Tunisie Medicale最新文献

Introduction: Cleft lip and palate (CLP) is the most common congenital malformation of the head and neck. Children with CLP often exhibit dental anomalies.

Aim: To evaluate the dental age (DA) of unilateral CLP in Tunisian children.

Methods: This was a cross-sectional study carried out in the department of pediatric dentistry at the University Hospital La Rabta, Tunis. Patients aged between 5 and 14 years, with no other congenital anomalies or syndromes in the craniofacial region other than CLP, were included. The patients' chronological ages were first calculated in years and months. DA was assessed in panoramic radiographs using Demirjian's method. The score of each stage is allocated, and the sum of the scores provides an evaluation of the subject's dental maturity.

Results: Fifty-three patients were included in the present study. No difference was observed between the two groups regarding the dental age. A strong and positive correlation between the DA and the chronological age in the two groups was observed (r=0.826). Estimated regression showed that chronological age alone explained 57,4% (r2=0.574) of the dental age variation in the study group and 64.5% (r2=0.645) in the control group.

Conclusion: For dental management, CLP children should have the same approach in orthodontics and pediatric dentistry as individuals without clefts, with a focus on the individualization of diagnosis and treatment planning.

Aim: To describe the epidemiological and clinical data of impaired functional outcome secondary to anterior resection of the rectum and to identify the predictive factors of major low anterior resection syndrome (LARS) Methods: This retrospective study considered patients operated on for rectal tumors in surgical department in our hospital, between January 1st,2009 and December 31st, 2021. The primary outcome measure was the development of a major LARS immediately or after stoma closure. In order to identify independent predictors of major LARS, patients were divided into two groups: the "Major LARS" group and the "No Major LARS" group, and then we carried out a descriptive study, followed by an analytical study with logistic regression.

Results: We enrolled 42 patients operated for rectal tumor and had an anterior resection. Half of our patients developed LARS of which 14 developed major LARS. The median time to onset of LARS symptoms was 9 [2 -24] months. At the end of this study, 2 factors were retained: age (OR=2.48; CI95% [1.2- 5.10], p=0.012) and pT3T4 stage (OR=5.95; CI95% [1.07- 33.33], p=0.041) as independent predictive factors of a major LARS. Neoadjuvant therapy was also a risk factor for major LARS in our study with a statistically significant difference (p=0.025) between the two groups "Major LARS" and "No major LARS".

Conclusion: LARS should be appropriately considered in the management of rectal cancer. Based on our results and data from the literature, age and mesorectal invasion were found to be independent predictors of major LARS.

Introduction: Vaginal delivery after caesarean section (VBAC) is recommended, but the rising rate of uterine rupture calls into question the safety of this practice.

Aim: To identify risk factors for uterine dehiscence and rupture.

Methods: This was a prospective, analytical and descriptive observational study, carried out in a tertiary care maternity. We included all parturients with one previous caesarean section undergoing trial of labor. We assessed the quality of the uterine scar which was evaluated after delivery.

Results: We included 300 patients with one previous caesarean section undergoing trial of labor. The trial of labor was successful (vaginal delivery) in 50.7% of cases. The uterine scar, assessed after delivery, was of good quality in 79% of cases. We noted 7 cases of uterine rupture, i.e. 2.3% of cases, and dehiscence in 56 patients, i.e. 18.6% of cases. Parity, conditions of previous caesarean section (programmed or emergency) and interpregnancy interval were significantly related to the labor outcome (p=0.004, p=0.001 and p=0.135 respectively). The occurrence of rupture or dehiscence was not significantly related to macrosomia, defined as a neonatal weight greater than 4000g (p=0.135).

Conclusion: Knowing the risk factors for uterine dehiscence and rupture would enable the obstetrician to properly assess the situation in order to make the correct decision and avoid neonatal and maternal complications.

Introduction: Granular cell tumors (GCT) are predominantly benign neoplasms composed by cells with abundant eosinophilic granular cytoplasm. Although the majority of GCTs exhibit a benign clinical course, a minority display cytological atypia and may exhibit aggressive, cancer-like behavior. Definitive evidence of malignancy in GCTs is reliably established only through the presence of metastasis. Addi- tionally, a subset of GCTs demonstrates a high rate of recurrence, underscoring the need for better prog- nostic markers. Therefore, it is crucial to identify molecular markers associated with aggressive behavior in GCTs. Molecular analysis may be particularly beneficial in cases exhibiting cytological atypia to in- form clinical outcome prognostication and guide therapeutic strategies.

Observation: In this case report, a 45-year-old female with multiple gastrointestinal GCTs is pre- sented. The patient did not have any genetic syndromes commonly associated with GCT, such as neu- rofibromatosis type 1, Noonan syndrome or LEOPARD syndrome. The tumors not only demonstrated nuclear atypia, but also harbored a unique FLT3 Y842C somatic alteration identified by next-genera- tion sequencing. The patient remains asymptomatic and under endoscopic surveillance two years after diagnosis and complete resection of the neoplasms.

Conclusion: We presented an exceedingly rare case of multifocal atypical GCT in an adult without any previously known genetic syndrome. A tumoral FLT3 Y842C point mutation not previously reported in GCT was discovered. Although the precise significance of this finding is uncertain, FLT3 Y842C has been cataloged as likely pathogenic in ClinVar. This report underscores the potential predictive utility of next-generation sequencing in the characterization and management of rare neoplasms.

