Taoufik Najjar

Hôpital Charles-Nicolle, Tunis-Ville, Tūnis, Tunisia

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Publications (123)77.13 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the association between the HLA-G 14bp dele-tion/insertion (Del/Ins) polymorphism and soluble (s) HLA-G production in patients with Crohn's disease (CD). We analyzed also the sHLA-G molecules by ELISA and Western Blot in plasma samples. Among unselected patients, the 14bp Del/Ins polymorphism was not sig-nificantly associated with increased Crohn's disease risk neither for alleles (p=0.371) nor for genotypes (p=0.625). However, a significant association was reported between the 14bp Del/Ins polymorphism and CD, in particular in young-onset CD patients for alleles (p=0.020, OR= 2.438, 95%CI: 1.13-5.25) but not with adult-onset CD patients. A significant associa-tion was reported concerning the genotype Ins/Ins for young-onset CD patients (p=0.029, OR=3.257, 95%CI:1.08-9.77). We observed also a significant increase in sHLA-G dosed by ELISA in CD patients compared to controls (p=0.002). The 14bp Del/Del and 14bp Del/Ins genotypes are the high HLA-G producers. Among sHLA-G(positive) patients, a 43% of subjects present dimers of HLA-G. The presence of dimers seems to be related to the advanced stages of the disease. The 14bp Del/Ins polymorphism is associated with an increased risk of CD particularly in young-onset CD patients and controls sHLA-G plasma levels. Dimers of sHLA-G are frequent in advanced disease stages. The above findings indicate that the genetic 14bp Del/Ins polymorphism in the exon 8 of HLA-G gene is associated with the risk of CD, and suggest a role for sHLA-G as prognostic marker for progressive disease. © The Japanese Society for Immunology. 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    International Immunology 01/2015; · 3.18 Impact Factor
  • La Revue de Médecine Interne 06/2014; 35:A192. · 1.32 Impact Factor
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    ABSTRACT: Many classification systems are currently used for histological evaluation of the severity of chronic viral hepatitis, including the Ishak and Metavir scores, but there is not a consensus classification. The objective of this work was to study the intra and inter-observers agreement of these two scores in the histopathological analysis of liver biopsies in patients with chronic viral hepatitis B or C. Fifty nine patients were included in the study, 26 had chronic hepatitis C and 33 had chronic hepatitis B. To investigate the inter-observers agreement, the liver biopsies were analyzed separately by two pathologists without prior consensus reading. The two pathologists conducted then a consensual reading before reviewing all cases independently. Cohen's kappa coefficient was calculated and in case of asymmetry Spearman's rho coefficient. Before the consensus reading, the agreement was moderate for the analysis of histological activity with both scores (Metavir: kappa=0.41, Ishak: rho=0.58). For the analysis of fibrosis, the agreement was good with both scores (Metavir: kappa=0.61, Ishak: rho=0.86). The consensus reading has improved the reproducibility of the activity that has become good with both scores (Metavir: kappa=0.77, Ishak: rho=0.76). For fibrosis improvement was observed with the Ishak score which agreement became excellent (kappa=0.81). In conclusion, we recommend in routine practice, a combined score: Metavir for activity and Ishak for fibrosis and to make a double reading for each biopsy.
    Annales de biologie clinique. 02/2014; 72(1):57-60.
  • La Tunisie médicale 12/2013; 91(12):741-2.
  • La Tunisie médicale 10/2013; 91(10):619-20.
  • La Tunisie médicale 09/2013; 91(9):562-3.
  • La Tunisie médicale 07/2013; 91(7):474-6.
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    ABSTRACT: aim: To investigate the characteristics of urolithiasis associated with Crohn's disease (CD) in a sample of Tunisian population. methods: We retrospectively studied 184 patients with CD to reveal any urolithiasis during evolution. Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography and computed tomography. results: Renal calculi were found in only three patients with CD. All patients were woman. Mean time from diagnosis of CD to diagnosis of calculi was 22 months (range 6 to 48 months). Clinical features were not specific. Calculi were bilateral in two cases. Conclusions: The rate of concurrent urolithiasis was very low in the present series of Tunisian patients. Although rare, efficient treatment and prevention of calculi formation are mandatory in CD patients'.
    La Tunisie médicale 07/2013; 91(7):440-3.
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    ABSTRACT: Background: Deterioration of renal function in cirrhotic patients with spontaneous bacterial peritonitis (SBP) is a predictor for inhospital mortality. However, the clinical significance of renal dysfunction during bacterial infection other than SBP is unknown. aim: To investigate the prevalence and clinical significance of renal dysfunction due to bacterial infections other than SBP in patients with liver cirrhosis. methods: Retrospective data from in-patients with bacterial infections other than SBP were analyzed. results: Eighty-two patients were recruited for the analysis. Infection was located in urinary tract (41.5%), pneumonia (34.1%), biliary tract (3.7%), cellulitis (6.1%), gastrointestinal tract (4.9%) and bacteremia of unknown origin (9.7%). Renal dysfunction developed in 40 patients (48.8%), of which 13 patients had irreversible renal dysfunction. In the univariate and multivariate analysis, the initial MELD score, neutrophil count, bilirubin, and blood pressure were significant risk factors for renal dysfunction. Conclusion: The prevalence of renal dysfunction during bacterial infection other than SBP in patients with liver cirrhosis was 48.8%, and its development was related to the severity of the liver disease. Occurrence of irreversible renal dysfunction seemed to affect the prognosis of these patients.
