[show abstract][hide abstract] ABSTRACT: Background
Toll-like receptor 4 (TLR4) and its co-receptor CD14 play a major role in innate immunity by recognizing PAMPs and signal the activation of adaptive responses. These receptors can recognize endogenous ligands mainly auto-antigens. In addition, TLR4 (Asp299Gly) and CD14 (C/T -159) polymorphisms (SNPs) may modify qualitatively and/or quantitatively their expression. Therefore, they could be implied in autoimmune diseases and can influence both susceptibility and severity of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
Patients and methods
TLR4 (Asp299Gly) and CD14 (C/T -159) SNPs were genotyped using polymerase chain reaction (PCR)-RFLP in 127 SLE patients, 100 RA patients, and 114 healthy controls matched in age and gender.
CD14*T allele was significantly more frequent in SLE patients (0.456) comparatively to controls (0.355), p = 0.02 OR (95% CI) = 1.53 [1.04-2.24]. In RA patients, the higher frequency of CD14*T allele (0.405) failed to reach significance, p = 0.28. Investigation of the TLR4 (Asp299Gly) SNP showed no significant association neither with SLE nor with RA.
Analysis of these SNPs according to clinical and biological features showed a significant higher frequency of arthritis in SLE patients carrying CD14*T/T genotype (92%) comparatively to those with C/C and C/T genotypes (72.5%), p = 0.04. Moreover, SLE patients carrying CD14*T/T/TLR4*A/A haplotype had significantly more arthritis (91.3%) than the rest of SLE group (73%), p = 0,044 and confirmed by multivariable analysis after adjustment according to age and gender, p = 0.01.
The CD14 (-159)*T allele seems to be associated with susceptibility to SLE and arthritis occurrence.
[show abstract][hide abstract] ABSTRACT: Takayasu disease is rarely associated with other autoimmune diseases. Therefore, the cases discussued herein are uncommon because we are reporting Takayasu disease associated with rheumatoid polyarthritis and spondylarthropathy. The first case concerns a 40-year-old woman presenting with Takayasu disease 11 years after the diagnosis of erosive and seronegative rheumatoid polyarthritis. The upper limb arteries and 1 lower limb artery were affected. The second 41-year-old case presented with ankylosing spondylitis that had been evolving for 10 years. Human leukocyte antigen-B27 typing was negative. Takayasu disease was revealed by severe high blood pressure. In both cases, radiologic examination revealed a typical aspect of the aorta and its main collaterals. Rarely in the literature have these associations been reported, and the pathology remains unknown.
Annals of Vascular Surgery 04/2013; 27(3):353.e1-6. · 0.99 Impact Factor
[show abstract][hide abstract] ABSTRACT: Dermatophytes are keratinophilic and usually infect the corneal layer of the epidermis and appendages On the occasion of immunosuppression, such as solid organ transplant, they can invade deeper tissues or cause an infection of the skin and subcutaneous disseminated. Aim: To report the first observation of subcutaneous dematophytosis in a Tunisian renal transplant patient.
A 29-year-old man had an erythematous lesion of 2 cm at the front of the left leg. He was treated with prednisone and tacrolimus. The skin lesion was has been neglected. The outcome was the occurrence of oozing whose mycological examination showed numerous hyphae and culture was positive for Microsporum canis. Initial treatment was voriconazole, but an interaction with tacrolimus has shortened the duration of treatment to 1 month. Three months later, the lesion became deeper, and then a biopsy was performed. The mycological examination showed the same appearance, previously described. The patient was put on fluconazole by adjusting the doses of tacrolimus and then underwent surgical excision of the lesions. The evolution after 4 months of antifungal treatment was favorable.
The increasing incidence of immunosuppressive therapy has given rise to unusual clinical forms of invasive and sometimes serious fungal agents whose pathogenicity is usually limited. Clinicians should be mindful of superficial fungal infections of the skin in a renal transplant patient.
[show abstract][hide abstract] ABSTRACT: Posttransplant diabetes mellitus (PTDM) is a common, serious complication of renal transplantation. The aim of this retrospective study was to estimate the incidence and to identify potential factors predisposing to PTDM.
We evaluated 296 adult nondiabetic patients who underwent kidney transplantation at our center. PTDM was defined according to 2003 international consensus guidelines. Potential factors predisposing to PTDM were analyzed individually and simultaneously using a logistic regression model.
Over 2054.5 years of cumulative follow-up, 51 patients (17.2%) developed diabetes corresponding to an annual incidence of 2.5%. PTDM was diagnosed after a median of 2.9 months (range: 0.2-168). The mean age of affect individuals was 33.3±7.4 years. Patients with PTDM were significantly older (P<.0005) and showed an higher body mass index (BMI; P<.004). Univariate analysis revealed that age, BMI, family history of diabetes, vascular nephropathy, and hepatitis C infection were associated with PTDM. Multivariate analysis rescaled the roles of age (relative risk [RR]=1.046/y; P<.04), BMI (RR=1.107/kg/m2, P<.05), vascular nephropathy (RR=7.06, P<.03), and hepatitis C infection (RR=2.72, P<.03) as independent factors predisposing to PTDM.
