Publications by authors named "N Mehiri"

32 Publications

[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

[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

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

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

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

[Tuberculous pseudotumour, a challenging diagnosis].

Rev Mal Respir 2018 Mar 5;35(3):295-304. Epub 2018 Apr 5.

Université de Tunis El Manar, faculté de Médecine de Tunis, CHU Mongi Slim, service de pneumologie allergologie (unité de recherche 12SP06), La Marsa, Tunisie.

Introduction: The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation.

Methods: We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor.

Results: Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment.

Conclusion: Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.
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http://dx.doi.org/10.1016/j.rmr.2017.03.038DOI Listing
March 2018

Contribution of fixed-dose combinations in the treatment of tuberculosis.

Tunis Med 2016 Jul;94(7):401-405

Background - The introduction of fixed-dose combinations (FDCs) of TB treatment in Tunisia is recent (July 2009). WHO and the National Tuberculosis Programme recommend the use of fixed-dose combination (FDC) tablets for the treatment of tuberculosis (TB). The effectiveness of ADF has been demonstrated, however the risk of relapse and tolerance were controversial. Objective - Through a retrospective study, we evaluate, the contribution of FDCs compared with dissociated treatment (TD) (efficacy, tolerance and the occurrence of relapses). Patients and methods - This is a retrospective study conducted in the Department of Pneumology la Rabta. Are included patients with pulmonary tuberculosis (TB) first attack. Two groups were studied: Group I (TC) treated between July 2009 and June 2011 who received ADF. Group II (TD) treated between July 2008 and June 2009 who received TB dissociated treatment. Results - One hundred and seventy one patients were included: 122 in the TC group with an average age of 39.2 years and 49 patients in the TD group with an average age of 38.2 years. Male predominance was observed in the two groups (82/75.5%). The period of apyrexia was below 7 days at more than 80% of patients in the two groups. Sputum smears conversion were obtained between one and two months (median 52,8 vs 55,8 days) in both groups with no significant difference (p = 0.06). The rate of smears conversion at 2 months was 74% in TC group versus 65.3 % (p = 0.12). Eighty patients (65%) of the TC group and 29 patients (59%) of the TD group had one or more adverse effects to treatment without significant difference (p = 0.270). The most common adverse effects were those related to digestive system (17.2% vs 6.1%), liver toxicity (7.4% vs 4.1 %) and urticaria (9.8% vs 8.1%). The treatment successful rate was: 73.7 % in TC group and 77.5 % in TD group. There was no significant difference in treatment compliance, neither in relapse rate nor in the death rate. Conclusion - This study demonstrated non-inferiority of the effectiveness of ADF with a comparable safety. Its effects in the prevention of relapse and resistance BK remain unproven.
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July 2016

Role of metalloproteinases MMP-2 in asthma.

Tunis Med 2016 Jun;94(6):167-171

Background - Many metalloproteinases (MMPs) play a role in the pathogenesis and modulation of the severity of asthma. MMP-9 is the predominant in asthma but other MMPs are involved such as the MMP-2. Aim - To determine the role of single nucleotide polymorphism of the gene MMP2 in susceptibility to asthma and its severity. Methods - Study case-control with prospectively enrolled patients with asthma and healthy subjects. We determined within two groups genotypes corresponding to the MMP2 polymorphism in -735C / T position, using a polymerase chain amplification technique associated with a polymorphism in the length of restriction fragments. Results - We included 150 patients with asthma and 150 healthy controls. Comparison of allele and genotype frequencies of the studied polymorphisms between patients and controls showed that there was no association between the SNP-735C / T and susceptibility to asthma and its severity. Conclusion - The role of MMP 2 in asthma remains unclear and no study has been conducted till date, to determine the role of MMP-2 -735C/T gene polymorphism in asthma. This study does not disprove such association. Further studies are needed to clarify the exact role the pathogenesis of asthma.
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June 2016

Abstracts of the Communications of the Sixteenth Francophone Allergology Meetings Hammamet, 4-7 October 2017.

