H Selmi

Faculté de Médecine Ibn El Jazzar de Sousse, Susa, Sūsah, Tunisia

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Publications (28)13.82 Total impact

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    ABSTRACT: In spite of its rarity in the paediatric age, Graves' disease constitutes the principal aetiology of hyperthyroidism in child. Our goal is to analyze the clinical and evolutive particularities of Graves's disease in children. We studied retrospectively seven cases of Graves' disease in children enrolled in the pediatrics department of Sousse during ten years period (1993-2002). There were six girls and one boy (sex - ratio = 0.16) aged 4.5 to 16 years (mean age: nine years and one month). The diagnosis has been established clinically on the presence of classic symptoms of the illness associated to the biological and radiological findings. As part of research of possible associations with this illness, we observed solely in a case, in addition of Graves's disease, the coexistence of Down syndrome and coeliac disease, rarely described. Among the HLA antigens predisposing the Graves's disease, we only found HLA B8 antigen in a patient. The evolution under antithyroid drug treatment (ATD) has been marked by fast disappearance of functional signs in all patients. However, biological and clinical euthyroidism was more difficult to achieve. The treatment has been stopped in only one patient after 40 months period. Graves' disease is usually easy to recognize but difficult to treat. Radical treatments (thyroidectomy or radioactive iodine therapy) are indicated in second intention after having tempted ATD beforehand.
    La Tunisie médicale 09/2008; 86(8):728-34.
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    ABSTRACT: Analyze the clinical and evolutive particularities of complete primary distal renal tubular acidosis in children, We studied retrospectively 11 cases enrolled in the pediatrics department of Sousse during 10 years period (1993-2002). It is about 9 boys and 2 girls (sex-ratio = 45) aged 3 month to 5 years (mean age: 18 months). Diagnosis was suspected on clinical and biological data of presumption and confirmed by acidification test. Radiological investigation objectified a nephrocalcinosis in eight patients and urinary lithiasis in two other cases. Auditive exploration showed sensorineural deafness in three patients. The illness appears sporadic in two cases and autosomal recessive in nine other cases. After alkali treatment (sodium bicarbonate), evolution was globally favorable.
    La Tunisie médicale 08/2008; 86(7):629-35.
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    ABSTRACT: Analyze the clinical and evolutive particularities of Henoch Schonlein purpura in children We studied retrospectively 122 cases enrolled in the pediatrics department of Sousse during 10 years period (1992-2001). It is about 66 boys and 56 girls (sex - ratio= 1.18) aged 3 to 13 years (mean age: 7 years and half). The diagnosis has been established clinically on the presence of cutaneous syndrome with symmetrical declivitous region purpura in all patients with articular syndrome (91cases) and/or digestive syndrome (65cases). Complications were variable: digestive hemorrhage (19 cases), occlusive syndrome (2cases), renal involvement at variable severity (56 cases), scrotal and testicular complications (11 cases), cardiac complications (tamponade in a case). Henoch Schonlein purpura was associated with a primary antiphospholipid syndrome in a case, renal tuberculosis in a case and cholestatic hepatitis A in another case. All patient receeved symptomatic treatment (rest in bed + / - antalgic treatment). Digestive rest was prescribed for 20 patients presenting severe abdominal pains with corticosteroid during 2 at 4 weeks (1-2mg/kg/d) in eight cases. Corticosteroid-cyclophosphamid association was prescribed for 2 patients with severe renal involvement; one of them benefitted of extra-renal purification. One or several relapses of Henoch Schonlein purpura were noted in 13 patients. All sick evolved favorably same those presenting renal or cardiac involvement (middle receding of 5 years).
    La Tunisie médicale 01/2007; 85(1):54-60.
