Cerebrovascular disease in patients with COVID-19 infection: a case series from Lebanon.

COVID-19 has been associated with a variety of multi-organs complications, with an increasing proportion of patients presenting with neurologic manifestations. There is still an uncertainty in the relationship between stroke and COVID-19. Therefore, in this study, the authors report 18 cases of acute stroke occurring in the setting of COVID-19 infection, including 11 ischaemic strokes and 7 haemorrhagic strokes and identified in a Lebanese tertiary hospital. In this case series, patients with ischaemic and haemorrhagic stroke had elevated markers of inflammation and coagulation. Ischaemic stroke patients were treated with different regimens of anti-platelets, anticoagulants, and thrombolytic therapies. Death was the most common outcome observed and was associated with the severity of COVID-19 infection.

Neurological Manifestations of Coronavirus Disease 2019 in Hospitalized Patients: A Lebanese Cohort Study.

BACKGROUND: Concerns regarding potential neurologic complications of COVID-19 are being increasingly reported worldwide. Our objective was to investigate the neurologic complications of COVID-19 among a cohort of Lebanese patients with SARS-CoV-2 infection admitted to Rafik Hariri University Hospital (RHUH), the leading COVID-19 testing and treatment center in Lebanon. METHODS: This is a retrospective, single-center, observational study conducted from March to July 2020 at RHUH, Lebanon. RESULTS: Of 169 hospitalized patients with confirmed SARS-CoV-2 infection (mean {SD} age was 45.75 {19} years and 62.7% were men), 91 patients (53.8%) had severe infection and 78 patients (46.2%) had non-severe infection according to the American Thoracic Society guidelines for community-acquired pneumonia. Overall, 112 patients (66.3%) developed neurologic symptoms: CNS (46.1%), PNS (43.7%), and skeletal muscle injury (2.4%). Compared with patients with non-severe infection, patients with severe infection were significantly older, were male and more likely to have underlying disorders, especially diabetes and cardiac or cerebrovascular disease. Moreover, those patients experienced more typical COVID-19 symptoms at onset of illness such as fever, cough and fatigue. However, there was no significant difference in the frequency of all nervous system manifestations between the severe and the non-severe infection groups (57 {62.6%} vs 55 {70.5%}; p =0.316), except for impaired consciousness, where seven patients had impaired consciousness in the severe group compared to none in the non-severe group (p=0.012). CONCLUSION: A wide variety of neurologic symptoms were detected in our Lebanese cohort of hospitalized COVID-19 patients. A comprehensive knowledge of the neurologic manifestations will help healthcare providers to be more attentive to these complications.

The Effectiveness of COVID-19 Vaccines in Preventing Hospitalizations During the Delta Wave: A Patient-Population Study at a Major Referral Center.

Background and objective Coronavirus disease 2019 (COVID-19) has turned into a deadly global pandemic since its first discovery in Wuhan, China in December 2019. Safe and effective vaccines against COVID-19 have been introduced to the public and have been shown to reduce the severity of the disease and related mortality rates. COVID-19 vaccination was first introduced in Lebanon in mid-February 2021. In this study, we analyzed the effectiveness of vaccination against COVID-19-related hospitalization during the Delta wave at a major referral center in Lebanon. Methods This patient-population study was conducted on patients hospitalized with COVID-19 between July 1, 2021, and September 30, 2021, at the Rafik Hariri University Hospital (RHUH) in Beirut, Lebanon. Data were collected directly from the patients or from digitized records and included demographic characteristics (age, sex, and comorbidities), vaccination status, oxygen requirement, and outcomes. National vaccination data were collected from the daily bulletin provided by the Lebanese Ministry of Public Health. The data collected were analyzed using SPSS Statistics Version 19.0 (IBM Corp., Armonk, NY). Results A total of 289 patients were included in the study, of whom 90.3% were unvaccinated and 9.7% were vaccinated with at least one dose of a two-dose regimen. Only 4.5% of the 289 patients were fully vaccinated. Among those fully or partially vaccinated, the mean time from symptom onset to hospitalization was shorter but the hospital stay was longer compared to the unvaccinated group. The mortality rate was higher in the unvaccinated group (25.7%) compared to 14.3% among the vaccinated. The vaccine effectiveness compared to the national vaccination rate (22.5% in the population after the first and second dose) was 71.71% and 83.78% respectively. Conclusion The findings of this study highlight the fact that complete/partial vaccination against COVID-19 was highly protective against severe disease and hospitalization during the period with a predominance of the Delta variant in Lebanon.

