Publications by authors named "B Louzir"

132 Publications

Pharmacological Management of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome Syndrome: A Proposal of a Treatment Algorithm.

J Clin Rheumatol 2021 Apr 9. Epub 2021 Apr 9.

From the Department of Internal Medicine, Military Hospital Tunis El Manar University Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

Abstract: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic disease with marked clinical and radiological heterogeneity. It is characterized by a combination of dermatological and osteoarticular manifestations. The treatment of SAPHO syndrome is not yet codified. It includes several therapeutic options such as anti-inflammatory drugs, bisphosphonates, antibiotics, conventional disease-modifying antirheumatic drugs, and biological treatment.This article aims to provide an updated review of the different pharmacological options for SAPHO syndrome. We also propose a therapeutic algorithm for the management of this disease.
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http://dx.doi.org/10.1097/RHU.0000000000001740DOI Listing
April 2021

[Diagnostic and therapeutic management of operable bronchopulmonary carcinoid tumours].

Rev Mal Respir 2021 Mar 2;38(3):249-256. Epub 2021 Mar 2.

Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie.

Introduction: Bronchial carcinoid tumours (CT), divided into typical carcinoid (TC) or atypical carcinoid (AC), are rare tumours whose therapeutic management remains unspecified.

Methods: Retrospective study collecting cases of bronchial CT operated at the thoracic surgery department of Abderrahmane-Mami hospital of Ariana and recruited from the pneumology departments of Northern Tunisia, during a 12-year period.

Results: Ninety patients were collected (74 cases of TC and 16 cases of AC). The mean age was 45 years and the sex ratio H/F=0.5. The chest X-ray was normal in 11 cases, as well as flexible bronchoscopy in seven cases. The tumour was classified: stage IA (10 cases), IIA (28 cases), IIB (31 cases), IIIA (15 cases) and IIIB (six cases). Surgery resulted in a complete resection in 78 patients, an extensive resection in six patients, and a conservative resection in six patients. Adjuvant chemotherapy was given in 10 patients. The survival was 84% at five years and 42% at 10 years.

Conclusion: The prognosis of CT depends directly on the histological subtype. It is excellent for TC after complete resection, unlike ACs that are similar to well-differentiated bronchial carcinomas.
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http://dx.doi.org/10.1016/j.rmr.2021.02.062DOI Listing
March 2021

Psoriatic arthritis associated with peliosis hepatis: characteristics and therapeutic management.

Clin Rheumatol 2021 Feb 17. Epub 2021 Feb 17.

University of Tunis El Manar, Tunis, Tunisia.

Peliosis hepatis is characterized by hepatic sinusoidal dilatation and multiple blood-filled cystic cavities within the liver parenchyma. It can be due to infectious diseases, immunological disorders, neoplasia, and the use of various kinds of drugs. We presented the case of a nonsmoker 55-year-old man who complained about a 5-month history of arthritis. Medical history was consistent with psoriasis and hypertension. He denied any drug use or alcohol consumption. Physical examination showed extended psoriatic lesions. He had arthritis of the knees, ankles, wrists, and elbows. His body mass index was 22 kg/m. Laboratory findings revealed an increased serum gamma-glutamyl transferase level (1014 UI/L, normal value (N) 11-55) and total alkaline phosphatase (278 U/L, N 30-171). Hepatitis A, B, and C serologic test results were negative. Anti-nuclear antibodies, anti-Ro/SSA, anti-GP210, anti-SP100, anti-SLA, anti-LKM1, anti-M2, anti-LC1, and anti-PML were also negative. Histopathological examination of a liver biopsy specimen revealed peliosis hepatis.The pelvic radiograph showed bilateral ankylosis of sacroiliac joints. Hand and foot radiographs showed periosteal bone apposition. The diagnosis of psoriatic arthritis associated with peliosis hepatis was made. The patient received infliximab (5 mg/kg) with a significant improvement after 3 months of follow-up. Peliosis hepatis should be considered as a possible etiology of liver enzyme abnormalities in patients with psoriatic arthritis. We highlighted the effectiveness and safety of the TNF inhibitors in the treatment of peliosis hepatis associated with psoriatic arthritis. Key Points • Peliosis hepatis should be considered as a possible etiology of liver enzyme disturbance in patients with psoriatic arthritis. • Special caution should be advised in the management of psoriatic arthritis associated with peliosis hepatis to avoid the worsening of liver function. • Infliximab is suggested as a possible treatment of peliosis hepatis associated with psoriatic arthritis.
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http://dx.doi.org/10.1007/s10067-021-05647-1DOI Listing
February 2021

[Sleep disorders and psycho-affective problems in paramedical personnel working an atypical schedule].

Rev Mal Respir 2021 Feb 3;38(2):147-156. Epub 2021 Feb 3.

Service de pneumologie et allergologie, université de Tunis El Manar, faculté de médecine de Tunis, CHU Mongi Slim La Marsa, Tunis, Tunisie.

Introduction: Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA).

Methods: It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey.

Results: One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%.

Conclusion: Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.
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http://dx.doi.org/10.1016/j.rmr.2021.01.004DOI Listing
February 2021

[Confusion in the diagnosis of endobronchial tumor].

Pan Afr Med J 2020 29;37:201. Epub 2020 Oct 29.

