Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

IntroductionReports of multisystem inflammatory syndrome in children (MIS-C), following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, have been increasing worldwide, with an incidence varying significantly across studies based on the definition used for the diagnosis. At our tertiary medical center in Lebanon, we encountered several cases that presented a diagnostic challenge because they mimicked MIS-C but did not meet the US Centers for Disease Control and Prevention (CDC) definition. We decided to review these cases and describe their features in comparison with cases that met the CDC criteria of MIS-C and those that had an alternative diagnosis.MethodsThis is a retrospective chart review of subjects aged <19 years old admitted to the American University of Beirut Medical Center (AUBMC) between March 1, 2020, and May 31, 2021, with suspected or confirmed MIS-C, following documented COVID-19 infection, with sufficient or insufficient criteria for diagnosis. Subjects were classified into 3 groups: “MIS-C”, “Near MIS-C” and “Alternative Diagnosis”.ResultsA total number of 29 subjects were included in our cohort. Fever was present in all subjects. In the MIS-C group, evidence for cardiovascular system involvement was the most common feature followed by the mucocutaneous and gastrointestinal systems. In the “Near MIS-C” and “Alternative Diagnosis” group, gastrointestinal symptoms were the most common with only one patient with cardiac abnormalities and none with coagulopathy. Subjects with typical MIS-C presentation had higher inflammatory markers when compared to subjects in the other groups. Almost all the subjects had positive IgG for SARS-CoV-2. Of the 29 subjects, the Royal College of Paediatrics and Child Health (RCPCH) case definition would have identified all suspected cases without an alternative diagnosis as MIS-C, whereas the World Health Organization (WHO) and the CDC definitions would have excluded 6 and 10 subjects, respectively.ConclusionMIS-C presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria. Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions

Cannabis use and psychosis among patients hospitalized in psychiatric wards in Lebanon: a retrospective chart review

Abstract Background Trends in cannabis use suggest a global increase in the past decade. Current evidence associates cannabis use with an increased risk of psychosis. This association has prompted a growing research interest in the association between cannabis use and psychiatric disorders, especially psychotic disorders. This study aims to gain a better understanding of the effect of cannabis on psychosis and its clinical progression. Results We conducted a retrospective chart review of cannabis use in patients hospitalized for a psychosis episode over five years at the American University of Beirut Medical Center (AUBMC). Cannabis users were more likely to be young single males using other substances compared to non-cannabis users. Frequent cannabis use was associated with a higher likelihood of paranoia and legal problems. Other psychotic symptoms did not significantly differ between frequent cannabis users and non-users. The length of hospital stay and the duration of the psychotic episode did not significantly differ between cannabis users and non-users. Family stressors and family history of a psychotic disorder were associated with a higher likelihood of personal history of violence. Conclusions This study is the first in Lebanon to reproduce findings supporting the association between cannabis and psychosis previously highlighted in other populations. Further prospective research is needed to better understand the effect of cannabis use on psychosis and to accordingly revise policies on cannabis legalization to reduce the global burden of psychotic disorders

Feasibility of a novel ultra-low-cost bubble CPAP (bCPAP) System for neonatal respiratory support at Muhimbili National Hospital, Tanzania.

ObjectiveContinuous Positive Airway Pressure (CPAP) is recommended in the treatment of respiratory distress syndrome of premature newborns, however there are significant barriers to its implementation in low-resource settings. The objective of this study was to evaluate the feasibility of use and integration of Vayu bCPAP Systems into the newborn unit at Muhimbili National Hospital in Tanzania.Study designA prospective qualitative study was conducted from April 6 to October 6 2021. Demographic and clinical characteristics of patients treated with Vayu bCPAP Systems were collected and analyzed. Healthcare workers were interviewed until thematic saturation. Interviews were transcribed, coded, and analyzed using a framework analysis.Results370 patients were treated with Vayu bCPAP Systems during the study period. Mean birth weight was 1522 g (500-3800), mean duration of bCPAP treatment was 7.2 days (ConclusionsIt was feasible to implement and integrate Vayu bCPAP Systems into the care of neonates at Muhimbili National Hospital