No abstract

Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question "Did parents/caregivers take adequate measures?") in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 -100), 91.5% (88.4 -93.9), 27.7% (16.5 -41.5), and 100% (99.3 -100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of "Did parents/caregivers take adequate measures?" represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.

During transcatheter aortic valve replacement with a self-expanding prosthesis, prosthesis embolization represents a rare but severe complication. Etiologies of prosthesis embolization include improper sizing and malpositioning, specifically high deployment with respect to the aortic annulus. Treatment of embolization into the aorta relies upon repositioning of the prosthesis using endovascular snares or removal with open surgery. Patients with prosthesis embolization have a high risk of mortality and morbidity including stroke and aortic dissection associated with manipulation of the prosthesis in the ascending aorta. We describe a case of self-expanding prosthesis embolization and present a solution using a second prosthesis to capture the embolized one.

People with disabling hearing disabilities face multiple levels of daily-life challenges where access to services and information remain difficult. In Lebanon, no data is available about the hard-of-hearing individuals. The aim of the study is to reflect the current situation of the Deaf community in Lebanon, to compare it with that of the general Lebanese population and propose practical ways to improve their national status and quality of care. A snowball sampling method was used to recruit hard-of-hearing individuals over the age of eighteen, via institutions and schools for the Deaf. Participants were asked to anonymously fill a qualitative questionnaire, individually or in groups in the presence of interpreters. The analysis was descriptive, and 95% binomial exact confidence intervals were constructed to compare parameters with those of the general population. Deaf adults in Lebanon have poorer socioeconomic conditions, lower literacy levels and limited access to information. However, they appear to be physically healthier than the general population while presenting frequent mental health problems and facing discrimination and poorer access to services. There still is no valid data available about the Deaf community in Lebanon. Hard-of-hearing people remain underserved by the current Lebanese healthcare, education, employment and public systems.