Université de Tunis El Manar, Faculté de Médecine de Tunis, Centre Hospitalier Universitaire Mongi Slim La Marsa, Service de Pneumologie Allergologie, Tunis, Tunisie.

Bronchopulmonary cancer is the leading cause of death in men and the second in women. Some endoscopic or radiological features may guide histological diagnosis and thus facilitate therapeutic management. We here report the case of a 54-year old man, with a history of smoking and recent coronary stent implantation, presenting with haemoptysis and worsening of dyspnea which had evolved over the last month. Chest x-ray showed left pulmonary hemifield lucency with signs of retraction. Bronchial fibroscopy objectified raspberry bud formation spontaneously bleeding, originating from the left main bronchus and suggesting carcinoid tumor. Chest computed tomography (CT) scan showed poorly enhanced endoluminal tissue process at the level of the left main bronchus, located four cm from the carina and complicated with atelectasis. Diagnostic and therapeutic surgery helped to adjust to a diagnosis of endobronchial amartocondroma.
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http://dx.doi.org/10.11604/pamj.2020.37.201.22896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813657PMC
February 2021

Hypercalcemia in a patient with a bowing femur.

Clin Case Rep 2021 Jan 23;9(1):516-521. Epub 2020 Nov 23.

Department of Internal Medicine Military Hospital Tunis Tunisia.

Hypercalcemia in PDB is rare; its occurrence requires thorough investigations as it may reveal several diseases, such as primary hyperparathyroidism, malignant transformation, metastases, or myeloma.
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http://dx.doi.org/10.1002/ccr3.3569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813087PMC
January 2021

Esophageal leiomyomas presenting as a mediastinal mass.

Tunis Med 2020 Jun;98(6):475-479

Although benign tumors of the esophagus are very rare, the leiomyomas are frequently recorded. Most of them are small, asymptomatic and without risk of malignant degeneration. These benign tumors are usually discovered fortuitously on endoscopy. Sometimes, they may manifest clinically by dysphagia, hematemesis or other signs. They may mimic the esophageal cancer, which is more frequent, or some mediastinal tumors. The diagnosis can be oriented by the barium swallow esophagogram or other imaging methods, yet, only the histological examination gives the confirmation of the diagnosis. We report the case of a 50-year-old man, non-smoker, complaining of dysphagia, epigastric pain and deterioration of general condition. The clinical and radiological presentation mimicked a mediastinal tumor. Surgery was performed, and histological examination concluded to two leiomyomas of the esophagus.
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June 2020

[Assessment of body composition during pulmonary tuberculosis].

Rev Mal Respir 2021 Jan 8;38(1):34-40. Epub 2021 Jan 8.

Service de pneumologie allergologie (Unité de recherche LR18SP02), faculté de Médecine de Tunis, université de Tunis El Manar, CHU La Rabta, Tunis, Tunisie.

Background: Although the body mass index (BMI) is the most commonly used tool to assess the nutritional status of patients with active tuberculosis (TB), it does not assess changes in body composition. This study aims to assess the contribution of bioelectrical impedancemetry (BIA) for the assessment of body composition during the course of TB compared to BMI and to examine the associated factors.

Methods: Cross-sectional study carried out in patients with active TB at the pulmonology department of CHU la Rabta in Tunis, Tunisia. The nutritional assessment was based on the measurement of BMI and the analysis of body composition by BIA. Malnutrition was accepted when the lean mass index (LMI) was ≤16kg/m in men and 15kg/m in women.

Results: Ninety-five patients were included. According to their LMI, 38 patients were undernourished. The decline in LMI was associated with the severity of TB. Although BMI and LMI were correlated, the use of BMI alone failed to recognize lean mass loss in one in ten patients.

Conclusion: Undernutrition is frequent in patients with active TB. It is correlated with the severity of the disease. In addition to anti-tuberculosis drugs, nutritional management of these patients is essential.
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http://dx.doi.org/10.1016/j.rmr.2020.12.003DOI Listing
January 2021

Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein to albumin ratio, and albumin to fibrinogen ratio in axial spondyloarthritis: a monocentric study.

Curr Rheumatol Rev 2020 Dec 23. Epub 2020 Dec 23.

Department of Internal Medicine, Military Hospital, Tunis, Tunisia, Tunis El Manar University. Tunisia.

Background: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are routinely used to assess disease activity in spondyloarthritis. New biomarkers have been reported, such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), CRP to albumin ratio (CAR), and albumin to fibrinogen ratio (AFR). Our study aimed to assess these ratios in spondyloarthritis and to determine the relationship between these ratios and the disease activity.

Methods: We conducted a cross-sectional study, including patients with spondyloarthritis. The following ratios were calculated: PLR, NLR, AFR, and CAR. Pearson correlation analysis was carried out to test the correlation of the data. Receiver operating characteristic curves were evaluated for each ratio using ASDASCRP as the gold standard for disease activity.

Results: Eighty-five patients were included. The sex ratio was 60 males to 25 females. The mean age was 42.58 ± 11.75 years. There was a positive correlation between the PLR and the following parameters: CAR, CRP, and ESR. A negative correlation was found between AFR and the following ratios: PLR, NLR, CRP, and ESR. The ASDAS correlated negatively with AFR and positively with both PLR and CAR. The cut-offs values of CAR and PLR to distinguish patients with very high disease activity (ASDASCRP>3.5) were 0.442 and 173.64, respectively.

