Cultural assimilation of adult Syrian refugees in Lebanon: Effect modification by religiosity and sex on the relation between cultural adversities and common mental health disorders.

OBJECTIVE: In this study, we aimed to explore the prevalence and determinants of common mental health disorders (CMHDs, posttraumatic stress disorder [PTSD], depression, and anxiety) in Syrian refugees in Lebanon. Specifically, we examined how the associations between cultural adversities (discrimination, unemployment, and separation from family) and CMHDs are modified by levels of religiosity and sex. METHOD: Between March and June 2017, a cross-sectional study was conducted targeting adult Arab Syrian refugees residing in Beirut and Southern Lebanon. Eligibility criteria comprised being a United Nations High Commissioner for Refugees-registered Syrian refugee residing in Lebanon, 18 years and older, and having no history of mental disorder or physical disability. A total of 191 refugees agreed to participate and complete a battery of six questionnaires. Exposures were measured using a sociodemographic questionnaire, the Postmigration Living Difficulties Checklist, the Harvard Trauma Questionnaire, and the Belief into Action Scale, while outcomes were measured using the Posttraumatic Stress Disorder Checklist for DSM-5 and the Depression and Anxiety Scale-21 Items. RESULTS: Half (50.3%) of our sample had high PTSD risk, 73.8% had high depression risk, and 73.8% had high anxiety risk. Stratified analysis revealed religiosity and sex to be effect modifiers of the associations between cultural adversities and CMHDs. Specifically, cultural adversities were only significantly associated with CMHDs in the low religiosity stratum and males. Only unemployment was a significant risk factor for PTSD in both males (OR = 4.53, 95% CI [1.44, 14.27]) and females (OR = 2.77, 95% CI [1.14, 6.74]). CONCLUSIONS: Religiosity and sex are effect modifiers of the associations between cultural adversities and CMHDs. Religious and spiritual interventions in mental health care should be adopted in refugee settings. Moreover, there is an urgent need for capacity-building initiatives addressing social determinants of mental health among Syrian refugees in Lebanon. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effect of macrocyclic ionic and non-ionic gadolinium agents on neuronal injury and myelin loss in the spinal cords of rats with and without diabetes mellitus.

BACKGROUND: The effect of gadolinium-based contrast agents (GBCA) on the spinal cord is not established, especially in patients with diabetes mellitus. PURPOSE: To investigate neuronal and myelin loss in the spinal cord when employing macrocyclic ionic Gadoterate Meglumine (Gd-DOTA) and non-ionic Gadobuterol (Gd-BT-DO3A) GBCA in rats with and without diabetes mellitus. MATERIALS AND METHODS: This study was performed between November 2018 and February 2020. Sixty young Sprague Dawley white rats (n = 6/group) were given injections of two macrocyclic GBCA: 0.5 mmol/ml Gd-DOTA and 1 mmol/ml Gd-BT-DO3A, using volumes based of the recommended doses (0.1 ml and 0.2 ml) for 42 days in both healthy and diabetic rats. Control groups received saline injections. Morphological assessment of spinal cord tissues was performed on three spinal segments. Neuronal counts in the ventral horns and myelin sparing percentage in the white matter were determined and compared in each group employing one-way ANOVA and Dunnett test for each category followed by three-way factorial analysis. RESULTS: Low neuronal count and myelin percentage-area were obtained in groups receiving 0.2 ml Gd-DOTA (p = .001;p = .002;p < .001 neurons; and p < .001;p = .007;p = .001 myelin %) and Gd-BT-DO3A (p = .01;p = .048;p = .006 neurons; p < .001;p = .01;p = .001 myelin %). Similarly, neuronal loss was seen in diabetics receiving low volume-injection (0.1 ml) of Gd-DOTA (p = .04;p = .03;p = .42), Gd-BT-DO3A (p = .002;p = .007;p = .01); or high volume-injection (0.2 ml) of Gd-DOTA (p = .001;p = .003;p = .01) or Gd-BT-DO3A (p < .001,p = .002;p = .002), with associated decrease in myelin sparing for each category with low dose Gd-DOTA (p < .001, p = .001; p. = 09),Gd-BT-DO3A (p = .003;p = .003;p = .007); or the higher dose counterparts of Gd-DOTA (p < .001; p < .00; p = .001) and Gd-BT-DO3A (p < .001, p < .001, p < .001). Damage was observed using the standard dose (equivalent of 0.1 mmol/kg for rats) of Gd-DOTA (0.2 ml) but not that of Gd-BT-DO3A (0.1 ml) in healthy rats. CONCLUSION: Multiple high-volume injections of gadoterate meglumine and gadobuterol are associated with neuronal and myelin injury in the spinal cord, more so in rats with diabetes mellitus.

