Background: This is a literature review aiming to provide an update about the recent findings related to the efficacy of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematomas (cSDHs), comparison with conventional therapy and deduction of the current recommendations and indications. Methods: The literature is reviewed using a search through the PubMed index using keywords. Studies are then screened, skimmed, and thoroughly read. 32 studies fulfilled the inclusion criteria and are included in the study. Results: Five indications for the application of MMA embolization (MMAE) are deducted from the literature. The usage as a preventive measure after surgical treatment of symptomatic cSDHs in patients with a high risk of recurrence and the usage as a standalone procedure has been the most common reasons for indication of this procedure. Rates of failures for the aforementioned indications have been 6.8% and 3.8%, respectively. Conclusion: The safety of MMAE as a procedure is regarded as a general theme in the literature and can be considered for future applications. Usage of this procedure in clinical trials with more patient segregation and timeframe assessment relative to surgical intervention are recommendations of this literature review.

BackgroundChronic low back pain (CLBP) is one of the most common complaints affecting the population worldwide including in Lebanon. Until 15 years ago, surgery was the treatment of choice. However, conservative measures are now preferred because of the large number of post-surgical complications, in addition to the many conditions where surgery cannot be performed. ObjectiveThe aim of our study is to determine the effectiveness of transformational epidural injection of ozone (TFEOI) in the management of CLBP among the Lebanese population in the Nabatieh area in comparison with patients who received transformational epidural steroid injection (TFESI). MethodsA one-year (2016-2017) retrospective study where 100 patients with CLBP were selected from two hospitals (Alnajdah, and Ragheb Harb hospitals) and divided into two groups. Fifty patients were treated with Ozone injections while the other 50 were treated with steroid injections. For each patient, we recorded the type of pain, irradiation, paresthesia, and the type of injection given (steroid or Ozone). We used the patients' files and contacted them via phone calls. The results of this study were reached based on Vas Score and Mac Nab criteria which are subjective questionnaires. ResultsThe study showed that the TFESI was effective for a short duration (86% of results were excellent and good after one month of injection, but they decreased to 16% after six months). On the other hand, TFEOI was effective over both short and long duration (82% excellent and good after one month, 64% excellent and good after six months). ConclusionResults from this study provide that ozone injection has high benefits in the management of CLBP in the Lebanese population.

Background and Objectives. In the area of dentistry, musculoskeletal disorders (MSDs), particularly neck discomfort, are significant occupational health hazards. The purpose of this study was to ascertain how neck pain affected the capacity and productivity of dental practices. Additionally, it examined the advantages of preventive measures in lessening pain intensity and rated the degree of dentists’ incapacity. Subjects and Methods. This study used a cross-sectional survey design to examine how neck pain affected dentists’ ability to work and their productivity between July 2022 and November 2022. The study included 342 dentists from all around Lebanon. An online validated survey was designed, and the data collection process was performed via direct calls and emails where the survey link was shared. Data included demographic characteristics, gender, type, and duration of the dental practice, which were presented by the toll of hours of work per week, general health status, exercise habits, and Neck Disability Index (NDI). The weight of the participants was not included in the study. The statistical analysis was performed using IBM SPSS version 25. Results. The majority of participants were between the ages of 25 and 35, and the gender distribution of the demographic distribution was comparable. The prevalence of pain was 86.8% (97/342 dentists). NDI analysis showed that 65.7% had mild disability, 12.8% have a moderate disability, and 1% had severe disability. Bivariate analysis showed that pain was affected by age ( p = 0.013 ), orthodontist practices ( p = 0.031 ), regular exercise ( p < 0.001 ), using vibrating instruments ( p < 0.001 ), cervical flexion for better vision while working ( p < 0.001 ), knowledge, and experience about ergonomic posture ( p < 0.005 ). Multivariate analysis showed four predictors for pain: age ( p = 0.017 ), performing stretching exercises after finishing clinical practice ( p = 0.022 ), orthodontist specialty ( p = 0.029 ), and performing cervical flexion for better vision while working ( p = 0.004 ). Conclusion. This study showed that through the application of some strategies such as stretching, exercising, and being careful in using vibrating instruments, the dentist may be able to relieve the pain.

