Efficacy of rituximab in refractory polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium and small-sized vessels resulting in multiple organ involvement. Refractory PAN requires a different therapeutic approach. We herein report the case of a 42-year-old male presenting a non-virus-related refractory PAN with a favorable outcome on rituximab.

Palate Tuberculosis with Paradoxical Lymphadenitis.

Oral cavity involvement in tuberculosis (TB), particularly palatine, is extremely rare and mostly described in case reports. Management of these cases usually responds to classic antitubercular therapy. Some serious complications such as paradoxical reactions (PRs) may however occur, making it more challenging for physicians to treat and to manage.

Teaching of evidence-based medicine principles in Family medicine curriculum: a descriptive study.

Background: Family medicine was considered officially and legally in early 2019 in Tunisia. In order to help general practitioners to fit with the new profile of family doctors, the faculty of medicine of Tunis launched an MBA curriculum in 2018. Teaching evidence-based-medicine (EBM) principals was planned in a one-day training and was divided into a morning lecture-based session and an afternoon work team session.

Family medicine: attractiveness, constraints and prospects as perceived by residents of the specialty.

Introduction: Medical studies reform in Tunisia was conducted to upgrade general medicine, depreciated by the population and experienced by practitioners as a path of failure, thus elevated to the rank of family medicine (FM).

Aim: To determine the factors of attractiveness of the FM, the prospects and career aspirations of future family physicians.

Methods: We conducted a cross-sectional survey by an anonymous questionnaire distributed via an online questionnaire platform from February 11th to April 13th, 2018 that targeted students in the 2nd year of FM at the Faculty of Medicine of Tunis.

[Traumatic and psychosocial complications of falls in the elderly in Tunisia].

Introduction: Falls in the elderly are a major health problem due to their traumatic and psychosocial complications which may lead to a loss of autonomy and a state of dependency. This study aims to study the traumatic circumstances and psychosocial consequences of falls in the elderly.

Methods: We conducted a retrospective study of 40 patients aged 65 years and over with a history of at least one fall in the previous year between September 2014 and January 2016.

Interstitial Cystitis: An uncommon revelation in primitive Sjögren syndrome.

Interstitial cystitis is an exceptional entity during primary Sjögren's syndrome. In this regard, we report the case of a 67-year-old patient in whom initially idiopathic interstitial cystitis revealed primary Sjögren's syndrome after 5 years of evolution in front of xerostomiaa, xerophtalmia and bilateral parotid hypertrophy with histological confirmation at the biopsy of accessory salivary glands.

Three scenarios of nasal obstruction revealing sarcoidosis.

The nasal location of sarcoidosis is rare. In this regard, we report three observations of sarcoidosis observed in three women with an average age of 53.6 years, revealed by annoying nasal manifestations.

[Characteristics of deep vein thrombosis in the elderly].

Purpose Of The Study: Deep vein thrombosis is a common condition in geriatric. The identification of risk factors for venous thrombosis in the elderly is important because it allows an appropriate prescription of preventive treatments. The purpose of this study is to identify the etiologic and therapeutic characteristics of deep vein thrombosis of the lower limbs in the elderly.

[Syndrome d'activation macrophagique: une série de 11 cas tunisiens].

Background: Hemophagocytic syndromes are mostly associated with underlying pathology, they can reveal: immunodeficiency, infections, hemopathies, cancers and auto-immune diseases.

Aim: to investigate clinical, biological features, outcome characteristics and underlying pathology of Tunisian patients with hemophagocytic syndromes.

Methods: A retrospective study of patients with hemophagocytic syndromes admitted in an internal medicine department in Tunis over the period 2009-2012.

Deep vein thrombosis and tuberculosis: a causative link?

Pulmonary tuberculosis is very devastating in developing countries and its thrombogenic potential is a disturbing new entity. We report an 18-year-old woman who presented with a first episode of deep vein thrombosis. Pulmonary, hepatic and splenic tuberculosis was diagnosed while looking for secondary causes.

Liver involvement in tuberous sclerosis.

Tuberous sclerosis complex (TSC) is a rare inherited disease that affects many organs and tissues, which explains the diversity of its clinical manifestations. This disease is often diagnosed at an early age when cutaneous angiofibromas, epilepsy and mental retardation are associated. The hepatic involvement in this phakomatosis is an uncommon location.

Orbital metastasis as the inaugural presentation of occult rectal cancer.

Orbital metastasis is uncommon and occurs in 2-3% of patients with cancer. It is rarely the initial manifestation of a systemic malignancy. It usually indicates extensive haematogenous dissemination of a primary cancer and is associated with poor prognosis.

[Skin sensitization to aeroallergens in the child: cross-sectional study of 200 cases].

Background: The prevalence of the allergic diseases increased considerably during the last decades. The clinical expression of allergy depends on the interaction of genetic and environmental factors.

Aim: The aim of our study was to evaluate the prevalence of sensitizing to aeroallergens in the child and to determine the risk factors of sensitizing.

Phalangeal lytic lesion: do not forget osseous sarcoidosis.

Sarcoidosis is a systemic granulomatous disease that most commonly involves the lung and thoracic lymph nodes. However, any organ can be affected. Osseous sarcoidosis has been reported in 3-13% of the cases.

Polymorphisms of Toll-like receptor-4 and CD14 in systemic lupus erythematosus and rheumatoid arthritis.

Background: Toll-like receptor 4 (TLR4) and its co-receptor CD14 play a major role in innate immunity by recognizing PAMPs and signal the activation of adaptive responses. These receptors can recognize endogenous ligands mainly auto-antigens. In addition, TLR4 (Asp299Gly) and CD14 (C/T -159) polymorphisms (SNPs) may modify qualitatively and/or quantitatively their expression.

Isolated caecal tuberculosis mimicking a neoplastic tumour in an immunocompetent woman.

Although tuberculosis is endemic in Tunisia, only a few cases of intestinal disease have been reported. This entity is usually associated with pulmonary tuberculosis. Any part of the gastrointestinal tract may be affected but usually with ileocaecal involvement.

Hypokalemic rhabdomyolysis: an unusual presentation of Sjogren's syndrome.

Hypokalaemic rhabdomyolysis represents a medical emergency requiring rapid diagnosis and appropriate aetiological treatment. Renal tubular acidosis is a common cause of hypokalemia which can be idiopathic or secondary to systemic disorders such as Sjogren's syndrome. It can remain asymptomatic or manifest with metabolic abnormalities including hypokalemia paralysis, hypocalcaemia and hyperchloremic metabolic acidosis.

Osteomalacia as inaugural manifestation of Sjögren syndrome.

Osteomalacia is a relatively common condition, which is frequently underdiagnosed due to lack of clinical suspicion and non-specific symptoms. Osteomalacia can complicate tubulo-interstital nephritis. However, it occurs exceptionally as the first manifestation of Sjögren syndrome with renal involvement.