RESUMEN

Cholera is a life-threatening gastrointestinal infection caused by a toxigenic bacterium, Vibrio cholerae. After a lull of almost 30 years, a first case of cholera was detected in Lebanon in October 2022. The outbreak lasted three months, with 8007 suspected cases (671 laboratory-confirmed) and 23 deaths. In this study, we use phenotypic methods and microbial genomics to study 34 clinical and environmental Vibrio cholerae isolates collected throughout this outbreak. All isolates are identified as V. cholerae O1, serotype Ogawa strains from wave 3 of the seventh pandemic El Tor (7PET) lineage. Phylogenomic analysis unexpectedly reveals the presence of two different strains of the seventh pandemic El Tor (7PET) lineage. The dominant strain has a narrow antibiotic resistance profile and is phylogenetically related to South Asian V. cholerae isolates and derived African isolates from the AFR15 sublineage. The second strain is geographically restricted and extensively drug-resistant. It belongs to the AFR13 sublineage and clusters with V. cholerae isolates collected in Yemen. In conclusion, the 2022-2023 Lebanese cholera outbreak is caused by the simultaneous introduction of two different 7PET strains. Genomic surveillance with cross-border collaboration is therefore crucial for the identification of new introductions and routes of circulation of cholera, improving our understanding of cholera epidemiology.

Asunto(s)

Cólera , Brotes de Enfermedades , Filogenia , Líbano/epidemiología , Humanos , Cólera/epidemiología , Cólera/microbiología , Genoma Bacteriano/genética , Genómica/métodos , Vibrio cholerae/genética , Vibrio cholerae/aislamiento & purificación , Vibrio cholerae/clasificación , Masculino , Antibacterianos/farmacología , Femenino , Vibrio cholerae O1/genética , Vibrio cholerae O1/aislamiento & purificación , Vibrio cholerae O1/clasificación , Adolescente , Adulto , Adulto Joven , Persona de Mediana Edad , Niño , Epidemiología Molecular

RESUMEN

The rapid spread of the coronavirus disease COVID-19 has imposed clinical and financial burdens on hospitals and governments attempting to provide patients with medical care and implement disease-controlling policies. The transmissibility of the disease was shown to be correlated with the patient's viral load, which can be measured during testing using the cycle threshold (Ct). Previous models have utilized Ct to forecast the trajectory of the spread, which can provide valuable information to better allocate resources and change policies. However, these models combined other variables specific to medical institutions or came in the form of compartmental models that rely on epidemiological assumptions, all of which could impose prediction uncertainties. In this study, we overcome these limitations using data-driven modeling that utilizes Ct and previous number of cases, two institution-independent variables. We collected three groups of patients (n = 6296, n = 3228, and n = 12,096) from different time periods to train, validate, and independently validate the models. We used three machine learning algorithms and three deep learning algorithms that can model the temporal dynamic behavior of the number of cases. The endpoint was 7-week forward number of cases, and the prediction was evaluated using mean square error (MSE). The sequence-to-sequence model showed the best prediction during validation (MSE = 0.025), while polynomial regression (OLS) and support vector machine regression (SVR) had better performance during independent validation (MSE = 0.1596, and MSE = 0.16754, respectively), which exhibited better generalizability of the latter. The OLS and SVR models were used on a dataset from an external institution and showed promise in predicting COVID-19 incidences across institutions. These models may support clinical and logistic decision-making after prospective validation.

Asunto(s)

COVID-19 , Modelos Epidemiológicos , Algoritmos , COVID-19/epidemiología , COVID-19/virología , Aprendizaje Profundo , Humanos , Aprendizaje Automático , Máquina de Vectores de Soporte , Carga Viral

RESUMEN

Background The aim of this retrospective study was to identify prevalence and risk factors for vitamin D inadequacy in a sunny Mediterranean country. Methods Results of 2,547 patients aged 19 to >60 years were included in this study. Data were derived from the laboratory database at Rafik Hariri University Hospital, Beirut, Lebanon, over a period of two years (2016-2017). Data included patient's age, gender, date of test, and vitamin D level. Females were questioned through phone call for marital status, parity, and veiling. Results The prevalence of vitamin D inadequacy was 83.5% overall, 86.4% in males, and 82.3% in females. At a cut-off of 20 ng/mL, vitamin D deficiency affected 63% of the studied population. A significant association was observed between vitamin D and age. The highest prevalence (71.2%) was found in females in the age group of 19-39 years, while no significant correlation with age was observed in males. Vitamin D levels were lower in veiled women (mean 25(OH)D = 17.9 ng/mL) compared to non-veiled women, although this difference was not significant. In addition, vitamin D inadequacy does not show a significant association with gender, parity, marital status, and season of the year. Conclusion The high prevalence of vitamin D inadequacy in our study in both males and females of all age groups calls for urgent actions at the national level to increase awareness in the population and to prevent the serious complications of vitamin D deficiency in all patients, especially those who are at a high risk.

RESUMEN

The patellar sleeve fracture is a rare entity in pediatric traumatology. Its diagnosis is challenging due to its rarity and subtle radiographic finding, and it is easily missed by emergency physicians. Early recognition and treatment of this fracture is of paramount importance in order to guarantee better outcomes. We present herein a case of severely displaced patellar sleeve fracture in an eight-year-old girl, which was treated successfully by open reduction and fixation of the osteochondral fragments using anchor sutures, yielding very positive clinical outcomes at the two-year follow-up.