Characteristics of Hospitalized COVID-19 Patients at Admission and Factors Associated with Clinical Severity in Low- and Middle-Income Countries: An Observational Study.

Despite the numerous articles published on the clinical characteristics and outcomes of COVID-19 with regard to high-income countries, little is known about patients in low- and middle-income countries (LMIC) in this context. The objective of this observational, prospective, hospital-based multicentric study was to describe clinical features and outcomes of laboratory-confirmed COVID-19 patients hospitalized in each of the participating centers in Bangladesh, Guinea, Ivory Coast, Lebanon, Madagascar, and Mali during the first year of the pandemic (March 5, 2020 to May 4, 2021). The study outcome was the clinical severity of COVID-19, defined as hospitalization in intensive care unit or death. Multivariate logistic regression models were performed to identify independent variables associated with disease severity. Overall, 1,096 patients were included. The median age was 49.0 years, ranging from 38.0 in Mali to 63.0 years in Guinea. The overall clinical severity of COVID-19 was 12.3%, ranging from 6.4% in Mali to 18.8% in Guinea. In both groups of patients <60 and ≥60 years old, cardiovascular diseases (adjusted odds ratio [aOR]: 1.99; 95% CI: 1.13-3.50, P = 0.02; aOR: 2.47; 95% CI: 1.33-4.57, P = 0.004) were independently associated with clinical severity, whereas in patients <60 years, diabetes (aOR: 2.13; 95% CI: 1.11-4.10, P = 0.02) was also associated with clinical severity. Our findings suggest that COVID-19-related severity and death in LMICs are mainly driven by older age. However, the presence of chronic diseases can also increase the risk of severity especially in younger patients.

PRevalence of the Eosinophilic Phenotype Among SeveRE asthma patients in Lebanon: results of the PREPARE study.

BACKGROUND: The prevalence of eosinophilic asthma in Lebanon, one of the most severe phenotypes among severe asthma, is not known. This study aimed at determining the prevalence of the eosinophilic phenotype defined as an eosinophil count ≥ 300 cells/mm3 among severe asthma patients in Lebanon. METHODS: The Lebanese Chapter of the PREPARE study was a national, multicenter, cross-sectional observational study. Patients aged ≥ 12 years with severe asthma were identified and prospectively enrolled during clinic visits and completed the Global Initiative for Asthma (GINA) assessment of asthma control questionnaire. Patients' health characteristics were collected from medical records and blood samples were obtained for measurement of serum IgE levels and blood eosinophils count. RESULTS: Overall, 101 patients (with mean age of 46.3 ± 17.0 years and 73.27% females) with severe asthma were included and, among them, 37% had eosinophilic phenotype, 67.3% had atopic phenotype with IgE > 100 IU/mL and 25.7% patients had overlapping atopic and eosinophilic phenotypes. Close to 80% had late-onset asthma, beyond 12 years of age, and around 85% had at least one severe exacerbation in the 12 months prior to study enrolment. The majority of participants [64.4%] had uncontrolled asthma, 24.7% had partially controlled symptoms and 10.9% had controlled symptoms. 19.8% of participants were on chronic oral corticosteroids, 78.2% had short course treatment of corticosteroids and all were prescribed a combination of inhaled corticosteroids and long-acting beta-agonist. CONCLUSIONS: The majority of patients with severe asthma were uncontrolled of which 37% present with an eosinophilic phenotype, which should be taken into consideration for better management of these patients in view of the novel phenotype-specific therapeutic options.

Negativation of PD-L1 Postoperatively in Initially Inoperable Stage III Non-Small Cell Lung Cancer Treated with Pembrolizumab: Two Case Reports.

Stage III non-small cell lung cancer is a border line stage between localized and metastatic disease. PDL-1 is gaining an important role in the therapeutic arsenal of lung cancer, the most frequent cancer worldwide. We report for the first time a negativation of PDL-1 status in 2 cases of stage IIIA NSCLC with conversion to operable disease after using immunotherapy. The first patient was a 59-year old female diagnosed incidentally to have stage IIIA inoperable NSCLC that was treated with combination chemo-immunotherapy, and converted to operable disease with a negative PD-L1 in the postoperative setting. The second case is that of a 56-year old male that also had an inoperable stage IIIA NSCLC treated with chemotherapy first line followed by pembrolizumab at progression, then operated after surgical conversion, with negative PD-L1 postoperatively. In front of these findings, further work should be done to elucidate if the reverse of the PDL-1 status and the conversion to operability were due to the use of immunotherapy or to an incidental finding. If confirmed, it may have a therapeutic impact.

