La Revue de médecine interne
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Cholesterol crystal embolism is a systemic pathology associated with diffuse atherosclerosis. Pathophysiology corresponds to tissue necro-inflammation secondary to arteriolar occlusion associated with microembolism from atherosclerotic plaques of large diameter arteries. The clinical presentation is heterogeneous and polymorphic. ⋯ It will be discussed in the implementation of surgery or angioplasty to exclude potentially responsible atherosclerotic lesions. Eviction of antithrombotic therapy should be considered in terms of the benefit-risk balance, but often in favour of maintaining it. Finally, other treatments may be proposed in a case-by-case basis, such as oral or intravenous corticosteroid therapy, colchicine or LDL aphaeresis.
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Hydroxychloroquine is widely prescribed in systemic lupus erythematosus. Dermatologic adverse drug reactions are rare but can mimic a disease specific manifestation of lupus. Exceptionally, Sweet's syndrome, or acute febrile neutrophilic dermatosis, may be drug-induced. ⋯ We report two exceptional cases of drug-induced Sweet's syndrome related to hydroxychloroquine treatment in autoimmune rheumatic diseases.
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Systematically ascertained data on job stress and burnout and their antecedents and mediators in health professionals from low- and middle-income countries are scant. ⋯ This study provides data that will inform the design and implementation of interventions to reduce job stress and burnout and improve retention of faculty.
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Clinical presentation of cholesterol crystal embolism (CCE) can be dermatologic when cholesterol crystals become lodged in small cutaneous arteries resulting in ischemia. We report a case of CCE with erythroderma misleading to a diagnostic of drug reaction with eosinophilia and systemic symptoms (DRESS). ⋯ This case is the first to report a DRESS like presentation of CCE. Clinical findings are secondary to HE and not to occlusion of cutaneous arteries.
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Restless legs syndrome, also called Willis-Ekbom disease, is a frequent sensorimotor disease, more often encountered in women than men. It is characterized by an urge to move legs, during the evening or the beginning of the night, increased by rest and relieved by movement. Two forms are classically distinguished: primary restless legs syndrome occurring in young adults with family history and secondary forms occurring in older adults with comorbidities such as iron deficiency, chronic renal failure or neurological diseases (affecting central or peripheral nervous system). ⋯ That's why, besides nutritional and sleep hygiene advices, treatment of restless legs syndrome includes iron supplementation if there is an iron deficiency. Pharmacological treatment, for severe to very severe forms, includes use of dopamine agonists, antiepileptic drugs or opioids. These medications have numerous side effects and each prescription has to be individually customized for each patient.