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    ABSTRACT: Gastrointestinal manifestations of Kawasaki disease are usually limited to stomatitis, paralytic ileus, and hydrops of the gallbladder. We report a case of Kawasaki disease complicated with hemophagocytosis and ischemic colitis. CASE REPORT: A 5-year-old girl with Kawasaki disease presented with hemophagocytosis that responded to gamma-globulin therapy. On day 4 she had abdominal pain and diarrhea. CT scan showed features suggesting ischemic colitis. Symptoms resolved on total parenteral nutrition. CONCLUSION: Ischemic colitis and hemophagocytosis are potential severe complications of Kawasaki disease.
    Archives de Pédiatrie 04/2004; 11(3):226-8. · 0.36 Impact Factor
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    ABSTRACT: In beta-thalassemia major impaired biosynthesis of beta globin leads to accumulation of unpaired alpha globin chain. An iron overload, usually observed, generates oxygen-free radicals and peroxidative tissue injury. To investigate hematological parameters, oxidative stress and the antioxidant capacity in beta-thalassemia patients compared to control subjects in order to determine their impact in several organs functions. This study was conducted on 56 beta-thalassemia major patients compared to 51 healthy subjects. We determined metabolic parameters (glycaemia, lipid parameters, electrolytes, iron indices, hepatic, renal and heart functions tests), plasmatic thiobarbituric acid reactive substances (TBARS), plasmatic peroxyl radical trapping potential (TRAP), plasmatic superoxide dismutase (SOD), erythrocyte gluthathione peroxidase (GPX), plasmatic vitamin E, vitamin A and trace elements. Except triglycerides, lipid fractions were significantly decreased in beta-thalassemia compared to controls. Serum ferritin, iron, TBARS concentrations, SOD and GPX activities were significantly increased. But TRAP, vitamin E and zinc concentrations were significantly decreased. Our findings confirm the peroxidative status generated by iron overload in beta-thalassemia major patients and highlight the rapid formation of marked amounts of TBARS and the increase of SOD and GPX activity. Our study suggested that in beta-thalassemia the first organ impaired is the liver.
    Clinica Chimica Acta 01/2004; 338(1-2):79-86. · 2.85 Impact Factor
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    ABSTRACT: Gastrointestinal manifestations of Kawasaki disease are usually limited to stomatitis, paralytic ileus, and hydrops of the gallbladder. We report a case of Kawasaki disease complicated with hemophagocytosis and ischemic colitis.Case report. – A 5-year-old girl with Kawasaki disease presented with hemophagocytosis that responded to gamma-globulin therapy. On day 4 she had abdominal pain and diarrhea. CT scan showed features suggesting ischemic colitis. Symptoms resolved on total parenteral nutrition.Conclusion. – Ischemic colitis and hemophagocytosis are potential severe complications of Kawasaki disease.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2004; 11(3):226-228.
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    ABSTRACT: Aicardi syndrome is usually associated with a very poor outcome. We report a particular case of Aicardi syndrome characterised by a partial agenesis of the corpus callosum associated with an arachnoidal interhemispheric cystic formation, and by a complete control of epilepsy and a favorable outcome regarding visual and psychomotor performances. A better prognosis could be expected in Aicardi syndrome when spasms occur lately and are not preceded by partial seizures, when agenesis of corpus callosum is partial and especially when chorioretinal lacunae are small, isolated, few and spare the macula.
    Archives de Pédiatrie 07/2003; 10(6):530-2. · 0.36 Impact Factor
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    ABSTRACT: Background. – Aicardi syndrome is usually associated with a very poor outcome.Case report. – We report a particular case of Aicardi syndrome characterised by a partial agenesis of the corpus callosum associated with an arachnoidal interhemispheric cystic formation, and by a complete control of epilepsy and a favorable outcome regarding visual and psychomotor performances.Conclusion. – A better prognosis could be expected in Aicardi syndrome when spasms occur lately and are not preceded by partial seizures, when agenesis of corpus callosum is partial and especially when chorioretinal lacunae are small, isolated , few and spare the macula.
