Nail involvement in connective tissue diseases: an epidemiological, clinical, and dermoscopic study.

BACKGROUND: The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. METHODS: A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). RESULTS: Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. CONCLUSION: Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool.

Non-invasive and rapid diagnosis of type 2 diabetes mellitus based on the analysis of hair by front-face fluorescence spectroscopy.

Rapid and early detection of pathologies for screening purposes is not always easy with traditional methods. New low-cost optical techniques that are suitable for preventive detection and, more specifically, for developing countries must be developed. The objective of this work is to propose UV-VIS fluorescence of hair as a promising technique for a simple and rapid preliminary diagnosis of type II diabetes. In this work, we analyzed 130 hair samples taken from volunteers of different ages at the Habib Thameur Hospital in Tunis, Tunisia. These samples were analyzed clinically beforehand, and 50 were classified as healthy acting as a control, 24 were classified as low-level diabetics with a glycated hemoglobin A1C (HbA1c) <7%, and the other 56 were classified as high-level diabetics having an HbA1c >7%. The fluorescence of the patients' hair led to several interesting results. Indeed, a clear discrimination was obtained not only between the healthy and patients with a disease, but also a discrimination between diabetics with low levels and high levels or diabetics with and without complication. Also, a strong correlation between fluorescence spectra and glycated HbA1c for the diabetic population was clearly established. A linear discriminant analysis shows that it is possible to predict the status of test patients after having trained a fraction of the population. All these results show the ability of the front-face fluorescence (FFF) technique to detect disease and predict advanced states simply by capturing the fluorescence of the hair illuminated by a single LED. This work shows for the first time, to our knowledge, the capability of the FFF technique on hair samples for the diagnosis of diabetes.

Epidemiological, clinical, and therapeutic characteristics of Behçet's disease: a monocentric study in Tunisia.

INTRODUCTION: to describe the epidemiological, clinical, therapeutic and evolving characteristics of Behçet´s disease and identify prognostic factors. METHODS: we have realized a retrospective, single-center study, conducted over a period of 26 years and including 130 patients presenting Behçet´s disease and hospitalized in an Internal Medicine Department. RESULTS: the mean age of the Behçet´s disease at onset was 30.3 ±8.8 years and that at diagnosis was 34.6 ±9.4 years. The sex ratio (male/female) was 2.5. The mean delay of diagnosis was 53.5 months. Oral aphthosis was constant. The frequency of the manifestations was: genital aphtosis 71.5%, pseudofolliculitis 84.6%, erythema nodosum 11.5%, positive pathergy test 50%, ocular disease 36.9%, venous thrombosis 30%, arterial disease 4.6%, joint damage 30.8%, neurological disease 19.2% and digestive disease 0.8%. The male gender was significantly associated with ocular involvement (p =0.02), venous disease (p =0.01) and occurrence of relapses (p =0.01). The mean follow up was 68.5 ± 77.3 months. The poor survival prognostic factors were male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤ 24 months. Conclusion: improving the prognosis of Behçet´s disease requires a shortening of the time to diagnosis, multidisciplinary collaboration, intensive treatment of functional threats, regular monitoring, and patient adherence.

Myxofibrosarcoma of the leg: A diagnostic challenge.

We should keep in mind slowly growing malignancies when the lesion is located close to the synovial regions of the extremities. The diagnosis of certainty of myxofibrosarcoma is histological and is based on the demonstration of the myxoid matrix, fibroblastic cells with a curvilinear arrangement of the vessels.

Arterial Hypertension in Systemic Lupus Erythematosus: About 40 Cases.