Conclusions: Given their good correlation with ESR and CRP, we suggest that PLR, CAR, and AFR can be used as potential indicators of inflammation in spondyloarthritis. The CAR and PLR are useful to identify patients with very high disease activity.
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http://dx.doi.org/10.2174/1573397116666201224105359DOI Listing
December 2020

Bicipitoradial bursitis: A diagnosis challenge!

Clin Case Rep 2020 Nov 18;8(11):2265-2268. Epub 2020 Jul 18.

Department of Internal Medicine Military Hospital Tunis Tunisia.

Bicipitoradial bursitis should be considered in patients with antecubital mass and painful forearm pronation and supination movement. It can be due to several conditions such as calcium pyrophosphate dihydrate deposition, even in young patients. Ultrasound is useful to confirm the diagnosis, determine the etiology and to guide the treatment of bicipitoradial bursitis.
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http://dx.doi.org/10.1002/ccr3.3125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669374PMC
November 2020

Cardiac tamponade: an uncommon presenting feature of systemic lupus erythematosus (a case-based review).

Pan Afr Med J 2020 28;36:368. Epub 2020 Aug 28.

Department of Cardiology, Military Hospital of Tunis, Tunis, Tunisia.

Although pericarditis is the most prevalent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is extremely infrequent notably as the first manifestation of the disease. Here we report the case of a 22-year-old woman presenting with cardiac tamponade as the initial presentation of SLE.
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http://dx.doi.org/10.11604/pamj.2020.36.368.25044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666689PMC
January 2021

Neuro-meningeal cryptococcal infection revealing a multiple myeloma.

Pan Afr Med J 2020 21;36:324. Epub 2020 Aug 21.

Department of Internal Medicine, Military Hospital, Tunis, Tunisia.

Rare cases of Cryptococcus have been documented in patients living with multiple myeloma. To date there has been no documented evidence of cryptococcosis revealing multiple myeloma. We reported a 63-year-old man who had a 2-months history continuous holocranial headaches, morning vomiting, complaining of blurred vision and fever. The biologic and the imaging showed a Cryptococcus meningoencephalitis. The search for a cause of immunodeficiency revealed a multiple myeloma. The diagnosis for Cryptococcus was confirmed according to an India ink stain, blood and cerebrospinal fluid culture. The patient's treatment for multiple myeloma was initiated with a chemotherapy regimen. The evolution was good without complication. Cryptococcosis, especially in the neuro-meningeal form, is a serious, deadly opportunistic infection. The search of an underlining immunodeficiency must be systematic. In this case, it was associated with early stage multiple myeloma.
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http://dx.doi.org/10.11604/pamj.2020.36.324.20407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603827PMC
January 2021

Anti drug antibodies monitoring in biologics use: clinical implications.

Curr Clin Pharmacol 2020 Sep 16. Epub 2020 Sep 16.

Internal Medicine Department, Military Hospital of Tunis. Tunisia.

Background: Over the years, drug monitoring-such as anti drug antibodies (ADA) dosage- has witnessed major transformations. In fact ADA are more and more used in rheumatology and gastro-enterology in monitoring chronic inflammatory diseases therapeutic response. The main purpose of those researches is to produce less immunogenic drug and in consequences to improve tolerance and efficiency, since immunogenicity of those drugs still is the main constraint to their long-term use. The aim of this review was to highlight anti-drug-antibodies potential effects on the pharmacokinetics and bioavailability of biotherapies as well as their clinical implications.

Methods: For this purpose we did collect and summarize published data on pubmed using key words "Biologics, Rheumatoid Arthritis, Spondyloarthritis, Crohn disease, Anti drug antibodies, residual rate, immunogenicity, efficacy, tolerance". The time-period selected for this study was 2000-2019.

Results: Anti- Drug-antibodies do decrease pharmaco-availability of drugs and in consequences its efficiency and high risk of refractory disease and side effects.

Conclusion: Recent literature is consistent with the fact that drug monitoring using ADA dosage coupled with residual drug concentration offers reliable options to comfort practitioner' therapeutic management decisions. This is particularly interesting in failure to treatment or in side effects onset situations.
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http://dx.doi.org/10.2174/1574884715666200917102055DOI Listing
September 2020

Multiple endocrine neoplasia type 1 revealed by a hip pathologic fracture.

Clin Rheumatol 2021 Feb 14;40(2):775-782. Epub 2020 Jul 14.

Department of Internal Medicine, Military Hospital, 1007, Tunis, Tunisia.

