De France Hospital Research Articles

The Different Surgical Approaches to Maxillofacial Reconstruction after Ballistic Trauma.

Ballistic trauma to the face is a challenge, combining complex bone injury with severe soft tissue loss. The various surgical methods available are influenced by the extent of injuries. This study compares different operative modalities and their outcomes with different variables, aiming to define the ideal therapeutic approach. We retrospectively compared reconstructive modalities used to treat facial ballistic trauma cases at Hôtel-Dieu de France Hospital, Beirut, Lebanon, for a 12-year span. Statistical analysis was used to determine correlation between several factors and satisfactory results. Eighteen patients were included, with varying degrees of bone and soft tissue loss. After conservative debridement, fractures were treated by different modalities: open reduction and internal fixation, maxillomandibular fixation, and osteosynthesis with a reconstruction plate. Although primary closure was sufficient in 10 cases, severe loss of tissues was reconstructed with a fibular free flap in five cases, radial free forearm flap in two cases, and free parascapular flap in one case. Two others received an iliac bone graft as secondary reconstruction. The average follow-up was 2.45 years. Most cases achieved good aesthetic and functional results after several secondary operations, with few late complications. Early reconstruction and younger patients were associated with better outcomes. We favor early debridement and reconstruction. Free flaps were ideal for extensive tissue loss. Bone grafting was needed secondarily. A single surgical procedure seldom led to satisfactory functional and aesthetic outcomes, and secondary operations were inevitable.

Evolution of Depression and Anxiety among Breast Cancer Patients: a prospective analysis using clinical, biological and genetic factors

IntroductionNumerous studies have explored the symptoms and course of depression and anxiety in breast cancer patients and identified various clinical, sociodemographic, and genetic factors associated with their evolution. Nevertheless, these studies have been limited in duration and have focused on specific time points during chemotherapy or post-treatment follow-up. Furthermore, these studies included patients receiving different treatment regimens and used different tools to assess symptoms.Objectives To assess the prospective evolution of depression in breast cancer patients over eight consecutive chemotherapy cycles, taking into account sociodemographic, clinical, biological, and genetic factors.MethodsA prospective longitudinal study was conducted on 69 breast cancer patients treated with intravenous chemotherapy at the oncology outpatient unit of the Hôtel-Dieu de France hospital (2017-2019; Ethics: CEHDF1016). The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression in patients. Genotyping was performed for several genes (ABCB1, COMT, DRD2, OPRM1, CLOCK, CRY2, PER2) using the Lightcycler® 2.0 (Roche).ResultsUnivariate repeated measures analysis showed differences in the evolution of depression and anxiety over time. For depression, a polynomial linear contrast for HADS-D scores was noted from cycle 1 to cycle 8, with a significant increase in depression at cycles 7 and 8 compared with cycle 1 (p-value cycle7=0.004 and p-valuecycle8=0.009; Figures 1 & 2). Repeated measures analysis for anxiety showed a decrease in anxiety scores between cycles 1 and 6 of chemotherapy, followed by an increase starting cycle 6 (a polynomial trend for contrasts) (p-value cycle6 versus 1=0.038; Figures 1 & 2). Multivariable analysis showed that higher anxiety and depression scores at baseline were both associated with higher depression and anxiety scores over time. Other clinical and genetic factors, including polymorphisms in the OPRM1, PER2, and COMT genes, were also significantly associated with higher depression and anxiety scores.Image:Image 2:ConclusionsOur findings highlight the importance of understanding the trajectories of depression and anxiety over time in women with breast cancer and identifying the triggering factors. Such personalized approaches would improve patient quality of life.Disclosure of InterestNone Declared

Prevalence and predictors of vitamin D deficiency in Lebanon: 2016-2022, before and during the COVID-19 outbreak.

Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years. Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved. Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (<30 ng/mL) decreased from 76.2% in 2016 to 56.5% in 2022 (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables). Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.

