Secondary Syphilis Presenting as Erythema Multiforme in the Setting of AIDS and Psoriasis.

Syphilis is a highly infectious sexually transmitted infection (STI) with a multitude of presentations. The disease is known as "the great imitator" as it often presents as other chronic dermatoses, leading to a difficult and delayed diagnosis. Here, we describe the case of a 17-year-old Vietnamese male from Dong Nai Province who was initially diagnosed with psoriasis. However, upon further investigation, he was found to have concurrent secondary syphilis and psoriasis complicated by an undiagnosed human immunodeficiency virus (HIV) infection which presented clinically as generalized erythema multiforme (EM). The patient demonstrated significant improvement after being treated for syphilis and psoriasis, and he was subsequently referred to an infectious disease specialist for treatment of the underlying HIV infection.

Association Between Adherence to Statins, Illness Perception, Treatment Satisfaction, and Quality of Life among Lebanese patients.

OBJECTIVES: The main objective of this study was to evaluate treatment adherence to statin and health-related quality of life (QOL) in Lebanese patients with dyslipidemia. Secondary objectives were to examine associations between treatment adherence, QOL, treatment satisfaction, and illness perception. METHODS: This cross-sectional study, conducted in 20 community pharmacies from all districts of Lebanon between August 2016 and April 2017, enrolled 247 adult patients taking any statin. RESULTS: The mean age of the participants was 52.63 ± 11.92 years (57.5% males); the mean duration of treatment with a statin was 59.72 months. A significant association was found between adherence and marital status ( P < .0001), educational level ( P = .001), cigarette smoking ( P < .0001), and alcohol drinking ( P < .0001). A negative but significant correlation was found between the adherence score and the duration of dyslipidemia ( r = -0.199). A significant but negative correlation was also found between the side effect score and age ( r = -0.137). The monthly salary, the marital status, the educational level, smoking cigarettes or waterpipes, and drinking alcohol were all associated with the Illness Perception Questionnaire scores ( P < 0.0001 for all variables). Secondary level of education (ß = 13.43), smoking more than 3 waterpipes per week (ß = 14.06), global satisfaction score (ß = 0.32), convenience score (ß = 0.29), and effectiveness score (ß = 0.27) would significantly increase the adherence score. Smoking more than 15 cigarettes per day (ß = -11.15) and a divorced status (ß = -14.81) would however significantly decrease the adherence score. Significant associations were found between the illness perception score, the QOL domains, and the satisfaction domains ( P < .05 for all variables). CONCLUSION: This study showed that global satisfaction with treatment, convenience, and effectiveness are important factors that increase treatment adherence. Patient adherence results in patient satisfaction and improved QOL and is an important criterion for achieving desired therapeutic outcomes.

Risk factors for heterotopic ossification in primary total hip arthroplasty.

Heterotopic ossification (HO) is a recognised complication of total hip arthroplasty (THA). This study aims to correlate demographics, surgical approach and type of arthroplasty to the incidence of HO in an attempt to quantify patient risk. A total of 920 primary THAs in 893 patients were performed between 2006 and 2008 in a single arthroplasty centre. Radiographic evaluation was conducted and all cases of HO were classified using the Brooker classification. Age, sex, arthroplasty type and surgical approach were all considered as variables. Arthroplasty type was classified into four groups; total cemented (TC), total uncemented (TU), hybrid (H) and reverse hybrid (RH). Two-level logistic regression analysis was conducted. The overall incidence of HO was 24%. Male sex [OR=3.57, 95% CI (1.79-7.10); p=0.001], lateral approach [OR=2.47, (95% CI 1.23-4.95); p=0.001] and total cemented implants [OR=3.14, (95%CI 1.37-7.23); p=0.007] were significantly associated with HO. The intra-class correlation coefficient was 0.52 [95% CI (0.21, 0.81); p=0.004], demonstrating that patients with previous HO to one THA were very likely to suffer HO in subsequent THA. The results demonstrate very large effects for sex, surgical approach, and implant type on HO incidence. This raises a three arm hypotheses that reaming of the femoral canal for the insertion of cemented implants contaminates the surgical field with bone marrow increasing the risk of HO, whereas modern cementless implants generally employ impaction broaching. In addition surgical insult to the hip abductors during exposure, particularly in males due to higher muscle mass, may also predispose to HO.

An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis.

INTRODUCTION: An increasing trend of incidence in hepatocellular carcinoma (HCC) has been recorded in most developed countries. HCC ranks among the ten most common cancers worldwide. The health costs and burden to the economy implicated by HCC are huge. In recent years, the surveillance programs and screening for the disease, in addition to increasing awareness, led to the detection of smaller precursor lesions of HCC in the liver. The rise of molecular-targeted therapies and the publication of various conflicting guidelines on the management of the disease demand a review of evidence into the curative therapies and medical management of HCC. AIMS: The primary objective was to identify the survival benefit of the primary medical modalities in HCC, as more trials were uncovered between 2005 and 2010. The secondary objective was to conduct a meta-analysis. Selection criteria were implemented to select randomized controlled trials (RCTs), to include in this study. After selection, all the articles were ranked according to their strength. MATERIALS AND METHODS: The MEDLINE, CANCERLIT, Embase databases, and the Cochrane Library were reviewed using the national library of health website. The time limit used for searching for RCTs was between January 2005 and December 2010. Overall survival and the cumulative probability of no recurrence were the primary endpoints considered in the studies to be assessed. These endpoints were measured over one, two, or three years, depending on the size of the study and the length of follow-up. The software package comprehensive meta-analysis ver 2.0.exe (Biostat, USA) was used to comply with the results, to conduct the meta-analysis, and help with analyzing the data. RESULTS: The original general search yielded 193 RCTs between 2005 and 2010. Only 32 studies met the inclusion criteria. However, after the ranking of the studies according to strength, only 17 studies were eventually selected. The 17 studies were subsequently classified according to the following; surgical resection (n = 2); percutaneous treatments (n = 5); chemoembolization (n = 1); systemic treatments (n = 8); and other treatments (n = 1). Randomized studies comparing the percutaneous ethanol injection (PEI) to the surgical resection were inconclusive. However, percutaneous treatments showed results similar to surgical resection in terms of overall survival. The meta-analysis comparing PEI to radiofrequency ablation (RFA) showed RFA to be superior to PEI in terms of overall survival at three years (odds ratio 1.698; 95% CI 1.206 - 2.391; P = 0.002). When adverse events were considered there was no statistically significant difference between the RFA and PEI groups (odds ratio 1.199; 95% CI 0.571- 2.521; P = 0.632). CONCLUSION: RFA should be the first-line treatment in patients with a single small HCC tumor ≤ 3 cm. Careful patient selection is crucial prior to transarterial chemoembolization (TACE), as the procedure may be associated with an increased risk of liver failure. Tamoxifen has no role to play in the treatment of HCC. Sorafenib should be the first-line treatment in patients with advanced and inoperable HCC. The role of Sorafenib in the management of early stage HCC remains to be determined.