Predictive factors and quality of life assessment among patients with spinal cord injury in the Middle East: a systematic review.

PURPOSE: Spinal cord injury (SCI) is impairment of the spinal cord that adversely affects patients' health and quality of life (QoL). The aim of the study was to assess the quality of life (QoL) and related factors in patients with traumatic spinal cord injury in Middle Eastern countries. METHODS: PubMed, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, psycINFO, and Google Scholar were systematically searched for eligible studies published in peer-reviewed journals up till October 2023. RESULTS: Out of 1060 papers found in the literature, only 18 studies from Iran, Lebanon, and Turkey met the inclusion criteria. The majority of the studies employed the SF-36 scale to assess for QoL. In general, all SCI patients had reduced QoL scores when compared to the healthy population. Some of the factors such as age, education level, the level of injury, time since injury onset, marriage, and job opportunities were correlated with SCI subjects QoL. Our papers were assessed and found to be of both good and high quality. CONCLUSION: This review emphasizes the significant shortage of QoL studies among SCI patients in the Middle East countries and highlights the importance of improving the QoL of this marginalized population. This work should enhance the governments to establish rehabilitation centers, social and economic support systems, and mental health services to diminish complications arising from SCI.

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).

Assessing Surgical Outcomes for Cage Plate System versus Stand-Alone Cage in Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for addressing cervical spine conditions. It involves the utilization of either cage plate system (CPS) or stand-alone cage (SC). The objective of our study is to compare perioperative complications, patient-reported clinical outcomes measures, and radiographic outcomes of SC versus CPS in ACDF. METHODS: We carried out a literature search in PubMed, Embase, Cochrane library, Web of science, Medline, and Google Scholar. All studies comparing the outcomes between CPS versus SC in ACDF were included. RESULTS: Forty-one studies, 33 observational and 8 randomized clinical trials met the inclusion criteria. We found that both devices demonstrated comparable effectiveness in monosegmental ACDF with respect to Japanese Orthopedic Association Score, Neck Disability Index score, visual analog score, and fusion rates. CPS demonstrated superior performance in maintaining disc height, cervical lordosis, and exhibited lower incidence rates of cage subsidence. SC showed significant advantages over CPS in terms of shorter surgical duration, less intraoperative bleeding, shorter duration of hospitalization, as well as lower incidence rates of early postoperative dysphagia and adjacent segment disease. CONCLUSIONS: Most of the included studies had monosegmented fusion, and there wasn't enough data to set recommendations for the multisegmented fusions. Larger studies with longer follow-up are necessary to draw more definitive conclusions to provide evidence for clinicians to make clinical decisions.

Prevalence of anxiety and depression among Lebanese women using oral contraceptives: a cross-sectional study.

BACKGROUND: Oral contraceptives (OCs) are used worldwide, including Lebanese women. However, the association between OCs use and anxiety or depression remains unclear. This study aims to assess the prevalence of anxiety and depression among Lebanese women using oral contraceptive pills and investigate the differential impact of combined oral contraceptives (COCs) versus progestogen-only pills (POPs) on mental health outcomes. METHODS: A cross-sectional study was conducted among a sample of Lebanese women using OCs between January and March 2023. Nine hundred nighty seven out of the 2051 women who took part in the survey met our criteria and were included in this study. Data on anxiety and depression were collected using validated and reliable scales, the Arabic versions of the Generalized Anxiety Disorder-7 Questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses, including multivariate analysis, were performed to assess the association between OCs type (COC vs. POP) and anxiety/depression. RESULTS: The prevalence of anxiety and depression among Lebanese women taking OCs was found to be 39.9% and 64.3%, respectively. Furthermore, the study revealed that POP users had 2.8 times higher odds of developing anxiety (adjusted odds ratio ORadj = 2.8 with 95% confidence interval CI of 1.770 to 4.435) p-value < 0.001 and 9.2 times higher odds of developing depression (adjusted odds ratio ORadj = 9.2 with 95% confidence interval CI of 5.790 to 14.506) p-value < 0.001 compared to COC users. CONCLUSION: The results of this study shed light on the elevated prevalence of anxiety and depression among Lebanese women using OCs and emphasized the varying effects of COCs and POPs on their mental health outcomes. Further research is needed to comprehensively understand this association, considering both the dosage and specific type of oral contraceptive to improve the overall well-being of women using these contraceptives.