Management of the 4th of August explosion in an orthopedics department

Abstract Mass casualty incidents (MCI) are rare, large-scale events that result in heavy damage to people and infrastructure. These types of incidents result in a high influx of patients in local hospitals. In Beirut, this was witnessed on the 4th of August. A massive explosion took place in Lebanon’s capital city Beirut. Although Hotel-Dieu de France Hospital was damaged, it played a crucial role in the management of numerous injured, especially in the orthopedics department. Six months later, the hospital contacted all patients that had been hospitalized during that night and the following 2 days for musculoskeletal injuries. The contact was done for feedback purposes as the event was considered one of the largest non-nuclear explosions in international history. Accordingly, most of the patients that were contacted gave a credible and positive rating. There were few who had suggestions for management improvement. MCIs are rare, but it is crucial to be prepared to face any edging situation. Having effective communication and an organized plan in any risk management process are essential tools to foster for the well of the community and to scale down the losses of the locals in the area.

Pharmaceutical brochures in Lebanon: do they meet WHO recommendations?

BackgroundDrug promoting brochures can influence physicians prescription patterns. The validity of the info presented in these brochures is of major importance. World Health Organization (WHO) issued criteria to guarantee validity, equity and ethical presentation of data in medical brochures. This study aims to evaluate the quality and the validity of information presented in the pharmaceutical brochures distributed among family physicians in Lebanon.MethodsPharmaceutical brochures were randomly collected at the family medicine center in Hôtel Dieu de France hospital in Beirut - Lebanon. These brochures were evaluated in reference to the WHO ethical criteria for medicinal drug promotion and on guidelines for quality assurance of the graphs, references, texts and illustrations.ResultsAmong the 60 brochures collected, only 4 fulfilled all the WHO ethical criteria, and 24 presented less than half the required criteria. Information concerning the drug safety are the least mentioned. Only 11.8% of the presented graphs are based on studies of high methodological level. Half of the brochures presented necessary information to identify studies references which are not always retrievable. Texts present mainly brand names instead of generic names and emphasize on information reflecting the drug efficacy.ConclusionThe pharmaceutical brochures in this study presented incomplete or invalid information. Prescribing physicians should be aware of the claims found in the brochures distributed by pharmaceutical companies and should be familiar with the principles of the evidence-based medicine to be able to critically appraise the validity of the reference studies and avoid the pitfalls in graphs reading.

Genetic susceptibility of bladder cancer in the Lebanese population

BackgroundBladder cancer (BC) is the 10th most frequent tumor worldwide. Evidence shows an association between elevated risk of BC and various single nucleotide polymorphisms (SNP). BC incidence was the highest in Lebanon according to Globocan 2018 report, but little is known about the genetic susceptibility of Lebanese people to this disease. We aim to evaluate whether this prominent incidence of BC in Lebanon is attributable to known coding genetic variants.MethodsA case-control study was conducted at Hotel-Dieu de France Hospital, Beirut. A cohort of 51 Lebanese patients with BC were recruited between 2017 and 2020. Whole Exome Sequencing (WES) was performed on peripheral blood samples to detect coding genetic variants in the patients. An in-house database including WES data from 472 Lebanese individuals served as control. Literature review of the genetic predisposition to BC was conducted to establish a database of variants known to influence the risk of BC. In-common SNPs were identified between cases and the aforecited database, and their allelic frequencies was quantified in the former and in controls. Comparative analysis of the allelic frequencies of each in-common SNP was carried out between cases, controls, and the genome aggregation database (gnomAD). Analysis was performed by applying the binomial law and setting the p-value to 10− 10.Results484 polymorphisms associated with BC were extracted from the literature review ;151 of which were in-common with the 206 939 variations detected by WES in our cases. Statistically significant differences (p-value < 10− 10) in allelic frequencies was seen in 11 of the 151 in-common SNPs, but none of which corresponds with a higher BC risk. Moreover, rs4986782 variant in the NAT1 gene is not associated with BC in the Lebanese population. `.ConclusionThis is the first next-generation sequencing (NGS)- based study investigating BC risk in a Lebanese cohort of 51 patients. The majority of known exonic variants in the literature were not associated with BC in our patients. Further studies with larger sample sizes are warranted to explore the association of BC in our population with known non-coding genetic variants, and the remainder of WES-generated private Lebanese variants.

Validation of an Arabic version of the Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome.

