Tunisie Medicale最新文献

Introduction: Lipoid pneumonia is a rare disease affecting adults' which frequency increases with age. Exogenous lipoid pneumonia results from the penetration, usually by inhalation, of oily substances into the pulmonary parenchyma.

Aim: To study the clinical and radiological features of exogenous lipoid pneumonia and to define therapeutic strategies.

Methods: We performed a monocentric, retrospective study of patients followed in the Pneumology Department of the Hedi Chaker Hospital in Sfax between 2004 and 2023. The diagnosis of exogenous lipoid pneumonia was confirmed by bronchoalveolar lavage with positive Oil Red O staining or by biopsy with anatomopathological examination showing lipid-laden foamy histiocytes.

Results: During this period, we collected nine patients with an average age of 46. Dyspnea and cough were the most frequent symptoms. Chest computed tomography revealed ground-glass opacity in five cases, parenchymal condensations in three cases and crazy paving in three cases. The frequent risk factors were occupational exposure to a lipid in five cases and consumption of a lipid product in four cases. In terms of treatment, four patients underwent occupational reclassification and a declaration of occupational disease. Systemic corticotherapy was indicated in six patients.

Conclusion: Exogenous lipoid pneumonia is a rare entity. This study highlights the difficulty of making a diagnosis, due to misleading clinico-radiological presentation in the absence of exposure.

Background: Non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) still spark controversy regarding histological diagnostic criteria and therapeutic management.

Aim: To elucidate the clinicopathological characteristics of NIFTP tumors and discuss their therapeutic management.

Methods: A retrospective study including 23 patients (26 nodules) operated on and followed up for NIFTP tumors according to the 2017 WHO classification over a 5-year period (January 2016-December 2020). The 2017 EUTIRADS classification was used for ultrasound nodule characterization. Fine-needle aspiration cytology was reported according to the 2017 Bethesda system.

Results: All patients were female, with a mean age of 47 years [19-71]. The average consultation delay was 9 months [2 months-7 years]. Thyroid nodules were incidentally discovered in 6 cases (26%). Examination revealed a solitary thyroid nodule in 20 cases. Nodules were classified as EUTIRADS III or IV in 82%. Fine-needle aspiration cytology, performed in 61% of cases, showed Bethesda III in 64% and IV in 14%. Total thyroidectomy was performed in 74%. Three cases of bifocal NIFTP were identified. Association with thyroid carcinoma was noted in 7 cases. No locoregional or distant recurrence was reported during a mean follow-up of 3 and a half years.

Conclusion: Recent revisions of NIFTP morphological criteria underscore the importance of strict adherence to inclusion and exclusion histo-morphological criteria.

Introduction: Acute kidney Injury (AKI) is the most frequent complication of septic shock. Bedside ultrasound measurement of the renal resistance index (RRI) is an interesting way of assessment of renal hemodynamics.

Aims: To study the variability of RRI during septic shock and its correlation with the occurrence of AKI.

Methods: This is a prospective observational study including patients in septic shock and on mechanical ventilation. Data collection was carried out between October 2022 and July 2023. RRI was measured during the first five days of shock.

Results: Forty patients were enrolled in the study. Mean age was equal to 51 years ±13.4 and sex ratio was equal to 2.33. The mean RRI value was 0.704, with extremes ranging from 0.52 to 0.83. Patients were divided into two groups : AKI(+) and AKI (-). RRI in the group AKI (+) was higher than in the group AKI (-) (0.757 vs. 0.672; p=0.013). RRI predicted the occurrence of AKI, with an area under the ROC curve of 0.75 (p=0.007) and a cut-off value of 0.71 (specificity=64%, sensitivity=73%).

Conclusion: Assessment of RRI could be a useful technique of predicting the onset of AKI in association with the conventional markers. Its validation will guide management towards optimal renal protection in patients with septic shock.

Introduction: Total hip arthroplasty (THA) is an effective surgical procedure. Several surgical approaches have been described.

Aim: To compare postero-lateral and anterior approaches in terms of postoperative care, functional and radiological outcomes in patients undergoing primary THA surgery.

Methods: Patients undergoing primary THA were included in a retrospective descriptive study and divided into two groups according to surgical approach: anterior approach (AA) and postero-lateral approach (PLA). We compared demographic, perioperative data and functional outcome at 6 weeks and 6 months postoperatively according to Postel Merle d'Aubigné (PMA) and Harris (HHS) scores, radiological positioning of implants and postoperative complications.

