Intercostal lung herniation secondary to thoracotomy: a case report.

Intercostal lung herniation is defined as a protrusion of the lung parenchyma through a defect in the intercostal muscles between adjacent ribs. The authors report a case of intercostal pulmonary hernia in a 45-year-old male patient, with smoking habit (30 packs-year), presented to the emergency department with dyspnea. He had the history of pulmonary emphysema complicated with a total right pneumothorax in 2015 treated by mini-thoracotomy with bullectomy and pleural abrasion. In 2019, he was admitted to hospital for left chest pain. The computed tomography (CT) scan of the chest revealed a bilateral emphysema with intercostal lung hernia through the fourth intercostal space the patient underwent, a left thoracotomy with repair of the intercostal muscle defect. He was discharged from hospital free of complications.

Association of MTHFR C677T, MTHFR A1298C, and MTRR A66G Polymorphisms with Neural Tube Defects in Tunisian Parents.

OBJECTIVE: This study aims to investigate the association of 5,10-methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) and methionine synthase reductase (MTRR A66G) gene polymorphisms with neural tube defects (NTDs) in a Tunisian population. METHODS: Genotyping was performed by polymerase chain reaction with restriction fragment length polymorphisms (PCR-RFLPs) using the restriction enzymes. Allele and genotype frequencies were compared between mothers and fathers of fetuses with NTDs with matched controls based on an association analysis using SPSS software. RESULTS: MTHFR (C677T, A1298C) and MTRR A66G polymorphisms were found to be protector factors for NTD fetuses in the mother group. In addition, a combination of the three wild-type alleles C677/A1298/A66 has increased four-fold the incidence of NTDs (p = 0.004, OR = 3.96, 95% CI: 1.53-10.23). In the father group, MTHFR C677T was a risk factor for NTDs. However, no association was found between MTHFR A1298C, MTRR A66G, and the occurrence of this anomaly. The analysis of MTHFR C677T and MTRR A66G polymorphisms has demonstrated a significant difference in vitamin B12 levels between recessive and dominant genotypes in case mothers (p < 0.05). CONCLUSION: Additional studies are required to better understand the roles of parental gene polymorphisms related to folate-homocysteine metabolism in the pathogenesis of NTD.

Problem solving learning in emergency medicine: Effects and student's perception.

INTRODUCTION: the Problem solving Learning (PSL) is an interactive method of teaching that allows students to learn at once clinical reasoning and acquisition of knowledge. The PSL is used to assess learner's competencies. AIM: To was to assess the educational relevance of PSL in emergency medicine and the perception of learners. METHODS: Evaluative study carried out in an emergency department on 5th grade students of medical studies. We proceeded through a PSL dossier. Were assessed, the size of the effects of the PSL measured using the Cohen Index (d) reported to the Hattie's effect size scale. The perceptions of learners was assessed thanks to a questionnaire. RESULTS: 42 students from the Faculty of Medicine of Tunis were enrolled in our study. The relative gain was greater than 40% in 90% of the cases and greater than 50% in 57% of the cases. The average rating of the PSL was 12.75 [8.5-17.85]. The effect size (d) of the PSL was 0.9 on the Hattie scale. The overall assessment of the PSL experience by the learners was very satisfactory in 66.5% of the cases and excellent in 33.5% of the cases. CONCLUSION: The PSL represents a major development in learning pedagogical strategies with a rather interesting impact and effect size. We strongly encourage the use of PSL as a learning tool in emergency medicine. Further impact studies at larger scales are needed to confirm our results.

The A445C Variant in Apelin Receptor and Diabetic Retinopathy in Tunisian Patients.

BACKGROUND: Apelin and apelin receptor (APLN/APLNR) are involved in the retinal neovascularization of diabetic retinopathy (DR). METHODS: This study investigated the impact of the APLNR A445C variant on the risk of DR in a sample of the Tunisian population (100 patients with DR and 105 healthy controls) using PCR-RFLP. RESULTS: The genotype frequencies of the APLNR A445C variant were not significantly different between the patient and control groups. The genotype was not associated with DR (OR = 1.49; 95% CI [0.49 - 4.48], p = 0.47 for the AC heterozygous genotype and OR = 1.57; 95% CI [0.43 - 5.71], p = 0.49 for the CC homozygous genotype). Furthermore, the clinical and biochemical parameters according to the APLNR A445C genotypes revealed that only total cholesterol (TC) was significantly higher in the DR group with the CC genotype compared to the AA genotype (p < 0.02). CONCLUSIONS: The APLNR A445C polymorphism was not associated with DR in a sample of the Tunisian population, but the CC genotype carrier patients with DR had a high TC concentration.

Positional convulsant syncope in a pacemaker patient following insulation break of the right ventricular lead.

In spite of the advances made in the technology of pacemakers which resulted in a decrease in the incidence of pacemaker lead fracture, the latter remains a potential complication of implanted pacemakers manufactured in the early days. In this report, we present a case of fracture of the unipolar electrode diagnosed by an emergency physician in a patient on a pacemaker for 10 years who presented to the emergency department with positional convulsant syncopes.