The Radboud dysarthria assessment: validity and reliability of the Arabic version.

PURPOSE: To cross-culturally adapt and validate the Radboud Dysarthria Assessment (RDA) and the speech component of the Radboud Oral Motor inventory for Parkinson's disease (ROMP-speech) into the Arabic language among Lebanese subjects with dysarthria. MATERIALS AND METHODS: This study included 50 participants with dysarthria. The Arabic versions of the RDA (A-RDA) and the ROMP-speech (A-ROMP-speech) were administered in addition to the Arabic Speech Intelligibility test, the Lebanese Voice Handicap Index-10 (VHI-10lb) and semantic verbal fluency tasks. The maximum performance tasks were analyzed using the Praat software. The A-RDA qualitative recording form and the A-ROMP-speech were assessed for construct validity and internal consistency. The convergent validity of the maximum performance tasks, the severity scale, and the A-ROMP-speech were evaluated. RESULTS: Exploratory factor analysis of the qualitative recording form extracted 3 factors explaining 82.973% of the total variance, and it demonstrated high internal consistency (α = 0.912). The maximum performance tasks of the RDA correlated significantly with the corresponding Praat scores. The severity scale and the A-ROMP-speech correlated fairly to strongly with the Arabic Speech Intelligibility test (rs=-0.695 and -0.736, p < 0.001) and the VHI-10lb (r = 0.539 and 0.640, p < 0.001). CONCLUSION: The A-RDA and the A-ROMP-speech are valid and reliable dysarthria tools among Lebanese subjects.

The present study cross-culturally adapts and validates a dysarthria assessment tool in the Arab culture.The Arabic Radboud Dysarthria Assessment (A-RDA) and the speech component of the Arabic Radboud Oral Motor inventory for Parkinson's disease-speech component (A-ROMP-speech) are valid and reliable measures to be used among Lebanese individuals with dysarthria.The use of the A-RDA and the A-ROMP-speech will contribute to better therapeutic outcomes and will lead to a common language among speech and language therapists.

Cervical intradural traumatic neuroma without history of trauma: illustrative case.

BACKGROUND: Traumatic neuroma typically refers to a reactive process in the injured peripheral nerve, characterized by an excessive growth of axons, Schwann cells, and fibroblasts at the proximal end of the nerve after its interruption. The authors report a case of a traumatic neuroma in the cervical nerve root in a patient with no history of trauma. OBSERVATIONS: The patient presented with sensation loss in the right-hand ulnar distribution, right flank around the T4-11 region, and right small toe along with motor power weakness over the right upper and lower extremity. Magnetic resonance imaging revealed an intradural extramedullary mass lesion with extension along the C7 nerve root. Histological examination showed traumatic neuroma. A total resection of the lesion along with the resolution of sensory and motor deficits was achieved directly after surgery. LESSONS: Traumatic neuroma should always be kept in the armamentarium for diagnosis of an intradural nerve sheath tumor.

Evaluation of the accuracy of new modalities in the assessment and classification of lumbar lordosis: A comparison to Cobb's angle measurement.

