All for one and one for all: Scaling mountains for a good cause. SDG 4: quality education awareness campaign.
How it all started? In the mountains, I discover a profound inner tranquility, revitalizing my mind and fortifying myself to confront life’s obstacles. Hiking has deeply transformed my life, igniting a passion to push the boundaries of my physical capabilities, enabling me to venture further and ascend higher. In 2017, during my inaugural hiking expedition, I seized the opportunity to spotlight the issue of burnout, a struggle I was personally overcoming. Amidst inquiries about how I managed time for training and hiking, I found a platform to raise awareness and advocate for self-care amidst life’s demands.In July 2023, fueled by a Law school course on the significance of international organizations and inspired by the UAE’s designation of 2023 as the year of sustainability, I resolved to amplify awareness around Sustainable Development Goal (SDG) 3: Health. In the four days leading up to my departure, I delved into research, crafted social media campaigns, and hand-painted banners bearing meaningful messages, each destined to be showcasing varying altitudes throughout my journey. Remarkably, this preparatory work alleviated the stress that typically accompanies summit preparations. It transformed the purpose of my expedition from a solitary pursuit of reaching the peak to a collective endeavor of championing a noble cause. This shift not only mitigated stress but also infused each hiking day with embedded purpose, as I ascended to new altitudes, unveiling campaign banners—a tangible representation of progress and a triumph in itself.
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Unilateral optic disc swelling: an atypical presentation for a large frontal meningioma
Intracranial space occupying lesions pose a frequent diagnostic dilemma from history and clinical signs alone. They remain an important differential in those presenting with neurological or ophthalmological symptoms. We present a case of a large frontal meningioma in a 47-year-old man presenting with unilateral optic disc swelling and contralateral visual field disturbance alongside a subacute history of severe, intermittent, non-orthostatic headaches and mild behavioural disturbance. Neuroimaging demonstrated a large right sphenoid wing mass, suggestive of a meningioma with signs of raised intracranial pressure (ICP), local mass effect and parenchymal herniation. He subsequently underwent surgical intervention for debulking and biopsy, confirming the suspected diagnosis. This case highlights that whilst raised intracranial pressure classically leads to bilateral optic disc swelling, unilaterality does not exclude this. Concerns should therefore be raised with contralateral visual acuity (VA) changes. Detailed history and examination are important to assess for presence of red flags in determining need for neuroimaging.
Peritoneal carcinomatosis presenting as a mimic for DVT
Unilateral leg swelling poses a diagnostic challenge with a myriad of potential differential diagnosis, including deep vein thrombosis (DVT), Baker's cyst, and cellulitis. As some of these causes can be benign and easily treatable, other causes may be more severe and even life threatening. This article highlights the critical need for healthcare professionals to expand their differential diagnosis when common causes have been excluded, recognizing that some rare etiologies may signify severe underlying conditions. We present the case of a 55-year-old female with a two-month history of right leg swelling, initially attributed to erysipelas due to negative DVT findings. Upon closer examination, an abdomino-pelvic CT scan revealed diffuse peritoneal carcinomatosis, obstructing the right external iliac vein and elucidating the unilateral lower limb edema. This case focuses the importance of considering atypical causes, especially in patients with a history of cancer, and the potential life-threatening nature of rare etiologies. The article emphasizes the significance of a multidisciplinary approach, comprehensive laboratory assessments, and advanced imaging techniques in achieving accurate and timely diagnoses, ultimately guiding effective patient management.
Elderly patient with late diagnosed metastatic bone lytic lesions
In this case report, we present a patient with bony lytic lesions who was mobile despite having many pathological fractures and metastatic lesions. Patients should be investigated, especially in persistent pain. Patient with advanced age and back pain not improving with progressive feature should be investigated for serious conditions especially bone metastases. Red flags, which are frequently used for lower back pain, should be kept in mind. In addition, it should not be forgotten that the physical examination of patients may be normal despite advanced bone lesions.
