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Introduction and hypothesisThe objective was to assess the prevalence of symptoms of overactive bladder syndrome (OAB) among healthy nulliparous female university students, and to evaluate the correlation of these symptoms with a variety of factors, including waterpipe (WP) smoking.MethodsThis is a cross-sectional study. A questionnaire was administered to evaluate symptoms of OAB in healthy nulliparous female university students. Variables assessed included body mass index (BMI), cigarette smoking, WP smoking, consumption of alcohol, coffee, and tea with and without artificial sweeteners, soft drinks, and energy drinks. Adjusted odds ratio were calculated to determine the correlation of these variables with OAB symptoms.ResultsA total of 767 out of 2,900 females responded to the questionnaire. Bothersome frequency was reported in 32.3%, and nocturia in 47.5% of the women. Urgency and urgency urinary incontinence (UUI) were present in 25.5 and 24.7% of the study participants respectively. Urgency was associated with WP smoking (p value 0.048). Bothersome frequency was associated with artificial sweeteners used with coffee and tea (p value 0.013). UUI was associated with cigarette smoking (p value 0.034) and elevated BMI (p value < 0.001). OAB symptoms were not found to be significantly associated with soft drink and energy drink consumption. A lower prevalence of nocturia (p value 0.009) and urgency was associated with alcohol consumption (p value 0.017). More than two-thirds (69.2%) of WP smokers expressed readiness to decrease WP smoking if this would improve their lower urinary tract symptoms (LUTS).ConclusionOveractive bladder is common in healthy young nulliparous women and is associated with multiple risk factors, including WP smoking.

Introduction and hypothesisMicroscopic hematuria (MH) in women is a common incidental finding that can trigger morbid and costly investigation. Identifying non-pathologic etiologies of MH may help limit unnecessary investigation. Our study aimed to determine whether pelvic examination (PE) increases the prevalence of MH in women.MethodsBetween May 2018 and October 2018, 157 women > 18 years of age and presenting to the Obstetrics and Gynecology private clinics at a tertiary care center were approached and asked to provide two urine samples: one before PE and one after. Samples were then analyzed to asses for the presence of MH. The McNemar test was used to evaluate whether the conversion from no MH to MH could be attributed to PE rather than to chance. An associated p < 0.05 was determined to be significant. Chi-square test was used to determine whether this conversion is influenced by age and menopausal status.ResultsThirteen women (8.3%) had MH before PE. Of 144 participants with no initial MH, 22 (15.3%) had MH after PE. PE was significantly correlated with the conversion from no MH to MH (p = 0.002). The conversion from no MH to MH following PE was not correlated with age (p = 0.451) or menopausal status (p = 0.411).ConclusionsPE performed within an hour before urinalysis was found to be a risk factor for MH in women.

The COVID-19 pandemic, which emerged in early 2020, has had a profound and lasting impact on global health, resulting in over 7.0 million deaths and persistent challenges. In addition to acute concerns, there is growing attention being given to the long COVID health consequences for survivors of COVID-19 with documented cases of cardiovascular abnormalities, liver disturbances, lung complications, kidney issues, and noticeable cognitive deficits. Recent studies have investigated the physiological changes in various organs following prolonged exposure to murine hepatitis virus-1 (MHV-1), a coronavirus, in mouse models. One significant finding relates to the effects on the gastrointestinal tract, an area previously understudied regarding the long-lasting effects of COVID-19. This research sheds light on important observations in the intestines during both the acute and the prolonged phases following MHV-1 infection, which parallel specific changes seen in humans after exposure to SARS-CoV-2. Our study investigates the histopathological alterations in the small intestine following MHV-1 infection in murine models, revealing significant changes reminiscent of inflammatory bowel disease (IBD), celiac disease. Notable findings include mucosal inflammation, lymphoid hyperplasia, goblet cell hyperplasia, and immune cell infiltration, mirroring pathological features observed in IBD. Additionally, MHV-1 infection induces villous atrophy, altered epithelial integrity, and inflammatory responses akin to celiac disease and IBD. SPIKENET (SPK) treatment effectively mitigates intestinal damage caused by MHV-1 infection, restoring tissue architecture and ameliorating inflammatory responses. Furthermore, investigation into long COVID reveals intricate inflammatory profiles, highlighting the potential of SPK to modulate intestinal responses and restore tissue homeostasis. Understanding these histopathological alterations provides valuable insights into the pathogenesis of COVID-induced gastrointestinal complications and informs the development of targeted therapeutic strategies.

