Physician and Patient Perceptions of Physical Touch in Primary Care Consultations in Lebanon: A Qualitative Study

Background: Verbal and non-verbal communications are an inherent component of physician-patient interactions. The psychological and physiological benefits of non-verbal communication such as gestures, expressions, eye contact, and particularly physical touch in healthcare have been previously explored by the scientific community, albeit insufficiently in the primary care context. Objective: This study aims to address this gap by investigating physician and patient perceptions of expressive touch and its effect on patient satisfaction in primary care consultations in Lebanon. Methods: We recruited 12 physicians and 13 patients and subjected them to audiotaped semi-structured interviews. We selected the patients from three hospitals, while physician responders were from the Faculty of Medical Sciences of the Lebanese University. We translated the survey instrument into Arabic and validated it using back translation sustained by a pilot study. We performed constant comparative qualitative analysis for obtained relevant data. Results: Patient satisfaction and trust were associated with good verbal and non-verbal communication. Patient and physician responders recognized the benefit of empathy in building long-term relationships. Social and non-intimate expressive touches were positively perceived by patients, although within ethical and religious boundaries. Male physicians expressed clear apprehension for the use of touch, especially towards female patients, due to religious considerations. On the other hand, touch from female physicians was reportedly accepted by patients of both genders, while touch from their male counterparts was associated with more uneasiness. Discussion and Conclusions: Religious concerns are prevalent among Lebanese physicians and patients alike. However, the use of reassuring physical touch is still a cornerstone of the patient-physician relationship in Lebanon, albeit with some limitations. The potential therapeutic effect of verbal and non-verbal communication is evident and warrants further investigation. Communication training efforts should emphasize the importance of religiously and ethically appropriate expressive touch in healthcare. This would serve to promote positive physician and patient perceptions of this practice and improve clinical communication and expressiveness

Prevalence and management of diabetic neuropathy in secondary care in Qatar

Aims Diabetic neuropathy (DN) is a “Cinderella” complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU and those at risk of (DFU) in patients with T2DM in secondary care in Qatar. Materials and methods Adults with T2DM were randomly selected from the two National Diabetes Centers in Qatar. DN was defined by the presence of neuropathic symptoms and a vibration perception threshold (VPT) ≥ 15 V. Participants with a VPT≥25 V were categorized as high risk for DFU. Painful DN was defined by a DN4 score ≥ 4. Logistic regression analysis was used to identify predictors of DN. Results In 1082 adults with T2DM (age 54 ± 11 years, duration of diabetes 10.0 ± 7.7 years, 60.6% males) the prevalence of DN was 23.0% (95% CI: 20.5%‐25.5%), of whom 33.7% (95% CI: 27.9%‐39.6%) were at high risk of DFU and 6.3% had DFU. 82.0% of the patients with DN were previously undiagnosed. The prevalence of DN increased with age and duration of diabetes and was associated with poor glycemic control (HbA1c ≥ 9%) AOR = 2.1 (95%CI: 1.3‐3.2), hyperlipidemia AOR = 2.7 (95%CI: 1.5‐5.0) and hypertension AOR = 2.0 (95%CI: 1.2‐3.4). Conclusions Despite, DN affecting 23% of adults with T2DM, 82% had not been previously diagnosed with 1/3 at high risk for DFU. This argues for annual screening and identification of patients with DN. Furthermore, we identify hyperglycemia, hyperlipidemia and hypertension as predictors of DN

Prevalence and risk factors for painful diabetic neuropathy in secondary health care in Qatar.

AIMS/INTRODUCTION:Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa (MENA) region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in T2DM patients attending secondary care in Qatar. MATERIALS AND METHODS:This is a cross-sectional study of 1095 participants with T2DM attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the DN4 questionnaire with a cut-off ≥4 and the Neurothesiometer with a cut-off ≥15V, respectively. RESULTS:The prevalence of PDPN was 34.5% (95% CI: 31.7%-37.3%), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared to South Asians (P<0.05). PDPN was associated with impaired vibration perception AOR=4.42 (95%CI: 2.92-6.70), smoking AOR=2.43 (95%CI: 1.43-4.15), obesity AOR=1.74 (95%CI: 1.13-2.66), being female AOR=1.65 (95%CI: 1.03-2.64) and duration of diabetes AOR=1.08 (95%CI: 1.05-1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN. CONCLUSIONS:PDPN occurs in 1/3 of T2DM patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar. This article is protected by copyright. All rights reserved

