S. Yaich

Sirolimus for the Treatment of Kaposi Sarcoma After Renal Transplantation: A Series of 10 Cases

The incidence of Kaposi sarcoma (KS) has substantially increased among immunocompromised patients, suggesting a role for immunosuppressive drugs. The aim of this study was to evaluate the incidence, features, and outcome of KS among 307 kidney transplantation patients at our center between January 1994 and June 2010. During the study period, the 10 patients who developed KS (3.25%) showed a mean age at transplantation of 35.8 ± 8.7 years (range, 22 to 49 years). The mean interval between transplantation and occurrence of KS was 24.7 ± 21.36 months (range, 6 to 64 months). The mean time of antithymocyte globulin induction was 9.5 days (range, 6 to 13 days). KS was restricted to the skin in 7 cases, among which, one presented with associated Hodgkin lymphoma. Visceral involvement (one lung and one colon) was observed in two cases. One patient presented with a gastric KS without skin lesions. Immunosuppressive treatment was reduced, then withdrawn in three cases, resulting in regression of KS a few weeks later, but with graft loss requiring hemodialysis at 1, 3 and 4 months. Among the remaining 7 cases, we stopped mycophenalate mofetil (MMF) and switched from calcineurin inhibitors to sirolimus. Allograft function remained stable after the switch. Only one patient who already had allograft dysfunction due to biopsy-proven chronic allograft nephropathy. Deteriorated progressively, undergoing hemodialysis at 2 years after KS diagnosis. In conclusion, we observed a relatively high incidence of KS among our cases. The introduction of sirolimus resulted in complete regression of KS lesions with preserved graft function.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder

OBJECTIVE To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. METHOD The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASDs children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. RESULTS Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. CONCLUSIONS The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

The Reliability and Concurrent Validity of a Modified Version of the International Physical Activity Questionnaire for Adolescents (IPAQ-A) in Tunisian Overweight and Obese Youths

Objective: The aim of the present study was to assess the reliability and validity of an Arabic version of the International Physical Activity Questionnaire for Adolescents (IPAQ-A) modified for use in Tunisia among overweight and obese adolescents. Subjects and Methods: Fifty-one voluntary healthy, overweight or obese adolescents (15-18 years old) participated in the study. Physical activity (PA) indicators derived from the modified self-administered IPAQ-A were compared with pedometer-recorded data of step counts. The test-retest reliability of the IPAQ-A was evaluated using intraclass correlation coefficients (ICC) and Kappa tests between the response of participants in the two interviews. Validity was assessed using Spearmans rank correlation coefficient between the scores of the IPAQ-A and the step count pedometer. Results: ICC revealed that the reliability of IPAQ-A values was high and ranged from 0.73 to 0.95. IPAQ-A scores were also significantly related to pedometer step counts (r = 0.66, p < 0.001). Strong relationships were observed between pedometer step count data and the IPAQ-A data for vigorous PA (r = 0.57, p < 0.001) and walking (r = 0.61, p < 0.001). However, a weaker relationship for moderate PA was observed (r = 0.24, p < 0.05). Conclusions: The modified version of the IPAQ-A questionnaire demonstrated an acceptable reliability and validity when used to assess the levels and patterns of PA in overweight or obese Tunisian adolescents.

Atypical Presentation of a Brown Tumor in a Kidney Transplant Recipient: A Case Report

Brown tumor is a rare complication of secondary hyperparathyroidism. It is exceptionally encountered after kidney transplantation. We here report on a 54-year-old male recipient who developed a brown tumor localized in the right forearm, and whose initial presentation was atypical, mimicking a bone tumor. Hence, diagnosis of brown tumors should be suggested by clinicians in a context of hyperparathyroidism.

Early onset of paucisymptomatic cryptococcal meningitis in a kidney transplant patient: a case report and review of the literature.

Fungal infections of the central nervous system are rare and are more frequently encountered in immunocompromised patients. Cryptococcocal infection is the most common opportunistic fungal infection after Candida and Aspergillus in organ transplant recipients. Atypical manifestations and nonspecific neuroradiological findings due to the lack of inflammatory response in these immunocompromised patients are responsible for a delay in diagnosis. This diagnosis should be considered even in atypical neurological signs, and additional tests (cerebrospinal fluid examination, magnetic resonance, etc) that may help to suggest the correct diagnosis should be used. We report a case of cryptococcal meningitis in a renal transplant recipient, which was misdiagnosed for several months because of an atypical presentation of headaches without fever or neurological signs.