Musculoskeletal disorders (MSD), notably neck pain, are important occupational health issues in the field of dentistry. Many studies were done worldwide to gather data about neck and back pain. They used different characteristics and risk factors. Other studies aimed to determine only the prevalence of neck and back problems among dentists. We aim to review the literature for research about the optimal factors to be assessed and the proper measures to be installed by dentists to prevent cervical pain and to be taught and shared with dental students. Such an aim requires a thorough review of the current condition. This is a brief review of the literature to shed light on the latest news on this topic. Research using keywords such as dentistry, neck pain, neck pain index, occupational pain, and dental specialties were used to skim the literature for related topics. Publications are considered based on their relevance to the topic. Topics related to other professions and pain induced by illnesses other than occupational factors are not included. The final conclusion shows that no final results were conducted regarding the optimal characteristics that the dentists should be using. Therefore, we recommend a study with an aim to determine the optimal factors to be used by dentists to prevent cervical pain and to be taught to dental students.

BackgroundEarly epidural steroid injections are currently widely used for patients experiencing lumbago. However, there is uncertainty about their efficacy, such as the limitation of continuous drug infusion and the need for well-trained physicians on this technique. The main objective of this study was to evaluate the effectiveness of early epidural steroid injections in treating patients with acute sciatica in the lower back in terms of symptom relief and recurrence rate. MethodsA case series was conducted in Lebanon from 2015 to 2019. We recruited 98 patients suffering from sciatica due to disc disease over three-time intervals: two weeks, one, and three months. The immediate results accounted for the intensity of various symptoms (numerical rating scale (NRS) for pain) and the assessment of patient satisfaction (Macnab criteria). ResultsThe clinical results showed at least a three-point pain relief according to Numerical Rating Scale (NRS) and a good grade according to MacNab (P <0.001), with only 10.4% of the total population having a positive leg raise test post-injection. The maximum benefit was noted after two weeks from the injection with a 5.7 mean change in NRS (p<0.001) with a good/excellent response in MacNab and a 4.9 change with only a good response after one month. This study noticed a rebound phenomenon where around half of the patients needed two steroid injections after three months (39.6 % after three months and 17.9 % after six months). ConclusionEven though current guidelines worldwide may suggest the use of conservative treatment for low back pain with acute sciatica, our study has demonstrated the effectiveness of epidural steroid injections in the Lebanese population with a significant outcome.

Idiopathic intracranial hypertension (IIH), called pseudotumor cerebri, could cause postpartum headaches. Generally, this diagnosis is idiopathic and treatment is mainly medical to avoid serious complications of possible vision loss. In this paper, we report the case of a 24-year-old lady who developed a similar constellation of symptoms and was diagnosed with this condition. Postpartum, the patient demonstrated symptoms of headache and vision disturbances. Workup ruled out infectious processes and intracranial pathologies. Normal cranial magnetic resonance imaging (MRI) and high cerebrospinal fluid (CSF) pressure during lumbar puncture led to a diagnosis of IIH. Initiation of medication allowed rapid improvement of symptoms and evaded imminent morbidity. Further discussion in light of the latest findings of the literature is held after the presentation of the case. This case sheds light on the importance on importance of fundoscopy in patients demonstrating new-onset headaches especially postpartum with the absence of intracranial pathologies.

Achalasia manifests as lack ofperistalsis of the esophagus. It is a common disease of a usually benign course. The incidence of esophageal-bronchial fistulahas been reported in the literature. In this study, we present the case of a patient, who was previously diagnosed with achalasia. He was received at the emergency department (ED) having respiratory failure and cardiopulmonary arrest. Resuscitation followed by radiological and laboratory workup revealed acute respiratory distress syndrome and bilateral esophageal-bronchial fistulas. Attempt to do surgical intervention was limited due to the severe sepsis and compromised respiratory status of the patient. Discussion of this case in light of the literature findings reveals the possible treatment methods and prognosis of similar conditions.

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