Impact of online learning during COVID-19 pandemic on digital device related ocular health.

Objective: The aim of this study was to evaluate the impact of the COVID-19 pandemic on ocular health related to digital device usage among university students in Lebanon. Design: A cross-sectional design was utilized to examine the association between the pandemic and ocular health. Participants: A total of 255 university students in Lebanon participated in the study, selected based on their enrollment during the pandemic. Methods: An online survey assessed participants' digital device usage, awareness of digital eye strain, and experienced symptoms. The study addressed the relationship between symptom frequency and screen time, especially in their connection to the pandemic and online learning. Results: Prior to the pandemic, the majority of participants (73.0 %) were unaware of digital eye strain. Following the transition to online learning, nearly half of the participants (47.0 %) reported using digital devices for 12 or more hours. The majority (92.0 %) experienced a substantial increase in daily digital device usage for learning, with an average increase of 3-5 h. Symptoms of digital eye strain, including headache, burning of eyes, blurry vision, sensitivity to light, worsening of vision and dryness of the eyes intensified in both frequency and severity during the pandemic and online learning period. Conclusions: The study emphasizes the importance of promoting healthy habits and implementing preventive measures to reduce the prevalence of digital eye strain symptoms among university students. Healthcare professionals and public health authorities should educate individuals on strategies to alleviate digital eye strain, considering the persistent reliance on digital devices beyond the pandemic.

Pulmonary artery banding: a 20-year experience at a tertiary care center in a developing country.

Aim: Pulmonary artery banding serves as an important palliative procedure used for the management of several congenital heart lesions. This study aims to describe a 20-year experience of pulmonary artery banding at a tertiary care center in a developing country. Methods: This is a retrospective chart review of patients who underwent pulmonary artery banding over a 20-year period between January 2000 and July 2020 in a tertiary care center in a developing country. Data regarding demographics, indications, diagnosis, echocardiographic findings, postoperative complications, hospital stay, and outcomes were recorded. Results: A total of 143 patients underwent pulmonary artery banding between 2000 and 2020, with a decrease from approximately 15 surgeries per year in 2012 to 1-2 surgeries a year in 2020. At the time of banding, the median age of patients was approximately 90 days [interquartile range, IQR, 30-150 days]. Four patients (2.8%) died during the band placement. No significant association was observed between baseline characteristics or type of heart defect at presentation and postoperative morbidity and mortality. Conclusion: Pulmonary artery banding remains useful in a subset of congenital heart lesions and as a surgical palliation, with relatively low mortality, allowing postponement of total correction to a higher weight. This technique continues to be valuable in developing countries or for heart surgical programs with limited resources.

An Emerging Ophthalmology Challenge: A Narrative Review of TikTok Trends Impacting Eye Health Among Children and Adolescents.

In today's digital age, children and teenagers are deeply entrenched in the world of personal electronic devices including laptops, tablets, and smartphones. These serve as gateways to captivate online content. With children as young as 4 years old having access to these gadgets, the potential benefits of technology coexist with many possible risks. One such risk is the growing global issue of myopia. TikTok, a mobile application that gained immense popularity since its inception in 2016, has garnered 1.7 billion active monthly users in 2023 and is expected to reach two billion in 2024. A significant portion of TikTok's user base consists of adolescents, with approximately 41% falling in the 16-24 age group and a third aged 14 or younger. This social media platform has given rise to the phenomenon of "internet challenges," where users complete and share various tasks through videos. While most of these challenges are harmless, some pose serious risks to teenagers who eagerly seek validation and attention from their peers. This manuscript sheds light on a specific subset of TikTok challenges, namely those related to ophthalmological risks. These challenges include "rubbing castor oil trend," "bleach/bright eye challenge," "mucus fishing challenge," "eggsplosions", "beezin challenge", "Orbeez challenge", "blow-drying eyelashes", "sun gazing," and "popping styes". The manuscript emphasizes the importance of monitoring and regulating potentially dangerous content on social media platforms like TikTok. While these platforms offer educational opportunities, they can also promote life-threatening actions, necessitating efforts to protect vulnerable young users and promote safe online engagement.

Modified partial Jensen procedure to treat a hypertropic Knobby eye syndrome in a high myopic monocular patient.

We present a case of severe esotropia and hypertropia in a monocular high myope with an inferolateral staphyloma. Surgery was undertaken to secure the inferior rectus to the lateral rectus via a modified partial Jensen technique, along with medial rectus recession successfully improving head and eye positions and ductions.

