ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire.

OBJECTIVE: Support for ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing; however, few studies include refugees or examine the clinical utility of PTSD/CPTSD classifications. This study sought to provide the first evaluations of (i) the factor structure of ICD-11 PTSD/CPTSD amongst refugees in the Middle East; and (ii) the clinical utility of the International Trauma Questionnaire (ITQ) to identify PTSD/CPTSD in a humanitarian context. METHOD: Participants were 112 treatment-seeking Syrian refugees living in Lebanon. Factorial validity was assessed using confirmatory factor analysis (CFA) based on responses to the ITQ. Clinical utility of the ITQ was assessed through semi-structured interviews with six Lebanese psychotherapists. RESULTS: Complex PTSD (36.1%) was more common than PTSD (25.2%), and no sex or age differences were observed at the prevalence or symptomatic levels. CFA results supported a two-factor higher-order model consistent with ICD-11 PTSD/CPTSD. Qualitative findings indicated that the ITQ is generally positively regarded, with some limitations and suggested modifications noted. CONCLUSION: This is the first study to support the ICD-11 PTSD/CPTSD amongst refugees in the Middle East and the clinical utility of the ITQ in a humanitarian context. Findings support the growing evidence for the cross-cultural applicability of ICD-11 PTSD/CPTSD.

Liquid index matching for 2D and 3D terahertz imaging.

Two-dimensional (2D) terahertz imaging and 3D visualization suffer from severe artifacts since an important part of the terahertz beam is reflected, diffracted, and refracted at each interface. These phenomena are due to refractive index mismatch and reflection in the case of non-orthogonal incidence. This paper proposes an experimental procedure that reduces these deleterious optical refraction effects for a cylinder and a prism made with polyethylene material. We inserted these samples in a low absorption liquid medium to match the sample index. We then replaced the surrounding air with a liquid with an optimized refractive index, with respect to the samples being studied. Using this approach we could more accurately recover the original sample shape by time-of-flight tomography.

Terahertz imaging and tomography as efficient instruments for testing polymer additive manufacturing objects.

Additive manufacturing (AM) technology is not only used to make 3D objects but also for rapid prototyping. In industry and laboratories, quality controls for these objects are necessary though difficult to implement compared to classical methods of fabrication because the layer-by-layer printing allows for very complex object manufacturing that is unachievable with standard tools. Furthermore, AM can induce unknown or unexpected defects. Consequently, we demonstrate terahertz (THz) imaging as an innovative method for 2D inspection of polymer materials. Moreover, THz tomography may be considered as an alternative to x-ray tomography and cheaper 3D imaging for routine control. This paper proposes an experimental study of 3D polymer objects obtained by additive manufacturing techniques. This approach allows us to characterize defects and to control dimensions by volumetric measurements on 3D data reconstructed by tomography.

Low-frequency noise effect on terahertz tomography using thermal detectors.

In this paper, the impact of low-frequency noise on terahertz-computed tomography (THz-CT) is analyzed for several measurement configurations and pyroelectric detectors. We acquire real noise data from a continuous millimeter-wave tomographic scanner in order to figure out its impact on reconstructed images. Second, noise characteristics are quantified according to two distinct acquisition methods by (i) extrapolating from experimental acquisitions a sinogram for different noise backgrounds and (ii) reconstructing the corresponding spatial distributions in a slice using a CT reconstruction algorithm. Then we describe the low-frequency noise fingerprint and its influence on reconstructed images. Thanks to the observations, we demonstrate that some experimental choices can dramatically affect the 3D rendering of reconstructions. Thus, we propose some experimental methodologies optimizing the resulting quality and accuracy of the 3D reconstructions, with respect to the low-frequency noise characteristics observed during acquisitions.

Ordered subsets convex algorithm for 3D terahertz transmission tomography.

We investigate in this paper a new reconstruction method in order to perform 3D Terahertz (THz) tomography using a continuous wave acquisition setup in transmission mode. This method is based on the Maximum Likelihood for TRansmission tomography (ML-TR) first developed for X-ray imaging. We optimize the Ordered Subsets Convex (OSC) implementation of the ML-TR by including the Gaussian propagation model of THz waves and take into account the intensity distributions of both blank calibration scan and dark-field measured on THz detectors. THz ML-TR reconstruction quality and accuracy are discussed and compared to other tomographic reconstructions.

Usability testing of a prototype Phone Oximeter with healthcare providers in high- and low-medical resource environments.

