University Medical Center Rizk Hospital

BackgroundHuman papillomavirus (HPV) is among the causes of cervical and other cancers globally, but vaccination rates are low in Lebanon. Parental decisions may be influenced by cultural sensitivities, misinformation, and financial constraints.ObjectiveThis study evaluates the prevalence of HPV vaccination among children in Lebanon and identifies demographic, socioeconomic, and informational determinants of parental choice.MethodsA survey was conducted at two hospital-based universities in Beirut between August 2022 and March 2024 as part of a cross-sectional study. A structured questionnaire was given to Lebanese parents of children aged 9–18 to assess HPV knowledge, vaccine awareness, and barriers. Data were examined in SPSS, with bivariate and multivariate analyses to reveal predictors of vaccine uptake.ResultsAmong 100 participating parents, 23% reported vaccinating their children. Females were more likely to be vaccinated than males (p = 0.04). Awareness that HPV causes cancer and affects both genders was significantly associated with uptake (p = 0.049). High cost was a major barrier (p = 0.002), while doctors were the most trusted source of information.ConclusionHPV vaccination rates among Lebanese children remain low due to financial barriers and limited awareness. Targeted education and integration into national immunization programs are essential.

Skin aging is a multifactorial process driven by a combination of intrinsic genetic programming and extrinsic environmental exposures. Recent advances in epigenetics have illuminated how changes in DNA methylation, histone modifications, and non-coding RNAs regulate skin aging, with the epigenetic clock emerging as a powerful tool to quantify biological age. This review aims to synthesize current evidence on how environmental and lifestyle factors – particularly ultraviolet radiation, pollution, smoking, diet, and stress – accelerate skin aging through epigenetic mechanisms, while also evaluating the potential of skin-specific epigenetic clocks as biomarkers for early detection of premature aging and for guiding therapeutic interventions. We further discuss the expanding field of epigenetic-targeted therapies in dermatology, encompassing topical agents, energy-based devices, and systemic approaches that may reverse or delay visible signs of cutaneous aging. By integrating insights from molecular biology, environmental science, and clinical dermatology, this review positions skin aging not as an irreversible outcome but as a modifiable, biologically regulated process with promising avenues for personalized prevention and rejuvenation.

Introduction: Femoral neck fractures in older adults are associated with appreciable short-term mortality, yet long-term survival after hip arthroplasty is incompletely characterized. We analyzed early mortality risk factors and 5- and 10-year mortality after hemi-arthroplasty or total hip arthroplasty (THA) for femoral neck fractures. Materials and Methods: In this single-center retrospective cohort, 397 consecutive patients underwent arthroplasty for femoral neck fracture in 2014 and 2015. Mean age was 83.3 years and 70.3% were women. Demographic data, Charlson Comorbidity Index, Parker Mobility Score, medication history, operative and anesthetic details, transfusion, and peri-operative complications were extracted. Survival status up to 10 years was obtained from hospital and civil registries. p-value < 0.05 was considered statistically significant. Results: A total of 397 patients were included. When categorized by age and ASA scores into low-, medium-, and high-risk groups, mortality rates increased with higher risk (p < 0.001). The mortality rate at 30 days, 90 days, 1 year, 5 years, and 10 years postoperatively was 3.5%, 7.1%, 14.1%, 48.36% and 71.03%, respectively; mean time-to-death was 3.3 years. At 30 days, mortality was higher in males, those on clopidogrel, in patients with lower mobility (lower Parker Score), higher morbidity (higher Charlson Score), NNIS score of 1, higher ASA, patient who underwent hemiarthroplasty, and patients with medical complications post-op. Additional 90-day risks were antivitamin K therapy, immunosuppressants, and continuous spinal anesthesia; 1-year risks also encompassed advanced age, prolonged hospital stay, and peri-operative transfusion. Conclusions: Arthroplasty after femoral neck fracture is associated with high mortality rate; only half of patients survive 5 years and fewer than one-third reach 10 years. Mortality rate is affected by many risk factors, both non-modifiable factors and modifiable peri-operative variables. Targeted optimization of modifiable peri-operative factors and multidisciplinary geriatric-orthopedic care may improve outcomes in this frail population.

Congenital afibrinogenemia is a rare autosomal recessive bleeding disorder characterized by the complete absence of fibrinogen, a key protein in the coagulation cascade. Patients usually present with hemorrhagic manifestations, ranging from mild mucocutaneous bleeding to life-threatening events, such as intracranial or gastrointestinal hemorrhage. Paradoxically, thrombotic complications have been increasingly described, underscoring the dual nature of the disease. We report a case of a 15-year-old female with congenital afibrinogenemia who presented with abdominal pain and was diagnosed with Budd-Chiari syndrome (BCS), a rare but potentially fatal hepatic venous outflow obstruction. Genetic testing further revealed the presence of a heterozygous factor V Leiden mutation, a well-known inherited thrombophilia that likely contributed to the development of BCS in this patient. She was treated with fibrinogen replacement and anticoagulation therapy, with careful monitoring to balance bleeding and thrombotic risks. The patient showed clinical improvement and remained stable at three-month follow-up. The coexistence of a bleeding disorder and a prothrombotic mutation illustrates the complexity of clinical management, as therapeutic strategies must balance hemostatic replacement with anticoagulation while minimizing risks on both sides. This case highlights the need for heightened awareness of thrombotic complications in congenital afibrinogenemia, the importance of investigating concomitant thrombophilic risk factors, and the necessity of an individualized, multidisciplinary approach to optimize outcomes in rare coagulation disorders.

