International Journal of Clinical Research
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Assessing the Effects of the 2023 Turkish Earthquakes on Mental Health in Lebanon: A Cross-sectional Study
Get PDFBackground: On the 6 of February 2023, an earthquake registering 7.8 on the Richter Scale hit the South and center of Turkey, as well as the North and West Syria. Subsequently, another seismic event with a magnitude of 7.5 ensued a few hours later. Two weeks later, a new earthquake of 6.4 magnitude shook both countries again. These two events left behind more than 50000 deaths and a lot of damage, both economically and psychologically, which affected the Lebanese population.
Aim: This study evaluates the adverse effects of these earthquakes on the mental health of people in Lebanon.
Methods: This is a cross-sectional study conducted between 6 March, and 23 March 2023, using an online survey. The questionnaire was divided into 4 sections: demographics, the mental health of participants, anxiety before the earthquakes, and anxiety after the earthquakes using the Lebanese Anxiety Scale- to differentiate between healthy and anxious participants.
Results: The study involves 670 Lebanese participants aged 18 or above. Anxiety proportion rose post-earthquakes. Pre-earthquakes, anxiety risk factors included female gender, younger age, Beirut residency, mental health issues, and medication use; these factors also significantly raised anxiety after earthquakes.
Conclusion: This study demonstrates a remarkable escalation in anxiety proportion following the earthquakes. Pre-existing risk factors such as female gender, younger age, Beirut residency, mental health issues, and medication use for symptom relief exhibited a heightened association with anxiety after the tectonic events. These findings deepen the importance of targeted interventions to address the psychological impact of earthquakes on vulnerable populations
Association of Pre-Treatment Serum Testosterone Levels with Prostate Cancer: A Prospective Study
Get PDFIntroduction: It has been widely accepted that prostate cancer (PCa) growth is related to serum testosterone (ST). A direct correlation between pre-treatment ST level and PCa growth and progression has been reported. However, recent studies have shown that pre-treatment ST levels have a negative correlation with PCa. Thus, the literature is, at best, conflicting. In this study, we examined the pre-treatment serum total testosterone (ST) levels in PCa.
Methods: In this prospective observational study, suspected cases of PCa underwent digital rectal examination, routine blood investigation, Prostate-Specific Antigen (PSA) measurement, and prostate biopsy. Diagnosed cases of PCa without any risk factors affecting testosterone levels were included. Their pre-treatment total ST levels were measured. All patients underwent staging evaluation with either Magnetic Resonance Imaging (MRI) & Bone scan or Ga-68 Prostate Specific Membrane Antigen Positron Emission Tomography (PSMA PET). ST levels were also measured in patients with Benign Prostatic Hyperplasia (BPH) and compared with those in PCa patients. ST levels were also assessed according to Gleason Score (GS) and clinical stage in PCa.
Results: 110 cases and 54 patients with BPH were included in the study. The median ST level in PCa patients was significantly lower as compared to BPH patients [352.28 ng/dL (Interquartile Range (IQR) 224.99-563.17) vs. 448.29 ng/dL (IQR 400.97-596.42) (p =0.004)]. The median ST level in metastatic PCa was significantly lower than the localized PCa group [298.20 ng/dL vs. 452.30 ng/dL (p=0.0001)]. Moreover, the median ST level was also significantly lower in patients with Gleason Score ≥ 8 than those with Gleason Score ≤ 7 [285.92 ng/dL (149.97-560.40) vs. 425.13 ng/dL (320.43-571.46) (p=0.002)].
Conclusion: This study shows lower ST levels in patients with PCa compared to patients with BPH, thus supporting a potential association as described in previous studies. ST levels may have prognostic value since a low pre-treatment ST level is associated with a higher clinical stage and aggressive PCa
3 mL Versus 5 mL of 0.75% Ropivacaine for Ultrasound-Guided Interscalene Block: A Randomized Clinical Trial
Get PDFBackground: Ropivacaine is a local anesthetic used in nerve blocks for post-operative analgesia with dose-dependent side effects. Research indicated that ropivacaine may have better safety profiles than most local anesthetics, but toxicity and other dose-dependent side effects can still occur. Our aim is to show that a lower dose of ropivacaine is as effective when it comes to anesthesia and has a lower rate of complications.
Methods: This study aims to compare 3 mL and 5 mL of 0.75% ropivacaine used for ultrasound-guided interscalene nerve block in shoulder arthroscopy in terms of postoperative analgesia and complications. We compared two groups (group 3 and group 5). Each group consisted of 30 patients. One group received 3 mL of 0.75% ropivacaine while the other group received 5 mL of the same product. The pain scale was evaluated in the post-anesthesia care unit (PACU) every 30 minutes up to two hours, then via phone call questionnaire for patients discharged during the first 24 hours. The incidence of complications was also evaluated in both groups.
