Cirrhotic cardiomyopathy: a subject that's always topical.

Cirrhosis is the final stage in the development of hepatic fibrosis in chronic liver disease. It is associated with major hemodynamic disturbances defining the hyperdynamic circulation and may be complicated by specific cardiac involvement or cirrhotic cardiomyopathy which is a silent clinical condition that typically remains asymptomatic until the late stages of liver disease. Recently, new criteria defining CC, based on modern concepts and knowledge of heart failure, have been proposed. Despite knowledge of the main mechanisms behind this entity, there is no specific treatment available for cirrhotic cardiomyopathy. The management approach for symptomatic cardiomyopathy in cirrhotic patients is similar to that for left ventricular failure in non-cirrhotic individuals.

Bladder metastasis originating from gastric signet-ring cell carcinoma: a case report.

Bladder metastasis of gastric adenocarcinoma is a rare phenomenon. Hereby, we report a case of a 52-year-old patient who presented with upper gastro-intestinal bleeding and ascites and was diagnosed with gastric signet-ring cell carcinoma. A CT scan revealed peritoneal infiltration and anterior parietal thickening of bladder wall. Cystoscopy showed three budding lesions of the anterior wall of the bladder. He had an endoscopic resection. Histology concluded that the bladder was infiltrated by a poorly differentiated carcinoma with independent cells consistent with a gastric origin. The patient was to be treated with palliative chemotherapy.

We report a case of a 52-year-old patient who presented with symptoms such as stomach bleeding and a buildup of fluid in the stomach (ascites). The doctors diagnosed the patient with gastric cancer. The doctors also noted a thickening in the wall of the bladder during a CT scan. After more investigations, they discovered that the cancer from the stomach had spread to the bladder (metastasis).

Assessment of histology's performance compared with PCR in the diagnosis of Helicobacter pylori infection.

Aim: Histology is the most widely used test to detect H. pylori. PCR is less used but allows the detection of both infection and antibiotics' resistance. Methods: We conducted a monocentric cross-sectional study, collecting 97 symptomatic patients to assess the diagnostic performance of histology in the detection of H. pylori infection compared with PCR. Results: Sensitivity of histology in comparison with PCR was 81.5% and specificity was 56.3%. A history of anti-H. pylori therapy intake, as well as the density of the bacterium on the gastric sample and the presence of gastric atrophy, were significantly correlated to the PCR's result in terms of H. pylori detection. Conclusion: Thus, histology can be considered as an efficient test compared with PCR in H. pylori detection.

Helicobacter pylori is a type of bacteria that can cause diseases in the stomach and the upper part of the small intestine. A number of different methods are applied by scientists to determine if this bacterium is present. In our research, we specifically examined the accuracy of two types of tests ­ one where doctors examine tissues under the microscope to find signs of the bacteria (pathological test), and another where they use a method called PCR to find the bacteria's genetic material. Our aim was to determine which test worked better.

Squamous cell carcinoma and Crohn's disease: a sometimes-challenging diagnosis.

Aim: Non-melanoma skin cancers are more common in people with inflammatory bowel disease. However, these tumors can rarely mimic a cutaneous manifestation of the disease, which delays diagnosis and clouds prognosis. Observation: A 35-year-old man with stenosing and fistulizing ileocolic Crohn's disease developed squamous cell carcinoma mimicking a groin fold abscess. After surgical drainage of the abscess, despite antibiotics and therapy combining azathioprine with infliximab, the abscess has recurred. Biopsies revealed a cutaneous squamous cell carcinoma. Palliative radiotherapy-chemotherapy was initiated, but the patient died after 3 months. Conclusion: This observation illustrates the increased risk of non-melanoma skin cancers in inflammatory bowel disease patients, particularly those exposed to thiopurines, and the value of diagnosing them at an early stage.

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density.