Results: Each group comprised 100 patients. In the AA group, operative time was shorter, patients had less pain, less bleeding and a shorter hospital stay, better PMA and Harris scores at six weeks post-operatively, with no difference at six months, better positioning of the acetabular cup, undersizing of the femoral stem and more iatrogenic fractures of the proximal femur. Patients in the PLA group had fewer skin and nerve complications and more prosthetic instability.

Conclusion: Current data do not demonstrate superiority of one approach over another in primary THA. We recommend the choice of surgical approach according to the patient's characteristics and surgeons' convictions.

Introduction: Tranexamic acid (TXA) has revolutionized perioperative blood management of total hip (THA) and knee arthroplasties (TKA). However, there is currently no consensus on the optimal administration route.

Aim: To compare the combined administration of TXA (intravenously (IV) and topically) versus IV alone on the reduction of postoperative bleeding in THA and TKA.

Methods: A nine-month double-blind randomized trial was conducted. Adult consenting patients scheduled for primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were included. The primary outcome measure was the decrease in hemoglobin levels 24 hours after surgery. They were randomized either to the IV group (51 patients) receiving 2 doses of 1 g of IV TXA 3 hours apart, or to the Combined group (50 patients) receiving 1 g of IV TXA and a topical dose of 1.5 g.

Results: The mean decrease in hemoglobin 24 hours after surgery was similar for both groups in THA (p=0.91) and TKA (p=0.19). There was no difference in perioperative transfusion rate between the two THA groups (p=0.6). In TKA, no perioperative transfusion was required. Total and measured blood losses were similar in both groups. Immediate and 3-month postoperative complications were similar.

Conclusion: Compared to IV TXA alone, the combined route does not reduce the risk of bleeding in prosthetic surgery.

Introduction: Sudden cardiac death (SCD) risk stratification for primary prevention in patients with sarcomeric hypertrophic cardiomyopathy (HCM) has recently been reinforced by the establishment of a new model by the American College of Cardiology (ACC). This algorithm was characterized by a different approach compared to the previous HCM Risk Score.

Aim: The objective of this study was to compare risk stratification using both the European society of cardiology (ESC) and the ACC risk scores.

Methods: This was an observational, cohort-type prognostic study with retrospective data collection. Patients were classified according to their rhythmic risk estimated by both models and followed for a period of at least one year.

Results: Forty-seven patients were followed over a mean period of 32,4 months. The mean age of our patients was 55 years ± 14 years. We found a weak concordance between the two models (Kappa = 0.28). Four patients (9 %) presented arrhythmogenic events. The ACC algorithm indicated the implantation of an implantable cardioverter defibrillator (ICD) for these four patients whereas the HCM Risk Score indicated only two. The American algorithm had a better predictive potency with an area under the ROC curve of 0.785 compared to 0.654 with the HCM Risk Score with an NRI of 0.35. However, the number of ICDs to be implanted according to this algorithm was increased by 1.6 times.

Conclusion: The ACC algorithm was more efficient in detecting high-risk patients, but it considerably increased the number of ICDs indicated.

Introduction: Simulation using serious games (SG) has emerged in the field of training and assessment of medical students.

Aim: to compare the results of medical students' evaluation by virtual simulation using online SG and clinical case-based multiple-choice questions (MCQ), and to assess the degree of satisfaction with these two evaluation methods.

Methods: Medical students from the same level of study participated in this study. SG group had an evaluation by SG dealing with "diagnosis and management of ST-segment elevation myocardial infarction (STEMI). MCQ group was evaluated by clinical case-based MCQ having the same topic as SG group. Results of the two groups were compared. A satisfaction questionnaire was filled out by the two groups. The satisfaction degree was compared between the two groups.

Results: A total of 64 medical students (G1:31 and G2: 33) were enrolled. Thirty learners (96.8%) in SG group obtained a total score ≥ 50% versus 69.7% in clinical case-based MCQ group (p = 0.004). The full score was obtained by three learners in SG group; however, no student scored 100% in clinical case-based MCQ group (p = 0.027). Medical evaluation using SG was reported to be more innovative, fun, and realistic compared to evaluation by clinical case-based MCQ.