    La Tunisie médicale 06/2013; 91(6):391-5.
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    ABSTRACT: Malignant epithelioid hemangioendothelioma (EH) is a rare tumor of vascular origin. We report a case of a woman who was found to have multiple hepatic masses in the right lobe of the liver on radiologic investigations, initially misdiagnosed as a metastatic carcinoma. The diagnosis of EH was made on histopathological study and confirmed by immunohistochemistry, which showed diffuse response for CD34 marker and no response to tissue CEA, HMB-45 or S-100 protein. Partial hepatectomy was made with good results.
    Oman medical journal. 03/2013; 28(2):135-137.
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    ABSTRACT: Background: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. Aim: To describe epidemiological patterns of hepatitis C in Tunisia. Methods: Literature review. Results: In Tunisia, the prevalence of HCV infection is about 0, 7 % in the general population with an increased transmission in the north of the country. Genotype 1b is the most frequent (76 % - 88 %).
    La Tunisie médicale 02/2013; 91(2):86-91.
  • La Tunisie médicale 12/2012; 90(12):894.
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    ABSTRACT: Background: Infections are frequent in cirrhotic patients. They are potentially severe, modifying pejoratively the natural history of the cirrhosis and are suppliers of a heavy mortality. Aim: To determine the predictive factors of hospital mortality in cirrhotic infected patients. Methods: We conducted a retrospective study including 97 cirrhotic patients hospitalized in the department of gastroenterology of Charles Nicolle's hospital, for a first infectious episode and not having received antibiotics in the previous 15 days. Clinico-biological, bacteriological, therapeutic and evolutionary data were collected. Scores were adopted and calculated such as the score of Child-Pugh, the score MELD (The Model for End-Stage Liver Disease) and the score SOFA (Sequential Organ Failure Assessment). These data allowed a descriptive study and an uni and multi-varied analysis. Results: The median age of the studied population was of 59 ± 12 years with a sex ratio of 0.83. The diabetes was the comorbidity most frequently associated with the cirrhosis (26.8 % of the cases) Viral aetiology of the cirrhosis was dominant (3/4 of the cases) especially the virus C (62.5 % of the cases). The clinical presentation of the infection was polymorphic with presence of symptoms connected to the infection and the other connected to the progression of the liver disease. The fever was absent in 3/4 of the cases. The identified infections were, in order of frequency, urinary, infection of ascite, bronchopulmonary, cutaneous and gynecological. The responsible germs were especially bacilli gram negative of intestinal origin. The estimated scores of gravity were: a score of Child-Pugh C in 60 % of the cases, an average score MELD in 18±8 points and a score average SOFA in 8 ± 4 points. Multivariate study found that only encephalopathy, bilirubin level more than 40 μmol/l and creatinin level more than 120 μmol/l was independent factors predicting mortality. Conclusion: Infection in cirrhotic patients was a severe and mortal complication. The hepatic encephalopathy, the hyper bilirubinemia and the renal failure are predictive of the hospital mortality. The use of the scores of gravity: Child-Pugh, MELD and SOFA would an important help for the decision to admit in intensive care unit any infected cirrhotic patient.
    La Tunisie médicale 11/2012; 90(11):807-11.
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    ABSTRACT: In this study, we evaluated the prevalence of the most common mutations occurring in Enhancer II (EnhII), Basal Core Promoter (BCP), Precore (PC), and Core (C) regions of hepatitis B virus (HBV) genome. We also investigated the correlation between HBV variants, their genotypes, and patients' HBe antigen (HBeAg: soluble shape of the capsid antigen) status. We retrieved viral DNA from 40 serum samples of Tunisian patients positive for hepatitis B surface antigen (HBsAg) and HBV DNA, amplified the above mentioned regions using specific primers, and sequenced the corresponding PCR (polymerase chain reaction) products. For further analysis purpose, the patients were divided into two groups: Group1 including 34 HBeAg-negative patients and Group2 with 6 HBeAg-positive patients. Twenty-one patients (52.5%) showed PC G1896A mutation and 11 (27.5%) carried A1762T/G1764A double mutations. These mutations were more frequent in HBeAg-negative patients than that in HBeAg-positive ones. Indeed, 58.8% of patients bearing G1896A mutation were HBeAg-negative while 16.7% were positive. In patients bearing T1762/A1764 double mutation, 29.4% were positive and 16.7% were negative. In addition, the A1896 mutation was restricted to HBV isolates that had wild-type T1858, while C1858 was rather linked to the occurrence of T1762/A1764 mutation. Interestingly, this study revealed a high frequency of genotype E. This frequency was important as compared to that of genotype D known to be predominant in the country as delineated in previous studies. Previous results supported and showed that HBV strains present in Tunisia belonging to genotype D and, to a lesser extent, to genotype E, were prone to mutations in BCP/ PC regions. This observation was more obvious in HBV isolates from asymptomatic chronic carriers (AsC). The high mutational rates observed in our study might result from a mechanism of viral escape that plays an important role in the loss of HBeAg.