Changes in Pulmonary Vascular Resistance and Obstruction Score Following Acute Pulmonary Embolism in Pigs.

OBJECTIVES: To investigate the contribution of mechanical obstruction and pulmonary vasoconstriction to pulmonary vascular resistance (PVR) in acute pulmonary embolism (PE) in pigs. DESIGN: Controlled, animal study. SETTING: Tertiary university hospital, animal research laboratory. SUBJECTS: Female Danish slaughter pigs (n = 12, ~60 kg). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PE was induced by infusion of autologous blood clots in pigs. CT pulmonary angiograms were performed at baseline, after PE (first experimental day [PEd0]) and the following 2 days (second experimental day [PEd1] and third experimental day [PEd2]), and clot burden quantified by a modified Qanadli Obstruction Score. Hemodynamics were evaluated with left and right heart catheterization and systemic invasive pressures each day before, under, and after treatment with the pulmonary vasodilators sildenafil (0.1 mg/kg) and oxygen (Fio2 40%). PE increased PVR (baseline vs. PEd0: 178 ± 54 vs. 526 ± 160 dynes; p < 0.0001) and obstruction score (baseline vs. PEd0: 0% vs. 45% ± 13%; p < 0.0001). PVR decreased toward baseline at day 1 (baseline vs. PEd1: 178 ± 54 vs. 219 ± 48; p = 0.16) and day 2 (baseline vs. PEd2: 178 ± 54 vs. 201 ± 50; p = 0.51). Obstruction score decreased only slightly at day 1 (PEd0 vs. PEd1: 45% ± 12% vs. 43% ± 14%; p = 0.04) and remained elevated throughout the study (PEd1 vs. PEd2: 43% ± 14% vs. 42% ± 17%; p = 0.74). Sildenafil and oxygen in combination decreased PVR at day 0 (-284 ± 154 dynes; p = 0.0064) but had no effects at day 1 (-8 ± 27 dynes; p = 0.4827) or day 2 (-18 ± 32 dynes; p = 0.0923). CONCLUSIONS: Pulmonary vasoconstriction, and not mechanical obstruction, was the predominant cause of increased PVR in acute PE in pigs. PVR rapidly declined over the first 2 days after onset despite a persistent mechanical obstruction of the pulmonary circulation from emboli. The findings suggest that treatment with pulmonary vasodilators might only be effective in the acute phase of PE thereby limiting the window for such therapy.

Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead.

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.

Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study.

PURPOSE: Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS: The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS: In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS: There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.

Low Contrast Volume Protocol in Routine Chest CT Amid the Global Contrast Shortage: A Single Institution Experience.