Multiple endocrine neoplasia type 1 is a rare autosomal inherited syndrome that affects a variety of endocrine tissues such as the parathyroid, endocrine pancreas, and anterior pituitary. Osseous complications are often misdiagnosed. We presented a case of a 46-year-old woman with pathological fractures of the lower limb. She had a history of type 1 diabetes and galactorrhea. Laboratory examinations showed hypercalcemia and an increased level of parathyroid hormone related to hyperparathyroidism. Serum chromogranin A level was increased at 9369 ng/mL (N < 102). A somatostatin receptor scintigraphy (octreoscan) revealed pathological uptake in the gastric wall, later cave adenopathy, and liver. The diagnosis of multiple endocrine neoplasia type 1 was made based on radiological and histological findings. The patient underwent a subtotal parathyroidectomy associated with somatostatin analog treatment leading to significant improvement. A literature review was conducted by searching PubMed using these following terms: multiple endocrine neoplasia type 1, hyperparathyroidism, fracture, menin, osteoporosis. We emphasized bone involvement related to multiple endocrine neoplasia type 1 syndrome. This diagnosis should be considered when pathological fractures occur in young patients with a history of endocrine disorder. We highlighted the importance of imaging features in making the diagnosis of multiple endocrine neoplasia type 1. Early management of this disease is necessary. Treatment including parathyroidectomy and somatostatin analogs leads to bone preservation and functional improvement.
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http://dx.doi.org/10.1007/s10067-020-05281-3DOI Listing
February 2021

Presacral extramedullary hematopoiesis: a rare cause of back pain in a patient with thalassemia.

Clin Rheumatol 2020 12 7;39(12):3883-3884. Epub 2020 Jul 7.

Department of Internal Medicine, Military Hospital, Tunis El Manar University - Tunisia, 1007, Tunis, Tunisia.

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http://dx.doi.org/10.1007/s10067-020-05277-zDOI Listing
December 2020

Calcifying nucleopathy mimicking infectious spondylodiscitis.

Acta Reumatol Port 2020 Jan-Mar;45(1):61-64

Tunis El Manar University - Tunisia.

Spinal hydroxy apatite deposition disease is a scarce condition. It can be misdiagnosed. Clinical signs may be remarkable mimicking an infectious spondylodiscitis. We report a case of a 53-year-old man with acute febrile inflammatory back pain. MRI showed spondylodiscitis of T12-L1 intervertebral disc without abscesses. Spine X-ray revealed a calcifying nucleopathy with a complete disappearance of this calcification during the follow-up. The diagnosis of HADD should be considered in patients with acute inflammatory back pain. We highlight the importance of the relevance of imaging features in making the diagnosis. A total disappearance of the calcification is possible during the follow up.
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June 2020

Epidural myeloid sarcoma as the presenting symptom of chronic myeloid leukemia blast crisis.

Clin Rheumatol 2020 Aug 26;39(8):2453-2459. Epub 2020 May 26.

Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia.

Epidural myeloid sarcoma revealing chronic myeloid leukemia is scarce. Herein, we describe a patient that presented with back pain and bilateral sciatica secondary to root compression due to epidural deposition of leukemic cells. The magnetic resonance imaging showed epidural masses, causing a slight restriction of the spinal canal with bilateral L5 root compression. Laboratory examinations showed hyperleukocytosis (white blood cell count: 83 × 109/L, absolute neutrophil count: 60 × 109/L). The bone marrow cytology and immunophenotypic findings confirmed the diagnosis of myeloid leukemia. The diagnosis of spinal myeloid sarcoma revealing chronic myeloid leukemia during the blast phase was established. The patient underwent induction chemotherapy. Then, bone marrow cytology revealed less than 3% of blasts, which correspond to cytological remission. Three months later, MRI showed complete disappearance of the epidural masses. A literature review was conducted by searching PubMed using these terms: "Leukemia, Myeloid" AND "Spine" AND "Sarcoma, Myeloid". We emphasize clinical and radiological findings of spinal myeloid sarcoma. This diagnosis should be considered when the MRI reveals epidural mass lesion. The early management of this disease is necessary, and the treatment of myeloid sarcoma is not codified. Our case highlighted that chemotherapy treatment could be sufficient to lead to the disappearance of myeloid sarcoma and the remission of leukemia.
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http://dx.doi.org/10.1007/s10067-020-05167-4DOI Listing
August 2020

Clinical Features of Systemic Lupus Erythematosus in Tunisian Males.

Curr Rheumatol Rev 2020 ;16(2):139-142

Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia.

Purpose: Systemic Lupus Erythematosus (SLE) in males is rare. Clinical and biological features, as well as, the outcome may differ comparatively to female patients. The purpose of our study is to define these clinical and biological features in Tunisian male patients presenting SLE.

Methods: A mono-centric, retrospective and descriptive study of 96 patients followed for SLE out of which 21 are males. A comparative study was then performed between male and female patients groups.

Results: Sex-ratio female/male was 3.6/1, the average age at diagnosis of SLE was 37.8±14 years. The most frequently noted clinical manifestations were: skin involvement (81%), renal involvement (71.4%) and joint damage (66.7). We observed a significant difference in clinical features between male and female patients (21 males and 76 females): renal failure (52% vs. 71.4%), serositis (23.8% vs. 2.7%), peripheral neuropathy (19% vs. 4%) and lung interstitial disease (14.3% vs. 1.3%). No significant difference was found in the positivity of serum antibodies between the two groups. Fifteen male patients (71.4%) had a SLEDAI score greater than or equal to 11, referring to high/very high disease activity. Out of the 32 patients who developed infectious complications during the course of the disease, 11 were male (52.4% of males). Concerning the male group, complete remission was observed in 10 patients (47.6%), while 10 others presented persistent sequella. We observed one death in the male group secondary to infective acute respiratory failure.

