Beirut Ammonium Nitrate Blast: Analysis, Review, and Recommendations

Assessing primary Tokophobia among Lebanese childless men and nulliparous women: psychometric validation of the Arabic versions of the fathers' fear of childbirth scale and Tokophobia severity scale

INTRODUCTION

Tokophobia is an intense and pathological fear of pregnancy and childbirth. Despite its significance, no research in Lebanon has investigated primary tokophobia within the general population. Nevertheless, it is crucial to assess the attitudes of both women and men, as potential future parents, towards pregnancy and childbirth, particularly during these challenging times for the Lebanese population. Therefore, this study aims to evaluate the psychometric properties of the Tokophobia Severity Scale (TSS) and Fathers' Fear of Childbirth Scale (FFCS) for assessing primary tokophobia among Lebanese nulliparous women and childless men, respectively.

METHODS

This cross-sectional investigation encompassed all Lebanese governorates; 651 women and 618 men were recruited via social media platforms, using a snowball sampling technique. The questionnaire included the Tokophobia Severity Scale, the Fathers' Fear of Childbirth Scale, the Patient Health Questionnaire, and the Lebanese Anxiety Scale.

RESULTS

Factorial analysis of the TSS in women revealed a three-factor model: concerns related to personal complications (Factor 1), fetal well-being (Factor 2), and outward behavioral responses to fear (Factor 3). The FFCS also yielded a three-factor measurement model: emotional responses during the partner's childbirth (Factor 1), concerns regarding the hospital environment during childbirth (Factor 2), and anxieties surrounding the perinatal health of both the partner and child (Factor 3). Both scales were internally consistent with Cronbach's alpha > 0.9, indicating their reliability. The TSS and FFCS demonstrated statistically significant correlations with measures of anxiety and depression, thus attesting to convergent validity.

CONCLUSION

The results of this study provide evidence for the psychometric validity and reliability of the TSS and FFCS scales in Arabic-speaking populations. Given the previously overlooked nature of primary tokophobia in these populations, the availability of these validated instruments can significantly enhance the ability to detect and address this condition, ultimately facilitating the provision of necessary support services.

Using the Environmental Health Disparities Framework to understand Black and Latino perspectives of a local fertilizer plant fire

In February 2022, a fertilizer plant fire burned for four days and displaced thousands of residents, who were mainly low-income and Black or Latino, from their homes in Winston Salem, NC. In partnership with Black and Latino residents and nonprofit organizations, we sought to understand Black and Latino resident perceptions of the chronic and acute health risks, as well as the emotional and financial effects that resulted from the fire, which included the release of nitrous dioxide. We used the Environmental Health Disparities Framework to guide this community-engaged research study, capturing through semi-structured interviews: 1) how residents perceived their community before and after the fire, 2) how the fire impacted physical and mental health, and 3) how individuals coped with stress. We used thematic analysis to analyze the data and identified seven major themes. Participants: 1) perceived their neighborhood positively, 2) were unaware of the potential dangers of the fertilizer plant before the fire, 3) experienced adverse health and financial effects from the fire, 4) took action to protect themselves from the impacts of the fire, 5) raised concerns about the environmental impacts of the fire, 6) raised concerns about the city's response to the fire, and 7) provided recommendations for future city response.

Assessing the health risks of chemicals in a company supplying chemicals to drilling rigs in Southern Iran using COSHH, SHEM-SAM, and SQRA methods

