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Article ; Online: Predictors of intensive care unit admission in adult cancer patients presenting to the emergency department with COVID-19 infection: A retrospective study.

El Zahran, Tharwat / Kalot, Nour / Cheaito, Rola / Khalifeh, Malak / Estelly, Natalie / El Majzoub, Imad

2023 Volume 18, Issue 8, Page(s) e0287649

Abstract: Background: Adult cancer patients with COVID-19 were shown to be at higher risk of Intensive Care Unit (ICU) admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations ... ...

Abstract	Background: Adult cancer patients with COVID-19 were shown to be at higher risk of Intensive Care Unit (ICU) admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. Therefore, this study aimed to identify predictors of ICU admission (demographic, clinical, and COVID-19 targeted medications) in cancer patients with active COVID-19 infection presenting to the Emergency Department (ED). Methods: This is a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the American University of Beirut Medical Center ED from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data were extracted from electronic medical records. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. A p-value less than 0.05 was considered significant. Results: Eighty-nine distinct patients were included. About 37% were admitted to the ICU (n = 33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage above 22 breaths per minute, oxygen saturation less than 95%, and a higher c-reactive protein upon presentation to the ED. After adjusting for confounding variables, only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission. Conclusion: Physicians need to be vigilant when taking care of COVID-19 infected cancer patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission.
MeSH term(s)	Humans ; Adult ; Retrospective Studies ; COVID-19/epidemiology ; COVID-19/therapy ; Hospitalization ; Emergency Service, Hospital ; Intensive Care Units ; Neoplasms/complications ; Neoplasms/therapy
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0287649
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: "Predictors of in-hospital mortality in adult cancer patients with COVID-19 infection presenting to the emergency department: A retrospective study".

El Majzoub, Imad / Kalot, Nour / Khalifeh, Malak / Estelly, Natalie / El Zahran, Tharwat

PloS one

2023 Volume 18, Issue 1, Page(s) e0278898

Abstract: Background: Adult cancer patients are at higher risk of morbidity and mortality following COVID-19 infection. Being on the front lines, it is crucial for emergency physicians to identify those who are at higher risk of mortality. The aim of our study ... ...

Abstract	Background: Adult cancer patients are at higher risk of morbidity and mortality following COVID-19 infection. Being on the front lines, it is crucial for emergency physicians to identify those who are at higher risk of mortality. The aim of our study was to determine the predictors of in-hospital mortality in COVID-19 positive cancer patients who present to the emergency department. Methods: This is a retrospective cohort study conducted on adult cancer patients who presented to the ED of the American university of Beirut medical center from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data was extracted and analyzed. The association between different variables and in-hospital mortality was tested using Student's t test and Fisher's exact test or Pearson's Chi-square where appropriate. Logistic regression was applied to factors with p <0.2 in the univariate models. Results: The study included 89 distinct patients with an average age of 66 years (± 13.6). More than half of them were smokers (52.8%) and had received chemotherapy within 1 month of presentation (52.8%). About one third of the patients died (n = 31, 34.8%). Mortality was significantly higher in patients who had recently received chemotherapy (67.7% vs 44.8%, p = .039), a history of congestive heart failure (CHF)(p = .04), higher levels of CRP (p = 0.048) and/or PCT(p<0.04) or were tachypneic in the ED (P = 0.016). Conclusions: Adult cancer patients with COVID-19 infection are at higher risks of mortality if they presented with tachypnea, had a recent chemotherapy, history of CHF, high CRP, and high procalcitonin levels at presentation.
MeSH term(s)	Aged ; Humans ; COVID-19/complications ; Emergency Service, Hospital ; Heart Failure ; Hospital Mortality ; Neoplasms/complications ; Retrospective Studies ; Middle Aged
Language	English
Publishing date	2023-01-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0278898
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Article ; Online: Comparing emergency department visits 10-year apart at a tertiary care center in Lebanon.

