Lebanese Hospital Geitaoui-University Medical Center

ABSTRACTThis study investigates the knowledge, attitudes, and practices of the Lebanese population regarding thermal burns to inform targeted interventions. Using a cross‐sectional design, data was collected from 1090 participants though a structured questionnaire. Key findings revealed a mean knowledge score of 14.89/20, indicating moderate understanding, with gaps in identifying third‐degree burns and optimal cooling durations. Attitudes scores averaged 36.97/50, reflecting a strong support for burn prevention but low confidence in first aid. Practices scored 12.37/20, with many participants adhering to safety measures but relying on unverified remedies and lacking emergency preparedness. Significant correlations were found between the three domains, particularly between knowledge and practices (r = 0.328, p < 0.001), emphasising the role of education and attitudes in shaping behaviours. Multivariate analysis identified formal first aid training, education, and urban residency as strong predictors across all three domains, while older age negatively influenced knowledge. These results underscore the need for culturally tailored education and enhanced training to address gaps in burn prevention and management among the Lebanese population.

Isolated small bowel angioedema is an uncommon adverse reaction to angiotensin-converting enzyme (ACE) inhibitors, predominantly affecting females. The nonspecific clinical presentation, along with the lack of definitive diagnostic laboratory and radiological findings, makes the diagnosis particularly challenging. We present the case of a 63-year-old female patient who developed diffuse abdominal pain and nausea just seven days after starting ramipril. The diagnosis of ACE inhibitor-induced small bowel angioedema was confirmed by a computed tomography (CT) scan of the abdomen and the pelvis, which revealed circumferential wall thickening and submucosal edema involving multiple jejunal loops. Thesefindings were consistent with angioedema. The condition was successfully managed by discontinuing the medication, and the patient showed rapid clinical improvement within 48 hours of stopping ramipril. To our knowledge, this is only the second reported case of ramipril-induced isolated small bowel angioedema in the literature.

Red ear syndrome (RES) is a rare clinical entity presenting with paroxysmal erythema of one or both ears associated with a burning sensation or earache. The onset of symptoms could be either spontaneous or triggered by touch, stress, coughing, sneezing, neck movements, chewing, and combing hair. While most cases are usually described in adults, it can rarely present in children. This article reports a case of pediatric RES, first misdiagnosed as relapsing polychondritis. The patient's condition improved after introduction of ibuprofen, isoptin, and amitriptyline, with no new attacks reported after a 1 year follow up.

Parathytomatosis is a rare cause of persistent or recurrent hyperparathyroidism, defined by the presence of hyperfunctioning parathyroid tissues scattered throughout the neck and mediastinum. Preoperative diagnosis and localization of all the seeded parathyroid tissue is difficult, therefore, many imaging modalities are needed to determine the localization of these lesions for a more successful outcome. We report a case of a young girl with a severe primary hyperparathyroidism (PHPT) from a parathyroid adenoma, with renal and bone complications. She underwent parathyroidectomy and developed 2 years later recurrent disease in the form of parathyromatosis. We review the different tools for diagnosis and management since this condition remains a challenging issue. To our best knowledge, this case is the youngest case described in the literature and highlights the difficulties of management of parathyromatosis and the potential complications that may ensue from this disease.

Angiosarcoma is a rare and aggressive malignant tumor arising from vascular or lymphatic endothelial cells. Angiosarcoma at an arteriovenous fistula site is exceptionally rare. We report a case of a 37-year-old male renal transplant recipient who developed a high-grade epithelioid angiosarcoma at the site of an arteriovenous fistula six years post-transplant. The lesion presented as a bleeding, enlarging mass and was initially misdiagnosed, delaying definitive treatment. A biopsy confirmed the diagnosis, and the patient underwent radical surgery, chemotherapy, and radiotherapy. This case highlights the need for heightened clinical suspicion, particularly in patients with arteriovenous fistula-related complications, as early diagnosis and treatment are crucial for this rare but aggressive malignancy.

Meckel's diverticulum (MD), a prevalent congenital gastrointestinal anomaly affecting about 2% of the population, arises from the incomplete closure of the vitelline duct. It encompasses all layers of the small intestine and can lead to various complications like obstruction, hemorrhage, and perforation. When symptomatic, it presents challenges in diagnosis due to the low sensitivity of imaging techniques. Comprehensive understanding and accurate diagnosis are crucial for managing the complications associated with MD and forming the scientific rationale for publishing this case report. We present two cases, one of them being the case of a 73-year-old male who presented for an ileostomy closure procedure. Intra-operatively, a 4.5 cm diverticulum was identified 10 cm from the stomatal opening on the efferent limb. This finding led to segmental resection of the intestines. Later, pathology was compatible with MD, which didn't contain any malignant cells or heterotopic tissue. The second case was that of a 40-year-old female who presented for severe abdominal pain, abdominal distention, and obstipation for two days. Radiographic imaging was suspicious of a foreign object compatible with fish bone with local inflammation in the small bowel. Laparoscopic exploration showed an inflamed MD with fish bone lodged inside. In front of an incidental MD, the decision to resect is still controversial. Those who are against resection of uncomplicated believe that complications from resecting an uncomplicated MD are higher than the complications that arise if resection is not performed. Those who support resection say that the complications that arise following the resection of a complicated MD are worse than those after resecting an incidental one. Criteria have been put in place to help guide the decision for resection.

Palmar trans-scaphoid perilunar dislocation is a rare finding in clinical practice. Herein, we report a case of a young right-handedmale hairdresserbrought to the emergency room after a heavy blow to his right hand. An X-ray showed a palmar dislocation of the capitate, carpus, and distal scaphoid relative to the lunate, which remains in normal alignment with the radius, with the proximal scaphoid maintaining attachment to the lunate. Open reduction and internal fixation were done in the first week after trauma.

Stevens-Johnson syndrome (SJS), Stevens-Johnson/toxic epidermal necrolysis overlap syndrome (SJS/TEN) and toxic epidermal necrolysis (TEN) are rare, acute, potentially lethal conditions, considered to be part of the severe cutaneous adverse reactions (SCARs) spectrum, with TEN being the most life-threatening. The distinction between these three entities is based on the extent of total skin surface involvement, with SJS involving < 10%, SJS/TEN involving 10-30% and TEN involving > 30% of total body surface area. These mucocutaneous reactions are most commonly caused by a hypersensitivity reaction to a drug, with infections and vaccines being possible, less common etiologies. In the following case report, we summarize a rare case of a 43-year-old, previously healthy male patient who presented with TEN after taking ibuprofen, a non-steroidal anti-inflammatory drug. According to PubMed literature, this is the first documented case of ibuprofen-induced TEN in the Middle East and NorthAfrica (MENA) region. TEN is an autoimmune bullous disorder that results in the death of keratinocytes, leading to complete dermo-epidermal separation. In the caseof our patient, the desquamation was extensive, involving 70% of the total body surface area, and was complicated by a triple bacterial infection with Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient was treated with colistin and meropenem, in addition to supportive management, hydration and nutritional support. In the case of TEN, early diagnosis and hospitalization in a burn centre are crucial to allow rapid healing, and improve the quality of life of the affected patients. Immediate cessation of the causative mediation is critical. Supportive management, hydration, nutritional support, and maintenance of aseptic conditions are highly encouraged to reduce the mortality and morbidity associated with TEN.