Epidemiological profile and performance of triage decision-making process of COVID-19 suspected cases in southern Tunisia.

INTRODUCTION: During an epidemic, screening processes can play a crucial role in limiting the spread of the infection. The aim of this study was to describe the epidemiological profile of COVID-19 suspected cases and to evaluate the performance of the triage process in predicting COVID-19 in Southern Tunisia. METHODS: It was a prospective study including all patients consulting to the Hedi Chaker University Hospital departments from March to June 2020. A clinical triage score (CTS) was used to assess the risk of the infection and to refer patients to the appropriate part of the facility accordingly. RESULTS: Overall, 862 patients were enrolled, among whom 505 patients (58.6%) were classified as suspected cases (CTS ≥4). Of these, 46.9% (n = 237) were of mild form. Samples were collected from 215 patients (24.9%), among whom five were COVID-19 positive, representing a positive rate of 2.3%. The in-hospital cumulative incidence rate of COVID-19 was 580/100000 patients. The total daily incidence decreased significantly during the study period (p < 0.001, chi-square for linear trend = 25.6). At a cut-off of four, the CTS had a sensitivity of 40%, a specificity of 32.4%, and negative and positive predictive values of 95.8% and 1.4%, respectively. DISCUSSION: Although the triage process based on the CTS was not as performant as the RT-PCR, it was crucial to interrupt virus spread among hospitalized patients in "COVID-19-free departments".

[Diffuse infiltrating lung disease secondary to antisynthetase syndrome: a case report]. / Pneumopathie infiltrante diffuse secondaire à un syndrome des antisynthétases: à propos d´un cas.

Diffuse infiltrate lung diseases (DILDs) are frequent in patients with connective tissue diseases. They can be suggestive of connective tissue diseases or occur during follow-up. Antisynthetase syndrome (ASS) is a complex and heterogeneous connective tissue disease. Antisynthetase antibodies, in particular the anti-Jo1 antibody, are found in patients with this syndrome. The prognosis of ASS is conditioned by the occurrence of DILD and its severity, thus guiding therapeutic management. We here report the case of a 57-year-old female patient presenting with acute febrile DILD revealing ASS. Outcome was favorable under bolus corticosteroids in combination with cyclophosphamide treatment.

Aortic thrombosis associated with COVID 19 pneumonia.

Coronavirus disease 19 (COVID-19) predispose to both venous and arterial thrombotic events, especially in severe patients. There are reports of lowe risk patients whose courses are complicated by arterial thrombosis. We report the case of 53 year-old woman who presented  with severe acute respiratory syndrome due to COVID-19 with descending aortic thrombosis. The evolution was favorable under anticoagulant treatment.

Metastasis of small cell bronchopulmonary cancer in the submandibular gland: a new case.

The metastases of bronchopulmonary cancer in the submandibular gland are infrequent. We report a case of metastasis in the submandibular gland in a patient with small cell lung cancer who had chemotherapy with disease stability.

[Epicutaneous patch testing in delayed drug hypersensitivity reactions induced by antiepileptic drugs]. / Place du patch-test dans le diagnostic des réactions d'hypersensibilités retardées induites par les antiépileptiques.

INTRODUCTION: Antiepileptic drugs are widely used and are associated with numerous side effects including skin eruptions. Epicutaneous tests have been used with variable success in skin drug reactions. The purpose of this study was to evaluate the profitability of epicutaneous tests in delayed hypersensitivity reactions induced by antiepileptic drugs. METHODS: We analyzed all cases of allergic skin reactions to antiepileptic drugs notified in regional pharmacovigilance center of Sfax (Tunisia) between June 1, 2014 and April 30, 2016. The imputation score, determined using the French imputation method, should be at least doubtful. Patch-tests were performed in accordance with the general Europen network on Drug Allergy/European Academy of Allergy and Clinical Immunology (ENDA/EAACI) guidelines. Patch-tests were read according to the generally accepted criteria of the International contact dermatitis research group (ICDRG). RESULTS: In our study, 20 patients were included, among which 23 events were observed. The drug involved in delayed hypersensitivity reactions was carbamazepine in 11 cases, phenobarbital in 10 cases and valproic acid in 4 cases. The clinical reactions caused by the drug were classified as maculopapular exanthema (11 cases), DRESS syndrome (6 cases), Stevens-Johnson syndrome (2 cases), fixed drug eruption (2 cases) and erythroderma (2 cases). Patch-tests were positive in 19 patients (95 %). Cross-reactivity between antiepileptic drugs was observed in 4 cases: between valproic acid and carbamazepine in 2 cases between valproic acid and phenobarbital in 1 case and between phenobarbital and carbamazepine in 1 case. CONCLUSION: In this study, patch testing was a safe and useful method in confirming the culprit drug in delayed hypersensitivity reactions induced by antiepileptic drugs.

Hypodysfibrinogenemia: A novel abnormal fibrinogen associated with bleeding and thrombotic complications.

BACKGROUND: Congenital disorders of fibrinogen are rare diseases resulting in the complete absence (afibrinogenemia), reduced concentration (hypofibrinogenemia) or altered function of circulating fibrinogen (dysfibrinogenemia). A combination of two different fibrinogen abnormalities with a significant functional and secretion defect (hypodysfibrinogenemia) reported in Tunisian family members, was investigated in this study. METHODS: The coagulation-related tests, kinetics of fibrin polymerization and lysis and fibrinogen analysis using gel electrophoresis were performed in the family members to characterize fibrinogen abnormalities. All exons including exon-intron boundaries of fibrinogen genes were screened by direct sequencing. RESULTS: Mutational screening of the fibrinogen genes disclosed novel missense mutations, BßCys197Arg, in exon 4 of the fibrinogen Bß-chain gene. After the loose of its partner in Bß-chain, the γCys135 was probably disulfide-bridged to its corresponding Cys residue of another abnormal fibrinogen molecule, forming dimmer with an abnormal electrophoretic profile. Homozygous form carried by the proband found to be directly involved in the bleeding phenotype by affecting fibrin polymerization. In contrast, affected family members bearing the heterozygous mutation showed an impaired fibrin polymerization and fibrinolysis leading to thrombosis. CONCLUSION: These results suggest that this mutation could alter the extremely conserved conformations of fibrinogen D domain and D-D lateral regions on fibrin assembly.