ABSTRACT
Type 2 diabetes (T2D) is a global health problem accompanied by an elevated risk of complications, the most common being cardiac and renal diseases. In Lebanon, the prevalence of T2D is estimated at 8-13%. Local medical practice generally suffers from clinical inertia, with gaps in the yearly assessment of clinical manifestations and suboptimal screening for major complications. The joint statement presented here, endorsed by five Lebanese scientific medical societies, aims at providing physicians in Lebanon with a tool for early, effective, and comprehensive care of patients with T2D. Findings from major randomized clinical trials of antidiabetic medications with cardio-renal benefits are presented, together with recommendations from international medical societies. Optimal care should be multidisciplinary and should include a multifactorial risk assessment, lifestyle modifications, and a regular evaluation of risks, including the risks for cardiovascular (CV) and renal complications. With international guidelines supporting a shift in T2D management from glucose-lowering agents to disease-modifying drugs, the present statement recommends treatment initiation with metformin, followed by the addition of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists due to their CV and renal protection properties, whenever possible. In addition to the selection of the most appropriate pharmacological therapy, efforts should be made to provide continuous education to patients about their disease, with the aim to achieve a patient-centered approach and to foster self-management and adherence to the medical plan. Increasing the level of patient engagement is expected to be associated with favorable health outcomes. Finally, this statement recommends setting an achievable individualized management plan and conducting regular follow-ups to monitor the patients' glycemic status and assess their risks every 3-6 months.
ABSTRACT
Pneumococcal disease affects people across all ages but is more prevalent in young children and the elderly. Despite the availability of the pneumococcal vaccine for adults, the disease burden and mortality associated with it remains a challenge. A few studies conducted in Lebanon have reported epidemiology of pneumococcal disease, concurring the high burden among adults and older adults in the region. The pneumococcal vaccine is a part of the routine immunization schedule for children, but there are no recommendations for adult vaccination. A medical advisory board was hence conducted in September 2020 to discuss the burden of pneumococcal disease (PD) among adults in Lebanon. The participants were experts from the fields of internal medicine, family medicine, hematology, cardiology, oncology, endocrinology, pulmonology, and infectious diseases. The experts reached a consensus that there is a need to take steps to increase the rate of adult vaccination uptake and create awareness among physicians, pharmacists, caregivers, and patients. The physicians should be trained on adult immunization and should actively discuss the importance of the pneumococcal vaccine, especially with high-risk adult patients. Implementing adult vaccination as a routine practice and involving various stakeholders to address the gaps can help in reducing the burden of pneumococcal disease in adults.
ABSTRACT
BACKGROUND AND STUDY AIMS: Studies have shown that PPIs are frequently used in an inappropriate way, above the standard doses, and against the recommendations, leading to adverse events like malabsorption problems, community acquired pneumonia, hip fractures and Clostridium difficile colitis. In Lebanon only one study about the out-patient use of PPI was done in community pharmacies, but in-patient prescription studies are inexistent. Our study will evaluate the use of PPIs in a hospital setting in Lebanon and will compare it to international recommendations. PATIENTS AND METHODS: A cross-sectional study, conducted in a university hospital in Lebanon (CHU NDS) between June and November 2018, included 186 randomly selected Lebanese inpatient adults. RESULTS: Less than half of the participants (46.8%) received a PPI for the adequate indication and 83.9% received the adequate PPI molecule, whereas only 9.2% received the adequate dose. The rate of PPI misuse was higher in the surgery ward (59.6%) than in the medicine department (40.4%) (Cardiology, internal medicine, neurology, pneumology, nephrology, infectious diseases, gastro-enterology, rheumatology). Concerning age, 56.3% of the ≥ 65 years old patients were taking PPI for the right indication. However, among those who are < 65 years old, only 43.7% of the prescriptions were recommended. Also adequate PPI indication and adequate choice of drug was mainly noticed in patients having GI history or taking antiplatelet therapy. CONCLUSION: Our study has shown that a significant amount of PPIs was prescribed inadequately leading to a need to re-evaluate or adjust the use of PPIs among Lebanese physicians.