Hematopoietic cell transplantation (HCT) carries a high infection risk, especially pre-engraftment. Fluoroquinolone (FQ) prophylaxis is common, but rising FQ-resistant Enterobacterales (FQRE) rates may limit its effectiveness. This study evaluated febrile neutropenia, bacteremia, and mortality in HCT patients based on FQ prophylaxis and FQRE colonization. A retrospective analysis of HCT recipients at a tertiary center in Lebanon (2017–2022) was performed. Patients receiving FQ prophylaxis during neutropenia were compared with those who did not. FQRE colonization was monitored through weekly perianal swabs post-transplant. Of 156 HCT recipients (mean age 54 years; 61% males), 73.1% received FQ prophylaxis, and 39% had FQRE colonization. Febrile neutropenia occurred in 86%, more frequently in non-prophylaxis and FQRE-colonized patients, though prophylaxis delayed its onset within 10 days post-transplant. Bacteremia affected 39.1% of 64 eligible patients, with lower rates in the prophylaxis group (35.7% vs. 62.5%, p = 0.02). Escherichia coli and coagulase-negative staphylococci predominated. All-cause mortality was 3.8%, with pneumonia and Clostridioides difficile infections in 5.1% and 3.2%, respectively; prophylaxis showed non-significant reductions in these outcomes. FQ prophylaxis reduced febrile neutropenia and bacteremia in HCT recipients, including those colonized with FQRE. Larger studies are needed to confirm its effects on multiple outcomes. Not applicable.

In oncology, an accurate pathological diagnosis can often mean the difference between cure and failure, potentially determining a patient’s survival. We present the case of a 28-year-old, never-smoking man whose initial diagnosis of small cell lung cancer (SCLC) was confirmed by the anatomic pathology laboratory upon reevaluation, despite initial doubt. This misclassification ultimately led to therapeutic failure following an initial complete remission and likely contributed to the poor outcome after the diagnosis was later corrected to pulmonary Ewing sarcoma. Primary pulmonary Ewing sarcoma is a rare malignancy that is often overlooked in adults. This case underscores not only the striking clinical and histopathological overlap between SCLC and pulmonary Ewing sarcoma but also the potentially fatal consequences of missing key diagnostic red flags, including the patient’s young age, non-smoking status, and atypical clinical course. Through this patient’s journey, we emphasize the importance of multidisciplinary collaboration, the limitations of relying solely on immunohistochemistry, and the critical role of early molecular testing. This case serves as a stark reminder that behind every pathology report is a human life—one that depends on the vigilance, humility, and thoroughness of the medical team entrusted with their care.

ObjectivesTo develop a predictive model for symptomatic postoperative febrile urinary tract infections (UTIs) in children undergoing open reimplantation for vesicoureteral reflux (VUR) and evaluate the association with VUR recurrence.Patients and methodsThis multicentre retrospective study included children with unilateral VUR (grades III–V) who underwent open Cohen or Lich‐Gregoir reimplantation (2010–2022), had recurrent febrile UTIs, and ≥1 year follow‐up. Analyses used 10‐pooled multiple imputation, with complete case for sensitivity. Full and Least Absolute Shrinkage and Selection Operator (LASSO) Weibull regression models with centre clustering, bootstrapping, and 10‐fold cross‐validation identified predictors. Prediction used demographic, clinical, procedural and antibiotic factors. The non‐scaled LASSO model informed the nomogram, evaluated using C‐indices, calibration and decision curve analysis (DCA). UTI and VUR recurrence were analysed via cumulative incidence.ResultsA total of 404 children (median age 8 (6–9) years; follow‐up 2.3 (2.0–3.3) years, 233 complete‐case) were analysed. Median preoperative febrile UTIs were four, 74.5% had antibiotic resistance and median postoperative prophylaxis was two days. The 3‐year cumulative incidence of postoperative UTI was 27.2% (95% CI: 22.9–31.6). LASSO‐significant predictors included operative time (HR 1.10, 95% CI 1.03–1.16); in sensitivity analyses, prior injection (HR 2.08, 95% CI 1.88–2.30) and postoperative antibiotic duration (HR 0.81, 95% CI 0.69–0.97) were also significant. The nomogram included preoperative fever, antibiogram resistance, renal defect, VUR phase, prior injection, surgical indication, catheterization, hospitalization and stenting. The model performed well (C‐indices = 0.743; calibration slope = 1), with DCA supporting clinical utility for 10–40% predicted risk. Recurrent VUR grade ≥II after 12 months (3.3%–12.7% at 1–3 years, n = 273) did not increase UTI risk.ConclusionsChildren with unilateral dilating VUR remained at risk of postoperative febrile UTIs. The nomogram can assist in identifying high‐risk children for targeted interventions, but requires external validation and refinement.

Kidney stone disease, or nephrolithiasis, is a prevalent urological condition with variable pathogenesis. Among various factors, urine pH is not only considered to be a more influential factor in stone formation and can aid in the early diagnosis and management of specific stone types such as uric acid, cystine, calcium phosphate and struvite stones, but the role of urine pH in calcium oxalate stones, which comprise most cases, is more complex. Hypocitraturia in routine evaluation is another recognizable factor in lithogenesis, and administration of citrate, a widely used agent in the conservative management of stones. corrects hypocitraturia. Citrate also alkalizes the urine and can therefore be used to dissolve and prevent uric acid stones. However, citrate can induce the formation of insoluble calcium phosphate salts, such as brushite and hydroxyapatite, which can lead to mixed stones and the development of nephrocalcinosis. To address this complexity, innovative treatments that focus on a broader inhibition of lithogenesis with pH-modifying strategies may allow for more comprehensive management. In addition, modern technological tools such as pH meters and pH-tracking mobile applications can offer personalized treatment plans, potentially improving patient outcomes. The current lack of consensus on the standard and optimal management of pH measurement and modification underscores the need for further research and greater collaboration among experts. The development of evidence-based strategies will be essential to improve prevention and nephrolithiasis.