Pruritus ani: More than a decade of personal experience in Lebanon

Pruritus ani is a common medical condition that is difficult to treat in the absence of obvious predisposing factors. Hereby, we report more than a ten-year experience in the management of pruritus ani stressing the importance of early detection, identification of the etiology, and management. A total of 124 patients were managed in the surgical clinic. The follow-up was between 11 to 17 months. All patients had the symptoms for a period of time ranging between 6 and 40 months. Patients were treated according to their respective etiology. Medical cases like con- tact dermatitis and psoriasis were treated by applying proper topical ointments, while other cases like anal fissure and fistula were treated surgically. Idiopathic patients were treated by tattooing [injection to perianal skin with methylene blue]. The majority of patients with known medical etiology responded favorably to conservative treatment [= 92%]. In addition, surgical management for anorectal disorders like hemorrhoids and fistula showed a consistent improvement [94%]. However, patients who had their symptoms neglected for longtime or had used over the counter medication without a proper medical follow-up, experienced a lower success rate of cure [76%]. Patients who were diagnosed and treated at first hand, showed better results than those who sought late medical advice and management [i.e. > 18 months]. In light of the above, a multidisciplinary team approach consisting of a proctologist, a gastroenterologist and a dermatologist is recommended

Mycobacterium tuberculosis spoligotypes circulating in the Lebanese population: a retrospective study

Genotyping Mycobacterium tuberculosis in Lebanon on the national level may be beneficial for assessing patients and monitoring the therapeutic response to DOTS. This study aimed to characterize the spoligotypes of clinical isolates of M tuberculosis patients collected between April 2004 and October 2005 from all Lebanese provinces. Isolates [n = 60] were cultured and identified by their biochemical characteristics. DNA extracts of these samples were amplified by PCR and genotyped by spoligotyping. Thirteen [13] patterns of M tuberculosis complex family strains were identified: 41.6% of the strains belonged to the T 1 family, 25.0% to LAM 9,10.0% to Haarlem 3, 3.3% to each of CAS, LAM 8, BCG and Family 36 and17% to each of Haarlem 1, LAM 10, S, M. africanum, X 1 and T 3 families. The noticeable absence of Beijing and East African Indian families was not,consistent with the patterns reported in neighbouring countries. A more inclusive study of the Lebanese population Is necessary to accurately identify most of the prevailing families in the country

Human papillomavirus testing as an adjunct to cytology evaluation in cervical specimens of selected and consecutively screened Lebanese women: a prospective clinical study

Cervical cancer is the second leading cancer in women worldwide, with 85-100% of cervical cancers being HPV DNA positive. Our study aimed at evaluating the use of HPV DNA testing as an adjunct to the routine cervical cytology evaluation of Lebanese women. Cervical cytology evaluation and testing for human papillomavirus [HPV], as well as high-risk HPV were performed on two groups of women. One group consisted of 274 healthy women attending gynecology clinics for routine evaluation, while the other included 199 women selected based on a high-risk lifestyle and/or abnormal findings at cytology. HPV and HR-HPV DNA were 4 and 10 times higher, and HPV was 4 to 5 times more frequent at all age groups in selected, compared to healthy women. HPV infection decreased in healthy women with age but did not decrease in selected women. HPV positive-normal cytology decreased with age in both groups. Although HR-HPV detection decreased with age in healthy women, it doubled in selected women. In addition, more severe cytology was associated almost uniquely with selected women. HR-HPV detection and advanced cytology lesions correlated well and were mutually predictive. The overall sensitivity, specificity, positive and negative predictive values of HPV testing for squamous intraepithelial lesions were [85.5%], [90.95], [67.8%] and 96.5%, respectively. Based on these findings, we recommend implementing HPV screening as an adjunct to routine cervical cytology in selected Lebanese women older than 30 years of age

Frequency of the CCR5-delta 32 chemokine receptor gene mutation in the Lebanese population

A direct correlation between HIV infection and mutation in the chemokine receptor [CCR5] gene has been established. However, such correlation has never been investigated in Lebanon. We report the frequency of the CCR5-delta 32 mutation in a r and om sample of 209 healthy, HIV-1 seronegative Lebanese aged 19-68. Overall, 4.8% were heterozygous for the mutation. Homozygosity was absent from our sample. The frequency for the CCR5-delta 32 allele was 2.5%. Distribution of the mutation was unaffected by sex, age, religion or educational level. The frequency in the Lebanese population is consistent with that in the origin of the mutation in northern Europe. This could be attributed to a gene flow into the Middle East from northern Europe

Heterosexual awareness and practices among Lebanese male conscripts

To assess sexual behaviour and awareness about sexually transmitted infections [STIs] among young male adults in Lebanon, and to explore determinants associated with increasing levels of sexual risk, a cross-sectional survey of 730 conscripts was conducted. About 50% reported any lifetime heterosexual experience. Non-mutually exclusive sex predominated, and only half of the respondents reported consistent condom use during insertive vaginal sex. Higher sexual risk-taking was associated with urban residence, higher education, lower family crowding and younger age at first sexual experience. A national strategy with epidemiological and behavioural surveillance and educational programmes must be initiated before sexual risk-taking and incidence of STIs become a major public health issue