To validate an Arabic version of the short form of the Cambridge-Hopkins diagnostic questionnaire for restless legs syndrome (CH-RLSq13). The Arabic version was created using a standard forward-backward translation method. A pre-final Arabic version was administered with the original English version to a group of bilingual subjects as a pretest. The inter-rater agreement between these two versions was measured. A finalized Arabic version was obtained. For the validation, the Arabic version of the CH-RLSq13 was administered to Lebanese subjects, above 18years old, selected upon a clinical interview. The diagnosis provided by the Arabic version of the CH-RLSq13 was compared to the clinical diagnosis made by a neurologist at Hotel-Dieu de France hospital. Inter-rater agreement was assessed using Cohen's kappa coefficient. Sensitivity, specificity, and positive and negative predictive values of the translated questionnaire were calculated. Inter-rater agreement, between the 2 versions, for the entire questionnaire, was excellent (κ = 0.950). All items showed a substantial level of agreement between the two versions. In the validation process, 91 participants were included (17 patients diagnosed with RLS and 74 control subjects). The mean age was 40years, with female predominance. The final Arabic version of the CH-RLSq13 had a sensitivity of 71%, a specificity of 100%, and with negative and positive predictive values of 94% and 100% respectively. The Arabic version of the CH-RLSq13 is a reliable tool for the screening and diagnosis of RLS in Lebanese and Arabic-speaking populations.

HL-100 Outcomes of Patients With Hodgkin Lymphoma During a Period of Drug Shortage in Lebanon: A Single-Center Experience

Hodgkin lymphoma (HL) represents two-thirds of all lymphomas diagnosed in Lebanon. Due to the COVID-19 pandemic and the unprecedented financial crisis, shortages of oncology drugs are now common in Lebanon. The shortage of conventional agents has created remarkable challenges for both HL patients and health care providers. We lack studies that document the outcome of HL in Lebanon during this period. To determine the outcome of HL patients treated in Lebanon during the period of drug shortages. This retrospective study included 52 HL patients diagnosed between October 2019 and December 2021 at Hôtel Dieu de France Hospital in Lebanon. Patients had classical or nodular lymphocyte-predominant subtypes. The treatment patterns, frequency of incomplete protocols, missing agents, and response to first-line treatment were analyzed. A total of 52 patients were reviewed with a median age of 35 years (range, 15-85 years); 52% were male. In this study, 65% of patients had B symptoms at diagnosis, 70% had no comorbidities, 64% had an advanced stage, 60% had bulky disease, and 90% had low- to intermediate-risk disease according to the International Prognostic Score. The nodular sclerosing subtype was the most common histological subtype (77%). The ABVD regimen was offered to 85% of patients and radiotherapy was offered to 10%. Eleven patients (22%) did not receive the full treatment per protocol due to drug shortage: 8 patients (15%), 2 patients (4%), and 1 patient (2%) had missing bleomycin, dacarbazine, and vinblastine, respectively. Of these patients, 6 (54%) received treatment without the missing agent, 4 (36%) imported the medication from an external source at their own expense, and 1 (9%) was switched to another protocol. Among 11 patients who did not receive proper therapy, the rates of complete response, partial response, stable disease, and progressive disease were 70%, 15%, 5%, and 10%, respectively. In this single-institution study from Lebanon, the outcomes of patients with HL treated during an unprecedented crisis and drugs shortage were comparable to those of previous reports. This emphasizes the resilience of the Lebanese population and adaptability despite hard conditions.

Clinical and genetic factors associated with self-reported cognitive deficits in women with breast cancer: the “CAGE-Cog” study