The COVID-19 pandemic has been one of the most impactful events in our lifetime, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Multiple SARS-CoV-2 variants were reported globally, and a wide range of symptoms existed. Individuals who contract COVID-19 continue to suffer for a long time, known as long COVID or post-acute sequelae of COVID-19 (PASC). While COVID-19 vaccines were widely deployed, both unvaccinated and vaccinated individuals experienced long-term complications. To date, there are no treatments to eradicate long COVID. We recently conceived a new approach to treat COVID in which a 15-amino-acid synthetic peptide (SPIKENET, SPK) is targeted to the ACE2 receptor binding domain of SARS-CoV-2, which prevents the virus from attaching to the host. We also found that SPK precludes the binding of spike glycoproteins with the receptor carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) of a coronavirus, murine hepatitis virus-1 (MHV-1), and with all SARS-CoV-2 variants. Further, SPK reversed the development of severe inflammation, oxidative stress, tissue edema, and animal death post-MHV-1 infection in mice. SPK also protects against multiple organ damage in acute and long-term post-MHV-1 infection. Our findings collectively suggest a potential therapeutic benefit of SPK for treating COVID-19.

Glucagon-like peptide 1 (GLP-1), a hormone derived from the proglucagon gene, regulates various physiological processes; however, its impact on pregnancy outcomes remains poorly understood. Assessing the effects of GLP-1 on neonates is vital as GLP-1 is increasingly administered during pregnancy. This study evaluates the effect of GLP-1 exposure on maternal complications and neonatal defects in mice. Pregnant female A/J mice received subcutaneous injections of recombinant GLP-1 (rGLP-1; 1000 nmol/kg) on embryonic day 1 (EP, early pregnancy) or day 15 (E15, late pregnancy). Maternal and neonatal body weights, morphology, and mortality were recorded, and mRNA sequencing was conducted to analyze gene expression in neonatal tissues. Maternal body weight decreased following rGLP-1 exposure, and pups born to both the early and late exposure groups experienced significant weight loss. Pups in the late exposure group exhibited uniform skin detachment and a dramatically higher mortality rate than those born to the early exposure group. Further, RT-PCR analysis confirms the significantly increased expression of selected genes in the skin and associated pathogenesis. RNA sequencing of pups’ skin, brain, lung, and liver tissues from the late exposure group showed altered gene expression. Since maternal weight loss, increased neonatal mortality, and altered gene expression have been observed, GLP-1 receptor agonists (GLP-1RAs) should be avoided during pregnancy.

Studies around the world have shown that interactions between pharmaceutical companies, pharmacists and physicians have a great influence on prescribing and drug dispensing practices. In middle-income countries, the nature and extent of these interactions have not been well researched. Our objectives were to qualitatively explore the nature of the interactions between pharmaceutical companies, physicians and pharmacists, their impact on drug prescription and dispensing practices in Lebanon. We used grounded theory approach as well as the known sponsor, purposive, and snowballing sampling strategies to identify interviewees from the three respective groups: physicians, pharmacists, and pharmaceutical representatives. We conducted semi-structured and analyzed transcripts thematically. This study encompassed 6 pharmaceutical representatives, 13 physicians and 13 pharmacists. The following themes emerged: purpose and driver for the interactions, nature of the interactions, incentives, impact on prescription practices, ethical considerations, and suggestions for managing the interactions. The main purposes for the interaction were educational, promotional, and monitoring prescription practices and dispensing, while the main drivers for these interactions were market potential and neighborhood socio-economic status. Physicians, pharmacists and pharmaceutical representatives who engage in these interactions benefit from a variety of incentives, some of which were characterized as unethical. It appears that pharmaceutical companies give prominence to selected physicians within their communities. Although members of the three interviewed groups refer to some of the interactions as being problematic, they described a culture of acceptance of gift giving. We developed a framework that depicts the prevailing politico-cultural environment, the interactions between the three professional groups, and their impact on drug prescription. Underreporting is the main limitation of this study. Interactions between physicians, pharmacists and pharmaceutical representatives are frequent. Although these interactions can be beneficial, they still have a substantial effect on drug prescription and dispensing practices. Hence, the need for new policies that regulate these interactions and penalize any misconduct.

Advances in assisted reproductive technologies have enabled postmenopausal women to achieve pregnancy beyond their reproductive lifespan. Although rare, these pregnancies are challenging and require a multidisciplinary approach due to the higher prevalence of medical comorbidities in this population. The placenta accreta spectrum is characterized by an abnormal invasion of chorionic villi into the myometrium. Risk factors associated with the placenta accreta spectrum include prior uterine surgeries, advanced maternal age, multiparity, in vitro fertilization, and placenta previa. We present a case of a 59-year-old postmenopausal woman with chronic hypertension, stage II chronic kidney injury, and superimposed pre-eclampsia who underwent cesarean delivery complicated by suspected focal placenta accreta. Histopathological examination revealed significant deviations from normative placental architecture, emphasizing the invasion of the villi. Further, congested blood vessels and the presence of inflammatory cells, along with heightened collagen deposition, suggest an underlying pathological process affecting placental health. These findings underscore a perturbation of placental homeostasis, emphasizing the necessity for further investigation into the mechanisms contributing to placental pathology in postmenopausal pregnancies.