Conclusion: Simulation by SG could be an innovative and effective method in evaluating medical students.

Introduction: Chronic obstructive pulmonary disease (COPD) patients frequently complain of poor sleep quality, but the factors responsible for disturbed sleep are not well identified.

Aim: To determine the frequency of poor sleep quality and to investigate the demographic, clinical, and spirometric factors impacting sleep quality in COPD patients.

Methods: A descriptive, cross-sectional, single-center study was conducted in department 1 of Abderrahmane Mami Hospital of Ariana from January to June 2022 including COPD patients followed up at the external consultation. After their oral consent, all patients answered the questionnaire assessing sleep quality: Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined by a PSQI score≥5.

Results: The mean age was 66 years, with a sex ratio of 24. Our study included 100 patients. We counted 68 patients with comorbidities at admission. The most frequently reported comorbidity was arterial hypertension. A mean PSQI score was 6.59. Poor sleep quality was noted in 63% of the patients. The patients with arterial hypertension had significantly more impaired sleep quality (p=0.031). Chronic sputum was significantly associated with poor sleep quality (p<0.001). A CAT score≥ 10 was associated with poor sleep quality (p<0.001). The percentage of patients with significantly impaired sleep quality who belonged to group D was 65% (p<0.001). Poor sleep quality was significantly associated with GOLD stage 4 (p=0.039) and lower spirometry data (p=0.001 for FEV1).

Conclusion: Poor sleep quality is frequent in COPD patients. It is associated with more severe disease. This calls for early diagnosis of sleep disorders and early initiation of adequate treatment.

Introduction: A labyrinthine fistula (LF) is a challenging complication associated with cholesteatomatous chronic otitis media (CCOM).

Aim: To describe the clinical and audiometric characteristics of patients with cholesteatomatous LF and to evaluate the postoperative outcomes.

Methods: This was a retrospective study of 46 cases of LF, among 555 patients who underwent surgical treatment for CCOM at the Otolaryngology department of La Rabta Hospital, from 2010 to 2020.

Results: The mean age was 43.67 years. The incidence of LF was 8.3%. The most frequent symptoms were otorrhea and hearing loss (87%). Vertigo was present in 43.5% of patients. Facial nerve paralysis was observed in 5 patients (10.9%). Preoperative tonal audiometry showed hearing impairment in all cases, with no significant relationship between bone conduction hearing thresholds and the type of fistula (p: 0.16). LF diagnosis was made intraoperatively, involving the lateral semicircular canal (LSCC) in all cases, with or without other locations. Favorable hearing outcome was noted in 73,9% of patients, with improvement of vestibular signs in all cases. There was no correlation between the fistula size and postoperative hearing loss (p: 0.09).

Conclusion: Cholesteatomatous labyrinthine fistulas pose a complex challenge in managing middle ear pathologies. Typically, labyrinthine fistula is managed by one stage total removal of cholesteatoma matrix on the fistula, leading to satisfactory auditory and vestibular outcomes.

Introduction: Nematodes of the Trichostrongylus genus are primarily parasitic in herbivores, although sporadic zoonotic infections have been documented in various countries, including Iran, the Far East, and Australia. In Tunisia, one case has been reported, rendering this parasitic infection relatively unknown.

Observation: A 3-year-old female patient, congenitally monorenal, presented to the pediatric department at Charles Nicolle Hospital in Tunis with symptoms of anorexia, weight loss, and growth retardation. Hematological analysis revealed anemia concomitant with hypereosinophilia. The patient, originating from a rural region in Kasserin and currently residing in Tunis, had exposure to avian species, poultry, and sheep. Parasitological examination of stool samples, performed in our Parasitology and Mycology department, detected the presence of Trichostrongylus spp. eggs in two out of three specimens. A thorough family survey, including detailed interviews and stool parasitology, indicated no familial exposure to trichostrongylosis risk factors, and no parasitic eggs were found in the parents' samples.

Conclusion: Given the rarity or atypical nature of human infections with animal-derived hookworms, trichostrongylosis may be underrecognized, and the prevalence of common human hookworm infections might be overestimated. Enhancing environmental and personal hygiene and avoiding the consumption of raw vegetables in endemic regions are crucial preventive measures against this infection.