Prevalence of anxiety and depression among Lebanese women using oral contraceptives: a cross-sectional study.

BACKGROUND: Oral contraceptives (OCs) are used worldwide, including Lebanese women. However, the association between OCs use and anxiety or depression remains unclear. This study aims to assess the prevalence of anxiety and depression among Lebanese women using oral contraceptive pills and investigate the differential impact of combined oral contraceptives (COCs) versus progestogen-only pills (POPs) on mental health outcomes. METHODS: A cross-sectional study was conducted among a sample of Lebanese women using OCs between January and March 2023. Nine hundred nighty seven out of the 2051 women who took part in the survey met our criteria and were included in this study. Data on anxiety and depression were collected using validated and reliable scales, the Arabic versions of the Generalized Anxiety Disorder-7 Questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses, including multivariate analysis, were performed to assess the association between OCs type (COC vs. POP) and anxiety/depression. RESULTS: The prevalence of anxiety and depression among Lebanese women taking OCs was found to be 39.9% and 64.3%, respectively. Furthermore, the study revealed that POP users had 2.8 times higher odds of developing anxiety (adjusted odds ratio ORadj = 2.8 with 95% confidence interval CI of 1.770 to 4.435) p-value < 0.001 and 9.2 times higher odds of developing depression (adjusted odds ratio ORadj = 9.2 with 95% confidence interval CI of 5.790 to 14.506) p-value < 0.001 compared to COC users. CONCLUSION: The results of this study shed light on the elevated prevalence of anxiety and depression among Lebanese women using OCs and emphasized the varying effects of COCs and POPs on their mental health outcomes. Further research is needed to comprehensively understand this association, considering both the dosage and specific type of oral contraceptive to improve the overall well-being of women using these contraceptives.

Association Between Positive Troponin and Fear of Earthquakes: A Retrospective Study.

Introduction The association between natural disasters and cardiovascular events has been well-established. However, the impact of earthquakes on cardiac health, and the role of fear in this association, remains unclear. This study aims to examine the association between positive troponin levels, indicating cardiac ischemia, and fear of earthquakes among Emergency Room patients at a referral center in Beirut, Lebanon. Materials and methods This is a retrospective study conducted on patients who presented to the Emergency Room with suspected cardiac symptoms and were ordered a troponin level after the Kahramanmaras earthquake that occurred on the sixth of February 2023 and affected many neighboring countries, including Lebanon. A control group was taken from the same period in 2022 (January-February) and from the period prior to the earthquake (January up to 6 February 2023). Patients were divided into three groups: the first group (group 1) comprised patients who presented during January and February 2022 (period 1). The second group (group 2) included patients who presented from January up to the sixth of February 2023, when the Kahramanmaras earthquake occurred (period 2). The third group (group 3) consisted of patients who presented after the earthquake until the end of February 2023 (period 3). Patients who consented to participate in the study were sent a questionnaire to assess their Fear of Earthquake Scale (FES), chief complaints, date of presentation to the Emergency Room, past medical history, and other socio-demographic data. Results Our study involved 1410 participants, with 782 belonging to group 1, 470 to group 2, and 158 to group 3. The mean age was 62.96 ± 17.87 for the total population and 63.9 ± 18.49 for patients of group 3. The number of positive troponin results was higher during period 3 (62% of participants) in comparison to period 2 and 1 (22.1% and 28.5% of participants respectively) (p<0.001). Positive troponin was significantly more common among patients who are non-smokers (53%, p-value <0.001), with a negative family history of premature cardiac diseases (93.9%, p-value <0.05), previously healthy (46.9%, p-value <0.001) and presenting to the Emergency Room for dyspnea or palpitations (17.3% each, p-value <0.001). In addition, patients who tested positive for troponin had a higher mean FES (27.89 ± 1.23 versus 20.47 ± 6.02) and a higher mean age (71.07 ± 14.33 versus 52.25 ± 18.69) in comparison to those who tested negative for troponin (p-value <0.05). Conclusion This study suggests that fear of earthquakes may be associated with cardiac ischemia, as indicated by positive troponin levels. Healthcare providers should be aware of the potential impact of natural disasters on cardiovascular health and take measures to address patients' fears and concerns.

Complete Atrioventricular Canal Defect in a Non-syndromic Adult Patient: An Unusual Presentation.