BackgroundBreast cancer patients undergoing chemotherapy treatment are at particular risk of experiencing acute cognitive impairment leading to daily challenges in decision-making and reduced quality of life and functional autonomy. The aim was to assess the relationship between clinical and genetic factors and cognitive function in a sample of patients with breast cancer undergoing chemotherapy.MethodsA cross-sectional study was carried out between November 2017 and June 2019 on women (N = 112) treated for breast cancer by intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France Hospital, Beirut. Patients were evaluated with the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Other validated scales were also used to assess depression, anxiety, sleep disorders, pain, and fatigue. DNA was obtained by a buccal swab (FTA®technology) for genotyping of different genes (ABCB1, COMT, DRD2, OPRM1, CLOCK, CRY2, and PER2) using the Lightcycler®(Roche).ResultsThe mean age of participants was 56.04 years. Multivariable analysis, taking the four FACT-Cog subscores as the dependent variables, showed that the mean cognitive score decreased with higher depression, anxiety, and insomnia scores. Patients with university education levels had better perceived cognitive abilities than those with primary education. Moreover, carrying the G allele for the OPRM1 polymorphism (c.118A > G;rs197791) was significantly associated with a better cognitive function compared to AA patients (B = 2.05; p = 0.038).ConclusionsA comprehensive oncological care plan should include a personalized assessment of all factors related to cognitive functioning in cancer patients, particularly anxiety and depression, to achieve an optimal patient outcome.

Obesity: A risk factor for postoperative complications in laparoscopic surgery for colorectal cancer.

The prevalence of obesity in the Eastern Mediterranean is increasing significantly up to 20.8% in 2016. Therefore, a higher percentage of colorectal cancer (CRC) patients are expected to be obese. Laparoscopic colorectal cancer surgery (LCRCS) is regarded as a safe and feasible procedure as laparoscopic approach is becoming the gold standard in CRC surgery, especially in the early stages of disease. However, LCRCS is correlated with a higher risk of short-term post-operative complications in obese patients (body mass index [BMI] ≥30 Kg/m 2 ) than in patients with BMI <30 Kg/m 2 . This study aims to evaluate the impact of obesity on short-term post-operative complications in patients undergoing LCRCS. A retrospective study was conducted. Clinical data of case and control patients were extracted from medical records. These patients underwent LCRCS between January 2018 and June 2021 at Hôtel-Dieu de France Hospital, Beirut-Lebanon. Patients were divided into two groups: obese and non-obese. BMI ≥30 Kg/m 2 was used to define obese patients. Post-operative complications in the 30 days following surgery were the primary outcome. The severity of post-operative complications was evaluated using the Clavien-Dindo score. Chi-square test was used to evaluate the statistical correlation between collected variables. We identified 107 patients who underwent LCRCS during this study period at our institution. Among the patients, 23 were obese (21.49%). At 30 days post-operative, 26 patients were reported to having at least one complication. Non-significant differences were found between the two groups regarding the early post-operative complications rate (obese 26.1% and non-obese 23.8% with P = 0.821). Obesity was not demonstrated as a stratification risk by severity of the early post-operative complications ( P = 0.92). Obesity, which was defined as BMI ≥30 Kg/m 2 , was not a risk factor for early post-operative complications as well as a stratification risk by severity of post-operative complications in LCRCS.

Critical Care Nurses' Experiences During the Illness of Family Members: A Qualitative Study.

IntroductionA loved one's hospitalization in a critical care unit is a traumatic experience for families. However, because of their status and professional competence, a family member who is also a critical care nurse has additional obstacles and often long-term consequences.ObjectivesTo describe the experiences of critical care nurse-family members when a loved one is admitted to a critical care unit at the Hotel-Dieu de France hospital.MethodsA qualitative path based on van Manen's hermeneutic phenomenology combining both descriptive and interpretive models were adopted.ResultsThe lived experience of critical care nurses in providing care for their family members admitted into the same critical care were summarized in five themes. Nurses were torn between roles, consisting of confounding roles, their registered nurse status, and watchfulness. The lived experience of critical care nurses in providing care for their family members admitted into the same critical care was summarized into specialized knowledge that included a double-edged sword of seeking information and difficulty delivering the information. Critical nurses compete for expectations, including those placed on self and family members, resulting in emotional and personal sacrifice while gaining insight into the experiences.ConclusionsCritical care nurse-family members have a unique experience compared to the rest of the family, necessitating specialized care and attention. Increased awareness among healthcare providers could be a start in the right direction.

