Background: Diabetes mellitus is a chronic noncommunicable disease characterized by hyperglycemia and is associated with chronic complications affecting the overall quality of life. As of 2017, the prevalence of diabetes in Lebanon is estimated to be 14.6%. Depression is noted to be common among Lebanese citizens, present in around 17.3%. This study aims to investigate the prevalence of depression among the diabetic Lebanese citizens and to study its relationship with poor glycemic control and diabetes complications. Methods: In total, 436 diabetic patients participated in this cross-sectional study. Patients with diabetes mellitus attending several private clinics and health care centers were asked to fill out a well-structured questionnaire developed by an expert. Depression was assessed using Beck Depression Inventory (BDI). The study collected demographic information about the participants including their lifestyles, their last reported glycosylated hemoglobin values, and their reported microvascular and macrovascular complications. Data were collected, entered, and analyzed on SPSS software version 23.1. A descriptive analysis is carried out by calculating the mean and standard deviation for continuous variables and number and percentage for categorical ones. Association between categorical variables is evaluated using a chi-squared test. A P-value of <0.05 is considered to be significant. Results: Depression was prevalent among 28.8% of the patients with diabetes mellitus. The average age of participants was 64.08 years. In total, 280 (64.2%) of the participants were females and the average diabetes duration was 8.89 years. There was no significant relationship found between depression and glycemic control. By contrast, a significant association between retinopathy, nephropathy, and stroke and depression was found. Conclusion: Depression was found to be present among 28.8% of the patients with diabetes mellitus in Lebanon; however, no association was established between depression and glycemic control.

In early 20th century, Sir William Osler supported the use of humour as an efficacious tool in medical education, which continues to be used today. Despite the abundance of literature delineating this important role, it is often overlooked among medical students. A descriptive cross-sectional study was planned where a total of 295 medical students from the pre-clerkship and clerkship phases at Beirut Arab University Faculty of Medicine were included in the study. A questionnaire was distributed among the participants assessing their perception on the use of humour in medical education. Data were collected, entered, and analysed on SPSS software version 23.1. Results with p-value < 0.05 were considered statistically significant. The majority of participants agreed to the implementation of humour in medical education. They supported different forms of humour to be used, and considered mockery, sarcasm, the instructor appearing as a performer, and humour that is irrelevant to the course as inappropriate. Inappropriate humour distracts attention and disrupts the formal atmosphere. Our findings suggest that medical students’ opinions on using humour in medical education are supportive. The findings of this study might be of benefit to assist teachers in using humour to improve the attendance and interest of the students in the class and create an environment conducive to optimal student learning.

Background: Stenotrophomonas maltophilia is a rising opportunistic organism among hospitalized patients, leading to outbreak infections. It is known to be a nosocomial pathogen resistant to multiple antibiotics and may be transmitted via contaminated hospital equipment. Its infection can lead to cardiac complications, although very rare. Case Summary: We present a case of a 63-year-old patient who presented with insidious symptoms of fever, chills, and chest discomfort and was admitted for the management of prosthetic valve infective endocarditis caused by S. maltophilia evident by positive blood cultures and visualized vegetations on the mitral valve by echocardiography. The hospital stay was complicated by two embolic strokes. The patient underwent successful surgical replacement of the prosthetic mitral valve. However, given the patient’s significant disability and morbidity, he required assistance in performing the activities of daily living in addition to placement of a gastrostomy tube due to the high risk of aspiration. Conclusion: S. maltophilia infective endocarditis is a rare but serious infection that warrants immediate attention with prompt initiation of intravenous antibiotics. In addition, and when indicated, surgical intervention can lead to successful management and minimize the risk of complications, morbidity, and mortality.