Aim: Although Proton pump inhibitors (PPIs) are well-tolerated, their long-term use may be associated with decreased bone mass. Methods: This is a case-control study including patients treated with PPIs (>1 year) and control subjects who have not received PPIs treatment. Results: A total of 90 patients and 90 matched controls were included. PPIs use was associated with hypocalcemia and hypomagnesemia. Vitamin D3 deficiency and hyperparathyroidism were associated with PPIs use. Long-term PPIs use was significantly associated with decreased bone density. Risk factors of decreased bone mineral density (BMD) included age >50 years, menopause, lack of sun exposure, double PPIs dose, daily intake, post-meal intake and association with a mucoprotective agent. Conclusion: Our results highlight the risk of decreased BMD in patients on long-term PPIs treatment.

In this study, we investigated the impact of long-term use of proton pump inhibitors (PPIs) on bone health. Examining 90 patients on PPIs for over a year and matching them with control subjects, we found that PPIs were linked to lower bone density. Factors such as age over 50. menopause, limited sun exposure, higher PPIs dosage, daily intake, post-meal usage and combining PPIs with a mucoprotective agent were associated with decreased bone mineral density. Our findings emphasize the concern of reduced bone density in individuals undergoing prolonged PPIs treatment.

[Adverse effects of sulfasalazine: discussion of mechanism and role of sulfonamide structure]. / Effets indésirables de la sulfasalazine : discussion de leur mécanisme et du rôle de la composante sulfamidée.

Sulfasalazine is widely used in the treatment of chronic inflammatory bowel disease (IBD) and certain rheumatic diseases. However, its use is associated with a high rate of adverse effects (AEs) which can be cutaneous, hematological, renal, hepatic, gastrointestinal or neurological. The aim of our study was to collect all cases of AEs suspected to be associated with the use of sulfasalazine in patients hospitalized in the department of Gastroenterology from the Hospital Hedi Chaker of Sfax (Tunisia) for a period of 5 years and to search the incriminated fraction (sulfonamide or salicylate). Our study population included 69 patients who received sulfasalazine for the treatment of IBD. We collected, in 23 patients (33%), 25 AEs suspected to be related to sulfasalazine. Cutaneous and hematological reactions are the most common. The subsequent administration of mesalazine was performed in 15 patients. It was well tolerated in 14 patients. So we were suspecting probably the responsibility of sulfonamide fraction in these cases. The mechanism of sulfasalazine induced AEs may be toxic or immunoallergic with the possibility of a cross-reaction with the other antimicroacterial sulfonamides.

A survey to explore the psychological and professional impact of change imposed by COVID-19.

Aim: Staff of a department underwent a change following the COVID-19 pandemic. The objective of this study was to assess the psychological and professional impact of this change. Materials & methods: This is cross-sectional study, including all department staff conducted from 15 July 2021 to 15 August 2021. Results: All the staff concerned (n = 36) participated. Only 9.37% declared that they understood the change. The main problem encountered by participants was poor communication (86.2%). More than 75% among participants had a demotivation and 54.5% had resisted. The main cause of resistance was quality of organization (42.4%). Conclusion: Our study illustrates the difficulties encountered by actors involved in organizational change and the high risk of their resistance.

Clinical and therapeutic features of Plummer-Vinson syndrome in a Tunisian population: a case series.

Plummer Vinson syndrome (PVS) is a rare entity and most publications are case or series of cases. Thus, we report a series from southern Tunisia. Our aim was to analyse the epidemiological and clinical characteristics, the therapeutic modalities as well as the evolution of this pathology. Thus we carried out a retrospective study from 2009 until 2019. For each patient with PVS, we collected the epidemiological, clinical, paraclinical data and therapeutic modalities. A total of 23 patients were enrolled with a median age of 49.52 years [18-82 years] and a clear female predominance (M/F=2/21). The median duration of dysphagia was 42 months [4-92 months]. Moderate microcytic hypochromic anemia was noted in 16 patients. The anemia was without obvious cause in 60.8% (n=14) of cases. The main endoscopic finding was a diaphragm in the cervical area. Treatment was based on iron supplementation followed by endoscopic dilatation with Savary dilators in 90.9% (n=20) and balloons for 9.1% of patients (n=2). Dysphagia recurred in 5 patients after a median of 26.6 months [2-60 months]. Three cases of PVS were complicated by esophageal squamous cell carcinoma. In conclusion, our series confirms that PVS affects mostly women. Anemia is frequently noted in these patients. Treatment is based on endoscopic dilatation which is often an easy and risk-free procedure and iron supplementation.

