Effectiveness of a two-stage strategy using the 16-item Prodromal Questionnaire (PQ16/fPQ16) and the Comprehensive Assessment of At Risk Mental States (CAARMS) in the early detection of Ultra High Risk (UHR) patients in Lebanon: a cross-sectional pilot study.

OBJECTIVES: This study aims to identify the prevalence of Ultra High Risk (UHR) adults in a sample of patients in Lebanon and to compare screening and diagnostic tools. METHODS: This is a cross-sectional pilot study which targeted patients aged 17-30 years willingly seeking psychiatric care in a university hospital in Beirut, Lebanon. Participants were invited to fill either the English or the French version of the Prodromal Questionnaire (respectively, PQ16 or fPQ16). The abbreviated version of the "Comprehensive Assessment of At-Risk Mental States" (CAARMS) was then administered to all participants. The latter were subsequently sorted into one of the three UHR groups - vulnerability group, attenuated psychosis (APS), intermittent psychosis (BLIPS) - or were diagnosed as suffering from a psychotic disorder. RESULTS: Thirty-one patients participated in this study. The prevalence of positive screening on the PQ16/fPQ16 and positive diagnosis of UHR on the CAARMS were respectively of 61.29% and 45%. The APS group was the most prevalent (71.42%). A positive psychosis screening on PQ16/fPQ16 was statistically related to a UHR diagnosis on CAARMS (p-value: 0.011 on Chi2 test), OR=8.5 (95% CI: 1.4-50.9; p-value: 0.018). No relation was found between PQ16/fPQ16 results and risk stratification or between the number of "True" responses on PQ16/fPQ16 and the intensity of symptoms on CAARMS. PQ16/fPQ16 statements 5, 9, 11 and 16 predicted a UHR diagnosis on CAARMS (p-value of 0.045, 0.006, 0.045 and 0.045, respectively). CONCLUSION: This two-stage strategy for identifying UHR patients can be adopted in a tertiary health care center.

A comprehensive review on the role of testosterone on the neurobehavioral systems implicated in the reinforcement sensitivity theory of personality.

OBJECTIVES: The Reinforcement Sensitivity Theory (RST) is a neuropsychological theory of personality emphasizing approach and avoidance as the two core behavioral aspects. Approach is represented by the behavioral approach system (BAS). Avoidance is represented by the behavioral inhibition system (BIS) and the fight-flight-freeze system (FFFS). Although the influence of testosterone on human behavior has been demonstrated, few studies have investigated the relation between testosterone and the RST. The aim of this narrative review was to decipher the possible role of testosterone on the biological systems involved in the RST in humans. METHODS: Google scholar, PubMed, PsycARTICLES, PsycINFO, Scopus and Cochrane library databases were interrogated using keywords such as testosterone, BIS, BAS, FFFS, personality, reinforcement sensitivity theory. RESULTS: Seven original articles, published between 2009 and 2022, assessing the relation between testosterone and the systems implicated in the RST, were included. The results of these studies suggested the presence of a possible positive relation between testosterone and the BAS. However, the impact of testosterone on the BIS and/or FFFS seems to be less clear. DISCUSSION: The consistency in the results supporting the presence of a positive relation between testosterone and the BAS might lead to the consideration of testosterone as a potential correlate in the clinical assessment of several psychopathologies. The inconsistency in the conclusions regarding the impact of testosterone on the BIS and/or the FFFS might be attributed to the different questionnaires used as measurement tools. Additional research remains needed.

First data on latent tuberculosis infection in Syrian refugees with diabetes in Lebanon.

