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Resilience is defined as the ability to face adversities with positive outcomes. Various scales have been utilized, including 25-item Connor-Davidson Resilience Scale (CD-RISC), to evaluate resilience among populations. Resilience research is scarce, particularly in Lebanon as no such scales have been validated. Thus, in the present work, we aimed to assess the psychometric properties of the Arabic version of CD-RISC. The study was conducted at the Women's Health Center at the American University of Beirut Medical Center among Lebanese women presenting to the obstetrics and gynecology clinics. Internal validity of the Arabic CD-RISC was examined. Pearson's correlation coefficients between the scores of the Arabic version of CD-RISC and the other related constructs (Rosenberg Self-Esteem Scale, Dispositional Hope Scale, Life Orientation Test, and Positive and Negative Affect Schedule) were assessed to evaluate its divergent and convergent validity. We collected responses from a total of 63 Lebanese women. The studied scale displayed a high internal consistency. Adequate correlation coefficients were manifested by the significant positive moderate to strong and negative moderate correlations between the Arabic CD-RISC and the other related constructs. This is the first study to validate the Arabic version of the CD-RISC in a sample of Lebanese women. The findings of this study provide evidence that the Arabic version of CD-RISC is a reliable and valid tool for the evaluation of resilience among Lebanese women.

To investigate the difference in character strengths (CSs) between patients with and without polycystic ovary syndrome (PCOS) and the association between biological (i.e., testosterone levels) and psychological factors (i.e., character strengths). A total of 99 women divided into PCOS (49) and non-PCOS (50) groups who presented to the gynecological clinics at the women's center in the American University of Beirut Medical Center in 2017 were included. Women were assessed for testosterone bioavailable levels and completed a questionnaire that included Hospital Anxiety and Depression Scale and Values in Action Survey-72. Univariate and multivariable analyses were performed to examine the association of CSs between the two groups and its predictors. The scores of hope, judgement, perspective, and transcendence of the PCOS group were significantly higher in comparison with healthy participants. An increase in free androgen index was negatively correlated to the score of judgement only. Women with PCOS have their own profile of character strengths and virtues that constitute judgement, hope, perspective, and transcendence. This in turn can be utilized to reinforce those personality strengths and thus decrease the psychological distress and mood disorders accompanied with this disease.

The establishment of gut microbiota during early life is crucial for immune system development and its disturbance within this critical period exerts enduring adverse effects on health. Perinatal antibiotic exposure perturbs early-life microbiota and leads to long-term immune dysregulation. However, the underlying mechanisms remain inadequately explored. We investigated the persistent consequences of perinatal exposure to low-dose penicillin on gut immunity and the potential protective role of a prebiotic compound, Lentinula edodes cultured extract referred to as AHCC, against antibiotic-induced dysbiosis and immune dysregulation. Pregnant mice were subjected to penicillin and AHCC treatment from the third week of gestation until weaning of pups. Subsequently, the offspring were evaluated for gut microbiota at weaning as well as immune function, and microRNA (miRNA) changes at eight weeks of age. Microbiome analysis revealed substantial alterations in gut microbiota composition, characterized by an increase in Proteobacteria and a decrease in Firmicutes following antibiotic exposure. Lactobacillus, and some short-chain fatty acid (SCFA)-producing species were diminished by the antibiotic. AHCC intake prevented antibiotic effects on Proteobacteria in dams and offspring and some SCFA-producing bacteria in male offspring. In adult offspring, AHCC exhibited immunomodulatory activity by decreasing pro-inflammatory cytokines, including IL-2, IL-6, IL-15, and IL-21. In addition, antibiotic-induced increase in NF-κB was mitigated by AHCC. Early-life antibiotic exposure altered gut miRNA expression, increasing pro-inflammatory miR-221 and decreasing anti-inflammatory miR-145 in males while AHCC intake prevented antibiotic-mediated dysregulation of miRNA-145. These results highlight the potential of prebiotic intake as a promising strategy to prevent and mitigate persistent health issues arising from early-life dysbiosis.

Among adolescents with type 1 diabetes, some experience great difficulties with treatment adherence, putting them at high risk of complications. We assessed the effect of text messaging (Short Messaging Service [SMS]) on glycemic control. A two-arm open label randomized controlled trial enrolled adolescents with type 1 diabetes aged 12-21 years with baseline HbA1c ≥ 69 mmol/mol (8.5%). The intervention group received daily SMS reminders at self-selected times about insulin injections while the control group received standard of care. The patients allocated to the control group were not aware of the intervention. 92 patients were randomized, 45 in the SMS arm and 47 in the control arm. After 6 months, median HbA1c level was significantly lower in the intervention arm: 73 mmol/mol (8.8%) in the SMS arm and 83 mmol/mol (9.7%) in the control arm in the intent-to-treat analysis (P = 0.03) but no longer in the per protocol analysis (P = 0.65). When we consider the proportions of patients whose HbA1c level decreased by at least 1% between baseline and 6 months, we find a significant difference among patients whose baseline HbA1c was ≥ 80 mmol/mol (9.5%) (n = 56): 60% in the SMS arm and 30.6% in the control arm had lowered their HbA1c level (P = 0.03) in the intent-to-treat analysis but not in the per-protocol analysis (P = 0.50). Patients in the SMS arm reported high satisfaction with the intervention. While there is a trend to lower HbA1c in the intervention group, no firm conclusions can yet be drawn. Further studies are needed to address methodological issues as we believe these interventions can support behavior change among adolescents with poorly controlled type 1 diabetes. ClinicalTrials.gov identifier: NCT02230137.

