Heart involvement in systemic sclerosis.

INTRODUCTION: Primary and secondary heart involvement in systemic sclerosis are important mortality predictors. Aim of this study was to investigate by standard echocardiography associated to pulsed-tissue Doppler imaging, six-minute walk test (6MWT) and BNP level cardiac manifestation in 30 patients with ScS and to establish a strategy to detect and to evaluate this complication. METHODS: This was a cross-sectional study conducted over a period of 16 months: a total of 30 consecutive patients with ScS diagnosed as proposed by the American college of Rheumatology and the European League Against Rheumatism 2013 and who were hospitalized in Internal Medicine department of Habib Thameur hospital underwent cardiac assessment. RESULTS: Twenty-nine patients were female, the mean age of diagnosis was 46 years ± 13,49  [18-71 years]. Echocardiography found left ventricular systolic dysfunction (LVSD) on tissue doppler imaging, in 40% of cases, it was significantly associated with diffuse ScS (p=0,024), with Scl70 anti bodies (p=0,043) and interstitial lung disease (p=0,024). However, the left ventricular diastolic dysfunction (LVDD) was correlated with a high diastolic arterial hypertension (p=0,028), diffuse ScS (0,048), telangiectasia (p=0,029) and pulmonary hypertension (p=0,033). Higher systolic pulmonary arterial pressure (PAPs) (p=0,029) and higher BNP level (p=0,027) were noted in the group of patients with right ventricular systolic dysfunction (RVSD). Patients who had an elevated PAPs had: accelerated pulse (p=0,022), a cough (p=0,024), dyspnea III-IV (p=0,003), shorter six-minute walk distance (p=0,044), greater Borg score (p=0,025) and elevated BNP level (p=0,015). Thus, a positive correlation was found between PAPs and BNP (p=0,004, r=+0,53), a negative correlation was noted between PAPs and ST (p=0,006, r=-0,49). The ROC curve identified a discriminator threshold for ST<11,5cm/s (BNP ≥43,5pg/l) and PAPs >35mmHg (BNP ≥92pg/l). A discriminator value of the 6MWD (≥294m) was recorded for a PAPs >35mmHg. 2000-3000 salma Conclusion: Left ventricular diastolic impairment was the most frequent echographic abnormality in our study. The BNP level and 6MWT are sensitive and specific in the detection of an elevation of PAPs.

[Etiologic profile of digital necrosis in an internal medicine department]. / Profil étiologique des nécroses digitales dans un service de médecine interne.

BACKGROUND: Digital necrosis is a frequent event in vascular pathology. They are multiple etiologies and are the translation of a general or locoregional pathology. The aim of our study was to clarify the various causes of digital necrosis in an internal medicine department. METHODS: We conducted a retrospective study of 23 cases of digital necrosis collected in the internal medicine department of the hospital Habib Thameur over a period from January 1998 to April 2011 . RESULTS: There were 16 women and 7 men with mean age of 46 years. The cardiovascular risk factors were observed in 39.13% cases. Digital necroses were interested fingers in 73.91% and toes in 30.43% of the cases. The causes were dominated by the connective diseases. The treatment was symptomatic in all cases and etiologic in only two cases. CONCLUSION: In internal medicine, the causes are dominated by connectivites. The prognosis is especially functional. It remains unfavorable in spite of the improvement of the therapeutic and etiologic care.

Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women.

In women with pre-existing immune thrombocytopenic purpura (ITP), the effect of pregnancy on the course of the disease is poorly known. We performed a dual-centre retrospective cohort study of 118 pregnancies in 82 women with primary ITP. In early pregnancy, the platelet count was <100 × 10(9) /l in 35·6% of pregnancies. During pregnancy the median platelet count nadir was 66 × 10(9) /l (25th-75th percentile: 42-117), with platelet count <30 × 10(9) /l for 26 pregnancies (22%). In 49% of pregnancies, a significant decrease of the platelet count required treatment at least transiently in preparation for delivery. At the time of delivery, the median platelet count was 110 × 10(9) /l (77-155). Compared to before pregnancy, at 3 months post-partum, only 11% of pregnancies [95% confidence interval (95% CI): 6·8-20·2] showed disease worsening. Previous splenectomy was the only factor significantly associated with ITP worsening after pregnancy (53·9% vs. 10·3%, P < 0·001). For 8·3% of the pregnancies (95% CI: 3·8-15·1), neonatal thrombocytopenia required treatment, especially in case of previous maternal splenectomy (adjusted odds ratio 16·7, 95% CI: 2·61-106). The overall risk of exacerbation of ITP and severe thrombocytopenia during pregnancy is acceptable.

[Thrombosis and cancer: retrospective study of 17 cases]. / Thrombophlébites paranéoplasiques : etude rétrospective de 17 observations.