OBJECTIVE: To assess the effectiveness of low contrast volume (LCV) chest CT performed with multiple contrast agents on multivendor CT with varying scanning techniques. METHODS: The study included 361 patients (65 ± 15 years; M: F 173:188) who underwent LCV chest CT on one of the six 64-256 detector-row CT scanners using single-energy (SECT) or dual-energy (DECT) modes. All patients were scanned with either a fixed-LCV (LCVf, n = 103) or weight-based LCV (LCVw, n = 258) protocol. Two thoracic radiologists independently assessed all LCV CT and patients' prior standard contrast volume (SCV, n = 263) chest CT for optimality of contrast enhancement in thoracic vasculature, cardiac chambers, and in pleuro-parenchymal and mediastinal abnormalities. CT attenuations were recorded in the main pulmonary trunk, ascending, and descending thoracic aorta. To assess the interobserver agreement, pulmonary arterial enhancement was divided into two groups: optimal or suboptimal. RESULTS: There was no significant difference among patients' BMI (p = 0.883) in the three groups. DECT had a significantly higher aortic arterial enhancement (250 ± 99HU vs 228 ± 76 HU for SECT, p < 0.001). Optimal enhancement was present in 558 of 624 chest CT (89.4%), whereas 66 of 624 chest CT with suboptimal enhancement was noted in 48 of 258 LCVw (18.6%) and 14 of 103 LCVf (13.6%). Most patients with suboptimal enhancement with LCVw injection protocol were overweight/obese (30/48; 62.5%), (p < 0.001). CONCLUSION: LCV chest CT can be performed across complex multivendor, multicontrast media, multiscanner, and multiprotocol CT practices. However, LCV chest CT examinations can result in suboptimal contrast enhancement in patients with larger body habitus.

Suboptimal Chest Radiography and Artificial Intelligence: The Problem and the Solution.

Chest radiographs (CXR) are the most performed imaging tests and rank high among the radiographic exams with suboptimal quality and high rejection rates. Suboptimal CXRs can cause delays in patient care and pitfalls in radiographic interpretation, given their ubiquitous use in the diagnosis and management of acute and chronic ailments. Suboptimal CXRs can also compound and lead to high inter-radiologist variations in CXR interpretation. While advances in radiography with transitions to computerized and digital radiography have reduced the prevalence of suboptimal exams, the problem persists. Advances in machine learning and artificial intelligence (AI), particularly in the radiographic acquisition, triage, and interpretation of CXRs, could offer a plausible solution for suboptimal CXRs. We review the literature on suboptimal CXRs and the potential use of AI to help reduce the prevalence of suboptimal CXRs.

Auto-Detection of Motion Artifacts on CT Pulmonary Angiograms with a Physician-Trained AI Algorithm.

Purpose: Motion-impaired CT images can result in limited or suboptimal diagnostic interpretation (with missed or miscalled lesions) and patient recall. We trained and tested an artificial intelligence (AI) model for identifying substantial motion artifacts on CT pulmonary angiography (CTPA) that have a negative impact on diagnostic interpretation. Methods: With IRB approval and HIPAA compliance, we queried our multicenter radiology report database (mPower, Nuance) for CTPA reports between July 2015 and March 2022 for the following terms: "motion artifacts", "respiratory motion", "technically inadequate", and "suboptimal" or "limited exam". All CTPA reports were from two quaternary (Site A, n = 335; B, n = 259) and a community (C, n = 199) healthcare sites. A thoracic radiologist reviewed CT images of all positive hits for motion artifacts (present or absent) and their severity (no diagnostic effect or major diagnostic impairment). Coronal multiplanar images from 793 CTPA exams were de-identified and exported offline into an AI model building prototype (Cognex Vision Pro, Cognex Corporation) to train an AI model to perform two-class classification ("motion" or "no motion") with data from the three sites (70% training dataset, n = 554; 30% validation dataset, n = 239). Separately, data from Site A and Site C were used for training and validating; testing was performed on the Site B CTPA exams. A five-fold repeated cross-validation was performed to evaluate the model performance with accuracy and receiver operating characteristics analysis (ROC). Results: Among the CTPA images from 793 patients (mean age 63 ± 17 years; 391 males, 402 females), 372 had no motion artifacts, and 421 had substantial motion artifacts. The statistics for the average performance of the AI model after five-fold repeated cross-validation for the two-class classification included 94% sensitivity, 91% specificity, 93% accuracy, and 0.93 area under the ROC curve (AUC: 95% CI 0.89-0.97). Conclusion: The AI model used in this study can successfully identify CTPA exams with diagnostic interpretation limiting motion artifacts in multicenter training and test datasets. Clinical relevance: The AI model used in the study can help alert technologists about the presence of substantial motion artifacts on CTPA, where a repeat image acquisition can help salvage diagnostic information.

