Wafa Hamdi « Les muftis ottomans face aux changements du XIXe siècle : crises, mutations et réformes à Istanbul et à Tunis pendant les Tanzimat (1839-1876) »

Cette étude, effectuée sous la direction de M. Faruk BILICI, porte sur le rôle joué par les plus hautes autorités religieuses ottomanes d’Istanbul et de Tunis face aux réformes introduites dans les trois premiers quarts du XIXe siècle et connues sous le nom des Tanzimat. En effet, les Tanzimat désignent, dans l’histoire politique de l’Empire ottoman, la période des réformes qui débute en 1839, sous le sultan Abdülmecid, et dure jusqu’à la promulgation de la constitution (1876). Ce mouvement d..

0275: Diagnosis, complications and management of infective endocarditis: experience of Tunisian military hospital

BackgroundInfective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease – mostly chronic rheumatic heart disease – IE nowadays tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices and degenerative valvular heart disease…ObjectivesWe aimed to evaluate demographic data, underlying cardiac abnormalities, clinical profile, microbiological features, treatments and complications of IE.MethodsA retrospective study of all cases with the diagnosis of definite endocarditis according to Duke Criteria admitted to The Tunisian Military Hospital between January 2001 and December 2007.ResultsThe study included 53 patients (32 males and 21 females; mean age 44.5±16.5 years). Infective endocarditis developed on a native valve in 48 patients (90%), a mechanical prosthetic valve in 5 patients (5%). Rheumatic heart disease in 26 cases (49%) was the most common preexisting valvular abnormality in native valve endocarditis. The mitral valve was the most commonly affected valve 23 (43.4%). Fever occurred in 50 (94%) of the cases. Trans-thoracic and/or trans-esophageal echocardiography showed vegetation and/or abcess in 33 patients (62.2%). Streptococci in 17 cases (32%) and Staphylococci in 13 cases (24%) were the most common causative agents. Twenty-six patients (49%) underwent surgical treatment. Cardiac complications occurred in 13% of cases, vascular complications in 18% of cases, cerebrovascular accidents in 15% of cases and septic metastatic complications in 15% of cases.ConclusionsIE usually occurred on rheumatic heart disease. Its diagnosis is based on hemocultures and echocardiography. There are deficiencies in applying prophylaxis, which is a justification for the improvement of patient management through education

Navigating the Factors Affecting Functional Impairment in Spondyloarthritis

Objectives: This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI). Methods: This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI. Results: A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI. Conclusion: Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients. Keywords: Spondyloarthritis; North Africa; Tunisia

Pediatric rheumatology in Africa: thriving amidst challenges

Background: Pediatric Rheumatology is an orphan specialty in Africa which is gradually gaining importance across the continent. Main body: This commentary discusses the current state of affairs in the sphere of Pediatric Rheumatology across Africa and offers practical strategies to navigate the challenges encountered in research, models of care, education and training. We outline the establishment, opportunities of growth and achievements of the Pediatric Society of the African League Against Rheumatism (PAFLAR). Conclusion: This commentary lays the foundation for establishment of a formidable framework and development of partnerships for the prosperity of Pediatric Rheumatology in Africa and beyond

Sarcoidosis and spondyloarthritis: A coincidence or common etiopathogenesis?

Background: Sarcoidosis is a multisystem granulomatous disease. Co-existence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF α therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column. Case Presentation: A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes. Conclusions: Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF α are arguments for association than hazardous coincidence

Nutritional risk factors for postmenopausal osteoporosis

Background: Osteoporosis is a bone disease that combines both a decrease in bone density and its internal architecture changes. Nutrition is one of the major determinants of osteoporosis.Aim: The purpose of our study was to identify nutritional risk factors of osteoporosis of two groups of osteoporotic women and witnesses.Methods: We conducted a comparative cross-sectional study including 60 postmenopausal women and screening for osteoporosis by a bone densitometry, recruited the outpatient service of Rheumatology of the Institute KASSAB.Results: We have identified excessive supply of saturated fatty acids (SFA) in the osteoporotic compared with controls (13.27% vs 10.23%, p= 0.002) and an inadequate intake of monounsaturated fatty acids (MUFA) (12.6% vs 16.16%, p=0.012).A low calcium intake is another factor of risk of osteoporosis (574.27 ± 336.9 mg/day vs 782.45 ± 340.54 mg/day; p= 0.021). This is explained by the low consumption of milk and milk products objectified in the osteoporotic group (p= 0.001). We also found a negative relationship between inadequate intakes of potassium and osteoporosis (2241.55 ±1049.85 mg/day vs 2988.17 ± 1146.52 mg/day; p= 0.011). This may be due to the low consumption in fruit and vegetables, sources of potassium, found in the osteoporotic group (p= 0.003).We found a significant increase in the consumption of the VVPO group in the osteoporotic toward women witness (2.23 ± 0.99 number of times/day vs 1.67 ± 0.76 number of times/day; p= 0.019). A high consumption of coffee appears also as a risk factor since the osteoporotic group consume almost twice than controls (p= 0.002).Conclusion: Nutritional risk factors of osteoporosis are all the most important that they are editable and can take their place in a prevention of public health policy.Keywords: Osteoporosis; Menopause; Risk factors; Nutritio

Health-related Quality of Life Assessment on 100 Tunisian Patients with Ankylosing Spondylitis using the SF-36 Survey

Objectives: The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.Methods: A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.Results: This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.Conclusion: Impairment in the quality of life can be significantwhen suffering from AS, affecting mental health more than physicalhealth. Among disease parameters, functional impairment,disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life

Résection laparoscopique d’une duplication gastrique chez l’adulte: traitement avec succès pour une pathologie rare

Les duplications de l'appareil digestif sont les malformations congénitales rares qui peuvent toucher tout  l'appareil digestive depuis la bouche jusqu' à l'anus. Certaines duplications sont asymptomatiques et sont diagnostiqués dans la plupart des cas pendant l'enfance. La prise en charge de la duplication gastrique est essentiellement chirurgicale. Le traitement de choix est l'exérèse complète de la duplication gastrique. Les auteurs rapportent un cas inhabituel de duplication gastrique complètement reséquée par laparoscopie. A notre connaissance, ceci est le premier cas d'une duplication gastrique traitée avec succès par laparoscopie dans la littérature Tunisienne. La Résection laparoscopique peut être ajoutée à l'arsenal thérapeutique dans le traitement chirurgical de duplications du tube digestif.Key words: Duplication, estomac, diagnostic, endoscopi