Rafik Hariri University Hospital

Introduction: Facelift surgery is a key procedure for facial rejuvenation, with deep plane facelifts providing long-lasting aesthetic improvements. The proposed Caves maneuver is a dissection technique to enhance surgical time efficiency and minimize risks in deep plane facelift procedures. Methods: A prospective study included 123 patients who underwent deep plane facelift and neck lift procedures from January 1, 2023, to December 1, 2024. Sixty-three patients (group 1) underwent the deep plane surgery with Caves maneuver, while 60 patients (group 2) received the traditional deep plane surgery without the Caves maneuver. Demographic data, operative times, and complications were analyzed. Results: Group 1 consisted of 63 patients (87.3% women and 12.7% men), while group 2 consisted of 60 patients (98.3% women and 1.7% men). Group 1 had a significantly shorter deep plane dissection time (9.5 minutes, range = 8-10 minutes) compared with group 2 (23 minutes, range = 20-25 minutes). Complications included 1 case of hematoma in group 2, 8 cases of temporary paresis of the marginal mandibular nerve, and 7 cases of hypertrophic scarring. No infections were reported. Group 1 demonstrated a lower incidence of complications, and in relation to nerve paresis, group 1 (1 case; 1.5%) had a lower incidence compared with group 2 (7 cases; 11.6%). Conclusion: The Caves maneuver significantly reduced dissection time and showed a lower incidence of nerve paresis. Complications were minimal, suggesting that the Caves maneuver is a safe and effective modification. Further studies with larger cohorts are recommended to validate these results.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia globally, causing a major burden on many determinants of quality of life, including sleep quality. The aims of the study were to describe sleep quality in a sample of patients with AF in a tertiary center in Lebanon, examine associations between sleep quality and the number and discomfort level of AF symptoms, and identify the predictors of sleep quality in these patients. This was a cross-sectional descriptive correlational study conducted at the cardiology clinics of a tertiary center in Lebanon. A sample of patients with AF were assessed for their heart rhythm, and interviewed for sleep quality and symptoms using the Pittsburgh Sleep Quality Index and the Patient's Perspective of Arrhythmia Questionnaire. One hundred and forty-four patients participated in the study. The majority of the sample (91%) suffered from poor sleep quality. The most prevalent AF symptoms were fatigue, dyspnea, heart flutter, and headache, whereas the most bothersome symptoms were fatigue, chest pressure, and dizziness. Most symptoms and their discomfort level were significantly associated with poor sleep quality. The number of symptoms, discomfort level of symptoms, intake of caffeine before bedtime, and history of chronic obstructive pulmonary disease were independent predictors of poor sleep quality. Healthcare professionals need to manage the symptoms of patients with AF, regularly assess the quality of their sleep, and provide interventions accordingly. Future studies need to test the effect of symptom management interventions on sleep quality in these patients.

BackgroundCommunity integration is a critical factor influencing the quality of life for individuals with physical disabilities. However, there is a lack of culturally adapted tools to assess community integration in Arabic-speaking populations. This study aimed to translate, validate, and examine the psychometric properties of the Arabic version of the Community Integration Questionnaire (AR-CIQ) among Lebanese adults with physical disabilities.MethodsA total of 150 individuals with various physical disabilities participated in the study. The AR-CIQ was translated and adapted to the Lebanese cultural context. Exploratory Factor Analysis (EFA) was conducted to determine the factor structure, while reliability was assessed using Cronbach’s alpha coefficients. Correlations between community integration and quality of life (QOL) were also explored using the SF-12 questionnaire.ResultsThe EFA revealed a four-factor structure of the AR-CIQ, which explained 68.27% of the total variance. These factors included social outdoor integration, productive and social management, domestic integration, and social support. The reliability of the AR-CIQ subscales varied, with the domestic integration subscale showing excellent internal consistency (α = 0.830). Correlation analysis revealed significant associations between community integration and QOL, with the mental health component (MCS-12) showing a moderate positive correlation with community integration (r = 0.418, p < 0.01).ConclusionThe AR-CIQ is a valid and reliable tool for assessing community integration in Lebanese adults with physical disabilities. Its factor structure reflects the unique cultural and contextual aspects of Lebanon. This study highlights the need for culturally sensitive tools in disability research and suggests that enhancing community integration could improve mental health outcomes for individuals with physical disabilities. Future research should explore longitudinal outcomes and the effectiveness of community-based interventions to further support the integration of individuals with disabilities in Lebanese society.