    Hepatitis Monthly 11/2012; 12(11):e6191. · 1.80 Impact Factor
  • La Tunisie médicale 08/2012; 90(8):667-8.
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    ABSTRACT: Hepatocellular carcinoma (HCC) is the most frequent primitive hepatic tumor, the fifth most common cancer in the world,and the third highest cause of cancer-related mortality. The presence of cirrhosis is the main risk factor.Aim: To describe the epidemiological, clinical and therapeutic features of HCC. Retrospective study including all the patients with HCC occurring in cirrhotic liver followed in the gastroenterological department of Charles Nicolle hospital between 1997 and 2009. A hundred and one patient were enrolled; 64 men and 37 women with a median age of 65.4 years (31-88 years). Cirrhosis was due to viral hepatitis B or C in 25.7% and 62.2% of cases respectively and was classified Child Pugh A, B and C in 30.7%,50.5% and 18.8% of patients respectively. HCC was inaugural in most cases (68.3 %) and it was revealed by a tumoral syndrome in 38.6% of cases, by decompensation in 22.7% and was discovered during systematic screening when cirrhosis was already known in 19.8% of cases. Diagnosis of HCC was non invasive, relying on imaging and alphafetoprotein in most cases (95%). 84 patients(83.2%) had an advanced HCC, with vascular or extra hepatic spread in 58 (57.5%) of them. Treatment was curative in 14 cases, based on surgical resection in one case and percutaneous ablation in 13 cases.Six patients received transarterial chemoembolization as a palliative treatment. In 71 patients, only symptomatic treatment was given. The median survival time was 11 months. In the majority of the cases, HCC was diagnosed at an advanced stage and treatment was only symptomatic.
    La Tunisie médicale 06/2012; 90(6):468-72.
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    ABSTRACT: Congenital megacaecum is a rare entity and difficult to diagnose. The pathogenesis of this malformation is not well known since there are very few cases reported in the literature. The purpose of this observation is to describe the functional signs that may suggest this rare diagnosis and the means to confirm it. We report the case of a 22-year-old young man, who complained of constipation associated with pelvic pain in the form of gravitational pull exacerbated by standing, sitting and going down the stairs. However, symptoms seemed to be relieved by supine positions. The radiological investigations concluded that the megacaecum dipped into the pelvis, but there was no evidence of mechanical or functional obstruction distally. The treatment consisted of a laparoscopic right colectomy. The postoperative course was uneventful. The megacaecum is rare and poorly understood. The abdominal pain is directly related to fecal stasis, which increases the pressure on cecal colonic segment and this in turn causes a pull on the mesentery. The entero-MRI is valuable in the diagnosis so as to eliminate other causes of chronic abdominal pain.
    Gastroentérologie Clinique et Biologique 05/2012; · 0.80 Impact Factor
  • La Tunisie médicale 03/2012; 90(3):271-3.
  • Revue du Rhumatisme 03/2012;
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    ABSTRACT: Introduction La pseudo-obstruction intestinale chronique (POIC) désigne un syndrome clinique évoquant une obstruction mécanique de l’intestin grêle sans obstacle. Il s’agit d’une affection peu fréquente et grave d’origine primitive ou secondaire. La maladie cœliaque en constitue une étiologie rare. Nous en rapportons une observation. Observation Il s’agissait d’une patiente âgée de 36 ans, sans antécédents pathologiques notables, qui avait été hospitalisée à plusieurs reprises en chirurgie pour des syndromes occlusifs à répétition cédant sous aspiration digestive. Elle était opérée pour suspicion de volvulus du sigmoïde, diagnostic infirmé en peropératoire. Une POIC était suspectée. L’examen clinique était normal. La biologie avait objectivé une anémie ferriprive sans autres signes carentiels. La fibroscopie oesogastroduodénale était normale, alors que la jéjunoscopie avait mis en évidence un aspect en mosaïque des plis jéjunaux avec une atrophie villositaire totale à l’examen histologique. La sérologie de la maladie cœliaque était positive. La coloscopie ainsi que les biopsies coliques systématiques étaient normales. La patiente était mise sous régime sans gluten avec une évolution clinicobiologique favorable. Conclusion La maladie cœliaque est une cause rare de pseudo-obstruction intestinale d’origine secondaire. C’est une étiologie à ne pas méconnaître, particulièrement chez l’enfant et l’adulte jeune.
    Journal Africain d?Hépato-Gastroentérologie 12/2011; 5(4).

Publication Stats

214 Citations
77.13 Total Impact Points


  • 1991–2013
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia
  • 2012
    • Centre de Biotechnologie, Technopole Borj Cédria
      Hamman-Lif, Tūnis, Tunisia
  • 1997
    • Faculty of Medecine of Tunis
      Tunis-Ville, Tūnis, Tunisia