    Archives de Pédiatrie 06/2003; 10(6):530-532. · 0.36 Impact Factor
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    ABSTRACT: Symptoms of the late infantile form of type II glycogen storage disease are mainly due to functional impairment of skeletal muscle. Cardiac muscle can be involved in the late stage of the disease. CASE REPORT: We report the cases of two siblings seven and 12 years old with type II glycogen storage disease. The initial symptoms were hypertrophic cardiomyopathy with Wolf-Parkinson-White syndrome. CONCLUSION: Hypertrophic cardiomyopathy may be the form of presentation of the late infantile form of type II glycogen storage disease. The risk of sudden death is high.
    Archives de Pédiatrie 08/2002; 9(7):697-700. · 0.36 Impact Factor
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    ABSTRACT: A child showing signs of Henoch-Schönlein purpura developed a right tibiofibular vascular thrombosis. Antiphospholipid antibody tests were positive for both lupus anticoagulant and anticardiolipin antibodies. This suggests that an antiphospholipid syndrome should be considered in cases of Henoch-Schönlein purpura and antiphospholipid antibodies should be measured to determine whether prophylactic antithrombotic measures are needed to prevent thrombotic manifestations.
    Archives of Disease in Childhood 03/2002; 86(2):132-3. · 3.05 Impact Factor
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    ABSTRACT: Symptoms of the late infantile form of type II glycogen storage disease are mainly due to functional impairment of skeletal muscle. Cardiac muscle can be involved in the late stage of the disease.Case report. – We report the cases of two siblings seven and 12 years old with type II glycogen storage disease. The initial symptoms were hypertrophic cardiomyopathy with Wolf-Parkinson-White syndrome.Conclusion. – Hypertrophic cardiomyopathy may be the form of presentation of the late infantile form of type II glycogen storage disease. The risk of sudden death is high.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2002; 9(7):697-700.
  • Archives de Pédiatrie 01/2002; 9(7). · 0.36 Impact Factor
  • La Presse Médicale 01/2002; 30(38):1880. · 0.87 Impact Factor
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    ABSTRACT: There is no data available on the cardiovascular risk of children under 18 years of age in Tunisia, although it is well known that these risk factors present themselves in childhood. The authors performed an epidemiological study based on a representative sample of 793 schoolchildren in the rural region of Sousse, in Tunisia, to determine the incidence of the following risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and smoking. The main results show that the prevalence of hypertension is 11.2% with no statistically significant difference between the sexes. The prevalence of hypercholesterolaemia (2.9%), of hyper-LDL cholesterolaemia (0.6%) and hypertriglyceridaemia (1%) were comparable in boys and girls. Obesity (BMI > 30) was observed in 1.8% of the study population and was as common in girls (1.7%) as in boys (1.9%). Smoking was recorded in 4% of the study population and was commoner in boys (7.3%) than in girls (1.2%). This cardiovascular risk profile is encouraging and efforts should be made to maintain these levels until adulthood. This data will form the basis of a regional programme for the promotion of cardiovascular health in schools.
    Archives des maladies du coeur et des vaisseaux 12/2001; 94(12):1381-5. · 0.40 Impact Factor
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    ABSTRACT: A 4-year-old female was hospitalized with clinical and electroencephalographic evidence of acute encephalopathy. Five days later the classic signs of Kawasaki disease appeared. The neurologic outcome in this female was poor despite early treatment with immunoglobulin. Like many other vasculitidies, Kawasaki disease can have predominant neurologic symptoms as the initial presentation and during the subsequent evolution of the condition.
    Pediatric Neurology 10/2001; 25(3):239-41. · 1.42 Impact Factor
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    ABSTRACT: This retrospective study includes 139 infants (74 girls and 65 boys) treated for status epilepticus at two University hospitals in Tunisia between 1990 and 1997. Their mean age was 11 months. The majority of seizures were generalized (74%) and lasted between 30 minutes and 1 hour (70%). The cause of status epilepticus was classified as acute symptomatic in 56, febrile in 57, remote symptomatic in nine, progressive neurologic in 10 and idiopathic in seven. Overall mortality was 15.8% and neurological sequelae were identified in 36% of the cases during the mean follow-up time of 3.5 years. The incidence of significant sequelae was a function of aetiology (especially acute symptomatic causes) and age (under 1 year of age). We conclude that the most frequent causes of infantile status epilepticus in Tunisia were fever and acute symptomatic causes. Status epilepticus among infants is an important public health problem, with significant associated mortality and morbidity. Management of status epilepticus can be improved by more rapid access to appropriate medical care.
