Positive and negative correlates of suicidal ideations and behaviors in the emergency department of a university hospital in Beirut: A cross-sectional comparative study.

This study aims to identify the prevalence and correlates of current suicidal ideations and past suicidal behaviors among psychiatric emergencies. A cross-sectional comparative study was conducted using the Ask Suicide Screening Questions (ASQ) as a screening tool that targeted all patients presenting for a psychiatric emergency in a university hospital in Beirut during a four-month period. One hundred and three patients of all age groups have been divided into a group of patients with a positive suicidal screening (n=67, 65%), and another one with a negative suicidal screening (n=36, 35%). Suffering from a personality disorder was found to be a positive correlate of suicide screening (OR: 21.6, 95% CI: 2.6-179.0). Female gender (OR: 4.5, 95% CI: 1.6-13.2) and an elevated number of previous hospitalizations were found to be positive correlates of past suicidal attempts. These correlates should be assessed in the emergency room department (ER) to prevent any subsequent suicidal behavior.

Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic.

INTRODUCTION: Several studies have shown that COVID-19 pandemic has a negative impact on type 2 diabetic mellitus (T2DM) patients' quality of life (QoL). However, very few studies were performed in Middle Eastern countries. AIM: The aim of the current study was to assess, the QoL and diabetes-specific QoL, treatment satisfaction and psychological distress of Lebanese patients with T2DMs using: the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and Kessler 10 (K10) questionnaires and to compare results to those obtained during the pre-COVID-19 period. RESULTS: 461 patients with T2DM participated in the study; 52.6% men, 47.4% women; median age 59 years old. The respective median ADDQoL and DTSQs scores were - 2.2 (interval interquartile range (IQR) - 3.9, - 0.8) (range from - 9 maximum negative impact to + 3 maximum positive impact) and 30(IQR22-36) (range from 0 maximum dissatisfaction to 36 maximum satisfaction). K10 median score was 26(IQR18-35) (range from minimum score of 10 indicating no distress to maximum score of 50 indicating severe distress). Rural dwelling, lack of exercise, current smoking, diabetic complications, injectable diabetes treatment, and previous COVID-19 infection were all associated with significantly worse ADDQoL, DTSQs, and K10 score indicating greater distress. A significant worsening of ADDQoL scores followed onset of the pandemic with no significant change in DTSQs scores. CONCLUSION: During the COVID-19 pandemic, T2DM Lebanese patients experienced more negative impact of diabetes on QoL and mental health. Those infected with COVID-19 also reported worse QoL, treatment satisfaction and mental health. This highlights the need for community and individual support.

Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study.

PURPOSE: Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio). METHODS: Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively. RESULTS: NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (ß = 0.17; p = 0.027) contributed significantly to NLR variability. CONCLUSION: In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization. LEVEL OF EVIDENCE: III. Evidence obtained from well-designed cohort or case-control analytic studies.

Spirituality and the quality of life of cancer patients: An antidepressant effect.

OBJECTIVES: Cancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. METHODS: This is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hôtel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. RESULTS: Thirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. CONCLUSIONS: Our study is a pilot study which for the first time investigates the implication of depression in a "spirituality-quality of life" association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

Anxiety and sleep quality in a sample of Lebanese healthcare workers during the COVID-19 outbreak.

A cross-sectional, survey based study was conducted in order to assess mental health outcomes among healthcare workers in a private university hospital involved in the COVID-19 response in Lebanon. The main objective was to quantify symptoms of anxiety and sleep quality using self-rating scales (the State-Trait Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI) respectively), while identifying factors that might affect those symptoms. A total of 628 healthcare workers completed the survey; 409 (66.2%) were younger than 40 years, and 441 (71.4%) were women. Of all participants, 503 (81.4%) were nurses, 52 (8.4%) were physicians and 63 (10.2%) were residents. Registered nurses, residents, women, and younger participants presented higher scores on both scales than other categories of participants. Among factors related with COVID-19, those associated with higher scores were having relatives affected by the virus (22.2%), being excessively exposed to media (12.9%), and increasing the consumption of substances/alcohol (31.2%) during this period. Factors associated with higher risk of anxiety symptoms after multivariable logistic regression analysis were: female sex, young age, poor sleep quality, and living with elderly. Our findings contribute to the understanding of the psychological wellbeing of health care workers involved in the acute COVID-19 outbreak in Lebanon.

