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Challenges to associate early onset epilepsy with COVID-19 autoimmune encephalitis:A case

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World Journal of Immunology 2023年第1期13卷 1-10页

作者： Salma Zouari Mallouli olfa Jallouli Wafa Bouchaala Sihem Ben Nsir Fatma Kamoun Feki Chahnez Charfi Triki Department of Child Neurology Hedi Chaker Sfax University Hospital and Research Laboratory LR19ES15-University of SfaxTunisiaSfax 3029Tunisia

BACKGROUND Diagnosis of coronavirus disease 2019(COVID-19)-related neurological events in the pediatric population is *** clinical picture of children with altered neurological state and inborn errors of metabolism,in addition to the frequency of asymptomatic COVID-19 cases,pose the main challenges for *** approaches to the onset post-COVID 19 subacute encephalopathy are still troublesome as seronegative autoimmune encephalitis(AIE)is *** SUMMARY A 27-mo-old boy was admitted for stormy refractory seizure of polymorphic semiology and altered mental status followed by various neuropsychiatric features that were suggestive of *** magnetic resonance imaging and cerebrospinal fluid analysis were *** the immunological assessment,including viral serologies,antinuclear antibodies,autoimmune antibodies(NMDA,AMPA,CASPR2,LG11,GABARB,Hu,Yo,Ri,CV2,PNMA2,SOX1,Titin,amphiphysin,Recoverin),nor the metabolic assessment for lactate and pyruvate showed significant *** positive history of COVID-19 infection and the findings of characteristic repetitive extreme delta brush played a key role in the diagnosis of COVID-19-related AIE.A remarkable improvement in the state of the child was noted after two pulse doses of intravenous Veinoglobulin and high dose of intravenous *** Diagnostic biomarkers for AIE might aid effective treatment.

关键词： Post-COVID-19 Auto-immune encephalitis Diagnosis biomarkers Pediatric population Delta brush sign Autoimmune antibodies

Medical Expulsive Therapy (MET) for Large Distal Ureteral Stones: A Prospective Study Comparing Three Drugs

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Open Journal of Urology 2020年第5期10卷 152-157页

作者： Mourad Dali Khereddine Traore Mamadou Tiéoulé kacem Aziz Chaker Kays Ben Rhouma Sellami Ahmed Nouira Yassine Service d’urologie de Hospital la Rabta Tunis Tunisia Service d’urologie de l’Hôpital de Ouahigouya Ouahigouya Burkina Faso

Introduction: One of the most common disorders of the urinary tract is Urolithiasis. Twenty percent of lithiasis are located in the ureter of which 68% are seen in the distal ureter. The concept of medical expulsive therapy (MET) has been developed with enough knowledge of the ureter physiology in order to make easier the spontaneous expulsion of the stone. The aim of this study was to evaluate the efficacy and safety of three different drugs for the treatment of pelvic ureteral stones. Materiel and Methods: Between October 2017 and November 2018, 90 adult patients presenting with low or non-obstructive pelvic ureteral stones sized 8 to 10 mm were included. They were prospectively randomized, using computer-based randomization charts, into three equal groups: treatment with ketoprofen 100 mg once daily (Group I), silodosin 8 mg once daily (Group II) and tadalafil 5 mg once daily (Group III). The aim was to compare spontaneous expulsion of stone between those drugs Results: The mean expulsion time from the start of MET was 11.5 ± 3.27 days for ketoprofen group, 10.71 ± 3.98 days for silodosin group and 10.57 ± 3.40 days for tadalafil group. But these differences were also not significant (P = 0.79). The use of analgesics (grade II) was higher in groups II and III compared to group I, but without significant difference (23.33% in group I, 33.33% in group II and 40% in group III, p = 0.38). Discussion: The overall chance of spontaneous passage is low when the stone diameter is sized more than 7 mm. A wide range of spontaneous passage rates have been reported in the literature, varying from 71% to 98% for distal ureteral stones less than 5 mm and 25% - 53% for stone sized 5 to 10 mm with a mean expulsion time of more than 10 days. Conclusion: The three drugs have a low expulsion rate for 8, 9 and 10 mm pelvic ureteral stones with a higher adverse event rate for the NSAID group.

关键词： Expulsive Therapy Ureteral Stones Drugs

Early hemodynamic resuscitation of septic shock:what do the new Surviving Sepsis Campaign guidelines really provide?