Chemical industries are among the process industries and cause many risks. The present research aimed to analyze the health risks of a chemical warehouse of drilling rigs chemical Supply Company based on COSHH (Control of Substances Hazardous to Health), CHEM-SAM (Chemical Risk Management Self-Assessment Model), and SQRA (Subjective Quantified Risk Assessment) methods in 2021. The information was collected based on document review, MSDS of chemicals, processes, employees, and chemical exposure. Flammability, toxicity, allergy-causing, corrosivity, reactivity, LD50, and permissible thresholds of chemicals were also collected. The present research results showed that out of 59 main chemicals in the operational processes of the chemical warehouse of drilling rigs, 14 chemicals are flammable, 22 cause allergy responses, and three can cause death if inhaled. According to the results of the CHEM-SAM method, the employees and people outside the organization are at medium and low chemical risk based on the current management of the chemical warehouse, respectively. The results of the COSHH health assessment showed that chemicals had low, medium, high, and very high risk in 31, 13, 12, and 3 cases, respectively. The high-risk cases consisted of Ammonium Nitrate، Caustic Soda, and Poly.Aluminum.Chloride. Health risk assessment was also performed using the SQRA method, and results showed that chemicals have a very low, low, medium, high, and very high risk in 27, 12, 8, 9, and 3 cases, respectively. The results showed that the adverse health effects of chemical exposure in the drilling industry are alarming. Employees of different sectors of oil and gas industries are exposed to chemicals.

The role of international renal disaster preparedness working groups in difficult settings: bridge over troubled water

PURPOSE OF REVIEW

Disasters, natural and man-made, are rising in frequency and pose significant challenges to the provision of renal care worldwide. Patients with kidney disease, particularly those on dialysis, are extremely vulnerable during disasters. This timely review summarizes the potential roles international renal disaster preparedness working groups have in addressing these challenges.

RECENT FINDINGS

The vulnerability of kidney patients has galvanized the evolution of global response mechanisms and the contemporary efforts of various organizations. In this review, the importance of preparedness, networking, and collaborations at all levels are highlighted, citing recent crises. It will also note key areas for improvement, including an enhanced engagement with global health organizations. Finally, it is imperative to urge the international community to recognize that individuals with kidney disease are often among the first patient groups to suffer in disaster zones. These messages are intended to persuade global stakeholders that kidney patients, including pediatric ones, should be prioritized as requiring immediate support during disasters.

SUMMARY

The unique and life-threatening challenges faced by individuals with kidney disease in natural disaster- or war-torn areas demand special consideration in humanitarian efforts and international crisis response strategies. International organizations can play a major role in this regard.

Advancements in nanomaterials for nanosensors: a comprehensive review

Nanomaterials (NMs) exhibit unique properties that render them highly suitable for developing sensitive and selective nanosensors across various domains. This review aims to provide a comprehensive overview of nanomaterial-based nanosensors, highlighting their applications and the classification of frequently employed NMs to enhance sensitivity and selectivity. The review introduces various classifications of NMs commonly used in nanosensors, such as carbon-based NMs, metal-based NMs, and others, elucidating their exceptional properties, including high thermal and electrical conductivity, large surface area-to-volume ratio and good biocompatibility. A thorough examination of literature sources was conducted to gather information on NMs-based nanosensors' characteristics, properties, and fabrication methods and their application in diverse sectors such as healthcare, environmental monitoring, industrial processes, and security. Additionally, advanced applications incorporating machine learning techniques were analyzed to enhance the sensor's performance. This review advances the understanding and development of nanosensor technologies by providing insights into fabrication techniques, characterization methods, applications, and future outlook. Key challenges such as robustness, biocompatibility, and scalable manufacturing are also discussed, offering avenues for future research and development in this field.

Disaster Preparedness among Healthcare Professionals in Lebanon

BACKGROUND

Disaster disrupts the normal functioning of a community, causing significant damages and losses. In recent years, Lebanon faced multiple disasters, including one of the largest explosions ever recorded, the Beirut Blast, in August 2020. Limited studies in the literature have examined disaster medicine preparedness among healthcare professionals (HCPs).

OBJECTIVE

To examine the knowledge (K), attitude (A), readiness to practice (rP), and KArP associated with disaster medicine preparedness among HCPs in Lebanon.

METHODS

A cross-sectional observational study was conducted in Lebanon using data from participants answering an online survey. Participants enrolled in this study were HCPs (residents and faculty), medical students, and postdoctoral research scholars. Levels of knowledge, attitude, and readiness to practice were assessed and used to examine their association with participants' socio-demographic characteristics.