Morbidity of redo surgery for thyroid disease.

OBJECTIVE: Redo thyroid surgery is generally associated with more complications than firsthand surgery. The actual study reports a single center experience of redo thyroid surgery compared to primary bilateral thyroidectomy. STUDY DESIGN: Mono institutional retrospective study. METHODS: Institutional review of redo thyroid surgery patients (Group 2 : completion thyroidectomy and Group 3 : thyroidectomy for recurrent thyroid diseases) compared to Group 1 : primary bilateral thyroidectomy operated on during the same time interval. RESULTS: Demographic characteristics were not different between groups. Substernal extension and hyperthyroidism were more frequent in group 1. Weight of the resected thyroid gland was lower in groups 2 and 3. Incidence of transient hypocalcemia, permanent hypoparathyroidism, transient and permanent recurrent laryngeal palsy was not different between the groups. Hematoma occurred in 5% of cases in the 3 groups and postoperative length of stay was 1 day in 92% of cases of the 3 groups. CONCLUSIONS: Redo thyroid surgery can be performed with no excess morbidity provided strict selection criteria, having reoperation in mind while performing firsthand intervention.

Restless legs syndrome among multiple sclerosis patients in Lebanon.

BACKGROUND: Multiple sclerosis (MS) is often associated with fatigue, with an increased prevalence of sleep disorders compared to the general population, notably restless legs syndrome (RLS). The aim of this study was to evaluate the prevalence and severity of RLS as well the co-occurrence of spinal demyelination lesions in patients with MS in Lebanon. METHODS: In this cross-sectional study, we consulted the MS database of the Lebanese association against Multiple Sclerosis and sent out questionnaires to 300 MS patients to screen then confirm the presence of RLS. The final sample included 28 MS participants with confirmed RLS. We conducted further questionnaires to collect demographic data, screen for comorbidities, gather spinal MRI results, and evaluate the severity of both diseases (using the EDSS and the JHRLSS). RESULTS: Prevalence of RLS was 15% among MS patients in our study. 46.4% of RLS-affected MS patients had spinal cord demyelination lesions on their MRIs. Participants with MRI lesions had a lower severity score on the JHRLSS (p = 0.088). No association was found between the EDSS results and JHRLSS, demographic data, or comorbidities. CONCLUSION: Restless legs syndrome is commonly found among patients with multiple sclerosis in Lebanon, is underdiagnosed, and ought to be systematically evaluated for in order to improve the patients' quality of life.

Beneficial role of simvastatin in experimental autoimmune myositis.

OBJECTIVE: Statins have immunomodulatory potential in autoimmune diseases but had not been studied as a disease-modifying agent in inflammatory myopathies. The objective of this study is to assess the effect of simvastatin in an experimental model of autoimmune myositis in mice on muscle strength and histopathology. METHODS: Four groups of mice (n = 5 per group) were selected for experimentally induced myositis. Mice were immunized with 1.5 mg myosin in complete Freund's adjuvant weekly for two times and injected with 500 ng pertussis toxin twice immediately after each immunization. From day 1 before immunization to 10 days after the last immunization, mice were treated with oral simvastatin (10 or 20 or 40 mg/kg) diluted in DMSO. The control group mice were injected with complete Freund's adjuvant weekly for two times and did not receive treatment. Non-immunized mice (n = 5 per group) were treated either with simvastatin (5 mg/kg or 20 mg/kg or 40 mg/kg of simvastatin diluted in DMSO) or with DMSO. RESULTS: Inflammation was observed in myositis groups with positive myositis-specific antibodies. Muscle strength dropped significantly after immunization. Immunized simvastatin 20 mg/kg treated group had significantly higher muscle strength versus non-treated myositis mice and versus other simvastatin doses. Besides, a trend toward higher serum Th17 percentage population was found in immunized non-treated mice, versus immunized simvastatin- treated mice, without significant difference. CONCLUSION: Simvastatin at 20 mg/kg decreases the severity of myositis in experimental autoimmune myositis and is a candidate of being a disease-modifying agent in inflammatory myopathies.

Thyroidectomy in patients at high-risk of bleeding: can it be safely performed?