The Killer Wound; Early Diagnosis and Management of Necrotizing Fasciitis Utilizing Point-of-Care Ultrasound: A Case Repor
Background: Necrotizing fasciitis (NF) is a rapidly progressive and life-threatening infection of the fascia and subcutaneous tissues. Early diagnosis and prompt surgical intervention are critical to reducing morbidity and mortality. This case report highlights the importance of point-of-care ultrasound (PoCUS) in the rapid diagnosis of NF. Case Presentation: A 34-year-old male carpenter presented to the Emergency Department of Casey Hospital, with a 48-hour history of increasing swelling and pain in his right arm and chest. Two weeks prior, he sustained an open wound to his right wrist from a rusty nail. Initial management by his family doctor focused on musculoskeletal injury without antibiotics. On ED presentation, the patient exhibited signs of systemic infection and gross swelling of the right upper limb and chest. PoCUS demonstrated characteristic findings of NF, including cobble stoning and subcutaneous air with dirty shadowing, leading to an expedited surgical consultation and immediate intervention. Management and Outcome: The patient underwent multiple debridements, antibiotic therapy, and hyperbaric oxygen therapy. Post-surgical rehabilitation showed substantial gains in function and mobility. Discussion: This case underscores the crucial role of PoCUS in the early diagnosis and management of NF. PoCUS allows for rapid bedside imaging, enabling timely surgical consultation and intervention, thereby improving patient outcomes. The multidisciplinary approach, involving emergency physicians, surgeons, and intensivists, is essential for optimal management of NF. Conclusion: Early recognition and treatment
Assessment of Relatives’ Satisfaction in the Emergency Department
Introduction: Emergency departments (EDs) are high-pressure environments where both patients and their relatives face numerous challenges. While patient satisfaction has been widely studied, the satisfaction of relatives remains underexplored, despite their crucial role in supporting patient care and decision-making. Recognizing relatives as key actors in the care process helps improve communication and reduce stress. This study aimed to assess the satisfaction of relatives of patients treated in the ED. Methods: A prospective, descriptive study was conducted at the ED of the Mahmoud Yaacoub Center for Urgent Medical Assistance in Tunis from October 2023 to January 2024. Satisfaction was assessed using a 25-item structured questionnaire. Included participants were adult relatives directly involved in patient care who gave informed consent. Assessed dimensions included reception and management, information provided and overall satisfaction. Results: The study included 165 relatives (mean age 41 ± 13 years, 52.1% female). Relationships included parents (26%), offspring (18.9%), and siblings (14.8%). Overall satisfaction was high: 78% were satisfied with the overall care, 82% with the initial reception, 74% with waiting times, 80% with accessibility, and 77% with information clarity. No significant associations were found between age or education and overall satisfaction. However, relatives from healthcare or paramedical backgrounds showed significantly higher satisfaction (85%) with the registration process compared to non-healthcare relatives (62%) (p = 0.043). Conclusion: The study supports strengthening the involvement of relatives in strategies aimed at improving ED care quality
Admission Criteria and Successful Care of Adults in a Tertiary Care Pediatric Hospital During the COVID-19 Pandemic
Objective: The purpose of this study was to review the health outcomes of adult patients selected using admission criteria and subsequently admitted on pediatric wards and intensive care unit (PICU) of the Montreal Children’s Hospital (MCH) in Canada during the first and second waves of the COVID-19 pandemic. Methods: A retrospective chart review was conducted and included all adult patients hospitalized at the MCH on pediatric units between March 14, 2020 and March 31, 2021. Results : Forty adults were admitted to MCH pediatric units. The median age was 28.5 years. There were 26 females and 14 were males. The average length of stay (LOS) at the MCH was 6.3 days. There were 32 consultations from adult medical consultants performed at the MCH. Seventeen incident reports were completed. There were no in-hospital deaths and 6 in-hospital incidents were reported. Of the 24 patients that were discharged home from the MCH units, 1 patient (4%) returned, and an additional 4 patients (16.6%) returned within 30 days. Conclusion : With clear admission criteria, careful planning, and well-planned supportive resources treating adult patients within a pediatric care facility by pediatric care teams also caring for pediatric patients in the same units could be considered as a safe contingency plan in a time of crisis.
Adherence to Screening Recommendations for Diabetic Nephropathy in Lebanese Patients With Diabetes
Background: Diabetic nephropathy (DN) is a debilitating microvascular complication of diabetes mellitus that often progresses before becoming symptomatic, highlighting the importance of screening during comprehensive diabetes management. Therefore, we captured a snapshot of DN screening in a country caught in the whirlwind of a pandemic and a severe economic crisis limiting access to healthcare facilities and adherence to screening schedules. Methods: We conducted a cross-sectional study that assessed the adherence of 258 Lebanese patients with diabetes to the recommended DN screening guidelines in a tertiary medical center. Medical records were analyzed for patient demographics, medication profile and laboratory indicators of glycemic control, e.g. glycated hemoglobin (HbA1c), and kidney function. Results: Less than half of patients in our cohort screened for DN with almost two-thirds recording abnormal markers of kidney function. Only half of the screened cohort underwent follow-up testing. Multivariate analysis revealed that lower HbA1c, lower age, outpatient status and year of first abnormal HbA1c were independently associated with DN screening. Conclusion: National-scale interventions through funding an annual screening and awareness campaign, while institutional-level interventions by implementing a quality improvement process to detect and address gaps in practice, are needed to increase adherence to screening recommendations.