Spirituality and the quality of life of cancer patients: An antidepressant effect

ObjectivesCancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. MethodsThis is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hôtel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. ResultsThirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. ConclusionsOur study is a pilot study which for the first time investigates the implication of depression in a “spirituality-quality of life” association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

CML-296: First-Line Treatment Outcomes of CML Patients in a Real-World Data Setting in Lebanon

Context: BCR–ABL-targeting tyrosine kinase inhibitors (TKIs) constitute the cornerstone of treatment for CML, leading to a life expectancy that is currently very close to that of age-matched individuals in the general population. Objective: To describe aspects of CML in a real-world data setting in Lebanon, including responses to first-line treatment with the first-generation TKI imatinib compared to those with the second-generation TKIs dasatinib and nilotinib. To evaluate the proportion of patients eligible for an attempt to stop TKI treatment. Design: Medical charts of patients diagnosed with CML between 2003 and 2019 were reviewed and updated in January 2020. Settings: Lebanese patients from two university medical centers in Beirut, Mount Lebanon Hospital and Hotel-Dieu de France Hospital, were included. Patients: The registry covered 70 patients, of which 54 patients were included. Inclusion criteria were patients older than 18 years, confirmed diagnosis with CML based on BCR-ABL PCR, and available follow-up data in the clinical chart for at least 2 years. Outcomes: Major and deep molecular responses were based on BCR-ABL1 levels; time of attaining these responses and duration of sustained responses were measured. The reason for switching to another TKI was noted (‘treatment failure’ or ‘intolerance’). Eligibility criteria for an attempt to stop TKI were based on the EURO-SKI trial. Modality of Treatment: Imatinib was given at a dose of 400 mg once daily, nilotinib 300 mg twice daily, and dasatinib 100 mg once daily. Results: 70% of patients were treated with imatinib and 30% with a second-generation TKI. 14% of patients discontinued their first-line treatment, mainly due to intolerance (10%) or treatment failure (5%). At 24 months, deep molecular response (MR4.0 and MR4.5) was achieved, at 15.3% and 40.3%, respectively, for imatinib, and 22% and 33.5%, respectively, for second-generation (p=1). The 5-year cumulative incidence of eligibility for TKI cessation attempt was 37%. Conclusion: We report the experience in CML from two health care institutions in Beirut, Lebanon. There was no statistically significant difference in response between the first- and second-generation TKIs. The criteria for an attempt to stop TKI therapy were met by one-third of patients.

Environmental Exposure in Lebanese Infants (EELI): A Longitudinal Birth Cohort- Pilot Study

BACKGROUND AND AIM: The Environmental Exposure in Lebanese Infants (EELI) study is a longitudinal birth cohort designed to assess a wide range of pre- and post-natal environmental exposures and genetic factors underlying the health and development of Lebanese infants in Beirut. The aim of the study is to better understand the origins of complex and often lifelong diseases like asthma, allergies, and other chronic conditions. METHODS: As part of the EELI study, a sub-cohort study was conducted with pregnant Lebanese women recruited in their third trimester from Hôtel-Dieu de France hospital in Beirut. The mothers, fathers and infants are followed up for 4 months after birth. Upon being recruited, the parents and eventually the infants are screened at critical time points for prospective exposures via standardized questionnaires, clinical tests, and biological samples. RESULTS:The assessment of early-life exposures in domains such as environmental pollutants, lifestyle habits, maternal stress help to elucidate their effect of the aforementioned exposures on growth and development in the fetal and early childhood stage. CONCLUSIONS:As a sub-cohort to a larger multi-year study that will potentially involve 500 Lebanese families, this pilot study also aims to test the interest and willingness of the Lebanese population to participate in environmental health research. KEYWORDS: Air pollution, birth outcomes, children’s environmental health, exposure assessment, pregnancy outcomes

Clinical and genetic factors associated with anxiety and depression in breast cancer patients: a cross-sectional study

