Najet Bel Hadj

Faculty of Medecine of Tunis, Tunis-Ville, Tūnis, Tunisia

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Publications (13)0.87 Total impact

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    ABSTRACT: Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. The aim of this study is to evaluate the prevalence of MHE in patients with liver cirrhosis and analyze risk factors. Between September 2011 and December 2012, consecutive cirrhotic patients seen in our department were evaluated. Patients included were screened by the psychometric hepatic encephalopathy score (PHES) battery comprising 5 tests: number connection test A and B, line tracing test, serial dotting test and digit symbol test. Patients included were regularly followed-up for the development of overt hepatic encephalopathy, driving accidents, falls and death. We included 45 cirrhotic patients. Etiology of cirrhosis was viral in half of cases. Child-Pugh score was A in 55.6 %, B in 26.7 % and C in 17.8 %. Median Meld score was 14. According to the PHES score, MHE was detected in 44.4 % of patients. Univariate analysis identified 4 variables significantly associated with the presence of MHE: age≥55years (P=0.031), poor educational status with years of study<9years (P=0.007), MELD score≥15 (P=0.002) and Child-Pugh≥7 (P=0.001). At multivariate analysis, the only independent risk factor of MHE was a MELD score≥15 (OR=15.4; P<0.001). During the follow-up, patients with MHE developed more often overt encephalopathy, falls and driving accidents, and had a lower survival, although the difference was not statically significant. In this preliminary small series, prevalence of MHE in Tunisian cirrhotic patient was 44.4 %. A MELD score≥15 was the only independent risk factor. MHE had a negative impact on the outcome, justifying an early diagnostic. Adequate therapy may improve cognitive function.
    La Presse Médicale 04/2014; · 0.87 Impact Factor
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    ABSTRACT: Background and aims Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. The aim of this study is to evaluate the prevalence of MHE in patients with liver cirrhosis and analyze risk factors. Methods Between September 2011 and December 2012, consecutive cirrhotic patients seen in our department were evaluated. Patients included were screened by the psychometric hepatic encephalopathy score (PHES) battery comprising 5 tests: number connection test A and B, line tracing test, serial dotting test and digit symbol test. Patients included were regularly followed-up for the development of overt hepatic encephalopathy, driving accidents, falls and death. Results We included 45 cirrhotic patients. Etiology of cirrhosis was viral in half of cases. Child-Pugh score was A in 55.6 %, B in 26.7 % and C in 17.8 %. Median Meld score was 14. According to the PHES score, MHE was detected in 44.4 % of patients. Univariate analysis identified 4 variables significantly associated with the presence of MHE: age ≥ 55 years (P = 0.031), poor educational status with years of study < 9 years (P = 0.007), MELD score ≥ 15 (P = 0.002) and Child-Pugh ≥ 7 (P = 0.001). At multivariate analysis, the only independent risk factor of MHE was a MELD score ≥ 15 (OR = 15.4; P < 0.001). During the follow-up, patients with MHE developed more often overt encephalopathy, falls and driving accidents, and had a lower survival, although the difference was not statically significant. Conclusion In this preliminary small series, prevalence of MHE in Tunisian cirrhotic patient was 44.4 %. A MELD score ≥ 15 was the only independent risk factor. MHE had a negative impact on the outcome, justifying an early diagnostic. Adequate therapy may improve cognitive function. Ce qui était connu•L’encéphalopathie hépatique minime (EHM) représente le stade le moins sévère des anomalies neuro-cognitives compliquant la cirrhose.•Elle n’est pas détectable par un examen neurologique conventionnel.•Sa prévalence et son impact pronostique sont sous-estimés du fait de son caractère latent.Ce qu’apporte l’article•Le « psychometric hepatic encephalopathy score » (PHES) est un test simple et validé qui permet de diagnostiquer une EHM en pratique courante.•L’EHM est fréquente et liée à la sévérité de la cirrhose.•Son retentissement sur le pronostic n’est pas négligeable, justifiant un diagnostic et une prise en charge précoce.
    La Presse Médicale. 01/2014;
  • La Tunisie médicale 01/2014; 92(1):42-43.
  • La Tunisie médicale 12/2013; 91(12):748-50.