Objective: This pilot study investigated the potential of a video game-based cognitive rehabilitation program, utilizing Nintendo Wii Big Brain Academy, to enhance cognitive functions in Lebanese adults with chronic traumatic brain injury (TBI). Methods: Six adult males with moderate to severe chronic TBI were randomly assigned to either an intervention group (n=3), which received 12 individualized sessions of Wii-based cognitive training over six weeks, or a control group (n=3), which continued with standard rehabilitation without gaming. Cognitive performance was assessed before and after the intervention using the Montreal Cognitive Assessment (MoCA), the Stroop Word-Color Test, and in-game task performance metrics targeting domains such as memory, attention, and analytical reasoning. Main results: Post-intervention results indicated marked cognitive improvements in the gaming group. The intervention group showed a mean increase of 4.67 points on the MoCA (Cohen's d=4.06) and a mean improvement of 25.33 points on the Stroop test (Cohen's d=1.71), reflecting substantial gains in executive function and cognitive flexibility. Additionally, participants demonstrated performance enhancements in multiple game-based cognitive domains and reported subjective improvements in memory, concentration, and problem-solving skills. No significant changes were observed in the control group. Implications: These preliminary findings suggest that Wiibased cognitive training may serve as an engaging and effective adjunct to traditional rehabilitation for individuals with chronic TBI. Given the small sample size, further research involving a larger and more diverse population is needed to confirm these results and evaluate long-term outcomes.

ABSTRACTBackgroundCombining calcium hydroxylapatite‐carboxymethylcellulose (CaHA‐CMC) with hyaluronic acid (HA) products using Cohesive Polydensified Matrix (CPM) technology leverages the volumizing and hydrating effects of HA and draws upon the regenerative properties of CaHA‐CMC, providing a potentially synergistic approach in aesthetic filling treatments. Despite this potential, the rheological and physical properties of these hybrid fillers remain unreported.ObjectiveTo characterize the rheological properties of CaHA‐CMC blended with various CPM‐HA products and identify factors influencing their physical and clinical behavior.MethodsHybrid fillers were prepared by mixing CaHA‐CMC with different CPM‐HA products at varying ratios (1:1 to 1:4 syringe CaHA:syringe CPM). Rheological properties, including storage modulus (G′), loss modulus (G″), complex shear modulus (G*), tan delta (tan δ), and complex viscosity (η*), were measured using an oscillatory rheometer. Extrusion force, cohesivity, stability, and axial strain (εa) were also evaluated.ResultsThe rheological properties of the hybrid fillers varied with the type of HA, mixing ratio, and crosslinking degree. Higher HA concentrations increased G′, G″, and η*, enhancing gel stiffness and resistance to deformation, while increased HA dilution and lower crosslinking favored spread and injectability. The addition of CaHA‐CMC to CPM‐HA products always increased the G′ in a volume‐dependent manner. These properties were closely correlated with the fillers' performance in different tissue planes.ConclusionsThe properties of CaHA‐CMC and CPM‐HA hybrids influence their injection behavior and clinical outcomes. Understanding these factors can guide filler selection and application techniques to maximize safety, efficacy, and patient satisfaction in aesthetic treatments.

Budd-Chiari Syndrome (BCS) is a rare vascular disorder caused by hepatic venous outflow obstruction, often due to thrombosis, leading to liver congestion and portal hypertension. Behçet’s Disease (BD), a chronic vasculitis, can cause BCS through inflammation-induced thrombosis. We report a 14-year-old male with BD who developed BCS. He initially presented with foot pain, uveitis, and a bilateral rash, later progressing to abdominal distension, jaundice, and hepatic dysfunction. Investigations revealed elevated transaminases and hyperbilirubinemia, with imaging confirming hepatic vein thrombosis. Management included corticosteroids, immunosuppressants, and anticoagulation. Despite treatment, liver function deteriorated, necessitating a transplant, after which he stabilized with significant symptomatic improvement. This case underscores the need for early recognition of BD-related vascular complications, timely intervention to prevent irreversible liver damage, and consideration of liver transplantation in severe BCS. Increased awareness of BD as a potential cause of BCS is crucial for prompt diagnosis and management.

The advancement of drug-eluting stents (DES) to distal, severely calcified, and tortuous coronary artery lesions presents a significant challenge in interventional cardiology. Techniques such as extra-backup catheters, buddy wires, and guiding extension catheters are commonly employed to overcome these difficulties. When these conventional methods fail, the stepwise approach enhanced by repeated proximal to distal balloon anchoring helps advance the guiding extension catheter deep into the coronary artery, allowing the delivery of DES to the distal calcified lesions even in tortuous arteries, and serves as an effective bailout strategy. The stepwise approach enhanced by repeated proximal to distal balloon anchoring is used to overcome difficulties in DES delivery. It allows deep advancement of the guiding extension catheter into the coronary artery over the shaft of the anchored (inflated) balloon, facilitating DES delivery.This case report details the percutaneous coronary intervention (PCI) of the right coronary artery (RCA) in a 69-year-old male patient with multiple severe diffuse calcified stenosis. Despite initial attempts with a Judkins right curve (JR4) 6 French guiding catheter (Medtronic, Inc., Minneapolis, MN) and a buddy wire technique, DES delivery was unsuccessful, given that the guiding catheter support was unstable when the DES was advanced into the artery. Thus, to facilitate DES delivery, a guiding extension catheter was used, but it failed to advance into the RCA. However, using the stepwise approach with repeated proximal to distal balloon anchoring allowed deep advancement of the guiding extension catheter into the RCA over the anchored (inflated) balloon shaft. This anchored balloon technique was done three times starting at the proximal part of the RCA and advancing the guiding extension catheter to proximal, mid, and finally distal part of the vessel, ultimately allowing the successful placement of three DES from the distal to the proximal part of the vessel, demonstrating the technique's efficacy in overcoming complex anatomical challenges. At the end of the procedure, all lesions were successfully stented with no residual stenosis and a thrombolysis in myocardial infarction (TIMI) III flow in the RCA, and the patient was stable hemodynamically with no chest pain.

