RESUMEN
Hemophagocytic syndrome is a rare life-threatening disorder that can be triggered by various conditions such as HIV infection and opportunistic agents. We report a case of disseminated toxoplasmosis complicated with severe hemophagocytic syndrome and revealing an unknown acquired immunodeficiency syndrome. The patient presented with multiple organ failure in intensive care unit. Once diagnosed, he benefitted from etoposide infusion, administration of specific anti-toxoplasmosis treatments and secondary antiretroviral therapy. He was alive at intensive care unit discharge and returned home with little sequalae. This case illustrates both the importance of rapid investigations of hemophagocytic syndrome etiologies in HIV positive patients and the necessity to prompt etoposide and specific treatments in order to improve potentially dramatic outcomes.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Linfohistiocitosis Hemofagocítica , Toxoplasmosis , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Etopósido/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/diagnóstico , Masculino , Toxoplasmosis/complicaciones , Toxoplasmosis/diagnósticoRESUMEN
BACKGROUND: Over the past 20 years, the neurology specialty has changed because of the explosion of information and new treatment modalities that became available, and has consequently become more complex and diversified. The satisfaction of residents concerning their training and the competencies that they acquire has never been thoroughly assessed in France. METHODS: We conducted a national survey in order to assess (1) the methods for training and validation; (2) the level of knowledge that residents perceived to have acquired in different domains; and (3) their satisfaction towards training and their wishes. RESULTS: One hundred and eight residents replied to the survey. The main sources of training were local teaching (74%), personal work (61%), scientific (57%) and didactic (54%) papers. Residents seemed unable to acquire knowledge on all domains of the curriculum established at a national level, particularly for neurophysiology, neuropsychology, comatose state and sleep disorders, oncology and psychiatry. Even postgraduate year four residents were not fully competent with several technical tools, particularly neurophysiological tests. Fifty eight percent of residents were satisfied with their training, but 16% were not and 26% were half-hearted. Overall the residents were in favor of more standardization in their training, national-level certification, and would be keen on having access to clinics and the use of a follow-up monitoring chart. CONCLUSION: Our results suggest that it would be useful to better identify the competencies that every neurologist should acquire and to use appropriate tools to reach these objectives.
Asunto(s)
Internado y Residencia/estadística & datos numéricos , Neurología/educación , Adulto , Actitud del Personal de Salud , Competencia Clínica , Curriculum , Recolección de Datos , Femenino , Francia , Humanos , Internado y Residencia/normas , Satisfacción en el Trabajo , Masculino , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Neurología/normas , Neurofisiología/educación , Neuropsicología/educación , EnseñanzaRESUMEN
INTRODUCTION: The consequences of lightning injuries on the peripheral nervous system are widely unknown. CASE REPORT: We report on a 31 year-old woman who developed a bilateral brachial plexopathy 15 days after a lightning strike. The patient recovered progressively. CONCLUSION: Peripheral neuropathies due to lightning strikes are probably unrecognized in most of the cases, because occurrence may be delayed and only few patients were adequately investigated. Pathophysiological hypotheses are unclear and lean on experimental studies using electrical current.