Assessing the psychological impact of Beirut Port blast: A cross-sectional study

Beirut Port blast's magnitude is considered the third after Hiroshima and Nagasaki atomic bombings. This blast occurred in the densely populated section of Beirut, leaving more than six thousand injured patients. The psychological disturbances were assessed in the blast survivors who presented to the Emergency Department (ED) at the American University of Beirut Medical Center (AUBMC). This was a cross-sectional study at the ED of AUBMC. Identified patients were contacted and consented to participate in the study. Post-Traumatic Stress Disorder (PTSD) was selected as an outcome. Depression, PTSD, and concussion were assessed using patient health questionnaire (PHQ)-9, PTSD checklist for DSM-5 (PCL5), and brain injury symptoms (BISx) tools, respectively. The association of patients and injury characteristics with the study outcome was assessed using logistic regression. 145 participants completed the study procedures. The participants' average age was 39.8 ± 15.4 years, and 60% were males. Almost half of the participants showed depression on PHQ, and 2-thirds had PTSD. The participant's age was negatively associated with PTSD, whereas being a female, having depression, and having a concussion were positively associated with PTSD. The results of this study were in line with the previous literature report except for the association between younger age and PTSD, which warrants further investigations to delineate the reasons

The Arabic Hospital Anxiety and Depression Scale: validation in a sample of Lebanese patients with cancer

Abstract Background Depression and anxiety are common comorbid psychological disorders among patients with cancer. Despite the wide use of the Arabic Hospital and Anxiety Scale (HADS) in oncological settings, it has not been yet validated among Lebanese patients with cancer. We aimed to assess the reliability and validity of the HADS in a sample of Lebanese patients with cancer. One-hundred one Lebanese patients diagnosed with cancer presenting to the Ambulatory Care Center in the Hematology Oncology Department at the American University of Beirut Medial Center filled the Arabic version of the HADS. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire 9-Item Scale (PHQ-9) were used to assess its concurrent validity in capturing anxiety and depression, respectively. Results Reliability analysis using Cronbach’s alpha (α) coefficient revealed good internal consistency for the Arabic HADS (α = 0.89) and both subscales (α = 0.86 for depression and α = 0.78 for anxiety). Correlations between HADS with both GAD-7 and PHQ-9 were statistically significant and strong for both depression (r = 0.795; p < 0.0001) and anxiety (r = 0.727; p < 0.0001). Confirmatory factor analysis revealed that the observed data fits the two-factor model of depression and anxiety (Kaiser–Meyer–Olkin = 0.86; Tucker Lewis Index = 0.879; root-mean-square error of approximation = 0.08). Depression and anxiety rates were approximately 52% and 25%, respectively. Conclusion We conclude that the Arabic version of the HADS is a credible and valid tool for clinical assessment of psychological distress (anxious and depressive states) among Lebanese patients with cancer

Biomarkers of delirium and relation to dementia among the elderly in the intensive care unit: A narrative review

Delirium is a neuropsychiatric disorder highly prevalent in the intensive care unit (ICU), especially among elderly patients. Symptoms develop suddenly over a short period of time in the form of a fluctuating mental state marked by severe inattention and disturbance in cognition. Dementia, on the other hand, develops over a long period of time as a result of a neurodegenerative disorder. In this review, we aim to identify overlapping biomarkers between delirium and dementia to have a better understanding of the underlying pathophysiological mechanisms relating these two disorders. Overlapping biomarkers included low levels of albumin and IGF-1, a presence of the APOE ε4 allele (APOE ε4 +), as well as higher levels of of AβN-40, S100β, procalcitonin, IL-1β, NfL, prolactin, creatinine, MMP-9, and homocysteine. We put forward several hypotheses on the convergence of the pathophysiology of these two disorders. It is plausible that ICU-acquired delirium arises as a sign of prodromal dementia or as a result of chronic systemic inflammation and concomitant neuroinflammation due to an increase in S100β proteins in the brain as a byproduct of chronic glial activation. Simultaneously, accumulation of creatinine may render the functioning of the kidneys sub-optimal, which can have deleterious effects on cognitive functioning, while lower serum albumin can increase the risk of Aβ accumulation in the brain and therefore increase the likelihood of delirium and future dementia. Moreover, homozygosity in the APOE ε4 allele coupled with elevated plasma CRP might increase the risk of delirium and trigger the onset of Alzheimer’s disease (AD). Therapeutic approaches targeting the above biomarkers need to be the subject of further investigation, especially among those exhibiting persistent delirium

Psychological distress experienced by self-quarantined undergraduate university students in Lebanon during the COVID-19 outbreak

IntroductionQuarantine, although essential during contagious outbreaks, has been correlated with poor psychological outcomes in the general population. Such outcomes include low mood, suicide, and post-traumatic stress symptoms. Studies have mostly looked at the mental health of general citizens, healthcare workers, or infected survivors, with limited research targeting university students. This study aimed to understand the psychological distress experienced by self-quarantined undergraduate university students in Lebanon during the COVID-19 outbreak.MethodsUndergraduate students enrolled at the American University of Beirut were invited to participate in a 47-item online questionnaire. 73 participants completed the questionnaire. Demographic data, data about COVID-19 exposure, stressors during quarantine, understanding the rationale, compliance, and difficulties associated with quarantine, and levels of psychological distress were analysed.Results75.3% of the participants were considered as having a high risk of developing acute stress. Undergoing quarantine for more than 14 days, having a chronic medical illness, inadequate access to supplies, and fear of infection were all significantly associated with an increased risk of acute stress.ConclusionDespite being a necessary preventive measure during infectious disease outbreaks, quarantine can be associated with negative psychological effects, particularly in undergraduate students. Providing preventive and effective interventions is of utmost necessity