Clinical and epidemiological characteristics of the first 150 patients with COVID-19 in Lebanon: a prospective descriptive study.

Background: Clinical features of confirmed COVID-19 cases cover a wide spectrum. Aims: To study the clinical, radiological and virological features of the first 150 patients with COVID-19 in Lebanon. Methods: Our university hospital was designated as the primary COVID-19 care centre in Lebanon. Between 21 February 2020, the date of the first confirmed case of COVID-19 in Lebanon, and 3 April 2020, our team treated 150 patients diagnosed with COVID-19. In this prospective descriptive study, we present our experience in treating these patients, specifically the diagnostic criteria, outcome, and demographic, clinical, radiological and biological characteristics. Results: Ninety-five (63.33%) of the patients were male and 55 (36.67%) were female. Most patients (58%) were aged > 50 years, and 8 (5.33%) were healthcare workers. Diagnosis was based on reverse transcription polymerase chain reaction, and patients were classified as mild, moderate or critical. Fifteen (10%) patients had a critical presentation and fever was the most prominent symptom at presentation. One hundred and thirty-eight (92%) patients underwent radiological evaluation. The most common laboratory findings were lymphocytopenia (34.38%), followed by neutropenia (28.13%), but leukocytosis was not prevalent (1.56%). Old age and comorbidity were significant indicators in patient risk stratification. Chest computed tomography was an invaluable method of diagnosis and management. Our radiological findings were consistent with the published literature. Conclusion: Our study underlines the variable presentation of COVID-19, the difference in severity, and the diverse methods of diagnosis. This suggests the need for a tailored approach, taking into consideration the wide spectrum of presentation.

Epidemics and local governments in struggling nations: COVID-19 in Lebanon.

Municipalities in Lebanon represent local governments at the basic community level. The proximity of the municipality to the local community and its knowledge of available resources, can be crucial in easing the impact of any disaster. This study aimed to document the range of preparedness/reactivity of municipalities as COVID-19 swept through Lebanon. A qualitative case study was implemented to explore municipal response to control the epidemic, using in-depth semi-structured interviews with twenty-seven stakeholders from nine municipalities across all governorates in Lebanon. In each municipality, participants included mayors/deputy mayors, available members of municipal councils, prominent community leaders, health care professionals, and managers of local NGOs. The collected data were analyzed using the comparative thematic analysis. The socioecological model was adopted to illustrate the dynamic interplay between the barriers and facilitators at all ecological levels. The response to the pandemic differed significantly in volume and nature among different municipalities across regions, with rural areas clearly disadvantaged in terms of adequacy and completeness of response. Barriers consistently mentioned by most municipalities included economic collapse and poverty, shortage in resources, lack of support from the central government, stigma, lack of awareness, underreporting, flaws in the MOPH surveillance system, impeded accessibility to healthcare services, limited number and weak role of municipal police, increased mental illnesses, and political patronage, favoritism, and interference. On the other hand, increased donations, community engagement, social support and empathy, sufficient human resources, the effective role of healthcare systems, and good governance were identified as key facilitators. The socioecological model identified several multi-level facilitators and loopholes which can be addressed through a suggested strategic "roadmap" providing evidence-based interventions for future epidemics. It is crucial meanwhile that the central government strengthens the administrative and financial resources of municipalities in preparing and rapidly deploying the expected optimal response.

Questioning the sex-specific differences in the association of smoking on the survival rate of hospitalized COVID-19 patients.