BackgroundDespite the progress in assessment and treatment of breast cancer, being diagnosed with it or receiving chemotherapy treatment is still conceived as a traumatic experience. Women develop negative thoughts about life and death with detrimental effects on their daily physical functioning/activities, emotional state and overall quality of life. The aim of our study was to evaluate the level of anxiety and depression among breast cancer patients receiving chemotherapy and explore the correlation between these psychological disorders, clinical, sociodemographic and genetic factors.MethodsA cross-sectional study was conducted among breast cancer patients undergoing intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France hospital (November 2017–June 2019; Ethical approval number: CEHDF1016). All patients gave their written informed consent and completed several validated scales, including the Hospital Anxiety and Depression scale (HADS) for the assessment of anxiety and depression. Sleep quality, insomnia, cognitive function, fatigue and pain were also evaluated. Genotyping for certain gene polymorphisms (CLOCK, PER2, CRY2, OPRM1, ABCB1, COMT, DRD2) was performed using the Lightcycler® (Roche).ResultsA total of 112 women was included. The prevalence of depression was 43.4%, and 56.2% of the patients reported anxiety (based on the HADS classification). Multivariable analysis showed that higher cognitive scores and taking fosaprepitant were significantly associated with lower depression and anxiety scores. Moreover, being married compared to single was also associated with lower depression scores, whereas higher PSQI scores (worse sleep quality) and having the PER2 AA variant genotype compared to GG were significantly associated with higher depression scores. Finally, reporting a more severe insomnia and having the COMT Met/Met genotype were significantly associated with a higher anxiety score.ConclusionsOur study demonstrated a strong relationship between depression scores and cognitive impairment, sleep quality, marital status, fosaprepitant intake, and PER2 polymorphism, while anxiety scores were correlated to cognitive impairment, insomnia severity, fosaprepitant intake, and COMT polymorphism. The association with PER polymorphism was not previously reported. Identification of genetic and clinical risk factors for anxiety and depression would help clinicians implement an individualized management therapy aiming at preventing and alleviating the burden of these symptoms in breast cancer patients, hence improving their overall quality of life.

MRI-based predictive factors of axillary lymph node status in breast cancer.

To evaluate the diagnostic value of diffusion-weighted imaging (DWI) in combination with conventional MRI in predicting metastatic axillary lymph nodes (ALN) in breast cancer (BC). We reviewed pathological findings and clinical breast MRI examinations of 169 patients with invasive BC who were evaluated at the Hôtel-Dieu de France Hospital in 2009-2015. Morphological parameters and apparent diffusion coefficient (ADC) value were compared with pathological nodal status. Independent t-test/chi-square test and a Pearson correlation analysis were used. With pathological diagnosis as reference, MRI-based interpretations were 87.5% specific and 70.3% sensitive. On conventional MRI, the round shape of lymph nodes (LNs), loss of fatty hilum, irregular margins and hypo-intensity/heterogeneous intensity on T2-weighted sequence were statistically significantly different between metastatic and nonmetastatic groups (P<.001, each). Mean size of metastatic ALN was larger compared with negative ALN (13.9mm vs. 10.9mm, P<.001). LNs≥12mm were associated with higher risk of metastasis (P<.001). ADC value was not significantly different between both groups (P=.862). Conventional MRI using the ALN shape, signal intensity in T2-weighted sequences, loss of fatty hilum, regularity of the margins and size of the LNs can evaluate the axilla with high specificity. ADC value could not be used as a reliable parameter.

Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage.

Musculoskeletal disorders remain a major problem in hemodialysis patients. The aim of the study was to estimate the prevalence of musculoskeletal manifestations in hemodialysis patients and identify disease cluster profiles. We performed a cross-sectional study including all adult patients in the hemodialysis unit at Hotel-Dieu de France Hospital. We collected demographic characteristics, musculoskeletal symptoms, biologic parameters, and treatments. Musculoskeletal disorders were classified by a rheumatologist into predefined diagnostic categories. Prevalence was presented, and a cluster analysis was performed. Eighty-nine patients were included, mean age was 67.5 ± 12years, and 43.8% were female. Dialysis vintage was 5.7 ± 5.37years. Musculoskeletal symptoms were reported by 76.4% of the patients. Pain was the most frequent symptom (44.9%). The main diagnoses were osteoarthritis (53.9%) and fracture (27%). Musculoskeletal symptoms and disorders were significantly associated with dialysis vintage and age. Cluster analysis identified three patient profiles: younger with low calcium levels, younger but long dialysis vintage with osteoarthritis and carpal tunnel syndrome, and older with long dialysis vintage and fractures. The prevalence of musculoskeletal manifestations is high in the hemodialysis population and increases with dialysis vintage. Musculoskeletal disorders cluster according to age and dialysis vintage. Key Points• Musculoskeletal symptoms are highly prevalent among hemodialysis patients (76.4%).• All musculoskeletal disorders are associated with dialysis vintage and age.• Three clusters are identified among hemodialysis patients: young with low calcium levels, young but long dialysis vintage with osteoarthritis and carpal tunnel syndrome and old with long dialysis vintage with fractures.