Authors:
A Abdelghani M Abouda K Adelmoulah C Aichaouia Nadia Ajmi A Akad Ines Akrout Jamel Ammar Zeineb Amouri S Aouadi Hichem Aouina A Aounallah S Atitallah H Ayadi N Ayadi Sirine Ayadi Saloua Azzabi Mohamed Ali Baccar N Bahloul B Bdira D Bejar M Beji C Belajouza I Belhadj Rafik Belhaja H Ben Abdelghaffar Jihen Ben Amar E Ben Jemia L Ben Mahmoud Amani Ben Mansour M Ben Romdhane A Ben Saad H Ben Saad S Ben Saad N Ben Salah Nawel Ben Salem A Ben Tkhayat M Benzarti Anissa Berraïes Hamdi Besma Hayet Bouakkez M Bouhoula K Boussetta L Boussoffara Hanene Bouzekri A Brahem I Brini N Chaouech Ilhem Charfeddine M R Charfi Rihab Charrad S Chatti R Cheikh S Cheikh M'hamed S Cheikh Rouhou Hela Cherif J Cherif S Dabboussi Hafaoua Daghfous J Daghfous Awatef Dahmouni M Denguezli Besma Dhahri Joseph Djaman Allico L Douik El Gharbi Leila El Gharbi S El Guedr A El Kamel O El Maalel Leila Elfekih Maha Essalah N Fahem R Fessi W Fki R Gammoudi A Garrouch N Ghariani H Gharsalli H Ghedira Abdelmoneem Ghorbel H Ghozzi Najla Ghrairi Dorra Greb Y Gribaa S Guedri A Gueriani E Guermazi Chaima Habouria S Hadj Hassine S Hajjej Bassma Hamdi B Hamdia Amal Hammami S Hamouda Agnes Hamzaoui Kamel Hamzaoui Hela Hassen M Hayouni A Hedhli Y Houaneb Marghli S Jdidi S Joober Wajih Kaabachi I Kacem R Kaddoussi H Kalboussi Nesrine Kallel Souha Kallel S Kammoun Hela Kamoun H Kchouk W Ketata M Khadhraoui F Khalsi A Khattab Amin Khbou Z Khessain Z Khessari R Khmekhem I Khouaja H Khouani Z Khssairi Eudes Kpan Sea H Kwas Oussema Lahmer L Loued Sabrine Louhaichi B Louzir S M'saad S Maalej Sarra Maazaoui M Maoua Donies Masmoudi N H Mbarek Mohamed Lamine Megdiche N Mehiri I Mejri S Mhamdi M Mjid N Mkaouar Z Moatemri S Mokni N Mrizak Jean David N'guessan R Nouira Y Ouahchi S Oujani Sawsen Raies Sonia Rouatbi N Rouetbi H Rouis D Sakka Mariem Salhi M Slama Hanen Smadhi H Snene N Souissi A Tabboubi F Tinsa S Toujeni G Trigui M Triki Fatma Tritar Sadok Yalaoui F Yangui I Yangui Chiaye Yapo-Crezoit Haifa Zaibi A Zaim Ines Zayani K Zayen I Zendah

Tunis Med 2017 Aug - Sep;95(8-9):806-836

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June 2018

The Z-score: A new tool in the interpretation of spirometric data.

Tunis Med 2017 Aug - Sep;95(8-9):767-771

Spirometry is an important tool in the diagnosis and management of patients with respiratory pathology. An appropriate interpretation of the spirometric data requires the use of a population-specific reference equation. However, the most widely used equations were established in European populations with limited age groups. The extrapolation of these equations, based on a specific population, and their uses for a different population led to measurement and interpretation biases. In 2012, an international working group conducted a multicenter study and published new reference equations called The Global Lung Initiative (GLI). These enabled the modeling of spirometric parameters from a very large sample collected in several ethnic groups using modern statistical techniques to establish continuous equations for all ages and in many countries. The GLI also recommends the use of a new statistical tool for the expression of results: The Z-score. This tool allows to express, in a simple way: how many standard deviations a subject is deviated from its reference value. The Z-score is calculated by the ratio of the difference between the measured value and that predicted with the residual standard deviation. This simple approach has reduced the false positive results found by the use of the conventional limits of 80% compared to a predicted value or 0.70 in absolute value for the definition of bronchial obstruction that remain still used.
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July 2019

Drug Rash with Eosinophilia and Systemic Symptoms to antituberculosis treatment.

