ABSTRACT
Introduction: Sarcoidosis is a rare granulomatosis. The absence of well-defined criteria for definition and the existence of differential diagnosis makes the positive diagnosis difficult. Method(s): We report a case of sarcoidosis that illustrates the difficulty of this diagnosis in the presence of atypical clinical manifestations and a strong suspicion of tuberculosis. Ultimately, renal histology allowed the positive diagnosis and the response to corticosteroids confirmed it retrospectively. Result(s): Our patient was a 66 years-old female with a history of hypertension who presented with a sensory and motor polyneuropathy a couple of months after a mild COVID-19 pneumonia, hospitalized for exploration of a worsening renal function due to a tubulointerstitial neuropathy (creatinine upon admission at 250 micromol/l, eGFR = 16 ml/min/1,73m2 -MDRD). Kidney biopsy revealed an interstitial infiltrate of monocytes and fibrosis alongside non-necrotic and giant-cell epithelioid interstitial granulomas. Extra-renal signs consisted of the above-mentioned neuropathy, bilateral mediastinal adenopathies with no signs of a pulmonary disease at the bodyscan, a hepatomegaly, splenomegaly, a pleural and pericardial effusion of low abundance, and a peritoneal thickening. Bronchoscopy and bronchoalveolar washing found no evidence for malignancies and screening for mycobacterial infections by polymerase chain reaction was negative. No granulomas were found at the hepatic biopsy. Digestive tract endoscopy and biopsies showed no abnormalities. During hospitalization, the patient presented an episode of acute polyradiculonevritis confirmed by cerebral-spine fluid study and nerve conduction study results. Our patient received intraveinous immunoglobulins (IgIV) with a favorable outcome but relapsed one month later, showing signs of respiratory failure. Upon the second relapse of the chronic polyradiculonevritis and based on the absence of bacteriological and histological evidence for a mycobacterial infection and the results or the renal biopsy, the patient received high-dose corticosteroids alongside a second course of IgIV. The neuropathy regressed totally within a month with a decrease of creatinine level to 140 micromol/l (eGFR = 35ml/min/1,73m2) alongside the polyserositis and organomegaly. The final diagnosis was that of a sarcoidosis with pulmonary and renal involvement. Although the neuropathy could be considered a manifestation of sarcoidosis, its origin was intricated as post-viral original could not be formally excluded. Conclusion(s): The etiological diagnosis for granulomatous interstitial nephropathies can be challenging due to similar clinical presentations and the need to start specific treatments especially in the presence of life-threatening situations and the absence of clear criteria defining sarcoidosis further enhances the level of difficulty. No conflict of interestCopyright © 2023
ABSTRACT
IntroductionOn March, Tunisian government imposed lockdown measures on cities to contain the COVID19 outbreak. Media coverage, social distancing, quarantine and isolation led to a global atmosphere of anxiety and depression.ObjectivesTo assess the level of anxiety and depression among citizens of southern Tunisia and theirs associated factors.MethodsWe conducted a cross-sectional, descriptive and analytical online-based survey, from April 19, 2020, to May 5, 2020 on 331 citizens living in south of Tunisia. During this period, the total confirmed cases of COVID-19 exceeded 900 in Tunisia. We used a self-administered anonymous questionnaire containing citizen’s sociodemographic and clinical data. Hospital Anxiety and Depression Scale (HAD) validated in the Tunisian dialectal version was used to assess anxiety and depression. Data were analysed using SPSS version 21.ResultsThe 331 Participants were males (35%), singles (43,2%),aged between 20 and 40 years old(71%). From them, 37.5 % were suffering from anxiety and 42% of them from depression. Anxiety was correlated to the personal history of anxiety (p<10-3), the depression (p<10-3), the fear of contamination (p<10-3), the increased consumption of coffee and tea (p=0.005) and sleep disorders (p<10-3). Meanwhile, depression was associated to a past psychiatric history (p=0.001), a personal experience of psychological violence (p=0.011), increased cannabis use (p=0.011) and a broken sleep (p=0.007).ConclusionsOur study identified a high prevalence of adverse psychological symptoms experienced by Tunisian citizens during this first wave of virus spread. Mitigating coronavirus effect on mental health is becoming an international public health priority.
ABSTRACT
IntroductionLockdown imposed by the Tunisian government had a psychological impact such as depression, stress and anxiety, which triggered the development of eating disorders especially binge eating disorder.ObjectivesTo screen the binge eating disorder among general population in Gabes (south of Tunisia) and to identify factors associated with it.MethodsWe conducted a cross-sectional, descriptive and analytical web-based survey, from April 19, 2020, to May 5, 2020 on Facebook on citizens living in south of Tunisia. During this period, the total confirmed cases of COVID-19 exceeded 900 in Tunisia. We used a self-administered anonymous questionnaire containing citizen’s sociodemographic and clinical data. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used to assess Binge-Eating Disorder.ResultsA total of 331 persons were included. They were females (65%) and singles (43,2%). 71% of our population were aged between 20 and 40 years old. Among citizens of southern Tunisia, 6,9% suffered from binge eating disorder during this period of the lockdown. Binge eating disorders were associated to past psychiatric history (2,1% vs 4,53%, p<10-3), history of eating disorder (4,5% vs 2,4%, p<10-3), social isolation (5,1% vs 1,8%, p=0,015) and lack of physical activity (3,3% vs 3,9%, p=0,025).ConclusionsOur study showed that lockdown during the COVID-19 pandemic has changed the eating behavior of citizens of southern Tunisia. It is therefore important to screen them in order to manage them before complications emerge.