BACKGROUND: The association cancer and venous thrombosis is almost always an independent criterion of poor prognosis of cancer. Thus, venous thromboembolic disease is with infection and organ failure, one of the leading causes of death in patients with malignant disease. AIM: To identify the characteristics of the association between cancer and venous thrombosis in any patient with deep vein thrombosis of lower limbs seemingly unexplained. METHODS: This is a retrospective study from January 1994 to December 2008, concerning 17 cases of patients with deep vein thrombosis of lower limbs associated with neoplasia, hospitalized in internal medicine department at Habib Thameur hospital between a total of 290 patients with deep vein thrombosis of lower limbs. Only patients hospitalized for deep vein thrombosis of lower limbs complicated or not by a pulmonary embolism were included. RESULTS: Our study concerned 17 patients. There were 10 women and 7 men with a sex ratio (Female / Male) at 1, 42. The average age was 68.7 years, with extreme ages ranging from 40 to 90 years. Cancer has formed 6% of the causes of deep venous thrombosis of lower limbs. Eight of our patients were known to suffer from a cancerous disease. Six cases of cancers were discovered at an advanced stage of evolution with multiple metastases. In seven cases the etiological could not be achieved. Deep venous thrombosis was complicated by pulmonary embolism in four inaugural events, five patients had recurrent thrombosis, and two cases of bleeding complications were noted. CONCLUSION: Venous thromboembolism is common in cancer patients. It can be the first manifestation of cancer completely silent. The course and prognosis depend on the stage of cancer combined.

Corticoid-associated complications in elderly.

BACKGROUND: Corticosteroids are widely prescribed products in the elderly particularly in systemic diseases. Corticosteroids were indispensable in controlling a variety of disease states. Various complications associated with this drug class warrant caution and monitoring with each formulation especially with old population. AIM: To evaluate the frequency and type of side effects and complications of long-term corticosteroid therapy in the elderly. METHODS: We conducted a retrospective study of 23 patients aged 65 and older hospitalized in the internal medicine department of the Habib Thameur hospital during January 2000 to December 2004. Corticoid adverse effects were recorded throughout the follow up period. RESULTS: There are 20 women and 3 men aged 66 to 87 years with a mean age of 75.7 years. The diagnoses were 8 cases of temporal arteritis, 7 cases of rheumatoid arthritis, 3 cases of multiple myeloma, 2 scleroderma, 1 case of systemic lupus erythematosus, 1 case of retroperitoneal fibrosis and 1 case of psoriatic arthritis. We selected 66 complications. Infectious complications were found in 26 cases (39.3%), 11 cases (16.7%) of iatrogenic diabetes, arterial hypertension in 9 cases (13%), skeletal complications in both cases,psychiatric complications in two cases, ophthalmologic complications in one case. CONCLUSION: Despite lifestyle rules and adjunctive therapy, complications seem to be frequent. To minimize the disadvantages of prolonged corticosteroid treatment, regular monitoring and careful screening is imperative for the support and time.

[Rheumatoid arthritis in the elderly: ten cases report]. / La polyarthrite rhumatoïde du sujet âgé : A propos de dix observations.

BACKGROUND: The occurrence of rheumatoid arthritis (RA) in elderly is frequent. If the reality of a real difference in clinical presentation between younger and older subjects is discussed, the central point remains that the prognosis is not better for the elderly. Finally, conventional treatment is as effective and safe as in younger patients, and the same stringent targets for management of the PR used for young subjects must be applied in the elderly. AIM: To identify the characteristics of RA in the elderly in its epidemiological, clinical, radiological, evolutive and therapeutic. METHODS: We conducted a retrospective study of RA in the elderly aged 65 and over, we've compiled ten cases hospitalized over a period of 4 1/2 years in the service of Internal Medicine, Habib Thameur Hospital (Tunis). RESULTS: There were 8 women and 2 men. The average age was 70.6 years. The onset of arthritis and the disease was progressive in seven cases. An inflammatory syndrome was present in seven cases. Rheumatoid factor was positive in eight cases. Five patients were classified as stage III and IV according to the radiological classification of Steinbrocker. The treatment was based on painkillers and anti-inflammatory drugs in all cases. Long-term treatment was initiated in seven patients. The outcome was favorable in all cases. CONCLUSION: Late-onset RA is a heterogeneous framework in which multiple clinical forms deserve to be individualized and should reflect this diversity, rather than approach to the problem of global RA after 60 years.

[Takayasu's arteritis in Tunisia: a monocentric study of 11 patients]. / La maladie de Takayasu en Tunisie: etude mono-centrique de 11 cas.