Background: Because of the association of lumbar lordosis with some clinical conditions such as low back pain, the chiropractic field has emphasized the significance of evaluating the lumbar lordotic status, by measuring Cobb's angle, regarded as the radiological gold standard, for the assessment of lumbar lordosis, on lateral radiographs. However, research has shown that this technique has some considerable drawbacks, mostly in terms of low accuracy and high variability between clinicians when compared with other radiological modalities. The main objective was to compare the diagnostic accuracy of newly established radiological measurements with one of Cobb's angle methods, for the characterization of lumbar lordosis status in a sample of Lebanese patients aged 15 and above. Material and methods: This retrospective single-center study consisted of measuring Cobb's L1-S1 and Cobb's L1-L5 angles, along with the novel established measurements which are the derivative and the normalized surface area, on 134 lateral radiographs of the lumbar spine of Lebanese patients aged fifteen years old and above, gotten from the Radiology department at Zahra'a's Hospital in Beirut, performed by two observers using MATLAB. Inter-rater agreement was assessed by calculating the Intra-class correlation coefficients. Spearman correlation was analyzed between both Cobb's angle methods and with the derivative and normalized area respectively. 54 patients of the sample were diagnosed by two radiologists, according to their LL status. ROC curve analysis was performed to compare the diagnostic accuracy of the four techniques used. Data were analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results: According to the ROC curve analysis the new methods, which are the derivative and the normalized surface area, displayed lower diagnostic accuracy (AUCderivative = 0.818 and 0.677, AUCsurface area = 0.796 and 0.828) than Cobb's L1-L5 (AUCL1-L5 = 0.924 and 0.929 values) and L1-S1 (AUCL1-S1 = 0.971 and 0.955) angles, in the characterization of hypo and hyperlordotic patients, respectively, in our Lebanese sample consisting of patients aged 15 and above, because of their lower area under the curve's values compared to the traditional Cobb's techniques. The Cobb's L1-S1 has shown to have the highest diagnostic accuracy among the four methods to characterize normal patients from hypo and hyperlordotic ones, by referring to its highest area under the curve's values. However, the sensitivity of Cobb's L1-L5 angle in characterizing hyperlordotic patients was similar to the one of the normalized surface area with a value of 100%.Conclusion: among the four modalities, the new methods didn't show a better diagnostic accuracy compared to the traditional modalities. Cobb's L1-S1 displayed the highest diagnostic accuracy despite its drawbacks. Further prospective studies are needed to validate the cut-offs obtained for Cobb's L1-S1 angle in our sample.

Racial Disparities and Surgical Outcomes After Anterior Cervical Discectomy and Fusion: National Surgical Quality Improvement Program Analysis 2015-2020.

BACKGROUND: Our objective was to assess the effect of race on outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS: We identified 57,913 adult patients who underwent elective ACDF spine surgery from 2015 to 2020. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Demographics, comorbidities, perioperative course, and 30-day postoperative outcomes were stratified by race. RESULTS: A total of 57,913 patients, white (n = 49,016), African American (AA; n = 7200), Native American (NA; n = 565), and Asian (n = 1132) underwent ACDF fusion surgery. AA patients had higher comorbidities, including diabetes (24.7%), dyspnea (5.9%), and hypertension (61.6%) compared with the other groups (P < 0.001). NA and AA were higher tobacco users, (33.1%) and (28.7%), respectively (P < 0.001). Most of the patients reported in this dataset had single-level surgeries. AAs had a longer average hospital stay (2.51±7.31 days) and operative time (144.13±82.26 min) (P < 0.001). Lower risk of superficial surgical site infection (adjusted odds ratio [ORadj], 0.41; 95% confidence interval [CI], 0.22-0.77; P = 0.005) and greater risk of reintubation (ORadj, 1.65; 95% CI, 1.25-2.17; P < 0.001), pulmonary embolism (ORadj, 1.88; 95% CI, 1.27-2.79; P = 0.001), renal insufficiency (ORadj, 3.15; 95% CI, 1.38-7.20; P = 0.006), and return to the operating room (ORadj, 1.41; 95% CI, 1.18-1.65; P < 0.001 were reported in AAs compared with whites. NAs showed an increased risk of superficial surgical site infection compared with whites (ORadj, 2.59; 95% CI, 1.05-6.36; P = 0.037). CONCLUSIONS: Racial disparities were found to independently affect rates of complications after surgery for ACDF.

Sleep Quality and Nicotine Dependence Among Lebanese University Residents and Fellows: A Cross-Sectional Study.

