Lebanon, one of the smallest countries in the Middle East, has held for decades a reputation for being the premier medical hub for patients from the Arab world as well as neighboring countries and for offering world-class treatment and advanced medical services. However, this once world-renowned healthcare sector is now facing a risk of imminent collapse as overlapping crises have struck the country since October 2019. In this article, we describe the concomitant political, economic, and financial challenges that Lebanon is facing, which have strained the national healthcare system and have undermined its ability to respond to the coronavirus disease 2019 (COVID-19) pandemic. We present an overview of the political instability, the Lebanese revolution with countrywide protests, as well as the devaluation of the Lebanese currency representing one of the worst economic meltdowns since the 19th century. We describe the unprecedented energy crisis the country is facing and the disastrous consequences of the Beirut port explosion of August 2020. We review the efforts and measures taken by different stakeholders to contain the COVID-19 pandemic amid the multifaceted challenges and the large exodus of healthcare personnel.

The recent development of new offshore projects in pre-salt deepwater fields has placed offshore loading operations as the main production outflow alternative, increasing the operational complexity and risks. Numerous dangerous situations are associated with oil offloading, such as the messenger line transfer during the mooring stage. Nowadays, this critical task is realized by launching a thin messenger cable using the pneumatic line throwing apparatus. This is a complex and slow process since the operation usually occurs with the ship opposite to the wind. This work proposes a hybrid flight methodology based on computer vision and sensor fusion techniques for autonomous unmanned aerial vehicles (UAVs). The UAV takes off from an oil rig and precisely reaches a specific point in the shuttle tanker without using expensive positioning devices and augmenting UAV’s orientation (yaw) precision since the compass can suffer from severe interference due to naval metallic structures near the vehicle. The proposed framework was tested in a realistic simulated environment considering several practical operational constraints. The results demonstrated both the robustness and efficiency of the methodology.

Background: Degenerative cervical myelopathy is characterized by progressive compression of the spinal cord resulting in debilitating loss of dexterity, independent ambulation, and sphincter control. Diffusion tensor imaging (DTI) has shown that, compared to healthy controls, myelopathy patients have decreased integrity of the corticospinal tracts and corpus callosum (Bernabeu-Sanz et al, 2020). Methods: Twenty-six myelopathy patients consented to cerebral diffusion tensor imaging (3 Tesla, 32 directions, b=1000) preoperatively, as well as 6-weeks, 12-weeks, and 6-months postoperatively. Average mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) were measured in the corticospinal tracts, forceps major, and forceps minor. Results: Both MD and RD decreased from 6-12 weeks postoperatively in the right corticospinal tract. The forceps major of the corpus callosum showed an initial postoperative increase in MD followed by a subsequent increase in FA and decrease in RD 3-6 months postoperatively. The AD of the forceps major increased both immediately and 3-6 months postoperatively. Conclusions: Changes in microstructural integrity of the corticospinal tract and forceps major over the postoperative recovery period suggest a pattern of recovery in myelopathy patients. This study is the first to report postoperative DTI changes in myelopathy-relevant white matter tracts in the brain.

On August 4, 2020, Beirut experienced a large explosion when 2750 tons of ammonium nitrate detonated in the Beirut port resulting in more than 220 deaths, 76 000 injuries, 300 000 people displaced, and 15 billion dollars loss in property damage. Hôtel-Dieu de France (HDF), one of the largest university hospitals in the capital, has an emergency department that typically accommodates 25 patients. On that night, it received the largest number of injuries and had to accommodate more than 700 casualties within a few hours of the blast. This article describes HDF’s preparedness, emergency response, as well as the distribution of admissions to the emergency department, operation rooms, and the general ward. Surge capacity and the triage system are also detailed.

Child psychological / behavioral disorders such as withdrawal may persist when the psychosocial context is unfavorable. Health promotion strategies (Olds' paradigm) have proved their efficacy in vulnerable populations. CAPEDP project sets out to evaluate a program of home visits in France. 440 primagravida will be randomized into two groups. They will ALL be under 26 and vulnerable by having a low level of education AND/OR a low income AND/OR being socially isolated. The first group will receive routine follow-up as currently provided by national community health and social services. The second group will receive home visits by community workers. These visits will start during pregnancy and will continue up to the child's 2nd birthday. This program aims at reducing psychosocial disorders and promoting mental health, social support and attachment amongst at-risk young women and their families. The ten objectives for the home visiting : Enhancing parental skills, Preventing prenatal and postnatal depression, Preventing psychosocial disorders in the children, Promoting secure attachment in the children, Enhancing knowledge and use of available health, educative and social resources, Promoting parental self-esteem for their roles, Reducing parental stress, Enhancing mothers' social network and perceived support, Promoting psychomotor development in the children, Enhancing mothers' knowledge about child development. This will be the first time in France that such a program will be implemented. Our hypothesis is that a targeted prevention and health promotion will reduce physical and mental health care needs.This is also the first prospective randomized control trial in France on mother-child attachment.