    Seizure 08/2001; 10(5):365-9. · 2.00 Impact Factor
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    ABSTRACT: The authors report a retrospective study of 39 cases of Guillain-Barré syndrome in children. Including 23 boys and 16 girls. The mean age was 4 years (14 months to 10 years). A history of infection preceded the polyradiculoneuritis in 75% of cases. The mean duration of extensive phase and of the maximum paralysis was 10 days. A severe respiratory involvement was observed in 9 children and cranial nerve paralysis in 8 children. An early raised cerebrospinal fluid protein concentration was found in 95%. Electrodiagnostic studies, performed in 37 patients, showed nerve conduction velocity slowing in all cases. 28 children (73%) recovered clinically, 8 patients (20%) had residual deficits and 3 patients (7%) died.
    La Tunisie médicale 04/2001; 79(3):183-7.
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    ABSTRACT: Congenital self healing histiocytosis, described for the first time in 1973 by Hashimoto and Pritzker, is characterized by multiple violaceous brown cutaneous papulonodules present at birth and disappearing spontaneously in 2 to 4 months. There are classically no systemic manifestations and the prognosis is always good. We present a case, particular by the intensity of hemosiderinic deposits. The patient was a 2-month-old female infant. Physical examination at birth revealed a healthy-appearing full-term newborn, with five skin lesions: firm violaceous-reddish pigmented papules and nodules distributed over the head (scalp and forehead), right ear, right forearm and the flexural aspect of the left thigh. There was no hepatosplenomegaly or lymphadenopathy, and the patient's general condition was excellent. Histologic examination confirm the diagnosis by showing a dense polymorphous infiltrate composed of histiocytes associated with giant cells and erythrocytes extravasation. Perls stain was strongly positive. Staining with S100 Protein was positive. Outcome was good with involution of all lesions with atrophic and pigmented scars. The patient's excellent general condition, the absence of visceral locations and the spontaneous self healing allows us to classify this form as a benign self healing congenital histiocytosis. This patient presented intensely hemosiderinic deposits giving the lesions a strongly pigmented aspect.
    Annales de Dermatologie et de Vénéréologie 04/2001; 128(3 Pt 1):238-40. · 0.60 Impact Factor
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    ABSTRACT: Fifteen patients (9 girls and 6 boys) with different forms of cerebromeningeal tuberculosis (meningitis: 13 cases, tuberculoma: 2 cases) was reported. Their mean age was 6 years (4 months to 14 years). The initial diagnosis was difficult. Half patients had meningism, abnormal mental state and defects signs. The cerebrospinal fluid (CSF) leukocyte count was > 20/mm3, protein > 1 g/l (66%) and glucose < 2.2 mmol/l (80%). BK was isolated in 7 patients. Five patients (33%) died. Major neurological sequelae developed in 5 patients and 5 patients completely recovered. Factors predicting fatal outcome and permanent sequelae were: diagnosis delay, altered level of consciousness, hypotrophy and low glucose level in CSF.
    La Tunisie médicale 02/2001; 79(1):20-5.
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    ABSTRACT: Traumatic and non-traumatic rhabdomyolysis have been mostly reported in adults. Polymyositis rarely leads to rhabdomyolysis. CASE REPORT: We report the case of a 13-year-old girl with rhabdomyolysis. Full recovery was observed after symptomatic treatment. Nine months later she developed polymyositis. CONCLUSION: Long-term follow-up is necessary for rhabdomyolysis, even in those cases with an isolated occurrence caused by viral infection.
    Archives de Pédiatrie 02/2001; 8(1):51-4. · 0.36 Impact Factor