International Journal of Clinical Research
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A Cross-Sectional Study of the Alarming Prevalence of Smoking Among Lebanese Physicians and Its Negative Impact on Promoting Cessation
Get PDFBackground: There is a paucity of data on the prevalence of smoking among physicians. As physicians are on the front line caring for patients’ health, a detailed analysis of their smoking habits and its impact on counseling their patients to quit is warranted. So far, no study in Lebanon has addressed the real prevalence of physicians smoking and its impact on promoting cessation. This study aims to fill this purpose.
Methods: A cross-sectional study conducted using a web-based self-administered questionnaire was e-mailed to 4037 Lebanese physicians between November 2015 and February 2016. The questionnaire included 11 questions about basic sociodemographic information (age, gender, work province, specialty), smoking habits and attitude towards smoking cessation. SPSS was used for analysis. The main outcome was to calculate the percentage of physicians that smoke, its relationship to gender and age, and its impact on counseling their patients about smoking cessation.
Results: 529 responders were analyzed (13.1% response rate). A high rate of physician ever-smokers was noted at 37% (n=195) whereas the prevalence of current smokers was 13% (n=70).. In addition, there was a difference in the gender of ever-smoking physicians where 47% of males were smokers compared to 20% of females only. Regarding the prevalence of smoking within different specialties, it was noted that 35% (n=74) of internal medicine physicians were ever-smokers compared to approximately 50% (n=51/102) of surgeons. There was a statistically significant difference between former-smokers and current-smokers in regards to how frequently they urge their patients to quit smoking.
Conclusion: The high prevalence of smoking among Lebanese physicians is depicted and its negative impact on counseling patients to quit is a serious consequence. This is a major drawback in the fight against tobacco and further awareness may be needed among our future doctors to increase smoking cessation counseling and decrease the burden of smoking in Lebanon and worldwide
Coronavirus Disease (COVID-19) Associated Rhinocerebral Mucormycosis and Complications: A Case Report
Get PDFBackground: Mucormycosis is a rare fatal infection caused by a ubiquitous fungus from the order of Mucorales, which can have varying clinical presentations. Immunocompromised patients are particularly susceptible to mucormycosis and can suffer fatal consequences if not treated adequately. COVID-19 infection with its immunomodulatory properties has been associated with a wide range of secondary bacterial and fungal infections. We present a case of rapidly progressive rhinocerebral mucormycosis post-COVID-19 infection with the subsequent development of several complications associated with the disease.
Case Report: A 62-year-old male patient with a history of hypertension and diabetes mellitus type II, presented 14 days post-COVID-19 recovery with right facial swelling, erythema, and right eye proptosis. Throughout his disease, the patient developed blindness and cranial nerve palsies. He was also found to have palatal necrotic lesions, consistent with the diagnosis of mucormycosis. The patient’s disease was complicated by Garcin syndrome, meningitis, orbital apex syndrome, cavernous sinus thrombosis, brain infarction, and hemorrhage. Despite all measures and interventions, the patient died.
Conclusion: COVID-19 infection and its treatments are associated with an increased risk of secondary fungal infections like mucormycosis. As such, a high index of suspicion is needed amongst healthcare workers for the early diagnosis and treatment of such opportunistic infections since prompt treatment is associated with a marked improvement in outcome. Furthermore, optimal glucose control and judicious use of corticosteroids in COVID-19 patients decreases the risk of developping such life threatening superinfections
Necrotizing Fasciitis Causing Complete Femoral Vessels Necrosis and Thrombosis in an Intravenous Drug Abuser: A Case Report
Get PDFBackground: Intravenous drug abuse is an anciently known health and social problem worldwide. The nonsterile application of addicting drugs leads to severe life-threatening vascular complications. The femoral triangle is an easy target for this purpose. Groin necrotic fasciitis (NF) with vessel necrosis is a challenging diagnosis that requires prompt treatment.
Case Report: A 44-year-old male intravenous drug user presented for a left groin pain. He was diagnosed by computed tomography scan to have necrotizing fasciitis. Urgent debridement was performed and identified infected and necrotic ruptured femoral vessels without active bleeding. Debridement with vessel ligation was performed, and delayed revascularization was planned. The patient was admitted six weeks later with a left fifth toe necrosis and delayed arterial revascularization was performed via extra-anatomic trans-obturator ilio-femoral anastomosis. The patient had a favorable follow-up.