Conclusion: SLE in male patients is rare and associated with poor prognosis. Disparity was observed in clinical and biological features as well as outcome in the different studies. In our study, we concluded that male lupus is more severe.
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http://dx.doi.org/10.2174/1573397115666190916142945DOI Listing
March 2021

Skeletal Manifestations of Autoimmune Hypoparathyroidism.

J Clin Rheumatol 2020 Jan 21. Epub 2020 Jan 21.

From the Department of Internal Medicine, Military Hospital; and Tunis El Manar University, Tunis, Tunisia.

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http://dx.doi.org/10.1097/RHU.0000000000001307DOI Listing
January 2020

Toxocariasis and nephrotic syndrome.

Saudi J Kidney Dis Transpl 2019 Nov-Dec;30(6):1461-1463

Department of Internal Medicine, Military Hospital of Tunis, Montfleury, Tunis, Tunisia.

We describe a case of toxocariasis as a rare cause of nephrotic syndrome in an adult woman. This rare association was confirmed by elevated Toxocara-specific immunoglobulin M titers. Renal biopsy was not done because of prolonged activated partial thromboplastin time. Our patient was treated with prednisone and albendazole. These treatments resulted in partial remission of renal symptoms as well as the abatement of the Toxocariasis infection. The relationship between toxocariasis infection and glomerular disease is still unclear. In the literature, exceptional renal impairment secondary to toxocariasis have been described, especially in children. To the best of our knowledge, this is the second case of nephrotic syndrome associated with toxocariasis in adults.
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http://dx.doi.org/10.4103/1319-2442.275494DOI Listing
August 2020

IFN-α kinoid in systemic lupus erythematosus: results from a phase IIb, randomised, placebo-controlled study.

Ann Rheum Dis 2020 03 23;79(3):347-355. Epub 2019 Dec 23.

Department of Physiology, College of Medicine, University of the Philippines Manila and ManilaMed, Manila, Philippines.

Objective: To evaluate the efficacy and safety of the immunotherapeutic vaccine interferon-α kinoid (IFN-K) in a 36-week (W) phase IIb, randomised, double-blind, placebo (PBO)-controlled trial in adults with active systemic lupus erythematosus (SLE) despite standard of care.

Methods: Patients with SLE (185) with moderate to severe disease activity and positive interferon (IFN) gene signature were randomised to receive IFN-K or PBO intramuscular injections (days 0, 7 and 28 and W12 and W24). Coprimary endpoints at W36 were neutralisation of IFN gene signature and the BILAG-Based Composite Lupus Assessment (BICLA) modified by mandatory corticosteroid (CS) tapering.

Results: IFN-K induced neutralising anti-IFN-α2b serum antibodies in 91% of treated patients and reduced the IFN gene signature (p<0.0001). Modified BICLA responses at W36 did not statistically differ between IFN-K (41%) and PBO (34%). Trends on Systemic Lupus Erythematosus Responder Index-4, including steroid tapering at W36, favoured the IFN-K and became significant (p<0.05) in analyses restricted to patients who developed neutralising anti-IFN-α2b antibodies. Attainment of lupus low disease activity state (LLDAS) at W36 discriminated the two groups in favour of IFN-K (53% vs 30%, p=0.0022). A significant CS sparing effect of IFN-K was observed from W28 onwards, with a 24% prednisone daily dose reduction at W36 in IFN-K compared with PBO (p=0.0097). The safety profile of IFN-K was acceptable.

Conclusions: IFN-K induced neutralising anti-IFN-α2b antibodies and significantly reduced the IFN gene signature with an acceptable safety profile. Although the clinical coprimary endpoint was not met, relevant secondary endpoints were achieved in the IFN-K group, including attainment of LLDAS and steroid tapering.

Trial Registration Number: NCT02665364.
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http://dx.doi.org/10.1136/annrheumdis-2019-216379DOI Listing
March 2020

Non-coronary cardiac manifestations of systemic lupus erythematosus in adults: a comparative study.

Pan Afr Med J 2019 2;33:156. Epub 2019 Jul 2.

Autoimmune Disease Research Unit (Ur17dn02), Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunisia.

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.
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http://dx.doi.org/10.11604/pamj.2019.33.156.18697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756817PMC
October 2019

46th Medical Maghrebian Congress. November 9-10, 2018. Tunis.

