[Management of venous thromboembolism in psychiatric patients]. / Prise en charge de la maladie veineuse thromboembolique chez les patients psychiatriques.

BACKGROUND: Several studies conducted in psychiatric populations, have reported the promoting and pejorative role of psychiatric community in thrombogenesis. AIMS: To clarify the specificity of psychiatric community in deep vein thrombosis (DVT) and to propose a set of general recommendations for appropriate care. METHODS: We searched MEDLINE (PubMed) between 1956 and 2010. We reviewed article titles and abstracts and full text of selected studies of psychiatric patients with venous thromboembolism disease. We identified 50 studies that investigated the association between psychiatric disease and venous thromboembolism events. RESULTS: In psychiatric community venous thromboembolism disease has several characteristics: epidemiological, clinical and evolutionary and is conditioned by a combination of several thromboembolism risk factors: - Linked in part to the psychiatric illness itself, - But above all specific therapeutic methods in psychiatric community (anti-psychotic, restraint...) which are easily preventable. CONCLUSION: Besides the medical side, the psychiatric community itself is characterized by a large number of variables, giving a particularly encouraging and derogatory about the advent and development of VTE.

[General rules of the management of diabetes with psychiatric disorders]. / Regles generales de la prise en charge du diabete avec troubles psychiatriques.

BACKGROUND: Psychiatric disorders appear to be frequent in patients with diabetes mellitus. The presence of psychiatric co-morbidity may affect adherence to medication and self-care regimes. AIM: To establish rules of the management of diabetes among people with psychiatric disorders. METHODS: Literature review on the PUBMED database using the following keywords: diabetes, psychiatric disorders, anti-psychotics, complications. RESULTS: Psychiatric disorders appear to be frequent in patients with diabetes mellitus. Their presence is associated with poor glycemic control and more diabetes complications. This negative effect may be increased by taking atypical antipsychotics which expose to several metabolic effects such as overweight, insulin resistance, hyperglycemia, Type 2 diabetes and dyslipidemia. CONCLUSION: The management of diabetes among people with psychiatric disorders should be multidisciplinary including internist, diabetologist, psychiatrist, and paramedical staff. This treatment includes medical (anti-diabetics, anti-psychotics) and psychotherapeutic interventions through which we can have better glycemic control and decreased rates of diabetes complications.

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.

[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.

[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.

[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.

[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.

[Venous involvement in Behcet's disease: a series of 28 cases]. / Atteinte veineuse au cours de la maladie de Behcet: a propos de 28 cas.

BACKGROUND: Venous involvement is a rare and severe clinical feature in Behcet disease (BD). AIM: We reported our experience with a rare and interesting subset of BD patients with venous involvement. METHODS: From 1994 to 2008, twenty eight cases of venous BD were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. RESULTS: 45 episodes of venous thrombosis occurred in 28 patients. There were 25 men and 3 women the mean age when venous involvement manifested was diagnosed was about 32.25. Venous thrombosis occur in the first five years following the diagnosis of BD. Pericarditis was more frequently noted in patients with venous BD than others without vasculo-Behcet disease. In contrast digestive and rheumatologic symptoms were more likely observed in patients without vasculo-Behcet disease. Thirteen patients underwent corticosteroids. Relapses occurred more frequently in patients without corticosteroid therapy. CONCLUSION: Venous involvement is more frequently noted in vasculo-Behcet than arterial involvement. Its treatment should include anticoagulation in association with corticosteroids.

[Arterial involvement in Behcet's disease: a series of 7 cases]. / Atteinte artérielle au cours de la maladie de Behcet: a propos de 7 cas.

BACKGROUND: Arterial involvement is rarely described in Behcet disease BD and it is associated with poor prognosis. AIM: We report our experience with a rare and interesting subset of Behcet disease patients with arterial involvement: thrombosis and aneurysm formation types of angio-BD. METHODS: From 1994 to 2008, seven cases of arterial BD with 3 aneurysm formation and 4 thrombosis were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. RESULTS: Combination of venous and arterial manifestations occurred in 4 patients. All patients were male and the mean age when arterial involvement manifested was diagnosed was about 39.3. The artery most often affected is the aorta followed by the pulmonary arteries. Brain infraction occurred in about 4 cases. Pericarditis and neurological symptoms were more frequently noted in patients with arterial BD than others without vasculo-Behcet disease. All patients underwent corticosteroids and immunosuppressive therapy. Two patients were successfully operated for aneurysms. All patients were alive after a mean of 7.8 years follow-up. CONCLUSION: Arterial involvement is more frequently noted in vasculo-Behcet than venous thrombosis and it's associated with a high morbidity and mortality rate.

[Catastrophic antiphospholipid syndrome and rituximab: a new report]. / Syndrome catastrophique et anti-CD20: une nouvelle observation.

BACKGROUND: Catastrophic antiphospholipid syndrome is a distinctly rare dramatic condition characterized by widespread thrombosis of small vessels. Early diagnosis and aggressive therapies are essential in this condition because of its extremely high mortality rate. Therapeutic management include heparine, high dose steroids, cyclophosphamide, plasma exchange, intravenous immunoglobuline, however a number of patients are refractory to treatment. AIM: We review and discuss alternative and emerging treatment options by rituximab for patients who fail or cannot tolerate conventional therapy. CASE-REPORT: A 36-year-old female with a two mounths history of dyspnea, palpitation and chest pain was admitted. Physical examination upon admission revealed a fever, ischemic digital necrosis, scleroderma of the hands and beaking of the nose. Laboratory tests showed normal level of liver enzymes, elevation of creatinine level, lymphopenia, haemolytic anaemia with negative Coombs tests, low platelet count, prolonged partial thromboplastin time. The D-Dimer value was 158 ng/ml. Urinalysis revealed a proteinuria. Antinuclear antibody tests and lupus anticoagulant were strongly positive. Echocardiography revealed severe pulmonary hypertension and pericarditis. There was no pulmonary embolism on thoracic angio tomodensitometry. The diagnosis of catastrophic antiphospholipid antibody syndrome associated with systemic lupus and scleroderma was established. She was treated with anticoagulants, corticotherapy, one pulse of intravenous cyclophosphamide, 2 doses of intravenous immunoglobuline and 5 sessions of plasmapheresis. Because of lack of response 2 doses of 375 mg weekly rituximab i.v. were added but she developed pulmonary embolism, alveolar haemorrhage and she died. CONCLUSION: Effectiveness of Rituximab for the CSAPL should be demonstrated by further studies.