AIM: This study evaluated the safety of thyroid surgery in patients where anticoagulation was unavoidable or in patients with coagulopathy. METHODS: The records of all patients having high risk of bleeding at the time of thyroidectomy (July 2000 and March 2005) were retrospectively reviewed to evaluate intraoperative and postoperative bleeding. RESULTS: Ten patients were studied. Thyroid lobectomy with isthmusectomy (N=3) and bilateral thyroidectomy (N=7) were performed. Intraoperative surgical hemostasis was meticulous using ligasure vessel sealing system. Patients were divided in 3 groups. Group I (N=2) had small-vessel vasculitis, underwent thyroidectomy under full heparinization. Heparin therapy was continued until full anticoagulation by oral anticoagulants. Group II (N=2) had a documented congenital coagulation defect, had a pre and postoperative special protocols. Group III (N=6) underwent simultaneous thyroid and cardiac surgery (e.g.: intraoperative full heparinization and postoperative antiplatelet therapy in some cases). No extra-bleeding was noted on surgical reports. In the postoperative period, one patient developed a superficial small hematoma in the neck that resolved spontaneously. Transient unilateral laryngeal nerve palsy and transient hypocalcemia were seen in one and two patients respectively. CONCLUSIONS: Thyroidectomy in patients with coagulopathy is feasible with low risk of bleeding if meticulous hemostasis, particularly using ligasure vessel sealing system, is respected.

Intradialytic hypotension: beyond hemodynamics.

Intradialytic hypotension is a major complication during hemodialysis session, associated with increased risk of cardiovascular events and mortality. Its pathophysiology is believed to be multifactorial and remains not well elucidated. The aim of this study is to put forward new mechanisms behind the development of intradialytic hypotension. The study included sixty-five subjects on chronic hemodialysis, divided into two groups: intradialytic hypotensive (n=12) and normotensive (n=53), according to the variation of systolic blood pressure between post-dialysis and pre-dialysis measurements. Renin and angiotensin converting enzyme I plasma concentrations increased in both groups but more likely in normotensive group. Aldosterone plasma concentration is increased in the normotensive group while it decreased in the intradialytic hypotension group. Plasma endothelin concentrations showed higher values in intradialytic hypotension group. Post-dialysis asymmetric dimethylarginine and angiotensin converting enzyme 2 plasma concentrations were significantly higher in intradialytic hypotension group as compared to normotensive one. Collectrin plasma concentrations were significantly lower in intradialytic hypotension group. Finally, post-dialysis vascular endothelial growth factor C plasma concentration significantly increased in intradialytic hypotension group. In conclusion, endothelial dysfunction characterized by a lower level of vasoactive molecule seems to play a critical role in intradialytic hypotension development.

Comparison between dexmedetomidine and remifentanil for controlled hypotension during tympanoplasty.

BACKGROUND AND OBJECTIVE: Controlled hypotension is frequently used for obtaining better exposure during tympanoplasty. The aim of this study was to compare dexmedetomidine, a selective, short-acting, central alpha2-adrenergic agonist with remifentanil, an ultra-short-acting opioid with properties similar to other mu-specific agonists, regarding their effects in achieving controlled hypotension and improving surgical field exposure and surgeon's satisfaction during tympanoplasty. METHODS: In this prospective, double-blind pilot study, 24 consecutive patients scheduled for elective tympanoplasty were randomly assigned to receive either dexmedetomidine 1 microg kg(-1) over 10 min at anaesthesia induction followed by 0.4-0.8 microg kg(-1) h(-1) infusion during maintenance or remifentanil 1 microg kg(-1) over 1 min at anaesthesia induction followed by 0.2-0.4 microg kg(-1) min(-1) infusion during maintenance. Mean arterial pressure and heart rate were recorded before induction, at incision, 30, 60, 90 and 120 min after incision and 10 min after stopping the infusion. Surgical field exposure condition and satisfaction scores were assessed by the surgeon, blinded to the study drugs. RESULTS: Mean arterial pressure and heart rate were significantly lower in the remifentanil group compared with the dexmedetomidine group at all times (P = 0.03 and 0.036, respectively). Surgical field exposure condition (3 +/- 0.01 vs. 2.3 +/- 0.7; P = 0.039) and surgeons' satisfaction (3 +/- 0.01 vs. 2.25 +/- 0.87; P = 0.039) scores were significant after remifentanil compared with dexmedetomidine. CONCLUSIONS: Infusion of dexmedetomidine, at the doses used in this study, was less effective than remifentanil in achieving controlled hypotension, good surgical field exposure condition and surgeons' satisfaction during tympanoplasty.