Outcomes of critically ill COVID-19 patients boarding in the emergency department of a tertiary care center in a developing country: a retrospective cohort study.

BACKGROUND: Boarding of critically ill patients in the emergency department (ED) has long been known to compromise patient care and affect outcomes. During the COVID-19 pandemic, multiple hospitals worldwide experienced overcrowded emergency rooms. Large influx of patients outnumbered hospital beds and required prolonged length of stay (LOS) in the ED. Our aim was to assess the ED LOS effect on mortality and morbidity, in addition to the predictors of in-hospital mortality, intubation, and complications of critically ill COVID-19 ED boarder patients. METHODS: This was a retrospective cohort study, investigating 145 COVID-19-positive adult patients who were critically ill, required intensive care unit (ICU), and boarded in the ED of a tertiary care center in Lebanon. Data on patients who boarded in the emergency from January 1, 2020, till January 31, 2021, was gathered and studied. RESULTS: Overall, 66% of patients died, 60% required intubation, and 88% developed complications. Multiple risk factors were associated with mortality naming age above 65 years, vasopressor use, severe COVID pneumonia findings on CT chest, chemotherapy treatment in the previous year, cardiovascular diseases, chronic kidney diseases, prolonged ED LOS, and low SaO2 < 95% on triage. In addition, our study showed that staying long hours in the ED increased the risk of developing complications. CONCLUSION: To conclude, all efforts need to be drawn to re-establish mitigation strategies and models of critical care delivery in the ED to alleviate the burden of critical boarders during pandemics, thus decreasing morbidity and mortality rates. Lessons from this pandemic should raise concern for complications seen in ED ICU boarders and allow the promotion of health measures optimizing resource allocation in future pandemic crises.

Sun protection use and habits in the LGBTQI+ community in Lebanon: A cross sectional study.

BACKGROUND: Sun exposure is an extrinsic risk factor for skin aging, wrinkle formation, and the development of skin cancer, namely melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Sun protection measures have emerged as an important means of preventing these harmful effects. Studies have shown that sexual minority men have a greater prevalence of skin cancer than heterosexual men. AIMS: There is limited research investigating the reasons behind this risk of skin cancer development. This is especially important because identifying preventable risk factors, like those pertaining to sun exposure behaviors, can be targeted in the fight against skin cancer and help establish screening tools and preventive interventions for the SGM community. This study focused on members of the SGM community and demonstrated their tendency not to use sun-protective measures, as well as their deficits in knowledge of skin cancer prevention. MATERIALS AND METHODS: This study is a cross-sectional study that investigates sun protection practices and trends among adults in Lebanon's SGM community using a survey. It includes adults aged 18-80 that were recruited from the dermatology clinics at AUBMC as well as LGBTQ+ organizations Helm and SIDC. RESULTS: A total of 129 participants took part in the study and completed the survey. Reasons for tanning varied among our participants: tanning to get a color (13.1%), tanning to get vitamin D (4.6%), tanning socially (6.9%), and tanning for mood elevation (0.8%). No significant association was found between sexual orientation and SPF use (p = 0.167). No significant association was found between sexual orientation and tanning frequency during summer (p-value: 0.231). Similarly, no significant association was noted between sexual orientation and tanning bed use (0.951). No significant association was noted between the type of job and SPF use (p = 0.601). Despite no significance between SPF use and the highest educational degree attained (p = 0.070), the tendency to use SPF increased with higher levels of education. Moreover, awareness of sun-induced skin cancer did not significantly affect SPF use (p = 0.067). However, a significant association was found between the information source for skin cancer and SPF use (p < 0.001) where participants receiving information from dermatologists displayed notably higher SPF use (72.2%), compared to those obtaining information from media (18.2%) or family and friends (5.3%). DISCUSSION: Surveying the perception of the Lebanese SGM community towards sun damage and their adaptive practices to prevent it can help implement and gear a nation-wide campaign to spread proper awareness about this subject. Studying their behavioral tendencies for not using sunscreen can help overcome this contributing risk factor for skin cancers. CONCLUSION: Future investigations have yet to identify confounding variables contributing to higher levels of skin cancers in this population.

Melitracen and flupentixol (deanxit) use disorder in Lebanon.