RESULTS

A total of 195 participants (average age 30.6 ± 11.4 years) were included in this study. Participants reported moderate scores of knowledge, attitude, and readiness to practice. Older participants reported better readiness to practice and a KArP score. A significant difference was observed in all categories according to gender, with men having higher scores than women. No significant difference was observed between the level of education and knowledge, attitude, and total KArP scores.

CONCLUSIONS

Our study's findings showed that age and the level of education were positively correlated with readiness to practice. Men, compared to women, had significantly higher scores in all categories. Barriers to the KArP should be identified and targeted in future studies, as disaster preparedness at the institutional level may improve outcomes in future disaster encounters.

Esophageal pressure monitoring and its clinical significance in severe blast lung injury

Background

The incidence of blast lung injury (BLI) has been escalating annually due to military conflicts and industrial accidents. Currently, research into these injuries predominantly uses animal models. Despite the availability of various models, there remains a scarcity of studies focused on monitoring respiratory mechanics post-BLI. Consequently, our objective was to develop a model for monitoring esophageal pressure (Pes) following BLI using a biological shock tube (BST), aimed at providing immediate and precise monitoring of respiratory mechanics parameters post-injury.

Methods

Six pigs were subjected to BLI using a BST, during which Pes was monitored. We assessed vital signs; conducted blood gas analysis, hemodynamics evaluations, and lung ultrasound; and measured respiratory mechanics before and after the inflicted injury. Furthermore, the gross anatomy of the lungs 3 h post-injury was examined, and hematoxylin and eosin staining was conducted on the injured lung tissues for further analysis.

Results

The pressure in the experimental section of the BST reached 402.52 ± 17.95 KPa, with a peak pressure duration of 53.22 ± 1.69 ms. All six pigs exhibited an anatomical lung injury score ≥3, and pathology revealed classic signs of severe BLI. Post-injury vital signs showed an increase in HR and SI, along with a decrease in MAP (p < 0.05). Blood gas analyses indicated elevated levels of Lac, CO2-GAP, A-aDO2, HB, and HCT and reduced levels of DO2, OI, SaO2, and OER (p < 0.05). Hemodynamics and lung ultrasonography findings showed increased ELWI, PVPI, SVRI, and lung ultrasonography scores and decreased CI, SVI, GEDI, and ITBI (p < 0.05). Analysis of respiratory mechanics revealed increased Ppeak, Pplat, Driving P, MAP, PEF, Ri, lung elastance, MP, Ptp, Ppeak - Pplat, and ΔPes, while Cdyn, Cstat, and time constant were reduced (p < 0.05).

Conclusion

We have successfully developed a novel respiratory mechanics monitoring model for severe BLI. This model is reliable, repeatable, stable, effective, and user-friendly. Pes monitoring offers a non-invasive and straightforward alternative to blood gas analysis, facilitating early clinical decision-making. Our animal study lays the groundwork for the early diagnosis and management of severe BLI in clinical settings.

A phenothiazine-functionalized pyridine-based AIEE-active molecule: a versatile molecular probe for highly sensitive detection of hypochlorite and picric acid

In this study, we designed and synthesized a novel compound (PTH-AB-PY) based on phenothiazine and pyridine moieties with aggregation-induced emission enhancement (AIEE) properties. The compound has shown exceptional selectivity and sensitivity towards ClO- ions with an impressive detection limit of 6.86 × 10-4 M. Its remarkable sensitivity arises from its effective inhibition of the photoinduced electron transfer (PET) mechanism. Job's plot analysis and high-resolution mass spectrometry (HR-MS) confirmed the 1 : 1 binding ratio between the compound and ClO-. The synthesized compound also exhibits higher sensitivity and fluorescence quenching towards the explosive species (picric acid), with a detection limit of around 1.44 × 10-6 M. Furthermore, our work was carried out for real-time water sample analysis to check ClO- and picric acid detection and high recovery rates (94 to 99%) were achieved. These findings highlight the potential of PTH-AB-PY as a promising molecular probe for ClO- ions and picric acid detection with various analytical and environmental applications.