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Journal of Intensive Medicine 2022年第1期2卷 1-2页

作者： Jean-Louis Teboul olfa Hamzaoui Service de Médecine Intensive-Réanimation Hôpital BicêtreAP-HPUniversitéParis-SaclayInserm S_999Le Kremlin-BicêtreFrance Service de Réanimation Polyvalente Hôpital Antoine BéclèreAP-HPUniversitéParis-SaclayClamartFrance

A new version of the Surviving Sepsis Campaign(SSC)guide-lines for sepsis and septic shock[1]has been published a few months *** this editorial,we aim to focus on similarities and differences between the 2021 and 2016 SSC guidelines,[2]in terms of hemodynamic *** first striking differ-ence concerns blood lactate *** is now suggested to guide resuscitation to decrease serum lactate but not normal-ize it as previously ***,as stated in an editorial by Hernandez and Teboul,“since non-hypoperfusion-related causes of hyperlactatemia might predominate in an unknown number of patients,aiming at strictly normalizing lactate might lead to excessive resuscitation with inherent fluid and vasopressor over-load,and eventually to increased morbidity and mortality”.[3]In a recent multicenter randomized controlled trial in septic shock called ANDROMEDA-SHOCK,an early resuscitation strat-egy guided on capillary refill time(CRT)was shown to result in lesser organ dysfunction at 72 h than a strategy based on decrease in blood lactate.[4]In a subsequent Bayesian analysis of ANDROMEDA-SHOCK,the CRT-based strategy was shown to reduce mortality as compared to the lactate-based strategy.[5]These data support the new SSC recommendations stating that CRT can be used to guide resuscitation.[1]

关键词： resuscitation mortality shock

Low Back Pain among Nurses: Prevalence, and Occupational Risk Factors

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Occupational Diseases and Environmental Medicine 2017年第1期5卷 26-37页

作者： Wided Boughattas olfa El Maalel Maher Maoua Iheb Bougmiza Houda Kalboussi Aicha Brahem Souhaiel Chatti Fethi Mahjoub Néjib Mrizak Department of Occupational Medicine Faculty of Medicine Ibn El Jazzar Sousse Tunisia Department of Community Health Faculty of Medicine Ibn El Jazzar Sousse Tunisia

Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosocial risk factors. Methods: It is a cross-sectional study based on a self-administered questionnaire destined for all nurses working in Farhat Hached Teaching hospital of Sousse (Tunisia). Results: Our study included 203 nurses with an average age of 39.8 years. The prevalence of low back pain over the last twelve months was 58.1%. The factors that are significantly associated to low back pain were: high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of inappropriate posture for the activity being performed, and the layout of materials in the workplace. Conclusion: Our study evidenced the high prevalence of LBP among nurses and allowed bringing to light the role of individual and ergonomic physical factors in the genesis of LBP. Such identification permits to undertake targeted preventive actions. The association between psychosocial factors and LBP was not emphasized.

关键词： Low Back Pain Prevalence Nurses Physical Factors Psychosocial Factors

Diagnosis and management of pituitary apoplexy:a Tunisian data

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Chinese Neurosurgical Journal 2023年第3期9卷 183-189页

作者： Faten Hadj kacem Oumeyma Trimeche Imen Gargouri Dhoha Ben Salah Nadia Charfi Nabila Rekik Fatma Mnif Mouna Mnif Mouna Elleuch Mohammed Abid Hedi Chaker Hospital 3029 SfaxTunisia

Background Pituitary apoplexy(PA)is defined as the hemorrhage or the infraction of a pituitary *** to determine the epidemiological,clinical,paraclinical characteristics as well as management and outcomes of PA in our population,we conducted this cross-sectional *** This cross-sectional study was conducted at the Department of Endocrinology of Hedi chaker university hospital,*** was collected from medical charts of patients with pituitary apoplexy admitted in our department between 2000 and *** We included 44 patients with *** mean age was 50±12.6 *** them,31.8%had a known pituitary adenoma,and it was in all cases a macroadenoma,predominantly a prolactin secreting tumor(42.8%).A triggering factor of PA was encountered in 31.8%of cases and it was mainly:head trauma,dopamine antagonists,and *** clinical presentation of PA encompassed headaches(84.1%),visual disturbances(75%),and neurological signs(40.9%).Gonadotropin deficiency was the most frequent form of hypopituitarism noted(59.1%),followed by corticotropin deficiency(52.3%),thyrotropin deficiency(47.7%),and somatotropin deficiency(2.3%).Hormonal assessment at PA onset,concluded that 23 had a secreting adenoma:18 prolactinomas,3 ACTH-secreting adenomas,and 2 GH-secreting *** the 21 remaining cases,the tumor was non-functioning(47.7%).Pituitary MRI was performed in 42 cases(95.5%),revealing infraction and or hemorrhage in the pituitary gland in 33 cases;a heterogenous signal or a fluid level within the adenoma,in nine *** administration of intra venous hydrocortisone was required in 19 *** administration was mandatory in a patient who had severe intracranial *** management of the PA was imperative in 24 patients(54.5%):15 suffered from severe visual impairment,4 had an intracranial hypertension,2 cases demonstrated an impaired consciousness,2 patients experienced a tumor enlargement and one case had a severe

