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1.
Iran J Otorhinolaryngol ; 33(116): 177-181, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34222110

RESUMO

Introduction: Organized hematoma of the maxillary sinus (OHMS) is a rare benign disease that can be locally aggressive. The diagnosis of this condition is challenging. Case Reports: We report two cases of OHMS presented with recurrent nasal bleeding, nasal obstruction and anosmia. Radiological findings were suggestive of a vascularised lesion in the first case and a malignant tumor of the maxillary sinus in the second case. Both patients underwent an endonasal endoscopic surgery, There was no recurrence at 19 months' and six months' follow-up respectively. Conclusions: OHMS should be included in the differential diagnosis if a patient presents with history of recurrent epistaxis and nasal obstruction and radiological findings reveal an expansible maxillary mass with or without bone erosion. Correct preoperative diagnosis is important to avoid unnecessary extensive surgery. The prognosis is very good and minimally invasive surgery such as endonasal endoscopic surgery can cure it completely.

2.
Pan Afr Med J ; 38: 272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122699

RESUMO

Introduction: emergency obstetric care (EmOC) is a high-impact priority intervention strongly recommended for improving maternal health outcomes. The objectives of this study were to assess the availability, utilization, and quality of emergency obstetric care services in the Governorate of Sousse (Tunisia). Methods: a cross-sectional study was conducted among public health facilities which performed deliveries in Sousse in 2017. Data were collected by consulting clinical records and registers and interviewing staff using WHO EmOC tools. Emergency obstetric care (EmOC) indicators were calculated. Results: only the University maternity Unit functioned as full comprehensive EmOC facility. No other public facility provided all the 7 Basic EmOC signal functions 3 months prior to the survey. The unperformed signal functions were: administration of parenteral antibiotics, manual removal of placenta and assisted vaginal delivery. The number of EmOC facilities was 0.72 per 500,000 inhabitants. The met need for EmOC was 89.5%. The proportion of caesarean section was 24.2%. The direct obstetric case fatality rate was 0.159% and intrapartum and very early neonatal death rate was 0.65%. Conclusion: raising maternity facilities to a minimum level of basic EmOC status would be a major contributing step towards maternal mortality reduction.


Assuntos
Serviços Médicos de Emergência/organização & administração , Serviços de Saúde Materna/organização & administração , Obstetrícia/organização & administração , Qualidade da Assistência à Saúde , Cesárea/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Feminino , Instalações de Saúde/normas , Instalações de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Serviços de Saúde Materna/normas , Mortalidade Materna , Obstetrícia/normas , Morte Perinatal , Gravidez , Tunísia
3.
Ann Diagn Pathol ; 49: 151624, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32919337

RESUMO

INTRODUCTION: Mucinous colorectal carcinoma (MC) is a rare subtype of colorectal adenocarcinoma known to be associated with bad prognosis. Lately, research has turned to identify new prognostic markers allowing the use of targeted therapy. The aim of our study is to evaluate the prognostic impact of E-cadherin and Cox-2expression in MC. MATERIALS AND METHOD: A total of 40 formalin-fixed, paraffin-embedded MC specimens were collected within a period of 13 years and were studied for the expression of the two proteins. We used SPSS 22 software to study associations with clinicopathological parameters and overall survival (OS). RESULTS: A reduced or absent E-cadherin expression was noted in 52.5% of cases. It was associated with distant metastases (p = 0.049) and venous invasion (p = 0.049). Cox-2 was overexpressed in 17.5% of cases. It was associated with negative lymph node status (p = 0.020) and with early stage tumor (p = 0.020). A significant association between the two proteins was also noted (p = 0.04). No significant association with OS was found; However, there was an improvement in the survival of patients overexpressing Cox-2 (p = 0.16). CONCLUSION: Our findings link the loss of E-cadherin expression with spread and aggressiveness in MC and Cox-2 overexpression with better prognosis and survival. Because MC has a distinct genetic pathway we encourage the analysis of MSI and Cox-2 expression in all MC. Cox-2 inhibitors may not be effective chemopreventative agents in the setting of defective DNA mismatch repair. More molecular studies are needed to better understand the role of these markers and their prognostic significance in MC.

