Impact of COVID-19 on Workload and Workflow in Echocardiography Unit in a Tertiary Care University Hospital: A Monocentric Observational Study.

Background: The COVID-19 pandemic is a new unexpected worldwide condition with a heavy burden on health-care institutions and health-care workers. Objective: We sought to examine the impact of COVID-19 on workload and workflow in the echocardiography unit in a tertiary care university hospital. Methods: We conducted a monocentric observational study, evaluating workload and workflow during the COVID-19 year relative to the previous year. Results: The findings show a substantial reduction in workload (55.20%) along with significant changes in workflow in the echocardiography unit during the pandemic. Changes in workflow involved measures implemented for protection, changes in echo indications which became more selective, changes in echo pattern, reduction in human flow in echocardiography laboratory, delays in reporting and archiving, and changes in training and teaching. Conclusion: COVID-19 pandemic had a substantial impact on the echocardiography unit, with a significant reduction in workload and considerable changes in workflow. In the future, it is essential to be better prepared as individuals, health-care workers, health-care institutions, and the general community, to deal better with any potential "invisible enemy."

Child abuse and aggressiveness in individuals diagnosed with schizophrenia in Lebanon.

OBJECTIVES: To identify individual and clinical risk factors of aggressiveness, including exposure to different forms of childhood trauma, in a sample of Lebanese patients with schizophrenia. METHODS: A total of 131 patients diagnosed with schizophrenia participated in this cross-sectional study. RESULTS: Higher physical (Beta = 0.24, p < 0.001) and sexual (Beta = 0.29, p = 0.003) abuse, alcohol drinking (Beta = 1.46, p = 0.008), having a history of head trauma (Beta = 1.10, p = 0.041), and male gender (Beta = -1.59, p = 0.009) were significantly associated with higher mean aggression scores. PRACTICAL IMPLICATIONS: Our investigation of the factors linked to aggressiveness in patients with schizophrenia complement those of earlier findings, showing that the relationship between interacting individual and environmental risk factors and later aggressiveness is quite complex, and needs further longitudinal and prospective studies.

A cross-sectional study of current and lifetime sexual hallucinations and delusions in Lebanese patients with schizophrenia: frequency, characterization, and association with childhood traumatic experiences and disease severity.

BACKGROUND: Till that date, a sparse body of research has been dedicated to perusing psychotic symptoms of sexual type, particularly in psychiatric populations. Our study's objective was to delineate psychotic symptoms with a sexual content, namely sexual delusions and hallucinations, among inpatients diagnosed with schizophrenia in Lebanon, and scrutinize their relationships with the severity of schizophrenia symptoms and childhood abusive events. METHODS: We conducted structured interviews with 167 chronic schizophrenia patients, who completed the Questionnaire for Psychotic Symptoms with a Sexual Content, the Child Abuse Self-Report Scale, and the Positive and Negative Syndrome Scale. RESULTS: 36.5% and 50.3% of the participants screened positive for current and lifetime episodes of sexual delusions and/or hallucinations, respectively. Alcohol drinking (aOR (adjusted odds ratio)current = 2.17; aORLifetime = 2.86) and increased psychological (aORcurrent = 1.09; aORLifetime = 1.09) and sexual (aORcurrent = 1.23; aORLifetime = 1.70) abuse were significantly associated with higher chances of experiencing current and lifetime sexual hallucinations and/or delusions. Additionally, an increased severity of schizophrenia symptoms (aOR = 1.02) was significantly associated with higher chances of current sexual hallucinations and/or delusions, whereas having a university level of education compared to primary (aOR = 0.15) was significantly associated with lower odds of current sexual hallucinations and/or delusions. CONCLUSION: In sum, our findings suggest that sexual psychotic symptoms are prevalent in chronic schizophrenia patients, providing support for their associations with antecedents of childhood traumatic experiences, illness severity, and substance use disorders. They endorse the vitalness of preventive measures against abuse, in order to circumvent such phenomenological outcomes. Our study offers the first data on sexual hallucinations and delusions in a non-Western psychiatric population, thus allowing clinicians and researchers to draw featural comparisons across different cultural settings.

Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review.

Stress echocardiography (SEC) is a technique established more than 35 years ago; however, it is still poorly implemented in many countries and institutions, and this reluctance may be related to many obstacles such as operator skills, lack of awareness or institutional policy. Stress echo was initially used for assessing coronary artery disease (CAD), with respect to myocardial viability, using wall motion response; however, current use of stress echo extends beyond CAD, such as valvular heart disease and diastolic stress test. Dobutamine is a commonly used agent when pharmaceutical approach is implemented. With regard to CAD, there are four stress responses: normal, ischemic, viable and necrotic. A low dose dobutamine protocol is recommended in patients with baseline wall motion abnormalities, and a very low dose dobutamine is used in low flow low gradient aortic stenosis in order to check the flow and contractility reserve. Of note, respecting protocols, indications and contraindications are important to avoid or minimize risks of complications during the procedure. This article presents a focused update and review regarding SEC, along with an overview of the different indications, structures and steps, and obstacles and outcomes; also the article aims to highlight more awareness and sensitization on this useful technique.

Predictors of Undiagnosed and Uncontrolled Hypertension in the Local Community of Byblos, Lebanon.

OBJECTIVE: This study aimed to determine the prevalence and predictors of undiagnosed and uncontrolled hypertension (HTN) in a local community in Lebanon. DESIGN AND METHODS: In this cross-sectional study, we interviewed 911 adults in the local community of Byblos, Lebanon, and 691 were enrolled in the study. Blood pressure (BP), height, and weight were measured. The diagnosis of HTN was based on the 2013 European Society of Hypertension (ESH)/ European Society of Cardiology (ESC) guidelines (systolic BP ⩾140 mm Hg and/or diastolic BP ⩾90 mm Hg). The data collected were analyzed using "Statistical Package for the Social Sciences" software (SPSS). RESULTS: A total of 260 participants were found to be hypertensive, either previously diagnosed or undiagnosed, yielding an overall prevalence of HTN of 37.62%. Of these participants, 149 (57.31%) were previously diagnosed and had controlled BP, and 111 (42.69%) had undiagnosed or uncontrolled HTN. Of these 111 participants, 44 had undiagnosed HTN and 67 were previously documented as hypertensive but had uncontrolled BP. Younger age and the absence of associated cardiovascular comorbidities were found to be associated with undiagnosed HTN, whereas high body mass index, smoking, and nonadherence to therapy were found to be associated with uncontrolled HTN. CONCLUSION AND IMPLICATIONS: This study revealed a relatively high prevalence of HTN in the studied population, along with a high prevalence of undiagnosed and uncontrolled HTN. These findings emphasize the need for wider and more efficient screening strategies to better diagnose and control HTN in the general population.

Perspectives on the value of biomarkers in acute cardiac care and implications for strategic management.

Biomarkers in acute cardiac care are gaining increasing interest given their clinical benefits. This study is a review of the major conditions in acute cardiac care, with a focus on biomarkers for diagnostic and prognostic assessment. Through a PubMed search, 110 relevant articles were selected. The most commonly used cardiac biomarkers (cardiac troponin, natriuretic peptides, and C-reactive protein) are presented first, followed by a description of variable acute cardiac conditions with their relevant biomarkers. In addition to the conventional use of natriuretic peptides, cardiac troponin, and C-reactive protein, other biomarkers are outlined in variable critical conditions that may be related to acute cardiac illness. These include ST2 and chromogranin A in acute dyspnea and acute heart failure, matrix metalloproteinase in acute chest pain, heart-type fatty acid binding protein in acute coronary syndrome, CD40 ligand and interleukin-6 in acute myocardial infarction, blood ammonia and lactate in cardiac arrest, as well as tumor necrosis factor-alpha in atrial fibrillation. Endothelial dysfunction, oxidative stress and inflammation are involved in the physiopathology of most cardiac diseases, whether acute or chronic. In summary, natriuretic peptides, cardiac troponin, C-reactive protein are currently the most relevant biomarkers in acute cardiac care. Point-of-care testing and multi-markers use are essential for prompt diagnostic approach and tailored strategic management.