[Predictive factors of long-term functional rehabilitation in thoracic outlet syndromes: 85 patients]. / Facteurs prédictifs des résultats à long terme de la rééducation fonctionnelle des syndromes de la traversée thoracobrachiale: à propos de 85 patients.

INTRODUCTION: Thoracic outlet syndromes are expressed by various clinical manifestations. Treatment is mainly rehabilitation. We aimed to identify factors predicting long-term functional rehabilitation in patients with this treatment and recurrence of symptoms. PATIENTS AND METHODS: We performed a descriptive retrospective analysis of 84 patients who underwent rehabilitation for thoracic outlet syndrome as defined by Revel and colleagues. Data collection involved a questionnaire exploring personal information, risk factors for developing thoracic outlet syndrome, clinical signs, and x-ray results. Long-term results of treatment were evaluated by telephone questionnaire. Data analysis involved use of Stata 6 software. RESULTS: Univariate analysis: predictive factors of negative results with treatment were ligament hypermobility, sensitive disturbances at the time of diagnosis, and a positive Adson's test result. Predictive factors of positive results were absence of paresthesia at the end of the treatment, and a negative "bell sign" at the end of the treatment. Predictive factors of nonrecurring symptoms were age younger than 34, bilateral positive Adson test result, and need for a supplementary number of sessions. MULTIVARIATE ANALYSIS: predictive factors of positive results with treatment were absence of sensitive impairment at the time of diagnosis, compliance with home exercises, initial negative Adson's test result, absence of hypermobility, and absence of paresthesia at the end of treatment. Predictive factors of recurring symptoms were age younger than 34, the need for a supplementary number of sessions and bilateral positive Adson's test result. CONCLUSION: A larger number of subjects are needed to further explore the predictive factors of rehabilitation and recurring symptoms in thoracic outlet syndrome for better validity and significance.

[Segmental variations of great saphenous vein diameters in a coronary triple vessel disease population]. / Variations des diamètres segmentaires des veines saphènes internes chez une population coronaire tritronculaire.

BACKGROUND: Great saphenous vein is one of the most used grafts in cardiovascular surgery. There is little amount of data in the medical literature describing dimensions of this vein. This series describes dimensions of the great saphenous vein in a coronary population and their variations. PATIENTS AND METHODS: Retrospective series of patients admitted to the cardiovascular surgery department of Hotel-Dieu de France Hospital - Beirut, between January 2003 and June 2006 for elective coronary artery bypass grafting and having a preoperative Doppler ultrasound of the saphenous veins according to a standardized protocol. Great saphenous vein dimensions were analyzed with regard to patients' characteristics using multivariable analysis of variance. RESULTS: Four hundred and two subjects were included with a mean age 64.4+/-9.3 years and a mean body mass index 27.9+/-4.5 kg/m(2). Women presented 22.6% of the series. Great saphenous vein dimensions' variations according to gender were significant (Multivariate Pillay trace=0.001) below the knee. Dimensions' variations were also significant as function of body mass index (P=0.001) and body surface (P=0.001). Age and cardiovascular risk factors did not influence GSV diameters. CONCLUSION: This series allowed constructing reference tables of the great saphenous vein segmental diameters in patients admitted for coronary artery surgery. Female sex is associated with lower segmental diameters below the knee and body mass index and body surface are linearly associated with segmental diameters at all levels.

[Prevention and treatment of atrial fibrillation after cardiac surgery]. / Prevention et traitement de la fibrillation atriale après chirurgie cardiaque.

The incidence of postoperative atrial fibrillation in cardiac surgery is still high despite major advances in anesthetic, pharmacological and surgical techniques. Its precise mechanism is still totally unknown. Postoperative atrial fibrillation increases length of stay as well as hospital costs. Rate of postoperative atrial fibrillation spontaneous conversion is high. Several protocols have been developed for prevention and/or treatment of postoperative atrial fibrillation. Beta-blockers, amiodarone and atrial pacing reduce.atrial fibrillation incidence as compared to placebo. On the other hand, amiodarone and propafenone achieve a high conversion rate of installed postoperative atrial fibrillation. However, among many pharmacological options, the best treatment is still to be defined.