El Zahran, Tharwat / Ghandour, Lara / Chami, Anwar / Saliba, Najat / Hitti, Eveline

Medicine

2023 Volume 102, Issue 39, Page(s) e35194

Abstract: Presentations to the emergency department (ED) are growing worldwide. With the increasing risk factors of non-communicable disease (NCD) and communicable diseases (CD) in low- and middle-income countries, it is crucial to understand how ED presentations ... ...

Abstract	Presentations to the emergency department (ED) are growing worldwide. With the increasing risk factors of non-communicable disease (NCD) and communicable diseases (CD) in low- and middle-income countries, it is crucial to understand how ED presentations are changing with time to meet patients' needs and allocate acute care resources. The aim of this study is to compare the changes in patient and diseases characteristics over 2 time periods 10 year apart at the largest tertiary care center in Lebanon. This was a retrospective descriptive study of patients presenting to the ED at a large tertiary care center in 2009/2010 and 2018/2019. The discharge diagnoses were coded into Clinical Classification Software codes. We used descriptive statistics, odds ratios (OR), and non-parametric test to compare the different diagnoses. The total number of ED visits increased by 33% from 2009/2010 to 2018/2019. The highest increase rate was among patients older than 65 years (2.6%), whereas the percentage of pediatric patients decreased from 30.8% to 25.3%. ED presentations shifted from NCD to CD. A shift in the discharge diagnoses was also noted within age groups, specifically a shift in cardiovascular diseases to a younger age. Our study suggests that the role of the ED is changing and moving towards treating the aging population and CD. There is a need to invest and mitigate CD, better allocate resources to accommodate the aging population, focus on awareness campaigns targeting early detection of cardiovascular diseases and modifying its risk factors.
MeSH term(s)	Humans ; Child ; Aged ; Tertiary Care Centers ; Retrospective Studies ; Cardiovascular Diseases/epidemiology ; Lebanon/epidemiology ; Noncommunicable Diseases ; Emergency Service, Hospital ; Communicable Diseases
Language	English
Publishing date	2023-09-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000035194
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Article ; Online: Melitracen and flupentixol (deanxit) use disorder in Lebanon

El Zahran, Tharwat / Al Hassan, Sally / Khalifeh, Malak / Aboukhater, Diana / Hammoud, Lina / Al Hariri, Moustafa / Kazzi, Ziad

Heliyon. 2023 May, v. 9, no. 5 p.e15847-

2023

Abstract: Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit use disorder, ... ...

Abstract	Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit use disorder, assess the source of the medication, and the consumers' awareness of the therapeutic and side effects of Deanxit, among the Lebanese population. This is a cross-sectional study that included all patients taking Deanxit and visited the Emergency Department between October 2019 and October 2020. All patients who agreed to participate in the research through written consent forms were contacted by telephone and a questionnaire was filled out. A total of 125 patients taking Deanxit were included in the study. According to the DSM-V criteria, 36% (n = 45) had a Deanxit use disorder. Most of the participants were females (n = 99, 79.2%), married (n = 90, 72%), and between the ages of 40-65 years (n = 71, 56.8%). Most patients (n = 41, 91%) had Deanxit prescribed by a physician for anxiety (n = 28, 62%), and obtained it using a prescription (n = 41, 91%). Almost half of all patients (n = 60, 48%) did not have sufficient knowledge of the reason it was prescribed, 54.4% (n = 68) were not sure they are taking the medication appropriately, and 19.2% (n = 23) were satisfied by the overall explanation of the physicians concerning Deanxit use. Deanxit use disorder is underrecognized among Lebanese patients. Most of our patients were prescribed Deanxit by their physicians but reported inadequate knowledge of its side effects and risk of abuse.
Keywords	antidepressants ; anxiety ; cross-sectional studies ; drug therapy ; questionnaires ; risk ; telephones ; Lebanon ; Flupentixol ; Melitracen ; Deanxit ; Substance use disorder ; Dependence ; Withdrawal
Language	English
Dates of publication	2023-05
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e15847
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Article ; Online: A Case Report of a Lebanon Viper (Montivipera bornmuelleri) Envenomation in a Child.