Screening for renal impairment in viral hepatopathy B: it is time to begin.

Aim: The aim of this study was to assess the value of routine screening for renal damage in cases of B viral infection, by looking for proteinuria and elevated creatinemia. Materials & methods: We investigate the frequency and associated factors of renal impairment in patients with viral B hepatopathy. Results: Pathological albuminuria was confirmed in 44.73%. The chronic kidney disease with slightly decreased filtration rate was found in 21.05%. In multivariate analysis, only BMI was an independent factor for pathological albuminuria (p = 0.013) and only age was an independent predictor of chronic kidney disease (p = 0.056). Conclusion: Urine dipstick and creatinemia are useful for routine screening in viral B hepatopathy especially in the elderly and overweight.

Alexithymia impairs quality of life in irritable bowel syndrome.

Aim: Our objectives were to compare the frequency of alexithymia and the alteration of quality of life in irritable bowel syndrome (IBS) and to determine the factors associated with alexithymia and quality of life deterioration. Method: This is a comparative study which collected 80 IBS patients and 80 controls. Results: Quality of life was impaired in 75% of patients vs 37.5% (p < 0.0001). The prevalence of alexithymia was 50% in patients vs 1.2% (p < 0.0001). In multivariate analysis, an impaired quality of life was associated with alexithymia (p = 0.003). The factors associated with impaired quality of life were anxiety and alexithymia. Conclusion: Alexithymia was present in half of patients with IBS and its was associated with impaired quality of life.

[Emotional disorders and inflammatory bowel disease]. / Troubles émotionnels associés aux maladies inflammatoires chroniques de l'intestin.

BACKGROUND: The co-occurrence of emotional disorders (alexithymia, depression and anxiety) and inflammatory bowel disease (IBD) is reported in the literature. There are several possible explanations for this co morbidity. AIM: To evaluate the prevalence of alexithymia, anxiety and depression among patients with IBD and to compare them with a control group of healthy individuals and to discuss the relation between emotional disorders and IBD. METHODS: We built a case - control study of 50 patients with IBD (ulcerative colitis (UC) and Crohn's disease (CD)). The control group compounded 50 subjects without IBD and paired according sex, age, and school level. Alexithymia was assessed with the 20-item version of the Toronto Alexithymia Scale (TAS -20). Participants completed the Hospital Anxiety and Depression Scale (HADS), which is a 14-item self-report scale providing separate subscale scores for anxiety (HADS-A) and depression (HADS-D). RESULTS: Among the group of patients, the rates of anxiety, depression and alexithymia were, respectively, 52%, 44% and 54%. In this group, there were significantly more anxious, depressed, and alexithymic subjects than in the control group (p respectively, 0,007, 0,015 and 0,002). The anxiety and the depression were more frequent among patients who had active disease or symptoms than those in remission (p respectively, 0,011 and 0,035). CONCLUSION: The comorbidity of emotional disorders and IBD seems to be frequent. Therefore, clinicians should look for those disorders in patients with IBD, by using specific scales. The adjunction of emotional disorder treatment, if needed, would allow optimizing the management of MICI.

Prevalence of Helicobacter pylori resistance to clarithromycin in Tunisia.