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    ABSTRACT: Toxic megacolon is a rare and serious complication of Crohn's disease. Because of the associated high morbidity and mortality, early recognition and management of toxic megacolon is important. Through two cases of toxic megacolon complicating Crohn's disease, we assessed the clinical, radiologic and therapeutic characteristics of this complication. A 35-year-old man presented a first course of Crohn's disease treated with corticosteroid. He exhibited sudden severe abdominal pain and distension with shock. A plain abdominal radiography revealed toxic megacolon. He underwent medical therapy, but symptoms not relieved. The patient underwent subtotal colectomy with ileostomy. The resected specimen confirmed the diagnosis. Recovery of digestive continuity was performed. Endoscopic evaluation six months later did not shown recurrence. A 57-year-old man presented with severe acute colitis inaugurating Crohn's disease, was treated with corticosteroid and antibiotics. He exhibited signs of general peritonitis. Computed tomographic examination revealed toxic megacolon with free perforation, showing prominent dilation of the transverse colon and linear pneumatosis. The patient underwent emergent subtotal colectomy and ileostomy. The final histological patterns were consisting with diagnosis of Crohn's disease associated with cytomegalovirus infection. The patient underwent antiviral therapy during 15 days. Because of the high risk of postoperative recurrence, he underwent immunosuppressive therapy. Recovery of digestive continuity was performed successfully. Toxic megacolon in Crohn's disease is a serious turning of this disease. We underscore the importance of early diagnosis of toxic megacolon and rapid surgical intervention if improvement is not observed on medical therapy.
    Clinics and practice. 08/2013; 3(2):e24.
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    ABSTRACT: Background: The Budd-Chiari syndrome is a rare disease, often fatal if not treated optimally. It is characterized by a blocked hepatic venous outflow tract. aim: This review attempted to present pathophysiology, aetiologies,diagnosis and therapeutic modalities of the Budd-Chiari syndrome. methods: Review of literature. results: Budd-Chiari syndrome is a complex disease with a wide spectrum of aetiologies and presentations. Hematologic abnormalities, particularly myeloproliferative disorders, are the most common causes of the Budd-Chiari syndrome. The clinical presentation is governed by the extent and rapidity of the hepatic vein occlusion. Doppler-ultrasound, computed tomography or magnetic resonance imaging of hepatic veins and inferior vena cava are usually successful in demonstrating non-invasively the obstacle or its consequences. A therapeutic strategy has been proposed where anticoagulation, correction of risk factors, diuretics and prophylaxis for portal hypertension are used first; then angioplasty for shortlength venous stenosis; then Transjugular Intrahepatic Portosystemic Shunt (TIPS); and ultimately liver transplantation. Treatment progression is dictated by the response to previous therapy. This strategy has achieved 5-year survival rates approaching 70%.Medium-term prognosis depends on the severity of liver disease. Conclusion: The diagnosis of the Budd-Chiari syndrome must be considered in any patients with acute or chronic liver disease. Management of this syndrome should follow a step by step strategy.
    La Tunisie médicale 06/2013; 91(6):376-81.
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    ABSTRACT: Hepatic encephalopathy (HE) is a common long term complication of porto-systemic shunt. We report herein the case of a 59-year-old man with Child-Pugh A cirrhosis treated successfully 9 years earlier with distal splenorenal shunt for uncontrolled variceal bleeding. In the last year, he developed a severe and persistent hepatic encephalopathy secondary to the shunt, which was resistant to medical therapy. As liver transplantation was not available and obliteration of the shunt was hazardous, we performed subtotal colectomy in order to reduce ammonia production. This therapeutic option proved successful, as the grade of encephalopathy decreased and the patient improved. Our experience indicates that colonic exclusion should be considered as an option in the management of HE refractory to medical treatment in highly selected patients when liver transplantation is not available or even as a bridge given the long waiting time on lists.
    Clinics and practice. 01/2013; 3(1):e4.