4.
Mater Sci Eng C Mater Biol Appl ; 113: 110978, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32487393

RESUMO

This work aimed to the development of chitosan and protein isolate composite hydrogels, for carotenoids-controlled delivery and wound healing. By increasing the concentration of the protein isolate, chitosan hydrogels were more elastic at a protein isolate concentration not exceeding 15% (w/w). Chitosan-protein isolate composite hydrogels revealed low cytotoxicity towards MG-63 osteosarcoma cells. Thanks to its appropriate structural, swelling and mechanical resistance properties, chitosan hydrogel (3%; w/v), reinforced with 15% (w/w) of protein isolate, was selected for the carotenoids in vitro release study. Release profiles, show delivery patterns, where carotenoids were more barely released at a pH 7.4 medium (p < .05), compared to more acidic microenvironments (pH 4.0 and pH 2.0). Thus, developed hydrogels could be applied as pH-sensitive intelligent carriers, for drugs-controlled release, with interesting antioxidant abilities. The in vivo healing potential of hydrogels in rats' models was further studied. Topical application of hydrogel-based patches allowed the acceleration of wound healing and the complete healing, for composite hydrogel enriched with carotenoids.


Assuntos
Materiais Biocompatíveis/farmacologia , Braquiúros/metabolismo , Carotenoides/química , Quitosana/química , Hidrogéis/química , Proteínas de Frutos do Mar/química , Cicatrização/efeitos dos fármacos , Animais , Antioxidantes/química , Materiais Biocompatíveis/química , Carotenoides/metabolismo , Carotenoides/farmacologia , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Liberação Controlada de Fármacos , Humanos , Hidrogéis/metabolismo , Concentração de Íons de Hidrogênio , Ratos , Ratos Wistar , Solubilidade , Temperatura
8.
Pan Afr Med J ; 29: 149, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050613

RESUMO

Fulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 7 days of hospitalization. A 15-year-old girl presented with headache, fever, body ache for 1 day and few ecchymotic rash over her body for 3 hours. Blood cultures confirmed infection with N. meningitidis. After 2 days in the hospital, the patient developed dyspnea, elevated jugular venous pressure and shock. The patient was managed with intravenous ceftriaxone, furosemide and norepinephrine. Over the next 4 days the patient rapidly improved. Meningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patient's rapid recovery from myocarditis.


Assuntos
Bacteriemia/diagnóstico , Infecções Meningocócicas/diagnóstico , Miocardite/diagnóstico , Neisseria meningitidis/isolamento & purificação , Adolescente , Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Ceftriaxona/administração & dosagem , Diuréticos/administração & dosagem , Feminino , Febre/etiologia , Furosemida/administração & dosagem , Humanos , Masculino , Infecções Meningocócicas/tratamento farmacológico , Infecções Meningocócicas/microbiologia , Miocardite/tratamento farmacológico , Miocardite/etiologia , Norepinefrina/administração & dosagem , Resultado do Tratamento
9.
Pan Afr Med J ; 29: 174, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050638