Spinal Rosai-Dorfman Disease with Isolated Severe Neuropathic Pain: A Case Report
Introduction: Rosia-Dorfman disease is a rare histiocytic disorder that presents as generalized lymphadenopathy. Rarely, patients experience atypical extra-nodal manifestations which can mimic other diseases. Case Presentation: We report a challenging diagnosis of Rosai-Dorfman disease in a 52-year-old female presenting with isolated symptomatic neuropathic pain. After excluding common diseases, a challenging diagnosis was made based on imaging, CSF studies and clinical progression that showed thoracic spine involvement and emperipolesis confirming RDD diagnosis and with a great clinical response to corticosteroids. Discussion: Clinical, laboratory and radiologic manifestations of the disease can vary a lot depending on the areas involved and patient progression. This can lead to challenges in establishing the diagnosis and deciding on treatment. Then unusual, first reported manifestations in our patient made the diagnosis exceptionally challenging, highlighting the importance of this report. Conclusion: This disease can have an atypical presentation that should be detected early to avoid any delay in diagnosis or treatment. Unusual cases must be reported to aid in such a difficult diagnosis in future similar cases.
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Post-COVID-19 Kawasaki-Like Vasculitis and Endocarditis: A Case Report
Background: Coronavirus Disease of 2019 (COVID-19) can cause mild to severe infection, but with a combination of inflammatory complications that target virtually anywhere in the body. Cardiac complications remain of utmost importance as they have the highest association with mortality. Case presentation: A 32-year-old male presents with a fever of unknown origin for a period of 3 months post SARS-CoV-2 infection. He was found to have endocarditis and underwent an aortic valve replacement that was complicated by an aortic aneurysm, needing another surgery. The fever and aneurysm remitted after a new COVID-19 infection and the patient underwent a Bentall procedure with reimplantation of the coronary arteries. Discussion: Cardiac complications of COVID-19 can range from small to large arteritis, valvopathy and aortic aneurysms, which can have significant morbidity and mortality, leading to the need of surgery and prolonged treatment. The scarcity of such cases makes reporting imperative so that clearer guidelines of management can be established. Conclusion: Cardiovascular complications of COVID-19 remain the scariest and the least reported, which necessitates the presence of more evidence of their management, which can be lifesaving.
Hippocampus infarct following a posterior cerebral artery occlusion
A 64-year-old gentleman, presented for subacute onset of short-term memory problem, preceded by headache, right arm numbness and visual disturbances. On neurological exam, he had anterograde amnesia, decreased pinprick sensation on his right arm and right homonymous hemianopsia. Brain Magnetic Resonance imaging (MRI) and Magnetic Resonance Angiography (MRA) showed subacute ischemic lesions in the left occipital lobe, hippocampus and thalamus, caused by a distal occlusion of the left Posterior Cerebral Artery (PCA). A distal occlusion of the PCA led to multiple infarcts in different anatomical structures, causing a constellation of variant neurological signs. Our case demonstrates an anterior hippocampus predominantly irrigated by the PCA.
Subarachnoid hemorrhage associated with ecstasy abuse in a young adult: a case report
3,4-Methyl​enedioxy​methamphetamine (MDMA), is a synthetic amphetamine derivative. Its usage can be complicated by intracerebral or subarachnoid hemorrhage. Drug-related intracranial hemorrhage (ICH) is a relatively uncommon occurrence, often associated with an underlying vascular anomaly, We report the case of a 28-year-old male with a history of Ecstasy abuse prior to the onset of a sever holocranial headache. Cerebral computed tomography angiography revealed a right sided sub-arachnoid hemorrhage and blood within all four ventricles, as well as a right sided pontine hematoma and an arteriovenous malformation. As the drug epidemic continues to worsen, it is important to take a full drug history in patients presenting with a severe headache, and to not overlook ICH as a potential complication of recreational drug abuse.
