American University of Beirut Medical Center

To explore the association between dysfunctional toileting behaviors (TB) and recurrent urinary tract infections (RUTI) in premenopausal women using a validated behavioral assessment scale. We conducted a case-control study at the American University of Beirut Medical Center between 2020 and 2023. A total of 294 premenopausal women were recruited, comparing 98 women with RUTI and 196 controls without RUTI. Participants completed a structured questionnaire, including demographic data and responses to the Toileting Behaviors-Women's Elimination Behavior (TB-WEB) scale, assessing five behavioral domains: place preference, premature voiding, delayed voiding, straining, and position preference. Statistical analysis involved t-tests, chi-square tests, and multivariable logistic regression adjusting for potential confounders. Women with RUTI were more likely to prefer crouching rather than sitting on toilet seat during micturition, both at home and in public restrooms. Women with RUTI showed significantly higher mean scores for dysfunctional TB when compared to those without RUTI in the following domains: place preference for voiding, premature voiding, delayed voiding, and straining. At least 62.5% of women with RUTI reported that these behaviors had been habitual prior to their diagnosis suggesting that these practices could have contributed to the development of RUTI. This study identifies a significant association between "dysfunctional" TB and RUTI in premenopausal women. The findings underscore the importance of further research to explore the causal mechanisms underlying this relationship and to develop targeted interventions aimed at modifying TB to try to curb the incidence of RUTI.

In the phase 2, double-blind, randomized controlled BEYOND trial (NCT03342404), luspatercept increased hemoglobin levels in patients with non-transfusion-dependent β-thalassemia (NTDT). This study assessed long-term effects of luspatercept on patient-reported outcomes (PROs), using data from BEYOND and patients who continued luspatercept treatment in the phase 3b long-term follow-up (LTFU) study (NCT04064060). In BEYOND, patients received luspatercept or placebo Q3W for ≥ 48 weeks. PRO instruments included NTDT-PRO (BEYOND only), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and 36-Item Short Form Survey (SF-36). Mixed-effects models with repeated measures estimated least squares mean changes from baseline in PROs. PROs were evaluable in 144 patients (luspatercept 95, placebo 49) from BEYOND and 58 (luspatercept) from LTFU. Luspatercept improved NTDT-PRO tiredness/weakness and shortness of breath domain, FACIT-F fatigue subscale, and SF-36 vitality scores versus placebo through double-blind treatment (generally maintained through week 96). In LTFU patients, significant, meaningful improvements from baseline in FACIT-F fatigue subscale and SF-36 vitality scores were observed within 12 weeks of treatment initiation and maintained for up to 5 years. Other FACIT-F and SF-36 domains improved or were maintained throughout LTFU. Luspatercept offers rapid and durable benefits by improving anemia-related symptoms and quality of life in patients with NTDT. Trial Registration: ClinicalTrials.gov Identifier: NCT03342404; NCT04064060.

Throughout history, the Mediterranean basin has experienced the occurrence of several large tsunamigenic events due to the active geodynamics of the existent plate boundaries and associated seismogenic structures. These events were documented by the many civilizations that have settled in northern Africa, eastern Mediterranean, and southern Europe. The tsunamis were generated either through seafloor rupture during offshore earthquakes, or through submarine landslides that were triggered by onshore earthquakes. In addition, some tsunamis were triggered by volcanic-eruption landslides. In this paper, the authors review the large tsunamis that took place in the Mediterranean basin, and they relate the sources and locations of those tsunamis to specific structures throughout the Mediterranean basin. They underline that the coasts with tsunami hazards can be near or far from the tsunamigenic sources, and that the near- and far-source effects of any tsunami that follows a major event can be equally critical as it propagates for short or long distances across the basin. They recommend that all Mediterranean countries should coordinate their efforts to handle their basin-wide tsunami hazards, and to undergo the required preparations ahead of the next big tsunami.

Telehealth has become an integral component of mental health care delivery worldwide. Understanding provider perceptions is essential to guiding its continued implementation. This international study used quantitative and qualitative methodologies to examine and broaden our understanding of the benefits and concerns related to telehealth for mental health care. An internet-based survey was conducted during the COVID-19 pandemic between November 11 and December 18, 2020, among mental health professionals, primarily psychiatrists and psychologists, registered with the World Health Organization's Global Clinical Practice Network. Clinicians completed the survey in 1 of 6 languages (Chinese, English, French, Japanese, Russian, or Spanish). Descriptive statistics and logistic regressions were used to analyze quantitative survey data on concerns and implementation of telehealth. Responses to an open-ended question about providers' perspectives on the benefits of telehealth were analyzed qualitatively. In total, 847 participants completed the telehealth section of the survey, and 496 provided a response to the open-ended question. Quantitative data on telehealth use and concerns revealed that clinicians' primary concerns focused on technical issues and clinical effectiveness relative to in-person services, specifically, loss of clinical information (eg, nonverbal behavior) and challenges with establishing a therapeutic alliance. Findings varied by profession, World Health Organization region, and telehealth training and experience. Qualitative data examining benefits fell into 3 major areas: accessibility and reach of mental health services, efficiency and flexibility for clinicians, and enhancement of clinical processes and outcomes. Taken together, findings revealed a trade-off between telehealth benefits and disadvantages. From the perspective of mental health professionals, telehealth practice comes with key challenges and valuable benefits. Findings offer important considerations for the implementation of telehealth systems, including the importance of training and education and balancing trade-offs to optimize care.