Background. Helicobacter pylori (H. pylori) resistance to clarithromycin is increasing worldwide. Data on the prevalence of H. pylori resistance are limited in Tunisia.Gap statement. Given that H. pylori resistance to clarithromycin has not been studied in Tunisia since 2010, there was a need to determinate its prevalence and the principal mutations implicated in this resistance.Aim. The aims were to define the prevalence of H. pylori infection among symptomatic patients and to determinate the level of clarithromycin resistance among these patients and the main mutations conferring this resistance.Methods. We conducted a cross-sectional study from March 2017 to February 2020 in the Hepato-Gastroenterology Department of Hedi Chaker University Hospital in Sfax that included 124 Tunisian patients who underwent gastroduodenal endoscopy with biopsies. Mutations conferring resistance to clarithromycin were detected using the Allplex H. pylori and ClariR PCR Assay.Results. Out of 124 biopsies, 101 (81.5 2 %) were PCR-positive for H. pylori. Mutations conferring resistance to clarithromycin were detected in 30/95 (31.6 %) of patients. The rate of primary resistance was 25.3 % and of secondary resistance 62.5 %. The most frequently detected mutation was A2143G (86, 90%) followed by A2142G (11, 36%). Seven patients had a double mutation A2143G-A2142G. The factors independently associated with resistance to clarithromycin were diabetes, high blood pressure, the presence of a bulbar ulcer on endoscopy and the presence of gastric atrophy on histology.Conclusion. Detection of more than 25 % of strains with clarithromycin resistance mutations makes the H. pylori first-line treatment with clarithromycin questionable in our setting, and a review of empirical treatment of H. pylori is urgently needed.

Simultaneous occurrence of a Takotsubo syndrome and paranoia delirium, related to Covid-19 pandemic: A case report.

Some psychosomatic diseases, like Tako-tsubo cardiomyopathy, may occur because of exposure to a stressful event like COVID-19. The simultaneous development of psychosis and Tako-tsubo cardiomyopathy suggests a field of vulnerability. Specific measures need to be taken to help vulnerable people to manage these stressful events.

Delusional misidentification syndrome and criminal acting out: A case report of maternal filicide.

Delusional misidentification syndromes are associated with danger and may lead to homicide. Early assessment of the danger is a key part of the psychiatric examination. Compliance to treatment in psychosis is important to avoid the devastating consequences, for the perpetrator, the victim, and the community.

First psychotic episode, related to COVID-19 pandemic, in a patient with tuberous sclerosis complex.

Clinical symptoms of tuberous sclerosis may occur because of exposure to a stressful event like COVID-19. During pandemics, specific considerations should be deserved to the mental state of people suffering from genetic diseases to prevent mental illness caused by a coronavirus.

Role of splenic and hepatic stiffness in predicting esophageal varices.

INTRODUCTION: Non-invasive assessment of portal hypertension in chronic liver disease is a topical subject. AIM: Evaluate accuracy of splenic (SS) and liver (LS) stiffness in predicting the presence of esophageal varices (OV) in chronic hepatitis B patients and determine a non-invasive composite score. METHODS: This was a monocentric cross-sectional study, including carriers of chronic hepatitis B. All patients benefited of SS and LS measurement by impulse elastography (FibroScan Echosens), FIB-4 score calculation and oeso-gastro-duodenal endoscopy. RESULTS: We included 84 patients. The average age was 49.04 ± 12.8 years. The mean value of SS and LS was significantly higher in presence of OV; p=0.000. At respective threshold values of 33.1 KPa and 43KPa, SS was able to predict the presence of OV and large OV with AUROC of 0.795 and 0.906. At respective threshold values of 7.75 KPa and 13.55 KPa, LS was able to predict the presence of OV and large OV with AUROC of 0.836 and 0.894. Arithmetic sum of SS, LS and FIB-4 values was able to predict the presence of OV and large OV with AUROC of 0.918 and 0.942. CONCLUSION: SS and LS are simple and reliable non-invasive tools for predicting OV and large OV. Their association with FIB-4 score improves their diagnostic accuracy.

Cutaneous manifestations of inflammatory bowel disease.

