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.

Oxford-AstraZeneca COVID-19 vaccine: need of a reasoned and effective vaccine campaign.

OBJECTIVES: A strong COVID-19 vaccine campaign is needed to reach the herd immunity and reduce this pandemic infection. STUDY DESIGN: In the Foch Hospital, France, in February 2021, 451 healthcare workers were vaccinated by a first dose of AstraZeneca vaccine. METHODS: Adverse effects were reported to our pharmaco-vigilance circuit, by an online and anonymous questionnaire following the first weeks of the vaccinal campaign to healthcare workers. RESULTS: Two hundred seventy-four (60.8%) of them reported multiple adverse effects. Main adverse effects reported were feverish state/chills (65.7%), fatigue/physical discomfort (62.4%), arthralgia/muscle pain (61.0%) and fever (44.5%). CONCLUSIONS: On March 2021 many European countries suspended AstraZeneca vaccine for one week due to safety uncertainty. Thus, confidence in its efficacy is undermined. However, the benefit/risk balance is clearly in favor of vaccination.

Are two consecutive negative RT-PCR results enough to rule out COVID-19?

The coronavirus disease 2019 (COVID-19) pandemic is redefining the world we live in, and scientists are struggling to find the best severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tool. Routine testing is currently performed using real-time reverse transcription PCR (RT-PCR) of upper or lower respiratory tract secretions. We sought to demonstrate the importance of conducting RT-PCR using deep sampling when initial upper respiratory testing is negative in cases of high index of suspicion for COVID-19. We present the case of a 47-year-old man admitted for fever and bilateral pneumonia diagnosed via chest computed tomographic scan amidst the early peak of the COVID-19 pandemic, suggesting a SARS-CoV-2 infection. Two RT-PCR results from nasopharyngeal swab samples were negative. A bronchoscopy was then performed, and RT-PCR testing on bronchoalveolar lavage samples yielded positive results, confirming the diagnosis of COVID-19 pneumonia. RT-PCR samples of the lower respiratory tract likely contain a higher virus load and thus retain a higher sensitivity for SARS-CoV-2 detection.

Intravesical Bacillus Calmette-Guérin (BCG) treatment's severe complications: A single institution review of incidence, presentation and treatment outcome.

OBJECTIVES: Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette-Guérin (BCG) following an intravesical instillation for bladder tumor encountered at our institution for the past 5 years. METHODS: Medical records of a tertiary teaching hospital, located in Beirut, Lebanon, were retrospectively analyzed from June 2014 to June 2019 searching for severe related complications of BCG. A comprehensive review of articles on this subject was conducted. RESULTS: The incidence of severe systemic adverse events related to BCG instillation was 1.5% (5 out of 332 patients). A total of five patients were found to have a severe BCG related complication, with fever, chills, and irritative urinary signs being the most frequent symptoms. All patients received antituberculosis therapy (Isoniazid, Rifampin and Ethambutol). Two were put on add-on corticosteroids. Three patients had a computed tomography scan image in favor of an infection. Two patients had a favorable outcome, three patients died. CONCLUSION: BCG severe adverse events were mostly seen in patients with a traumatic instillation. Treatment used at our institution was similar to most cases reported in the literature. A standardized diagnostic and treatment approach should be implemented to help physicians tackle these life-threatening complications.

Streptococcus G leading to septic abortion and multiple organ failure.

The authors report a patient admitted at 12 weeks of pregnancy with an acute infectious syndrome, leading to abortion, sepsis, and multiple organ failure. Admission to intensive care unit (ICU) was needed after curettage for incomplete abortion complicated by uterine atony, hemorrhage, and septic shock. The patient had multiple organ failure and required non-invasive ventilation. Hemoculture showed streptococcus G bacteremia. She had no evidence of concurrent infection, mainly genital or urinary, except amygdalitis few days before. Hematogenous spread to the gestational sac could have possibly been the cause of her sepsis. Streptococcus G infection during pregnancy can lead to severe consequences.

Cutaneous granular bacteriosis, a rarely diagnosed infection of the head and the neck.