Tabbara, Faysal / Abdul Nabi, Sarah S / Sadek, Riad / Kazzi, Ziad / El Zahran, Tharwat

Clinical practice and cases in emergency medicine

2022 Volume 6, Issue 4, Page(s) 318–322

Abstract: Introduction: Snake envenomation is a serious public health concern. In the Middle East little is known about snakebite envenomation, which raises several challenges for emergency physicians caring for these patients.: Case report: We report the case ...

Abstract	Introduction: Snake envenomation is a serious public health concern. In the Middle East little is known about snakebite envenomation, which raises several challenges for emergency physicians caring for these patients. Case report: We report the case of a five-year-old boy bitten by a rare snake, Montivipera bornmuelleri, who presented to an emergency department in Lebanon. We also discuss the proper management of snake envenomation. Conclusion: This case is unique as snakebites in Lebanon are poorly studied, and little is known about the epidemiology and clinical manifestations of local snakebites.
Language	English
Publishing date	2022-11-25
Publishing country	United States
Document type	Journal Article
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2022.2.56176
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Article ; Online: The Beirut Port Blast: spectrum of injuries and clinical outcomes at a large tertiary care center in Beirut, Lebanon.

El Zahran, Tharwat / Geha, Mirabelle / Sakr, Fouad / Bachir, Rana / El Sayed, Mazen

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2022 Volume 48, Issue 6, Page(s) 4919–4926

Abstract: Purpose: To describe injuries and outcomes of casualties of Beirut Port Blast treated at a large tertiary care center in Beirut, Lebanon.: Methods: A retrospective observational study assessing the spectrum of injuries, treatment, and medical outcome ...

Abstract	Purpose: To describe injuries and outcomes of casualties of Beirut Port Blast treated at a large tertiary care center in Beirut, Lebanon. Methods: A retrospective observational study assessing the spectrum of injuries, treatment, and medical outcome among casualties of the Beirut Port Blast, immediately after the blast and up to 1 week from the blast to the emergency department of the American University of Beirut Medical Center (AUBMC). Results: A total of 359 patients were included. Most (n = 343, 95.6%) were adults (> 19 years), and males (56%) with a mean age of 42 ± 20 years. The most frequent mechanism of injury was a penetrating injury (45.7%), followed by other blast-related injuries (30.4%), and blunt injuries (23.4%). The most affected anatomical location were the limbs. Most (n = 217, 60.4%) patients required imaging. The most frequently administered medication was analgesics (38%), followed by anesthetics (35%), antibiotics (31%), tetanus vaccine (31%), and fluids (28%). Blood and blood products were administered in 3.8% of cases. Emergent procedures included endotracheal intubation (n = 18, 5%), surgical airway (n = 3, 0.8%), chest tube insertion (n = 4, 1.1%), thoracotomy (n = 1, 0.3%), and CPR (n = 5, 1.4%). A quarter of patients required surgical operations in the operating room (n = 85, 23.6%) and 18% required noncritical care admissions, 5.3% required critical care admissions, and 2.8% were dead on arrival. Conclusion: Casualties from this event had significant injuries requiring lifesaving interventions, surgical procedures, and admission to critical care units. High utilization of imaging modalities and of medications from existing stockpiles was also observed.
MeSH term(s)	Adult ; Male ; Humans ; Young Adult ; Middle Aged ; Tertiary Care Centers ; Lebanon/epidemiology ; Explosions ; Blast Injuries/epidemiology ; Blast Injuries/therapy ; Wounds, Penetrating ; Retrospective Studies
Language	English
Publishing date	2022-06-25
Publishing country	Germany
Document type	Observational Study ; Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-022-02023-9
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The yield of neuroimaging in patients presenting to the emergency department with isolated neuro-ophthalmological complaints: A retrospective chart review.