A closer look at the international health regulations capacities in Lebanon: a mixed method study

BACKGROUND

Lebanon ratified the International Health Regulations (IHR) (2005) in 2007, and since then, it has been facing complex political deadlocks, financial deterioration, and infectious disease emergencies. We aimed to understand the IHR capacities' scores of Lebanon in comparison to other countries, the IHR milestones and activities in Lebanon, the challenges of maintaining the IHR capacities, the refugee crisis's impact on the development of these capacities; and the possible recommendations to support the IHR performance in Lebanon.

METHODS

We used a mixed-method design. The study combined the use of secondary data analysis of the 2020 State Party Self-Assessment Annual Report (SPAR) submissions and qualitative design using semi-structured interviews with key informants. Semi-structured interviews were conducted with nine key informants. The analysis of the data generated was based on inductive thematic analysis.

RESULTS

According to SPAR, Lebanon had levels of 4 out of 5 (≤ 80%) in 2020 in the prevention, detection, response, enabling functions, and operational readiness capacities, pertaining that the country was functionally capable of dealing with various events at the national and subnational levels. Lebanon scored more than its neighboring countries, Syria, and Jordan, which have similar contexts of economic crises, emergencies, and refugee waves. Despite this high level of commitment to meeting IHR capacities, the qualitative findings demonstrated several gaps in IHR performance as resource shortage, governance, and political challenges. The study also showed contradictory results regarding the impact of refugees on IHR capacities. Some key informants agreed that the Syrian crisis had a positive impact, while others suggested the opposite. Whether refugees interfere with IHR development is still an area that needs further investigation.

CONCLUSION

The study shows that urgent interventions are needed to strengthen the implementation of the IHR capacities in Lebanon. The study recommends 1) reconsidering the weight given to IHR capacities; 2) promoting governance to strengthen IHR compliance; 3) strengthening the multisectoral coordination mechanisms; 4) reinforcing risk communication strategies constantly; 5) mobilizing and advancing human resources at the central and sub-national levels; 6) ensuring sustainable financing; 7) integrating refugees and displaced persons in IHR framework and its assessment tools; 8) acknowledging risk mapping as a pre-requisite to a successful response; and 9) strengthening research on IHR capacities in Lebanon.

Imaging findings of the injured in the massive Beirut blast

PURPOSE

(1) Describe imaging utilization and findings within two weeks of the 2020 Beirut blast according to the mechanism of injury, (2) determine the appropriate imaging modality per organ/system, and (3) describe changes in the workflow of a radiology department to deal with massive crises.

MATERIALS AND METHODS

Two hundred sixty patients presented to the largest emergency department in Beirut and underwent imaging within 2 weeks of the blast. In this retrospective study, patients were divided into early (1) and late (2) imaging groups. Patients' demographic, outcome, type and time of imaging studies, body parts imaged, and mechanism and types of injuries were documented.

RESULTS

Two hundred five patients in group 1 underwent 502 and 55 patients in group 2 underwent 145 imaging studies. Tertiary blast injuries from direct impact and falling objects were the most common type of injuries followed by secondary (shrapnel) injuries. Both types of injuries affected mostly the head and neck and upper extremities. Plain radiographs were adequate for the extremities and CT for the head and neck. A regularly updated and practiced emergency plan is essential to mobilize staff and equipment and efficiently deliver radiology services during crises.

CONCLUSION

Because the powerful Beirut blast occurred at the port located in the periphery of the city, most injuries seen on imaging were of the upper extremities and head and neck caused by the severe blast wind or penetrating shrapnel and resulted from people using their arms to protect their heads and bodies from direct impact and falling objects.