Authors:
A Alami Aroussi A Fouad A Omrane A Razzak A Aissa A Akkad A Amraoui A Aouam A Arfaoui A Belkouchi A Ben Chaaben A Ben Cheikh A Ben Khélifa A Ben Mabrouk A Benhima A Bezza A Bezzine A Bourrahouat A Chaieb A Chakib A Chetoui A Daoudi A Ech-Chenbouli A Gaaliche A Hassani A Kassimi A Khachane A Labidi A Lalaoui A Masrar A McHachi A Nakhli A Ouakaa A Siati A Toumi A Zaouali A Y Condé Abdeddayem Haggui Abdelaziz Belaguid Abdelkader Jalil El Hangouche Abdelkarim Gharbi Abdelmajid Mahfoudh Abderrazek Bouzouita Abir Aissaoui Abir Ben Hamouda Abir Hedhli Adel Ammous Afef Bahlous Afef Ben Halima Ahlem Belhadj Ahlem Bezzine Ahlem Blel Ahlem Brahem Ahmed Banasr Ahmed Meherzi Ahmed Saadi Ahmed Sellami Ahmed Turki Aicha Ben Miled Aida Ben Slama Aida Daib Alaa Zommiti Ali Chadly Ali Jmaa Ali Mtiraoui Alia Ksentini Alia Methnani Alya Zehani Amal Kessantini Amani Farah Amani Mankai Amani Mellouli Amani Zaouali Amany Touil Ameni Hssine Amine Ben Safta Amine Derouiche Amine Jmal Amir Ferjani Amira Djobbi Amira Dridi Amna Aridhi Anis Bahdoudi Anis Ben Amara Anis Benzarti Anouar Youssef Ben Slama Anouer Oueslati Aouatef Soltani Aschraf Chadli Asma Aloui Asma Belghuith Sriha Asma Bouden Asma Laabidi Asma Mensi Asma Ouakaa Asma Sabbek Asma Zribi Assia Green Atef Ben Nasr Aymen Azaiez Aza Yeades Azza Belhaj Azza Mediouni Azza Sammoud Azza Slim B Amine B Chelly B Jatik B Lmimouni Bachir Daouahi Badereddine Ben Khelifa Bechir Louzir Ali Dorra Besma Dhahri C Ben Nasrallah C Chefchaouni C Konzi C Loussaief C Makni Chadli Dziri Chaker Bouguerra Chaker Kays Chekib Zedini Cherif Dhouha Cherif Mohamed Chiraz Aichaouia Chiraz Dhieb D Fofana Dalila Gargouri Dhekra Chebil Dhilel Issaoui Donia Gouiaa Dorra Brahim Dorra Essid Dorra Jarraya Dorra Trad E Ben Hmida E Sboui Ehsen Ben Brahim Elyes Baati Emna Talbi Eya Chaari Eya Hammami Ezzeddine Ghazouani F Ayari F Ben Hariz F Bennaoui F Chebbi F Chigr F Guemira F Harrar F Z Benmoula F Z Ouali F M R Maoulainine Faten Bouden Faten Fdhila Fatiha Améziani Fatma Bouhaouala Fatma Charfi Fatma Chermiti Ben Abdallah Fatma Hammemi Fatma Jarraya Fatma Khanchel Fatma Ourda Fatma Sellami Fatma Trabelsi Ferdaous Yangui Feten Fekih Romdhane Fethi Mellouli Fethi Nacef Jomli Fethia Mghaieth G Draiss G Elamine G Kablouti G Touzani G B Manzeki Ghada Garali Ghassen Drissi Ghazi Besbes H Abaza H Azzouz H Said Latiri H Rejeb H Ben Ammar H Ben Brahim H Ben Jeddi H Ben Mahjouba H Besbes H Dabbebi H Douik H El Haoury H Elannaz H Elloumi H Hachim H Iraqi H Kalboussi H Khadhraoui H Khouni H Mamad H Metjaouel H Naoui H Zargouni H O Elmalki Habib Feki Habib Haouala Habib Jaafoura Habiba Drissa Habiba Mizouni Hager Kamoun Haifa Ouerda Haifa Zaibi Haithem Chiha Hajer Kamoun Hajer Saibi Hajer Skhiri Hamza Boussaffa Hamza Majed Hana Blibech Hana Daami Hana Harzallah Hanan Rkain Hanen Ben Massoud Hanene Jaziri Hanène Ben Said Haroun Ayed Hassen Harrabi Hatem Chaabouni Hayet Ladida Debbache Hayett Harbi Haythem Yacoub Hela Abroug Hela Ghali Hela Kchir Hela Msaad Héla Ghali Héla Manai Hend Riahi Hiba Bousselmi Hiba Limem Hichem Aouina Hichem Jerraya Houda Ben Ayed Houda Chahed Houda Snéne I Lahlou Amine I Nouiser I Ait Sab I Chelly I Elboukhani I Ghanmi I Kallala I Kooli Ibtissem Bouasker Ilhem Fetni Imen Bachouch Imen Bouguecha Imen Chaabani Imen Gazzeh Imen Samaali Imen Youssef Imen Zemni Imene Bachouche Imène Youssef Ines Bouannene Ines Kasraoui Ines Laouini Ines Mahjoubi Ines Maoudoud Ines Riahi Ines Selmi Ines Tka Islem Hadj Khalifa Islem Mejri Ismail Béjia J Bellagha Jallel Boubaker Jalloul Daghfous Jamel Dammak Jamila Hleli Jihen Ben Amar Jihen Jedidi Jihen Marrakchi K Kaoutar K Arjouni K Ben Helel K Benouhoud K Rjeb Kacem Imene Kais Samoud Kaouther El Jeri Karem Abid Kays Chaker Khadija Abid Khadija Bouzghaîa Khaled Kamoun Khaled Zitouna Khalil Oughlani Khaoula Lassoued Khaoula Letaif Khaouther Hakim L Cherif Alami L Benhmidoune L Boumhil L Bouzgarrou L Dhidah L Ifrine Lamia Kallel Latifa Merzougui Leila Errguig Leila Mouelhi Lina Sahli M Maoua M Rejeb M Ben Rejeb M Bouchrik M Bouhoula M Bourrous M Bouskraoui M El Belhadji M El Belhadji M Essakhi M Essid M Gharbaoui M Haboub M Iken M Krifa M Lagrine M Leboyer M Najimi M Rahoui M Sabbah M Sbihi M Zouine M C Chefchaouni M H Gharbi M M El Fakiri M R Tagajdid Maha Shimi Maha Touaibia Mahbouba Jguirim Maher Barsaoui Maissa Belghith Maissa Ben Jmaa Makram Koubaa Makram Tbini Malak Boughdir Mamia Ben Salah Manel Ben Fraj Manel Ben Halima Manel Ben Khalifa Manel Bousleh Manel Limam Manel Mabrouk Manel Mallouli Manel Rebeii Mariem Ayari Mariem Belhadj Mariem Ben Hmida