Background and objectives Sleep quality and nicotine addiction are important public health issues with significant negative impacts on individual well-being and the performance of healthcare professionals. This study aims to determine the prevalence and association of nicotine dependence and poor sleep quality among residents and fellows enrolled in the Lebanese University. Methods A cross-sectional study using the snowball-sampling technique was conducted in Lebanon between January and March 2023. Data were collected through an online survey that included information on socio-demographic characteristics, nicotine dependence, and sleep quality. A total of 350 residents and fellows were included in the study. Bivariate analysis and multivariable logistic regression were carried out to identify the factors associated with sleep quality. Adjusted odds ratio and 95% confidence intervals were reported. Results One quarter (25.1%) of the residents and fellows were smokers; among them, 44.3% smoked I Quit Ordinary Smoking (IQOS), 14.8% smoked cigarettes, 10.2% smoked waterpipe (WP), 12.5% smoked cigarettes and WP, and 18.2% smoked IQOS and WP. According to the Pittsburgh Sleep Quality Index (PSQI), 34.3% of participants had poor sleep quality. Smokers had 12.5 times higher odds of experiencing poor sleep quality compared to non-smokers (adjusted odds ratio ORadj = 12.58 with 95% confidence interval [CI] of 7.07-22.36; p-value <0.001). In addition, smoking a combination of two types of tobacco products (cigarettes with WP or IQOS with WP) posed the highest risk of poor sleep quality, with an adjusted odds ratio of 31.54 (95% CI of 9.15-45.74, p-value <0.001). Elevated Fagerström Test for Nicotine Dependence (FTND) and Lebanon Waterpipe Dependence Scale (LWDS-11) scores indicated an increased risk of poor sleep quality (adjusted odds ratio ORadj = 4.69 with 95% CI of 2.179-10.10; p-value <0.001; and adjusted odds ratio ORadj =1.27 with 95% CI of 1.04-1.55; p-value 0.019, respectively). Conclusion Our study found a significant association between nicotine dependence and poor sleep quality among medical residents and fellows, with smokers being more susceptible to sleep disturbances. The high prevalence of IQOS smoking among medical residents and fellows in Lebanon highlights the urgent need for comprehensive research investigating the effects of heated tobacco products. Furthermore, our study reveals a critical insight into the potential additive effects of nicotine, suggesting that the concurrent use of multiple tobacco products may further elevate the risk of poor sleep quality. Recognizing the implications of our findings, it is imperative to develop targeted interventions and educational programs that promote healthier sleep habits and facilitate smoking cessation among medical residents and fellows.

How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?

STUDY DESIGN: Multicenter, prospective cohort. OBJECTIVES: Malalignment following adult spine deformity (ASD) surgery can impact outcomes and increase mechanical complications. We assess whether preoperative goals for sagittal alignment following ASD surgery are achieved. METHODS: ASD patients were prospectively enrolled based on 3 criteria: deformity severity (PI-LL ≥25°, TPA ≥30°, SVA ≥15 cm, TCobb≥70° or TLCobb≥50°), procedure complexity (≥12 levels fused, 3-CO or ACR) and/or age (>65 and ≥7 levels fused). The surgeon documented sagittal alignment goals prior to surgery. Goals were compared with achieved alignment on first follow-up standing radiographs. RESULTS: The 266 enrolled patients had a mean age of 61.0 years (SD = 14.6) and 68% were women. Mean instrumented levels was 13.6 (SD = 3.8), and 23.2% had a 3-CO. Mean (SD) offsets (achieved-goal) were: SVA = -8.5 mm (45.6 mm), PI-LL = -4.6° (14.6°), TK = 7.2° (14.7°), reflecting tendencies to undercorrect SVA and PI-LL and increase TK. Goals were achieved for SVA, PI-LL, and TK in 74.4%, 71.4%, and 68.8% of patients, respectively, and was achieved for all 3 parameters in 37.2% of patients. Three factors were independently associated with achievement of all 3 alignment goals: use of PACs/equivalent for surgical planning (P < .001), lower baseline GCA (P = .009), and surgery not including a 3-CO (P = .037). CONCLUSIONS: Surgeons failed to achieve goal alignment of each sagittal parameter in ∼25-30% of ASD patients. Goal alignment for all 3 parameters was only achieved in 37.2% of patients. Those at greatest risk were patients with more severe deformity. Advancements are needed to enable more consistent translation of preoperative alignment goals to the operating room.

Computed tomography findings as early predictors of long-term language impairment in patients with traumatic brain injury.