BACKGROUND: Cutaneous manifestations are relatively common complications of inflammatory bowel disease, although they vary widely. At the time of inflammatory bowel disease diagnosis, the mean incidence of these manifestations is around 10%. The aim of this article was to review some of the noteworthy skin disorders associated with inflammatory bowel disease. METHODS: An electronic research of the medical literature was carried out on the web sites "PubMed", "ScienceDirect" and "Interscience Wiley". RESULTS: The cutaneous manifestations associated with inflammatory bowel disease were divided into 3 groups based on the nature of the association: granulomatous cutaneous disease, reactive skin eruptions and other associated dermatoses. In this review, focus has been given on granulomatous cutaneous disease and reactive skin eruptions. CONCLUSION: Patients presenting with inflammatory bowel disease should be examined for cutaneous manifestations. For most of these cutaneous manifestations, the primary therapeutic target remains the bowel.

Health-related quality of life in patients with inflammatory bowel disease: a Tunisian study.

BACKGROUND: Inflammatory bowel disease (IBD) impairs healthrelated quality of life (HRQOL). AIM: To describe HRQOL in Tunisian patients with IBD and to compare it with a reference population. METHODS: HRQOL was assessed with the Tunisian versions of the Medical Outcomes Study Short Form 36 (SF 36) and the Inflammatory Bowel Disease Questionnaire (IBDQ-32). RESULTS: Sixty two IBD patients were included (23 CD, 39 UC). The control group consisted of 62 healthy subjects. We have shown that HRQOL in Tunisian patients with IBD, measured with the SF-36, is lower than that of a Tunisian reference population without significant differences. Using the IBDQ-32, we found lower scores in women, in patients with CD, with material deprivation, and with active disease. Factors such as the experience of previous relapses or hospitalisations, disease duration, previous resective surgery, remission duration, maintenance therapy, marital status and smoking status do not have a significant impact on HRQOL in these patients. CONCLUSION: Most patients with established inflammatory bowel disease showed only minor impairment of their HRQOL. However, women and the patients suffering from active and Crohn's disease as well as the materially deprived patients are most at risk.. Better clinical care and psychological counselling for these more vulnerable groups may improve their quality of life.

Large gastric diverticulum.

BACKGROUND: Gastric diverticula are infrequent anatomic abnormalities that are usually asymptomatic. AIM: We report a case of large gastric diverticulum and discuss diagnostic and therapeutic challenges. CASE REPORT: A 63-year-old man was admitted with vague epigastric discomfort. Physical examination and laboratory investigations were normal. Endoscopy revealed an erosive gastropathy and a pouch arising from the posterior aspect of the greater curve, 8 cm from the hiatus. Barium meal confirmed the presence of a 5 cm diameter diverticulum arising from the gastric fundus. CONCLUSION: Careful examination of the whole stomach at gastroscopy is recommended for not missing a diverticulum.

[Role of the psychosocial factors in blood pression balance; cross-sectional study including 100 ambulatory hypertensive patients]. / Rôle des facteurs psychosociaux dans l'equilibre tensionnel: etude transversale de 100 hypertendus ambulatoires.

INTRODUCTION: Hypertension is a real public health problem. His pathogenesis involves a combination of several factors including environmental and psychosocial factors. AIM: We focus on the links between the blood pressure imbalance and some psychosocial factors in a population of ambulatory patients with hypertension. METHOD: It was a cross-sectional study on 100 patients with hypertension followed up in Cardiology in Sfax (Tunisia). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Behavioral pattern was evaluated by a clinical interview, referring to the model of Friedman and Rosenman. We also collected socio-environmental, clinical, therapeutic and prognostic data. RESULTS: The most predictive factors of an unbalanced blood pressure were independently: personality type "A" or unspecified (p = 0002), high fat diet (p = 0026), poor drug adherence (p = 0038) and depression (p = 0015). CONCLUSIONS: Several sociodemographic and lifestyle factors are interrelated and implicated in the blood pressure imbalance, suggesting the need of a hygienic behavior joining the international recommendations. We insist on the treatment of the anxious and depressive disease and the psychotherapeutic approach of some personality patterns in the management of hypertension.