Among our relatively young kidney transplant recipients, in whom only 8% received tacrolimus, PTDM was a frequent complication. We suggest that the use of oral glucose tolerance tests to screen patients identifies those predisposed to develop this complication.
[show abstract][hide abstract] ABSTRACT: Primary hyperparathyroidism revealed by a pathological fracture is very uncommon. We present a case of a 54-year-old female patient who was admitted with fracture of her right femur. She underwent closed intramedullary reconstruction nailing with bipolar locking. The pathological findings confirmed the diagnosis of primary hyperparathyroidism with brown tumor. Further tests showed increased both calcium level and PTH level. A parathyroidectomy was performed. She made an uneventful recovery and was discharged to home.
Case reports in orthopedics. 01/2011; 2011:521578.
[show abstract][hide abstract] ABSTRACT: Renal involvement in the Behcet's disease is rare. The clinical features vary from urinary sediment's abnormalities to ESRD.
We propose to study the clinical, biological and histological data, the therapeutic management and the prognosis of patients.
We report a retrospective study including 8 patients representing 1.23 % of cases.
The average age of the patient was of 37 +/- 12. 35 years with a clear male prevalence. Urinary signs were discovered fortuitously by the strips in the majority of the cases after an average of 18 months. It's about proteinuria and hematuria. Renal insufficiency and hypertension were rare. Pathological study highlighted 3 cases of amyloidosis, 2 cases of IgA nephropathy, 1 case of minimal change disease, 1 case of endo and extracapillary glomerulonephritis and 1 case of interstitial nephropathy. Patients having GN were treated by corticoids and immunosuppressive agents and those having an interstitial nephropathy were treated symptomatically with good evolution in the majority of the cases. Only one patient is dead, he had amyloidosis. Prognosis depended on the precocity of the diagnosis, the histological type and the treatment.
The renal involvement during Behçet's disease is rare. Amyloidosis and Ig A nephropathy are the most frequent. Treatment is still controversial.
[show abstract][hide abstract] ABSTRACT: Diabetic nephropathy (DN) is the single greatest cause of end-stage renal disease (ESRD). Without specific interventions, microalbuminuria (incipient nephropathy) gradually progresses to macroalbuminuria (overt nephropathy) within 10-15 years in about 80% of type 1 and 30% of type 2 diabetic patients, and to ESRD within further 20 years in about 75% and 20%, respectively. A primary alteration in DN consists of decreased concentration of glycosaminoglycans (GAGs) in the glomerular extracellular matrix. This evidence has prompted interest in using exogenous GAGs and specifically sulodexide in DN treatment.
In this uncontrolled multicenter study, diabetic patients with albumin excretion rate (AER) >or=30 mg/24 hours were treated with oral sulodexide 50 mg/day for 6 months, while receiving concomitant medication as required. Two hundred thirty-seven patients (54% males and 46% females, mean age 55 years, mean diabetes duration 11 years) were evaluated; 89% had type 2 and 11% type 1 diabetes mellitus, 67% microalbuminuria and 33% macroalbuminuria.
AER was significantly and progressively reduced during sulodexide treatment (p<0.0001): geometric mean after 3 and 6 months was 63.7% (95% confidence interval [95% CI], 59.3%-68.4%) and 42.7% (95% CI, 37.8%-48.2%) of baseline, respectively. The reduction was similar in type 1 and type 2 diabetes and was slightly greater in macroalbuminuric than in microalbuminuric patients. Blood pressure was slightly lowered, while fasting glucose and glycosylated hemoglobin were moderately reduced. Adverse effects were observed in 5.5% of patients, including gastrointestinal in 3.8%.
Sulodexide therapy was shown to reduce AER in patients with DN.
Journal of nephrology 02/2010; 23(4):415-24. · 2.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Patients with severe renal dysfunction have unexplained elevated serum concentrations of cardiac troponin T.
Study the frequency of elevated cTnT in hemodialysis patients and investigated whether cTnT is elevated.
The patient population consisted of 52 patients on maintenance hemodialysis and 20 healthy subjects. cTnT was measured before and after hemodialysis by using immunoenzymatic method. cTnT were undetectable in 7 cases(< 0.01 ng/ml) and higher than normal range (up to 0.1 ng/ml) in 9 cases. 32 cases have a level of cTnT > 0.01 and < 0.1 ng/ml. In addition, TnTc levels are significantly associated with cardiac dysfunction (p < 0.05) and inflammation (p 0.01).
