[Looking at palliative care and end of life in Lebanon:results of a survey of university students]

Objective: The aim of this study is to test, through university students in Lebanon, the attitudes in our society towards death, the end of life and their knowledge about palliative care

Method: The transversal, descriptive and comparative study was conducted between March and April 2015 among students divided into 2 groups: medical students in the 2[nd] cycle of medical studies [Group 1], university students in other faculties [Group 2]. The questionnaire included 17 questions distributed under three headlines: death as experienced, the end of life and palliative care

Results: We collected 145 responses with a 72% response rate for medical students and 73% for students from other faculties. More than half of students have experienced the death of a close relative but medical students were more frequently confronted with such a situation [72% vs 56%; p = 0.033] occurring often in hospital [43% vs 20%; p = 0.011]. 65% of students believe that our society refuses to face death and does not even allow us to choose where to die. The conditions for a "good death" were mainly represented by an appropriate management of pain, to die in the minimum of pain [55%]. 65% of students hoped for a better management of end of life, mainly through 3 ways: palliative care units [40%], palliative care at home [34%] and the development of pain management in hospitals [34%]. 81% of students had heard of palliative care units, their primary expectation from these units was pain relief [63%] followed by human accompaniment [43%] and personalized comfort care [43%]. For the future of palliative care, the main efforts are to support the establishment of a financial aid system for the person in the end of life [50% of students], the implementation of an ambitious policy to the development of palliative care units [43%] and training health professionals to care for and support in their daily practice terminally ill patients [27%]

Conclusion: In our society, there is a crisis facing the process of dying and we have difficulty in managing satisfactorily the terminal phase of existence. To improve care at the end of life, it is important to create palliative care services in hospitals and improve the care of these patients at home

[Antiphospholipid syndrome : Report of 30 patients]

Objectives : To analyze clinical and immunologic manifestations of Lebanese patients with the antiphospholipid syndrome [APS]

Patients and Methods: Our study was retrospective and was done on hospitalized patients between 2001 and 2013. All these patients fulfilled the international criteria for diagnosis [Sydney criteria]

Results: Of the 30 patients selected, we noticed a female predominance [sex ratio: 2.75]. The age at diagnosis ranged between 9 and 72 years with a mean age of 43 +/- 17 years. "Primary" APS was present in 70% of patients; APS was associated with systemic lupus erythematosus [SLE] in 23% of patients, with a mixed connective tissue disease in 3% and systemic vasculitis in 3%. A catastrophic APS occurred in 3 cases [10%]. The most common presenting manifestations were deep venous thrombosis [53%], pulmonary embolism [33%] and stroke [13%]. Eleven patients [37%] had venous thrombosis, 7 [23%] had arterial thrombosis alone and 7 [23%] both arterial and venous thrombosis. Deep venous thrombosis occurred mostly in the lower limbs [70%] whereas arterial thrombosis occurred in cerebral arteries in 50% of cases. The most common fetal complications were early fetal loss [62.5%]. Anticardiolipin antibodies were the most frequently identified antibodies [83%], followed by anti-beta2GPI [70%] and anticoagulant lupus [11%]. An effective anticoagulation by anti-vitamin K was performed in 29 patients. Corticosteroids were prescribed in 13 cases and were associated to immunosuppressant drugs in 6 cases of secondary APS and the 3 catastrophic APS. The patients with catastrophic APS received also intravenous immunoglobulin. Response to treatment was favorable in 86% of patients with a mean follow up of 6 +/- 4 years. We deplored 4 deaths, 2 within the catastrophic APS

Conclusion: The APS does not seem to have particular features in Lebanon. The primary form seems to be the most common. It is important to diagnose this syndrome earlier before the onset of serious complications

