Objectives: Human papillomavirus (HPV) is responsible for a multitude of lesions with high psychosocial burden. The "HPV Impact Profile" (HIP) questionnaire is one of the first and most specific tools evaluating the emotional impact of HPV. This study aimed to translate this questionnaire into Arabic and to validate it, in a sample of Lebanese female patients. Materials and Methods:The HIP questionnaire was translated to Arabic. It was then administered to 118 Lebanese women infected with HPV or screened for HPV-associated lesions, in parallel with the Hospital Anxiety and Depression Scale questionnaire. The psychometric properties of the questionnaire were studied in our sample population. Results:The internal consistency of the HIP questionnaire was weak as Cronbach α coefficients of most of the domains were low. The study of the composite matrix resulted in the improvement of the internal consistency after the elimination of some items. Moreover, the "adapted domains" were created by reverse-scoring items with positive implications. The composite reliability and the average variance extracted of all the domains were analyzed. Analysis of discriminate validity through heterotrait-monotrait ratio of correlation ratio analyses of corresponding Hospital Anxiety and Depression Scale domains was also performed along with reliability analysis. There results were satisfying for the adapted domains. Conclusions:The adapted domains of the 27 items questionnaire with reverse scoring of 8 items presented with good psychometric properties, allowing their use in clinical trials and in clinical practice.
Invasive breast carcinoma is the most common malignant neoplasia in women. 1 Beside tumor size, axillary lymph nodes (ALNs) status remains among the most important prognostic factors in terms of breast cancer (BC) survival 2,3 and provides primordial information to guide therapy. Clinical examination, mammography and ultrasonography (US) with image-guided biopsy have been tested for their capacity to predict ALN status. However, the diagnostic accuracy of predicting ALN metastases has not been satisfactory. 4-7 The actual practice relies on the assessment of ALN status using the sentinel lymph node biopsy (SLNB) technique. SLNB uses radiotracer or blue dye to identify the first node or nodes that drain the breast, and thus the initial nodes to encounter metastatic disease. SLNB is typically performed at the time of surgical resection of the primary tumor and has an accuracy of 93.5%-97.5%. 8 SLNs are examined intraoperatively with frozen section. Complete axillary lymph node dissection (ALND) is then performed only in patients with SLNB-proven lymph node (LN) metastases. However, the role of breast MRI has recently emerged in assessing the ALN status, in an attempt to reduce the morbidity that might be associated with SLNB (lymphedema, arm pain, infection, seroma). 9,10 The use of MRI for preoperative axillary
The COVID-19 pandemic is ongoingly affecting numerous pregnant patients around the world. Meanwhile, nationwide lockdowns have drastically limited counseling and followup visits of women during pregnancy. Throughout these difficulties, delivering via the cesarean route is becoming common, both in the infected and non-infected pregnant population. Looking into pregnant women with COVID-19, around 64% delivered via a cesarean route 1 , with this rate reaching 93% in China 2 . Due to the relative state of immunosuppression in pregnancy, women might be at an increased risk of severe illness compared to non-pregnant women, after adjusting for age and other confounding factors 3 . Death has occurred in around 0.1% of the cases, with ICU admissions reaching 3% 4 . In China, the rate of severe disease was 8% 2 .Knowing that the majority of COVID-19 infections in pregnancy occur in the third trimester 2,5 , with 15% requiring hospital admission 4 , the increased cesarean rate could be partially justified. However, many patients with non-severe disease are being delivered using the C-section route; experts consider that early delivery, even in non-severe cases, as beneficial for the subsequent treatment and outcome of COVID-19 16 . This has led to an increase in the rate of preterm deliveries (21%-31%), of which only few are related to spontaneous preterm labor and preterm premature rupture of membranes, while the rest are thought to be iatrogenic 5 . Preterm and term C-sections are performed due to concerns that excessive ventilation and stress during labor might aggravate the respiratory and