关键词： Pituitary apoplexy Pituitary neoplasms Neurosurgery Dopamine antagonists

First multicenter study for risk factors for hepatocellular carcinoma development in North Africa

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World Journal of Hepatology 2011年第1期3卷 24-30页

作者： olfa Bahri Sayeh Ezzikouri Nissaf Ben Alaya-Bouafif Fella Iguer Abdallah Essaid El Feydi Hafedh Mestiri Moustapha Benazzouz Tahar Khalfallah Rajaa Afifi Latifa Elkihal Salah Berkane Agnes Marchio Nabil Debzi Anne Dejean Pascal Pineau Hinda Triki Soumaya Benjelloun Laboratory of Clinical Virology Institut Pasteur of Tunis Laboratory of Viral Hepatitis Institut Pasteur of Casablanca Laboratory of Epidemiology Institut Pasteur of Tunis Laboratory of Viral Hepatitis Institut Pasteur of Algiers Department of Medicine C Ibn-Sina University Hospital Department of General Surgery Mongi Slim Hospital Department of Gastroenterology Bologhine University Hospital Bologhine 16090AlgiersAlgeria Nuclear Organization and Oncogenesis Unit INSERM U993Institut Pasteur of Paris Department of Gastroenterology Mustapha University Hospital

AIM:To assess the role of the major risk factors for hepatocellular carcinoma(HCC) development in the western part of North ***:A multicenter case control study was conducted in Tunisia,Morocco and Algeria in collaboration with Pasteur Institutes in these countries.A total of 164 patients with HCC and 250 control subjects without hepatic diseases were *** of HBsAg,anti-hepatitis C virus(HCV)and diabetes were *** and HBV genotyping were performed for anti-HCV and HBsAg positive ***:The mean age of patients was 62±10 years old for a 1.5 M:F sex *** percent of HCC patients were positive for anti-HCV and 17.9% for *** was detected in 18% of *** ratio(OR)and 95% confidence intervals(CI) were 32.0(15.8-65.0),7.2(3.2-16.1) and 8.0(3.1 -20.0)for anti-HCV,HBsAg and diabetes *** analysis indicated that the three studied factors were independent.1b HCV genotype and D HBV genotype were predominant in HCC *** was the only risk factor significantly associated with an excess of cirrhosis(90% vs 68% for all other risk factors collectively,P=0.00168).Excessive alcohol consumption was reliably established for 19(17.6%) cases among the 108 HCC patients for whom data is ***:HCV and HBV infections and diabetes are the main determinants of HCC development in North *** active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the *** Berkane,Department of Gastroenterology BologhineUniversity Hospital,Bologhine 16090,Algiers。

关键词： Hepatocellular carcinoma Hepatitis B virus Hepatitis C virus Non-insulin-dependent diabetes mellitus North Africa

Evaluation of Targeted Therapy for Locally Advanced or Metastatic Renal Cell Carcinoma in Tunisia

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Open Journal of Gastroenterology 2016年第7期6卷 197-204页

作者： Khaled Ben Ahmed Amira Daldoul Ghassen Tlili Laila Ben Fatma olfa Gharbi Mahdi Afrit Jihene Fkih Hammouda Boussen Mounir Frikha Faouzi Mosbah Slim Ben Ahmed Department of Urology Sahloul University Hospital Sousse Tunisia Department of Medical Oncology Farhat Hached University Hospital Sousse Tunisia Department of Medical Oncology Abderrahman Mami University Hospital Ariana Tunisia Department of Medical Oncology Habib Bourguiba University Hospital Sfax Tunisia

Introduction: Renal cell carcinoma (RCC) is known to be chemo resistant but with the introduction of targeted therapies;there has been a “revolution” in its treatment strategies. The only targeted therapy available in Tunisia for the treatment of metastatic and/or locally advanced RCC is sunitinib. Objective of the Study: To evaluate therapeutic results and tolerance of sunitinib in metastatic and/or locally advanced RCC. Subjects and Methods: This was a retrospective study covering a period of six years (from January 2008 to January 2014) conducted in 5 medical oncology departments in Tunisia. The population of the study consisted of 29 patients treated with sunitinib for metastatic and/or locally advanced RCC. Results: The mean age of patients was 51 years. Three patients had tumor recurrence and 26 patients had a metastatic RCC. The prognosis was good for 5 patients, intermediate for 19 patients and poor for 5 patients. The median duration of treatment was 5 months. Because of side effects, treatment was discontinued in 12.5% of cases and the dose was reduced in 10.3% of cases. Side effects consisted of asthenia (95.8%), stomatitis (70.8%), anemia (50%), hand-foot syndrome (55.8%) in addition to nausea and vomiting (54.2%). Objective response was observed in 37.5% of patients after 3 months of treatment and in 50% after 6 months. The median progression-free survival was 14 months (95% CI, 7.9 to 20.6). The median overall survival was 22 months (95% CI, 15.6 to 28.7). Conclusion: The prognosis of RCC in Tunisian patients has clearly improved with the introduction of sunitinib, but other therapies with a proven efficacy as a first and second line therapy should be considered.

