Respiratory viral infections like influenza, RSV, and COVID-19 cause significant healthcare strain, especially during seasonal surges. Traditional surveillance often fails to provide early warnings, but wastewater surveillance offers a promising real-time alternative. This study evaluates whether wastewater viral loads predict hospitalizations and identifies the lead time between detection and hospitalization surges. Correlation Between Wastewater Viral Load and Hospitalization Rates for Flu, RSV, and COVID-19 Granger Causality Analysis of Wastewater Data and Hospitalization Trends This retrospective observational study analyzed the relationship between wastewater viral loads and hospitalization trends for influenza, RSV, and COVID-19 across all 50 U.S. states from January 2021 to February 2025. Weekly viral concentrations were obtained from the National Wastewater Surveillance System and hospitalization rates from CDC reports, with datasets standardized by calendar week and no missing data. Pearson correlations, cross-correlation function analysis, granger causality testing, and distributed lag models were used to assess associations, lead times, causality, and effect sizes. Statistical significance was set at p< 0.05, and analyses were performed using R (v4.2.0). IRB approval was not required as only publicly available, de-identified data were used. Distributed Lag Model Results: Effect of Wastewater Viral Load on Hospitalizations Wastewater viral loads predicted hospitalizations, with a lead time of 2 weeks for Flu and 3 weeks for RSV and COVID-19 (p< 0.01). Correlations were observed for Flu (r = 0.93), RSV (r = 0.92), and COVID-19 (r = 0.88) (Table 1). Granger causality confirmed that RSV and COVID-19 wastewater signals predicted future hospitalizations (p< 0.01, Table 2). A one-unit rise in wastewater viral concentration corresponded to hospitalization rate increases of 0.54 for Flu, 0.34 for RSV, and 1.15 for COVID-19 (Table 3). However, Flu did not show a causal predictive relationship. Our study is the first to establish a causal relationship between wastewater viral loads and RSV and COVID-19 hospitalizations using Granger causality analysis, demonstrating that wastewater surveillance is a valuable tool for predicting hospitalizations weeks in advance and enabling timely public health interventions. This real-time monitoring system can improve hospital preparedness, optimize resource allocation, and guide vaccination strategies. All Authors: No reported disclosures

Infections are a major cause of illness and death in breast cancer patients. As survival improves, infection risk remains high despite being preventable. This study aims to identify key clinical and demographic factors associated with infectious disease mortality in breast cancer patients and develop a predictive nomogram for individualized risk estimation.Nomogram predicting risk for death from infectious causes in breast cancer patients.The nomogram estimates 1-, 3-, and 5-year infection-related mortality based on patient age, tumor subtype, tumor stage (T), and whether breast cancer is the only primary cancer. Points assigned to each variable are summed to calculate overall risk. We conducted a retrospective cohort study using SEER data from 2010 to 2015. Patients diagnosed with breast cancer were included if they had complete demographic, clinical, and survival data. The primary outcome was infectious disease-related mortality. Key variables included demographic factors, tumor characteristics, and treatment modalities. Kaplan-Meier survival analysis was performed, and Cox proportional hazards regression was used to identify factors associated with infection-related mortality. A nomogram was developed to provide clinicians with a risk prediction tool for infection-related mortality. Among 43,483 breast cancer patients, 482 died from infectious causes. Older age was a significant predictor of infection-related mortality (HR=1.017, 95% CI: 1.0098–1.0244, p< 0.001). The medullary subtype exhibited an increased risk of infection-related mortality (HR=4.778, 95% CI: 1.3926–16.3955, p=0.0129), while T2 tumor stage was associated with a protective effect (HR=0.7079, 95% CI: 0.5708–0.8779, p=0.0017). Patients with only one primary cancer had a higher risk of infectious disease mortality (HR=1.5737, 95% CI: 1.1841–2.0917, p=0.0018). Patients who received chemotherapy and radiotherapy had improved survival in Kaplan-Meier analysis. A predictive nomogram was constructed with a concordance index of 0.868, demonstrating strong predictive accuracy. This study identifies key risk factors for infection-related mortality in breast cancer, including older age, medullary subtype, and having a single primary cancer. Chemotherapy and radiotherapy were linked to better survival, likely reflecting patients with better performance status selected for treatment. The developed nomogram estimates individual mortality risk at 1, 3, and 5 years, supporting targeted prevention, reduced infections, and improved outcomes. All Authors: No reported disclosures