Forehead eyebrow lift (FEL) techniques have changed significantly over the past decades. They have slowly moved away from open coronal or hairline incision lifts toward minimally invasive endoscopic approaches. However, incomplete knowledge of functional anatomy, dynamic eyebrow muscle activity, and basic aging changes has frequently resulted in failed procedures, relapses, and an unnatural appearance with excessive brow elevation. The purpose of this review was to evaluate the long-term efficacy of open or endoscopic FEL and to highlight how evolving understanding of forehead and eyebrow functional anatomy can influence the practice of FEL procedures. A comprehensive patient/population, intervention, comparison, and outcome review of clinical studies published since 2000 in the English-language literature following preferred reporting items for systematic reviews and meta-analyses guidelines was performed using the PubMed, Embase, and Web of Science databases. A small number of studies were retrieved, describing techniques that were not well standardized and had many variables. In most reports, the medial eyebrow was the least elevated, whereas the highest elevation was achieved laterally. The highest long-term elevation in all studies did not exceed 5.6 mm, and long-term follow-up demonstrated a significant gradual decrease in elevation over time. Open or endoscopic FEL techniques do not seem to be highly effective in maintaining long-term brow elevation, in particular laterally. It is likely time for a critical appraisal of their efficacy and for a different, more personalized conceptual approach.

The WIL-31 study demonstrated efficacy and safety of prophylaxis with the plasma-derived von Willebrand factor/factor VIII concentrate wilate in von Willebrand disease (VWD) of all types and was the only prospective study with an on-demand run-in study as an intra-individual comparator. This subgroup analysis examines the efficacy of wilate prophylaxis in patients with type 3 VWD in WIL-31. Patients received 20-40 IU/kg wilate prophylaxis 2-3 times weekly for 12 months. Twenty-two patients in WIL-31 had type 3 VWD. Mean total annualized bleeding rate (ABRs) during on-demand versus prophylaxis was 37.1 versus 5.2 (86% reduction). During prophylaxis, 115 bleeds occurred, most (95%) of which were minor; the most common bleeding site was the nose (40% of bleeds). Mean overall spontaneous ABRs during on-demand versus prophylaxis were 26.5 versus 2.8 (89% reduction); mean treated spontaneous ABRs were 20.3 versus 1.4, respectively (93% reduction). ABRs were reduced further during the second 6 months of prophylaxis versus the first 6 months. Results were consistent in subgroups by age. No serious adverse events related to study treatment and no thrombotic events were observed. Prophylaxis with wilate was effective and well tolerated in patients with type 3 VWD, in all age groups. NCT04052698; https://clinicaltrials.gov/study/NCT04052698.

Invasive meningococcal disease poses a substantial disease burden worldwide, including older adults (aged ≥ 56years) along with higher case fatality rates. MenACYW-TT, a quadrivalent meningococcal tetanus toxoid-conjugate vaccine, is indicated worldwide in individuals ≥ 56years of age and is the only licensed vaccine in the USA for this age group. The annual Hajj pilgrimage is considered an epidemiologic event with approximately two million pilgrims per year; hence, immunization with a quadrivalent meningococcal vaccine is mandatory for visitors traveling to Saudi Arabia for Umrah and Hajj. We evaluated the immunogenicity and safety of a single dose of MenACYW-TT in prospective Hajj/Umrah pilgrims aged ≥ 56years in Turkiye and Lebanon. In this open-label phaseIII study (NCT03869866), conducted in Turkiye and Lebanon, healthy adults aged ≥ 56years received a single dose of the MenACYW-TT vaccine. Serum bactericidal assays were performed using human (hSBA) and rabbit (rSBA) complements to measure antibody titers against all four serogroups at baseline (D0) and 30days post vaccination (D30). Safety data were collected up to 30days (+ 14days) post vaccination. A total of 290 individuals were enrolled in the study. On D30, vaccine seroprotection rates (hSBA titers ≥ 1:8) for serogroupsA, C, Y, and W were 82.8%, 92.5%, 92.1%, and 83.5%, respectively, and rSBA titers (≥ 1:128) were 83.4%, 90.0%, 94.3%, and 88.9%, respectively. hSBA geometric mean titers (GMTs) were 32 [95% confidence interval (CI) 26.3-39.1], 132 (102-169), 126 (99.3-161), and 56.4 (43.8-72.6) for serogroupsA, C, Y, and W, respectively. On D30, seroresponse rates in the per-protocol analysis set (PPAS) were 48-71.0%. Safety concerns and any serious adverse events related to the study vaccine were not observed. MenACYW-TT vaccine induced a robust immune response against all serogroups (per seroprotection rates and GMTs). A single dose of the vaccine demonstrated acceptable safety profile in potential pilgrims aged ≥ 56years. ClinicalTrials.gov, NCT03869866. A Graphical Abstract is available for this article.

Retroperitoneal hematoma is a rare but potentially life-threatening cause of concealed postpartum hemorrhage. Because bleeding is contained within the retroperitoneum, external blood loss may be absent, and symptoms may be nonspecific, resulting in delayed diagnosis. Rapid recognition and intervention are essential to reduce morbidity and mortality. We report a 21-year-old primigravida who developed severe hypotension and pelvic pain a few hours after an uncomplicated vaginal delivery with a small median episiotomy. Ultrasound revealed a 9 × 9 cm pelvic hematoma. Despite aggressive resuscitation, she required laparotomy, which demonstrated diffuse venous oozing from the retro pubic region without an arterial source. Hemostasis was achieved with combined vaginal and retroperitoneal packing. She required a total of 23 units of packed red blood cells, 18 units of fresh frozen plasma, five units of platelets, and two units of cryoprecipitate. She fully recovered following staged re-exploration and definitive closure. Retroperitoneal hematoma should be suspected in postpartum patients with hemodynamic instability and no external bleeding. A multidisciplinary approach and individualized management, including surgical packing, are critical for successful outcomes.