Results: Both groups had the same analgesic effect. No difference in the incidence of postoperative complications was noted however, more hemidiaphragmatic paralysis was observed in group 5 (p=0.023).
Conclusion: Both 3 mL and 5 mL of 0.75% ropivacaine had the same post-operative analgesic effect with a lower incidence of hemidiaphragmatic paralysis seen in group 3, Further investigation on respiratory function must be undertaken
Endometrial Stromal Sarcoma in Term Pregnancy: A Unique Case Report and Review of the Literature
Get PDFBackground: Endometrial stromal sarcoma (ESS)is a rare malignancy described only in a limited number of case reports. It accounts for only 2% of all uterine tumors.
Case Report: We describe a case of a 29-year-old pregnant lady presenting at 37 weeks of gestation in labor. A huge intra-cavitary mass was seen on bedside ultrasound upon her presentation. The patient underwent an urgent repeat cesarean section where a twenty cm uterine mass was identified after delivering the baby and the placenta. The pathology exam of the group showed low-grade endometrial stromal sarcoma with anti-CD10 and anti-estrogen receptors. A radical hysterectomy with bilateral salpingo-oophorectomy was performed two days later as the ESS was staged 1B following the post-cesarean PET scan result.
Conclusion: ESS is infrequent in young women as well as pregnant patients. This is the first case of asymptomatic endometrial stromal sarcoma in pregnancy, giving birth to a full-term baby with successful treatment
Pilonidal Cyst of the Penis: Suggestion of a Management Plan Based on Literature Review and a Case Report
Get PDFBackground: Pilonidal sinus rarely affects the penis. This disease is only discussed in case reports, around 26 cases in the literature, and never in textbooks or guidelines. Along with the scarce data in the literature, most of the reported cases were managed differently, and the diagnosis, which could only be confirmed with specimen histopathology, was delayed. Besides the case report of a rare penile disease, the purpose of this paper is to suggest a management plan for suppurative penile lesions to avoid delay in diagnosis and treatment.
Case Report: We encountered a case of penile pilonidal sinus that was initially treated as an abscess based on an ultrasound result. The quick relapse and the suspicious second ultrasound of a hair-like septum in the lesion led to excision and histopathologic confirmation. Penile swelling in patients with a history of Papaverine or any vasoactive drugs injections, trauma, penile prosthesis, diabetes mellitus, intra-abdominal abscess, Tuberculosis, intravenous drug abuse, systemic symptoms, and signs of infection should be managed as an abscess; drainage, appropriate antibiotherapy, and management of risk factors and causes.
Discussion: The usual clinical presentation of pilonidal disease of the penis consists of tender penile swelling, dyspareunia, and purulent discharge, as well as erectile dysfunction which was reported in only one case. In contrast to penile abscess, the presentation usually includes a tender penile swelling, and systemic symptoms such as fever, chills, and night sweats. Physical examination of this patient revealed a non-specific tender, pus-pointing, and pus-containing lesion with mildly erythematous edges, located near the coronal sulcus
Conclusion: Pilonidal cyst of the penis is a rare disease with delayed management in the literature because of misdiagnosis caused by confusion with penile abscess. Though ultrasound could narrow the differential diagnosis, the clinical presentation remains the cornerstone in differentiating between penile abscess and pilonidal sinus
Myocarditis Mimicking ST-Elevation Myocardial Infarction: A Case Report
Get PDFBackground: Myocarditis is the inflammation of the heart muscle, which affects mostly the young population. Patients may experience symptoms ranging from chest pain, fatigue, dyspnea, to more serious conditions such as heart failure and arrhythmias. Diagnosis of myocarditis may be quite confusing as it may mimic myocardial infarction, particularly when ST-elevation is present on electrocardiogram (ECG). Here, we present a challenging presentation of myocarditis mimicking ST-segment elevation myocardial infarction (STEMI).
Case Report: A 54-year-old man admitted to the emergency department due to severe chest pain of two hours duration. Lab tests revealed high levels of troponin and D-dimer. ECG revealed tachycardia and ST-elevation in the anterolateral leads, making the diagnosis towards STEMI very likely. However, coronary angiogram didn’t show any obstruction in the right or left coronary arteries. Cardiac magnetic resonance (CMR) imaging was then performed and showed evidence of myocarditis. The patient was treated with colchicine and beta-blocker in which he showed a gradual recovery.
Conclusion: Our case highlights the difficulties that a physician may encounter when it comes to diagnosing a case of myocarditis. It should always be kept in mind when dealing with patients presenting with chest pain and ST-elevation, as it may mimic a typical STEMI presentation. A thorough clinical evaluation and the choice of appropriate diagnostic tools are key to the diagnosis of such challenging cases
Differentiating Between Mass-forming Chronic Pancreatitis and Pancreatic Ductal Adenocarcinoma: A Challenging Clinical Approach
Get PDFIntroduction: Pancreatic ductal adenocarcinoma (PDAC) is a tumor of the pancreas that has a 5-year survival rate as low as 7.8%. In cases of chronic pancreatitis, it is sometimes challenging to rule out neoplastic changes, as mass-forming pancreatitis (MFCP) that can occur secondary to long-lasting inflammation can commonly mimic the presentation of pancreatic ductal adenocarcinoma. The clinical picture, laboratory, and radiological imaging of PDAC and MFCP may sometimes overlap, resulting in a higher incidence of misdiagnosis and unnecessary surgery.