Patients with multidrug-resistant HIV (Human Immunodeficiency Virus) face limited treatment options, increasing their risk of virologic failure. Fostemsavir, a novel attachment inhibitor, has shown efficacy and safety in clinical trials, but real-world data is lacking. We aimed to evaluate virologic suppression, immunologic response, and safety outcomes in treatment-experienced individuals in a real-world clinical setting.Trends in CD4 Count and HIV Viral Load Over 12 Months in Patients Receiving Fostemsavir We conducted a retrospective chart review of patients living with HIV >18 years old in a Ryan White funded HIV clinic in Newark , NJ who were treated with Fostemsavir for more than 6 months. Data on viral load, CD4 counts, adverse effects, and adherence were collected and descriptive statistics was used to analyze outcomes over 12 months. Primary outcomes were virologic suppression (HIV RNA < 20 copies/mL) and CD4 count change from baseline. Secondary outcomes assessed adherence, adverse effects, and reasons for discontinuation. 17 patients met the inclusion criteria, with a mean age of 57.2 years. The majority were male gender (70.6%). 58.8% were Black or African American, 17.6% White, and 23.5% identified as other races. At baseline, the mean viral load was 56,402 copies/mL, which declined to 400 copies/mL at month 3, 84 copies/mL at month 6, and 53 copies/mL at month 12. Mean CD4 count increased from 439 cells/mm³ at baseline to 492 cells/mm³ at month 3, remained stable at 491 cells/mm³ at month 6, and rose further to 619 cells/mm³ by month 12 as shown in Figure 1. Virologic suppression was achieved in most patients by month 12. Adherence was high with 82.4% fully compliant, 11.8% intermittently compliant, and 5.9% non-compliant. Adverse effects were minimal; 76% reported none, while 11.8% experienced muscle wasting, and 5.9% each reported insomnia or arthralgia. Fostemsavir was discontinued in two patients: due to virologic failure (5.9%), oral intolerance (5.9%). Fostemsavir demonstrated effective virologic suppression and immune recovery, with a favorable safety profile, in a real-world cohort of treatment-experienced HIV patients. These findings support its clinical utility. Ongoing research in larger populations will build on these findings to further characterize long-term outcomes. Jihad Slim, MD, FACP, gilead: Honoraria|merck: Honoraria|Thera: Honoraria|ViiV: Honoraria

Listeria monocytogenes brain abscess is a rare phenomenon that is common in immunocompromised patients. Streptococcus equinus brain abscess has never been reported in the literature to our knowledge. In this case report, we describe a case of brain abscess secondary to Listeria monocytogenes and Streptococcus equinus in an immunocompetent patient with transient low CD4 count. A 27-year-old white, male patient, previously healthy, nonalcoholic, and occasional smoker, presented to the emergency department for confusion and headache. The patient was found to have a left parietal abscess, which was drained and the fluid was sent for culture. Culture grew Listeria monocytogenes and Streptococcus equinus. The patient was treated with intravenous ampicillin followed by oral amoxicillin for a total of 6 weeks. The CD4 count was low initially. However, after the resolution of the infection, the CD4 count came back within normal range. Another brain magnetic resonance imaging was done that showed a significantly decreased hyperintensity within the left parietal subcortical white matter at the site of surgery with significantly decreased enhancement and almost total resolution of the previous abscess. Transient low CD4 count is a rare phenomenon that exposes patients to unusual and atypical infections. Since low CD4 count is transient, patients treated promptly recover from their illness. Our patient developed a Listeria monocytogenes and Streptococcus equinus brain abscess, which is considered rare and has not been previously described in the literature to our knowledge.