Mariem Boughattas Mariem Drissa Mariem El Ghardallou Mariem Fejjeri Mariem Hamza Mariem Jaidane Mariem Jrad Mariem Kacem Mariem Mersni Mariem Mjid Mariem Sabbah Mariem Serghini Mariem Triki Maroua Ben Abbes Maroua Boussaid Maroua Gharbi Maroua Hafi Maroua Slama Maroua Trigui Marouen Taoueb Marouene Chakroun Marwa Ben Cheikh Marwa Chebbi Marwa Hadj Taieb Marwa Kacem Mehdi Ben Khelil Mehdi Hammami Mehdi Khalfallah Mehdi Ksiaa Mehdi Mechri Mehdi Mrad Mehdi Sboui Mejda Bani Melek Hajri Menel Mellouli Mohamed Allouche Mohamed Amine Mesrati Mohamed Amine Mseddi Mohamed Amri Mohamed Bejaoui Mohamed Bellali Mohamed Ben Amor Mohamed Ben Dhieb Mohamed Ben Moussa Mohamed Chebil Mohamed Cherif Mohamed Fourati Mohamed Kahloul Mohamed Khaled Mohamed Machghoul Mohamed Mansour Mohamed Morched Abdesslem Mohamed Ali Ben Chehida Mohamed Ali Chaouch Mohamed Ali Essid Mohamed Ali Meddeb Mohamed Chawki Gharbi Mohamed Habib Elleuch Mohamed Hédi Loueslati Mohamed Mehdi Sboui Mohamed Nabil Mhiri Mohamed Osman Kilani Mohamed Riadh Ben Slama Mohamed Ridha Charfi Mohamed Said Nakhli Mohamed Sami Mourali Mohamed Selim El Asli Mohamed Taher Lamouchi Mohammed Cherti Mohsen Khadhraoui Mokhtar Bibi Moncef Hamdoun Mondher Kassis Mongi Touzi Monia Ben Khaled Monia Fekih Monia Khemiri Monia Ouederni Monjia Hchicha Monther Kassis Mossadak Ben Attia Moufida Yahyaoui Mouna Ben Azaiez Mouna Bousnina Mounir Ben Jemaa Mounir Ben Yahia Mounir Daghfous Mourad Haj Slimen Msadak Assidi N Belhadj N Ben Mustapha N El Idrissislitine N Hikki N Kchir N Mars N Meddeb N Ouni N Rada N Rezg N Trabelsi Nabiha Bouafia Nabil Haloui Nacéra Benfenatki Naceur Bergaoui Naceur Yomn Nadia Ben Mustapha Nadia Maamouri Nadia Mehiri Nadia Siala Najeh Beltaief Najet Aridhi Najet Sidaoui Najia Walid Najla Mechergui Najla Mnif Nariméne Ben Chekaya Nawel Bellil Nawel Dhouib Nazek Achour Nejib Kaabar Nejib Mrizak Nejla Mnif Nesrine Chaouech Nesrine Hasni Nesrine Issaoui Nidhal Ati Nidhal Balloumi Nidhal Haj Salem Nizar Ladhari Nora Akif Nora Liani Nouha Hajji Nouha Trad Nour Elleuch Nour El Houda Marzouki Noureddine Larbi Nourelhouda M'barek Nouri Rebai Noursaf Bibani Nozha Ben Salah O Belmaachi O Elmaalel O Jlassi O Mihoub Olfa Ben Zaid Olfa Bouallègue Olfa Bousnina Olfa Bouyahia Olfa El Maalel Omar Fendri Ons Azzabi Ons Borgi Ons Ghdes Oussama Ben Rejeb R Rachid R Abi R Bahiri R Boulma R Elkhayat R Habbal R Rachid R Tamouza Rabaa Jomli Rabiaa Ben Abdallah Racha Smaoui Radhouene Debbeche Radhouene Fakhfakh Rafik El Kamel Rahma Gargouri Raja Jouini Ramzi Nouira Rana Fessi Rania Bannour Rania Ben Rabeh Rania Kacem Rania Khmakhem Raouf Ben Younes Raouf Karray Rezaik Cheikh Riadh Ben Malek Ridha Ben Slama Ridha Kouki Rim Baati Rim Bechraoui Rim Fakhfakh Rim Fradi Rim Lahiani Rim Ridha Rim Zainine Roua Kallel S Rostom S Ben Abdallah S Ben Hammamia S Benchérifa S Benkirane S Chatti S El Guedri S El Oussaoui S Elkochri S Elmoussaoui S Enbili S Gara S Haouet S Khammeri S Khefecha S Khtrouche S Macheghoul S Mallouli S Rharrit S Skouri Saan Helali Sabrine Boulehmi Sahar Abid Sahbi Naouar Saida Zelfani Salah Ben Amar Salem Ajmi Salem Braiek Salem Yahiaoui Salima Ghezaiel Salma Ben Toumia Salma Thabeti Salsabil Daboussi Salwa Ben Abderahman Samar Rhaiem Sami Ben Rhouma Samia Rekaya Samir Haddad Samir Kammoun Samira Merai Samira Mhamdi Rabaa Ben Ali Sana Gaaloul Sana Ouali Sana Taleb Saoussen Zrour Sarah Hamdi Sarah Zaghdoudi Sarra Ammari Sarra Ben Abderrahim Sarra Karaa Sarra Maazaoui Sarra Saidani Sarra Stambouli Seif Mokadem Selim Boudiche Selim Zaghbib Shema Ayedi Sinda Jardek Siwar Bouselmi Sonda Chtourou Sondos Manoubi Sonia Bahri Sonia Halioui Sonia Jrad Sonia Mazigh Sonia Ouerghi Sonia Toujani Soraya Fenniche Souad Aboudrar Souad Meriem Amari Souhaiel Karouia Soumaya Bourgou Soumaya Halayem Soumaya Rammeh Sourour Yaïch Syrine Ben Nasrallah Syrine Chouchane Syrine Ftini Syrine Makni Syrine Manoubi Syrine Miri Syrine Saadi Syrine Azza Manoubi T Khalfallah Takwa Mechergui Taoufiq Dakka Tarek Barhoumi Tej El Baha M'rad Thouraya Ajmi Trad Dorra Uta Ouali W Hannachi Wael Ferjaoui Wafa Aissi Wafa Dahmani Wafa Dhouib Wafa Koubaa Wafa Zhir Wafe Gheriani Wajdi Arfa Wajih Dougaz Wajih Sahnoun Walid Naija Y Sami Y Bouteraa Y Elhamdaoui Y Hama Yacine Ouahchi Yassine Guebsi Yassine Nouira Yosr Daly Yosra Mahjoubi Yosra Mejdoub Yosra Mosbahi Yosra Said Yosra Zaimi Yosra Zgueb Yousr Dridi Yousra Mesbahi Youssef Gharbi Youssef Hellal Z Hechmi Z Zid Z Elmouatassim Z Ghorbel Z Habbadi Zahra Marrakchi Zaki Hidouri Zeineb Abbes Zeineb Ouhachi Zied Khessairi Zied Khlayfia Zied Mahjoubi Zied Moatemri