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    ABSTRACT: To determinate factors that contribute to the steatosis's formation in chronic hepatitis B, to evaluate its influence on the development of hepatic fibrosis and to research an eventual relation to virologic factors in a Tunisian cohort of patients. All patients with chronic hepatitis B confirmed by data of liver biopsy were included in this study, which was enrolled from 1990 to 2006. The studied parameters were: age, gender, body mass index, transaminases, cholesterol, triglycerides, glycaemia and DNA rate, status HBe antigen and the degree of activity and histological fibrosis was estimated according to the score of METAVIR. Fifteen patients (34.1%) among the 44 patients includes in this study had hepatic steatosis; that was mild in 10 patients (66.6%), moderate in 3 cases (20%) and severe in 2 patients (13.4%). The antigen HBe was negative in 27 patients (62.22%). The mean age of the patients having a steatosis was of 32.33 years versus 27.75 years for those who had no it (p=0.185). The transaminases rate was superior in patients with steatosis than those without, the difference was not significant. Univariate correlation between predictor variables was studied. Significant predictors to steatosis included body mass index (p=0.011) and cholesterol (p=0.037). HBe Ag status was not associated with steatosis. Neither activity nor fibrosis was correlated with steatosis. In Tunisian patients, factors contributing to the formation of steatosis during the chronic hepatitis B were the body mass index and the rate of cholesterol. The steatosis did not seem to have an influence on the development of the hepatic fibrosis and seems to be independent on the viral effect.
    La Tunisie médicale 12/2008; 86(11):1000-3.
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    ABSTRACT: Digestive epilepsy is a vegetative comitial at the origin of abdominal pain that can dress a variety of clinical pictures returning its diagnosis difficult. Gastroenterologists and abdominal surgeons poorly recognize this entity. To determine clinical characteristics of digestive epilepsy and its therapeutic modalities. Patient and We report the particular case of an epileptic 36-year-old patient who came in emergency twice in a pseudo-surgical abdominal picture having brought to a laparotomy. The diagnosis of digestive epilepsy was carried in front of a beam of clinical arguments and the negativity of explorations. An anti-convulsive treatment allowed the decline of the symptomatology. Digestive epilepsy can be presented as a pseudo-surgical abdominal picture, so it is important to think about before surgery when there is a stereotyped symptomatology and whether the diagnosis of epilepsy is known or not.
    La Tunisie médicale 09/2008; 86(8):758-60.
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    ABSTRACT: The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma. Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively. Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%. The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.
    La Tunisie médicale 12/2006; 84(11):701-4.
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    ABSTRACT: Endoscopic sphincterotomy is a well-established procedure for treating choledocolithiasis and particularly residual lithiasis. The aim of this study is to expose our experience with this method and to evaluate his safety and efficacy. It is a retrospectively collected series of 661 patients with residual choledocolithiasis. Endoscopic retrograde cholangio-pancreatographies were performed in 651 patients (98.5%). Standard sphincterotomy was realized in 633 patients (95%) and a pre-cut technique was done in 15 (2%). Bile duct clearance was achieved in 583 cases (91%). Overall, the complication rate of sphincterotomy was about 8.4%. Endoscopic sphincterotomy is a safe and effective procedure for patients with residual choledocolithiasis.
    La Tunisie médicale 02/2005; 83(1):13-7.
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    ABSTRACT: In this retrospective study, 78 patients with acute biliary pancreatitis underwent endoscopic retrograde cholangio-pancreatography (31 men, 47 women; median age 61 years). It was a severe pancreatitis in 70% cases. The median time from admission to endoscopic sphincterotomy was 4 days. Endoscopic sphincterotomy was performed in 73 patients (93.3%). Bile duct clearance was achieved in 69 patients (88.37%). Overall, the complication rate was 7%. All the patients recovered after endoscopic sphincterotomy. Surgery was necessary in 40% cases.
    La Tunisie médicale 11/2003; 81(10):794-7.
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    ABSTRACT: The eradication of oesophageal varices by binding became the best traitment for the bleeding by rupture of the verices. She tends to substitute the sclerosis because of her fast delay of eradication and her fewer complications and gravity. The incidence of complications after the binding vary between 3.3 and 11%. The most frequent complication is the appearance of oesophageal ulcers that sometimes causes bleeding. A dysphagia can happen within a few hours after the binding. Infections are rare. We report two cases of pharyngeal mucosae binding occurring during the binding of the varices.
    La Tunisie médicale 10/2002; 80(9):562-4.