Mpox, formerly Monkeypox, is a viral illness caused by the Monkeypox virus. It was first discovered in 1958, and the first human infection was recorded in 1970.1 After that it caused several outbreaks, namely in 2003, 2021 and 2022.2There are 2 types of this virus, Clade I, the more severe form, and Clade II, the milder form.1 The 2022-2023 outbreak was caused by Clade II, but the 2024 outbreak is caused by Clade I, which has a case-fatality rate of around 10%.1,3 On Wednesday, August 14, 2024, the World Health Organization (WHO) declared the spread of Clade1 to be a public health emergency of international concern (PHEIC).4 This review will focus on what the clinician needs to know about mpox, and how to identify, manage and prevent it.
The Epidemiology of Syphilis and Co-infection with HIV in a Tertiary Care Center in Lebanon: A Retrospective Review
Introduction: Syphilis is an ancient STI causing a new worldwide outbreak in general and in Lebanon specifically. Methods: We conducted a retrospective chart review to assess the rate of syphilis increase in an infectious diseases clinic in Lebanon from 2006 to 2023. We studied the epidemiology of these cases, stage and treatment response and their association to HIV infection and its control. Results: There was an 862% increase in syphilis cases from 2006 to 2019.Most of our cases were middle aged men living with HIV. Most of them had well-controlled HIV infection with good CD4 counts. Most of the diagnosed cases of syphilis were primary and secondary, responding to penicillin G. Discussion: Our data mostly parallels international data, except for gender distribution. Despite successful treatment of most cases in our clinic, the alarming rise of new cases highlights the urgent need for public health measures to mitigate this epidemic. Conclusion: Inclusive awareness is needed to stop syphilis spread in Lebanon, and more screening is key in identifying new cases early for a successful eradication.
Copyright (c) 2024 Hilal Abdessamad, Dalida El Khatib, Moussa Hojeij, Rana Asmar, Julien Maamari, Hicham Baba, Rabih Ghazi, Wael T Azzam, Rola Husni, Jacques E. Mokhbat (Author) https://creativecommons.org/licenses/by/4.0
Bacteriophage-Based Treatment in Infectious Diseases: What Do We Know So Far? A Narrative Review
Purpose: To summarize the literature on bacteriophage use in human infection Methods: Using the MeSH terms “Phage” “Therapy”, “Treatment” “Outcome”, a search was performed in ScienceDirect, Scopus and Pubmed databases, including narrative review, systematic reviews and clinical trials, dating from 2020 till June 2023. A total of 191 articles and 389 articles were retrieved respectively from each database, which after duplication removal, added up to 505. After the primary screen, 131 texts were collected. Following that, a secondary ended up with 56 articles included. Conclusion: With the constant increase in antibiotic resistance, there is a need for newer antimicrobial agents, which led to the revival of bacteriophages. Due to advances in molecular microbiology, phages became a possibility that has proven itself promising. More studies and funding are needed towards this field, that offers us a promising salvation from the antimicrobial resistance pandemic.
Quality of life following Covid-19 vaccination in Lebanese adults
Background: This study investigates the quality of life (QoL) among individuals in Lebanon post-COVID-19 vaccination, focusing on various demographic and lifestyle factors influencing physical, psychological, social, and environmental health domains. Objective: To explore the associations between COVID-19 vaccination status and QoL across four sub-scales: physical health, psychological health, social relationships, and environmental quality, examining the impact of gender, tobacco and alcohol consumption, chronic diseases, physical activity, employment status, education level, geographic location, and marital status. Methods: A cross-sectional study was conducted involving 507 Lebanese adults who completed a structured questionnaire. The questionnaire collected data on demographics, lifestyle factors, and QoL using a standardized measurement tool. Statistical analysis, including bivariate analysis, was performed to determine significant associations between independent variables and QoL scores across the four domains. Results: The majority of participants were female (71.6%), non-smokers (83%), and non-drinkers (76.7%). Most had no chronic diseases (83%), and 42.4% engaged in regular physical activity. High educational attainment (80.5% with graduate or professional degrees) and full-time employment (77%) were prevalent. Significant associations were found between gender and all QoL domains, with males reporting higher scores. Physical health scores were higher among non-drinkers, the physically active, independent workers, and vaccinated individuals. Psychological health was better in males, the physically active, and independent workers. Social relationships were stronger among males, independent workers, and those in relationships. Environmental quality was higher among males, non-drinkers, independent workers, and those with no formal education. Vaccination status positively influenced physical health and showed near-significant effects on social relationships and environmental quality. Conclusion: COVID-19 vaccination is associated with improved QoL in Lebanon, particularly in physical health. The findings highlight the importance of considering socio-economic factors and lifestyle choices in public health strategies to enhance overall well-being. Future research should explore longitudinal impacts and address the specific needs of diverse populations.