HPV-related oropharyngeal cancer prevalence in a middle eastern population using E6/E7 PCR

Background: Given the paucity of data and widely variable rates that have been reported, the main objective of this study was to examine the prevalence of HPV-positivity in oropharyngeal squamous cell carcinoma (OPSCC) in Middle Eastern patients presenting to one of the region's largest tertiary care centers using polymerase chain reaction (PCR) amplification of the HPV E6/E7 oncogenes, a highly sensitive and specific method of detection. Methods: Medical charts and archived pathological specimens were obtained for patients diagnosed with biopsy proven oropharyngeal cancer who presented to the American University of Beirut Medical Center between 1972 and 2017. DNA was extracted from paraffin-embedded specimens and tested for 30 high-risk and low-risk papilloma viruses using the PCR-based EUROarray HPV kit (EuroImmun). Results: A total of 57 patients with oropharyngeal cancer were initially identified; only 34 met inclusion/exclusion criteria and were included in the present study. Most patients were males (73.5%) from Lebanon (79.4%). The most common primary tumor site was in the base of tongue (50%), followed by the tonsil (41.2%). The majority of patients (85.3%) tested positive for HPV DNA. Conclusion: The prevalence of HPV-positivity amongst Middle Eastern OPSCC patients, specifically those from Lebanon, may be far greater than previously thought. The Lebanese population and other neighboring Middle Eastern countries may require a more vigilant approach towards HPV detection and awareness. On an international level, further research is required to better elucidate non-classical mechanisms of HPV exposure and transmission. © 2020 The Author(s)

Air quality and urban sustainable development: the application of machine learning tools

[EN] Air quality has an efect on a population¿s quality of life. As a dimension of sustainable urban development, governments have been concerned about this indicator. This is refected in the references consulted that have demonstrated progress in forecasting pollution events to issue early warnings using conventional tools which, as a result of the new era of big data, are becoming obsolete. There are a limited number of studies with applications of machine learning tools to characterize and forecast behavior of the environmental, social and economic dimensions of sustainable development as they pertain to air quality. This article presents an analysis of studies that developed machine learning models to forecast sustainable development and air quality. Additionally, this paper sets out to present research that studied the relationship between air quality and urban sustainable development to identify the reliability and possible applications in diferent urban contexts of these machine learning tools. To that end, a systematic review was carried out, revealing that machine learning tools have been primarily used for clustering and classifying variables and indicators according to the problem analyzed, while tools such as artifcial neural networks and support vector machines are the most widely used to predict diferent types of events. The nonlinear nature and synergy of the dimensions of sustainable development are of great interest for the application of machine learning tools.Molina-Gómez, NI.; Díaz-Arévalo, JL.; López Jiménez, PA. (2021). Air quality and urban sustainable development: the application of machine learning tools. 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The phocein homologue SmMOB3 is essential for vegetative cell fusion and sexual development in the filamentous ascomycete Sordaria macrospora

Members of the striatin family and their highly conserved interacting protein phocein/Mob3 are key components in the regulation of cell differentiation in multicellular eukaryotes. The striatin homologue PRO11 of the filamentous ascomycete Sordaria macrospora has a crucial role in fruiting body development. Here, we functionally characterized the phocein/Mob3 orthologue SmMOB3 of S. macrospora. We isolated the gene and showed that both, pro11 and Smmob3 are expressed during early and late developmental stages. Deletion of Smmob3 resulted in a sexually sterile strain, similar to the previously characterized pro11 mutant. Fusion assays revealed that ∆Smmob3 was unable to undergo self-fusion and fusion with the pro11 strain. The essential function of the SmMOB3 N-terminus containing the conserved mob domain was demonstrated by complementation analysis of the sterile S. macrospora ∆Smmob3 strain. Downregulation of either pro11 in ∆Smmob3, or Smmob3 in pro11 mutants by means of RNA interference (RNAi) resulted in synthetic sexual defects, demonstrating for the first time the importance of a putative PRO11/SmMOB3 complex in fruiting body development

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

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