Introduction: Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit use disorder, assess the source of the medication, and the consumers' awareness of the therapeutic and side effects of Deanxit, among the Lebanese population. Methods: This is a cross-sectional study that included all patients taking Deanxit and visited the Emergency Department between October 2019 and October 2020. All patients who agreed to participate in the research through written consent forms were contacted by telephone and a questionnaire was filled out. Results: A total of 125 patients taking Deanxit were included in the study. According to the DSM-V criteria, 36% (n = 45) had a Deanxit use disorder. Most of the participants were females (n = 99, 79.2%), married (n = 90, 72%), and between the ages of 40-65 years (n = 71, 56.8%). Most patients (n = 41, 91%) had Deanxit prescribed by a physician for anxiety (n = 28, 62%), and obtained it using a prescription (n = 41, 91%). Almost half of all patients (n = 60, 48%) did not have sufficient knowledge of the reason it was prescribed, 54.4% (n = 68) were not sure they are taking the medication appropriately, and 19.2% (n = 23) were satisfied by the overall explanation of the physicians concerning Deanxit use. Conclusion: Deanxit use disorder is underrecognized among Lebanese patients. Most of our patients were prescribed Deanxit by their physicians but reported inadequate knowledge of its side effects and risk of abuse.

Carbapenemase Inhibitors: Updates on Developments in 2021.

Carbapenem resistance, an emerging global health problem, compromises the treatment of infections caused by nosocomial pathogens. Preclinical and clinical trials demonstrate that a new generation of carbapenemases inhibitors, together with the recently approved avibactam, relebactam and vaborbactam, would address this resistance. Our review summarizes the latest developments related to carbapenemase inhibitors synthesized to date, as well as their spectrum of activity and their current stage of development. A particular focus will be on ß-lactam/ß-lactamase inhibitor combinations that could potentially be used to treat infections caused by carbapenemase-producer pathogens. These new combinations mark a critical step forward the fight against antimicrobial resistance.

Pulmonary artery debanding in the cath lab: Lessons learned!

Background: Although primary definitive repair of congenital heart disease has become the preferred management approach, pulmonary artery banding (PAB) remains a valuable palliative procedure used to restrict pulmonary blood flow in certain conditions. However, when the band is to be removed, another surgical intervention is usually required. Methods: To describe percutaneous removal of pulmonary artery band, the medical records of patients who underwent this procedure were reviewed. Results: Between 2000 and 2020, 143 patients underwent PAB. Of these, we attempted balloon debanding of the pulmonary artery in four patients. At the time of the procedure, the average age of patients was 36 ± 6.24 months, and their average weight was 12.37 kg. Band removal via catheter was successful in three cases and was associated with an adequate reduction in pressure gradient across the pulmonary artery band site (average of 71.67 ± 12.58 to 23.67 ± 2.89 mm Hg). None of the patients experienced complications during or after the procedure. Follow-up data after discharge (3-10 years) provides reassuring and satisfactory results. Conclusion: Based on our findings, we suggest that percutaneous removal of the pulmonary artery band might be a safe and effective alternative to surgical debanding. However, studies with a larger sample are required for further clinical implementation of the technique.

Hydroxychloroquine in COVID-19 Patients: Pros and Cons.

The pandemic of COVID-19, caused by SARS-CoV-2, has recently overwhelmed medical centers and paralyzed economies. The unparalleled public distress caused by this pandemic mandated an urgent quest for an effective approach to manage or treat this disease. Due to their well-established anti-infectious and anti-inflammatory properties, quinine derivatives have been sought as potential therapies for COVID-19. Indeed, these molecules were originally employed in the treatment and prophylaxis of malaria, and later in the management of various autoimmune rheumatic and dermatologic diseases. Initially, some promising results for the use of hydroxychloroquine (HCQ) in treating COVID-19 patients were reported by a few in vitro and in vivo studies. However, current evidence is not yet sufficiently solid to warrant its use as a therapy for this disease. Additionally, the therapeutic effects of HCQ are not without many side effects, which range from mild gastrointestinal effects to life-threatening cardiovascular and neurological effects. In this review, we explore the controversy associated with the repurposing of HCQ to manage or treat COVID-19, and we discuss the cellular and molecular mechanisms of action of HCQ.

Inflammatory polyps occur more frequently in inflammatory bowel disease than other colitis patients.

