[Clinical and endoscopic prognostic factors in peptic ulcer bleeding]

Bleeding ulcer represent the most common cause of upper gastrointestinal hemorrhage. This study aims to evaluate the prognostic factors of recurrent bleeding and mortality in patients presenting with high risk of peptic ulcer bleeding. A cohort study with 88 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. Endoscopic hemostasis was performed in 32 cases [36%]. Recurrent bleeding and death occurred in 30 [34, 1%] and 3 cases [3, 4%] respectively. The predictors factors of rebleeding were hypovolemia at admission and the localization of the ulcer in bulb. The only predictor factor of death was the anticoagulant therapy. The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will allow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality

[Occult hepatitis B among hemodialysed patients]

The rate of hepatitis B infection remains high in hemodialysis units despite preventive measures. This could be attribuated to the presence of occult hepatitis B among hemodialysis. To study the prevalence of occult HBV infection in haemodialysis patients with negative Hbs Ag. A group of patients Hbs Ag [-] [n=173] followed in hemodialysis units in Monastir has been tested by the hepatitis B virus Amplicor Monitor test to detect hepatitis B virus viremia [virus hepatitis B DNA] in serum. A total of 173 patients HBs Ag [-] were included in the study [mean age: 60 years [13-74 years] sex ratio: 1, 98]. 11EV vaccination was made in 93%of patients. Twenty percent of patients were infected with HCV. The rate of transaminases was always normal even in patients anti HCV [+]. No dialysis patients had detectable hepatitis B virus-DNA by polymerase chain reaction technology. Multivariate analysis demonstrated an independent and significant relationship between anti-HCV antibody and anti-hepatitis B virus core antibody in serum. occult hepatitis B virus was absent in our study group. This could be explained by the high prevalence of patients hepatitis B vaccinated

[Sternal osteomyelitis: an exceptional osteo-articular lesion in inflammatory bowel disease: a case study]

Primary sternal osteomyelitis is a rare condition. It's association with ulcerative colitis is exceptional. We report a case of a 34 years old woman with multiple extra-intestinal manifestations presenting sternal osteomyelitis successfully treated with combined surgical intervention and intravenous antibiotics

[Chronic HBS antigen carriers casually discovered - evolutionary aspects about 221 adults]

Hepatitis B virus infection constitutes a health public problem notably in our country where the frequency of chronic HBs antigen carriage is about 5%. Most of these patients are asymptomatic and so underestimated. Study epidemiological characters and clinical, biological and virological profile of chronic HBs Ag carriers whose discovery was fortuitous. retrospective study of 221 patient's files where HBs Ag was casually discovered: blood donors [128], pregnant women [40], exposition to risk factor [24], familial inquiry [23] and prenuptial examination [6]. average age was 31 years with a male predominance. Among the hepatitis risk factors found: high frequency of multiple syringes use and scarifications. All patients were asymptomatic with a normal physical exam. Prevalence of anti-HCV antibodies was 0,28% and that of anti-HDV 9,3%. A moderate cytolysis was noted in 14 patients [6,3%] and about 2/3 of them had positive markers of viral replication [HBe Ag+ and/or DNA+]. HBe antigen was positive in 12,7% of cases. Average duration of follow-up was 20,7 months. Three patients made spontaneous conversion HBe Ag/anti-HBe, and one conversion HBs Ag/anti-HBs. Hepatic biopsy was practised in 8 patients with cytolysis and showed 3 cirrhosis and 5 chronic hepatitis. Conclusion : despite favorable evolution of these patients, a clinical and biological supervision is necessary to search cytolysis and/or viral replication requiring then more agressive management