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Background: The side-comparative coracoclavicular (CC) distance is used to describe the vertical instability component of acute acromioclavicular (AC) joint dislocations. Elevation of the clavicle or a depression of the shoulder girdle can lead to an increased CC distance. The dislocation direction has not yet been investigated and is not included in common classification systems. Hypothesis: Clavicle elevation is primarily responsible for vertical dislocation in AC joint separation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Weighted and nonweighted bilateral plain anteroposterior views of the shoulder girdles of patients with AC joint dislocations (Rockwood [RW] types III and V), diagnosed in our trauma department between 2001 and 2018, were included in this study. After determining the CC distance, a side-comparative determination of the positions of both the clavicle and shoulder girdle, with reference to the spinal column, was conducted. Results: In total, 245 bilateral plain anteroposterior views were evaluated (RW III, n = 116; RW V, n = 129). All patients showed a side-comparative clavicle elevation (mean ± SD: RW III, 5 ± 14 mm; RW V, 11 ± 17 mm) in weighted and nonweighted views. While no depression of the shoulder girdle was measured in RW III injuries (weighted and nonweighted views, 0 ± 11 mm), dropping of the shoulder girdle in RW V lesions on nonweighted views was observed (–5 ± 11 mm). Conclusion: Vertical dislocation is mostly associated with clavicle elevation in RW III injures, while in high-grade AC joint dislocations (RW V), a combination of clavicle elevation and shoulder girdle depression is present. A significantly greater superior displacement of the clavicle in RW V injuries was seen in weighted views, while a depression of the shoulder girdle could be detected in nonweighted views. For the first time, these results include the dislocation direction in the classification of an AC joint injury. Further studies are needed to investigate the extent to which dislocation types differ in optimal therapy and outcome.

Purpose The outcome of elective total joint arthroplasty (TJA) in patients with Parkinson’s disease (PD) is controversial due to the concomitant risk profile. This study investigated postoperative complications and revision rates following total hip (THA) and knee arthroplasty (TKA) in patients with PD. Methods Ninety-six patients with PD undergoing THA or TKA were matched 1:1 with non-PD patients using propensity score matching for age, sex and comorbidity (Charlson Comorbidity index, CCI). Rates of revisions, medical and surgical complications were compared. Univariate and multivariate regression analyses were calculated. Results PD patients exhibited higher rates of revision-surgeries within 90 days (13.5% vs. 5.2%; p  = 0.048), medical complications (68.8% vs. 43.8%; p  < 0.001) and surgical complications (40.6% vs. 21.9%; p  = 0.005). Multivariate regression analysis confirmed PD as a significant risk factor for complications and long-term revision-surgeries. Conclusion PD increases the risk of adverse outcomes following THA and TKA. Improvements in pre-operative planning and post-operative care are critical to the improvement of outcomes in this vulnerable population.

Objective To evaluate the effectiveness and safety of tofacitinib in patients with ulcerative colitis (UC) in clinical practice in Lebanon. Design This was a retrospective cross-sectional study. The data were collected from hospital records. Patients with moderate to severe UC treated with tofacitinib between 2018 and 2021 were included. Patients’ demographics, disease-specific characteristics, clinical assessment at three time points (8, 26, and 52 weeks), endoscopic evaluation at 24 weeks, and adverse events were collected. Results A total of 60 UC patients with a mean duration of disease of 7.9 ± 4.7 years were enrolled. 61.7% of patients had extensive disease, and 58.3% had received ≥ 1 biologic prior to tofacitinib. Clinical remission was reported in 25, 34, and 31 patients (41.7%, 56.7%, and 56.4%) at 8, 26, and 52 weeks respectively. Endoscopic remission (endoscopic Mayo score 0 or 1) was observed in 58.3% of patients at 52 weeks. About one-third of patients (31.7%) stopped tofacitinib at one year, primarily for lack of efficacy or loss of response, with no significant difference between biologics-naïve and experienced patients (24% vs. 37.1% respectively). No serious adverse events or deaths were reported. Adverse events were reported in 3 patients (5.0%) - one C. difficile infection, one case of reversible lymphopenia, and one case of facial acne. No serious adverse events or deaths were noted. On multivariate analysis, biologic-naïve status and reduction or normalization of CRP were associated with clinical remission (OR = 10.87, 95% CI = 1.57, 100, and OR = 78.47, 95% CI = 2.09, 2940.32 respectively), while reduction or normalization of CRP was associated with endoscopic remission at 1 year (OR = 19.03, 95% CI = 1.64, 221.09). Conclusion Tofacitinib was effective in the treatment of moderately severe ulcerative colitis in this real-world cohort in Lebanon. Further, the predictors associated with clinical and endoscopic remissions were found to be biologic-naïve status and reduction in CRP. Observed AEs were consistent with the known safety profile. One of the major limitations of this study is the smaller sample size and the retrospective nature of the study. Key Message What is already known on this topic – Although effectiveness of tofacitinib in ulcerative colitis has been established via real world evidence studies (RWDs), there have been no reports of RWD in West Asia or the Middle East and North Africa (MENA) region. What this study adds – It was observed that biologic-naïve status of patients and reduction in C-reactive protein (CRP) levels were associated with clinical and endoscopic remission outcomes. Tofacitinib was effective in the treatment of moderately severe UC in the Lebanese real-world cohort and observed AEs were consistent with the known safety profile. How this study might affect research, practice, or policy – This study provides insights to the physicians managing UC patients in the MENA region on the expected clinical journey for patients being treated with tofacitinib as well as the predictors of outcome. Future comparisons of this study with similar RWE studies in different geographical locations, will delineate the differences, if any, in the clinical course, based on demographical factors.

The phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)-IgG associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Febrile meningoencephalitis has rarely been reported as a feature of MOGAD and represents a diagnostic challenge. We report the case of 24-year-old women with high-grade fever, meningoencephalomyelitis, and persistently positive MOG-IgG, for whom an extensive infectious work-up was negative and who responded to high-dose intravenous methylprednisolone. The full clinical spectrum of MOGAD is yet to be completely elucidated. In patients presenting with febrile meningoencephalitis, MOG-IgG testing should be considered particularly if infectious work-up is negative.

Background: Chronic illnesses, such as cancer and end‐stage kidney disease (ESKD), impose significant emotional and physical burdens not only on patients but also on their caregivers. Caregivers play a vital role in providing care, often facing psychological distress, including anxiety and depression, while their quality of life (QoL) may deteriorate. This study aims to compare anxiety, depression, and QoL among caregivers of cancer and ESKD patients in Lebanon. Methods: A cross‐sectional study was conducted with 134 caregivers, including 71 cancer caregivers and 63 hemodialysis caregivers, at the Hôtel Dieu de France University Hospital in Beirut. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization QoL (WHOQoL–BREF) Scale. Results: Caregivers of hemodialysis patients reported significantly lower QoL scores compared to cancer caregivers ( p = 0.0006). Anxiety was prevalent in both groups, with no significant difference in anxiety or depression levels between the two groups. However, caregivers’ educational level ( p = 0.01), anxiety scores ( p = 0.006), and the patient’s comorbidity count ( p = 0.007) significantly predicted QoL. Caregivers with higher education and fewer anxiety symptoms reported better QoL. Conclusion: Caregivers of ESKD patients experience poorer QoL than cancer caregivers, though both groups suffer from high anxiety and depression. To address these disparities, we emphasize the need for universal healthcare coverage, targeted support programs, and routine caregiver well‐being assessments.

Valvular heart disease frequently occurs as a consequence of premature atherosclerosis in individuals with familial hypercholesterolemia (FH). Studies have primarily focused on aortic valve calcification in heterozygous FH, but there is paucity of data on the incidence of valvular disease in homozygous FH. We performed echocardiographic studies in 33 relatively young patients (mean age: 26 years) with homozygous FH (mean LDL of 447 mg/dL, 73% on LDL apheresis) to look for subclinical valvulopathy. Twenty-one patients had evidence of valvulopathy of the aortic or mitral valves, while seven subjects showed notable mitral regurgitation. Older patients were more likely to have aortic valve calcification (>21 versus ≤21 years: 59% versus 12.5%; p = 0.01) despite lower LDL levels at the time of the study (385 versus 513 mg/dL; p = 0.016). Patients with valvulopathy were older and had comparable LDL levels and a lower carotid intima-media thickness. Our data suggests that, in homozygous FH patients, valvulopathy (1) is present across a wide age spectrum and LDL levels and (2) is less likely to be influenced by lipid-lowering treatment. Echocardiographic studies that focused on aortic root thickening and stenosis and regurgitation are thus likely an effective modality for serial follow-up of subclinical valvular heart disease.