To increase the use of pulse oximetry by capitalise on the wide availability of mobile phones, we have designed, developed and evaluated a prototype pulse oximeter interfaced to a mobile phone. Usability of this Phone Oximeter was tested as part of a rapid prototyping process. Phase 1 of the study (20 subjects) was performed in Canada. Users performed 23 tasks, while thinking aloud. Time for completion of tasks and analysis of user response to a mobile phone usability questionnaire were used to evaluate usability. Five interface improvements were made to the prototype before evaluation in Phase 2 (15 subjects) in Uganda. The lack of previous pulse oximetry experience and mobile phone use increased median (IQR [range]) time taken to perform tasks from 219 (160-247 [118-274]) s in Phase 1 to 228 (151-501 [111-2661]) s in Phase 2. User feedback was positive and overall usability high (Phase 1--82%, Phase 2--78%).

Inflammatory myofibroblastic tumor of the mesentery associated with high fever and positive Widal test.

Inflammatory myofibroblastic tumor (IMT) is associated in 15-30% of cases with systemic symptomatology, such as prolonged fever, weight loss, elevated erythrocyte sedimentation rate (ESR), anemia, thrombocytosis, and leukocytosis. We report the case of a 4-year-old Lebanese boy who presented with high-grade fever of long duration, and a single (unpaired) positive Widal agglutination test. Blood culture was negative. A diagnosis of typhoid fever was made. An abdominal (mesenteric) IMT was incidentally discovered, 30 days after the fever had appeared. After surgery, the fever disappeared immediately, and the ESR returned to normal. We strongly favor the possibility of a false positive Widal test, due to polyclonal increase in serum immunoglobulins, which often occurs in IMT. We also think that IMT might be a mimicker of typhoid fever, both clinically and serologically. Physicians, especially pediatricians practicing in endemic areas, should probably be aware of this mimicry.

Are posttraumatic stress disorder (PTSD) and complex-PTSD distinguishable within a treatment-seeking sample of Syrian refugees living in Lebanon?

BACKGROUND: The World Health Organization will publish its 11th revision of the International Classification of Diseases (ICD-11) in 2018. The ICD-11 will include a refined model of posttraumatic stress disorder (PTSD) and a new diagnosis of complex PTSD (CPTSD). Whereas emerging data supports the validity of these proposals, the discriminant validity of PTSD and CPTSD have yet to be tested amongst a sample of refugees. METHODS: Treatment-seeking Syrian refugees (N = 110) living in Lebanon completed an Arabic version of the International Trauma Questionnaire; a measure specifically designed to capture the symptom content of ICD-11 PTSD and CPTSD. RESULTS: In total, 62.6% of the sample met the diagnostic criteria for PTSD or CPTSD. More refugees met the criteria for CPTSD (36.1%) than PTSD (25.2%) and no gender differences were observed. Latent class analysis results identified three distinct groups: (1) a PTSD class, (2) a CPTSD class and (3) a low symptom class. Class membership was significantly predicted by levels of functional impairment. CONCLUSION: Support for the discriminant validity of ICD-11 PTSD and CPTSD was observed for the first time within a sample of refugees. In support of the cross-cultural validity of the ICD-11 proposals, the prevalence of PTSD and CPTSD were similar to those observed in culturally distinct contexts.

Return to dialysis after renal allograft loss: is dialysis treatment initiated too late?

INTRODUCTION: Allograft failure is a common complication after renal transplantation. However, data describing the level of renal function and the clinical condition of patients returning to dialysis after graft failure are scarce. The purpose of this analysis was to retrospectively determine the stage of end-stage renal failure at dialysis initiation and the outcome during the first year of dialysis among patients who lost their grafts. METHODS: We analyzed deaths with a functioning graft and graft losses among patients transplanted in our center between January 1, 1994, and December 31, 2003. Weight, blood pressure, serum albumin, hemoglobin, phosphorus-calcium levels, and vascular access for dialysis were analyzed at the beginning (D(0)) and at 1 year after initiation of dialysis (M(12)). Creatinine clearance (CrCl), and hemoglobin were also studied at 3 months before beginning renal replacement therapy (M(-3)). RESULTS: Ninety-eight patients lost their grafts after a mean follow-up of 94 +/- 34 months; 37 died with a functioning graft and 61 returned to dialysis. Patient age was 62 +/- 10 years for the first group and 47 +/- 13 years for the second. At D(0), patients were hypertensive and anemic with a mean CrCl of 10 +/- 3 mL/min, suggesting that they were referred too late for dialysis. Surprisingly, at M(-3), CrCl was 19 +/- 7 mL/min and hemoglobin 10.6 +/- 3.6 g/dL. Four patients died during the first year of dialysis. CONCLUSIONS: Our data suggest that transplant patients returned to dialysis too late. CrCl and hemoglobin deteriorate rapidly during the 3 months preceding dialysis initiation.

Nasal fossae dimensions in the neonate and young infant: a computed tomographic scan study.

