Familial occurrence of painful subacute thyroiditis associated with human leukocyte antigen-B35.

INTRODUCTION: Subacute thyroiditis (SAT) is a spontaneously remitting inflammatory disorder of the thyroid that is presumed to be virally induced in genetically predisposed individuals. A strong association has been suggested between human leukocyte antigen (HLA)-B35 and patients who developed SAT. However, familial occurrence of SAT associated with HLA-B35 is reported only rarely. CASE-REPORTS: We report three sibs, (two brothers and one sister) living in the same Lebanese town, who developed SAT during an 18-month-period. All tested positive for HLA-B35. DISCUSSION: The family described here represents the first Third World third familial report of SAT associated with HLA-B35. It highlights the probably underestimated importance of genetic predisposition to SAT in families.

[Obesity and related diseases in a Lebanese medical center]. / L'obésité et les pathologies associées dans un centre de soins au Liban.

INTRODUCTION: Obesity is actually a pandemic disease by itself, especially by its numerous associated complications. Obesity is considered among the most important cause of morbidity and mortality throughout the world. Its prevalence is variable between countries, but could be estimated to be around 20%. Few data concerning obesity is available in Lebanon. The objective of this study is to assess the prevalence of obesity in Lebanese patients consulting a primary care medical center in Beirut, as well as to study the links between obesity and other associated diseases. METHOD: Three hundred and thirteen patients, aged 13 years and above, consulting for the first time between 2000 and 2001 (one-year period), have been included in the study. Obesity is defined by a body mass index (BMI)> or =30 kg/m(2), and overweight is defined by a BMI between 25 and 29.9 kg/m(2). RESULTS: Among the 313 patients included, 22.1% were overweight, and 18% obese. The percentage of obesity is significantly higher in patients aged 40 years and above. No difference between men and women was observed. Obesity was significantly related to high blood pressure, diabetes, hypertriglyceridemia, low HDL and ischemic coronaropathy. CONCLUSION: Obesity and its associated diseases are frequently encountered problems in Lebanon, as it is in the rest of the world. Wider national studies are needed to define more accurately the magnitude of the problem, in order to apply efficient prevention strategies.

Peripheral venous catheter-related inflammation. A randomized prospective trial.

BACKGROUND: Peripheral venous catheter-related inflammation (PVCRI) is a serious health and economic issue. It is mainly linked to peripheral venous catheter (PVC) duration and other risk factors. METHODS: PVCRI was prospectively evaluated in a 3 month-study according to PVC duration. Other risk factors were also studied such as age, gender, diabetes, intravenous steroids and antibiotics. 221 patients admitted to 3 different departments in a university hospital were randomized to undergo a 72 hours versus 96 hours PVC. The primary endpoint was to evaluate if this prolonged duration would increase the incidence of lymphangitis. The secondary endpoints were to evaluate if other risk factors such as age, gender, diabetes, intravenous steroids and antibiotics, have a direct impact on lymphangitis. Fever, local inflammatory signs and date of occurrence have been noted by two different nurses. The Stata 8.0 program, and the Pearson chi-square test to compare percentages (alpha = 0.05) were used. RESULTS: PVCRI occurred in 20.4% of all studied patients. PVCRI incidence did not differ between the patients who kept the catheter for 72 hours and those who kept it for 96 hours, but we found a significantly increasing incidence of PCVRI while comparing 24 hours versus 48 hours duration and 24-48 hours duration versus 72-96 hours duration respectively. Age, as well as intravenous antibiotherapy showed to be a significant risk factor for PVCRI. As for diabetic patients, there was a trend towards a higher incidence of PVCRI. Intravenous steroids showed to have a beneficial effect. It is to be noted that the rate of PVCRI was significantly higher in the internal medicine/infectious diseases department compared to the two other departments. CONCLUSION: No difference on PVCRI risk was found between 72 and 96 hours catheter duration. However the risk seems to increase between the first and the third day of catheterization. We suggest that an adapted duration of the PVC to the patient risks would be more cost-effective.

Treatment of central pontine myelinolysis with thyrotropin-releasing hormone.

INTRODUCTION: Central pontine myelinolysis (CPM), demyelination of the brain stem, is a brain injury apparently due to osmotic forces. There is no consensus for its treatment. CASE: We describe here a case of CPM that occurred in a young patient after correction of hyponatremia, its treatment by intravenous thyrotropin-releasing hormone, and its outcome. DISCUSSION: Although very few instances of thyrotropin-releasing hormone treatment for CPM have been described, it appears to be effective and well tolerated. Studies are needed to assess its real efficacy.

[Thrombotic thrombocytopenic purpura occurring simultaneously with systemic lupus erythematosus. A case report]. / Association simultanée de purpura thrombotique thrombocytopénique et de lupus chez un même patient: fait inhabituel et implications thérapeutiques.

INTRODUCTION: The association between thrombotic thrombocytopenic purpura and systemic lupus erythematosus has been rarely described, especially when the occurrence of both situations is simultaneous. OBSERVATION: We report the case of a 21-year-old young woman who presented with this association. DISCUSSION AND CONCLUSION: The simultaneous diagnosis of these two diseases is difficult because both share similar features. Treatment must be given early. It relies on therapeutic plasma exchange, systemic glucocorticoids or other immunosuppressive agents. The prognosis is very much related to the rapidity of the diagnosis and subsequent treatment.

[Human brucellosis in Lebanon. Clinical features and therapeutic responses in 88 patients]. / Brucellose humaine au Liban. Etude clinique et thérapeutique de 88 patients.

OBJECTIVES: Present clinical features of brucellosis in Lebanon. METHODS: Eighty-eight patients were seen at Hotel-Dieu de France Hospital of Beirut between 1994 and 2002. Diagnostic criteria were brucellar agglutinins at a titer; 1/160 with symptoms suggestive of brucellosis in the absence of other diagnosis and a therapeutic response. RESULTS: Out of the 88 hospitalized patients, 11 pediatric cases are noted. The disease is acute in 58 (66%), subacute in 28 (32%) and chronic in 2. The main presenting symptoms are fever, sweating, easy fatigability and diffuse aches. Osteoarticular involvement is the most prevalent complication (28%) and spondylitis is seen in 44% of these cases. Meningoencephalitis is the most frequent neurological manifestation. Among the haematological tests, relative lymphocytosis is significantly more frequent in children than adults (73% vs 19% ; p < 0,001) and in the acute form than the subacute (36% vs 7%; p < 0,001) whereas leucocytosis is more frequent in the subacute form (21% vs 7%; p < 0,01). CONCLUSION: Brucellosis is still an endemic disease in Lebanon and should be systematically evoked in the case of prolonged fever, articular and neurological manifestations.

[Typhoid fever. Clinical and therapeutic study in 70 patients]. / Fievre typhoide. Etude clinique et thérapeutique de 70 patients.

OBJECTIVE: 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 > or = 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. CONCLUSION: 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.