Ventricular Tachycardia in an Infant Without Congenital Anomaly: A Case Report.

Ventricular tachycardia (VT) is a serious form of arrhythmia that can be life-threatening; that's why diagnosis and treatment are very important in order to avoid serious complications. We are reporting this case of VT which is a rare entity, especially, in healthy infants. This infant, without cardiac pathology known from birth, presented with poor food intake and grunting with hepatomegaly on clinical examination, and a heartbeat at 200/ min. The electrocardiogram (ECG) showed wide QRS complex tachycardia, and the echocardiogram showed a dilated and hypokinetic cardiomyopathy. The clinical signs and chest X-ray changes were consistent with mild cardiac failure. This presentation makes the diagnosis challenging, therefore, it is important to take a good history of the case with a complete clinical exam to achieve the correct diagnosis, and to avoid potential complications. VT of an infant may be benign but should not be diagnosed as such before eliminating serious causes.

How do Lebanese patients perceive the ideal doctor based on the CanMEDS competency framework?

BACKGROUND: During their training, Lebanese medical students develop a high medical expertise but are not focusing on other competencies such as communication, collaboration, erudition, professionalism, leadership and health promotion. There is also insufficient data about patients' preference for these skills. This study describes the different weights patients attribute to these physician's competencies. METHODS: This is a cross-sectional study based on a questionnaire distributed to 133 Lebanese patients. It included 15 questions assessing how patients prioritize the physician's competencies, with open-ended questions asking them to define "the good doctor". Krippendorff's alpha coefficient was used to analyze the reliability of the competencies' classification. RESULTS: One hundred twenty five patients completed the questionnaire in this cross-sectional study. Their mean age was 48 ± 16.76 years. When classifying competencies, 73.6% opted for medical expertise as first choice and 48% put communication as second. Based on the Krippendorff's coefficient, we identified a moderate agreement for the seven choices (alpha = 0.44). In open-ended questions, patients defined the good doctor in 325 answers: 64.3% mentioned medical expertise, 34.1% high ethics and 26.2% communication. CONCLUSIONS: This patient-centered study concurs well with the worldwide practice that puts medical expertise at the center of medical education. However Lebanese patients don't perceive equally other competencies and favor professionalism and communication that should be integrated in priority in students' curricula.

[Epidemiology of cardiac tumors in adults in Lebanon]. / Epidémiologie des tumeurs cardiaques des adultes au Liban.

Primary cardiac tumors are rare but potentially fatal. No studies have discussed this issue yet on the national level. We describe the epidemiology of cardiac tumors in adults in Lebanon. The data were taken from the hospitals, the patients and/or their doctors by means of a questionnaire. Fifty-seven cases of cardiac tumors were found, mainly myxomas in the left atrium. Dyspnea was the most frequent symptom. Transthoracic echocardiography was the main diagnostic tool. Transesophageal echocardiography was inconstantly made, scanner and MRI rarely while contrast echocardiography has never been used. Almost half of the patients had a follow-up and none had a familial screening. The collected data urged us to propose a unique and homogenous strategy for diagnosis, treatment and follow-up of cardiac tumors in Lebanon.

[Control of blood pressure morning surge in a Lebanese hypertensive population]. / Contrôle du pic matinal de la pression artérielle par telmisartan chez une population libanaise hypertendue.

OBJECTIVE: The primary endpoint of this prospective clinical study is to ascertain the degree of blood pressure control in the early-morning hours after 8 weeks of treatment with Telmisartan in hypertensive patients using home blood pressure measurements. METHODS: Two hundred forty Lebanese patients with uncontrolled hypertension are enrolled in the study. The blood pressure is measured at the initial visit, then at week 4 of follow-up (optional visit) and after the 8 weeks period, by the physician at his office (with pulse rate) and by the patient at home in the morning. RESULTS: The blood pressure measured by the patient at home in the morning has a mean value of 129.7/79.1 mmHg, significantly less than 135/85 mmHg (P < 10(-1)), and it is reduced by 31.9/13.5 mmHg (P < 10(-5)). At the physician's office, the reduction is 34.8/16 mmHg (P < 10(-4)). Heart rate is decreased by 4.7+/-0.5 bpm (P < 10(-5)). The drug was well tolerated. CONCLUSION: This study has demonstrated that Telmisartan, by his long half-life, protects the patients against the early-morning hours blood pressure surge, period during which coronary and cerebral events are the most frequent.

[Two-year follow-up study of postoperative rehabilitation, return to work, and athletic activities of 111 Lebanese patients after coronary bypass]. / Rééducation postopératoire, réinsertion socio-professionnelle et reprise du sport chez 111 patients libanais opérés de pontage aorto-coronarien suivis pendant 2 ans.

The goal of this paper is to study the progress of the first phase of rehabilitation of a Lebanese population treated by coronary artery bypass surgery, as well as to follow long-term socioprofessional reinsertion and resumption of physical activity in these patients. 111 patients operated in our hospital of coronary artery bypass in 1997 have been studied retrospectively two years after the surgery. The analyzed parameters are socioprofessional demographic data, physical and sports activities before and after the bypass surgery as well as the applied rehabilitation program. Among the studied patients (mean age = 64 years, 77% of men), 30% only had a professional activity before the surgery. The majority of these patients returned to work in a mean delay of 45 days. 76% of the patients have regular physical activity two years after the surgery versus 50% before. On the 63 smoking patients before the bypass surgery, 41 continue to smoke 2 years later. The behavior of the Lebanese patients after a coronary artery bypass surgery is particular and different from what is reported in the literature: 1) The resumption of the initial work is more frequent and more precocious. 2) The patients start regular physical activity without surveillance or previous codification of the frequency and the intensity of the effort. 3) The majority of the smoking patients continue to smoke after surgery. 4) The functional rehabilitation is limited to the phase I.