[Platypnea-orthodeoxia syndrome secondary to pneumonia: Two cases]. / Syndrome platypnée-orthodéoxie secondaire à une pneumopathie : à propos de deux cas.

INTRODUCTION: The platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism. OBSERVATIONS: We report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound. CONCLUSION: This syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.

[Smoking cessation in secondary prevention of acute coronary syndrome: The role of the electronic cigarette]. / Sevrage tabagique en prévention secondaire d'un syndrome coronarien aigu : la place de la cigarette électronique.

OBJECTIVES: To study the use, efficiency and wishes for a "medicalization" of the electronic cigarette (EC) for smoking cessation in secondary prevention of acute coronary syndrome (ACS). PATIENTS AND METHOD: Prospective epidemiological study with inclusion of smoker patients hospitalized from 1st June 2015 to 31st March 2016 at the St Quentin Hospital (Picardy, France) for an ACS (except unstable angina), interviewed 1 year after their ACS, excluding patients over 75 years or with personal history of ACS. RESULTS: Eighty-one patients were included. 59 questionnaires (73%) were returned and analyzed. The average age was 53.3 years. There were 45 men (76.3%) and 14 women (23.7%). 11 patients (18.6%) had used the EC at least once before their ACS and 11 (18.6%) had used it after. That was the second most used smoking cessation method after the nicotine patches. One year after their SCA, 39 patients (66.1%) had stopped smoking: 63.6% (7/11) of EC users after the ACS against 66.7% (32/48) of non-users (P=0.848). After multivariate analysis, only cessation without help was associated with ceasing (P=0.013). CE users were significantly younger, were smoking more before their ACS, and had started smoking earlier. 50% of CE users would have appreciated to be better informed by their general practitioner and 53.3% expressed themselves in favor of a sale in pharmacies. CONCLUSION: EC is the second most common means of smoking cessation after an ACS. Further comparative studies are essential to know more about its efficiency and safety.

Myogenic Disease and Metabolic Acidosis: Consider Multiple Acyl-Coenzyme A Dehydrogenase Deficiency.

BACKGROUND: Multiple acyl-coA dehydrogenase deficiency (MADD) is a rare, inherited, autosomal-recessive disorder leading to the accumulation of acylcarnitine of all chain lengths. Acute decompensation with cardiac, respiratory or hepatic failure and metabolic abnormalities may be life-threatening. CASE PRESENTATION: A 29-year-old woman presented with severe lactic acidosis associated with intense myalgia and muscle weakness. The clinical examination revealed symmetric upper and lower limb motor impairment (rated at 2 or 3 out of 5 on the Medical Research Council scale) and clear amyotrophy. Laboratory tests had revealed severe rhabdomyolysis, with a serum creatine phosphokinase level of 8,700 IU/L and asymptomatic hypoglycemia in the absence of ketosis. Electromyography revealed myotonic bursts in all four limbs. The absence of myositis-specific autoantibodies ruled out a diagnosis of autoimmune myositis. Finally, Acylcarnitine profile and gas chromatography-mass spectrometry analysis of organic acids led to the diagnosis of MADD. A treatment based on the intravenous infusion of glucose solutes, administration of riboflavin, and supplementation with coenzyme Q10 and carnitine was effective. Lipid consumption was strictly prohibited in the early stages of treatment. The clinical and biochemical parameters rapidly improved and we noticed a complete disappearance of the motor deficit, without sequelae. CONCLUSION: A diagnosis of MADD must be considered whenever acute or chronic muscle involvement is associated with metabolic disorders. Acute heart, respiratory or hepatic failure and metabolic abnormalities caused by MADD may be life-threatening, and will require intensive care.