RESUMO

Introduction: To describe all patients admitted to Tunisian intensive care unit with a diagnosis of influenza A/H1N1 virus infection after the 2009 influenza pandemic and to analyse their characteristics, predictors of complications and outcome. Methods: All patients with influenza > 18-years-old hospitalized to the ICU department of Tunisian University hospital of Sousse, between December 1, 2009 and March 31, 2016, with a positive influenza A/H1N1/09 reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal specimen were included, were included. Results: 40 cases were admitted to intensive care units. During the reporting period, 22 deaths in intensive care units (55%) were reported, the median age was 53 years (IQR 37-61), 24 (61%) were male, The median scores SAPS II and SOFA were respectively 29 (IQR 23-36) and 6 (IQR 3-10), 27% had chronic obstructive pulmonary disease (COPD), 33.3% diabetic and no patients were vaccinated against influenza A. The cause of admission was in 72.5% of the cases was hypoxemic pneumonae. By using a logistic regression, we found after adjustment to age, that acute respiratory distress syndrome (ARDS) (OR = 27; 95%CI: 3.62-203.78) was the only factor significantly associated with severe outcomes of the cases. Conclusion: Patients in the first post pandemic season were significantly older and more frequently had underlying medical conditions. Multivariate analysis showed that older male patients with chronic lung disease were at increased risk for a severe clinical outcome.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva , Adulto , Fatores Etários , Estudos de Coortes , Estado Terminal , Feminino , Humanos , Influenza Humana/virologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Pulmonar Obstrutiva Crônica , Síndrome do Desconforto Respiratório/epidemiologia , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Estações do Ano , Fatores Sexuais , Tunísia/epidemiologia
10.
Urol J ; 14(5): 5008-5012, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28853106

RESUMO

PURPOSE: To evaluate the impact of lymphovascular invasion on the prognosis of patients treated for upper urinary tract urothelial carcinomas. MATERIALS AND METHODS: Clinical records of 49 patients treated surgically at our institute for upper urinary tract urothelial carcinomas were reviewed retrospectively. LVI was defined as the presence of cancer cells within an endotheluim-lined space without underlying muscular walls. Actuarial survival curves were analysed by Kaplan-Meier method. Multivariate analysis was performed using Cox's proportional hazard model. RESULTS: Median follow-up was 32 months. Lymphovascular invasion was present in 26 (53%) patients. Lymphovascular invasion was associated with higher pathological tumor stage (pT) and higher tumor grade. The disease-free and overall survival rates of the patients with lymphovascular invasion were significantly worse than those of the patients without lymphovascular invasion (p < 0.001 and p = 0.027 respectively). Multivariate analysis revealed that lymphovascular invasion as well as tumor grade and pathological tumor stage were significant prognosticfactors for disease-free and overall survival. CONCLUSION: The presence of lymphovascular invasion was a strong predictor of a poor outcome for UTUC. This finding could help identify patients at greater risk for disease recurrence who would benefit from close follow-up and early adjuvant therapy.


Assuntos
Carcinoma de Células de Transição/patologia , Neoplasias Renais/patologia , Neoplasias Ureterais/patologia , Vasos Sanguíneos/patologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Pelve Renal , Vasos Linfáticos/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida
11.
Sante Publique ; 29(2): 255-262, 2017 Apr 27.
Artigo em Francês | MEDLINE | ID: mdl-28737344

RESUMO

Aim: This study was designed to assess the prevalence of alcohol consumption and factors associated with alcohol consumption among students of the Sousse region of Tunisia. Methods: This was a cross-sectional study conducted among 556 students of Sousse universities during the 2012-2013 academic year, using an anonymous self-report questionnaire. Data capture and statistical analysis were performed with SPSS software 18.0. Results: Our study population was composed of 268 males (48.2%) with a mean age of 21.8 ± 2.1 years. Eighty-four students (15.1%) had consumed alcohol at least once. On multivariate analysis, male gender (OR = 6.94; 95%CI = [2.32-20.72]), smoking (OR = 13.21; 95%CI = [6.20-27.78]), drug use (OR = 32.22; 95%CI = [6.73-154.26]) and parental alcohol consumption (OR = 4.31; 95%CI = [1.70-10.91]) were the factors significantly associated with alcohol consumption among students. Conclusion: This study was designed to determine the characteristics of alcohol consumption among Tunisian students. Alcohol consumption levels were comparable to those reported in the general population and were significantly related to smoking and drug use. The next step of this study will consist of developing strategies to prevent risk behaviours in the student population.


