La Tunisie médicale (Tunis Med)

Publisher: Ordre des médecins de Tunisie; Société tunisienne des sciences médicales

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Other titles Tunisie Medicale
ISSN 0041-4131
OCLC 2268769
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: Background: Ataxia-telangiectasia (A-T) is a multisystem disorder characterized by progressive neurologic impairment, variable immunodeficiency, impaired organ maturation, X-ray hypersensitivity, oculocutaneous telangiectasia, and a predisposition to malignancy. Aim: We performed this study in order to describe clinical, immunological and molecular features of patients with AT followed in the south of Tunisia Methods: we performed a retrospective study (1996-2012) in the south of Tunisia about all cases of A-T in order to describe their clinical, immunological and molecular features. Results: 11 cases of AT were found. The mean age at onset of symptoms was 20 months with extremes varying from 3 months to 4 years. The median time to diagnosis was 3.6 years (range: 0-12 years).The main clinical feature of cerebellar syndrome, ataxia, was present at diagnosis in 8 patients and occurred at mean ages of 2.8 years. Ocular telangiectasia occurred at a mean age of 3.9 years (extremes: 3 months and 7 years). Recurrent sino-pulmonary infections that affected 7 children occurred at the mean age of 4.3 years. The most common humoral immune abnormality was serum IgA deficiency. Lymphopenia was found in 7 cases and lack of CD4 T in 6 cases. Cytogenetic analyses showed chromosomal instability in all children and a translocation (7-14) in two patients. A molecular diagnosis established in 6 patients from 4 families showed 5 different mutations of ATM gene. After an average decline of 5 years and 6 months, 7 patients died of severe pulmonary infection. Among them, 3 were ATM mutated. Conclusion: Morbidity and mortality among patients with A- T are associated with ATM genotype.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: to assess clinical factors that may influence the prognosis of malignant melanoma of the uvea Methods: We conducted a retrospective study from January 1990 to December 2013, involving 80 patients suffering from malignant melanoma of the uvea. We determined the location, the size, the tumor thickness, the clinicopathological aspect, the degree of pigmentation of the uveal melanoma, and associated signs Results: Factors significantly associated with poor prognosis were: a tumor location (p = 0.01), the infiltrative or fungus aspect (p = 0.001), a diameter equal to or larger than 10 mm (p = 0.003), the thickness greater than or equal to 5 mm (p = 10-3), achromatic or hyperpigmented melanomas (p = 0.02) and retinal detachment (p = 10-3). Conclusion: Clinical prognostic factors are important to know because they determine the evolutionary profile and the metastatic potential of the uveal melanoma.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Methods: We analyzed 70 questions: 16 (exam"A") given to 533 students (1st year), 28 and 26 (exams"B1" and "B2") given respectively to 285 and 292 students (3rd year). For every question, we determined difficulty and discrimination indices and the highest cognitive level required to resolve it. We calculated mean difficulty and discrimination indices for each exam and cognitive level, and mean indices of discrimination for every difficulty degree. Results: The 70 questions were of optimum difficulty (0.58), good discrimination (0.31) and explored mainly (58.57%) the lowest cognitive level. For both years, mean indices of difficulty were acceptable, while those of discrimination were good (0.33) and marginal (0.27) for respectively 3rd and 1st year. "A" explored Lower Orders of Cognitive Skills (LOCS), "B2" both Lower and High Orders and "B1" all orders. Mean difficulty indices of every cognitive level were acceptable except for the median one (0.83). Mean discrimination indices were good for all cognitive levels except for LOCS of the 1st year (0.27). Mean indices of discrimination were marginal (0.29) for difficult questions and good for others. Compared to B2, B1 was more attainable and discriminative, free of poor discrimination questions, and explored all cognitive orders. Conclusion: Our study remains specific to particular questions and generalizations seem difficult. However, it can serve as a guideline to other similar studies.
    No preview · Article · Jan 2016 · La Tunisie médicale