Fievre typhoide

Objectives: Present clinical features of typhoid fever in Lebanon. Methods: Retrospective study of 70 patients admitted to a university hospital center between 1995 and 2002. The criteria for inclusion were a positive Salmonella typhi or paratyphi hemoculture and/or a Widal serodiagnosis >/= 1/160 for O agglutinin, in the presence of evocative symptoms. Results Among the 70 patients, 25 pediatric cases were noted. The patients were aged a mean of 28 +/- 22 years. Average duration of symptoms before the diagnosis was 10 +/- 7 days. Fever were observed in 97% of cases and the other predominant symptoms were abdominal pain [41%], diarrhoea [36%], chills [31%] and headache [29%]. Febrile gastroenteritis was a frequent manifestation in children [52%]. Complications were noted in 31% of cases and were predominantly digestive. Leucopenia was not a helpful diagnostic marker. S. typhi was the most frequent [87%] serotype identified. Resistance to ampicilline was 10%, to cotrimoxazole and chloramphenicol 7% for each and to ofloxacine 2%. One death was reported [1%] of an immunosuppressed patient. Typhoid fever is still an endemic disease in Lebanon and should be systematically evoked in the case of prolonged fever, febrile gastroenteritis and/or headache. The appearance of bacteria resistant to antibiotics makes ceftriaxone or ciprofloxacine the empirical treatment of choice

[Pseudomyxoma peritoneal, about two cases and review of the literature]

In this article, we present two cases of peritoneal pseudomyxoma suspected on abdominal CT Scan and then confirmed on pathologic examination. A mucinus carcinoma was the primary lesion in the two cases, appendicular in the first case and with an undeterminate origin in the second. The prognosis was bad in these cases despite the debulking surgery and the systemic and intraperitoneal chemotherapy

Actinomycose vertebrale. A propos d'un cas et revue de la litterature

In this article, the case of a 32-year-old man with a paravertebral actinomycosis is discussed. Initially, the diagnosis was not obvious but it was confirmed later with the repetitive radiologic procedures, the elimination of other etiologies [purulent, mycobacterial or mycotic infections and neoplasia] and the biopsy Treatment with penicillin initially and then with tetracycline for a long term led to a very good outcome at a 3-year follow-up with a radiologic remission. Following the discussion of the case, a review of the literature concerning the paravertebral actinomycosis, its diagnostic clues and treatment is undertaken

neurobrucellosis in Lebanon: about 6 observations

The authors report 6 cases of nervous system brucellosis [3 males, 3 females] and present the different clinical features of this localization. Me-ningoencephalitis is observed in 4 patients and is associated with subarachnoid hemorrhage in one. Pure meningitis occurred in one case and acute myelitis in another one. Cerebrospinal fluid composition is studied in all these patients. Rifampicine associated with Cotrimoxazole, for at least 3 months, is very helpful in nervous system brucellosis because of their good central nervous system penetration but neurological sequelae are noted in one case of meningoencephalitis with chronic infection and in the case of myelitis

Behcet's disease in Lebanon: reportof 100 cases

Purpose: To present clinical features of Behcet's disease in Lebanon and to evaluate the efficacy of treatment. Patients and methods: The 100 patients are seen at Hotel-Dieu de France Hospital of Beirut between 1980 and 1992. Diagnostic criteria are those of the Behcet Syndrome Research Committee of Japan. Results: Recurrent oral ulcers are present in 95% of cases, genital ulcers in 78%, ocular manifestations are more frequent than those of several studies whereas skin lesions and vascular signs are less frequent. Joint involvement are recorded in 65% of cases and neurological one in 14%. The effectiveness of colchicine therapy is confirmed for mucocutaneous lesions and arthritis. Immunosuppressive agents are more beneficial than steroids alone on serious uveitis. An aggressive treatment with corticosteroids and immunosuppressive drugs improve the prognosis of meningoencephalitis. Conclusion: Behcet's disease doesn't have any specific characteristics in Lebanon despite some variation in the frequency of lesions

manifestations digestives de la dermatomyositis juvenile: a propos d'un cas avec revue de la litterature

Childhood dermatomyositis should be separated from the adult polymyositis and is characterized by the frequency of vasculitis and ulcerations of the gastrointestinal tract. The authors present a case of colonic perforation with a review of the different disorders of the gastrointestinal system secondary to this disease