Background/Objectives: Endocrine disruptors are ubiquitous agents in the environment and are present in everyday consumer products. These agents can interfere with the endocrine system, and subsequently the reproductive system, especially in pregnancy. An increasing number of studies have been conducted to discover and describe the health effects of these agents on humans, including pregnant women, their fetuses, and the placenta. This review discusses prenatal exposure to various endocrine disruptors, focusing on bisphenols, phthalates, organophosphates, and perfluoroalkyl substances, and their effects on pregnancy and fetal development. Methods: We reviewed the literature via the PubMed and EBSCO databases and included the most relevant studies. Results: Our findings revealed that several negative health outcomes were linked to endocrine disruptors. However, despite the seriousness of this topic and the abundance of research on these agents, it remains challenging to draw strong conclusions about their effects from the available studies. This does not allow for strong, universal guidelines and might result in poor patient counseling and heterogeneous approaches to regulating endocrine disruptors. Conclusions: The seriousness of this matter calls for urgent efforts, and more studies are needed in this realm, to protect pregnant patients, and ultimately, in the long term, society.

In this dissertation, we present advances in turbulence modeling for magnetically confined plasmas. We investigate the ecology of microscopic drift wave turbulence and the self-generated macroscopic flows in magnetically confined plasmas. We formulate reduced models that self-consistently describe the evolution of turbulence and mean plasma profiles (including flows) and recover trends obtained from the CSDX device and HL-2A tokamak. The dissertation is divided to three parts. The first part presents a reduced model that describes the interplay between drift wave turbulence and zonal and axial flows in the adiabatic plasma of CSDX, where the electron response is Boltzmann. The model explains how free energy released from the density gradient accelerates both axial and azimuthal flows in CSDX. A description of the interactions between the disparate scales of the plasma via the parallel and perpendicular Reynolds stresses ⟨v˜xv˜z⟩ and ⟨v˜xv˜y⟩ is presented. Expressions for these stresses are decomposed into a diffusive component that relaxes the flow profile, and a residual stress responsible for accelerating the corresponding flow. Moreover, parallel and perpendicular flow dynamics are described using an extended mixing length approach. This accounts for the degree of symmetry breaking in the parallel direction and parametrizes the efficiency of ▿n in driving the axial flow. In the second part of the dissertation, the relationship between drift waves and zonal flows is examined in depth via a more specific model. Analytical results obtained from this model confirm the published experimental data showing a suppression of turbulence with the increase in magnitude of the magnetic field B. A new criterion for access to enhanced confinement is introduced. This criterion captured by the dimensionless quantity RDT, compares the production rate of turbulent enstrophy due to relaxation of the mean profiles, to the corresponding destruction rate via coupling to the mean flow. When RDT >1, the profiles steepen and enhanced confinement is accessible. In the third paper, a novel idea for understanding the physics of the density limit problem in low β tokamaks is presented. The collapse of the zonal shear flow when the electron response transitions from Boltzmann to hydrodynamic scaling, along with cooling of the edge and the onset of MHD activity is predicted by the observation that the zonal flow drive will drop as the electron parallel diffusion time increases with density. This leads to a simple, verified understanding of the density limit phenomenon in L-modes.

The use of polluted water to irrigate is an increasing problem in the developing world. Lebanon is a case in point, with heavily polluted irrigation waters, particularly in the Litani River Basin. This study evaluated the potential health risks of irrigating vegetables (radishes, parsley, onions, and lettuce) using three water sources (groundwater, river water, and treated wastewater) and three irrigation methods (drip, sprinkler, and surface) over two growing seasons in 2019 and 2020. Water, crop, and soil samples were analyzed for physicochemical parameters, pathogens, and metals (Cu, Cd, Ni, Cr, and Zn). In addition, the bioaccumulation factor, estimated dietary intakes, health risk index, and target hazard quotients were calculated to assess the health risk associated with metal contamination. The study showed that, for water with less than 2 log E. coli CFU/100 mL, no pathogens (Escherichia coli, salmonella, parasite eggs) were detected in irrigated vegetables, irrespective of the irrigation method. With over 2 log E. coli CFU/100 mL in the water, 8.33% of the sprinkler-and surface-irrigated vegetables, and 2.78% of the drip-irrigated root crops (radishes and onions), showed some degree of parasitic contamination. E. coli appeared only on root crops when irrigated with water having over 3 log CFU/100 mL. The concentrations of most metals were significantly lower than the safe limits of the FAO/WHO of the Food Standards Programme Codex, except for zinc and chromium. The trends in the bioaccumulation factor and the estimated dietary intakes of metals were in the order of Cu < Cd < Ni < Cr < Zn. The target hazard quotient values for all metals were lower than 1.0. Under trial conditions, the adoption of drip irrigation with water with less than 3 log E. coli CFU/100 mL proved to be safe, even for vegetables consumed raw, except for root crops such as onions and radishes that should not be irrigated with water having over 2 log E. coli CFU/100 mL. Treated wastewater had no adverse effect on vegetable quality compared to vegetables irrigated with other water sources. These results support efforts to update the Lebanese standards for water reuse in agriculture; standards proposed in 2011 by the FAO, and currently being reviewed by the Lebanese Institution of Standards. This research will inform a sustainable water management policy aimed at protecting the Litani River watershed by monitoring water quality.