Shoshin Beriberi in Critically-Ill patients: case series.

Thiamine plays a fundamental role in cellular metabolism. The classical syndrome caused by thiamine deficiency is beriberi, and its fulminant variant, once considered an uncommon finding, is now encountered among the critically ill.We present a case series of four critically ill non-septic non-alcoholic patients with severe lactic acidosis and refractory cardio-circulatory collapse caused by acute fulminant beriberi, which drastically responded to thiamine administration.In critical care settings, increased awareness of this life-threatening but reversible condition is a requirement, especially among patients receiving parenteral nutrition and those with unexplained recalcitrant lactic acidosis.

Withholding and withdrawal of life-sustaining treatment in a Lebanese intensive care unit: a prospective observational study.

OBJECTIVE: To evaluate the implementation and process of withholding and withdrawing life-sustaining treatment in an intensive care unit. DESIGN AND SETTING: Prospective observational study in the medical intensive care unit of a university hospital in Lebanon. PATIENTS: Forty-five consecutive adult patients admitted to the ICU for a 1-year period and for whom a decision to withholding and withdrawal of life-sustaining treatment was made. MEASUREMENTS AND RESULTS: Patients were followed up until their death. Data regarding all aspects of the implementation and the process of withholding and withdrawal of life-sustaining treatment were recorded by a senior staff nurse. Withholding and withdrawing life-sustaining treatment was applied to 9.6% of all admitted patients to ICU. Therapies were withheld in 38% and were withdrawn in 7% of patients who died. Futility of care and poor quality of life were the two most important factors supporting these decisions. The nursing staff was not involved in 26% of the decisions to limit care. Families were not implicated in 21% of the cases. Decisions were not notified in the patients' medical record in 23% of the cases. Sixty-three percent of patients did not have a sedative or an analgesic to treat discomfort during end-of-life care. CONCLUSIONS: Life-sustaining treatment were frequently withheld or withdrawn from adult patients in the Lebanese ICU. Cultural differences and the lack of guidelines and official statements could explain the ethical limitations of the decision-making process recorded in this study.

[Inflammatory pseudotumors of the lung with spontaneous regression]. / Inflammations pulmonaires intraparenchymateuses pseudotumorales avec regression spontanée.

Inflammatory pseudotumors of the lung can be confusing in their presentation because they lack specific symptoms clinically and can easily be mistaken for malignancy on imaging studies. Their definite diagnosis requires pathologic analysis of tissue which is usually obtained only after surgical resection of the lesion. We report herein the case of a 65-year-old man who presented with recent onset of cough, shortness of breath and hemoptysis. CT scan of the chest showed several ill-defined suspicious densities in both lungs. CT guided needle core biopsy of one of the nodules showed changes consistent with inflammatory pseudotumor of the lung without any evidence of malignancy. The pulmonary lesions, which had rapidly progressed initially, resolved completely with simple clinical observation. The total regression of the "tumor nodules" in this case, without any treatment, illustrates a very unusual outcome of these pseudotumors.

Intrathoracic transverse colon and small bowel infarction in a patient with traumatic diaphragmatic hernia. Case report and review of the literature.

OBJECTIVE: Herniation of abdominal contents through the diaphragm has been described for a variety of diaphragmatic defects and may be secondary to diaphragmatic injury, either traumatic or iatrogenic. The sequelae of diaphragmatic hernia include intestinal obstruction, strangulation, gangrene and, eventually, perforation. The aim of this study was to report a case of intrathoracic infarction of transverse colon and two meters of small bowel in a patient with traumatic diaphragmatic hernia. PATIENT: Young man with past history of blunt abdominal trauma presented abdominal pain with dyspnea. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4.5 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the transverse colon and a proximal small bowel. The herniated transverse colon and jejunum were massively dilated with evidence of infarction. Transverse colectomy and resection of two meters of jejunum with direct anastomosis were performed. Following bowel removal, diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax. RESULTS: Postoperative course was uneventful and he recovered without complications. He was discharged from hospital 10 days after surgery. CONCLUSION: Surgeons, internists and emergency medicine personnel should be aware of the possibility of diaphragmatic hernia in patients with a known history of abdominal trauma. Though uncommon, strangulation of colon and small bowel through a rent in diaphragm should be considered when there is radiologic evidence of herniation.