Tunis Med 2015 Oct;93(10):590-3

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome reflects a serious hypersensitivity reaction to drugs. This syndrome is an uncommon adverse reaction due to antituberculosis drugs and is sometimes difficult to identify the culprit agent. We report a case of a 45-year-old woman who received combined antituberculosis drugs (RHZE) for lymph node tuberculosis. Clinical manifestations included fever, dyspnea, rash, hypereosinophilia and visceral involvement (liver involvment). After symptom resolution and biology normalization, anti-tuberculosis drugs were reintroduced successively one after another. Systemic symptoms reappeared with the four anti-tuberculosis drugs. The clinical outcome was favorable with second line antituberculosis treatment.
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October 2015

[Diagnosis delay of pleural and pulmonary tuberculosis].

Rev Pneumol Clin 2014 Aug 27;70(4):189-94. Epub 2014 May 27.

Service de pneumologie allergologie, unité de recherche 99/UR/08-21, faculté de médecine de Tunis, université de Tunis El Manar, CHU La Rabta, 1007 Tunis, Tunisie.

Tuberculosis (TB) is still being endemic in our country. Time until management determines both evolution and prognosis of this condition. The aim of this work is to evaluate the delay in diagnosis of TB in a respiratory unit from a university hospital series. The authors conducted a cross-sectional study including patients with pulmonary TBC and/or pleural. An evaluation of time management was conducted from the beginning of symptoms and various consultations with reference to the date of hospitalization and treatment set up. One hundred patients were included (pulmonary TB: 68 cases, pleural TB 23 cases, miliary pulmonary TB: 4 cases, pulmonary TB associated with other extrathoracic locations: 5 cases). The mean time of patient delay and total delay institution were respectively 43.6, 25.7 and 69.3 days. Variables responsible for long delays were: number of consultations more than 3 before hospitalization, empirical antibiotic therapy, of a regional hospital first consultation and the presence of extra-respiratory impairment. The patient delay was considered long. A reorganization of the TB control program, in particular by partial decentralization of care and health education is imperative in order to improve the quality of tuberculosis management in our country.
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http://dx.doi.org/10.1016/j.pneumo.2013.10.005DOI Listing
August 2014

[Diagnosis approach of pulmonary embolism].

Tunis Med 2012 Nov;90(11):759-63

Service de Pneumologie-Allergologie, Hopital Mongi Slim.

Background: Pulmonary embolism (PE) is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not helpful in diagnosis of PE.Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization ofa confirming examination.

Aim: To precise the confirming examinations of PE and propose analgorithm based on clinical prediction rules in combination with D-Dimers.

Methods: A Pub Med search was conducted using the following keywords: pulmonary embolism,computed tomogramphy pulmonary angiography, scintigraphy and D Dimer. The study was based on are view of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism.

Results: Ventilation/perfusion scan is a type of examination that is used less often because it is not a widespread technology. However,it may be useful in patients who have an allergy to iodinated contrast.Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis (DVT) may help the diagnosis approach particularly when other exams are not available or contraindicated.This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive.A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE.

Conclusion: D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability
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November 2012

[Sarcoidosis in Tunisia: epidemiologic and clinical study].

Tunis Med 2011 Apr;89(4):332-5

Service De Pneumologie Allergologie.

Background: The epidemiologic study of sarcoidosis is problematic and differing incidences across the world are reported. In Tunisia, the incidence of this affection is yet unknown. This is at least attributable to the lack of large series and the overshadowing presence of tuberculosis.

Aim: To determine presenting signs, symptoms and investigations particularities.

Methods: We report a retrospective series patients with sarcoidosis followed up in the Rabta university hospital between 1991 and 2005 and try to determine presenting signs, symptoms and investigations particularities.

Results: 131 patients (79 women and 52 men) with a median age of 47 ± 14 years were reviewed. They were symptomatic in 95 % of cases. Cutaneous symptoms were present at onset in 56.8 %, respiratory symptoms in 48.6 % and general symptoms in 41.6 %. Thoracic presentation was observed in 81.3%. Chest X-ray changes and tomodensitometry showed that type II and III were predominant. Lung function was disturbed in 58.5% of the cases. Extrathoracic involvement, observed in 89.3 % of the cases, was largely dominated by cutaneous lesions. Histopathological lesions provided diagnosis in 66.6%.