Pediatric respiratory tract diseases: Chronological trends and perspectives

The aim of this study was to describe the epidemiological profile of childhood respiratory tract diseases (RTD) in the region of Sfax, Tunisia, and to evaluate their trends over a 13 year period.

Factors Affecting the Management of Somatic Comorbidity in Tunisian Patients with Schizophrenia

Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.

BLOOD PRESSURE BALANCE IN CHRONIC KIDNEY DISEASE

Objective: Hypertension is common in chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed as a better method to evaluate blood pressure (BP) in real life conditions. The objective of our study is to better specify the characteristics of ABPM in patients with CKD compared to the rest of the hypertensive population. Design and method: We conducted a retrospective study including all patients who benefited from an ABPM between January 2014 and Juin 2017. The CKD was established based on the definitions of KDIGO 2012. We divided our patients into 2 groups: G1: patients with ckd and G2: patients without CKD. The comparison between the 2 groups was carried out by Chi-square test and one factor ANOVA. Results: The study included 241 cases with a sex ratio of 0,84. The prevalence of CKD was 81% including 33 % stage 2, 56 % stage 3; 10 % stage 4 and 1% stage 5. Patients with CKD were older (55 ± 16 years vs 42 ± 15 years; p < 0,001). There were no significant difference regarding sex (p = 0,07) and body mass index (p = 0,06). The mean blood pressure (BP) in consultation was 157/85 (G1) and 145/ 86 (G2) (p = 0,03; p = 0,5). The indications of ABPM were different in the two groups: unbalanced hypertension (G1: 67%, G2: 37,5%), borderline hypertension (G1: 13.4%, G2: 22,5 % (G1: 1.7%, G2: 3%) and the search for masked hypertension (G1: 20%, 40%) with a significant difference (p = 0.002). In the ABPM, there was no difference in systolic and diastolic BP, whereas the difference was significant comparing patients having satges 4 and 5 CKD with other patients (149/82 vs 136 /78; p = 0,016; p = 0,3).The mean number of antihypertensive drugs was greater in the presence of CKD (1,8 ± 1,3 vs 0.8 ± 0,9; p < 0.001). Conclusions: BP should be monitored closely in hypertensive patients with CKD. ABPM seems to be the appropriate method in detecting hypertension and monitoring adequacy of treatment in patients with CKD.

Safety and Disease Evolution of Fixed-Dose Combination of Antitubercular Treatment Compared to Separate-Drugs Preparation in Extra-Pulmonary Tuberculosis

Purpose of ReviewExtra-pulmonary tuberculosis (EPTB) treatment was previously based on separate-drugs preparation (SDP). In the hope of reducing the rates of treatment default and resistance, the WHO have recommended the use of fixed-dose combination (FDC) for first-line in EPTB. We aimed to compare the tolerance and the disease evolution between FDC and SDP regimens in EPTB patients.Recent FindingsWe conducted a retrospective study including 388 cases of EPTB hospitalized between 1996 and 2016. We compared anti-tuberculosis treatment outcomes and the disease evolution between patients receiving FDC and those receiving SDP. The main EPTB site was lymph node (39.2%). There were no statistical differences between the two groups in terms of musculoskeletal, hematological disorders, cutaneous events, and hepatotoxicity. We noted that neurological disorder (OR = 12; p < 0.001), notably paresthesia (OR = 16; p < 0.001), and retrobulbar neuritis (OR = 10; p = 0.006), as well as gastro-intestinal intolerance (OR = 4; p = 0.015) including nausea (OR = 8.9; p = 0.011) and vomiting (OR = 1.1; p = 0.005) were significantly more frequent in the SDP group. The disease evolution comparison showed that complicated forms were statistically more frequent in the SDP group than those in the FDC group (OR = 2.4; p = 0.003), while there was no significant difference in relapse, sequelae, and death frequencies between the two groups.SummarySDP tolerance was characterized by higher frequency of paresthesia, retrobulbar neuritis, nausea, and vomiting than FDC. Evolutionary profiles were similar, except a higher risk of complicated forms in SDP.

The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study

Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.