Computers have become indispensable in daily activities. With this excess use of electronics, computer vision syndrome (CVS), a highly prevalent condition, is associated with various symptoms. Although understanding the relationship between CVS and mental health has been reported, the impact of CVS has not been explored on more than one psychological aspect. We hypothesize that higher CVS symptoms could be associated with higher levels of anxiety and depression, mediated by higher stress. Therefore, the objective of this study was to determine the association between CVS and depression and anxiety among a sample of Lebanese young adults, along with evaluating the mediating effect of stress on these associations. Between August 2020 and April 2021, 749 participants completed an online questionnaire for this cross-sectional study. Females compared to males (Beta = 3.73) and those with CVS compared to those who did not (Beta = 3.14) were significantly associated with more anxiety, whereas having a university level of education compared to secondary or less (Beta = −3.02) was significantly associated with less anxiety. Females compared to males (Beta = 2.55) and those with CVS compared to those without (Beta = 2.61) were significantly associated with more depression, whereas being of an older age (Beta = −0.18) was significantly associated with less depression. Stress partially mediated the association between CVS and anxiety and between CVS and depression. More CVS was significantly associated with more stress (Beta = 3.05). Higher stress was significantly associated with more anxiety (Beta = 0.70) and depression (Beta = 0.71), whereas more CVS was significantly and directly associated with more anxiety (Beta = 3.14) and depression (Beta = 2.61). This study is the first worldwide to evaluate an association between CVS and mental health. Our results serve as a starting point for healthcare providers (psychiatrists and psychologists, most importantly) to look deeper into CVS when looking for reasons behind mental health issues. Further studies are warranted to confirm our results and look for more factors and mediators in such associations.

Kluyvera ascorbata is a gram-negative bacillus which is a rare cause of clinically significant infections in humans. We report a rare case of K. ascorbata infection causing septic shock in a patient with a history of urothelial cancer. After the antimicrobial susceptibility testing, the patient was successfully treated with ceftriaxone. Recognition of the disease-producing potential of this rare pathogen with prompt initiation of effective antimicrobial coverage is paramount for appropriate management in the adult immunocompromised population. To our knowledge, this is the first case report of septic shock secondary to K. ascorbata urinary tract infection.

Objective: Computer vision syndrome (CVS) refers to a group of ocular and extraocular symptoms due to prolonged digital device screen use. The objective of this study was to assess the correlation between CVS, insomnia, and migraine, taking into consideration stress as a mediating factor between these 3 variables.Methods: This cross-sectional study was conducted between August 2020 and April 2021 using an online questionnaire filled out by 749 participants. Participants were enrolled using a snowball sampling technique. The link to the Arabic questionnaire was sent to the individuals by WhatsApp and by e-mail.Results: The prevalence of CVS among participants was 70.5%. The presence of CVS (β = 3.26) was significantly associated with higher insomnia. The presence of CVS (adjusted odds ratio [aOR] = 1.66) and higher stress (aOR = 1.09) was significantly associated with higher odds of having migraine. Stress fully mediated the association between CVS and migraine by 52.76% and between CVS and insomnia by 79.99%.Conclusion: CVS was significantly associated with insomnia and migraine. Stress mediated the relationship between CVS and insomnia, and between CVS and migraine. The precise mechanisms behind these associations were not evaluated in this study, with the hope that future research will provide more information on this topic.

Objective To create a Lebanese Depression Scale (LDS) and evaluate its performance on a group of Lebanese individuals. Methods This cross-sectional analysis enrolled 997 residents (January-December 2018). Results The elements in the Lebanese Depression Scale-19 items (LDS-19) scale converged over a combination of four factors (alpha(Cronbach) = .864). The correlation was positive between the LDS-19 and both the Hamilton Anxiety Scale score (r = .637;P < .001) and Lebanese Anxiety Scale score (r = .694;P < .001). According to the receiver-operating characteristics curve, the optimal score for the LDS-19 scale, which was a cutoff between healthy controls and depressive patients, was 18.50 (80.3% and 75.8%, respectively); the scale's positive predictive value was 31.0%, while the negative predictive value was 96.5%. Practice Implications The LDS-19 is a useful tool to screen for depression in the Lebanese population, in both clinical and research settings.