This study aims to assess the relationship between computed tomography (CT) findings, during the acute phase of hospitalization, and long-term language impairment in people with traumatic brain injury (TBI). Another aim was to assess the receptive and expressive abilities of subjects with TBI based on the location of the injury. This is a retrospective observational study including 49 participants with TBI due to war injuries. The Arabic Diagnostic Aphasia Battery (A-DAB-1) was administered to the participants and the Helsinki CT score was computed to quantify brain damage. The results showed that the Helsinki CT score was negatively correlated with the total score of the A-DAB-1 (r = -0.544, p-value < 0.0001). Simple linear regression supported such findings and reflected an inversely proportional relationship between both variables (p-value < 0.0001). When compared with subjects having right hemisphere damage, subjects with left hemisphere and bilateral brain damage performed more poorly on language tasks respectively as follows: A-DAB-1 overall score (92.08-66.08-70.28, p-value = 0.021), Content of descriptive speech (9.57-6.69-7.22, p-value = 0.034), Verbal fluency (6.57-3.54-3.89, p-value = 0.002), Auditory comprehension (9.71-7.54-7.78, p-value = 0.039), Complex auditory commands (9.71-7.65-7.56, p-value = 0.043), Repetition (9.75-7.08-7.61, p-value = 0.036), Naming (9.93-7.15-8.11, p-value = 0.046). Following TBI, CT findings on admission can significantly predict long-term language abilities, with left side lesions inducing poorer outcomes.

Prevalence of Body Dysmorphic Disorder (BDD) among the Lebanese University students: associated risk factors and repercussion on mental health.

Introduction: Body Dysmorphic Disorder (BDD) is a psychological illness characterized by persistent and intrusive preoccupation with an imagined or slight defect in appearance. This study aimed to determine the prevalence of BDD and investigate its association with mental health status (depression and anxiety), religiosity, eating disorder risk, and self-esteem among Lebanese University students. Methods: A cross-sectional study was conducted in March 2020, involving students from the Lebanese University. Data were collected using the dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale (RSE), religiosity scale, patient health questionnaire (PHQ-9), generalized anxiety disorder assessment (GAD-7), Eating Attitude test-26 scale (EAT-26). Results: A total of 6,448 participants were enrolled in our study. The overall prevalence of BDD among university students was (6.4%).Our results showed that Lebanese students with BDD were more likely to have anxiety ORadj 1.3 (95% CI: 1.2-1.7) p-value 0.001, depression ORadj 1.2 (95% CI: 1.15-1.5) p-value 0.007, and eating disorder (Bulimia & Food preoccupation ORadj 1.06 (95% CI: 1.03-1.2) p-value 0.0, and oral control ORadj 1.09 (95% CI: 1.05-1.1) p-value < 0.001) compared to those with no BDD. We also found that students with BDD had Lower Self-esteem ORadj 0.88 (95% CI: 0.78-0.9) p-value < 0.001), and less likely to be religious ORadj 0.88 (95% CI: 0.82-0.9) p-value 0.02) compared to those with no BDD. Conclusions: This pioneering study sheds light on the prevalence of BDD among Lebanese university students and its associated factors. Our findings underscore the importance of early detection of BDD during adolescence and young adulthood, necessitating timely psychological intervention to prevent chronicity and complications.

Neuroanatomical regions associated with non-progressive dysarthria post-stroke: a systematic review.

BACKGROUND: Dysarthria is a common and persisting sequela to stroke. It can have a negative influence on psychological wellbeing, and quality of life. This systematic review aimed to describe and identify the neuroanatomical regions associated with non-progressive dysarthria following stroke. METHODS: A systematic search of PubMed, Ovid Medline, CINAHL, Cochrane, Scopus, and ScienceDirect was conducted to identify all relevant articles published in peer-reviewed journals up to December 2021. Following data extraction, the National Institutes of Health (NIH) quality assessment tools were used to evaluate the methodological quality of the included studies. RESULTS: Out of 2186 papers found in the literature related to dysarthria post-stroke, 24 met the inclusion criteria. Eligible articles assessed 1150 post-stroke subjects. Out of them, 420 subjects had dysarthria from isolated lesions. Regarding dysarthric subjects with ischemic strokes, 153 sustained supratentorial infarctions, while 267 had infratentorial infarctions. The majority had pontine infarctions (n = 142), followed by infarctions in the corona radiata (n = 104), and the cerebellum (n = 64). CONCLUSION: This systematic review is the first step toward establishing a neuroanatomical model of dysarthria throughout the whole brain. Our findings have many implications for clinical practice and provide a framework for implementing guidelines for early detection and management of dysarthria post-stroke.

