Assessing the Lebanese population for their knowledge, attitudes and practices of antibiotic usage

Antibiotic-resistant bacteria has become a global phenomenon, mainly due to the inappropriate use of antibiotics. There are no studies in Lebanon to assess the public's knowledge, attitudes and practices [KAP] of antibiotic usage. A cross-sectional study was carried out using a self-administered questionnaire completed by a random convenience sample of 500 people. Nearly half of the respondents [46.1%] demonstrated moderate knowledge levels, while 40.6% demonstrated moderate attitudes. Although 80.2% knew that antibiotics are anti-bacterial, 73.5% did not know that antibiotics are not anti-viral. Moreover, 68.3% of respondents reported consuming antibiotics 1-3 times per year, while 22.4% consumed antibiotics on their own accord. Approximately 66.7% realized that abusing antibiotics could lead to resistance. Participant knowledge and attitudes were significantly associated with monthly family income, educational level, place of residency, having medical insurance, working in the health sector or having a relative working in the health sector. Nation-wide awareness campaigns targeting susceptible demographics should be initiated

High vacuum phacoemulsification technique in cataract surgery

Phacoemulsification offers the advantage of cataract removal through a small wound which decreases the surgical complications and enhances rehabilitation. In phacoemulsification corneal endotlielial loss was correlated to duration of ultrasound power used. The longer the duration, the greater is the loss . Increasing the power carries the risk of increasing the insult. While decreasing the power causes less effective cutting power and more stress on capsule and zonules. Vacuum is one of the tools that can be used in phacoemulsification. It can be used as a holding power at probe port for efficient cutting. It also, aspirates soft materials and therefore reduces the need for ultrasound power. To evaluate the use of high vacuum while performing phacoemulsification and to correlate the ultrasonic power needed in relation to the vacuum level. Forty patients with 40 cataractous eyes were enrolled in this study. Their ages ranged between 53 to 65 years with a mean of 59 +/- 6.5 years. Patients were divided into two groups each containing 20 patients [eyes]. Group I underwent phacoemulsification cataract extraction with posterior chamber [PC] foldable acrylic lens using the highest possible vacuum and accordingly lowest possible ultrasound power. Group II underwent traditional phacoemulsification cataract extraction with posterior chamber [PC] foldable acrylic lens. In both groups phacoemulsification was performed in-situ using stop and chop technique. The viscoelastic substance that had been used was sodium hyalurinate [Healon]. Central corneal ultrasound pachymetry was done for all patients preoperatively. Postoperatively; patients were examined weekly in the first postoperative month then after second and third month where central corneal pachymetry was done in each visit. These pachymetric values were used as a sensitive indicator of corneal endothelial physiology. The ultrasound powers and times used in emulsification were recorded during surgeries to correlate them to the vacuum. Postoperatively; the corneal thickness had been increased in all patients due to corneal edema. This corneal edema continued to improve during the 3 months follow up period. The corneal edema postoperatively was less in group I than in group II. With the high vacuum; the ultrasound power needed was less that that needed with traditional vacuum levels. The ultrasound energy [Power x Time] was inversely proportional to the vacuum used. From our study we can conclude that using the highest possible vacuum while doing phacoemulsification is a good tool that allows the use of lower ultrasound power. This lower ultrasonic power is safer for the corneal endothelium. Thus; the final visual outcome of the phacoemulsification cataract surgery can be refined

Strategies for myocardial protection during cardiopulmonary by-pass in congenital cyanotic heart disease guided by troponin I

Forty cyanotic infants with age ranging from six to 24 months and body weights ranged from six to 11 kg were included in this study and the surgical correction of their congenital cardiac problems was done under cardiopulmonary bypass. The selected cases were divided into four equal groups according to the concentration of KCl added to the blood cardioplegia and the intravenous administration of aprotinin. In group A, 30 mEq KCl/L was added to the blood cardioplegic solution. In group B, 40 mEq KCl/L was added to the blood cardioplegic solution. In group C, together with blood cardioplegia as group A, the patients received intravenous high dose regimen of aprotinin. In group D, the patients received the same intravenous regimen of aprotinin as group C, but with blood cardioplegia as group B. The serum level of cardiac troponin I [cTnI] was assessed as an index of myocardial injury simultaneously with serum sodium, potassium and calcium. These variables were measured in different periods of the study, starting from period I [baseline value, before induction of anesthesia] and ending by period VII [after the transfer to intensive care unit]. The total dosage of inotropic supporters [adrenaline and dopamine], vasodilators [sodium nitroprusside] and myocardial behavior were monitored in all studied cases. The study concluded that the intravenous administration of the high dose regimen of aprotinin with the addition of 40 mEq/L KCl to the blood cardioplegic solution was one of the best strategies for myocardial protection during cardiopulmonary bypass in cyanotic infants