Aim: We aim to describe the various tools available to help physicians distinguish between mass-forming chronic pancreatitis and pancreatic ductal adenocarcinoma.
Methods: A literature search was conducted on “PubMed” using the following terms: pancreatic carcinoma, mass-forming chronic pancreatitis, and pancreatic mass. Several articles discussing imaging modalities including ultrasound, CT-scan, and MRI; and laboratory markers including cancer antigen 19–9 (CA 19-9), carcinoembryonic antigen (CEA), glypican-1 (GP-1), low-density lipoprotein receptor (LDLR), and K-RAS, were reviewed.
Discussion: Despite their similar presentations, the management of MFCP and PDAC is very different. The similarity in history, clinical symptoms, and imaging findings can lead to unnecessary procedures. In this review, we examined several modalities that physicians might use to avoid any misdiagnosis.
Conclusion: Although none of these tests alone has been shown to be superior to the others, a potential suggestion might be to use a combination of these tests to allow a reliable diagnosis
Abdominal Cocoon Syndrome in a Liver Transplant Patient: A Case Report and Review of the Literature
Get PDFIntroduction: Cocoon syndrome is an uncommon cause of intestinal obstruction caused by the formation of a fibrous band around small intestines, thought to be caused by chronic peritoneal inflammation and associated with several conditions such as liver cirrhosis and liver transplantation.
Case Report: We present a case of a 72-year-old male patient who had liver transplantation three years ago for liver cirrhosis. He had an acute presentation of intestinal obstruction where a computed tomography (CT) scan showed dilated bowel loops and signs of intestinal ischemia, which warranted surgical laparotomy where the diagnosis of cocoon syndrome (sclerosing encapsulating peritonitis) was made and was then treated by adhesiolysis. No immediate or postoperative complications were documented and his life was back to normal.
Conclusion: Therefore, an abdominal cocoon is a challenging diagnosis and should be considered in front of intestinal obstruction, especially in those with risk factors such as liver transplantation
Omental Necrosis and Mesenteric Ischemia Secondary to Hypercoagulability Due to COVID-19: A Case Report
Get PDFBackground: Omentum necrosis is a rare cause of acute abdomen. Its main etiologies are torsion on its axis, hypercoagulability, and intra-abdominal infections. Its clinical diagnosis is difficult since its symptoms resemble other abdominal pathologies, so diagnostic confirmation when the pain is present in the right abdomen, which occurs most frequently, is usually intraoperative Surgical treatment is more effective than conservative management in reducing hospital stays and does not require follow-up.
Case Report: We present the case of a 45-year-old male suspected to be infected with SARS-CoV-2, which potentially triggered hypercoagulability with necrosis of the greater omentum and mesenteric ischemia, requiring multiple surgical interventions.
Conclusion: It is a rare cause of acute abdomen and to the best of our knowledge, the description of the first case of necrosis of the omentum secondary to COVID-19
Diagnosis and Progression of Rectal Signet Ring Cell Carcinoma in a 15 Year Old Lebanese Boy: A Case Report
Get PDFIntroduction: Colorectal cancer (CRC) is a rare entity in children and adolescents compared to adults. In the young, it is mostly detected in the right and transverse parts of the colon. Among the variants of CRC are the uncommon Signet Ring Cell Carcinoma (SRCC) which has a late presentation and pessimistic prognosis. Patients are asymptomatic for a long time and suddenly develop changes in bowel habits or obstruction.
Case Report: A 15-year-old boy with no known health issues presented with recent rectorrhagia and weight loss. He was stable but pale with abdominal tenderness and no rectal mass on digital rectal examination (DRE). Colonoscopy unveiled a 13 centimeters segment of circumferential ulcerated blackish mucosa extending from the upper rectum to the rectosigmoid junction. Pathology studies revealed SRCC of the rectum and sigmoid. Metastatic workup showed rectosigmoid wall thickening and denoted the tumor a stage IV with ascites and intraperitoneal implants. Palliative treatment with chemotherapy was initiated, and a follow-up CT was done later to assess disease progression and response to treatment. The disease had worsened and the patient deteriorated.
Conclusion: In children, colorectal SRCC is scarce and usually presents at a late stage due to the lack of characteristic symptoms and findings. It is then usually missed by physicians and not considered in the differential thus delaying the diagnosis and rendering the prognosis poorer. To improve the outcome, pediatricians ought to keep CRC in mind when facing obstructive symptoms or refractory abdominal pain