Lebanese University Students and COVID-19: A Survey on their Related-Knowledge, Practice, and Behaviors.

Introduction: Young adults are at the epicenter for preventing the progression of COVID-19 pandemic and must be targeted for education to impede any potential transmission of the disease. This study aimed to assess the knowledge, practice and behaviors of Lebanese university students regarding COVID-19. Methods: A cross-sectional study was carried out among university students at the Lebanese University between March 30, 2020, and April 4, 2020. Information on socio-demographic data, knowledge, practice, and additional information concerning COVID-19 were collected. Results: Our survey showed that the majority of the students had good knowledge 90.8%, and more than two third of the respondents 78.6% reported good practice regarding COVID-19. Graduate students were more knowledgeable compared to undergraduate students (unstandardized beta 0.349 with a 95% confidence interval (CI) of 0.165 to 0.533; p-value < 0.0001). Moreover, male students had a negative impact on good practice compared to females (unstandardized beta -0.280 with a 95% confidence interval (CI) of -0.402 to -0.159; p-value < 0.0001). Nearly half of the students (55.2%) reported that their food intake has increased, and 82.5% of the students didn't practice sport during the quarantine. The most common information source of the students was the television (63.3%) followed by social media (53.9%). Conclusions: This study offers useful insights into the knowledge and practices of Lebanese university students towards COVID-19. Our findings support the importance to deliver health education campaign by the ministry of public health through television and social media to improve the knowledge on disease transmission and preventive measures.

COVID-19 mortality surveillance in Lebanon.

Since the beginning of the COVID-19 pandemic, the Epidemiological surveillance program of the Lebanese Ministry of Public Health has launched a rapid surveillance system for collecting COVID-19-related mortality data. In this study, we document the Lebanese experience of COVID-19 mortality surveillance and provide an analysis of the epidemiological characteristics of confirmed deaths. The implementation of the rapid COVID-19 mortality surveillance system, data sources, and data collection were described. A retrospective descriptive analysis of the epidemiological characteristics of confirmed cases occurring in Lebanon between February 20, 2020, and September 15, 2021, was performed. Epidemiological curves of Covid-19 confirmed cases and deaths as well as the geographic distribution map of mortality rates were generated. Between February 21, 2020, and September 15, 2021, a total of 8163 COVID-19-related deaths were reported with a predominance of males (60.4%). More than 60% were aged 70 years or above. Of all deaths, 84% occurred at hospitals and 16% at home. The overall cumulative mortality rate was 119.6 per 100,000. The overall case fatality ratio (CRF) was 1.3%. Of the total deaths, 82.2% had at least one underlying medical condition. The top reported COVID-19 comorbidities associated with COVID-19-related deaths are cardiovascular diseases including hypertension (59.1%), diabetes (37.2%), kidney diseases including dialysis (11%), cancer (6.7%), and lung diseases (6.3%). The CFR was 30.9% for kidney diseases, 20.2% for cancer, 20.2% for lung diseases, 18.1% for liver diseases, 14% for diabetes, and 12.2% for cardiovascular diseases. Considering the limited human and financial resources in Lebanon due to the economic and political crisis, the rapid mortality surveillance system can be considered successful. Improving this system is important and would contribute to better detection of deaths from emerging and re-emerging diseases during health crises.

Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up.