BACKGROUND: Colitis is generally considered a risk factor for colon neoplasia. However, not all types of colitis seem to have equal neoplastic transformation potential. AIM: To determine the prevalence of colorectal polyps in a predominantly African American population with inflammatory bowel disease (IBD) and Non-IBD/Non-Infectious Colitis (NIC). METHODS: We retrospectively evaluated medical records of 1060 patients previously identified with colitis at Howard University Hospital, based on ICD-10 code. Among these, 485 patients were included in the study: 70 IBD and 415 NIC based on a thorough review of colonoscopy, pathology and clinical reports. Logistic regression analysis was applied to estimate the risk of polyps in patients with IBD compared to those with NIC after adjusting for age and sex. A subgroup analysis within the IBD group was performed. RESULTS: Of the 485 patients, 415 were NIC and 70 were IBD. Seventy-three percent of the NIC patients and 81% of the IBD patients were African Americans. Forty six percent of IBD and 41% of NIC cases were male. IBD patients were younger than NIC patients (median age of 38 years vs. 50, P < 0.001). The prevalence of all types of polyps was 15.7 and 8.2% in the IBD and NIC groups, respectively (P = 0.045). Among patients with polyps, the prevalence of inflammatory polyps was higher in the IBD group (55%) compared to the NIC group (12%). After adjusting for age, sex and race, odds ratio of inflammatory polyps in IBD patients was 6.0 (P = 0.016). Adenoma prevalence was 4.3% (3/70) in IBD patients and 3.9% (16/415) in the NIC patients (p = 0.75). The anatomic distribution of lesions and colitis shows that polyps occur predominantly in the colitis field regardless of colitis type. More polyps were present in the ulcerative colitis patients when compared to Crohn's disease patients (27% vs. 5%, P < 0.001) within the IBD group. CONCLUSION: Our study shows that inflammatory polyps are more common in IBD patients when compared to NIC patients. Most polyps were in the same location as the colitis.

MiR-155 and MiR-665 Role as Potential Non-invasive Biomarkers for Hepatocellular Carcinoma in Egyptian Patients with Chronic Hepatitis C Virus Infection.

BACKGROUND AND OBJECTIVES: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer associated death globally. Serum micro RNAs are full of potential as noninvasive biomarkers. Here, we aim to assess the performance of serum MicroRNA-155 and MicroRNA-665 as diagnostic biomarker for HCC comparing to AFP. METHODS: Serum samples were collected from 200 subjects (40 healthy control, 80 chronic hepatitis C patients with cirrhosis and without HCC (LC) and 80 HCC patients currently infected by hepatitis C infection and didn't start the treatment). The HCC patients didn't include alcoholic liver disease, nonalcoholic fatty liver disease nor autoimmune liver disease. MicroRNA-155 and MicroRNA-665 expression were measured by real-time quantitative PCR (RT-qPCR), while AFP level was assessed by ELISA method. RESULTS: Both miR-155 and miR-665 were significantly elevated in HCC group as compared to both control and LC groups. The comparison between LC and HCC patients revealed that the serum level of miR-155 was a significant increase in HCC patients compared to LC patients; however, the serum level of miR-665 didn't show any significant difference between the same two groups. MiR-665 expression level showed a direct correlation with tumor size in HCC patients. CONCLUSIONS: Using measurement against AFP level in serum, miR-665 is considered a promising serum biomarker for the diagnosis of HCC patients among the LC patients without HCC. MiR-155 didn't provide a better performance than serum AFP as a diagnostic biomarker among the same group. MiR-665 may serve as a good indicator for HCC prognosis.

Process change evaluation framework for allogeneic cell therapies: impact on drug development and commercialization.

AIMS: Some allogeneic cell therapies requiring a high dose of cells for large indication groups demand a change in cell expansion technology, from planar units to microcarriers in single-use bioreactors for the market phase. The aim was to model the optimal timing for making this change. MATERIALS & METHODS: A development lifecycle cash flow framework was created to examine the implications of process changes to microcarrier cultures at different stages of a cell therapy's lifecycle. RESULTS: The analysis performed under assumptions used in the framework predicted that making this switch earlier in development is optimal from a total expected out-of-pocket cost perspective. From a risk-adjusted net present value view, switching at Phase I is economically competitive but a post-approval switch can offer the highest risk-adjusted net present value as the cost of switching is offset by initial market penetration with planar technologies. CONCLUSION: The framework can facilitate early decision-making during process development.

A cell engineering strategy to enhance supercoiled plasmid DNA production for gene therapy.