Seizures in Cancer Patients: a Vast Spectrum of Etiologies

Aim: This study aims to recognize the distribution of different seizures etiologies in cancer patients, the most common primary tumors responsible for brain metastases, the most epileptogenic primary tumors and the therapeutic modalities. Methods: A retrospective study was conducted at Hotel-Dieu de France Hospital targeting patients admitted to hematology–oncology department between 2005 and 2016 who presented a seizure. Results: Of the 153 included patients, mean age was 57 years (standard deviation = 16 years) and a male predominance (66%). The majority of seizures were due to a primary tumor (49%) or brain metastases (32%). Other reversible (metabolic and drug) or nonreversible causes (carcinomatous meningitis, radiation and cardiovascular complications) formed the remaining causes. Regarding antiepileptic treatments, sodium valproate was mostly used, followed by levetiracetam and phenytoin. Conclusion: Numerous reversible causes are involved in the onset of epileptic seizures, including metabolic disorders, antibiotics and chemotherapies.

Impact of stress and burnout on the sexual desire of trainee doctors at Hôtel-Dieu de France hospital: A single-institution survey

ObjectivesThe sexuality of doctors in training, interns and residents, is not well explored, especially in its relation to daily stress. The aim of this study is to evaluate the sexual desire of this population, and the effect of burnout caused by the studies and the hospital work, on this function. MethodsMedical trainees from our institution (université Saint Joseph de Beyrouth – Hôtel-Dieu de France), interns and residents, were invited to complete a demographic questionnaire, questions about their work conditions, and validated questionnaires on burnout and sexuality. Selected instruments included “Maslach Burnout Inventory (MBI)” and “Sexual Desire Inventory (SDI)”. Statistical correlations were established using the Student's test, Spearmen's or Pearson's Correlations by type of dependent variable, Chi2 and Anova tests when needed. ResultsWe obtained 262 responses from a population of 300 trainees (131 men and 131 women, mean age 25.1 years). Among them, 123 (46.9%) reported a high burnout score, 137 (52.3%) a high depersonalization score, and 120 (45.8%) a low professional achievement score. Regarding sexuality scores, 21% of men suffered from low sexual desire, compared to 70% of women. It seems that there is a correlation going in the same direction: the more the burnout increases, the more the sexual desire increases, especially among the male population. ConclusionsThese results provide insights into the sexual life of medical students. The rate of low sexual desire among women in medicine in our institution is higher than the world's standard. Additional research is needed.

Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study.

Spiritual well-being was found to have some protective effect against end-of life despair in cancer patients. We aimed at assessing the impact of spirituality on the quality of life, depression, and anxiety of Lebanese cancer patients. Our observational transversal monocentric study was conducted between January and April 2016 among a convenient sample of 115 Lebanese cancer patients admitted to Hôtel-Dieu de France Hospital (HDF), Beirut-Lebanon. In addition to socio-demographic and clinical data, three questionnaires were used: EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 3rd version), FACIT-Sp-12 (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; The 12-item Spiritual Well-Being Scale, 4th version), and HADS (Hospital Anxiety and Depression Scale). Eighteen patients taking anxiolytic and/or antidepressants were not included in the analysis. The remaining 97 patients were analyzed. Better emotional and cognitive functioning was seen in patients with higher meaning, peace, faith, and total FACIT scores. Meaning, peace, and total FACIT scores were also higher among patients with better global health status and quality of life. Anxiety as well as depression was significantly associated to all spiritual well-being factors. Spirituality can improve quality of life and decrease the incidence of anxiety and depression in cancer patients. Our results highlight the need to incorporate spiritual care in healthcare systems.