  • No preview · Article · Jan 2016 · La Tunisie médicale

  • No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Introduction: Cutaneous metastasis of gastric tumors are very rare. Their topography is generally near to the primitive tumor, in the abdominal wall but rarely in cervical region. Aim: the aim of our study was to describe the topography and the clinic-pathological characteristics of cutaneous metastasis of ring cells gastric adenocarcinoma. Observation1: Our first patient is aged of 33 years has epigastralgias and vomiting. Gastric adenocarcinoma with independent cells was diagnosed by gastroscopy and gastric biopsy made for gastric pain and loss of weigh. During hospitalization, he developed 4 cutaneous nodes localized in cervical region. Cutaneous biopsy with histological examination confirmed the metastatic nature of the nodes. Patient was addressed in oncology unit in order to begin palliative systemic chemotherapy. Observation 2: Our second patient is a women aged of 4 3years who had surgical resection for independent cell gastric carcinoma diagnosed by gastroscpy and biopsy for gastric pain and loss of weigh. She had total gastrectomy without any complications and was addressed in oncology unit for adjuvant chemotherapy. After 2 years, she developed peritoneal carcinosis and cutaneous abdominal nodes. Cutaneous metastasis were confirmed by histological examination of cutaneous biopsy and the patient died within one month. Conclusion: Cutaneous metastasis of gastric cancer and especially ring cell adenocarcinoma are rare but do occur. They must be early diagnosed because they modify therapeutic options. Their prognosis remains poor.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: Upper gastrointestinal endoscopy (UGE) is an increasing and reliable procedure. Given the high costs and potential risks, appropriate indication of UGE may be facilitated by referring to qualifying criteria such as those devised by the European Panel (EPAGE). This prospective study evaluates the applicability and efficacy of these criteria in clinical practice. Methods: Cross sectional study. Consecutive patients were referred to our unit endoscopy for diagnostic upper gastrointestinal endoscopy between January 2011 and June 2011. Demographic data, indication of the procedure, and endoscopic diagnosis were collected. The appropriateness of UGE was assessed based on EPAGE II criteria before the procedure. Results: EPAGE criteria were applicable in 89.1% of cases. They were 78 men (48.1%) and mean age was 49 years [14 - 91]. Indications for UGE were extremely appropriate, appropriate, inappropriate and uncertain in 21.6%, 47.4%%, 8.8% and 22.2% respectively. Among patients with clinically significant lesions detected by UGE, 70.7% had an appropriate indication. Clinically significant lesions were disclosed in 59% of the appropriate group and 54% of the inappropriate group. All cancers were observed in patients with appropriate indications. Patients with appropriate indication were older than patients belonging to the inappropriate group (53.6 years versus 39.9 years, p =0,0001). Conclusion: In this present study, EPAGE criteria were applicable in 89.1% and indication was judged appropriate in more than two-third of cases. However, clinical significant lesions were observed in a proportion of patients with inappropriate indication, and in some relevant clinical situations EPAGE criteria were not applicable. Therefore, even if these criteria are helpful for decision-making, final decision must however rely upon practitioner. Qualifying criteria for an appropriate selection of endoscopical procedure adapted to our population are advisable.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: Lamotrigine is an effective anticonvulsant drug used in the treatment of epilepsy. It has a narrow therapeutic range, a large inter and intra-individual pharmacokinetic variability and some concentration-dependent side effects. Aim: The aim of this study was to develop and validate a new method for lamotrigine quantitation in plasma using HPLC with UV/visible detection. Methods: A rapid HPLC-UV method was developed for the determination of lamotrigine in plasma. All solvents used were HPLC grade. Results: After liquid-liquid extraction, chromatographic separation was achieved using an RP 18 (250 mm) column. The mobile phase was composed of acetonitrile and 0.1 M potassium dihyrogenophosphate (25/75) (v/v). Barbital sodium was used as internal standard. This technique was linear over the 2 μg/mL to 50 μg/mL range (r= 0.99). Detection and quantification limits were 0.07 μg/mL and 0.21 μg/mL, respectively. Within-day coefficient of variation (13.37 to 16 %) and day-to-day coefficients of variation (15.68 to 16.63 %) at three different concentrations. Under these conditions, each analysis required no longer than 10 min. We finally evaluated the plasma concentrations of lamotrigine in Tunisian patients treated with this drug. Conclusion: The results found are similar to those previously described and the developed method is repeatable and reproducible. It can be used for clinical applications.
    No preview · Article · Jan 2016 · La Tunisie médicale