Background/Objectives: The “weekend effect,” characterized by increased mortality and complication rates for weekend hospital admissions, is well documented in myocardial infarction and stroke but has been less thoroughly investigated in acute decompensated heart failure (ADHF). This study evaluates the weekend effect in ADHF using a national cohort. Methods: A retrospective cohort study was conducted using the 2016–2020 Nationwide Inpatient Sample (NIS). Adult ADHF admissions were identified by ICD-10 codes and classified as weekend or weekday admissions. Over 30 variables, including age, sex, and comorbidities, were analyzed. Propensity score matching (1:1) yielded 489,204 patients per group. Univariate and multivariate logistic regression models were used to assess outcomes, adjusting for key covariates. Results: Of 2,131,915 ADHF hospitalizations, 501,076 (23.5%) occurred on weekends. The cohort was 48% female, with a mean age of 72 years (SD ± 12.3). After 1:1 matching, weekend admissions had higher odds of cardiac arrest (aOR: 1.10; 95% CI: 1.06–1.13, p < 0.001), inpatient mortality (aOR: 1.07; 95% CI: 1.05–1.09, p < 0.001), acute kidney injury (AKI; aOR: 1.07; 95% CI: 1.06–1.08, p < 0.001), and acute respiratory failure (ARF; aOR: 1.28; 95% CI: 1.27–1.30, p < 0.001). No significant differences were observed in mechanical circulatory support (MCS) use or length of stay. Conclusions: Weekend ADHF admissions were associated with a higher risk of mortality and complications, which may be attributable to reduced specialist availability or delayed diagnostics. These findings underscore the need for standardized ADHF protocols to ensure equitable care throughout the week.

The United States Food and Drug Administration (FDA) has explicitly discouraged the use of ivermectin for the treatment of cancer outside of clinical trials. Nevertheless, patient self-administration persists, frequently influenced by information encountered online. Cases of ivermectin neurotoxicity in the oncology setting remain underreported despite growing off-label use driven by online misinformation. We present a case of severe neurotoxicity following unintentional high-dose self-administration of ivermectin as an off-label attempt to treat breast cancer. A 73-year-old female with metastatic breast cancer self-administered high doses of ivermectin based on information obtained online. She subsequently developed acute altered mental status, generalized seizures, and respiratory failure. Her clinical course was consistent with severe ivermectin-induced neurotoxicity, necessitating supportive management including intubation, mechanical ventilation, intravenous fluids, and anticonvulsant therapy. The patient demonstrated full neurological recovery to baseline within 48 hours. This case highlights the potential for life-threatening neurotoxicity associated with high-dose ivermectin use. Increasing online health misinformation has led to the self-administration of unproven therapies; therefore, clinicians should counsel patients on the risks of non-evidence-based treatments. A thorough exposure history is essential to identify uncommon causes and maintain vigilance for severe adverse reactions.

Background and Objectives: Acute or severe limb ischemic events are limb- and life-threatening complications of peripheral artery disease (PAD). Although cirrhosis is increasingly recognized as a systemic disorder associated with endothelial dysfunction, inflammation, and altered hemostatic balance, its relationship with coding-defined limb ischemic events among individuals with PAD remains poorly defined. We investigated whether cirrhosis is independently associated with coding-defined acute or severe limb ischemic events among hospitalized adults with PAD. Materials and Methods: We performed a retrospective discharge-level analysis of the National Inpatient Sample from 2016 to 2018. Adult hospitalizations with PAD were identified using ICD-10-CM diagnosis codes and stratified according to the presence or absence of cirrhosis. The primary outcome was coding-defined acute or severe limb ischemic events. Multivariable logistic regression was used to evaluate the association between cirrhosis and acute or severe limb ischemic events after adjustment for demographic and cardiovascular comorbidities. Propensity-score matching was additionally performed to balance baseline characteristics between hospitalizations with and without cirrhosis. Results: Among 276,702 hospitalizations with PAD, 5942 had cirrhosis. Before matching, cirrhosis was independently associated with higher odds of acute or severe limb ischemic events after multivariable adjustment (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.35–1.60; p < 0.001). After 1:1 propensity-score matching, 5883 matched pairs were analyzed. The association between cirrhosis and acute or severe limb ischemic events persisted in the matched cohort, with cirrhosis remaining significantly associated with increased odds of these events (OR 1.41, 95% CI 1.24–1.60; p < 0.001). Conclusions: In this large discharge-level analysis of hospitalizations with PAD, cirrhosis was independently associated with higher odds of coding-defined acute or severe limb ischemic events. These findings suggest that cirrhosis may represent an underrecognized vascular risk amplifier in PAD. Further prospective studies are needed to validate this association, clarify underlying mechanisms, and determine whether cirrhosis may improve PAD risk stratification.