A young man presented with a large multilobulated and mutilating tumour of the scalp, which had been relapsing for years. Histological examination of a biopsy from the lesion revealed chronic inflammation with granulation tissue and presence of granules with eosinophilic periphery, which was positive for Gram, Grocott and periodic-acid-Schiff stains. A large excision was performed. Cultures grew Staphylococcus aureus. The patient was treated with penicillin G, but 4 weeks after the start of treatment, new small nodules appeared over the same area. All these new nodules disappeared within 2 weeks the addition of clindamycin and cotrimoxazole. This triple antibiotic treatment was carried on for 18 months, and the patient remained disease-free after a follow-up of 4 years. Although the lesions were clinically and histologically suggestive of actinomycosis, culture revealed that they were caused by a completely different organism. We suggest grouping such lesions under a single term "granular bacteriosis" and combining surgery with broad-spectrum antibiotics covering Actinomyces species and botryomycosis-causing organisms (mainly Staphylococcus).

[Brucellar meningitis complicated by aneurysmal subarachnoid hemorrhage]. / Méningite brucellienne compliquée d'hémorragie méningée par rupture d'anévrisme: rapport d'un cas et revue de la littérature.

INTRODUCTION: Brucellosis is a rare disease in which neurological complications, and more particularly, intracranial aneurysmal hemorrhages were rarely reported. CASE REPORT: A brucellar meningitis was diagnosed in a 29-year-old man, who had been suffering from an unusual headache for about two months. Three days after beginning treatment, the patient developed an intracranial right frontal hemorrhage that led to the discovery of a ruptured anterior communicating artery aneurysm. The aneurysm was clipped surgically and doxycycline and rifampin were given for three months. The outcome was excellent. DISCUSSION AND CONCLUSION: Clinical manifestations of brucellosis are variable. Neurovascular complications are rare and probably linked to delay in diagnosis of CNS invasion or inadequate initial treatment. Appropriate and prompt medical, and if necessary, surgical management can lead to excellent outcome.

[Acute respiratory distress syndrome complicating Ebstein-Barr virus pneumonia]. / SDRA par pneumonie à EBV.

INTRODUCTION: In the immuno-competent adult Ebstein-Barr virus (EBV) infection is a self-limiting disease that resolves spontaneously. CASE REPORT: We report a case of acute respiratory distress syndrome (ARDS) complicating severe EBV pneumonia and requiring prolonged artificial ventilation. The diagnosis was confirmed by specific serology and estimation of the viral load by PCR. Apart from supportive treatment with artificial ventilation the medical treatment included the use of Acyclovir and polyclonal immunoglobulins in the early phase and corticosteroids in the late phase. Recovery was progressive and complete. CONCLUSION: ARDS can complicate EBV pneumonia in an immuno-competent subject. Its management represents a diagnostic and therapeutic challenge.

Detection of fastidious bacteria in cardiac valves in cases of blood culture negative endocarditis.

The diagnosis of blood culture negative endocarditis is still a problem. Fastidious bacteria such as bartonella and coxiella are responsible for cases of blood culture negative endocarditis, the identification of which is mainly based on serological and DNA studies only available in specialised centres. Therefore, a routine technique is needed in surgical pathology laboratories to detect these bacteria in cardiac valve tissue sections. This report describes a staining technique, the Gimenez stain, feasible and sensitive in detecting bartonella and coxiella in two cases of blood culture negative endocarditis.

[Stenotrophomonas maltophilia endocarditis following mitral valve prosthesis implantation. Report of a case]. / Endocardite à Stenotrophomonas maltophilia après plastie mitrale. A propos d'un cas.

The authors report the first case of early postoperative endocarditis after mitral valvuloplasty due to Stenotrophomonas Maltophilia, a Gram negative organism, in a 37 year old man with no special risk factors. Pyrexia and mitral valve vegetations were the main features, and, in the absence of complications or of embolism, the patient was treated initially with triple antibiotherapy (ceftazidime, amikacine, ciprofloxacine). Relapse two weeks after withdrawal of treatment due to two variants of Stenotrophomas Maltophilia, one of which was resistant to ciprofloxacine, and the presence of a large vegetation, required repeat mitral valvuloplasty and a change in antibiotic therapy (ticarcilline with clavulanic acid, trimethoprim sulphamethoxazole, colistine). This time, the outcome was good. The little known Stenotrophomonas Maltophilia infectious endocarditis is a serious complication and, in the absence of standardised management, the authors suggest that, in view of the multi-resistant character of the organism and in the light of this case, surgery should be considered in association with prolonged antibiotic therapy.