Background: Alopecia areata (AA) is an autoimmune disease leading to noncicatricial alopecia. Topical or intralesional corticosteroid (ILCS) is the accepted therapeutic option for mild cases; however, adverse effects are sometimes difficult to reverse. When the exposure to liquefied nitrogen is limited to a few seconds \"superficial\" cryotherapy, reactive vasodilation may improve microcirculation and nutritional status around hair follicles. Objective: This study aimed to evaluate and compare superficial cryotherapy and ILCS in the treatment of patchy AA. Materials and Methods: This prospective comparative study included 21 patients with patchy AA. Every patient received superficial cryotherapy on one patch, every 2 weeks for 3 months, and ILCS injection for another patch, once monthly for 3 months. Results: Clinical improvement was higher in cryotherapy group compared to ILCS group with a statistically significant difference (P = 0.002). On trichoscopic evaluation, terminal hair count was improved in lesions treated with cryotherapy more than lesions treated with ILCS but without statistical significance (P = 0.595) and vellus hair count was improved in lesions treated with cryotherapy more than lesions treated with ILCS with a statistical significance (P = 0.002). Conclusions: Cryotherapy is more effective and less painful than ILCS in the treatment of patchy AA.

Granulomatosis with polyangiitis (GPA) is a multi-organ vasculitic syndrome typically associated with neutrophil extracellular trap (NET) formation and aggressive tissue inflammation. Manifestations in head and neck (H&N) GPA include septal perforations, saddle-nose deformities, bony erosions of the orbital and sinus walls, middle ear damage and epiglottitis, indicative of bone, cartilage, and connective tissue destruction. Whether H&N-centric lesions engage disease pathways distinctive from the ischemic tissue damage in the lungs, kidneys, skin, and peripheral nerves is unknown. We have compared inflammatory responses triggered by neutrophilic NETs in patients with H&N GPA and systemic GPA (sGPA). Neutrophils and monocytes were isolated from the peripheral blood of patients with H&N GPA, sGPA, and age/gender matched healthy individuals. Neutrophil NETosis was induced. NETs were isolated and cocultured with monocytes. Gene induction was quantified by RT-PCR, protein upregulation by flow cytometry. Tissue invasiveness of monocytes was measured in a 3D collagen matrix system. Expression of MMP-9 in tissue-residing macrophages was assessed by immunohistochemistry in tissue biopsies. Neutrophils from H&N GPA patients showed more intense NETosis with higher frequencies of netting neutrophils ( < 0.001) and release of higher amounts of NETs ( < 0.001). Isolated NETs from H&N GPA functioned as an inducer of danger-associated molecular patterns in monocytes; specifically, alarmin S100A9. NET-induced upregulation of monocyte S100A9 required recognition of DNA. S100A9 release resulted in the induction of metalloproteinases, including MMP-9, and enabled monocytes to invade into extracellular matrix. Anti-MMP-9 treatment attenuated the tissue invasiveness of monocytes primed with NETs from H&N GPA patients. MMP-9-producing macrophages dominated the tissue infiltrates in naso-sinal biopsies from H&N GPA patients. Distinct disease patterns in GPA are associated with differences in NET formation and NET content. H&N GPA patients with midline cartilaginous and bony lesions are highly efficient in generating NETs. H&N GPA neutrophils trigger the induction of the alarmin S100A9, followed by production of MMP-9, endowing monocytes with tissue-invasive capabilities.