El Zahran, Tharwat / El Hadi, Dalia / Mostafa, Hala / Mansour, Hana / Hashim, Ibrahim / Tahhan, Soubhi / Bou Ghannam, Alaa

Medicine

2023 Volume 102, Issue 4, Page(s) e32740

Abstract: Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. The decision to perform a neuroimaging procedure is based on the clinical judgment of the medical team, without defined indications. ...

Abstract	Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. The decision to perform a neuroimaging procedure is based on the clinical judgment of the medical team, without defined indications. This study aims to identify presenting symptoms and physical exam findings associated with relative positive findings on neuroimaging studies. Electronic medical records of patients presenting to the emergency department (ED) with isolated neuro-ophthalmologic complaints between January 1, 2013 and September 30, 2019 were reviewed. We collected data on the clinical presentation, neuroimaging procedures and results, consults, and diagnoses. Two hundred eleven patients' charts were reviewed. Most presented with unilateral eye complaints (53.6%), and the most common symptoms were blurred vision (77.3%) and headaches (42.2%). A total of 126 imaging procedures were performed of which 74.6% were normal, while 25.4% showed relevant abnormal findings. Complaining of blurry vision (P = .038) or visual field changes (P = .014) at presentation as well as having a visual field defect (P = .016), abnormal pupil reactivity (P = .028), afferent pupillary defect (P = .018), or abnormal optic disc exam (P = .009) were associated with positive findings on imaging. Neuroimaging is more likely to yield positive findings in patients presenting to the ED with visual field irregularities, afferent pupillary defects, or abnormal optic discs. These findings - when combined with the proper clinical setting - should lower the threshold to proceed with neuroimaging in the emergency department. Based on our results, larger-scale studies might lead to a well-structured algorithm to be followed by ED physicians in decision making.
MeSH term(s)	Humans ; Retrospective Studies ; Vision Disorders/diagnostic imaging ; Vision Disorders/complications ; Emergency Service, Hospital ; Neuroimaging ; Headache/diagnostic imaging ; Headache/complications ; Pupil Disorders
Language	English
Publishing date	2023-01-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000032740
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Melitracen and flupentixol (deanxit) use disorder in Lebanon.

El Zahran, Tharwat / Al Hassan, Sally / Khalifeh, Malak / Aboukhater, Diana / Hammoud, Lina / Al Hariri, Moustafa / Kazzi, Ziad

Heliyon

2023 Volume 9, Issue 5, Page(s) e15847

Abstract: Introduction: Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit ... ...

Abstract	Introduction: Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit use disorder, assess the source of the medication, and the consumers' awareness of the therapeutic and side effects of Deanxit, among the Lebanese population. Methods: This is a cross-sectional study that included all patients taking Deanxit and visited the Emergency Department between October 2019 and October 2020. All patients who agreed to participate in the research through written consent forms were contacted by telephone and a questionnaire was filled out. Results: A total of 125 patients taking Deanxit were included in the study. According to the DSM-V criteria, 36% (n = 45) had a Deanxit use disorder. Most of the participants were females (n = 99, 79.2%), married (n = 90, 72%), and between the ages of 40-65 years (n = 71, 56.8%). Most patients (n = 41, 91%) had Deanxit prescribed by a physician for anxiety (n = 28, 62%), and obtained it using a prescription (n = 41, 91%). Almost half of all patients (n = 60, 48%) did not have sufficient knowledge of the reason it was prescribed, 54.4% (n = 68) were not sure they are taking the medication appropriately, and 19.2% (n = 23) were satisfied by the overall explanation of the physicians concerning Deanxit use. Conclusion: Deanxit use disorder is underrecognized among Lebanese patients. Most of our patients were prescribed Deanxit by their physicians but reported inadequate knowledge of its side effects and risk of abuse.
Language	English
Publishing date	2023-05-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e15847
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Telephonic Medical Toxicology Service in a Low-Resource Setting: Setup, Challenges, and Opportunities.

