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Purpose Prostate cancer care in the Middle East is highly variable and access to specialist multidisciplinary management is limited. Academic tertiary referral centers offer cutting-edge diagnosis and treatment; however, in many parts of the region, patients are managed by non-specialists with limited resources. Due to many factors including lack of awareness and lack of prostate-specific antigen (PSA) screening, a high percentage of men present with locally advanced and metastatic prostate cancer at diagnosis. The aim of these recommendations is to assist clinicians in managing patients with different levels of access to diagnostic and treatment modalities. Methods The first Advanced Prostate Cancer Consensus Conference (APCCC) satellite meeting for the Middle East was held in Beirut, Lebanon, November 2017. During this meeting a consortium of urologists, medical oncologists, radiation oncologist and imaging specialists practicing in Lebanon, Syria, Iraq, Kuwait and Saudi Arabia voted on a selection of consensus questions. An additional workshop to formulate resource-stratified consensus recommendations was held in March 2019. Results Variations in practice based on available resources have been proposed to form resource-stratified recommendations for imaging at diagnosis, initial management of localized prostate cancer requiring therapy, treatment of castration-sensitive/ naïve advanced prostate cancer and treatment of castration-resistant prostate cancer. Conclusion This is the first regional consensus on prostate cancer management from the Middle East. The following recommendations will be useful to urologists and oncologists practicing in all areas with limited access to specialist multidisciplinary teams, diagnostic modalities and treatment resources.

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Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a transition state between normal cognition and Alzheimer’s disease. Primary care physicians play an important role in its early diagnosis and identification of patients most likely to progress to Alzheimer’s disease while offering evidenced-based interventions that may reverse or halt the progression to further cognitive impairment. The aim of this review is to introduce the concept of MCI in primary care through a case-based clinical review. We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.

Connaissances, attitudes et comportements des étudiants en médecine en matière de consommation de substances psychoactives au Liban : étude transversaleRÉSUMÉ La présente étude vise à explorer les connaissances, les attitudes et les comportements des étudiants en médecine libanais en matière de consommation de substances psychoactives, ainsi qu'à déterminer leur prévalence et les prédicteurs psychosociaux. Une étude transversale auprès de 231 étudiants en médecine (48,6 % de sexe masculin ; 53,1 % en études précliniques, 46,9 % en études cliniques) a été conduite de juin 2012 à juillet 2013. Le questionnaire abordait les connaissances et les attitudes en matière de consommation de substances, la religiosité, la dépression, l'anxiété et les caractéristiques démographiques. Le score des connaissances était de 52,7 % (ET = 14,4 %), et était significativement moins élevé en deuxième qu'en troisième et quatrième années (48,53 % contre 57,51 % et 57,4 %, p < 0,05 ABSTRACT The study aims were to explore the knowledge, attitudes and behaviours of Lebanese medical students related to substance use and to determine prevalence and psychosocial predictors. A cross-sectional survey of 231 medical students (48.6% male; 53.1% preclinical, 46.9% clinical) was conducted during June 2012-July 2013. The questionnaire addressed knowledge and attitudes about substance use, religiosity, depression, anxiety and demographic characteristics. The knowledge score was 52.7% (standard deviation 14.4%), and was significantly lower in 2nd year students (48.53%) than in 3rd and 4th year students (57.5% and 57.4%) (P < 0.05). Students reported more training in drug abuse than alcohol abuse (38.2% vs. 34.4%). One-fourth reported smoking, 57.7% using alcohol and 46.8% using drugs. Significant predictors of lower substance use included intrinsic religiosity and interest in working in the field. The findings reveal inadequate knowledge and considerable substance use in Lebanese medical students. Therefore, training in substance use and counseling of students are necessary.