Conclusion: The relative high frequency of dermatological lesions suggests genetic or even environmental predisposition to develop sarcoidosis such as sunlight exposition.
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April 2011

[Sugar tumor].

Tunis Med 2011 Feb;89(2):202-5

Universite Tunis, El Manar, Tunisie.

Background: Clear cell tumor of the lung is a rare and very unusual benign pulmonary tumor. This tumor is called sugar tumor because of the abundance of glycogen on its cells.

Aim: To report a case of sugar tumor and discuss clinical, evolutive features and diagnosis difficulties of this tumor.

Case Report: A case of 75 years old woman presenting as a round pulmonary opacity. Computed tomography (CT) scans showed in the left lower lobe a solitary pulmonary solid tumor with central calcifications. The patient underwent tumor resection. Pathologic examination, including immunohistochemical studies, revealed a benign clear cell tumor, so-called "sugar tumor".

Conclusion: It's the second case reported in Tunisia. This very rare tumor of the lung is characterized by some immunohistological features. Its evolution is favourable after surgery.
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February 2011

Transitory, spontaneously recovering, peripheral facial nerve palsy after vionorelbine administration.

Tunis Med 2010 Jul;88(7):513-6

Service de Pneumologie Allergologie, Hôpital La Rabta Bab Saodun 1006, Tunis, Tunisie.

Background: Vinorelbine is a semi-synthetic vinca alkaloid that has demonstrated a broad spectrum of activity. It is widely used in non small cell lung cancer.

Case Report: We report the case of a 50 year old man, having stage IV lung carcinoma with a unique cerebral metastasis in the right hemisphere. Focal cerebral radiotherapy was first administrated followed by intravenous chemotherapy associating vinorelbine to cisplatin. He has developed multiple subsequent and transitory episodes of monolateral peripheral facial nerve palsy in the left side during vinorelbine administration. The palsy has completely and spontaneously resolved at a short interval, around twenty minutes, after the end of the drug infusion. Obvious cerebral tumor progression was excluded by means of CT scan; the drug was thereby administrated as scheduled until the end of the treatment.

Conclusion: We describe an unusual side effect, until now reported in only two cases, having brain-stem gliomas, among English and French literature, dealing with vinorelbine as adjuvant treatment. We discuss possible neurological and oncological implications.
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July 2010

[Pulmonary arteriovenous malformation in a bronchoscopy simulating a carcinoid tumour].

Rev Pneumol Clin 2010 Jun 6;66(3):201-3. Epub 2009 Nov 6.

Service de pneumologie et d'allergologie, hôpital la Rabta, 1007 Tunis, Tunisie.

The authors report a case of pulmonary arteriovenous malformation in a 48-year-old man. The bronchoscopy revealed a fragile lingular tumoral formation. The diagnosis was based on the thoracotomy and the histopathological findings. The endoscopic features and the different diagnostic options of pulmonary arteriovenous malformation are discussed.
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http://dx.doi.org/10.1016/j.pneumo.2009.09.003DOI Listing
June 2010

[Pulmonary tuberculosis in child].

Tunis Med 2008 May;86(5):497-9

Service de Pneumologie-Allergologie, CHU La Rabta.

Pulmonary tuberculosis is a major public health problem in the world and particularly in Tunisia. Child is not saved by this illness. The pulmonary tuberculosis present epidemiological and diagnosis specificity in child, especially characterized by difficulty diagnosis at this age. It is also characterised by therapeutic difficulties.
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May 2008

Rosai and Dorfman disease with pleural involvement: case report.

ScientificWorldJournal 2008 Aug 31;8:845-7. Epub 2008 Aug 31.

Service de Pneumologie Allergologie, Centre Hospitalo-Universitaire La Rabta, 1006 Bab Saadoun Tunis (Tunisie).

Sinus histiocytosis with massive lymphadenopathy (SHLM) disease is considered to be an indolent and self-limiting pathology. However, severe morbidity and mortality have been attributed to complications of SHLM. Lower respiratory tract involvement is rarely reported and is often unfavorable, and carries a particularly grave prognosis. A case of SHLM is reported, in which the patient had lower respiratory and pleural involvement.
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http://dx.doi.org/10.1100/tsw.2008.97DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848776PMC
August 2008

[Exercise induced anaphylaxis].

