Medical education in a foreign language and history-taking in the native language in Lebanon - a nationwide survey.

BACKGROUND: With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students' confidence in their history-taking skills in their native language. METHODS: This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n = 457). RESULTS: The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical history in Arabic either in the pre-clinical years or during extracurricular activities. Among students in their second clinical year, however, these factors were not associated with confidence levels. CONCLUSIONS: Despite having their medical education in a foreign language, the majority of students in Lebanese medical schools are confident in conducting a medical history in their native language.

Non-rheumatic Streptococcal Acute Myocarditis: The First Documented Sibling Case.

Myocarditis is an inflammatory disease of the cardiac muscle that manifests as chest pain, dyspnea, and other signs of heart failure. ST segment changes with elevated cardiac biomarkers mimic acute coronary syndromes. It is most commonly caused by viruses like the Epstein-Barr virus (EBV) and Coxsackie B virus, but it can also be due to cardiotoxic drugs like cyclophosphamide and cocaine or caused by a systemic infiltrative process like sarcoidosis or collagen vascular diseases. One relatively common bacterial cause of myocarditis is beta-hemolytic Group A Streptococcus, which is well known to lead, two to three weeks later, to rheumatic fever and pancarditis. Less commonly, it can cause non-rheumatic myocarditis, which occurs faster, with the pathogenesis not very well understood. We will be reporting a case series of two brothers suffering at the same time from non-rheumatic streptococcal A-isolated myocarditis, questioning the possibility of bacterial toxin-mediated myocarditis or inter-linked genetic predisposition.

Chronic urticaria and autoimmune thyroiditis.

GOAL: Idiopathic chronic urticaria may be associated to other auto-immune diseases, in particular thyroiditis. The goal of our study is to show that this association is higher than the incidence of auto-immune thyroiditis in the general population. METHODS: It is a retrospective observational study including 90 patients with chronic urticaria. We calculated the proportion of patients having associated auto-immune thyroiditis based on a level of anti-TPO >220 mUI/ml. RESULTS: The mean age of patients was 36.7 years with a sex ratio F/H of 2.9/1. The anti-TPO antibodies were positive in 16 patients (17.7%). Eight were euthyroid, seven had hypothyroidism and one had hyperthyroidism with positive anti-TSH receptor antibodies. The percentage of anti-TPO antibodies in the chronic urticaria patients was higher than the control group (17.7 vs. 8.7; p < 0.01). CONCLUSION: This significant association between chronic urticaria and autoimmune thyroiditis may change the medical practice in Lebanon by including anti-TPO and anti-thyroglobulin antibodies in the workup of patients with chronic urticaria.

Early Prediction of All-Cause Clinical Deterioration in General Wards Patients: Development and Validation of a Biomarker-Based Machine Learning Model Derived From Rapid Response Team Activations.

OBJECTIVE: The aim of the study is to evaluate the performance of a biomarker-based machine learning (ML) model (not including vital signs) derived from reviewed rapid response team (RRT) activations in predicting all-cause deterioration in general wards patients. DESIGN: This is a retrospective single-institution study. All consecutive adult patients' cases on noncritical wards identified by RRT calls occurring at least 24 hours after patient admission, between April 2018 and June 2020, were included. The cases were reviewed and labeled for clinical deterioration by a multidisciplinary expert consensus panel. A supervised learning approach was adopted based on a set of biomarkers and demographic data available in the patient's electronic medical record (EMR). SETTING: The setting is a 250-bed tertiary university hospital with a basic EMR, with adult (>18 y) patients on general wards. PATIENTS: The study analyzed the cases of 514 patients for which the RRT was activated. Rapid response teams were extracted from the hospital telephone log data. Two hundred eighteen clinical deterioration cases were identified in these patients after expert chart review and complemented by 146 "nonevent" cases to build the training and validation data set. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The best performance was achieved with the random forests algorithm, with a maximal area under the receiver operating curve of 0.90 and F1 score of 0.85 obtained at prediction time T0-6h, slightly decreasing but still acceptable (area under the receiver operating curve, >0.8; F1 score, >0.75) at T0-42h. The system outperformed most classical track-and-trigger systems both in terms of prediction performance and prediction horizon. CONCLUSIONS: In hospitals with a basic EMR, a biomarker-based ML model could be used to predict clinical deterioration in general wards patients earlier than classical track-and-trigger systems, thus enabling appropriate clinical interventions for patient safety and improved outcomes.

High-dose sublingual immunotherapy in patients with uncontrolled allergic rhinitis sensitized to pollen: a real-life clinical study.

BACKGROUND: High-dose pollen sublingual immunotherapy (SLIT) is indicated in patients with moderate to severe allergic rhinitis (AR), especially those who are unable to control their disease with pharmacotherapy. We explore the use of high-dose SLIT in patients with severe AR and sensitized to pollen, in real-life clinical practice. We also analyzed the effect on asthma. METHODS: This was a prospective observational study conducted at the Allergy outpatient clinic at Hotel Dieu de France Hospital (HDF), Beirut, Lebanon. The cohort, composed of 118 patients between 7 and 55 years old, was regularly evaluated at inclusion, at 12 months, and at 36 months. Fifty-five percent of AR patients had associated controlled asthma. Patients received a standardized pollen extract (Staloral 300IR). The pollen combination was 1 to 3 pollens, the most commonly used were Parietaria judaica, Cupressaceae, 5 grasses, and Oleaceae. In a previous study, those were the main allergenic pollens correlated to AR in the same population. Global assessment of the effect of SLIT was measured using a rhinitis total symptom score (RTSS), a rhinitis medication consumption score (RMCS), a global asthma score (ASS), and an asthma medication consumption score (AMCS). RESULTS: Using a t test we found that the average scores at inclusion, 12 months, and 36 months, respectively, were as follows: RTSS: 31.32, 16.39 (p < 0.041), and 13.35 (p < 0.041); RMCS: 6.96, 1.96 (p < 0.0162), and 1.61 (p < 0.0162); ASS: 4.62, 1.96 (p < 0.0005), and 1.33 (p < 0.0005); and AMCS: 2.35, 0.78 (p < 0.0005), and 0.7 (p < 0.0005). CONCLUSION: Our study showed favorable results of SLIT to aeroallergens in patients with uncontrolled AR. The effect is also applicable to the subgroup of patients suffering from concomitant, controlled asthma.