OBJECTIVE: Adult cervical deformity (ACD) has high complication rates due to surgical complexity and patient frailty. Very few studies have focused on longer-term outcomes of operative ACD treatment. The objective of this study was to assess minimum 2-year outcomes and complications of ACD surgery. METHODS: A multicenter, prospective observational study was performed at 13 centers across the United States to evaluate surgical outcomes for ACD. Demographics, complications, radiographic parameters, and patient-reported outcome measures (PROMs; Neck Disability Index, modified Japanese Orthopaedic Association, EuroQol-5D [EQ-5D], and numeric rating scale [NRS] for neck and back pain) were evaluated, and analyses focused on patients with ≥ 2-year follow-up. RESULTS: Of 169 patients with ACD who were eligible for the study, 102 (60.4%) had a minimum 2-year follow-up (mean 3.4 years, range 2-8.1 years). The mean age at surgery was 62 years (SD 11 years). Surgical approaches included anterior-only (22.8%), posterior-only (39.6%), and combined (37.6%). PROMs significantly improved from baseline to last follow-up, including Neck Disability Index (from 47.3 to 33.0) and modified Japanese Orthopaedic Association score (from 12.0 to 12.8; for patients with baseline score ≤ 14), neck pain NRS (from 6.8 to 3.8), back pain NRS (from 5.5 to 4.8), EQ-5D score (from 0.74 to 0.78), and EQ-5D visual analog scale score (from 59.5 to 66.6) (all p ≤ 0.04). More than half of the patients (n = 58, 56.9%) had at least one complication, with the most common complications including dysphagia, distal junctional kyphosis, instrumentation failure, and cardiopulmonary events. The patients who did not achieve 2-year follow-up (n = 67) were similar to study patients based on baseline demographics, comorbidities, and PROMs. Over the course of follow-up, 23 of the total 169 enrolled patients were reported to have died. Notably, these represent all-cause mortalities during the course of follow-up. CONCLUSIONS: This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of health-related quality of life at a mean 3.4-year follow-up, despite high complication rates and a high rate of all-cause mortality that is reflective of the overall frailty of this patient population. To the authors' knowledge, this study represents the largest and most comprehensive prospective effort to date designed to assess the intermediate-term outcomes and complications of operative treatment for ACD.

Outcomes of operative treatment for adult spinal deformity: a prospective multicenter assessment with mean 4-year follow-up.

OBJECTIVE: The current literature has primarily focused on the 2-year outcomes of operative adult spinal deformity (ASD) treatment. Longer term durability is important given the invasiveness, complications, and costs of these procedures. The aim of this study was to assess minimum 3-year outcomes and complications of ASD surgery. METHODS: Operatively treated ASD patients were assessed at baseline, follow-up, and through mailings. Patient-reported outcome measures (PROMs) included scores on the Oswestry Disability Index (ODI), Scoliosis Research Society-22r (SRS-22r) questionnaire, mental component summary (MCS) and physical component summary (PCS) of the SF-36, and numeric rating scale (NRS) for back and leg pain. Complications were classified as perioperative (≤ 90 days), delayed (90 days to 2 years), and long term (≥ 2 years). Analyses focused on patients with minimum 3-year follow-up. RESULTS: Of 569 patients, 427 (75%) with minimum 3-year follow-up (mean ± SD [range] 4.1 ± 1.1 [3.0-9.6] years) had a mean age of 60.8 years and 75% were women. Operative treatment included a posterior approach for 426 patients (99%), with a mean ± SD 12 ± 4 fusion levels. Anterior lumbar interbody fusion was performed in 35 (8%) patients, and 89 (21%) underwent 3-column osteotomy. All PROMs improved significantly from baseline to last follow-up, including scores on ODI (45.4 to 30.5), PCS (31.0 to 38.5), MCS (45.3 to 50.6), SRS-22r total (2.7 to 3.6), SRS-22r activity (2.8 to 3.5), SRS-22r pain (2.3 to 3.4), SRS-22r appearance (2.4 to 3.5), SRS-22r mental (3.4 to 3.7), SRS-22r satisfaction (2.7 to 4.1), NRS for back pain (7.1 to 3.8), and NRS for leg pain (4.8 to 3.0) (all p < 0.001). Degradations in some outcome measures were observed between the 2-year and last follow-up evaluations, but the magnitudes of these degradations were modest and arguably not clinically significant. Overall, 277 (65%) patients had at least 1 complication, including 185 (43%) perioperative, 118 (27%) delayed, and 56 (13%) long term. Notably, the 142 patients who did not achieve 3-year follow-up were similar to the study patients in terms of demographic characteristics, deformities, and baseline PROMs and had similar rates and types of complications. CONCLUSIONS: This prospective multicenter analysis demonstrated that operative ASD treatment provided significant improvement of health-related quality of life at minimum 3-year follow-up (mean 4.1 years), suggesting that the benefits of surgery for ASD remain durable at longer follow-up. These findings should prove useful for counseling, cost-effectiveness assessments, and efforts to improve the safety of care.

