Aniella Abi-Gerges

Public health efforts towards breast cancer (BC) prevention have been largely absent from healthcare planning in modern-day Lebanon. Mammography screening campaigns have been present since 2002, but their implementation has been inconsistent in terms of pricing, locations, and the centers involved. In 2020, Lebanon was caught in the whirlwind of the Covid pandemic while facing a brewing economic crisis and a direct hit to the capital’s center of commerce. The impact of the complex situation created by these crises on BC screening remains to be identified, given the high prevalence of BC and the survival benefits provided by early diagnosis. Therefore, we assessed BC screening practices of 400 women aged 35–75 with no prior history of BC from the Lebanese population between January and June 2023. One tenth of participants halted mammography screening, while more than half of participants had continued or improved their BC screening practices after 2020. Women with an unfavorable attitude towards general health check-ups and single participants were more vulnerable to experience change in their BC screenings. Contrarily, women with relatives affected by BC and those financially stable to cover basic needs and more had higher proclivities to undergo BC screening. In this vein, future campaigns should nurture a culture that promotes general health check-ups while still offering financial support. These campaigns should be clearly advertised and communicated to the general public, especially in terms of cost and centers involved. Additional studies are needed to elucidate the determinants that can influence the attitude towards general health check-ups.

Global research on gender bias has highlighted key trends in discrimination and inequality across various fields, including medicine. In Lebanon, a nation celebrated for its diverse cultural landscape and increasing female representation in medical education, there has been a notable absence of studies exploring gender dynamics in the medical profession. To address this gap, we conducted a cross-sectional study using an online survey to explore the Lebanese population’s perceptions towards female physicians and the quality of care they provide. The mean age of the study sample (n = 330) was 31.55 ± 10.07 years and included 114 females and 216 males. Most respondents had received care from a female physician. Notably, those who selected female physicians as their family doctors or had female doctors within their immediate family displayed a stronger tendency to engage in annual medical check-ups. While most respondents did not express any preference for the gender of their general practitioner or surgeon, there was a marked preference for female obstetricians/gynecologists, psychiatrists, pediatricians, and dermatologists. This preference was attributed to perceptions of female physicians being particularly compassionate, understanding, and proficient in communication. This study represents a groundbreaking contribution to understanding gender perceptions in the Lebanese medical field. It highlights the growing trust and positive regard for female physicians, underscoring the significant role in shaping healthcare experiences and outcomes in Lebanon.

Background: Against the backdrop of Lebanon’s escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis– its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. Methods: An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. Results: The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4^th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). Conclusion: Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.

Diabetic cardiomyopathy (DCM) is associated with differential and time‐specific regulation of β‐adrenergic receptors and cardiac cyclic nucleotide phosphodiesterases with consequences for total cyclic adenosine 3′‐5′ monophosphate (cAMP) levels. We aimed to investigate whether these changes are associated with downstream impairments in cAMP and Ca²⁺ signalling in a type 1 diabetes (T1D)‐induced DCM model. T1D was induced in adult male rats by streptozotocin (65 mg/kg) injection. DCM was assessed by cardiac structural and molecular remodelling. We delineated sequential changes affecting the exchange protein (Epac1/2), cAMP‐dependent protein kinase A (PKA) and Ca²⁺/Calmodulin‐dependent kinase II (CaMKII) at 4, 8 and 12 weeks following diabetes, by real‐time quantitative PCR and western blot. Expression of Ca²⁺ ATPase pump (SERCA2a), phospholamban (PLB) and Troponin I (TnI) was also examined. Early upregulation of Epac1 transcripts was noted in diabetic hearts at Week 4, followed by increases in Epac2 mRNA, but not protein levels, at Week 12. Expression of PKA subunits (RI, RIIα and Cα) remained unchanged regardless of the disease stage, whereas CaMKII increased at Week 12 in DCM. Moreover, PLB transcripts were upregulated in diabetic hearts, whereas SERCA2a and TnI gene expression was unchanged irrespective of the disease evolution. PLB phosphorylation at threonine‐17 was increased in DCM, whereas phosphorylation of both PLB at serine‐16 and TnI at serine‐23/24 was unchanged. We show for the first time differential and time‐specific regulations in cardiac cAMP effectors and Ca²⁺ handling proteins, data that may prove useful in proposing new therapeutic approaches in T1D‐induced DCM.

As Medicine shifts from a paternalistic practice to a patient-centered approach, the concept of medical informed consent (IC) has evolved to safeguard patient autonomy. However, its current implementation still presents many challenges in clinical practice. We assessed the knowledge and attitudes of the general Lebanese population regarding the IC process as well as their sociodemographic and medical correlates. An anonymous online survey was distributed to the Lebanese population using social media channels. A sample of 500 adults with an average age of 36.2 ± 13.5 years, including 319 females and 181 males, was recruited. Most of the respondents had a university degree (85.8%), reported previous hospital admissions (75.9%) and had signed an IC for surgical procedures (40.7%). Few participants were knowledgeable about IC Lebanese law. Variability in knowledge level was significantly related to gender and a previous hospitalization history. Positive attitudes toward patient autonomy (53.1%) and shared decision-making (57.5%) correlated with older age, female gender, graduate education, and a previous history of signing an IC document. Males were more likely to believe that IC has positive effects on health than females. This is the first study that provides novel findings regarding Lebanese peoples’ awareness of the ethico-legal components of medical IC.

Gasoline exposure has been widely reported in the literature as being toxic to human health. However, the exact underlying molecular mechanisms triggered by its inhalation have not been thoroughly investigated. We herein present a model of sub-chronic, static gasoline vapor inhalation in adult female C57BL/6 mice. Animals were exposed daily to either gasoline vapors (0.86 g/animal/90 minutes) or ambient air for five days/week over seven consecutive weeks. At the end of the study period, toxic and molecular mechanisms, underlying the inflammatory, oxidative, and apoptotic effects triggered by gasoline vapors, were examined in the lungs and liver of gasoline exposed mice. Static gasoline exposure induced a significant increase (+21 %) in lungs/body weight ratio in gasoline-exposed (GE) versus control (CON) mice along with a pulmonary inflammation attested by histological staining. The latter was consistent with increases in the transcript levels of proinflammatory cytokines [Interleukins (ILs) 4 and 6], respectively by ~ 6-, 4-fold in the lungs of GE mice compared to CON. Interestingly, IL-10 expression was also increased by ~ 10-fold in the lungs of GE mice suggesting an attempt to counterbalance the established inflammation. Moreover, the pulmonary expression of IL-12 and TNF-α was downregulated by 2- and 4-fold, respectively, suggesting the skewing toward Th2 phenotype. Additionally, GE mice showed a significant upregulation in Bax/Bcl-2 ratio, caspases 3, 8 and 9 with no change in JNK expression in the lungs, suggesting the activation of both intrinsic and extrinsic apoptotic pathways. Static gasoline exposure over seven consecutive weeks had a minor hepatic portal inflammation attested by H&E staining along with an increase in the hepatic expression of the mitochondrial complexes in GE mice. Therefore, tissue damage biomarkers highlight the health risks associated with vapor exposure and may present potential therapeutic targets for recovery from gasoline intoxication.