OBJECTIVE: The association between diabetes mellitus and tuberculosis is a health-threatening double trouble. Vulnerable populations such as refugees and conflict-displaced populations may be at higher risk of both diseases. Here, we examined the prevalence of latent tuberculosis infection (LTBI) and its associated risk factors in a population of Syrian refugees with diabetes in North Lebanon. STUDY DESIGN: This is a cross-sectional study. METHODS: A total of 87 Syrian refugees with diabetes were enrolled. Demographic and clinical data were collected using a structured questionnaire, and a blood sample was obtained from each patient. LTBI was examined using the last generation QuantiFERON-TB Gold Plus assay. RESULTS: The mean age of the study population was 54.1 ± 10.5 years, and the majority were women (79.3%). LTBI was found in 1 in 5 (17/87; 19.5%) enrolled patients, with the majority being originated from Aleppo (47.05%). Infection was significantly associated only with age (P = 0.009), and its risk was 4-fold higher in patients aged ≥60 years (odds ratio: 4.1, confidence interval: 1.4-12.5, P = 0.018). CONCLUSION: This study highlights the need to implement effective tuberculosis control strategies among refugees with diabetes, with particular attention to those at older age.

Cryopreservation media differentially affect sperm motility, morphology and DNA integrity.

INTRODUCTION: Human sperm freezing is very widely used for male fertility preservation. This procedure consists in adding cryoprotectants to the spermatozoa followed by cooling and storing the spermatozoa at a subzero temperature. Many standardized cryopreservation media are available on the market. However, these media differ in their chemical composition and there are no sufficient data to optimize their classification. Therefore, the aim of this study was to compare five commercially available sperm cryopreservation media, which have not been compared together, in terms of motility, morphology and DNA integrity. MATERIALS AND METHODS: One-hundred semen samples were obtained from 10 fertile participants and 90 infertile men. Each sample was evaluated before freezing for motility, morphology and DNA fragmentation index (DFI). Then, it was equally divided into five aliquots. Each aliquot was cryopreserved using one of the five media (A, B, C, D, and E). The same parameters were re-evaluated after the addition of the cryopreservation media in the fertile group, and after sperm thawing in fertile and infertile groups. RESULTS: The results showed that the five selected cryopreservation media had negative effects on sperm motility and morphology per se. In the infertile group, the cryosurvival factor was significantly lower in cryomedium A when compared to the four other media (p < 0.001). In addition, a significantly higher percentage of sperm with coiled tail was detected in cryomedium E compared to cryomedium A (p < 0.05) and to cryomedium B (p < 0.001) after thawing, in the infertile group. Furthermore, the sperm DFI was significantly higher in cryomedia A (p < 0.001), B (p < 0.001), C (p < 0.01), D (p < 0.01) and E (p < 0.05) compared to that of the fresh semen derived from infertile participants. CONCLUSION: This study indicates that the recovery rate of competent spermatozoa, after cryopreservation, is still critical in infertile men. Therefore, frozen semen sample should be used only when necessary.

[Equinovarus of the foot in adults treated with tibiocalcaneal arthrodesis. Review of 18 cases]. / Pied varus équin de l'adulte traité par arthrodèse tibiocalcanéenne. Revue de 18 cas.

The authors have retrospectively studied 18 cases of tibiocalcaneal arthrodesis performed to treat a fixed equinovarus deformity of the foot in 13 adult patients. The operations were performed between 1981 and 1998; there were 9 neurologic and 9 post-traumatic deformities. The mean calcaneal varus deformity was 50 degrees and the mean equinus deformity was 75 degrees. The results were evaluated using Kitaoka's criteria. We noted one postoperative cutaneous necrosis, two nonunions, one of which was reoperated by bone freshening and osteotomy of the midfoot. All rearfeet were in neutral alignment and were stable. Shortening was on average 2.8 cm. Plantar support was achieved in 10 feet, with improved autonomy, walking capacity and footwear. Overall, there were 10 good, 2 fair and 1 poor result. In the group with neurologic deformities there were 4 good, 1 fair and 1 poor result. In the group with post-traumatic deformities, there were 6 good and one fair results. Other series published also showed satisfactory results comparable to or better than those obtained with triple arthrodesis, which generates severe stiffness of the rear- and midfoot, disturbing gait. Fixed equinovarus deformity of the foot in the adult is a good indication for tibiocalcaneal arthrodesis, allowing in the majority of cases to achieve stable and painless plantar support.