Identifying weak signals to prepare for uncertainty in the energy sector

This study aims to prepare the energy sector for uncertainty using a foresight tool known as weak signals. Weak signals (subtle signs of emerging issues with significant impact potential) are often overlooked during strategic planning due to their inherent predictive uncertainty. However, the value does not lie in precise forecasting but in broadening the consideration of future possibilities. By proactively monitoring and addressing these otherwise neglected developments, stakeholders can gain early awareness of threats and opportunities and enhance their resilience, adaptability, and innovation. A panel of technology experts identified eight weak signals in this study: 1) growing mistrust and local grid security measures, 2) consumer reactions to overly prescriptive policies, 3) long-term forecasting errors for thin-margin projects, 4) emergence of variable power industries, and 5) establishment of intercontinental transmission precedence; including three potential 'wild cards' requiring proactive mitigation: 6) escalating electrical generation dependence on continued imports, 7) a new threat surpassing climate change, and 8) mass deployment of low-emissions technology triggering a runaway loss of social license. Political factors were the predominant source of uncertainty, as decisions can suddenly transform the energy landscape. Economic, technological, and social factors followed closely behind, generally through the emergence of new industries and behavioural responses. While environmental and legal factors were less frequent, stakeholders should still adopt a holistic approach, as the signals were found to be highly interconnected. Organisations should also assess their local context when applying these findings and continuously update and respond to their own list of weak signals.

Multicenter assessment of impairments and disabilities associated with Beirut blast injuries: a retrospective review of hospital medical records

Objectives

This study aims to describe the injury patterns of the Beirut blast victims and assess hospitals' disaster management and preparedness during the 2020 Beirut port blast.

Methods

A cross-sectional retrospective multicenter study was conducted in two stages. Data were collected on blast victims presented to participating hospitals from August 4 till August 8, using three designed questionnaires. Stage 1 included all blast patients' records and stage 2 examined a subset of inpatient and outpatient records. Binary logistic regression was performed to assess the factors associated with death and disability for blast patients.

Results

A total of 3278 records were collected, 83% were treated at emergency departments and 17% were admitted to hospitals. Among those, 61 deaths and 35 long-term disabilities were reported. Extremity operations (63%) were mostly performed. Outpatients (n=410) had a mean age of 40±17.01 years and 40% sustained lacerations (40%). 10% of those patients sustained neurological complications and mental problems, and 8% had eye complications. Inpatients (n=282) had a mean age of 49±20.7 years and a mean length of hospital stay of 6±10.7 days. Secondary (37%) and tertiary (25%) blast injuries were predominant. 49% sustained extremity injuries and 19% head/face injuries. 11 inpatient deaths and 20 long-term disabilities were reported. Death was significantly associated with tertiary concussion and crush syndrome (p<0.05). Of the 16 hospitals, 13 implemented disaster plans (87%), and 14 performed a triage with a mean time of 0.96±0.67 hours. One hospital (6%) performed psychological evaluations, without follow-up.

Conclusion

Beirut blast victims suffered deaths and disabilities associated with their injuries. They predominantly sustained lacerations caused by shattered glass. Tertiary injuries were associated with death. Triage, disaster plans, and hospital preparedness should be effectively implemented to enhance patients' clinical outcomes.

Level of evidence

Prognostic and epidemiological/Level III.

A practical method for predicting and analyzing the consequences of ammonium nitrate explosion accidents adjacent to densely populated areas

Several catastrophic ammonium nitrate (AN) explosion accidents have been reported during the last decades. Previous studies have been mainly focused on investigating adverse effects caused by the AN explosion, while only a few systematically analyzed the consequences and impacts of AN explosions. This study collects data from three typical AN explosions (accidental explosion of the US fertilizer plant in 2013; an accidental explosion of China's Tianjin port in 2015, and a recent explosion (2020) of the Beirut port in Lebanon). The consequences of accidental explosions were analyzed by mathematical equations that further provide scientific explanations for AN explosions. Based on the explosives' properties on-site, these accidental explosions were caused by condensed phase explosives. Comparison with the conditions at the explosion site indicated that blast overpressure was the primary factor in the loss of life and damage to the building, while ground shock was a secondary factor. The severity of loss of life and building damage from explosions decreased with increasing distance. These distances could be calculated by the scaling law, which was replaced by the equivalent TNT mass of the explosive and the damage scale's overpressure boundary value. In addition, mapping the damaged area on a map helped in the visual presentation of the consequence assessment. The long-term environmental and ecological impact due to the explosions was also an important issue that could not be ignored. Overall, this study establishes a simple and easy-to-use method to rapidly predict and assess the consequences of an explosion, and provides technical guidance for future emergency response to similar large-scale accidents.

