Beirut Blast 2020: Cries and Bloodshed at the Busiest Hospital.

On August 4, 2020, Beirut experienced a large explosion when 2750 tons of ammonium nitrate detonated in the Beirut port resulting in more than 220 deaths, 76 000 injuries, 300 000 people displaced, and 15 billion dollars loss in property damage. Hôtel-Dieu de France (HDF), one of the largest university hospitals in the capital, has an emergency department that typically accommodates 25 patients. On that night, it received the largest number of injuries and had to accommodate more than 700 casualties within a few hours of the blast. This article describes HDF's preparedness, emergency response, as well as the distribution of admissions to the emergency department, operation rooms, and the general ward. Surge capacity and the triage system are also detailed.

Rare cutaneous manifestation of COVID-19 infection and Pfizer-BioNTech COVID-19 vaccine with a unique pattern similarity.

In December 2019, a new emerging virus causing mild-to-severe pneumonia was detected in China. The virus was described as a variant of SARS-CoV and was called SARS-CoV-2, then declared a pandemic by the WHO on 11 March 2020. Millions of people contracted the virus and presented with a symptomatology of variable severity, including upper respiratory tract symptoms, systemic symptoms and diarrhea. We herein report a rare skin presentation in a 33-year-old female that occurred both during COVID-19 infection and after receiving the first dose of COVID-19 vaccine.

[Anticholinergic syndrome after intoxication by lupine seeds (Tourmos)]. / Syndrome anticholinergique après intoxication par des graines de lupin (Tourmos).

INTRODUCTION: Yellow lupine seeds (Tourmos) are frequently used as snack in Lebanon but their potential toxicity is extremely rare (five published cases) and often undiagnosed. CASE REPORTS: Two patients presented with anticholinergic syndrome (mydriasis, mouth dryness, palpitations, general malaise) after ingestion of 200-500 g of bitter lupine seeds (not soaked enough in water). No other cause of intoxication was found, and symptoms disappeared spontaneously in 24-36h. DISCUSSION: Yellow lupine seeds need a long preparation (boiling then soaking with several changes of water) to debitter before consumption. The spontaneous bitter taste is mainly due to the presence of a toxic substance with anticholinergic properties, lupanine. An insufficient preparation or a preference for bitter lupin can result in intoxication.

Effects of clopidogrel on soluble CD40 ligand and on high-sensitivity C-reactive protein in patients with stable coronary artery disease.

BACKGROUND: Antiplatelet therapy with clopidogrel decreases ischemic complication especially in patients with acute coronary syndromes or after percutaneous coronary interventions. Our study was designed to test the effects of clopidogrel on soluble CD40 ligand (sCD40l) and on high-sensitivity C-reactive protein (hs-CRP) in patients with stable coronary artery disease (CAD). METHODS: This is a randomized, double-blind, placebo-controlled study. A total of 73 patients with stable CAD for > 6 months were randomized to receive either clopidogrel (loading dose 300 mg followed by 75 mg/d) for 8 weeks or placebo. Soluble CD40 ligand and hs-CRP were measured at baseline and at completion of the study. RESULTS: All patients were on aspirin therapy, and 74% were on statins. Median and interquartile ranges (IQR) of sCD40l decreased from 64 pg/mL (43-99) at baseline to 53 pg/mL (35-77) at 8 weeks (P = .03) in the clopidogrel group and remained unchanged in the placebo group (59 pg/mL, IQR 35-77 vs 55 pg/mL, IQR 35-78) (P = non significant). Levels of hs-CRP were not affected by therapy and remained unchanged in both groups. CONCLUSIONS: In patients with stable CAD, clopidogrel inhibits the release of sCD40l by platelets, which may contribute to the clinical benefit provided by this drug. This, however, does not translate in a reduction of subclinical inflammation, as measured by hs-CRP.