A nationwide assessment of community pharmacists' attitudes towards dispensing errors: A cross-sectional study.

Objectives: Dispensing errors (DEs) are common causes of preventable harm to patients. Interestingly, very little is known about their prevalence and types in the community pharmacy setting in Lebanon due to the lack of an effective reporting system. Therefore, this study aims to explore the perceptions of community pharmacists about the types of these errors in Lebanon, the factors behind their occurrence, the reasons for underreporting, and the current practices for reducing them. Methods: A cross-sectional survey was conducted through a self-administered questionnaire, using a scale of 0-4, distributed among a sample of community pharmacists in Lebanon. Results: A total of 171 pharmacists responded to the survey, of whom 68% reported that DEs were common, and 52% believed that they were increasing. The main reported contributing factors to DEs were unreadable and incomplete prescriptions (≈3.0 ± 1.0 out of 5), workload, multitasking, interruptions, similarity in names of medications, and fatigue (≈2.5 ± 1.0). Moreover, the perceived strategies to limit the risks of DEs were collaboration with physicians, improving handwriting, double-checking, proper patient counselling, encouraging reporting, and issuance of guidelines (≈3.2 ± 1.0). Finally, the main reasons for underreporting DEs were the lack of obligation to report and the lack of reporting systems (59% and 56%, respectively). Conclusions: DEs may be very prevalent in Lebanon because they are unmonitored by the authorities. Electronic prescription and fair reporting systems are highly recommended, along with follow-up studies.

Radiologist-Trained and -Tested (R2.2.4) Deep Learning Models for Identifying Anatomical Landmarks in Chest CT.

(1) Background: Optimal anatomic coverage is important for radiation-dose optimization. We trained and tested (R2.2.4) two (R3-2) deep learning (DL) algorithms on a machine vision tool library platform (Cognex Vision Pro Deep Learning software) to recognize anatomic landmarks and classify chest CT as those with optimum, under-scanned, or over-scanned scan length. (2) Methods: To test our hypothesis, we performed a study with 428 consecutive chest CT examinations (mean age 70 ± 14 years; male:female 190:238) performed at one of the four hospitals. CT examinations from two hospitals were used to train the DL classification algorithms to identify lung apices and bases. The developed algorithms were then tested on the data from the remaining two hospitals. For each CT, we recorded the scan lengths above and below the lung apices and bases. Model performance was assessed with receiver operating characteristics (ROC) analysis. (3) Results: The two DL models for lung apex and bases had high sensitivity, specificity, accuracy, and areas under the curve (AUC) for identifying under-scanning (100%, 99%, 99%, and 0.999 (95% CI 0.996-1.000)) and over-scanning (99%, 99%, 99%, and 0.998 (95%CI 0.992-1.000)). (4) Conclusions: Our DL models can accurately identify markers for missing anatomic coverage and over-scanning in chest CTs.

Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study.

BACKGROUND: Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries. METHODS: An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants' demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values. RESULTS: A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants' country of residence was a significant predictor of the satisfaction score (P < 0.001), and participants who suffered income reduction due to the pandemic, had a history of SARS-CoV-2 infection, and held higher educational degrees had significantly lower satisfaction scores (P < 0.001). When benchmarked with other international publics, countries from the Gulf Cooperation Council had the highest satisfaction level, Jordan had an average score, and Lebanon had one of the lowest satisfaction scores. CONCLUSION: The political crisis in Lebanon merged with the existing corruption were associated with the lowest public satisfaction score whereas the economical instability of Jordan placed the country just before the lowest position. On the other hand, the solid economy plus good planning and public trust in the government placed the other countries of the Gulf Cooperation Council on top of the scale. Further investigation is necessary to find out how the governments of other low-income countries may have handled the situation wisely and gained the trust of their publics. This may help convey a clearer picture to Arab governments that have suffered during the pandemic.

Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates.

Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. It is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. In particular, PD negatively impacts the quality of life (QOL) of young females and is the main reason behind their absenteeism from school or work. It is suggested that increased intrauterine secretion of prostaglandins F2α and E2 are responsible for the pelvic pain associated with this disorder. Its associated symptoms are physical and/or psychological. Its physical symptoms include headache, lethargy, sleep disturbances, tender breasts, various body pains, disturbed appetite, nausea, vomiting, constipation or diarrhea, and increased urination, whereas its psychological symptoms include mood disturbances, such as anxiety, depression, and irritability. While its diagnosis is based on patients' history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed.

Imaging Modalities Employed in the TAVR Procedure With a Focus on CTA: What the Radiologist Needs to Know.

RATIONALE AND OBJECTIVES: Aortic stenosis (AS) is one of the most common valvular heart disease. Symptomatic AS is associated with a high mortality rate which prompts fast intervention. The introduction of transcatheter aortic valve replacement (TAVR) has drastically improved the outcome of high surgical risk for mortality patients with severe AS. However, this procedure requires the employment of multimodality imaging in the pre-procedural planning, intra-procedural optimization, and post-procedural follow-up stages. This also requires an accurate understanding of the indications, measurements, strength, and limitations of each imaging modality during the different TAVR stages. CONCLUSION: In this review, we aim to outline to radiologists the evidence-based approach and indications of different imaging modalities through the pre, peri, and post TAVR stages.

Pediatric Hip Disorders: Imaging Guidelines and Recommendations.

Hip disorders are a wide range of conditions commonly affecting patients in the pediatric age group. Reaching an accurate diagnosis of these conditions in children may be challenging. The optimal use of image modalities in the approach of a child with possible hip pathology is essential, which allows radiologists and clinicians to narrow the differential diagnosis and reach a definitive diagnosis, which can consequently result in early and appropriate interventions leading to improved outcomes. Therefore, this article aims to provide practicing radiologists and clinicians with up-to-date and evidence-based imaging spectrum guidelines and recommendations for common pediatric hip disorders.

Clinical characteristics and cardiovascular outcomes among young patients with acute myocardial infarction in Kerala, India: A secondary analysis of ACS QUIK trial.

Background: Limited data exist on the risk profile and outcomes among young patients with acute myocardial infarction(AMI) in low-and middle-income countries(LMICs). This study explored differences in the clinical characteristics, medical care, and outcomes of AMI in young adults in India with a subanalysis focusing on sex disparities amongst the young. Methods: Using the Acute Coronary Syndrome Quality Improvement in Kerala trial database, we compared baseline characteristics, management, and outcomes amongst the young patients(≤50 years) and their older counterparts. The primary outcomes were the rates of in-hospital and 30-day composite of in-hospital major adverse cardiovascular events(MACE). Results: Of the 21,374 adults enrolled, 4762(22%) were young, of which 614 (12.9%) were females. Young patients with AMI were more likely to be smokers(41.9% vs. 27.8%;P < 0.001) and undergo coronary angiography (66.3%vs.57.3%;P < 0.001) and percutaneous coronary intervention (PCI)(57.5% vs. 47.0%;P < 0.001), compared to older patients. After adjustment for potential confounders, younger patients had a lower likelihood of in-hospital (RR = 0.49; 95%CI 0.40-0.61;P < 0.001) and 30-day MACE (RR = 0.54; 95%CI 0.46-0.64;P < 0.001). Subgroup analysis comparing young males and females revealed worse cardiovascular risk profile among young women except for smoking. In-hospital MACE(RR = 1.60; 95%CI, 1.0-2.45;P = 0.048) were higher for young women compared to men. Conclusion: Young AMI patients had higher prevalence of modifiable risk factors, were more likely to receive reperfusion therapy, and had better short and intermediate outcomes, compared to older patients. Compared to young men with AMI, young women had worse cardiovascular risk profile, were less likely to be treated with diagnostic angiography or PCI and experienced higher in-hospital death and MACE.