Hitti, Eveline / El Zahran, Tharwat / Hamade, Hani / Morgan, Brent W / Kazzi, Ziad

The western journal of emergency medicine

2021 Volume 22, Issue 2, Page(s) 450–453

Abstract: Poisoning and envenomation are a global health problem for which the mortality burden is shouldered heavily by middle- and low-income countries that often lack poison prevention programs and medical toxicology expertise. Although telehealth or ... ...

Abstract	Poisoning and envenomation are a global health problem for which the mortality burden is shouldered heavily by middle- and low-income countries that often lack poison prevention programs and medical toxicology expertise. Although telehealth or teleconsult services have been used to bridge the expertise gap between countries for multiple specialties, the use of medical toxicology teleconsult services across borders has been limited. We aim to describe the use of a United States-based medical toxicology teleconsult service to support patient care at a hospital in a middle-income country that lacks this expertise. This report outlines the logistics involved in setting up such a service, including the challenges and opportunities that emerged from establishing medical toxicology teleconsult service in a low-resource setting.
MeSH term(s)	Developing Countries ; Expert Testimony/methods ; Humans ; International Cooperation ; Lebanon/epidemiology ; Poisoning/diagnosis ; Poisoning/epidemiology ; Poisoning/therapy ; Remote Consultation/methods ; Remote Consultation/organization & administration ; Toxicology/methods ; Toxicology/organization & administration ; United States
Language	English
Publishing date	2021-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2020.10.48534
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Article ; Online: Toxicological exposures among the pediatric patients at a tertiary care center in Lebanon: the case for establishing a national poison center.

El Zahran, Tharwat / Mostafa, Hala / Hamade, Hani / Hitti, Eveline / Morgan, Brent W / Kazzi, Ziad

Clinical toxicology (Philadelphia, Pa.)

2021 Volume 59, Issue 9, Page(s) 780–785

Abstract: Background: Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and ...

Abstract	Background: Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon. It also evaluates the appropriateness of ED visits among confirmed or suspected toxicological exposures in children, in order to assess the role of a national poison center in reducing unnecessary ED visits. Methods: This is a secondary analysis of a database for a telephonic medical toxicology service at the American University of Beirut Medical Center, the largest tertiary care center in Lebanon. Data relating to all pediatric patients aged 0-19 years of age were entered into the database by the medical toxicology team. The cases were independently reviewed by 2 medical toxicologists for the adequacy of referral to the ED and performance of invasive procedures. Results: Two hundred and nine exposures were recorded between 15 April 2015 and 31 December 2019, of which 53.1% were females. Children aged less than 5 years were involved in 67.0% of cases while adolescents aged 13-19 years were involved in 21.1%. The most commonly involved substances were analgesics (14.8%) and cardiovascular drugs (10.0%). The majority had no (59.3%) or minor (26.3%) effects and were treated and discharged home (67.5%). More than a third of ED visits were deemed unnecessary by the toxicologists (Kappa = 0.705), and when including only unintentional cases, around 45% of the ED visits were deemed unnecessary (Kappa = 0.677). Conclusion: Our data show that 37% of all pediatric poisoning ED visits and 45% of ED visits due to unintentional pediatric poisonings were unnecessary. Additionally, more often than not lavage suctions were done unnecessarily. Future research investigating the possibility of preventing unnecessary visits by establishing a national poison center is needed.
MeSH term(s)	Adolescent ; Age Factors ; Child ; Child, Preschool ; Emergency Service, Hospital/statistics & numerical data ; Female ; Hazardous Substances/poisoning ; Humans ; Infant ; Infant, Newborn ; Lebanon/epidemiology ; Male ; Poison Control Centers/organization & administration ; Poisoning/diagnosis ; Poisoning/epidemiology ; Poisoning/therapy ; Sex Factors ; Tertiary Care Centers/statistics & numerical data ; Young Adult
Chemical Substances	Hazardous Substances
Language	English
Publishing date	2021-02-08
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	204476-6
ISSN	1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
ISSN (online)	1556-9519
ISSN	0009-9309 ; 0731-3810 ; 1556-3650
DOI	10.1080/15563650.2021.1874404
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