[Rare neurological manifestations of West Nile virus infection in an immunocompetent patient]. / Association des manifestations neurologiques rares à West Nile virus chez un patient immunocompétent.

BACKGROUND: Neuro-invasive disease is the most dreaded complication of West Nile virus infection. We report the case of an immunocompetent patient who developed a meningeal syndrome associated with cerebellar ataxia, facial diplegia and hemiparesis caused by West Nile virus infection with a favourable outcome. OBSERVATION: A 42-year-old man was admitted for a febrile meningeal syndrome and confusion associated with cerebellar ataxia. The patient had developed facial diplegia, left hemiparesis with worsening cerebellar syndrome. He was diagnosed with neuro-invasive West Nile virus infection given the positive West Nile virus serologies in serum and cerebrospinal fluid as well as West Nile virus polymerase chain reaction in serum and urine. The outcome was favourable. CONCLUSION: Because of the increasing prevalence of West Nile virus, this infection should be suspected in the event of atypical neurological manifestations even in immunocompetent patients.

Getting to the heart of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series.

The aim was to investigate the frequency and spectrum of cardiac involvement (CI) in patients with Behçet syndrome (BS) in the Tunisian context, and to assess the clinical and imaging features, treatment, and outcomes. We retrospectively retrieved the medical records of patients with CI among 220 BS patients admitted to the hospital internal medicine department between February 2006 and April 2019, who fulfilled the International Study Group diagnostic criteria for BS. Ten patients (8 men, 2 women) were eligible for the study. Mean age was 37.3 years. Three patients had 2 isolated episodes of cardiac BS. The different types of CI were coronary artery disease (5/10), intracardiac thrombus (4/10), pericarditis (1/10), myocarditis (1/10), and myocardial fibrosis (1/10). Five patients had associated vascular involvement (50%). Medical treatment was based on corticosteroids and colchicine in all patients (100%), anticoagulants in 8 (80%), and cyclophosphamide followed by azathioprine in 9 (90%). The clinical course was favorable in 9 patients; 1 patient died. CI remains an important feature of BS because of its association with increased risk of mortality and morbidity. Therefore, early screening and detection with imaging methods are paramount. Also, better cooperation between rheumatologists and cardiologists could improve outcomes.

[Iron deficiency anemia in people aged 65 years and older: a cohort study of 102 patients]. / Anémies ferriprives chez les personnes âgées de 65 ans et plus: Etude d'une cohorte de 102 patients.

PURPOSE: Iron deficiency anemia is a common hematological abnormality in the older people. The aim of this study is to determine the clinical and biological characteristics and causes of the iron deficiency anemia in elderly patients. PATIENTS AND METHODS: We performed a retrospective study of 102 patients aged 65 years and older who were hospitalized for iron deficiency anemia in the internal Medicine Department of Mahdia University Hospital, over a 8-year period (January 2005 to December 2012). RESULT: A total of 184 patients aged 65 years or older were hospitalized for anemia during the study period. Iron deficiency was diagnosed in 102 (55.4%) of the patients, 58 were men (56.9%) and 44 were women (43.1%). The mean age was 74.7 +/- 6.3 years. The mean hemoglobin level was 7 +/- 1.7 g/dl. At least one cause of anemia was diagnosed in 90.2% of cases. A gastrointestinal bleeding was the most common etiology (70.5%). Non-steroidal anti-inflammatory drugs and anticoagulants intake were reported in 19.6% of cases. Multiple causes of gastrointestinal bleeding were identified in 12.7% of patients. Chronic gastrointestinal ulcers were the most frequent etiology (25.5%). The frequency of gastrointestinal cancers was 11.7%. CONCLUSION: Iron deficiency was the first cause of anemia in the elderly in our study. Occult bleeding from gastrointestinal lesions was the commonest cause and iron deficiency anemia in the elderly caused by an unknown etiology was rare.

Laparoscopic unroofing of symptomatic kidney cysts. A single center experience.

AIM: This study was aimed to evaluate success and complications of laparoscopic transperitoneal renal cyst unroofing and assess its long-term results at our center. METHODS: From October 2008 till April 2012, 23 patients (14 male and 9 female) with a mean age of 53.6 years (range 32-70), underwent transperitoneal laparoscopic renal cyst unroofing at our center. None of the patients, had history of ipsilateral kidney surgery. Complication and outcomes were evaluated. Symptom resolving and disappearance of the cyst or decreasing its size to less than 1/3 of its primary size in radiographies was considered as success. RESULTS: Unroofing was achieved in 100% of patients. Mean operative time was 36.6 minutes (range 25 to 60) and mean hospital stay was 3 days (range 2 to 8). No open conversions were necessary during procedure but one patient underwent open exploration hours after laparoscopy because of need to complete hemostasis. Symptomatic and radiologic success was achieved in 91.3% of patients, with a mean follow-up of 15 months (range 3 to 24). One patient developed a recurrence. One ureter stricture revealed in follow up period which needed open uretero-ureterostomy. No visceral complication occurred. CONCLUSION: Laparoscopic transperitoneal ureterolithotomy is an effective treatment option for skilled surgeons but care must be taken because complications may occur.