[Special features of systemic sclerosis in men]

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. To investigate the initial clinical features, evolution and prognosis of systemic sclerosis in men. 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. 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. This work has highlighted several features of systemic sclerosis encountered in men. These results warrant confirmation by analyzing a larger population

Corticoid-associated complications in elderly

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. To evaluate the frequency and type of side effects and complications of long-term corticosteroid therapy in the elderly. 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. 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. 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

[Takaysu's arteritis in Tunisia: a monocentric study of 11 patients]

Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. To assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. 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]. 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. 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

[General rules of the management of diabetes with psychiatric disorders]

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. To establish rules of the management of diabetes among people with psychiatric disorders. Literature review on the PUBMED database using the following keywords: diabetes, psychiatric disorders, anti-psychotics, complications. 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. 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

[Urinary tract infections in elderly]

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. To study the epidemiological, clinical, paraclinical and therapeutic aspects of UTI in the elderly. 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]. 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. 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

[Arterial involvement in Behcet's disease: a series of 7 cases]

Arterial involvement is rarely described in Behcet disease BD and it is associated with poor prognosis. 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. 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. 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 fo11owup, Arterial involvement is more frequently noted in vasculo-Behcet than venous thrombosis and it's associated with a high morbidity and mortality rate

[Venous involvement in behcet's disease: a series of 28 cases]

Venous involvement is a rare and severe clinical feature in Behcet disease [ED]. We reported our experience with a rare and interesting subset of ED patients with venous involvement. From 1994 to 2008, twenty eight eases of venous ED were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. 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 ED than others without vasculo-Behcet disease. In contrast digestive and rheumatologic symptoms were more likely observed in patients without vasculo-l3ehcet disease. Thirteen patients underwent corticosteroids. Relapses occurred more frequently in patients without corticosteroid therapy. Venous involvement is more frequently noted in vasculo-Behcet than arterial involvement. Its treatment should include anticoagulation in association with corticosteroids

leflunomide [Arava] dans le traitement de la polyarthrite rhumatoide

The aim of this study was to assess the effect and safety of leflunomide [LEF] in refractory RA and to review the literature on this subject. A one year prospective study was conducted on a group of patients [n: 15]. Mean duration of the disease was 6,46 years. Rheumatoid factor was present in 12 cases. Leflunomide was administered at a dos of 20mg/day following a loading dose of 100mg/day for three days. The efficacy of LEF was evaluated on clinical and biological parameters of RA evolutivity at one, 3,6,9 and 12 months. Our mean follow up period was about 8 months [2 to 12 months]. Good prognostic indicators of disease progression were observed with LEF at one month and later in eleven cases with a good safety. Non serious adverse events were observed with LEF. Our results confirm that LEF may present another therapeutic choice that is efficacious for the long term treatment of refractory RA. Nonetheless, these results must be evaluated on a larger series

modulateurs du TNF alpha dans le traitement de la polyarthrite rhymatoide

Current slow-acting anti-rheumatic drugs available at now for rheumatoid arthritis fail in majority of cases and have an inconstant chondro-protective effect. Improvements in our knowledge of its pathogenesis and advances in molecular biology have made possible to develop selective immunotherapy approaches. Tumor necrosis factor alfa [TNF alfa] is an important inflammatory mediator that play a crucial role in rheumatoid arthritis. This studies summarizes clinical essays that evaluate beneficial effects and tolerance of anti TNF alfa antibodies. This study showed the clinical, biological and radiological efficacy of these therapeutic agents. But some doubts persist concerning their long term side effects particularly infections, neoplasm or auto immune ones. High price of this treatment should evaluate report cost benefice to appreciate the better utilisation of these drugs

atteinte cardiaque au cours des spondylarthropathies

Cardiac involvement is a real manifestation of spondylarthropathies and include specially aortic reguragitation an conduction troubles. We present a prospective open study of fifty patients with spondylarthropathy [responded to Amor criteria] in order to evaluate the frequency of cardiac involvement, to see its type and if we can evaluate a group of patients able to this complication. We have included forty-four men and six women with a mean age of 38 years. The disease evolue for 8.8 years in mean. Ag HLA B27 was present in 70% of the cases. Thirty patients have ankylosing spondylitis, although twenty have a secondary spodylartropathy: psoriasic rheumatism [12 cases], inflammatory bowel disease: crohn's disease [4 cases], RCH [three cases] and fiessenger le Roy-reiter syndrom in one case. All the patients have had a cardiac check up with research of clinical cardiac manifestation, thoracic chest trans-thoracic echographi, Holter rhythmic done in five cases only. Cardiac involvement is found in five cases [10%]: aortic regurgitation in 3 cases [6%] and mitral regurgitation in 2 cases [4%]. These valvular disease are well tolerated