OBJECTIVE: To determine normal values in the size of nasal fossae to better delineate the concept of nasal stenosis in young infants with nasal obstruction and without choanal atresia. DESIGN: Case series. SETTING: Referral center. PATIENTS: Consecutive sample of 62 infants (aged 0 to 6 months) with no craniofacial anomalies who underwent conventional axial computed tomography scans for a neurologic disorder. INTERVENTION: From computer-stored images, the slices taken at the level of the nasal fossae floor and those just above were examined. The length and 10 measurements of the width of the nasal fossae were used to determine normal values. RESULTS: Most measurements, even the length of the nasal fossae, were positively correlated to the age of the patient (R = .44). In the age 0 to 2 months group, the median length was 29.35 mm (range, 21.3-40.4 mm). It was 31.5 mm in the age 4 to 6 months group (range, 25.3-36.9 mm). The anterior bony aperture seems to be the most accurate distance for the assessment of neonatal nasal fossae stenosis. Its median width was 13.5 mm (range, 8.8-17.2 mm). Large variations characterized the dimensions of the middle nasal fossae and the choanae: median values were 7.6 mm (range, 4.9-13.5 mm) and 14.3 mm (range, 10.8-19.0 mm), respectively. CONCLUSIONS: This study defined the normal range of variation for the main dimensions of the nasal fossae in the horizontal plane. These can be used as a basis for determining nasal stenosis in cases of neonatal obstruction.

Obliterative otosclerosis.

From January 1990 to December 1996, 293 primary stapedectomies for otosclerosis were performed, among which 14 had obliterative otosclerosis (4.7 per cent). Probability of bilateral obliterative disease was 50 per cent. With this particular condition, a drill-out procedure was used to perform either a stapedectomy or a stapedotomy. In two patients with bilateral 'far-advanced otosclerosis', surgery was effective in enabling the patient to benefit from hearing-aids. In patients with a measurable hearing-loss, an air-bone gap closure to within 10 dB was achieved in 62.5 per cent of the cases and to within 10-20 dB in 37.5 per cent of the cases, with no deterioration of air-conduction thresholds at 8 kHz. A mild sensorineural hearing loss at 4 kHz was observed in 25 per cent of the cases. There was no statistical difference between stapedectomy and stapedotomy. According to these results, the drill-out technique is a safe and effective procedure in cases of obliterative otosclerosis.

[Variations and incidents encountered during stapes surgery for otosclerosis]. / Variantes et incidents per-opératoires observés au cours de la chirurgie de l'otospongiose.

The aim of this study was to report peroperative variations and incidents encountered during stapes surgery for otosclerosis, from a retrospective series of 293 primary stapedectomies performed in the ENT department of Fondation Adolphe de Rothschild, from january 1990 to december 1996. Pitfalls related to anomalous states or pathological conditions were observed in 81 cases (27.6%) and were classified as follow: narrow oval window niche (12.3%), floating footplate (5.8%), obliterative otosclerosis (4.7%), ossicular chain problems (3.4%), loss of perilymph and/or intravestibular bleeding (2.4%), fixed malleus (1%). Hearing results following surgery are presented. Because of the relatively high incidence of these unforeseen events, the otologic surgeon must be well trained and experienced to be able to use all reasonable stapedectomy or stapedotomy techniques.

Helicobacter pylori infection, gastritis, and the temperature of choice for hot drinks.

BACKGROUND: The role of the temperature of the diet as a potential etiological factor for gastritis or peptic ulcer disease has been postulated since the beginning of the century. Animal studies have demonstrated damage to gastric mucosa caused by hot water at 60 to 80 degrees C. In the pre-Helicobacter pylori era it was reported that the majority of ulcer patients preferred hot drinks. It also was reported that the temperature of choice for drinks increased with severity of histological grade of gastritis. We evaluated the association between the preferred temperature of hot drinks and the presence of H. pylori infection. METHODS: We tested the temperature of choice for hot drinking liquids among 12 H. pylori-negative and 43 H. pylori-positive volunteers. We also compared the effect of H. pylori therapy on hot drink temperature preference and, in 32 individuals, whether there was a relation between temperature and the degree of gastric atrophy. RESULTS: There was no difference in the preferred temperature for hot drinks between those volunteers with and without H. pylori infection (63.4 degrees +/- 6 degrees C compared to 61.3 degrees +/- 7 degrees C, respectively) (mean +/- 1 SD, p = .3). There was no change in preferred temperature after successful therapy of the H. pylori infection compared to unsuccessful H. pylori therapy, nor was there a correlation between the preferred temperature and the presence, absence, or degree of gastric atrophy (r2 < 0.001). CONCLUSION: The temperature of preference for hot drinks was not influenced by H. pylori infection or by the presence of atrophic gastritis.