Anxiety, depression and post-traumatic stress disorder in patients on hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: a cross-sectional study

BACKGROUND

In 2020, Lebanon has witnessed its worst economic crisis, exacerbated by the COVID-19 pandemic and a massive explosion of its capital. Amidst these stressors, this study aims at assessing the prevalence of depression, anxiety, suicidality, post-traumatic stress disorder (PTSD) and cognitive impairment in patients undergoing hemodialysis in an academic hospital destroyed by the explosion.

METHODS

This cross-sectional study conducted 6 months after the blast included adults on hemodialysis, with no previous diagnoses of dementia or intellectual disability. It explores prevalence rates of psychiatric disorders, in addition to other medical and psychosocial variables such as frailty, malnutrition, sarcopenia, quality of life and religiosity.

RESULTS

Forty two patients (mean age 66.1; SD: 11.2 years) undergoing hemodialysis for 6.12 years (SD:7.22 years) were included. Anxiety and depression rates reached 54.8% and 57.1% using cut-offs of 6 and 7 respectively on the Hospital Anxiety and Depression rating Scale. 9.5% of the patients reported being in the hospital at the time of the blast and 7.1% reported being injured. 33.3% screened positively for PTSD using a cut-off of 23 on the PCL-5. 26.2% had passive death wishes and 7.1% had suicide plans, however no one had attempted it. 23.8% were found cognitively impaired as shown by the Mini-Cog (<3). Around two-third of participants were moderately to severely malnourished per the GLIM criteria. One third suffered from frailty, according to the FRAIL screening tool. Around 60% suffered from sarcopenia, based on handgrip strength measures. These findings contrast with "acceptable to good" quality of life subjectively reported by participants on the Short Form 36 (SF-36) Health Survey. While one-third of participants participated in organizational religious activities, 88% reported significant subjective meaning of religion in their heart.

CONCLUSIONS

Rates of depression, anxiety, PTSD, suicidality, and cognitive impairment were found to be alarming in the setting of an urban dialysis unit following a major explosion. Psychiatric disorders were found to be compounded with increased prevalence of malnutrition, frailty, and sarcopenia. These findings urge healthcare providers to implement early diagnostic and intervention strategies to improve both mental and physical wellbeing of this vulnerable population, in similar settings.

Disaster waste management challenges and enabling factors for strategic planning: The case of the Beirut Port explosion

Disasters occur in both developed and developing countries, generating large amounts of disaster waste including construction and demolition (C&D) waste that needs to be appropriately managed. While developed countries are capable of implementing adequate disaster waste management (DWM) strategies to facilitate their recovery processes, developing countries generally struggle to find the resources and expertise needed to develop such strategies. Lebanon is a developing country vexed by several systemic challenges that hindered its abilities to manage disaster waste. In this paper, we focus on the Beirut Port explosion (4 August 2020), which generated more than 800,000 tonnes of disaster wastes. This study first assesses the executed strategies and identifies their enabling factors and implementation challenges. It then proposes a framework for the proper management of disaster waste, which was validated through 18 in-depth interviews with experts and stakeholders involved in disaster management. Interview notes and transcripts were analyzed using an inductive-deductive process that allowed to identify themes using the constant comparative method. The data revealed that the main barriers toward implementing a successful DWM strategy were the absence of appropriate technologies, infrastructure, expertise, legislative framework and financial resources. The study concludes by proposing a DWM roadmap that includes contingency, risk reduction and implementation plans (IPs) that can enhance decision-making and ease the recovery process.

The Beirut ammonium nitrate blast: A multicenter study to assess injury characteristics and outcomes

BACKGROUND

Blasts incidents impose catastrophic aftermaths on populations regarding casualties, sustained injuries, and devastated infrastructure. Lebanon witnessed one of the largest nonnuclear chemical explosions in modern history-the August 2020 Beirut Port blast. This study assesses the mechanisms and characteristics of blast morbidity and mortality and examines severe injury predictors through the Injury Severity Score.