  • No preview · Article · Jan 2016 · La Tunisie médicale

  • No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: (PSMA+,PSA+) and (PSMA+,PSA-) are the two most individual clones that we have previously identified during prostate cancer (PC) progression. However, molecular signatures associated with these distinct PSMA-PSA prostate clones and their specific correlation with disease outcome is yet to be defined. Aim: Since Akt is a major pathway involved in the critical activating events that leads to malignant form of the disease, we studied the involvement of full Akt activation (T308+,S473+) connected with serum PSA levels, tissue PSMA expression and angiogenic activity on the emergence of (PSMA+,PSA+) and (PSMA+,PSA-) PC clones. Methods: The study was carried out in 6 normal prostate, 25 benign prostate hyperplasia (BPH) and 23 (PC). Immunohistochemical analysis was performed to study the expression of PSMA, PSA, pAkt(T308), pAkt(S473) and CD34 in prostate tissues. The evaluation of angiogenesis was made by CD34 immune marker. Serum levels of PSA were assayed by Immulite autoanalyser. Results: The most relevant result showed that, among PC patients with pAkt (T308+,S473+) profile, patients that exhibit the (PSMA+,PSA+) clone have .higher serum PSA levels, tissue PSMA expression and angiogenic activity than those with (PSMA+,PSA-) clone. Although have the same (PSMA+,PSA+) prostate clone, BPH patients have distinct molecular-biological features compared to PC patients among pAkt (T308+,S473+) profile. In fact, among patients with maximal Akt activation, the (PSMA+,PSA+) PC clone is characterized by higher serum PSA levels, tissue PSMA production and intensive angiogenic activity than (PSMA+,PSA+) BPH clone. Conclusion: These findings emphasize the potential role of the full Akt activation (T308+,S473+) in expansion of several PSMA-PSA prostate clones capable of driving both human PC initiation as well as progression to a metastatic phenotype. Pinpoint patients according to PSMA-PSA clones could recapitulate the histological and molecular features of human PC and may offer a novel approach for controlling metastasis.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: The frequency of cystic fibrosis is unknown in Tunisia, regarding the limited number of reported surveys and patients. Aim: to determine the clinical characteristics, outcome and genetic data of cystic fibrosis in Tunisian pediatric patients. Methods: Cases of cystic fibrosis managed at pediatric departments of Tunis, during 15 years (1997-2012), were reviewed. Results: 33 children (23 males and 10 females) were enrolled. The Onset was within the first year of life in 26 patients. Revealing symptoms were the following: recurrent bronchopneumonia (28 cases), chronic diarrhea (17 cases), hepatomegaly (6 cases), malnutrition (15 cases), pseudo Bartter syndrome (3 cases), edemaanemia- hypoprotidemia (4 cases) and meconium ileus (4 cases). The diagnosis was confirmed by sweat test and genotypic data, the F508 del was the most frequent mutation (17 cases). Several complications had occurred during follow-up: chronic pseudomonas aeruginosa infection (15 cases), chronic respiratory failure (14 cases), recurrent hemoptysis (2 cases), pleural effusion (3 cases) and cirrhosis (2 cases). Ten patients died at a mean age of 7 years. One patient had pulmonary transplantation. Prenatal diagnosis was performed in 9 families. Conclusion: In Tunisia, cystic fibrosis is not exceptional, but its diagnosis is delayed. Our survey is characterized by more severe earliest forms, difficult and insufficient therapeutic management. A Better medical awareness and a national action plan are needed.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: Radiation therapy plays an essential role in the management of pain caused by bone metastases Objectives: Evaluate the effect of radiation for the relief of pain caused by bone metastases. Methods: We conducted a prospective study of 86 patients suffering from pain associated with bone metastases treated at our department by external radiotherapy between September 2010 and December 2011. Patients recorded pain severity in the numeric rating scale and analgesic requirements before, at the end of irradiation, then weekly for a month, and every month for a year. Results: The median age of patients was 54 years (28-75 years). There were 45 (52.3%) women and 41 (47.7%) men. Radiotherapy was delivered in a multifraction schedule to a total dose of 30 Gy in 72% of patients or in a single fraction of 8 Gy in 28% of patients. A favorable analgesic response was observed in 59 (68.6%) patients with 8 (9.3%) complete responses and 51 (59.3%) partial responses. The median time-to-response was 2 weeks (0-7 weeks), and the median duration of pain relief was 22 weeks (9-46 weeks). Conclusion: Radiotherapy is effective in relieving pain associated with bone metastases in the majority of patients.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: BCR-ABL negative myeloproliferative neoplasms (MPN) include polycythemia Vera (PV), essential thrombocythemia (ET) and primitive myelofibrosis (PMF). the JAK2 V617F mutation has been introduced since 2008 as a major diagnostic criterion on the one hand and on the other hand, it would be linked to increased risk of thrombotic complications. Aim: This study aimed to evaluate the association of JAK2 mutation and thrombotic events in MPN. Methods: A retrospective study concerning 45 BCR-ABL negative MPN patients (mean age=53 old years, sex ratio=0.8) was conducted. Results: They were classified as PV (22 patients), ET (17 patients), PMF (3 patients) and atypical MPN (3 patients). The JAK2 mutation was found in 64.4% of patients: 72.7% of PV patients, 47% of ET patients and 66.7% of PMF patients. Thrombotic events were recorded in 11 patients (24.4%). Cerebral arteries and portal vein were the most frequent localizations. The JAK2 mutation was an independent risk factor of thrombotic events. Conclusion: Consequently, it seems that screening for JAK2 mutation in BCR-ABL negative MPN could play a role in identifying patients at high risk of vascular complications.
    No preview · Article · Jan 2016 · La Tunisie médicale
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    ABSTRACT: Background: The pollen-foods syndrome is rare and of difficult diagnosis. The aim is to report a rare case, it's the four case reported in the literature. Case report: A 48-year-old woman presenting with palatal itching and generalized urticaria following ingestion of olive fruit, 5 years after being diagnosed with olive pollinosis. She did not have a history of other food allergy or urticaria. The prick-test was positive in olive pollen.The olive pollen specific IgE was positive. The oral provocation test was positive for olives and negative for olive oil. The diagnosis of "pollen-food olive-olive syndrome" was accepted. Interestingly, in this rare case the patient developed olive fruit allergy in the presence of olive pollinosis, but did not experience allergic symptoms to fruits other than olive. Conclusion: In spite its rarity this syndrome should be evoke particularly in our country.
    No preview · Article · Nov 2015 · La Tunisie médicale

  • No preview · Article · Nov 2015 · La Tunisie médicale

  • No preview · Article · Nov 2015 · La Tunisie médicale