Prevalence, risk factors, and management practices of primary dysmenorrhea among young females.

BACKGROUND: Primary dysmenorrhea (PD) is one of the most common gynecological conditions among young females, which has a significant negative impact on health-related quality of life and productivity. Despite its high prevalence, the evidence is limited regarding the management-seeking practices and its perceived effectiveness among females with PD. METHODS: This is a cross-sectional study conducted among 550 female students in six universities across Lebanon. The prevalence of PD, associated risk factors, and management-seeking practices were assessed using a self-administered questionnaire. RESULTS: The prevalence of PD was 80.9%. Most of the females with PD described their menstrual pain as moderate (56%) to severe (34.6%), which significantly affected their daily activities and studying ability (P < 0.001). The major risk factors associated with PD included heavy menstrual flow (adjusted odds ratio [AOR] = 10.28), family history of PD (AOR = 2.52), history of weight loss attempt (AOR = 2.05), and medical specialization (AOR = 1.663). Only 36.9% of females with PD sought formal medical advice. Most dysmenorrheic females (76.4%) received medications for the management of PD, and remarkably none of them took hormonal contraceptives. Drugs commonly used for PD were mefenamic acid (26.2%), ibuprofen (25%), and paracetamol (11.5%), which were administered when the pain started (58.2%). All medications were significantly effective in reducing the pain score (P = 0.001), and most NSAIDs were more potent than paracetamol in managing PD (P = 0.001). However, no significant difference in adverse effects among medications was revealed. Moreover, no superiority of any individual NSAID for pain relief was established. Nevertheless, mefenamic acid was associated with the lowest risk of abdominal pain (OR: 0.03, P = 0.005) and the highest risk of flank pain (OR = 12, P = 0.02). CONCLUSIONS: Suboptimal management of PD is practiced among university students in Lebanon. Therefore, health care providers should educate dysmenorrheic females to optimize the self-management support of PD. Furthermore, future research is required to investigate females' misconceptions about hormonal contraceptives in the management of PD, aiming to raise awareness and correct misconceptions.

Provision of pharmaceutical care to suspected high-risk COVID-19 patients through telehealth: a nationwide simulated patient study.

BACKGROUND: The COVID-19 pandemic has overburdened the healthcare facilities, which demanded the use of alternative and effective methods for delivering healthcare services. The use of telehealth has become a necessity to provide initial health services. OBJECTIVE: To identify the pharmaceutical care provided by community pharmacists to suspected high-risk COVID-19 patients using telehealth. METHODS: A simulated patient (SP) phoned 100 randomly-selected community pharmacies throughout Lebanon using a standard scenario of uncontrolled diabetes mellitus with typical symptoms of COVID-19. Pharmacists' responses were compared with pre-defined ideal recommendations using a special form. RESULTS: The mean of the retrieved medical information score obtained by the pharmacists was 2.48 ± 2.79 (out of 21), with 34 % of the participants not retrieving any relevant medical data from the SP. The relative patient information, the exposure to COVID-19, and the possible COVID-19 symptoms were not retrieved by 61 %, 70 %, and 41 % of the pharmacists, respectively. Two percent of the pharmacists assured that the SP's symptoms were related to common cold, while 5 % confirmed that the SP is infected with COVID-19. Notably, 35 % of the pharmacists did not offer any recommendation. Among them, 14 % claimed that they were too busy to respond. Only 39 % of the pharmacists provided an appropriate recommendation by referring the SP to her physician to seek medical attention within 24 h since the SP is a high-risk patient, and 41 % recommended doing a PCR test. Antipyretics, antibiotics, and dietary supplements were recommended by 27 %, 7 %, and 16 % of the pharmacists, respectively. Less than 16 % of the pharmacists recommended using protective measures against COVID-19. In addition, the overall communication skills of the pharmacists were generally below expectations. CONCLUSIONS: This study is the first to assess the quality of pharmaceutical care provided by community pharmacists in the Middle East via Telehealth. An unsatisfactory level of preparedness through means of telehealth technology was evident. This resulted in the quality of pharmaceutical-care services provided to high-risk patients via telehealth to be below expectations. Therefore, health authorities should encourage community pharmacists to effectively adopt telehealth, by providing appropriate training, as well as recognizing their extra efforts with financial compensations, aiming to optimize patients' health outcomes.