After hemodialysis sessions, TnTc was less than 0.01 ng/1 in 11 patients (21.2%), between 0.01 and 0.1 ng/ml in 32 subjects (61.5%) and greater than 0.1 ng/ml in 9 subjects (17.3%). In the control group, only 1 subject (5%) had a rate of TnTc between 0.01 and 0.1 ng/ml, whereas it was less than 0.01 ng/ml for all others. We aim a statistically significant positive correlation between the rate of TnTc and heart failure (p < 0.05) on the one hand and serum CRP (p < 0.01) on the other.
The causes of elevated cTnT levels in hemodialysis patients was multiple: cardiac dysfunction, left ventricular dysfunction and inflammation.
[show abstract][hide abstract] ABSTRACT: Amyloidosis in Behçet's disease is rare and has a poor outcome.
Report a new case.
We report a case of a 38-year-old Tunisian woman who presented with Behçet's disease and nephrotic syndrome. Renal biopsy showed amyloid deposition consistent with AA type. She had not any associated disease that might be an additional cause of secondary amyloidosis. She was treated by colchicine. After 3 years, proteinuria had disappeared and persisted negative 11 years after the diagnosis. A second renal biopsy showed the persistence of amyloidosis.
As amyloidosis is one of the prognostic factors affecting survival in Behçet's disease, patients with this disease should be screened for amyloidosis. Administration of colchicine to these patients may be beneficial.
[show abstract][hide abstract] ABSTRACT: To analyse and discuss cardiovascular manifestations of ankylosing spondylitis, evaluate the frequency and giving special attention to unusual forms.
We retrospectively reviewed the medical records of 21 cases with cardiovascular manifestations among 210 cases of ankylosing spondylitis seen over a 25 years period who met the Amor criteria.
Cardiovascular complications were found in 21 patients (10%): 5 (2.40%) had aortic insufficiency, 2 (0.95%) had mitral insufficiency, 1 had mitral valve prolapse, 1 had pericarditis, 10 (4.7%) had atrioventricular block and 6 (2.8%) had bundle branch block. Takayasu's disease was diagnosed in one case. Cardiovascular involvement was common In patients longer disease duration. Peripheral arthritis was found in 33% and its prevalence did not differ in patients with or without cardiac involvement.
Aortic insufficiency and conduction disturbances were the most common cause of cardiovascular involvement in ankylosing spondylitis. The funding of cardiovascular manifestations in 10% of our patients suggests that in this illness evidence of cardiac manifestations should be actively investigated in ankylosing spondylitis.
[show abstract][hide abstract] ABSTRACT: To define the epidemiology, clinical, biological and histological features of renal diseases in ankylosing spondylitis, ginving special attention to unusual forms.
We retrospectively reviewed the medical record of 28 cases with renal involvement among 210 cases of ankylosing spondylitis seen over a 27 year period who met the Amor criteria.
Twenty-eight of 210 patients (13,3%) presented one or more signs of renal involvement: macroscopic hematuria (4 patients), microscopic hematuria (8 patients), proteinuria (15 patients), nephrotic syndrome (6 patients), decreased renal function (13 patients). Secondary renal amyloidosis and nephrolithiasis (8 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (3 patients).
The funding of renal abnormalities in 13,3% of our patients suggests that in this illness evidence of renal involvement should be actively investigated in ankylosing spondylitis.
La Revue de Médecine Interne 01/2006; 26(12):966-9. · 0.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: We studied the clinical, therapeutic and progressive characteristics of retroperitoneal fibrosis.
We analysed the observations of retroperitoneal fibrosis diagnosed between 1980 and 2002 in our hospital, from the summaries of 15 patients exhibiting retroperitoneal fibrosis (RPF). Therapeutical supervision was based on biology and radiology.
There were 11 men and 4 women with a mean age of 44.5 years ranging from 28-64 years. Pain was predominantly lumbar or abdominal in all patients. An inflammatory syndrome was observed in all patients and renal failure in 11. Radiological examinations revealed single or bilateral in 14 cases and the fibrosis plaque in 13 cases. Treatment consisted in corticosteroids alone in 9 patients, surgery alone in 3 cases and surgery with corticosteroids in 3 patients. Ten relapses (range: 1-5) occurred in 4 patients when corticosteroids were stopped. After a mean follow-up of 36 months (range:18 days-11 years), one death was observed, 12 patients had normal renal function and 2 patients had persistent moderate renal failure.
This study confirms the rarity of retroperitoneal fibrosis, the difficulty in its diagnosis, the frequency of pain, inflammatory syndrome and renal failure. Corticosteroids are efficient and regular follow-up is required.
La Presse Médicale 03/2005; 34(3):213-7. · 0.87 Impact Factor