Influenza Associated Pulmonary Aspergillosis: A Retrospective Study from a Tertiary Care Center in Lebanon
Introduction Influenza-associated pulmonary aspergillosis (IAPA) has been reported in multiple cohort studies, typically in the immunocompromised host. Limited data is available from the Middle Eastern region. Methods This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between January 1 2014 and March 1 2019, to describe the clinical characteristics, risk factors and outcomes of patients with influenza and invasive pulmonary aspergillosis (IPA). Six hundred fifty six patients were admitted with influenza pneumonia. Data about positive cultures for Aspergillus sp. isolated from sputum, deep tracheal aspirates (DTA) or bronchoalveolar lavage (BAL) or a positive aspergillus galactomannan test (GM) in serum or BAL was collected. Cases were identified based on the definitions and criteria for influenza and invasive aspergillosis suggested by the European Organization for Research and Treatment of Cancer/Mycoses study Group (EORTC/MSG), EORTC/MSG intensive care unit (EORTC/MSGERC ICU) Working Group, and IAPA definition. Results Nine patients had a positive result for Aspergillus sp. in culture or GM. Based on the EORTC/MSG criteria, 7 patients were classified as probable cases of IPA, and one as a possible case. On the other hand, only 2 patients were classified as probable cases of invasive fungal infection (IFI) based on the IAPA criteria. Only 1 out of 9 patients died. There was a preponderance of aspergillosis among immunocompromised patients. Conclusion Our study showed that the incidence of IPA in influenza patients was low compared to the data reported from European countries. This calls for national and regional surveillance to better understand the epidemiological variation in the regions.
Lemierre Syndrome in a Pediatric Patient with Nephrotic Syndrome: a Case Report
Lemierre syndrome is a rare thrombotic complication of head and neck infections. Nephrotic syndrome is sometimes treated by immunosuppressive medications that can present with severe infections without a fever. The association of the two diseases is extremely rare. We report the first case, to our knowledge, of Lemierre syndrome in an eleven-year-old patient with nephrotic syndrome on Tacrolimus. A patient with nephrotic syndrome is at higher risk for all kinds of thrombotic events. Also, being on immunosuppressive therapy can lead to late presentation and the absence of fever. A low level of suspicion in those patients can lead to timely diagnosis and early treatment.
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Heart rate, a poor predictor of Pulmonary Embolism
Objective: To determine if there is a significant difference in vital signs between patients with confirmed and excluded pulmonary embolism (PE) throughout their Emergency Department presentation. Methods: We conducted a retrospective cohort study with patients presenting with suspected PE to Monash Health Emergency Departments between July 2014 and July 2019. Vital signs were compared between patients with confirmed or excluded PE as determined by imaging (CTPA or VQ). Vital signs were compared at three unique data points: initial, minimum, and maximum values. Results: 3549 patients met inclusion criteria, 922 with confirmed PE and 2627 with excluded PE based on CTPA or VQ. Patients with PE had significant elevations in mean respiratory rates, systolic blood pressures and reduced oxygen saturations compared to patients without PE. Heart rate was not significantly different at initial and maximum datapoints. Conclusion: Vital signs were demonstrated to be poor predictors of acute PE. Receiver operating characteristic curve analysis suggests that heart rate has poor discriminative power. AUC values for heart rate were: 0.516 (initial), 0.549 (maximum) and 0.519 (minimum). Furthermore, 95% of patients with confirmed PE did not exceed heart rates of 100 BPM during presentation to Emergency. The utility of elevated heart rate and other vital signs in predicting PE were not substantiated in this study.