Introduction: Stroke mimics comprise a significant proportion of cases presenting with neurological deficits and can be difficult to differentiate from true stroke cases. Our aim in this study was to assess the frequency and etiologies of stroke mimics presenting to our emergency department (ED). Methods: We conducted a retrospective review of the charts of patients presenting to the ED of a tertiary- care center between November 2018–August 2023 and on whom the stroke code was activated. The cases were categorized into real strokes or stroke mimics based on patients’ discharge diagnoses. Results: Stroke code activation was implemented on 584 patients during the study period. These patients received full service and a final discharge diagnosis. Of these, 349 (59.8%) received a diagnosis of a true stroke, whether ischemic, hemorrhagic, or transient ischemic attack. The remaining 235 (40.2%) were classified as stroke mimics, with functional (12.8%) and medical (87.2%) etiologies. Medical stroke mimics were further categorized into non-cerebrovascular neurologic (59.5%), infection or allergic reaction (17.1%), cardiovascular (11.7%), metabolic or drug-induced (8.3%), and other (3.4%). Factors found to favor stroke mimics were history of neurological (adjusted odds ratio [aOR] 4.98; 95% confidence interval [CI] 2.89 - 8.57) or psychiatric disorders (aOR 2.88; 95% CI 1.29 - 6.41) and patients presenting with altered mental status (aOR 1.70; 95% CI 1.04 - 2.80) or generalized weakness (aOR 2.38; 95% CI1.12 - 5.03). Conversely, factors that favored true strokes (with OR <1 for mimics), were patients aged >65 years (aOR 0.61; 95% CI 0.38-0.96), history of hypertension (aOR 0.61; 95% CI 0.38 - 0.97) or atrial fibrillation (aOR 0.39; 95% CI 0.21 - 0.72), and presenting with speech disturbance (aOR 0.56; 95% CI 0.37-0.83) or extremity weakness (aOR: 0.22; 95% CI 0.15- 0.38). Conclusion: Approximately 40% of cases presenting to our ED with stroke code activation were found to be mimics. The high ratio warrants the establishment and adoption of a more specific triaging algorithm for stroke code activation to minimize the pressure on an already overburdened healthcare sector.

Background Depression and anxiety are common comorbid psychological disorders among patients with cancer. Despite the wide use of the Arabic Hospital and Anxiety Scale (HADS) in oncological settings, it has not been yet validated among Lebanese patients with cancer. We aimed to assess the reliability and validity of the HADS in a sample of Lebanese patients with cancer. One-hundred one Lebanese patients diagnosed with cancer presenting to the Ambulatory Care Center in the Hematology Oncology Department at the American University of Beirut Medial Center filled the Arabic version of the HADS. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire 9-Item Scale (PHQ-9) were used to assess its concurrent validity in capturing anxiety and depression, respectively. Results Reliability analysis using Cronbach’s alpha (α) coefficient revealed good internal consistency for the Arabic HADS ( α  = 0.89) and both subscales ( α  = 0.86 for depression and α  = 0.78 for anxiety). Correlations between HADS with both GAD-7 and PHQ-9 were statistically significant and strong for both depression ( r  = 0.795; p  < 0.0001) and anxiety ( r  = 0.727; p  < 0.0001). Confirmatory factor analysis revealed that the observed data fits the two-factor model of depression and anxiety (Kaiser–Meyer–Olkin = 0.86; Tucker Lewis Index = 0.879; root-mean-square error of approximation = 0.08). Depression and anxiety rates were approximately 52% and 25%, respectively. Conclusion We conclude that the Arabic version of the HADS is a credible and valid tool for clinical assessment of psychological distress (anxious and depressive states) among Lebanese patients with cancer.

We report a case of a 54-year-old female who presents with a gradually expanding mass at the right lateral malleolus. The diagnosis of undifferentiated pleomorphic sarcoma was made after a histopathological examination of the mass following a wide tumor excision. The defected soft tissue area was reconstructed using a local flap, reverse sural artery flap. Following the surgical management, multiple radiotherapy sessions were completed. The patient's follow-up result showed no signs of local recurrence or metastasis, and the wound was well-healed with no complications other than paresthesia in a small area at the posterolateral aspect of the ankle under the lateral malleolus. This case represents a rare form of malignant neoplasm and emphasizes the effectiveness and safety of the reverse sural artery flap reconstruction technique, especially in places where microsurgery is unavailable or when the patient's status does not allow for prolonged anesthesia.

Background Alexithymia is a condition in which cognitive processing of emotions is impaired. Associations between alexithymia and temporomandibular disorders (TMD) have been described in multiple studies, yet the coexistence or influence of oral behaviors has never been addressed. This study aimed to clarify the relationship between alexithymia, oral behaviors, and temporomandibular pain disorders. Results A total of 264 participants were included in this study. The mean age was 25.70 ± 5.99 years, with a range from 18 to 65 years. Eighty-two (31.1%) were possibly alexithymic, and 93 (35.2%) were alexithymic. A total of 12.5% of the participants were at high risk for TMD. With respect to oral behavior risk, 62.5% were at low risk, and 35.2% were at high risk. Alexithymia appeared to be a positive predictor of TMD risk ( p  < 0.001). Participants with high-risk oral behaviors were found to have an increased likelihood of TMD risk ( p  < 0.001). Moreover, both high-risk oral behavior and alexithymia correlated with increased somatic symptom burden levels ( p  < 0.001). Pain disorders exert significant distress on individuals and lead to poorer quality of life. Conclusion Understanding the association of alexithymia, somatic symptom burden, and coping strategies with oral behaviors and temporomandibular pain disorders can help improve the management of this condition. By tailoring the chosen therapy to the dominant co-existing psychosocial comorbidities in TMD patients, the risk of treatment failure or relapse may be diminished.