[Parathyroid adenoma localized in the mediastinum. Case report and review of the literature]. / Adénome parathyroïdien de localisation médiastinale. Rapport d'un cas et revue de la littérature.

In the primary hyperparathyroidism the vast majority of enlarged parathyroid glands may be excised by cervicotomy. Rarely the excision of ectopic mediastinal parathyroid adenoma, not accessible by cervical incision, necessitates another approach for parathyroidectomy. We report herein the case of primary hyperparathyroidism due to mediastinal adenoma treated by sternotomy with review of the literature for different modalities of treatment for mediastinal localization.

Cervical neck dissection without drainage in papillary thyroid carcinoma.

OBJECTIVE: To review the safety of thyroidectomy combined with cervical neck dissection without drainage, in patients with papillary thyroid carcinoma. MATERIALS AND METHODS: Two groups were defined depending on whether cervical neck dissection was or was not performed (groups one and two, respectively). RESULTS: Group one included 153 patients with central neck dissection and 52 patients with central and lateral neck dissection. Group two included 121 patients. Post-operative drainage was not used in either group. Overall, 17 patients (5 per cent) developed post-operative haematoma and/or seroma: 12 patients (6 per cent) in group one and 5 patients (4 per cent) in group two. There were no major bleeding episodes; only minor bleeding or seroma was encountered, not requiring surgical intervention. Overall, 91 per cent of patients had a post-operative stay of 1 day. The number of peri-operative local complications and length of stay did not differ significantly between the two groups. CONCLUSION: Thyroidectomy plus cervical neck dissection without drainage is safe and effective in the treatment of papillary thyroid carcinoma.

[Validation of the Arabic Version of the Epworth Sleepiness Scale: Multicentre study]. / Validation de la version arabe de l'échelle de somnolence d'Epworth: étude multicentrique.

OBJECTIVES: The Epworth Sleepiness Scale (ESS) is a self-completion questionnaire developed in the English language and used for the evaluation of sleepiness. The objective of this study was to develop an Arabic version of ESS (AESS) and to investigate its reliability and the validity. METHODS: The AESS was created according to the recommendations of the ISPOR Task Force for Translation and Cultural Adaptation with bilingual individuals. It was applied to 91 patients referred to three sleep Lebanese centers for suspicion of sleep-related breathing diseases, and to 166 controls in good health. AESS scores of 60 patients were compared to 60 matched controls according to their age, sex and body mass index. Reproducibility was tested in 30 controls. The treatment response was tested among 15 patients after one month of CPAP treatment. RESULTS: Principal component analysis showed convergence towards only one latent factor. The AESS had a good internal consistency (Cronbach's alpha 0.76, intraclass correlation coefficient of 0.85 (IC95%: 0.76-0.92), Spearman 0.97, P<0.001). An increase in the severity of sleep apnea was accompanied by an increase in the score on the AESS (P<0.001). AESS scores improved significantly after CPAP. CONCLUSION: The AESS, a reliable and valid instrument for the evaluation of daytime sleepiness, is a valuable tool for clinical practice and multicenter research.

[Stenting or coronary artery bypass surgery for triple vessel disease?]. / Maladie coronaire tritronculaire : angioplastie/stent ou pontages aortocoronaires ? Etat actuel et revue de la littérature.

This review was undertaken to objectively analyse the cumulated medical literature on techniques of myocardial revascularization (angioplasty, bare metal stenting, drug eluting stenting, coronary artery surgery) in multivessel coronary artery disease. Randomized trials, meta analyses and registries comparing these treatment modalities show a short and long term advantage of surgery over percutaneous techniques for angina recurrence and need for repeat revascularization, although mortality and myocardial infarction rate do not seem statistically different. Diabetes mellitus, chronic renal failure and female gender represent high risk subgroups. Data on drug eluting stents are to date limited to the short term; however, it does not seem that drug eluting stents have resolved the need for repeat revascularization. Stenting addresses focal lesion whereas future revascularization occurs on other coronary sites by progression of coronary disease. Cardiologists should objectively inform the consenting coronary multivessel disease patient on the risk of repeat revascularization inherent to percutaneous techniques and on the weight of actual data favouring surgery in multivessel disease.