pro-inflammatory status accompanying COVID-19 7 . Evidence also showed that maternal oxygenation can be quickly restored by delivery 6 . In parallel, new papers reported placental infection during the COVID-19, leading to placental vascular disease, preeclampsia-like syndrome, fetal growth restriction and higher risks of perinatal death 8 . Fearing these eventual adverse events could add to the increased rate of iatrogenic preterm deliveries using a C-section route. Also, some laboring women are undergoing C-sections due to prophylactic antiplatelets use against COVID-related thromboembolisms, precluding the administration of epidural anaesthesia; not forgetting the fear of vertical transmission in utero, which, even if yet unproven, is usually thought by obstetricians. This risk has been estimated to be around 5% and peaks at term 1,5 .In regard to the pregnant population in general, fears of contracting COVID-19 at healthcare centers as well as difficulties in transportation during lockdown periods has contributed to a reluctance in timely referrals to emergency care units. These facts have led to a delay in the management of obstetrical complications and therefore to an increase in stillbirths and preterm deliveries, with a higher risk of C-section in this context 9 . On the other hand, some obstetricians are reluctant when it comes to exposing themselves, trainees and midwives to pregnant patients whose PCR status is unknown, wi...
Objective: The human papillomavirus (HPV) has been associated with an important psychosocial impact. This impact has been poorly evaluated in developing countries, mostly because of the lack of instruments to quantify it. The HIP questionnaire aims to measure HPV-associated affective burden. Our team has previously translated this questionnaire to Arabic and used it to assess the impact of HPV on Lebanese women.Materials and Methods: While the HIP is a specific tool to evaluate the emotional impact of HPV, the Hospital Anxiety and Depression Scale questionnaire consists of 2 scales, anxiety and depression, and assess the psychological distress in nonpsychiatric patients. The HPV impact profile and Hospital Anxiety and Depression Scale questionnaires were administered to 118 Lebanese women with an HPV-related presentation, aiming to determine which aspect of these women's lives was mostly affected. The association with different sociodemographic factors was also assessed.Results: Feelings of "concerns and worries" were mostly strongly felt in our population except for women with genital warts who were more concerned with the risk of transmission and the impact on their partners. All women had predominant feelings of anxiety. Religion was a statistically significant influencing factor and employment a protective factor. Muslim women demonstrated significant adverse affects on HPV impact profile domains that included: "sexual impact," "selfimage," "interaction with doctors," and "health control/life impact."Conclusions: Different women perceive the diagnosis of HPV and HPVrelated lesions differently. In this study, employment was found to play a protective role, but the biggest influencers were social and religious beliefs.
Aim: To determine the rate, repartition and risk factors of lymph node (LN) metastasis in patients with epithelial ovarian cancer. Methods: We reviewed retrospectively the pathological and clinical data of 184 patients with epithelial ovarian cancer at a tertiary care center in Beirut, Lebanon. Results: 88% of patients received a pelvic and para-aortic lymphadenectomy. 70% of patients presented LN metastases at both pelvic and para-aortic levels, while isolated pelvic or para-aortic LN metastases were seen in 16 and 14% of cases, respectively. In a univariate analysis, the rate of positive LNs was higher in patients with serous histology (65 vs 33%; p < 0.001), high-grade tumors (68 vs 26%; p < 0.001), bilateral adnexal involvement (74 vs 27%; p < 0.001), advanced clinical stage (p < 0.001), interval debulking surgery (63.2 vs 36.8%; p = 0.003) and positive peritoneal cytology (79 vs 26%; p < 0.001). In a multivariate analysis, the rate of LN involvement was significantly higher in patients with higher grade, advanced clinical stage and positive peritoneal cytology. Conclusion: Serous histology, grade 3 tumors, positive peritoneal cytology, advanced clinical stage, interval surgery and bilateral adnexal involvement can predict LN metastasis in patients with epithelial ovarian cancer.
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