Tunis Med 2008 Jan;86(1):78-81

Service de Pneumologie Allergologie, Centre Hospitalo, Universitaire de la Rabta, Tunis, Tunisie.

Background: Exercise-induced anaphylaxis (EIA) is a rare physical allergy, sometimes severe, triggered by exertion following specific food intake. Although described several years ago, this condition is not well known; the diagnosis is frequently made several years after follow up.

The Aim: To describe the physiopathologic mechanism, etiologic factors, clinical manifestations and diagnostic means.

Methods: Review of the literature.

Results: It is likely that execise induce the release of a sufficient amount of mediators from mast IgE dependant cells exceeding a certain threshold. A number of food trigger have been suggested in EIA, the most commonly reported agent is wheat which has to be systematically looked for. A range of physical activities have been associated with EIA. Intensive physical activities are more likely to provoke an attack than less strenuous ones. The recognition of specific food causative role do not indicate the avoidance of food intake but exercise is forbidden within the four hours following specific aliment ingestion.

Conclusion: Further studies seem to be necessary to clarify the mechanism of food dependent exercise-induced anaphylaxis.
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January 2008

[Excavated right pleuro-pneumopathy with fever].

Rev Pneumol Clin 2005 Apr;61(2):119-21

Service de Pneumologie-Allergologie, Centre Hospitalo-Universitaire de la Rabta, Bab Saadoun, 1006 Tunis, Tunisia.

Respiratory manifestations are rarely observed in pyonephrosis. We report a new case revealed by lower respiratory infection with Escherichia coli empyema. Ultrasound and computed tomography rectified the diagnosis.
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http://dx.doi.org/10.1016/s0761-8417(05)84799-6DOI Listing
April 2005

[Pseudo-tumoral aspergilloma].

Rev Pneumol Clin 2001 Dec;57(6):431-3

Service de Pneumologie Allergologie, Centre Hospitalo-Universitaire de la Rabta, 1006 Bab Saadoun Tunis.

Aspergilloma is the most common form of pulmonary aspergillosis, generally developing pre-existing lung cavities. Fiberoptic bronchoscopy is required in case of hemoptysis. We report the case of a 74-year-old man with pulmonary aspergilloma where fiberoptic bronchoscopy visualized mycetoma and cavitation. Visualization and biopsy of the fungus ball during fiberoptic bronchoscopy is rare.
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December 2001

[Basis and guidelines for empirical antibody therapy in the management of community-acquired pneumonia].

Tunis Med 2001 Oct;79(10):491-7

Service de Pneumologie Allergologie, Centre Hospitalo-Universitaire de La Rabta, Tunis.

The choice of the antibiotic should be based on clinical, chest X-ray radiography and essentially microbiologic criteria. Incurrent practice treatment is more often empiric based on epidemiologic characteristics of the microbiologic agents and the particularities of each patient. A satisfactory approach requires, in addition, a perfect knowledge of different available antibiotics and the resistance of certain etiologic pathogens to these latters. because S. Pneumoniae is the most frequently encountered pathogen, B lactams and especially Penicillin G. and amoxicillin remain the most useful drugs prescribed for adults with risk factors. However, in advanced age patients and those with comorbidity, the spectrum should be enlarged and should include, besides S. Pneumoniae, H. influenzae and other Gram negative bacilli. When the pneumonia is more severe and has required hospitalization, the antimicrobial therapy must be immediate, multiple and large. The causal agent must be searched for desperately, so that the antimicrobial therapy can be adapted secondary to the results of the antibiogram.
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October 2001

[Severe chronic hypoxemia in cirrhosis].

Tunis Med 2001 Feb;79(2):125-8

Service de Pneumologie Allergologie, Centre Hospitalo-Universitaire de La Rabta.

In the course of cirrhosis, severe chronic hypoxemia (< 60 mmHg) is exceptional, it is the most often in contact with intrapulmonary vascular anomalies and necessitates complex investigations. Authors reported a case of 16-years old patient, breach of cirrhosis with underdevelopment and that presents a severe chronic respiratory insufficiency not improved by the addition of oxygen. The different practiced explorations are in favor of an hepatopulmonary syndrome secondary probably to intrapulmonary shunting.
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February 2001