[Anterior tarsectomy for cavus foot. Retrospective study of 52 cases]. / Tarsectomie antérieure pour pied creux essentiel. Etude rétrospective de 52 cas.

The authors reviewed 34 patients treated by tarsectomy for idiopathic pes cavus deformity between 1977 and 1996. Fifty two feet were treated surgically. All patients had undergone previous conservative treatment. The average age was 40 years. Podoscopic examination revealed 24 cavus feet stage 2, 28 cavus feet stage 3, adduction of the forefoot in 15 cases and an equinus deformity in 8 cases. On radiographic examination, Djian-Annonier's angle was 108 degrees on average. All patients were evaluated with a minimum ot two years follow-up, according to the evaluation system of the Massachusetts General Hospital. With an average follow-up of six years and six months, overall results were; 65.5% very good and good, 21% fair, 13.5% poor. The morphological correction was poor in 9 cases. Djian-Annonier's angle was 125 degrees on average. A number of cavus feet do not justify surgical treatment, because they are well tolerated, sometimes with orthopedic orthoses. Tarsectomy must be avoided in neurological conditions. We do not advise release of soft tissue or Dwyer's calcaneal osteotomy. In our opinion, the choice indication for anterior tarsectomy is the nonrigid cavus foot. It must be combined with lengthening of the Achilles tendon when a deficit of dorsiflexion of the foot persists following tarsectomy. According to their importance, associated deformations will be treated in the same operative session or not.

[Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases]. / L'ostéotomie cervico-capitale de Weil dans les métatarsalgies médianes. Etude de 70 cas.

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.

[Ankle instability with involvement of the subtalar joint demonstrated by MRI. Results with the Castaing procedure in 45 cases]. / Instabilité de cheville avec lésion de l'articulation sous-talienne démontrée par l'IRM. Résultats de l'intervention de Castaing dans une série de 46 cas.

The authors report 46 cases of instability of the hindfoot involving the subtalar joint, with or without combined involvement of the tibiotalar ligaments, which were treated using Castaing's technique of ligament plasty between 1988 and 1999. Preoperatively, the patients complained of instability, recurrent sprains and pain. A tarsal sinus syndrome was present in 39%. Forty six patients underwent NMR examination which demonstrated capsuloligamentous lesions in every case. The results were evaluated using Kitaoka's score. With an average follow-up of 5.7 years after operation, instability was no more present in 80% and 63% were painfree. Clinical examination showed a reduction in the range of inversion of the hindfoot in 43%, with values between 50 and 70% of the contralateral foot, but without any significant clinical repercussion. Incipient osteoarthritis was noted on xrays in three patients. The overall results were very good in 82%, fair in 11% and poor in 7%. Eighty seven percent of the patients were satisfied with the result of the operation. The authors found a significant correlation between fair or poor results and a body mass index above 26 kg/m2 or constitutional laxity. Besides, results got worse as the time interval between the first sprain and the operative treatment increased. Comparison of these results with those of other techniques shows that they are essentially similar. Ligament plasty using Castaing's technique is a reliable operation but direct repair of ruptured ligaments at the subtalar joint should be preferred for primary treatment, leaving the possibility for secondary ligament plasty if necessary.

Visual search in the real world: evidence for the formation of distractor representations.

Visual search in the real world often requires that we search the same environment a number of times for different targets. What is the fate of information about fixated distractor objects during these searches? Here, participants searched the same array of real objects on a tabletop twice for two different targets successively whilst wearing a head-mounted eye-tracker. We found that fixating an object when it was a distractor in the first search facilitated search for that same object when it became the target in the second search. The results suggest that the location and identity of fixated distractor objects are represented to a level that guides subsequent searches, even when this information is not required at the time of fixation.