Tunis Med 2019 Jan;97(1):177-258

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January 2019

Infectious Spondylodiscitis: Keep an Eye on the Heart.

J Clin Rheumatol 2020 Oct;26(7):e223-e224

From the Department of Internal Medicine, Military Hospital, and Tunis El Manar University, Tunis, Tunisia.

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http://dx.doi.org/10.1097/RHU.0000000000001090DOI Listing
October 2020

Unusual evolution of reactive arthritis induced by BCG therapy.

Therapie 2019 12 16;74(6):685-688. Epub 2019 May 16.

Department of Internal Medicine, Military Hospital, Tunis El Manar University, 1007 Tunis, Tunisia.

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http://dx.doi.org/10.1016/j.therap.2019.01.011DOI Listing
December 2019

Osteogenesis Imperfecta Type 1: When Eyes Talk About Bones.

J Clin Rheumatol 2020 Sep;26(6):e171-e173

From the Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia.

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http://dx.doi.org/10.1097/RHU.0000000000001038DOI Listing
September 2020

[Myocarditis in Still disease treated successfully with anakinra].

Therapie 2019 Oct 2;74(5):549-553. Epub 2019 Apr 2.

Service de médecine interne, hôpital militaire principal d'instruction, Montfleury, 1008, Tunis, Tunisie.

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http://dx.doi.org/10.1016/j.therap.2019.03.001DOI Listing
October 2019

[Toxocariasis: a possible cause of acute pancreatitis?]

Pan Afr Med J 2018 28;29:180. Epub 2018 Mar 28.

Service de Médecine Interne, Hôpital Militaire de Tunis, Tunisie.

Human toxocariasis is a cosmopolitan parasitic zoonosis caused by Toxocara canis and Toxocara cati which are roundworms of dogs and cats. It is mostly a benign condition. We here report a case of acute pancreatitis secondary to toxocariasis.
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http://dx.doi.org/10.11604/pamj.2018.29.180.9630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057587PMC
August 2018

Preoperative assessment in pulmonary resection surgery.

Tunis Med 2017 Dec;95(12):229-234

Pulmonary resection can be associated with a significant risk of morbidity and mortality, which depends on the nature and extent of pulmonary resection but also on the patient himself. This risk can be apprehended by a preoperative assessment which estimates the immediate operative risk as well as the physiological state and the post-operative quality of life which can require more conservative therapies. Currently, preoperative exploration of a patient is based on various technological tools, which can range from simple electrocardiogram or simple spirometry to a complex exploration such as a cardiorespiratory effort test. These multiple evaluation tools require the rationalization of good practice processes according to international recommendations, taking into account the patient's specificity and the country context. This approach makes it possible to prioritize examinations according to their availability and accessibility in order to identify patients with high operative risk and to offer them an appropriate therapeutic choice.
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December 2017