The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon.

BACKGROUND: The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. METHODS: This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. RESULTS: A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. CONCLUSIONS: The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.

Pilot assessment and survey of Syrian refugees' psychological stress and openness to referral for telepsychiatry (PASSPORT Study).

BACKGROUND: Given the scarcity of mental health resources available for refugees in areas of conflict, it is imperative to investigate interventions that would be accepted by the refugees. MATERIALS AND METHODS: In this study we surveyed 354 Syrian refugees using the HADStress screening tool and asked about their openness to referral to psychiatry and telepsychiatry. RESULTS: Of the surveyed sample, 41.8% had scores on HADStress that correlate to posttraumatic stress disorder. However, only 34% of the whole sample reported a perceived need to see a psychiatrist, and of those only 45% were open to telepsychiatry. CONCLUSIONS: Women, those who were bilingual, and those with positive HADStress status were less likely to accept telepsychiatry; however, this finding did not reach statistical significance. This study reports a partial acceptance of Syrian refugees for telepsychiatric services despite the high prevalence of psychological stress.

Occurrence of Fecal Coliforms and Enteropathogenic Escherichia coli (EEC) in Egyptian Soft Cheese.

One-hundred samples of Egyptian soft cheese (Damietta and Kareish) were examined for fecal coliforms and enteropathogenic Escherichia coli (EEC). Fecal coliforms and E. coli were more than 103/g in 2% and less than 10/g in 6% of the Damietta cheese samples. Fecal coliforms and E. coli existed in 84% of Kareish cheese samples with a level of contamination that ranged from 10-103/g. Fifteen of 46 E. coli strains isolated from Damietta and Kareish cheese were serotypes of EEC. They were serotyped as 0125/B15, 025/K11, 0128/B12, 0126/B16 and 0111/B4.

Growth and Survival of Yersinia enterocolitica in Yogurt.

Two lots of yogurt were prepared to contain two different strains of Yersinia enterocolitica (E675 serotype 0:3 and 2653 serotype 0:8) at an initial inoculum of 2 × 106 cells/ml, and then were refrigerated at 5±1°C for 7 d. Numbers of Y. enterocolitica , as well as pH value of yogurt were determined every 24 h. Y. enterocolitica survived until the end of the week at a population of 8,000 and 10,000 cells/ml for each strain, respectively. The pH value of yogurt decreased sharply from 6.3 to 4.5 by the end of preparation, and a low value of 4.2 was reached at the end of refrigerated storage.

Occurrence of Yersinia enterocolitica in Raw and Pasteurized Milk.

Raw milk (100 samples) and pasteurized milk (100 samples) were assayed for presence of Yersinia enterocolitica , using four different enrichment and post-enrichment techniques. Isolation of Y. enterocolitica was made on MacConkey agar and Cefsulodin-Irgasan-Novobiocin (CIN) agar directly from incubated broths containing the milk, and after treatment of enrichment broths with a potassium hydroxide solution. Twelve samples of raw milk and one of pasteurized milk contained Y. enterocolitica . Nearly all isolates were found after KOH treatment. All isolates except that obtained from the pasteurized milk sample produced detectable levels of heat-stable enterotoxin. However, none of the 13 isolates agglutinated in WA-SAA, an antiserum specific for virulent Y. enterocolitica .

Behavior of Virulent Yersinia enterocolitica During Manufacture and Storage of Colby-like Cheese.

The ability of Yersinia enterocolitica to grow and survive during manufacture and storage of Colby-like cheese was determined. Pasteurized whole milk artificially contaminated with two virulent strains of Y. enterocolitica (separately) was used to make cheese. Y. enterocolitica was enumerated by surface-plating of samples on Cefsulodin-Irgasan-Novobiocin (CIN) agar. Y. enterocolitica increased 1000-fold, to about 1 × 106/g of curd, during the manufacturing process. After this point, numbers of Y. enterocolitica in cheeses generally decreased over a period of weeks. One strain could not be detected in cheese after 7 weeks at 3 ± 1°C. However, the other strain persisted at numbers in excess of 200/g after 8 weeks at the same temperature.

Incidence of Bacillus cereus in Milk and Some Milk Products.

Four hundred samples of milk and milk products were obtained over a 5-month period from different retail outlets in Madison, Wisconsin, and were examined for presence and number of Bacillus cereus . B. cereus was isolated from 9,35, 14 and 48% of raw milk, pasteurized milk, Cheddar cheese and ice cream samples, respectively. No. B. cereus was recovered from yogurt. The level of contamination with B. cereus did not exceed 100/ml in raw milk, 1000/ml in pasteurized milk, 200/g in Cheddar cheese and 3800/g in ice cream.

Growth and Survival of Staphylococcus aureus in Egyptian Domiati Cheese.

Domiati cheese was prepared from unsalted raw milk and from raw milk with 5 or 10% added sodium chloride, Milks were inoculated with enterotoxigenic Staphylococcus aureus strain 100 (produces enterotoxin A) before addition of salt and rennet. Cheeses were stored in whey containing 15% sodium chloride; were held at 30°C and were examined periodically for S. aureus count, aerobic plate count, DNase and moisture and salt contents. Numbers of S. aureus increased rapidly during preparation of cheese. There was a rapid decrease in number of viable S. aureus during storage of cheese made from unsalted milk and cheese made from milk with 5% added salt. In cheese from milk with 10% added salt, S. aureus survived until the fourth week. An increase in salt content and a decrease in the pH value of all cheeses occurred during storage in salted whey. DNase was detected only in cheese made from salted milk, but these samples did not contain a detectable amount of staphylococcal enterotoxin either after cheeses were made or after they were stored for 1 week.

Growth and Enterotoxin Production by Staphylococcus aureus in Whey from the Manufacture of Domiati Cheese.

Staphylococcus aureus able to produce enterotoxin A was inoculated into Domiati cheese whey treated four different ways. Included were raw and pasteurized whey with 15% salt and unsalted raw and pasteurized whey. All wheys and their controls were kept at 30°C, and tested after 6, 12, 24, 48 and 72 h. There was a substantial loss in viability of S. aureus after 6 h of incubation in unsalted raw whey. Substantial loss of viability by S. aureus occurred in unsalted heat-treated whey after 24 h of incubation. S. aureus decreased in number slowly after 24 and 48 h of incubation in both salted raw and salted pasteurized whey. Thermonuclease and enterotoxin A were detected in unsalted heat-treated whey at and after 24 h when the number of S. aureus was 1.6 × 108/ml. Thermonuclease could not be detected after 6 h of incubation of unsalted or salted raw whey and after 48 h of incubation of salted whey.