Cross-cultural adaptation and validation of the Arabic Project for the Epidemiological Analysis of Critical Care Patients (PAEEC) scale in individuals with traumatic brain injury in Lebanon.

The aim of this study is to cross-culturally adapt the Project for the Epidemiological Analysis of Critical Care Patients (PAEEC) Quality of Life (QoL) scale into the Arabic language and to examine its clinimetric properties, including validity and reliability among Lebanese native speaker with traumatic brain injury (TBI). This is a cross-sectional study including 49 men with TBI aged between 20 and 59 years. The Arabic version of the PAEEC (PAEEC-A) was administered to the subjects or their primary caregiver as well as the Short Form Health Survey 36 (SF-36). The internal consistency, test-retest reliability, content, construct and convergent validity were evaluated. The PAEEC-A displayed high internal consistency (Chronbach's alpha = 0.916) and test-retest reliability (Intraclass Correlation coefficient = 0.966). Exploratory factor analysis extracted a 3-factor model that explained 68.48% of the total variance. As for the convergent validity, Spearman correlations between the PAEEC-A total score and the physical and mental components of the SF-36 were -0.788 and -0.794, respectively (p-value < 0.0001 for both). The findings indicate that the PAEEC-A has robust clinimetric properties and is a valid and reliable quality of life measure among Lebanese men with traumatic brain injury.

Erector Spinae Blocks for Spine Surgery: Fact or Fad? Systematic Review of Randomized Controlled Trials.

BACKGROUND: Patients undergoing spine surgery may experience substantial postoperative pain. The aim of this systematic review is to examine the clinical efficacy of a newly introduced regional anesthetic block, the erector spinae plane block (ESPB), for adults undergoing posterior spine surgeries. METHODS: A formal systematic database search was conducted in PubMed, Ovid Medline, Embase, Cochrane library, and Google Scholar for randomized controlled trials comparing ESPB with control or placebo. RESULTS: Our systematic review demonstrates a reduction of postoperative pain and opioid consumption in patients who had ESPB compared with control groups for lumbar spine surgery. However, the effect obtained revealed only a short-term benefit. CONCLUSIONS: Current evidence is insufficient to support the widespread use of ESPB for spine surgery. More studies are warranted to confirm or refute its role in clinical practice.

Assessment of non-progressive dysarthria: practice and attitude of speech and language therapists in Lebanon.

BACKGROUND: Non-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the assessment of non-progressive dysarthria remains limited with professional practices relying mainly on therapists' clinical experience. Limited information on the assessment practices of Lebanese speech and language therapists (SLTs) is available. Such information is crucial for the development of adequate therapy services for clients with non-progressive dysarthria. This study aims to explore the assessment practices and attitudes of Lebanese SLTs working with adults with non-progressive dysarthria and to investigate their adherence to the framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). METHODS: A cross-sectional study was conducted in Lebanon between March and May 2021. Data was collected through an online survey that included information on socio-demographic characteristics, practices, and attitudes of SLTs who assess adults with non-progressive dysarthria. RESULTS: A total of 50 Lebanese SLTs responded to the survey. The majority of SLTs (78%) assessed clients with non-progressive dysarthria across all ICF domains. SLTs reported dissatisfaction with the available assessment tools (64%) and reliance on informal tools (84%). In addition, 68% of the SLTs suggested the crucial need for the development of Arabic formal assessments that can quantitatively evaluate dysarthria and determine severity. The survey also showed that the respondents demonstrated a preference for the use of impairment-based tools. CONCLUSION: It can be concluded that the assessment practices of Lebanese SLTs, generally, follow the international trend and the recommended professional guidelines. Further research initiatives should be held to develop Arabic formal assessment tools for non-progressive dysarthria.