Assuntos
Consumo de Álcool na Faculdade , Consumo de Bebidas Alcoólicas/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Tunísia/epidemiologia , Adulto Jovem
12.
Tunis Med ; 94(4): 398-304, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27704514

RESUMO

Background Overweight in schools is a worrisome public health problem because they increase medium and long term risks of morbidity and mortality especially with an increased risk of persistence of obesity in adulthood. Aim To estimate the prevalence of overweight among school children and to identify its associated risk factors. Methods this is a descriptive cross-sectional study conducted among school students aged less than 18 years in the area of "Hazoua" (Tozeur). The references of BMI used for overweight and obesity are those of IOTF. The French BMI references are used to establish the prevalence of underweight. Data entry and analysis was performed using SPSS 20. Results Our sample included 445 students. The average BMI was 18.73±3.4 kg/m2. The prevalence of Underweight was 9.7%, while overweight and obesity have been reported among 6.7% of students. Overweight was significantly associated to gender and the practice of sport outside school. Conclusion Obesity in schools in the community of Hazoua is now lower than that reported in other studies. In contrast, we detected a problem of underweight, which deserves as much attention. Intervention programs should be established and whose objectives are to improve students' skills in terms of eating behavior and physical activity, these actions require collaboration at all levels.

13.
Sante Publique ; 28(5): 613-622, 2016 Nov 25.
Artigo em Francês | MEDLINE | ID: mdl-28155737

RESUMO

The results of this study will help guide public hospital human resource managers in the choice of measures designed to increase the motivation of their employees in order to ensure staff satisfaction as well as quality health care services..


Assuntos
Pessoal Técnico de Saúde/psicologia , Satisfação no Emprego , Motivação , Adulto , Estudos Transversais , Feminino , Hospitais Públicos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Tunísia , Recursos Humanos
14.
Cesk Patol ; 51(1): 48-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25671362

RESUMO

UNLABELLED: The presence of enlarged and pleomorphic nuclei is usually regarded as a feature of malignancy, but it may on occasion be seen in benign lesions such as mammary fibroadenomas. We present such a case of fibroadenoma occurring in a 37-year-old woman presenting with a self-palpable right breast mass. Histological examination of the tumor revealed the presence of multi and mononucleated giant cells with pleomorphic nuclei. The recognition of the benign nature of these cells is necessary for differential diagnosis from malignant lesions of the breast. KEYWORDS: fibroadenoma - pleomorphic stromal cells - atypia - breast.


Assuntos
Neoplasias da Mama/patologia , Fibroadenoma/patologia , Células Estromais/patologia , Adulto , Feminino , Humanos
16.
Ann Pathol ; 34(2): 115-8, 2014 Apr.
Artigo em Francês | MEDLINE | ID: mdl-24703020

RESUMO

INTRODUCTION: Male breast cancer is rare; the lobular type is exceptional. Only one case of mixed ductal and lobular type is reported in the literature. This is the first report on a mixed ductal and lobular carcinoma with melanocytic differentiation in a man. The aim of our study is to describe the clinicopathological characteristics of this rare type of breast tumor and to discuss its histogenesis. CASE REPORT: A 63-year-old man presented with cutaneous ulceration of the left breast. Ultrasound of the breast revealed a solid hypoechoic lesion, 13 mm in diameter. Microscopic evaluation of the biopsy showed an invasive ductal carcinoma. The patient received three cycles of chemotherapy and lost of view. Then consulted for increasing of the tumor size reaching 3 cm. Histological examination of the mastectomy specimen showed a mixed ductal and lobular carcinoma with melanocytic differentiation, confirmed by the immunohistochemical study. The patient received adjuvant chemotherapy and the evolution was favorable with an average follow-up of 9 months. CONCLUSION: Breast carcinoma with melanocytic differentiation is extremely rare; only seven cases are reported in the literature and all occurs in females. Its histogenesis is unclear; tumors exhibiting this combination of cell types may occur as collision or composite tumors.


Assuntos
Neoplasias da Mama Masculina/patologia , Carcinoma Lobular/patologia , Neoplasias Primárias Múltiplas/patologia , Doenças Raras/patologia , Carcinoma Ductal de Mama/patologia , Humanos , Masculino , Melanócitos/patologia , Pessoa de Meia-Idade
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