METHODS

A retrospective, multicenter cross-sectional study was conducted. Data of trauma patients presenting to five major acute-care hospitals in metropolitan Beirut up to 4 days following the blast were collected in a two-stage process from patient hospital chart review and follow-up phone calls.

RESULTS

A total of 791 patients with a mean age of 42 years were included. The mean distance from the blast was 2.4 km (SD, 1.9 km); 3.1% of victims were in the Beirut Port itself. The predominant mechanism of injury was being struck by an object (falling/projectile) (293 [37.0%]), and the most frequent site of injury was the head/face (209 [26.4%]). Injury severity was low for 548 patients (71.2%), moderate for 62 (8.1%), and severe/critical for 27 (3.5%). Twenty-one deaths (2.7%) were recorded. Significant serious injury predictors (Injury Severity Score, >15) were sustaining multiple injuries (odds ratio [OR], 2.62; p = 0.005); a fracture (OR, 5.78; p < 0.001); primary blast injuries, specifically a blast lung (OR, 18.82; p = 0.001), concussion (OR, 7.17; p < 0.001), and eye injury (OR, 8.51; p < 0.001); and secondary blast injuries, particularly penetrating injuries (OR, 9.93; p < 0.001) and traumatic amputations (OR, 13.49; p = 0.01). Twenty-five percent were admitted to the hospital, with 4.6% requiring the intensive care unit. At discharge, 25 patients (3.4%) had recorded neurologic disability.

CONCLUSION

Most injuries sustained by the blast victims were minor. Serious injuries were mostly linked to blast overpressure and projectile fragments. Understanding blast injuries characteristics, their severity, and management is vital to informing emergency services, disaster management strategies, hospital preparedness, and, consequently, improving patient outcomes.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III.

Assessing the psychological impact of Beirut Port blast: A cross-sectional study

Beirut Port blast's magnitude is considered the third after Hiroshima and Nagasaki atomic bombings. This blast occurred in the densely populated section of Beirut, leaving more than six thousand injured patients. The psychological disturbances were assessed in the blast survivors who presented to the Emergency Department (ED) at the American University of Beirut Medical Center (AUBMC). This was a cross-sectional study at the ED of AUBMC. Identified patients were contacted and consented to participate in the study. Post-Traumatic Stress Disorder (PTSD) was selected as an outcome. Depression, PTSD, and concussion were assessed using patient health questionnaire (PHQ)-9, PTSD checklist for DSM-5 (PCL5), and brain injury symptoms (BISx) tools, respectively. The association of patients and injury characteristics with the study outcome was assessed using logistic regression. 145 participants completed the study procedures. The participants' average age was 39.8 ± 15.4 years, and 60% were males. Almost half of the participants showed depression on PHQ, and 2-thirds had PTSD. The participant's age was negatively associated with PTSD, whereas being a female, having depression, and having a concussion were positively associated with PTSD. The results of this study were in line with the previous literature report except for the association between younger age and PTSD, which warrants further investigations to delineate the reasons.

Preliminary Considerations for Crime Scene Analysis in Cases of Animals Affected by Homemade Ammonium Nitrate and Aluminum Powder Anti-Personnel Landmines in Colombia: Characteristics and Effects

Simple Summary

Anti-personnel landmines are a major problem in countries that are subject to internal conflicts of a military or public order nature. They also continue to be a great threat to the population and biodiversity, even in post-conflict stages. Those most often used by armed groups are simple or homemade antipersonnel landmines that are designed without any type of technical regulations and standardized production systems. Their low-cost manufacturing and the use of easily accessible explosive substances for agricultural use, such as ammonium, have allowed their indiscriminate use, turning them into a huge public health problem. They are only detected when people or animals activate them, because they do not contain any materials that are detectable by traditional means. The scant literature on these artifacts focuses on injuries caused to humans, and only incidentally on field work. The objective of our study was to describe the behavior of a controlled explosion of a homemade antipersonnel landmine, and to verify the effects caused by the explosion on fauna and the environment. The results enable us to provide guidelines that may be implemented during field investigations, in which forensic veterinarians and related disciplines participate.