Previous research suggests that restrained eating is problematic in Lebanon and is associated with the occurrence of clinically diagnosed eating disorders. Because of the alarming prevalence and severity of these disorders, the aim of this study is to investigate factors that may contribute to restrained eating in adults among a representative sample of the Lebanese population. This is a cross-sectional study conducted between January and May 2018; 811 adult participants were enrolled from all Lebanese districts. The Dutch Restrained Eating scale was used to measure body disturbance. The factors that were assessed in the questionnaire were body dissatisfaction, self-esteem, perceived stress, anxiety, depression, emotion regulation, emotional eating and adult attachment styles. The mean age of the participants was 27.59 ± 11.76 years, and included 66.5% females. In the absence of a cutoff value for the Dutch Restrained Eating scale, we took the median (2.6) as the cutoff value. The results showed that 391 (48.3%) had restrained eating. The Dutch Restrained Eating scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 60.69% of the variance (Cronbach’s alpha was high =0.928). The linear regression results, taking the Dutch restrained eating scale as the dependent variable, showed that being a female (Beta = 0.31), increased age (Beta = 0.01), higher body mass index (Beta = 0.01), an intermediate monthly income (Beta = 0.25), higher body dissatisfaction scores (Beta = 0.03), higher adult anxiety attachment style (Beta = 0.008), higher emotion regulation cognitive reappraisal facet (Beta = 0.01), feeling pressure from TV/magazine to lose weight (Beta = 0.45) and practicing sport activities (Beta = 0.41) were associated with higher restrained eating scores. Our findings show that numerous factors are associated with restrained eating in the Lebanese community. They include body dissatisfaction, cognitive reappraisal, female gender, eating attitudes, social media pressure and adult attachment. Therefore, the development of prevention strategies directed at an improved body image perception and increasing knowledge about factors that might influence this body image and critical thinking regarding media images is warranted, with the ultimate goal of promoting healthier choices in the Lebanese population.

Objectives Patients with mental health disorders often have to endure the burdens of the condition itself and the stigma that follows. Since no study has been conducted in Lebanon on this topic, our objective was to assess the knowledge, attitude and behaviors towards public stigma of mental health diseases, among a sample of the Lebanese population. Methods A cross-sectional study, conducted between November 2017 and May 2018, enrolled 2289 participants. The Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward Mental Illness (CAMI) and the Reported and Intended Behavior Scale (RIBS) were used to assess knowledge, attitude and behaviors toward mental illness respectively. The 25th, 50th and 75th percentile of the MAKS, CAMI and RIBS scales scores were considered as cutoff points for low, medium and high scores respectively. Results A high knowledge score was found in 33.0% of the participants, whereas a high attitude score and a higher behavior score were found in 32.2% and 26.9% of the participants respectively. Living in North Lebanon (Beta = 1.331) and being familiar with a non-close person with mental illness (Beta = 0.811) were associated with higher knowledge of mental illness (higher MAKS score), whereas living in Bekaa (Beta = -8.693) and being 70 years old and above (Beta = -5.060) were associated with lower knowledge toward mental illness (lower MAKS score). Higher knowledge of mental illness (higher MAKS score) (Beta = 0.670), having a high level of education (university (Beta = 8.785), secondary (Beta = 6.084) and technical (Beta = 5.677)) were associated with less stigmatizing attitudes (higher CAMI scale). Being familiar with close people with mental illness (Beta = 0.577), less stigmatizing attitudes (higher CAMI scale) (Beta = 0.077) and higher knowledge of mental illness (higher MAKS score) (Beta = 0.115) were associated with higher favorable behaviors (higher RIBS score), whereas knowing a non-close person who have a mental illness (Beta = -0.720) was associated with lower favorable behaviors (lower RIBS score). Conclusion A mass media awareness campaigns that could transmit health messages to a wide public audience in the country to fight stigma toward mental illness, seems warranted.