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature.

BACKGROUND: Spontaneous pneumomediastinum (SPM) is a rare condition defined by the presence of air in the mediastinum in the absence of traumatic or iatrogenic injury. Although the imaging findings and complications of SARS-CoV-2 infection have been reported many times, there are few reports of the prevalence and outcomes of patients with SPM. PURPOSE: In this paper, we aimed to illustrate the different manifestations, management, and outcome of three cases of SPM in COVID-19 patients and provide an extensive review available literature. MATERIALS AND METHODS: Detailed report of patients' demographics, clinical presentation, management, and outcome of three cases of COVID-19 induced SPM seen in our institution was provided. Additionally, literature search was employed through March 2021 using Pubmed and Google scholar databases where a total of 22 articles consisting of 35 patients were included. RESULTS: Statistical analysis of the reviewed articles showed that SPM in COVID-19 occurs in patients with a mean age of 55.6 ± 16.7 years. Furthermore, 80% of the 35 patients are males and almost 60% have comorbidities. Intriguingly, SPM in COVID-19 is associated with a 28.5% mortality rate. These findings are consistent with our case series and are different from previous reports of SPM in non-COVID-19 cases where it most commonly occurs in younger individuals and has a self-limiting course with a good outcome. CONCLUSION: Therefore, SPM in COVID-19 patients occurs in older patients and is potentially associated with a higher mortality rate. Further studies are necessary to assess its role as a prognostic marker of poor outcome.

Community pharmacists' preparedness and responses to COVID-19 pandemic: A multinational study.

BACKGROUND: Community pharmacists play a pivotal role in healthcare worldwide. Their role became more critical during the COVID-19 pandemic. This study aims to investigate the community pharmacists' preparedness and responses to the COVID-19 pandemic and how efficiently they were prepared to contain and prevent the spread of infection. METHODS: An online questionnaire was distributed to community pharmacists in Saudi Arabia, Lebanon, and Jordan through social media platforms. A scoring system was developed to measure their level of adherence to the preventive measures of the global infection. RESULTS: The total included responses were 800. Around 44% of the pharmacists reported spending less than 15 min/d reading about COVID-19 updates. Although more than half of them were reviewing official sites, 73% of them were also retrieving information through non-official channels. Additionally, almost 35% of them were directly contacting customers without physical barriers, 81% reported encountering infected customers, and 12% wore the same facial masks for more than a day. Moreover, 58% of the pharmacies reported the absence of door signs requesting infected customers to declare the infection, 43% of the pharmacies were not limiting the number of simultaneous customers, and 70% were not measuring customers' temperatures prior to entry. Collectively, the mean total score of applied protective measures was 10.12 ± 2.77 (out of 17). CONCLUSION: The level of preparedness of the community pharmacies in these three Middle Eastern countries was not adequate for facing the COVID-19 pandemic. Health authorities in these countries should closely monitor their adherence to the protective guidelines.