rather than MG, emerged as a key predictor of adverse outcomes in ICU patients, being associated with longer hospital and ICU LOS, renal impairment, and increased mortality. These findings highlight GV as an important therapeutic target in the management of critically ill patients.

Primary aldosteronism (PA) is a frequent cause of secondary hypertension. Studies on the prevalence of PA are lacking in the Middle East region. To determine the proportion of patients with high aldosterone-to-renin ratio (ARR) among Lebanese patients with hypertension screened for PA and to compare their clinical and biological characteristics with patients with essential hypertension. A retrospective review of medical charts of patients with hypertension undergoing sampling of serum aldosterone and plasma renin concentration at a tertiary care center between October 2022 and 2023 was conducted. Of 144 patients with hypertension screened for PA, 23 (16%) had an ARR higher than 3.7 ng/dL/mU/L and serum aldosterone above 15 ng/dL. The mean age of the screened population was 51 ± 15 years, 56% were men. The median duration of hypertension was 4 years and the median number was 2 of antihypertensive medications. Patients with a positive screening test were mostly men (88%, P = .0001), and more frequently had diabetes (50%, P < .0001) than those with essential hypertension. Only 22% had hypokalemia. Of the 23 patients, 11 underwent intravenous saline suppression testing; PA was confirmed in all of them. The high frequency of PA in our center is comparable to other countries. More studies are needed to determine how to reduce healthcare disparities and overcome the barriers to appropriate diagnosis and treatment.

Background Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years. Methods Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved. Results Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables). Conclusion Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.

Background: High levels of non-HDL cholesterol (non-HDL-C), triglycerides (TG), lipoprotein (a) (Lp(a)), and Proprotein convertase subtilisin/kexin type 9 (PCSK9) as well as low levels of HDL-C are strongly associated with cardiovascular disease (CVD). Our study aims to estimate the prevalence of dyslipidemia and high Lp(a) in the Lebanese population and to study the relationship of these variables with gender, age, body mass index (BMI), and PCSK9. Methods: This cross-sectional study was carried out on a sample of healthy volunteers aged 18 to 65. Blood samples were drawn from volunteers for total cholesterol (TC), HDL-C, TG, PCSK9, and Lp(a) measurements. Non-HDL-C was calculated by subtracting HDL-C from TC. Results: In total, 303 volunteer subjects with an average age of 38.9 years were included in the study. Respectively, 44%, 29.8%, and 44% of men had high non-HDL-C and TG with low HDL-C versus 23.5%, 8%, and 37% in women. Non-HDL-C and TG were significantly higher in men than in women, while the reverse was observed for HDL-C (p < 0.0001 for the three comparisons). Non-HDL-C and TG were significantly correlated with age and BMI (p< 0.0001 for all correlations), while HDL-C was inversely correlated with BMI (p < 0.0001) but not with age. Abnormal Lp(a) levels (≥75 nmol/L) were found in 19.1% of the population, predominantly in women (24.1% versus 13.4% in men, p = 0.004). The median PCSK9 and its interquartile was 300 (254–382) ng/L with no gender difference (p = 0.18). None of the following factors: gender, age, BMI, non-HDL-C, HDL-C, or TG, were independently associated with Lp(a), while PCSK9 was significantly correlated with age, non-HDL-C, and TG in both men and women and inversely correlated with HDL-C in men. Dyslipidemia is very common in the Lebanese population and is associated with age, high BMI, and male sex. Lp(a) is higher in women without any correlation with the lipid profile, whereas PCSK9 is associated with non-HDL-C and TG. Further studies are needed to evaluate the potential role of Lp(a) and PCSK9 in predicting CVD in healthy populations.