Abstract

During the armed conflict in Colombia, homemade improvised antipersonnel landmines were used to neutralize the adversary. Many active artifacts remain buried, causing damage to biodiversity by exploding. The extensive literature describes the effects and injuries caused to humans by conventional landmines. However, there is considerably less information on the behavior and effects of homemade antipersonnel landmines on fauna and good field investigation practices. Our objectives were to describe the characteristics of a controlled explosion of a homemade antipersonnel landmine (using ammonium nitrate as an explosive substance), to compare the effectiveness of some evidence search patterns used in forensic investigation, and to determine the effects on a piece of an animal carcass. The explosion generated a shock wave and an exothermic reaction, generating physical effects on the ground and surrounding structures near the point of explosion. The amputation of the foot in direct contact with the device during the explosion and multiple fractures were the main effects on the animal carcass. Finally, it was determined that finding evidence was more effective in a smaller search area. Many factors can influence the results, which must be weighed when interpreting the results, as discussed in this manuscript.

The Beirut Port Blast: spectrum of injuries and clinical outcomes at a large tertiary care center in Beirut, Lebanon

PURPOSE

To describe injuries and outcomes of casualties of Beirut Port Blast treated at a large tertiary care center in Beirut, Lebanon.

METHODS

A retrospective observational study assessing the spectrum of injuries, treatment, and medical outcome among casualties of the Beirut Port Blast, immediately after the blast and up to 1 week from the blast to the emergency department of the American University of Beirut Medical Center (AUBMC).

RESULTS

A total of 359 patients were included. Most (n = 343, 95.6%) were adults (> 19 years), and males (56%) with a mean age of 42 ± 20 years. The most frequent mechanism of injury was a penetrating injury (45.7%), followed by other blast-related injuries (30.4%), and blunt injuries (23.4%). The most affected anatomical location were the limbs. Most (n = 217, 60.4%) patients required imaging. The most frequently administered medication was analgesics (38%), followed by anesthetics (35%), antibiotics (31%), tetanus vaccine (31%), and fluids (28%). Blood and blood products were administered in 3.8% of cases. Emergent procedures included endotracheal intubation (n = 18, 5%), surgical airway (n = 3, 0.8%), chest tube insertion (n = 4, 1.1%), thoracotomy (n = 1, 0.3%), and CPR (n = 5, 1.4%). A quarter of patients required surgical operations in the operating room (n = 85, 23.6%) and 18% required noncritical care admissions, 5.3% required critical care admissions, and 2.8% were dead on arrival.

CONCLUSION

Casualties from this event had significant injuries requiring lifesaving interventions, surgical procedures, and admission to critical care units. High utilization of imaging modalities and of medications from existing stockpiles was also observed.

Challenges of coronavirus disease 2019 (COVID-19) in Lebanon in the midst of the economic collapse

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.

4 août 2020 : explosion du port de Beyrouth, réponse de la Croix-Rouge libanaise et leçons apprises

Le 4 août 2020, vers 18h00, un entrepôt du port de Beyrouth contenant 2 750 tonnes de nitrate d’ammonium a explosé engendrant la plus grande explosion urbaine depuis Hiroshima et Nagasaki. Au cœur de ce désastre, la Croix-Rouge libanaise (CRL) a répondu à l’appel, et s’est déployée sur la totalité de la zone sinistrée offrant tout genre de service au peuple dévasté. Au total, plus de 4 000 patients ont été traités sur place et plus de 2 600 ont été transportés vers les hôpitaux de Beyrouth et du Mont Liban. Dans une époque où le Liban est profondément secoué par une crise économique étouffante et par la pandémie de la COVID-19, les défis rencontrés ont été majeurs. La documentation de cet évènement et l’évaluation des réponses de la CRL sont des éléments clés pour l’amélioration de la gestion de catastrophe. Vue la rareté du contexte, les leçons à tirer sont nombreuses.