Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country.

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis in all surgical risk groups. Reports of clinical outcomes post-TAVR in developing countries are scarce. We aimed to address the clinical outcomes and safety profile of TAVR in a developing country. METHODS: We conducted a single-center, retrospective study on patients undergoing TAVR at the American University of Beirut Medical Center (AUBMC) from January 2016 to April 2023. We included a total of 399 patients. Our primary endpoint was to assess the rate of TAVR in-hospital and 30-day mortality, neurologic events, and new permanent pacemaker implantation (PPI) in patients, stratified by the Society of Thoracic Surgeons (STS) risk of mortality score. RESULTS: Survival rates were 98.7% (394) at discharge vs. 97.5% (389) at 30 days post-procedure. The technical success rate was 95% (379) at the end of the procedure. Device success and early safety rates were 93.5% (373) and 83% (331), respectively at 30 days post-procedure. The all-cause mortality rate increased from 1.3% (5) at discharge to 2.5% (10) at 30-day intervals. The rate of ischemic stroke was 1.3% (five) at discharge and increased to 2% (eight) at 30 days post-procedure. PPI was needed in 5.8% (23) of patients at discharge with an increase to 7% (28) at one-month interval. Overall, the rates of TAVR outcomes among the three risk groups were comparable including neurologic events, valve-related complications, bleeding problems, vascular and access-related complications, and myocardial infarction. CONCLUSION: This study at AUBMC highlights the successful implementation of the TAVR program in a developing country, showcasing its efficacy and safety within 30 days post-operation, despite challenges such as financial constraints and limited access to specialized training. Larger cohorts and longer follow-up periods are needed to accurately represent clinical outcomes in developing countries.

Case report: acute myocardial infarction in the setting of acute transcatheter aortic valve thrombus.

We describe a case of valve thrombosis and a subsequent thromboembolic event within only 10 days of transcatheter aortic valve implantation (TAVI). Postprocedural anticoagulants are not standard of care medications post-TAVI in patients without atrial fibrillation. Valve thrombosis is an indication to initiate anticoagulation to resolve and prevent further thrombus.

Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess: a case report.

BACKGROUND: Human brucellosis is the most frequently contracted zoonotic infection worldwide. Although being an old disease that carries minimal risks of mortality, it remains a source of considerable sequelae and disability. However, noncontiguous multifocal spinal involvement is an exceptional presentation of brucellosis; additionally, an associated paravertebral abscess is extremely rare. CASE PRESENTATION: This paper focuses on a 67-year-old Lebanese woman with noncontiguous multifocal Brucella spondylodiscitis, involving the T12-L1 and L3-L4 segments, with paravertebral abscess formation. She presented with a 3-week history of acute severe lumbar back pain, radiating to the lower extremities and associated with impaired mobility and lower extremity weakness. The patient complained of night sweating but had no fever. No lymphadenopathy, hepatomegaly, or splenomegaly could be observed. She had painful percussion of the lumbar spine, painful passive mobilization, and paravertebral tenderness, yet her neurological examination was completely normal. BrucellaCapt test was positive at a titer of 1/5120 (reference range 1/180). The patient was treated with an inpatient regimen for 2 weeks, which was followed by an outpatient oral antibiotic regimen with doxycycline, rifampin, and ciprofloxacin to complete a total treatment duration of 3 months. Magnetic resonance imaging was performed at the end of the treatment and showed a complete resolution of the paravertebral abscess. CONCLUSION: Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess is an extremely rare presentation. It may be effectively managed by antibiotic therapy, without surgery or drainage, in the absence of neurological complications. Nonetheless, the principal challenge to an efficient management is establishing the diagnosis of Brucella in the first place. In endemic countries, a strong suspicion of spinal involvement of brucellosis should be elicited in front of back pain presentations-even in the absence of fever and other related symptoms.

Adaptation of the Young Adults' Cigarette Dependence (YACD) Scale for the development and validation of the Adolescent Cigarette Dependence Scale (ACDS).

Vulnerable adolescents may lose control over cigarette use within a day or two after smoking their first cigarette, as nicotine dependence (ND) symptoms may appear before actual daily smoking and usually occur at low levels of daily smoking. Moreover, smoking can cause illnesses and promote other types of substance abuse. Therefore, it was deemed essential to adapt the Young Adults' Cigarette Dependence (YACD) Scale to develop and validate the Adolescent Cigarette Dependence Scale (ACDS) in Lebanese adolescents and evaluate whether cumulative cigarette smoking is associated with nicotine dependence and symptoms of dependence. A cross-sectional study was carried out between August and September 2020, during the partial sanitary lockdown imposed by the government to limit COVID-19, coinciding with the summer holidays for most Lebanese. The total sample consisted of 564 community-dwelling adolescents aged 13 to 18. A factor analysis was performed using a varimax rotation. The Kaiser-Meyer-Olkin (KMO) measurement of sampling adequacy and Bartlett's sphericity test were appropriate. The factors retained corresponded to Eigenvalues > 1. Cronbach's alpha value represented the internal consistency of the scale. The Hooked on Nicotine Checklist (HONC) was used to screen for dependence symptoms. All items of the YACD were extracted, except for items 4 (smoking to concentrate at work) and 18 (smoking as a habit), which yielded a three-factor solution (factor 1 = smoking patterns; factor 2 = positive and negative reinforcements; factor 3 = smoking cessation) with Eigenvalues > 1 (variance explained = 56.18%; KMO = 0.784; Bartlett's sphericity test p < 0.001; αCronbach = 0.875). The newly generated scale was termed Adolescent Cigarette Dependence Scale (ACDS) and consisted of 19 items. Higher ACDS scores (higher cigarette dependence) were significantly associated with higher HONC scores (higher symptoms of dependence) (rho = 0.647; p < 0.001). Having deceased (B = 8.54) or divorced (B = 4.26) parents and higher cumulative cigarette smoking (B = 0.29) were significantly associated with higher ACDS scores. Higher cumulative cigarette smoking (B = 0.05) was significantly associated with higher HONC scores due to cigarettes. This study could validate a new tool to evaluate nicotine dependence among Lebanese adolescents, the Adolescent Cigarette Dependence Scale (ACDS). This version adapted from the Young Adults' Cigarette Dependence (YACD) Scale is reliable and valuable and correlates well with other scales, such as the HONC. However, further studies are necessary to improve this instrument, adding new questions useful for the diagnosis and evaluation of cigarette dependence.