We report the case of a 10-year-old girl with Takayasu arteritis who developed acute onset wrist drop diagnosed with a large right axillary artery aneurysm compressing the surrounding structures. Our case is unique because it describes a rare presentation of Takayasu arteritis (axillary aneurysm) in a child that was treated successfully in an unconventional manner by transcutaneous embolisation following failure of trans-arterial approach.

Background: The Gilenya® Go ProgramTM offers education and support services, including coordination of first dose observation (FDO) and follow-up contact to reinforce monitoring recommendations and compliance in fingolimod-treated relapsing-remitting multiple sclerosis (RRMS) patients. Methods: Data were analyzed for patients enrolled in the Canadian Gilenya® Go ProgramTM from March 2011 to January 2016. The retention to fingolimod therapy, reasons for treatment discontinuation and incidence of adverse events (AEs) during treatment are reported. Results: At data cut-off, 3956 patients had completed FDO; 3201 patients were being actively treated. Mean age at enrolment was 41.0 years; 74.9% patients were female. The overall fingolimod exposure was 7869 patient-years. Most recent previous therapies (n=3746) included interferons (43.3%) and glatiramer acetate (29.6%). Most common reasons for switching to fingolimod (n=3674) was lack of efficacy (31.8%). Retention to therapy at data cut-off was 81.3%. AEs (45.2%) were the most common reason (n=334) for treatment discontinuation and included low lymphocyte count/abnormal hematology values (13.8%), gastrointestinal disturbances (6.9%), and elevated liver enzyme levels (7.8%). Adherence to recommended ophthalmic examination was 92.4%. Conclusions: In real-world clinical practice in Canada, adherence to both fingolimod treatment and monitoring was high. The Gilenya® Go Program™ helps to meet the safety monitoring recommendations for fingolimod-treated RRMS patients.

Streptococcus dysgalactiae is a bacterium that accounts for a notable proportion of both clinical and subclinical intramammary infections (IMIs). Thus, the present study explores the function of milk neutrophils and the lymphocyte profile in mammary glands naturally infected with Streptococcus dysgalactiae. Here, we used 32 culture-negative control quarters from eight clinically healthy dairy cows with low somatic cell counts and 13 S. dysgalactiae-infected quarters from six dairy cows. Using flow cytometry, we evaluated the percentage of milk monocytes/macrophages and neutrophils, expression of CD62L, CD11b and CD44 by milk neutrophils, the levels of intracellular reactive oxygen species (ROS) production and phagocytosis of Staphylococcus aureus by milk neutrophils, and neutrophil viability. Furthermore, the percentages of B cell (CD21+) and T lymphocyte subsets (CD3+/CD4+/CD8−; CD3+/CD8+/CD4−; and CD3+/CD8−/CD4−), and the expression of CD25 by T milk lymphocytes (CD3+) and T CD4+ milk cells were also assessed by flow cytometry using monoclonal antibodies. The present study showed a higher SCC and percentage of milk neutrophils, and a decrease in the percentage of milk monocytes/macrophages from S. dysgalactiae-infected quarters when compared to uninfected ones. We also observed a higher expression of CD11b by milk neutrophils and a tendency toward a decrease in neutrophil apoptosis rate in S. dysgalactiae-infected quarters. In addition, the S. dysgalactiae-infected quarters had higher percentages of milk T cells (CD3+) and their subset CD3+CD8+CD4− cells. Overall, the present study provided new insights into S. dysgalactiae IMIs, including distinct lymphocyte profiles, and a tendency toward an inhibition of apoptosis in milk neutrophils.

Orf virus has a worldwide distribution among sheep and goats. The hypersensitivity reaction erythema multiforme (EM) is a known complication of orf infection in humans; however, its occurrence is poorly understood and has not been extensively reviewed. We present two unrelated cases of orf-associated EM, and a review of the literature, highlighting important clinical, epidemiological and immunological aspects of this condition. Orf and its associated complications can occur in rural areas, as well as urban settings, where it is less well-known, through religious or cultural practices involving animal slaughter. Obtaining a history of animal exposures from patients with lesions suspicious for orf and secondary skin eruptions can guide diagnosis and identification of the inciting immune stimulus. Determining the pathophysiology and relative contribution of host and viral factors contributing to EM and other orf-associated hypersensitivity reactions could facilitate the identification of risk factors and inform treatment decisions.

In the French watt balance experiment, in order to have a single point of application of a weight and an electromagnetic force balancing this weight, a system of double gimbals with flexure pivots was made out of copper-beryllium alloy. This allows the articulation of the suspension devices of the mass (generating the weight) and coil (on which the electromagnetic force acts) around four coplanar axes which intersect at one point (equivalent to a virtual centre of rotation). The study of the free dynamic behaviour under vacuum of this device dealt with resonance, damping due to internal friction of the material and coupling between the two systems of gimbals. The results obtained show that this novel device presents suitable characteristics for concentrating two different forces at a single point and aligning them around a common vertical axis. It can be used not only for watt balance experiments but also for any other mechanical applications where alignment and concentration of two forces are necessary.