Introduction-Aim: The iatrogenic risk in the elderly is a real public health problem due to its frequency and seriousness. Our study aimed to analyze the epidemiological, clinical and chronological aspects of adverse drug reactions occurring in elderly subjects and to identify the incriminated drugs.

Methods: We carried out a retrospective study of all the observations of adverse drug reactions in elderly subjects, notified to the Clinical Pharmacology department of Monastir over a period of 17 years (2004 - 2020). Drug skin tests were performed according to ENDA recommendations and imputability was analyzed using the French method of Bégaud et al. The drugs have been grouped according to the ATC classification.

Results: Among 545 events occurring in elderly subjects, drug responsibility was retained in 209 patients. They were 106 men and 103 women (gender-ratio=1.03). The average age of the patients was 72.3±6 years. Drug hypersensitivity reactions accounted for 75% of all adverse effects. The majority of these reactions were type IV (delayed). The incriminated drugs were: anti-infectives (47%), drugs for the musculoskeletal system (20%), drugs for the cardiovascular system (17%) and drugs for the central nervous system (5%).

Conclusion: Through this study, we noted a predominance of delayed drug hypersensitivity reactions as well as an increased involvement of anti-infectives and allopurinol in the occurrence of adverse effects in the elderly population.

Over the past century, classical approaches from microbiology and immunology have produced spectacular results in the control of infectious diseases. However, the recent SARS-COV-2 pandemic has highlighted our continued failure to control some infections. Other microorganisms still pose a threat to humanity such as HIV, Ebola, and influenza viruses. It seems that conventional approaches are not able to solve all the current problems caused by infectious diseases. Human genetics has shown that infections have a strong genetic determinism that can lead to a predisposition or resistance to infections. This explains much of the clinical variability observed in individuals infected with the same pathogen. The identification of the genetic etiology allows a better understanding of the pathogenesis of infectious diseases and, consequently, the consideration of appropriate preventive and therapeutic strategies. This review provides insights into the genetic theory and the concrete evidence to support it. We highlight the role of primary immunodeficiencies in the discovery of Mendelian and monogenic susceptibility to infections, then we show how genetic and phenotypic heterogeneity, redundancy, and resistance to infection manifest in the context of this genetic determinism. To effectively combat the constant threat of microbes, it is essential to integrate human genetics with microbiology to examine the interactions between pathogens and our immune system.

In order to improve the learning outcomes, skills, sense of belonging and well-being of their students, faculties around the world have chosen to implement mentoring programs for their learners. Given the complexity of implementing this approach, our objectives in this review are, on the one hand, to discuss and support the principles and recommendations of a mentoring project in an academic setting and, on the other hand, to present the vision of the Faculty of Medicine of Tunis regarding this mentoring approach.

Introduction: Echinococcosis is a relatively widespread anthropozoonosis in endemic regions, preferentially affecting the liver and lungs. Although rare, it can sometimes be localized in the muscles. The clinical symptoms are insidious and not very indicative, often leading to a delayed diagnosis. We reported a case of a hydatid cyst located in the gluteal muscle.

Observation: This was a 52-year-old female patient admitted for the appearance of a swelling in the left buttock region, progressively increasing in size. The radiological exam, revealed a large simple cyst originating from the gluteal muscle with purely liquid content. A surgical excision was performed, and the parasitological examination of the hydatid fluid confirmed the diagnosis.

Conclusion: Hydatid cysts in soft tissues are rare, slow-developing tumors with local extension. This diagnosis should be considered, especially in individuals from endemic countries. The treatment is primarily surgical, but the best way to combat hydatid disease, regardless of its location, remains prevention.

Unspecific back pain (UBP) has long puzzled medical professionals. Historically, back pain (BP) was often attributed to mystical causes, treated with incantations or herbal concoctions. The Middle Ages shifted towards empirical practices, though still intertwined with superstition, using methods like leeches and bloodletting. The Renaissance introduced systematic healthcare approaches, laying the foundation for modern medicine. The 20th century saw significant advancements with diagnostic imaging, pharmacotherapy, physical therapy, and surgical interventions, though UBP remained elusive. Recent decades have seen a paradigm shift towards multidisciplinary approaches, addressing BP's multifactorial nature through holistic methods considering biomechanical, psychosocial, and lifestyle factors. This shift integrates quantitative research with hermeneutic interpretation, emphasizing evidence-based guidelines. Non-pharmacological interventions such as exercise therapy, electrotherapy, cognitive behavioral therapy, and mindfulness-based stress reduction have gained prominence, empowering individuals in their recovery. Technological innovations like virtual reality and artificial intelligence offer personalized treatment plans, optimizing outcomes. The future of BP treatment holds promise with advancements in regenerative medicine, neuromodulation, telemedicine, and remote monitoring platforms, enhancing accessibility and continuity of care, especially in underserved communities. However, challenges such as the opioid epidemic and healthcare disparities remain, necessitating judicious prescribing practices and equitable resource distribution. The evolving treatment landscape for UBP reflects the dynamic interplay between scientific progress, clinical innovation, and societal needs, aiming to alleviate the burden of back pain and improve quality of life.