Abstract Objectives To test the psychometric properties of the Arabic version of the Binge Eating Scale (BES), a self-questionnaire assessing binge eating, in a sample of the Lebanese population. The secondary objective was to evaluate factors associated with binge eating. Methods This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The BES was administered to study its psychometric properties. The sample was divided into two separate samples (405 for sample 1 and 406 for sample 2). An exploratory factor analysis was executed on Sample 1, followed by a confirmatory factor analysis on Sample 2 using the structure obtained in Sample 1. Three hierarchical stepwise linear regressions were conducted to assess factors associated with binge eating. Results The factor analysis suggested a two-factor structure for the BES explaining a total of 41.4% of the variance. All items could be extracted from the list. The internal consistency of the measurement was adequate (Cronbach’s alpha = 0.86). The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ2/df), Steiger-Lind RMSEA, Joreskog GFI, and AGFI. Higher BMI, depression, anxiety, emotional eating, greater body dissatisfaction, and more pressure from media to lose weight were associated with higher binge eating. Higher expressive suppression facet score was associated with lower binge eating. Conclusion The Arabic version of BES could be a useful tool for screening and assessing the binge eating behaviors in clinical practice and research. Also, being dissatisfied with one’s body size, having a history of sexual abuse, family history of binge eating, increased depressive/anxiety symptoms, and lower self-esteem seem to be associated with higher BES scores.

To evaluate the factors associated with body dissatisfaction among the Lebanese population, including sociodemographic characteristics, self-esteem, stress, anxiety, depression, emotional regulation, emotional eating and the adult attachment style.

OBJECTIVES:To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL.METHODS:This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment.RESULTS:Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors.CONCLUSION:When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments.LEVEL OF EVIDENCE:Level V, cross-sectional descriptive study.

The aim of the study was to develop an Arabic version of the ORTO-15 test and to examine the scale reliability and validity among a sample of the Lebanese population. This was a cross-sectional study, conducted between January and May 2018, which enrolled 806 participants, divided into two equal samples, from all Lebanese governorates. The ORTO-15 scale was used to evaluate orthorexia nervosa (ON) tendencies and behaviors among participants. The factor analysis conducted on sample 1 suggested a three-factor structure for the ORTO-15 explaining a total of 50.59% of the variance. All items could be extracted from the list; none of the items was removed. The internal consistency of the measurement was adequate (Cronbach’s alpha = 0.82). Higher body dissatisfaction (r = − 0.082), higher restrained eating (r = − 0.13) and higher eating attitudes (EAT score) (r = − 0.13) were significantly associated with higher levels of orthorexia tendencies and behaviors (lower ORTO-15 score). We could not detect any significant association between BMI and ORTO-15 test. A confirmatory factor analysis performed on sample 2 supported the three-factor structure of the ORTO-15 test obtained in the first sample. The following results were obtained: the Maximum Likelihood Chi Square = 22.0 and Degrees of Freedom = 9, which gave a × 2/df = 2.4. For non-centrality fit indices, the Steiger–Lind RMSEA was 0.10 [0.040–0.208]. Moreover, the Joreskog GFI equaled 0.926 and AGFI equaled 0.901. The Arabic version of the ORTO-15 test can be used to screen for ON tendencies and behaviors. Level V, cross-sectional descriptive study.

Orthorexia nervosa (ON), or the pathological preoccupation and “fixation on healthy food” has been emerging as a new eating disorder. A limited amount of literature exists today on the prevalence of ON. The objective of the current study was to assess factors associated with ON tendencies and behaviors among a representative sample of the Lebanese population.