Conclusion: NF in intravenous drug abusers should always be taken into consideration when a patient presents with groin pain and swelling. Urgent surgical control should be established. Extra-anatomical trans-obturator ilio-femoral anastomosis is a good option for revascularization
SARS, MERS, COVID-19: Identification of Patients at a Higher Risk: A Narrative Review
Get PDFThe different presentations, comorbidities, and outcomes of COVID-19 highlight the importance of early identification and proper triage of patients. High-risk patients can be divided into patients with common comorbidities and patients with special categories. Common comorbidities include, but are not limited to, Cardiovascular Disease (CVD), Diabetes Mellitus (DM), immunosuppression, underlying respiratory disease, and obesity. Certain categories of COVID-19 patients are also at increased risk, including neonates and pregnant women. In the present article, we delineate the reported risk factors for acquisition of infection, and for increased severity of the clinical disease. We also comparatively analyze those risk factors associated with COVID-19 and with the antecedent human acute respiratory syndrome-causing viruses, SARS-CoV-1 and MERS-CoV. We hypothesize that the structural similarities of the three viruses predict a similarity in the profile of high-risk patients. Several pathophysiological patterns have been detected to support this theory
COVID-19 Infection Post-Laparoscopic Sleeve Gastrectomy: A Case Report and Review of Literature
Get PDFBackground: COVID-19 caused the suspension of elective surgeries in several hospitals around the world, in an attempt to help contain the spread of the virus. However, a safe resumption of such surgeries is warranted to reduce further burden on patients. It is important to understand when, how and where to resume elective surgeries, as published data suggested that peri-operative COVID-19 infection incurred an increased risk of morbidity and mortality to surgical patients.
Case Report: A 25-year-old patient presented for fever 5 days post Laparoscopic Sleeve Gastrectomy. He was diagnosed with COVID-19 using a PCR test. The patient was managed at home with symptomatic therapy. No life-threatening complications were reported during or after his infection.
Conclusion: Based on available data, our literature review regarding peri-operative COVID-19 complications, bariatric surgeons have to balance between the risk of undergoing an elective surgery like metabolic bariatric surgeries and the risk of postponing this procedure and thus delaying the resolution of obesity along with its comorbidities
Successful Resection of an Endobronchial Pleomorphic Adenoma Using Cryotherapy: A Case Report
Get PDFBackground: Pleomorphic adenomas are very rare benign bronchial tumors. They are typically either removed surgically, or if not amenable to surgery, via therapeutic bronchoscopy. We present the first case of an endobronchial pleomorphic adenoma removed by cryotherapy.
Case Report: This is the case of a 54-year-old man with a right middle lobe pleomorphic adenoma that was detected incidentally during a bronchoscopy, which was performed due to acute respiratory failure and presence of ground glass opacities on imaging. The tumor led to a chronic cough and partial right middle lobe atelectasis. It was resected successfully using endobronchial cryotherapy without any noted complications. There has been no recurrence of disease one year after the intervention.
Conclusion: This is the first report in the literature of a pleomorphic adenoma successfully removed via cryotherapy without recurrence. Endobronchial cryotherapy appears to be an effective and safe method of removing endobronchial pleomorphic adenomas.
Borderline Serous Papillary Tumor Arising in a Paraovarian Cyst: A Case Report and an Extensive Review of the Literature
Get PDFBackground: Paraovarian cysts are benign cysts that develop near the ovaries and fallopian tubes in the pelvic region. They can cause mass effects requiring excision. In rare cases, tumors may develop inside these cysts. These tumors may be benign, malignant, or borderline.
Case Report: A 26-year-old lady presented for excision of a paraovarian cyst. Pre-operative imaging showed the presence of few undulating folds at the periphery of the cyst. The patient underwent laparoscopic pelvic cystectomy without intra-operative drainage. Pathological examination of the specimen revealed a borderline serous papillary tumor protruding from the cyst wall.
Conclusion: The occurrence of a borderline tumor, also known as a tumor of low malignant potential, in a pre-existing paraovarian cyst is very rare and has only been reported few times in the literature. A thorough review of these cases showed that the most common imaging finding that raises suspicion for a borderline tumor within a paraovarian cyst is the presence of small intracystic projections within the unilocular adnexal cyst. However, since evaluating the presence of an intracystic tumor is not always possible, performing a fertility-preserving laparoscopic cystectomy without cyst content spillage, is recommended. If properly excised, the prognosis of this tumor is good, and recurrence is rare
Comorbidities and Negative Prognostic Factors in Lebanese Patients Presenting with Acute Decompensated Heart Failure with Preserved Ejection Fraction: A Multicenter Retrospective Study
Get PDFBackground: Congestive heart failure is responsible for repeated hospital admissions. It is classified into three types: (1) Heart Failure with reduced ejection fraction, (2) Heart failure with mid-range ejection fraction, and (3) Heart failure with preserved ejection fraction (HFpEF). It is essential to describe the risk factors of HFpEF patients' profiles as targeting them is crucial for management.