This case report presents a 30-year-old male patient with a history of autism spectrum disorder who experienced a drastic decline in physical activity in recent years. Upon examination, the patient was found to be relatively bedridden, lethargic, and unable to maintain an upright gait, accompanied by severe clubbing. Transthoracic echocardiography revealed a massive 4 cm complete atrioventricular canal (CAVC) defect. Although the patient was asymptomatic throughout most of his life, the CAVC defect appeared to have progressively impacted his health and activity tolerance. The importance of a multidisciplinary approach in early detection and timely intervention in managing CAVC defect is emphasized in this case.

Isolated Dextrocardia With Situs Solitus Diagnosed in a Centenarian Patient: A Case Report.

This case report presents a rare instance of dextrocardia with situs solitus in a centenarian patient, where the heart is abnormally positioned on the right side of the chest due to embryological development anomalies. The patient, a 102-year-old male with no significant medical history, sought medical attention for cataract surgery and was incidentally found to have a systolic murmur over the left upper sternal border, prompting further evaluation. Echocardiographic assessments revealed moderate aortic stenosis. Further imaging with an upright chest X-ray confirmed the presence of dextrocardia with situs solitus. This intriguing case exemplifies the complexities of diagnosing rare congenital anomalies and underscores the importance of comprehensive evaluations even in elderly patients.

Sleep Quality and Nicotine Dependence Among Lebanese University Residents and Fellows: A Cross-Sectional Study.

Background and objectives Sleep quality and nicotine addiction are important public health issues with significant negative impacts on individual well-being and the performance of healthcare professionals. This study aims to determine the prevalence and association of nicotine dependence and poor sleep quality among residents and fellows enrolled in the Lebanese University. Methods A cross-sectional study using the snowball-sampling technique was conducted in Lebanon between January and March 2023. Data were collected through an online survey that included information on socio-demographic characteristics, nicotine dependence, and sleep quality. A total of 350 residents and fellows were included in the study. Bivariate analysis and multivariable logistic regression were carried out to identify the factors associated with sleep quality. Adjusted odds ratio and 95% confidence intervals were reported. Results One quarter (25.1%) of the residents and fellows were smokers; among them, 44.3% smoked I Quit Ordinary Smoking (IQOS), 14.8% smoked cigarettes, 10.2% smoked waterpipe (WP), 12.5% smoked cigarettes and WP, and 18.2% smoked IQOS and WP. According to the Pittsburgh Sleep Quality Index (PSQI), 34.3% of participants had poor sleep quality. Smokers had 12.5 times higher odds of experiencing poor sleep quality compared to non-smokers (adjusted odds ratio ORadj = 12.58 with 95% confidence interval [CI] of 7.07-22.36; p-value <0.001). In addition, smoking a combination of two types of tobacco products (cigarettes with WP or IQOS with WP) posed the highest risk of poor sleep quality, with an adjusted odds ratio of 31.54 (95% CI of 9.15-45.74, p-value <0.001). Elevated Fagerström Test for Nicotine Dependence (FTND) and Lebanon Waterpipe Dependence Scale (LWDS-11) scores indicated an increased risk of poor sleep quality (adjusted odds ratio ORadj = 4.69 with 95% CI of 2.179-10.10; p-value <0.001; and adjusted odds ratio ORadj =1.27 with 95% CI of 1.04-1.55; p-value 0.019, respectively). Conclusion Our study found a significant association between nicotine dependence and poor sleep quality among medical residents and fellows, with smokers being more susceptible to sleep disturbances. The high prevalence of IQOS smoking among medical residents and fellows in Lebanon highlights the urgent need for comprehensive research investigating the effects of heated tobacco products. Furthermore, our study reveals a critical insight into the potential additive effects of nicotine, suggesting that the concurrent use of multiple tobacco products may further elevate the risk of poor sleep quality. Recognizing the implications of our findings, it is imperative to develop targeted interventions and educational programs that promote healthier sleep habits and facilitate smoking cessation among medical residents and fellows.

From Cardiac Mystery to Dental Discovery: Resolving Recurrent Infection in a Prosthetic Heart Valve Patient.

We present the case of a 71-year-old female with a history of surgical bioprosthetic aortic valve replacement who developed a liquefactive abscess near the mitral valve trigone following Streptococcus gallolyticus bacteremia. The patient initially presented with dyspnea and symptoms of an upper respiratory tract infection. A trans-esophageal echocardiogram revealed mitral valve vegetation and a possible source of sepsis near the prosthetic aortic valve. However, it was the identification of multiple silent dental abscesses during a routine dental check-up that led to the resolution of the patient's symptoms and the eradication of the infectious process. This case highlights the importance of considering dental infections as a potential cause of recurrent bacteremia and infectious complications in patients with prosthetic heart valves.