International Journal of Clinical Research
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A Case Report: Recurrence of Vogt-Koyanagi-Harada Disease after Rapid Tapering of Corticosteroids
Get PDFBackground: Vogt-Koyanagi-Harada's disease (VKHD) is an autoimmune disorder that targets melanocyte-rich tissues in genetically susceptible individuals. It can affect the eyes, inner ears, skin, hair, and meninges. When VKHD affects the eye, it can cause bilateral granulomatous panuveitis with exudative bullous retinal detachment and is usually associated with meningismus. It may lead to permanent loss of visual acuity. While the pathogenesis remains unknown, viral infection has been implicated. The most accepted theory remains a T-cell mediated autoimmune reaction against one or more antigens associated with melanocytes, melanin, and retinal pigment epithelium (RPE).
Case presentation: We report the case of a 17-year-old male patient presenting to our outpatient department for vision loss. The patient reported a 2-week history of hearing loss, tinnitus, and episodic headaches associated with vomiting. Physical examination showed white lashes (poliosis) and a bilateral decrease in visual acuity. Fluorescein angiography showed bullous exudative retinal detachments. The patient was diagnosed with VKHD. His symptoms resolved following a course of oral prednisolone that was initiated at 60 mg per day (1mg/Kg/day), then tapered down over 6 weeks. Six months later, the patient presented again with more pronounced symptoms. His Best Corrected Visual Acuity (BCVA) was lower than it was on his first presentation, and the retinal exam showed a sunset glow fundus and degenerative changes in the RPE. Combined therapy with prednisolone and methotrexate resulted in a complete resolution of symptoms, and his BCVA returned to more than 20/40.
Conclusion: This case emphasizes the importance of avoiding the rapid tapering of corticosteroids in VKHD due to the high risk of disease recurrence
Physician and Patient Perceptions of Physical Touch in Primary Care Consultations in Lebanon: A Qualitative Study
Get PDFBackground: Verbal and non-verbal communications are an inherent component of physician-patient interactions. The psychological and physiological benefits of non-verbal communication such as gestures, expressions, eye contact, and particularly physical touch in healthcare have been previously explored by the scientific community, albeit insufficiently in the primary care context.
Objective: This study aims to address this gap by investigating physician and patient perceptions of expressive touch and its effect on patient satisfaction in primary care consultations in Lebanon.
Methods: We recruited 12 physicians and 13 patients and subjected them to audiotaped semi-structured interviews. We selected the patients from three hospitals, while physician responders were from the Faculty of Medical Sciences of the Lebanese University. We translated the survey instrument into Arabic and validated it using back translation sustained by a pilot study. We performed constant comparative qualitative analysis for obtained relevant data.
Results: Patient satisfaction and trust were associated with good verbal and non-verbal communication. Patient and physician responders recognized the benefit of empathy in building long-term relationships. Social and non-intimate expressive touches were positively perceived by patients, although within ethical and religious boundaries. Male physicians expressed clear apprehension for the use of touch, especially towards female patients, due to religious considerations. On the other hand, touch from female physicians was reportedly accepted by patients of both genders, while touch from their male counterparts was associated with more uneasiness.
Discussion and Conclusions: Religious concerns are prevalent among Lebanese physicians and patients alike. However, the use of reassuring physical touch is still a cornerstone of the patient-physician relationship in Lebanon, albeit with some limitations. The potential therapeutic effect of verbal and non-verbal communication is evident and warrants further investigation. Communication training efforts should emphasize the importance of religiously and ethically appropriate expressive touch in healthcare. This would serve to promote positive physician and patient perceptions of this practice and improve clinical communication and expressiveness
A Case Report: Rare Anomaly of a Single Coronary Artery Arising from the Right Aortic Sinus of Valsalva
Get PDFBackground: Single Coronary Artery (SCA) is a rare, most commonly asymptomatic, congenital anomaly which is usually discovered incidentally during investigations. This entity consists of a single coronary artery supplying the entire myocardium. It may be classified based on the origin and the course of the artery. Depending on the patient's presentation and its severity, medical or invasive interventions may be warranted.
Case Report: A 65-year-old female patient known to have diabetes and hypertension presented to our emergency department with chest pain and discomfort. Blood tests and electrocardiography (ECG) showed no significant abnormalities, but on coronary angiography, we suspected an anatomical variation. Computed tomography angiography (CTA) confirmed our suspicion revealing a single coronary artery supplying the entire myocardium and arising from the right sinus of Valsalva. The patient received medical therapy and was discharged home.
Conclusion: We presented this case of Single Coronary Artery due to the rarity of this diagnosis. Presentation, treatment plan, and prognosis typically vary depending on the subtype of the anomaly. Early recognition is very important, especially in young adults
COVID-19: What We Know So Far: A Narrative Review
Get PDFObjective: Since the emergence of the COVID-19 pandemic at the end of 2019, the number of affected cases has not stopped rising. Similarly, the number of scientific publications and pre-prints has been increasing exponentially, with an effort to understand this disease more and find a proper solution. The purpose of this article is to review the current understanding of the novel coronavirus.
Background: The latest COVID-19 pandemic caused by the SARS-CoV-2 has spread globally ever since it emerged in Wuhan's city in China. This rapidly spreading disease has changed our lives in unimaginable ways, spreading fear and uncertainty due to the lack of knowledge and the flooding with new information, which lacks the scientific method and cannot be critically appraised. The purpose of this article is to gather some of the best knowledge that has been published so far in a unified narrative review, making it easy for the scientific community to review the most accurate and recent understandings about COVID-19.
Methods: We screened relevant articles using a specified number of keywords and specific databases, including PubMed and Embase. We selected peer-reviewed English published material related to the topic, except for a few pre-prints that we deemed necessary to include. We also screened the reference lists of these articles to find relevant publications with the same criteria.
Discussion: This narrative overview comprises several subsections that discuss the epidemiology, virology, pathogenesis, clinical manifestations, diagnostic methods, and management of the disease. We also presented a section on the implications of the disease in pregnancy. We wrapped up the review with a special division regarding the response to COVID-19, which has been diverse in different countries.
Conclusion: COVID-19 has been a serious global health threat with a high transmission and case fatality rate, particularly in vulnerable populations. Epidemiologic models have so far guided the response, but they need to be interpreted carefully, with an understanding of their limitations. The disease's response has varied among different countries; with no current vaccine or standard treatment, the world stands in fear, maximizing preventive strategies to reduce the damages caused by this virus. This manuscript presents a summary of everything that is so far known about COVID-19 to make it easier for the medical community to overview the disease that has changed the world