Association between septic shock prehospital hemodynamic parameters improvement and 28-day mortality
Objective: The early hemodynamic optimization of septic shock patients is a cornerstone of care to hope for a better outcome, e.g., mortality decrease. However, in the prehospital setting, hemodynamic evaluation is restricted to micro and macrocirculatory clinical parameters. This study aims to assess the relationship between micro and macrocirculatory hemodynamic parameters improvement and 30-days mortality among septic shock patients being taken care of for by a mobile intensive care unit (mICU) in the prehospital setting. Methods: We performed a retrospective multicenter study, from January 2015 to November 2019 including septic shock patients requiring pre-hospital mICU intervention. Results: Three hundred thirty-seven patients were analyzed. The mean age was 69 ± 15-years-old and 226 of which 67% were male patients. One hundred thirty-six patients (40%) had previous hypertension. Pulmonary infection was the main cause of septic shock (46%) and 30-days mortality reached 30%. After propensity score analysis, for the macrocirculation: when systolic blood pressure increased by at least 30mmHg the odd ratio (OR) for 30-days mortality was 0.77 [0.65-0.84], when diastolic blood pressure increased by at least 5mmHg, the OR for 30-days mortality was 0.95 [0.88-0.99], when mean blood pressure increased by at least 30%, the OR for 30-days mortality was 0.88 [0.77-0.92] and when the heart rate decreased by at least 30 bpm, the OR for 30-days mortality was 0.62 [0.55-0.76]. For microcirculation, when the mottling score decreased by at least 2 points, the OR for 30-days mortality was 0.83 [0.75-0.91]. Conclusion: In this study, we report that prehospital improvement in micro and macrocirculatory parameters are associated with 30-days mortality rate decrease.
Risk Factors for Return Visits to the Pediatric Emergency Department: Systematic Search and Review
Objectives Return visits (RVs) to the emergency department (ED) has always been a major concern. RVs to the emergency department are a big burden on the healthcare system as its cost is higher than the cost of the initial visit. This review was performed to identify factors associated with risk of RVs to the pediatric ED. Methods and Analysis One researcher searched Medline, Embase, Cochrane Library and Web of Science. Studies were identified by using MeSH and keywords and included RVs to the pediatric ED up to 1 year a primary outcome. All studies were screened by two independent reviewers for eligibility and in case of disagreement, a meeting was held to discuss the problematic studies and a consensus was achieved. Results The search identified 539 reports from which 28 articles were included. Data was then extracted from the included studies according to a preset format. The exposures were grouped in 3 different groups: very probable, possible, and less likely. As a result, young age, language barrier and high acuity were identified as very probable risk factors. Having a public insurance or with low income, patients with comorbidities and patients who had multiple previous ED visits were found to be possible risk factors for return visits. Conclusion Young age, high acuity and language barrier among others are risk factors for return visits to the pediatric ED. Physicians should be aware of these factors and have a low threshold for admission or a good discharge plan for patients with one or more factors.
Efficiency and relevance of post-exposure prophylaxis prescription by emergency physicians: a monocentric retrospective study
Background: Preventing infection with HIV remains a major public health challenge. Exposed persons are offered support and quick access to the post-exposure prophylaxis (PEP) by hospital emergency services. To investigate the accuracy of the prescription of emergency PEP for patients with sexual fluid exposure in a French emergency department (ED) by comparing data in medical files and actual prescriptions. Methods: We retrospectively collected data for patients consulting for sexual exposure in a single Parisian ED from 2015 to 2016. For each patient, researchers independently checked whether the emergency physician prescribed PEP according to French guidelines. Our primary outcome was the appropriateness of the emergency PEP prescription after sexual fluid exposure. We calculated the Cohen weighted kappa coefficient with its 95% confidence interval (CI) for determining the agreement in indication for PEP. Results: We included 346 patients in the analysis. Half of the patients were men who had sex with men (n=178). The most frequent sexual exposure was anal insertive or receptive (n=177; 51%). PEP was prescribed in 94% of cases (n=328). In 33 cases (10%) the indication for PEP was not clear, but PEP was prescribed in 17 cases (52%). The Kappa value for determining the indication for PEP was 0.55 (95% confidence interval 0.36-0.74), indicating poor agreement for prescription. The agreement was lowest for men who had sex with men: 0.29 (0.05-0.53). Conclusion: Strategies are needed to improve the relevance of the prescription of PEP in French EDs to avoid the excess secondary effects and cost.
Copyright (c) 2023 Xavier Eyer, Youri Yordanoff, Dominique Pateron, Patrick Plaisance (Author) https://creativecommons.org/licenses/by/4.0
Copyright (c) 2025 Panorama of Emergency Medicine
Copyright (c) 2025 Panorama of Emergency Medicine https://creativecommons.org/licenses/by/4.0