关键词： Renal Cell Carcinoma Metastasis Molecular Targeted Therapy Sunitinib Drug Tolerance

Metastatic Colorectal Cancer: Evolution of the Response Rate and Survival with Therapeutic Progress

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Open Journal of Gastroenterology 2016年第5期6卷 127-135页

作者： Amira Daldoul olfa Gharbi Laila Ben Fatma Imene Chabchoub Sonia Zaied Khaled Ben Ahmed Faten Ezzairi Makrem Hochlef Imtinene Belaid Sami Limem Slim Ben Ahmed Oncological Medical Department of the University Hospital of Sousse Sousse Tunisia Oncological Medical department of the University Hospital of Monastir Monastir Tunisia

Introduction: The therapeutic strategy for metastatic colorectal cancer (mCRC) has evolved greatly in the last two decades. This study aimed to compare patients with mCRC treated at the University Hospital of Sousse (Tunisia) through three periods, in terms of treatment strategy;objective response rate (ORR) to chemotherapy;median overall survival (OS) and prognostic factors conditioning OS. Methods: This was a retrospective study covering the period from January 1994 to December 2011. It involved 401 patients with mCRC divided into three groups: group 1 (G1) including patients treated in the period 1994-1998, group 2 (G2) including patients treated in the period 1999-2005 and group 3 (G3) including patients treated in the period 2006-2011. Results: The ORR after 3 cycles of first line chemotherapy was 33%, 50% and 57.8% for G1, G2 and G3 respectively. The median OS was 13.8 months for G1, 19 months for G2 and 23 months for G3. The prognostic factors associated with a better OS for G3 were absence of initial tumor complication, normal initial level of carcinoembryonic antigen, normal liver function tests, surgery of the primary tumor, surgery of liver metastases and the ORR after three cycles of first line chemotherapy. Conclusion: The development of the therapeutic strategy, whatever of medical or surgical nature, has led to improved response rates and survival of patients treated for mCRC.

关键词： Colorectal Neoplasms Prognosis Chemotherapy Metastasis

Hospital Night Shift and Its Effects on the Quality of Sleep, the Quality of Life, and Vigilance Troubles among Nurses

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International Journal of Clinical Medicine 2014年第10期5卷 572-583页

作者： Wided Boughattas olfa El Maalel Ridha Ben Chikh Maher Maoua Kalboussi Houda Aicha Braham Houssem Rhif Souheil Chatti Faten Debbabi Mohamed Dogui Nejib Mrizak Neurophysiology Department Sahloul Teaching Hospital Sousse Tunisia Occupational Medicine and Professional Pathologies Department Medicine Faculty of Sousse Sousse Tunisia

Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environment, such night shift is necessary so as to ensure the continuity of care. Sleep and vigilance disorders related to this work mode are frequent and often pose adaptation problems. The objective of this study is to detect the harmful effects of night shift on sleep, vigilance and the quality of life of nurses in Farhat Hached Teaching Hospital in Sousse. Material and Methods: It is a cross-sectional study carried out among two groups of nurses: one group performing a fixed night work and the other one working permanently during the day at Farhat Hached Teaching Hospital in Sousse. Data collection is mainly based on validated questionnaires evaluating sleep quality (Pittsburg sleep quality index), daytime sleepiness (Epworth sleepiness scale), sleep typology (Horne and Ostberg questionnaire), and the quality of life (SF-12). An objective evaluation of vigilance was realized by the study of reaction time and error rates to different tasks of “Super lab” software. Results: 50 night and 50 day nurses have been colligated. Both groups were age- and gender-matched. Sleep quality mean index was significantly higher among night nurses in comparison with day nurses (10.2 ± 5.9 versus 6.76 ± 5.16). After multivariate analysis, sleep quality was significantly correlated to age, department, schedule and the choice of schedule. Night shift was not related to daytime sleepiness. The objective analysis of vigilance showed that the reaction time to different tasks exploring the attentional mechanisms, as well as errors rate, were significantly more important among the night group. The mental score of the quality of life was significantly higher among day nurses. However, such difference was not significant with regard to physical score. Conclusion: The findings of our s

关键词： Night Shift Nurse Quality of Life Sleep Vigilance