A case of choroidal neovascularization as a first manifestaion of systemic lupus erythematosus.

BACKGROUND: To report a rare occurrence of pigment epitheliopathy associated with choroidal neovasculization as a first manifestation of systemic lupus erythematosus. CASE PRESENTATION: A 54-year-old female, with no prior medical history, sought a second opinion due to sudden drop in vision in her right eye to 20/80. Slit lamp examination was normal. Fundus examination revealed the presence of a subretinal hemorrhage in the macular area. Fundus imaging including optical coherence tomography and fluorescein angiography showed multifocal retinal pigment epitheliopathy associated with choroidal neovascularization (CNV). The patient had received an intravitreal injection of Bevacizumab 2 weeks ago. It was decided to complete the loading dose regimen with two additional Bevacizumab injections, and the first injection was done 2 weeks after her presentation. Two weeks later, the patient reported a rash on her cheeks, painful joints, and purpura. Systemic workup revealed positive ANA, anti-cardiolipin antibodies, and decreased complement levels, with negative anti-histone antibodies. This led to the diagnosis of systemic lupus erythematosus (SLE) based on the "Systemic Lupus International Collaborating Clinics" criteria. The patient was treated with 50 mg of prednisolone which was then tapered. 1 month after the third injection, an showed a total resolution of the sub-retinal fluid with an improvement of vision to 20/20. No recurrence was observed during follow-up. CONCLUSION: Based on the findings from the fundus exam and imaging, systemic symptoms and the blood work-up, we postulate that the pigment epitheliopathy associated with choroidal neovascularization was related to the vaso-occlusive disease at the level of the choroid that can be part of SLE vasculopathy. To our knowledge, this represents the first case in which pigment epitheliopathy and CNV were the primary manifestations of SLE.

Association between Personality Traits and Phubbing: The Co-Moderating Roles of Boredom and Loneliness.

Phubbing is defined as the use of one's phone while in a conversation, leading to a disconnection from interpersonal communications. This topic has become more interesting lately due to the increased use of smartphones worldwide and in Lebanon, where 86% of the population owns a smartphone. This study aims to assess the association between phubbing and personality traits with the moderating effects of loneliness and boredom proneness. This cross-sectional study was conducted between August-September 2020. 461 participants (18-29 years) filled out the survey. Higher open-mindedness was associated with less phubbing. Being married compared to single and higher open-mindedness were significantly associated with less phubbing. More boredom was significantly associated with more phubbing. The interaction extraversion by boredom was significantly associated with phubbing; this was significant at low levels of loneliness and boredom where extraversion was significantly associated with more phubbing. At moderate loneliness and high boredom and at high loneliness and boredom, extraversion was significantly associated with less phubbing. The interactions between boredom and loneliness and the other four personality traits did not show any significant association with phubbing. The current study highlights the importance of personality traits in influencing phubbing and might contribute to the preliminary assessment of phubbing. Healthcare professionals might be able to use the data of this study to implement appropriate smartphone use habits, as this would help patients improve their social relationships.

The Lebanese Depression Scale: A scale to screen for depression in the Lebanese population.

OBJECTIVE: To create a Lebanese Depression Scale (LDS) and evaluate its performance on a group of Lebanese individuals. METHODS: This cross-sectional analysis enrolled 997 residents (January-December 2018). RESULTS: The elements in the Lebanese Depression Scale-19 items (LDS-19) scale converged over a combination of four factors (αCronbach = .864). The correlation was positive between the LDS-19 and both the Hamilton Anxiety Scale score (r = .637; P < .001) and Lebanese Anxiety Scale score (r = .694; P < .001). According to the receiver-operating characteristics curve, the optimal score for the LDS-19 scale, which was a cutoff between healthy controls and depressive patients, was 18.50 (80.3% and 75.8%, respectively); the scale's positive predictive value was 31.0%, while the negative predictive value was 96.5%. PRACTICE IMPLICATIONS: The LDS-19 is a useful tool to screen for depression in the Lebanese population, in both clinical and research settings.

Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study.

OBJECTIVES: Patients with mental health disorders often have to endure the burdens of the condition itself and the stigma that follows. Since no study has been conducted in Lebanon on this topic, our objective was to assess the knowledge, attitude and behaviors towards public stigma of mental health diseases, among a sample of the Lebanese population. METHODS: A cross-sectional study, conducted between November 2017 and May 2018, enrolled 2289 participants. The Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward Mental Illness (CAMI) and the Reported and Intended Behavior Scale (RIBS) were used to assess knowledge, attitude and behaviors toward mental illness respectively. The 25th, 50th and 75th percentile of the MAKS, CAMI and RIBS scales scores were considered as cutoff points for low, medium and high scores respectively. RESULTS: A high knowledge score was found in 33.0% of the participants, whereas a high attitude score and a higher behavior score were found in 32.2% and 26.9% of the participants respectively. Living in North Lebanon (Beta = 1.331) and being familiar with a non-close person with mental illness (Beta = 0.811) were associated with higher knowledge of mental illness (higher MAKS score), whereas living in Bekaa (Beta = -8.693) and being 70 years old and above (Beta = -5.060) were associated with lower knowledge toward mental illness (lower MAKS score). Higher knowledge of mental illness (higher MAKS score) (Beta = 0.670), having a high level of education (university (Beta = 8.785), secondary (Beta = 6.084) and technical (Beta = 5.677)) were associated with less stigmatizing attitudes (higher CAMI scale). Being familiar with close people with mental illness (Beta = 0.577), less stigmatizing attitudes (higher CAMI scale) (Beta = 0.077) and higher knowledge of mental illness (higher MAKS score) (Beta = 0.115) were associated with higher favorable behaviors (higher RIBS score), whereas knowing a non-close person who have a mental illness (Beta = -0.720) was associated with lower favorable behaviors (lower RIBS score). CONCLUSION: A mass media awareness campaigns that could transmit health messages to a wide public audience in the country to fight stigma toward mental illness, seems warranted.