Wrist Drop as a Manifestation of Behçet's Disease

Radial mononeuropathy most commonly manifesting as wrist drop is generally secondary to penetrating trauma to the radial nerve or compression injuries. It may also involve sensory changes depending on the location of the lesion. However, it has never been described as a sign of an inflammatory process, in particular an autoimmune disease. We describe the case of a 55-year-old man who was admitted for wrist drop with bilateral paraesthesia of the upper extremities. Based on his medical history, we diagnosed Behçet’s disease and subsequently neuro-Behçet’s disease. He is receiving treatment with notable improvement. Neurological involvement in Behçet’s disease is common but frequently undiagnosed

Extraneural metastases from cranial meningioma: a case report

Extracranial metastases from brain meningiomas is a rare, but well-documented entity. Metastases occur mostly in the lungs, pleura and liver, but may also affect lymph nodes and bones. We report here on a patient who was treated for an atypical brain meningioma with multiple surgeries and multiple sessions of stereotactic radiosurgery with good control of his brain disease. Thirteen years after diagnosis, he developed bilateral large sacroiliac and abdominal metastases

COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm. Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection

Chemical meningitis and syndrome of inappropriate antidiuretic hormone release (SIADH): a rare presentation of pituitary adenoma apoplexy

Pituitary apoplexy is an uncommon condition typically resulting from a sudden haemorrhage within a pituitary adenoma. This bleed can present clinically with a wide array of signs and symptoms. This report documents the case of a 62-year-old male who presented to the Lebanese Hospital Geitaoui University Medical Center with signs and symptoms of meningeal irritation. He was initially thought to have meningitis, and was started on antibiotics; he was then found to have pituitary adenoma apoplexy that was complicated by syndrome of inappropriate antidiuretic hormone release (SIADH). The patient was successfully treated with antibiotics, and fluid restriction and hypertonic saline after ruling out other more common causes for his hyponatraemia, before undergoing a transsphenoidal resection of the pituitary adenoma. A three-month follow-up evaluation of the patient demonstrated the absence of hormonal imbalances and the absence of residual tumours on imaging

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Étude préliminaire des effets à court et long terme d’un dispositif de formation à la communication d’une mauvaise nouvelle

Introduction : L’expérience de son problème de santé par un malade est affectée aussi bien par les actes du médecin que par son attitude. L’annonce d’une mauvaise nouvelle est un défi pour les médecins. Objectif : La présente étude a pour objectif de mesurer les effets d’un atelier de formation aux techniques de communication dans le cadre de l’annonce d’une mauvaise nouvelle, en recourant à une évaluation écrite à court et à long terme et à un dispositif de simulation répondant au format de deux stations d’examen clinique objectif standardisé (ECOS), chez des résidents du tronc commun de médecine interne au Liban. Matériels et méthodes : L’étude rapportée est une étude interventionnelle, comparative et contrôlée, évaluant à l’aide de mesures à court et à long termes les effets du dispositif sur les apprentissages de 21 résidents comparativement à celui de 27 résidents d’un groupe contrôle. L’atelier comporte trois étapes réparties sur une durée totale de quatre heures. La méthode d’évaluation comportait des mesures effectuées lors de trois étapes théoriques/écrites (test pré-intervention avant l’atelier et tests post-intervention à trois mois et à deux ans) et d’une étape pratique grâce à un examen clinique objectif et structuré (ECOS), effectué trois mois après l’atelier par un évaluateur aveugle écoutant l’enregistrement sonore des entretiens. Résultats : Une amélioration théorique a été constatée chez les membres du groupe atelier (scores de 11,2, 13 et 14,1 pour les moyennes respectives du test pré-intervention, du test post-intervention à trois mois et du test post-intervention à deux ans ; p < 0,05) mais pas chez le groupe contrôle. Il n’y a pas de différence concernant l’évaluation pratique par deux stations de type ECOS entre les deux groupes. Discussion : Selon notre étude, l’atelier de formation a pu améliorer l’apprentissage théorique mais pas la pratique de l’annonce d’une mauvaise nouvelle. Conclusion : Un atelier de formation à la communication a un impact positif sur les connaissances en matière d’annonce d’une mauvaise nouvelle mais ses conséquences sur l’acquisition d’authentiques compétences restent à documenter