Aim: Our retrospective study aims to identify the clinical and echocardiographic characteristics associated with HFpEF and its mortality among hospitalized patients with acute decompensated heart failure.
Methods: 390 patients of all age groups presenting with acute heart failure decompensation at Mount Lebanon Hospital (MLH) and Middle East Institute of Health (MEIH, Bsalim) were recruited retrospectively between January 2014 and December 2016. We included 133 cases of HFpEF and collected data on each case including: baseline characteristics and comorbidities, electrocardiograms, laboratory studies, and echocardiographic parameters.
Results: The 133 Lebanese patients having HFpEF were elderly (76 ± 10 years), with predominantly female gender (56%). Hypertension (87.96%) and diabetes (53.38%) were the most frequently reported comorbidities. The overall in-hospital mortality was 4.5%. Data was compared between living and deceased patients and the frequency of valvular heart disease (p=0.005) and chronic kidney disease (p=0.018) was significantly higher among deceased patients. Right ventricular (RV) dilation on echocardiography was significantly correlated with mortality. Elevated troponin, increased creatinine, hypochloremia, hyponatremia, and anemia were all lab markers associated with increased mortality (p<0.05).
Conclusion: Patients with HFpEF represent 43.5% of all decompensated HF cases, with chronic kidney disease, valvular heart diseases, anemia and troponinemia, being the predominant risk factors for adverse clinical outcomes. HFpEF remains an enormous burden on cardiologists for appropriate evaluation, triage, and management
COVID-19 Myocarditis Clinical Presentation, Diagnosis and Management: A Narrative Review
Get PDFObjective: The purpose of this article is to review the cases of myocarditis in COVID-19 patients and synthesize the current understanding regarding the presentation, diagnosis, and management of myocarditis in the setting of COVID-19 disease.
Background: The novel coronavirus disease has shown serious implications for the cardiovascular system, including acute myocardial injury, arrhythmias, venous thromboembolism, and myocarditis. Several cases of myocarditis in COVID-19 patients have been reported since the disease's emergence at the end of 2019. The diagnostic approach and management have been variable. The purpose of this narrative review is to gather the most reliable published material regarding myocarditis in COVID-19 and present it as an overview to simplify the current understanding we have of this disease.
Methods: We screened PubMed, Scopus, and Embase. We then selected peer-reviewed and pre-print articles published in English that were related to the involvement of the cardiovascular system in COVID-19, with a focus on myocarditis. We included case reports describing myocarditis in COVID-19 patients and summarized their clinical presentation, diagnosis, and management. References of the selected articles were also screened, and some were included when relevant.
Discussion: This article is subdivided into sections that discuss the clinical presentation of COVID-19 myocarditis and move on to various diagnostic approaches and management options. Each subsection presents a brief literature review followed by a summary and interpretation of what was found in the reported cases.
Conclusion: After noticing the involvement of the cardiovascular system in COVID-19 patients, specifically through myocarditis, we present this narrative review to provide the medical community with a unified article regarding the current understanding of myocarditis in COVID-19 patients. This article further stresses the necessity of establishing proper treatment guidelines for COVID-19 myocarditis
Lyme Borreliosis Associated with Sensorineural Hearing Loss: A Case Report
Get PDFBackground: Lyme borreliosis is a tick-borne infection caused by Borrelia species. It has a geographic distribution that makes it more frequent in certain regions like like North America and Europe. It manifests in a wide range of symptoms but is often under-investigated in patients presenting with sensorineural hearing loss (SNHL).
Case Report: In this report, we describe a case presenting with SNHL as a manifestation of neuroborreliosis in a female adult patient suffering from Lyme disease, with multiple metachronous symptoms, including arthritis and seizures. Lyme borreliosis (LB) was clinically diagnosed and supported by positive serologic tests, along with Babesiosis. The patient was treated with intravenous (IV) ceftriaxone and azithromycin, in addition to oral atovaquone. Improvement after 4 weeks of IV ceftriaxone was noted in all aspects, including SNHL and arthritis.
Conclusion: LB is a possible, but rare, etiology of hearing impairment. It has been documented that if treatment is initiated early, improvement and even complete recovery are possible. Hence, in a patient presenting with SNHL and a high index of suspicion for LB, assessment for LB is warranted