Background: Breast cancer is a disease in which cells in the breast grow out of control and form tumors. Lesion that has radiological features suggesting likelihood of cancer 2-10% is 4a, 10-50% is 4b, and 50-95% is 4c and more than 95% is BIRAD 5. Methods: This cross-sectional study was done at department of radiology, SKBZH CMH Muzaffarabad from Nov 2023 to March 2024. Our study included 100 patients having BI-RADS 4 and 5 confirmed by the sonomammography. Then all those patients underwent biopsy to check the triple negative status and the samples were sent for histopatholoical analysis. Data was analyzed using SPSS 21 version. Chi-square test was used to find the association between parameters. Results: A total of 100 patients were included in this study. The mean age of the patients was 48.45±14.663 years. A significant association of radiological grading (BIRADS 4 and 4) with triple negativity status and LN metastasis with p values 0.00 were found. A significant association of triple negativity with grades, LN metastasis, Necrosis, scars with p value 0.008, 0.016, 0.001, and 0.006 respectively were found. No significant association of size of tumor with radiological grading and triple negative status were found. Conclusion: Although, traditionally lesions with BI-RADS 5 score are considered more malignant than lesions with BI-RADS 4 score by clinicians in the daily practice, as pointed out in recent reports, TN have more frequent radiological BI-RADS 4 score.

To explore the relationship between subfoveal choroidal thickness (SFCT) and persistent subretinal fluid (pSRF) at the macula after successful rhegmatogenous retinal detachment (RRD) surgery. This is a retrospective multicenter comparative study of Caucasian subjects with successful RRD repair. SFCT was measured in 2 groups: Group 1 with persistent subretinal fluid (pSRF) 1 month after repair, and Group 2 with absence of pSRF. SFCT was measured by a masked observer based on ImageJ. Multiple regression analyses were implemented to control for age, refraction, and gender. Surgery type was as follows: Group 1 (24 scleral buckle SB, 23 pars plana vitrectomy PPV, 9 SB+PPV, and 5 pneumoretinopexy), and Group 2 (68 PPV). Adjusted mean 1-month SFCT was thicker in Group 1 than in Group 2 by 41.0µm (p = 0.049). Within Group 1, PPV subgroup tended to have thinner SFCT than the other subgroups by: SB (117.4µm), SB-PPV (9.3) and pneumoretinopexy (1.2µm) (all p>0.05). SFCT at 1-month was not different between pSRF (237.5±77.2µm) and no pSRF (213.7±72.1µm) in PPV groups (p=0.2). SFCT post PPV appeared similar in eyes with or without pSRF. In eyes with pSRF, SFCT tended to be thicker following SB compared to PPV.

Introduction and importance:Atypical teratoid rhabdoid tumor (ATRT) is a rare and aggressive central nervous system malignancy. It primarily affects infants and young children, with adult cases being exceptionally uncommon. This case highlights the diagnostic and management challenges posed by ATRT in a 38-year-old pregnant woman.Case presentation:We present a case of ATRT in a 38-year-old pregnant woman, highlighting the diagnostic and management challenges posed by this aggressive tumor during pregnancy. A sellar-suprasellar lesion during the third trimester of pregnancy was discovered. Following neurosurgical evaluation and imaging studies, a diagnosis of ATRT was confirmed by histopathological examination. The patient underwent a left fronto-lateral craniotomy for tumor resection. Afterward a viable baby was delivered to proceed with adjuvant management.Clinical discussion:ATRT is an aggressive tumor mainly affecting infants, but with rare adult cases linked to inactivation of SMARCB1 (INI1) or SMARCA4 (BRG1). ATRT is characterized by a very poor prognosis. A multimodal treatment approach, combining surgery, chemotherapy, and radiotherapy has been associated with better survival rates. As unusual, maximal safe resection was achieved in our patient, but adjuvant therapy was deferred due to pregnancy, and highlighting the difficult balance between maternal and fetal health in such cases.Conclusion:This case highlights the aggressive nature of ATRT in adults, the challenges of managing the tumor during pregnancy, and the critical need for early recognition and intervention to optimize outcomes. Further research is essential to improve prognosis in ATRT cases, particularly in unique clinical scenarios like pregnancy.