BACKGROUND: Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. AIM: To assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. METHODS: This retrospective study analyzed 11 patients with Takayasu arteritis between 1999 and 2010 who met the criteria for inclusion proposed by the American College of Rheumatology (ACR). RESULTS: The file review identified 11 women, with a mean age at diagnosis of 29.1 years (range: 17-50 years). Our series included involvement of the aortic arch and its branches in 8 cases, while only 3 cases of the abdominal aorta. Arterial hypertension due to stenosis of the renal arteries was noted in 4 cases. Aortic insufficiency and pulmonary hypertension were noted in one case. In all, 3 patients had type I disease, 3 type V and one type IV. In all, 4 patients had glucocorticoid treatment, and one needed immunosuppressive therapy. Three patients required surgical intervention. Our patients were followed for a mean period of 67.5 months. Disease remained stable in all patients. CONCLUSION: Despite the small number of our patients, the clinical manifestations, angiographic data and course in our study were similar to those in other reported series.

[Special features of systemic sclerosis in men]. / Particularités de la sclérodermie systémique chez l'homme.

BACKGROUND: Systemic sclerosis (SS) is a generalized disorder of connective tissue and microvasculature characterized by tissue fibrosis and obliteration of the vessels. Several features of systemic scleroderma in men are discussed in the literature. AIM: To investigate the initial clinical features, evolution and prognosis of systemic sclerosis in men. METHODS: Patients with systemic sclerosis based on ACR's criteria were included. In this retrospective study we compared a cohort of men to a cohort of women, diagnosed between 2000 and 2010 in department of internal medicine. RESULTS: Fifty four patients were included amongst which nine men. The mean follow-up duration was 39.5 months. A higher proportion of cardiac, renal and lung involvement were noted at diagnosis Localized cutaneous sclerosis was predominant in men. CONCLUSION: This work has highlighted several features of systemic sclerosis encountered in men. These results warrant confirmation by analyzing a larger population.

[Hemophagocytic syndrome: report of 4 cases]. / Le syndrome d'activation macrophagique: a propos de 4 observations.

BACKGROUND: Hemophagocytic syndrome (HPS) is a rare but potentially fatal disease. The diagnosis is based on the combination of clinical and biological signs, requiring histological or cytological research hemophagocytosis and exhaustive etiological investigation. AIM: To report four cases of the HPS in an internal medicine department. CASES REPORT: We report four cases of HPS associated with Still's disease in two cases, with Sjogren syndrome in one case and a severe sepsis in one case. There are three women and one man. The mean age was 34.75 years, with extremes of 21 to 50 years. In all cases, patients were hospitalized for fever of unknown origin. The etiologic research of this fever remained negative. In all cases, patients validated criteria of HPS confirmed by cytological studies. The treatment was based on corticosteroids in all cases and immunosuppressant in one case. The evolution was favorable in two cases and fatal in two cases. CONCLUSION: HPS is a serious, often overlooked, may affect the prognosis and complicating various infectious, neoplastic or autoimmune diseases.

[Urinary tract infections in elderly]. / Les infections urinaires chez les personnes âgées.

BACKGROUND: Urinary tract infections (UTI) in elderly are frequent and polymorphic clinical symptoms. This is a public health problem both in support and cost they generate. AIM: To study the epidemiological, clinical, paraclinical and therapeutic aspects of UTI in the elderly. METHODS: We conducted a retrospective study of 50 cases of UTI in the elderly collected in the Internal Medicine Department at Habib Thameur Hospital between January 2002 and December 2006 (Group I). We compared this group to another group of patients aged below 60 years also explored for UTI in the same service and during the same period (Group II). RESULTS: They were 37 women and 13 men in group I and 41 women and 9 men in the group II. In group I, the average age was 74.10 ± 6.7 years, in group II 43.58 ± 11.26 years. In group I, 35 patients (70%) showed no evidence of suspicion of a UTI on admission. 15 patients (30%) were admitted for suspected UTI. In group II, 36 patients (72%) showed no evidence of suspicion of a UTI on admission. 14 patients (28%) were admitted for suspected UTI. Urological abnormalities underlying the UTI, detected by ultrasound, were more frequent in Group I (40%) than in Group II (12%). Second-line antibiotics, due to the likely resistance of the microorganism, had to be prescribed in 16% cases in Group I vs. 4% of cases in Group II. The evolution under antibiotic treatment was marked by the occurrence of 3 deaths and transition to renal failure in 4 cases for Group I. In Group II, the outcome was favorable in all cases. CONCLUSION: Urinary tract infection is a significant factor in morbidity and mortality in the elderly. Female is much more concerned than male. Clinical manifestations of UTI are often crude and misleading in a pathological and poly polymedicated patient. The preventive arm accounts for most of the management of urinary tract infection in the elderly.