With the recent revival of the promise of plasmid DNA vectors in gene therapy, a novel synthetic biology approach was used to enhance the quantity, (yield), and quality of the plasmid DNA. Quality was measured by percentage supercoiling and supercoiling density, as well as improving segregational stability in fermentation. We examined the hypothesis that adding a Strong Gyrase binding Site (SGS) would increase DNA gyrase-mediated plasmid supercoiling. SGS from three different replicons, (the Mu bacteriophage and two plasmids, pSC101 and pBR322) were inserted into the plasmid, pUC57. Different sizes of these variants were transformed into E. coli DH5α, and their supercoiling properties and segregational stability measured. A 36% increase in supercoiling density was found in pUC57-SGS, but only when SGS was derived from the Mu phage and was the larger sized version of this fragment. These results were also confirmed at fermentation scale. Total percentage supercoiled monomer was maintained to 85-90%. A twofold increase in plasmid yield was also observed for pUC57-SGS in comparison to pUC57. pUC57-SGS displayed greater segregational stability than pUC57-cer and pUC57, demonstrating a further potential advantage of the SGS site. These findings should augment the potential of plasmid DNA vectors in plasmid DNA manufacture. Biotechnol. Bioeng. 2016;113: 2064-2071. © 2016 The Authors. Biotechnology and Bioengineering Published by Wiley Periodicals, Inc.

Allogeneic cell therapy bioprocess economics and optimization: downstream processing decisions.

AIM: To develop a decisional tool to identify the most cost effective process flowsheets for allogeneic cell therapies across a range of production scales. MATERIALS & METHODS: A bioprocess economics and optimization tool was built to assess competing cell expansion and downstream processing (DSP) technologies. RESULTS: Tangential flow filtration was generally more cost-effective for the lower cells/lot achieved in planar technologies and fluidized bed centrifugation became the only feasible option for handling large bioreactor outputs. DSP bottlenecks were observed at large commercial lot sizes requiring multiple large bioreactors. The DSP contribution to the cost of goods/dose ranged between 20-55%, and 50-80% for planar and bioreactor flowsheets, respectively. CONCLUSION: This analysis can facilitate early decision-making during process development.

Breakage of transgenic tobacco roots for monoclonal antibody release in an ultra-scale down shearing device.

Transgenic tobacco roots offer a potential alternative to leaves for monoclonal antibody (MAb) production. A possible method for extraction of MAbs from roots is by homogenization, breaking the roots into fragments to release the antibody. This process was assessed by shearing 10 mm root sections ("roots") in a 24 mL ultra-scale down shearing device, including an impeller with serrated blade edges, intended to mimic the action of a large-scale homogenizer. Size distributions of the remaining intact roots and root fragments were obtained as a function of shearing time. The data suggest that about 36% of the roots could not be broken under the prevailing conditions and, beyond these unbreakable roots, the fragmentation was approximately first order with respect to intact root number. It was postulated that root breakage in such a high shearing device was due to root-impeller collisions and the particle size data suggest that roots colliding with the impeller were completely fragmented into debris particles of the order of 0.1 mm in length. IgG release normalized to release by grinding appeared to lag behind the number of roots that had fragmented, suggesting that a process of leakage followed fragmentation in the ultra-scale down shearing device.

Allogeneic cell therapy bioprocess economics and optimization: single-use cell expansion technologies.

For allogeneic cell therapies to reach their therapeutic potential, challenges related to achieving scalable and robust manufacturing processes will need to be addressed. A particular challenge is producing lot-sizes capable of meeting commercial demands of up to 10(9) cells/dose for large patient numbers due to the current limitations of expansion technologies. This article describes the application of a decisional tool to identify the most cost-effective expansion technologies for different scales of production as well as current gaps in the technology capabilities for allogeneic cell therapy manufacture. The tool integrates bioprocess economics with optimization to assess the economic competitiveness of planar and microcarrier-based cell expansion technologies. Visualization methods were used to identify the production scales where planar technologies will cease to be cost-effective and where microcarrier-based bioreactors become the only option. The tool outputs also predict that for the industry to be sustainable for high demand scenarios, significant increases will likely be needed in the performance capabilities of microcarrier-based systems. These data are presented using a technology S-curve as well as windows of operation to identify the combination of cell productivities and scale of single-use bioreactors required to meet future lot sizes. The modeling insights can be used to identify where future R&D investment should be focused to improve the performance of the most promising technologies so that they become a robust and scalable option that enables the cell therapy industry reach commercially relevant lot sizes. The tool outputs can facilitate decision-making very early on in development and be used to predict, and better manage, the risk of process changes needed as products proceed through the development pathway.