INTRODUCTION: In the absence of a universally accepted association between smoking and COVID-19 health outcomes, we investigated this relationship in a representative cohort from one of the world's highest tobacco consuming regions. This is the first report from the Middle East and North Africa that tackles specifically the association of smoking and COVID-19 mortality while demonstrating a novel sex-discrepancy in the survival rates among patients. METHODS: Clinical data for 743 hospitalized COVID-19 patients was retrospectively collected from the leading centre for COVID-19 testing and treatment in Lebanon. Logistic regression, Kaplan-Meier survival curves and Cox proportional hazards model adjusted for age and stratified by sex were used to assess the association between the current cigarette smoking status of patients and COVID-19 outcomes. RESULTS: In addition to the high smoking prevalence among our hospitalized COVID-19 patients (42.3%), enrolled smokers tended to have higher reported ICU admissions (28.3% vs 16.6%, p<0.001), longer length of stay in the hospital (12.0 ± 7.8 vs 10.8 days, p<0.001) and higher death incidences as compared to non-smokers (60.5% vs 39.5%, p<0.001). Smokers had an elevated odds ratio for death (OR = 2.3, p<0.001) and for ICU admission (OR = 2.0, p<0.001) which remained significant in a multivariate regression model. Once adjusted for age and stratified by sex, our data revealed that current smoking status reduces survival rate in male patients ([HR] = 1.9 [95% (CI), 1.029-3.616]; p = 0.041) but it does not affect survival outcomes among hospitalized female patients([HR] = 0.79 [95% CI = 0.374-1.689]; p = 0.551). CONCLUSION: A high smoking prevalence was detected in our hospitalized COVID-19 cohort combined with worse prognosis and higher mortality rate in smoking patients. Our study was the first to highlight potential sex-specific consequences for smoking on COVID-19 outcomes that might further explain the higher vulnerability to death from this disease among men.

The Lebanese COVID-19 Cohort; A Challenge for the ABO Blood Group System.

A sudden outbreak of pneumonia caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has rapidly spread all over the world facilitating the declaration of the resultant disease as a pandemic on March 2020. Predisposing factors for acquiring COVID-19 and for developing a severe form of this disease were postulated to be related to the epidemiological, clinical, and genetic characteristics of the patients. Biological markers such as the ABO blood group system were amongst these factors that were proposed to be linked to the variability in the disease course and/or the prevalence of the infection among different groups. Herein, we conducted the first retrospective case-control study from the Middle East and North Africa that tackles the association between the blood group types and the susceptibility to, as well as the severity of, SARS-CoV-2 infection. Contrary to the most acknowledged hypothesis, our results challenged the significance of this association and questioned the role of the ABO blood group system in dictating the severity of this disease. For future similar studies, we endorsed analyzing larger cohorts among different populations and we encouraged implementing more rigorous approaches to diminish the potential confounding effect of some underlying comorbidities and genetic variants that are known to be associated with the ABO blood group system.

Using the liquid nature of the stationary phase in countercurrent chromatography. IV. The cocurrent CCC method.

The retention volumes of solutes in countercurrent chromatography (CCC) are directly proportional to their distribution coefficients, K(D) in the biphasic liquid system used as mobile and stationary phase in the CCC column. The cocurrent CCC method consists in putting the liquid "stationary" phase in slow motion in the same direction as the mobile phase. A mixture of five steroid compounds of widely differing polarities was used as a test mixture to evaluate the capabilities of the method with the biphasic liquid system made of water/methanol/ethyl acetate/heptane 6/5/6/5 (v/v) and a 53 mL CCC column of the coil planet centrifuge type. It is shown that the chromatographic resolution obtained in cocurrent CCC is very good because the solute band broadening is minimized as long as the solute is located inside the "stationary" phase. Pushing the method at its limits, it is demonstrated that the five steroids can still be (partly) separated when the flow rate of the two liquid phases is the same (2 mL/min). This is due to the higher volume of upper phase (72% of the column volume) contained inside the CCC column producing a lower linear speed compared to the aqueous lower phase linear speed. The capabilities of the cocurrent CCC method compare well with those of the gradient elution method in HPLC. Continuous detection is a problem due to the fact that two immiscible liquid phases elute from the column. It was partly solved using an evaporative light scattering detector.