Characteristics and management of patients with substance use disorders referred to a consultation-liaison psychiatry service in Lebanon

Abstract Background This study explores the characteristics and management of individuals with substance use disorders (SUDs) who were referred to the consultation-liaison psychiatry (CLP) service in a tertiary care center in Lebanon. As part of the Consultation-Liaison at the American University of Beirut (CLAUB) analysis, we conducted a retrospective record review of patients referred to our CLP service between February 2019 and May 2020. We assessed differences between SUD and non-SUD consults using chi-square analysis, Fisher’s exact test, or Mann–Whitney U test, as appropriate. Results Of 1475 patients, 278 (18.8%) received a diagnosis of SUD. They were mostly males (73.7%) with an average age of 38.8 years. The most used substances were alcohol (60%) and cannabis (28.4%). Compared to non-SUD consults, patients with SUDs were more likely to be males (odds ratio OR = 3.18, p < 0.001) and to get intubated during admission (OR = 1.81, p = 0.048). Predictors of intensive care unit admission in patients with alcohol use disorder included pulmonary or endocrinological disease, benzodiazepine use disorder, and days until CLP referral. Conclusions The results of this study highlight the high prevalence of alcohol use among individuals with SUD referred to the CLP service. Additionally, they underscore the limited treatment avenues available in this part of the world. The institution of a comprehensive CLP service is crucial to address the unmet needs of patients with SUDs who present to a general hospital setting

End-Tidal CO

This prospective study included 32 patients undergoing cardiopulmonary bypass (CPB) for elective coronary artery bypass grafting correlates the respiratory end-tidal CO2 (ETCO2) during partial separation from CPB with cardiac output (CO) following weaning from CPB. After induction of general anesthesia, a pulmonary artery catheter was inserted for measurement of cardiac output by thermodilution. Patients were monitored using a 5-lead ECG, pulse oximeter, invasive blood pressure monitoring, rectal temperature probe, and end-tidal capnography. At the end of surgery, patients were weaned from CPB in a stepwise fashion. Respiratory ETCO2 and in-line venous oximetry were continuously monitored during weaning. The ETCO2 was recorded at quarter pump flow and after complete weaning from CPB. Following weaning from CPB, CO was measured by thermodilution. The CO values were correlated with the ETCO2 during partial bypass and following weaning from bypass. Regression analysis of ETCO2 at quarter-flow and post-bypass CO showed significant correlation (r = 0.57, p 30 mm Hg during partial CPB will always predict an adequate CO following weaning from CPB. An ETCO2 <30 mm Hg may denote either a low or a normal cardiac output and hence other predictive parameters such as SvO2 must be added

SARS-CoV-2 involvement in central nervous system tissue damage

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread globally, it became evident that the SARS-CoV-2 virus infects multiple organs including the brain. Several clinical studies revealed that patients with COVID-19 infection experience an array of neurological signs ranging in severity from headaches to life-threatening strokes. Although the exact mechanism by which the SARS-CoV-2 virus directly impacts the brain is not fully understood, several theories have been suggested including direct and indirect pathways induced by the virus. One possible theory is the invasion of SARS-CoV-2 to the brain occurs either through the bloodstream or via the nerve endings which is considered to be the direct route. Such findings are based on studies reporting the presence of viral material in the cerebrospinal fluid and brain cells. Nevertheless, the indirect mechanisms, including blood-clotting abnormalities and prolonged activation of the immune system, can result in further tissue and organ damages seen during the course of the disease. This overview attempts to give a thorough insight into SARS-CoV-2 coronavirus neurological infection and highlights the possible mechanisms leading to the neurological manifestations observed in infected patients

Management of psychiatric conditions and delirium during the COVID-19 pandemic across continents: lessons learned and recommendations

Background: With the uncertainties of COVID-19, people infected with coronavirus present with diverse psychiatric presentations. Some institutions have had to manage their patients with existing protocols, others have had to create them. In this article we aimed to report the challenges and good practices in the management of psychiatric conditions and delirium coexisting with COVID-19 across continents. Methods: Early Career Psychiatrists (ECPs) from across five continents were approached to share their experiences on the management of psychiatric conditions in patients with COVID-19 during the current pandemic. Results: We collected information about the experiences from sixteen countries. Commonalities were similar psychiatric presentations and poor preparedness across countries. Differences were varying adjustments made in the management of psychiatric conditions coexisting with COVID-19 and different innovations. Good practices which can be adopted by other countries are novel approaches such as telepsychiatry, proactive consultation-liaison units and enhanced community services targeted at circumventing challenges faced when providing mental health services. Conclusions: These findings highlight the need for global preparedness in the mental health sector during outbreaks of infectious diseases, and the need for concerted efforts targeted at global and locally sensitive adaptation of existing protocols and the development of new guidelines for the management of psychiatric conditions for the present pandemic and subsequent occurrences