The aim of this study was to determine the prevalence and the etiologic profile of hypertension (HTN) in systemic lupus erythematosus (SLE). A retrospective analysis was performed on 153 patients with SLE who attended our center for 16 years from January 2000 to December 2016. The diagnosis of SLE was established according to the classification criteria of the American College of Rheumatology in 1990. The prevalence of HTN in patients with SLE was 26.1% (40/153)' with an average delay of appearance of 21 months. There were 37 women and three men with a mean age of 46' eight years (20-70). HTN was associated with lupus nephritis (n = 8)' other renal impairments (n = 6)' and corticosteroid treatment (n = 20). Essential HTN was found in six cases. Cardiovascular factors associated with HTN were: diabetes (n = 14)' sedentary life (n = 15)' obesity (n = 12)' and dyslipidemia (n = 8). Main clinical manifestations associated with HTN were: arthralgia/arthritis (24 cases)' cutaneous involvement (22 cases)' and hematological manifestations (16 cases). Anti-phospholipid syndrome was found in 12 cases. Coronary artery disease' arteritis of lower limb' and transient ischemic attacks complicated the course of HTN in six patients. Angiotensin-converting-enzyme inhibitors were the most commonly used drug for treatment in this group. HTN was frequently associated with corticosteroid treatment in this study. We feel that the use of corticosteroids should be avoided as far as possible in all patients with SLE.

Predictive factors of the lupus nephritis in a Tunisian cohort.

INTRODUCTION: Renal involvement is a common and serious manifestation of systemic lupus erythematosus (SLE) and it is life-threatening. AIM: To identify the predictive factors of the lupus nephritis (LN). METHODS: A descriptive, analytical, single-centre, retrospective study of 115 patients with SLE (ACR 1997) was carried out in an internal medicine department for a period of 20 years from 1997 until 2017. LN was diagnosed by proteinuria ≥ 0.5 g /24h and / or urine sediment abnormality. Eighty patients did not have kidney damage during the follow-up and thirty-five developed renal involvement after SLE diagnosis. RESULTS: The univariate analysis retained several epidemiological, clinical and biological correlation parameters, according to the development of lupus nephritis, statistically significant. They are as follows, the male gender, the age of diagnosis of SLE less than or equal to 34 years, the presence of malar rash by the time of SLE diagnosis, naso/pharyngeal ulcerations, leucopoenia, positivity of anti-Sm antibody and low C3 complement.The multivariate analysis had found that age less than or equal to 34 years at the diagnosis of the SLE was the only predictive factor of the onset of LN (OR=5.1 and HR=3.4). CONCLUSION: Given the seriousness of the pathology and the complexity of its management, LN should be detected as soon as possible and must be treated appropriately by selecting the lupus population at risk for developing a serious LN.

Kaposi's Sarcoma Presenting as Lymphadenopathy in an Immunocompetent Patient.

INTRODUCTION: Kaposi's sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS. CASE REPORT: A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy. CONCLUSION: KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients. LEARNING POINTS: Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi's sarcoma (KS).Human herpes virus-8 is an important cofactor in all forms of KS.Pathology and immunohistochemistry are key to diagnosing KS.KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.

[Etiologic profile of digital necrosis in an internal medicine department]. / Profil étiologique des nécroses digitales dans un service de médecine interne.

BACKGROUND: Digital necrosis is a frequent event in vascular pathology. They are multiple etiologies and are the translation of a general or locoregional pathology. The aim of our study was to clarify the various causes of digital necrosis in an internal medicine department. METHODS: We conducted a retrospective study of 23 cases of digital necrosis collected in the internal medicine department of the hospital Habib Thameur over a period from January 1998 to April 2011 . RESULTS: There were 16 women and 7 men with mean age of 46 years. The cardiovascular risk factors were observed in 39.13% cases. Digital necroses were interested fingers in 73.91% and toes in 30.43% of the cases. The causes were dominated by the connective diseases. The treatment was symptomatic in all cases and etiologic in only two cases. CONCLUSION: In internal medicine, the causes are dominated by connectivites. The prognosis is especially functional. It remains unfavorable in spite of the improvement of the therapeutic and etiologic care.

Renal paraneoplastic vasculitis complicating lung adenocarcinoma.

Renal paraneoplastic vasculitis (RNPV) is rare. It can be revealed by glomerulonephritis, microaneurysms or renal failure. RPNV may precede the onset of the primary tumor, and treatment and prognosis depend on the etiology (primary tumor). A 54-year-old man who had a primary lung adenocarcinoma was admitted for nephrotic syndrome. The investigations revealed RNPV. The patient was treated with corticosteroids at high dose and cyclophosphamide with improvement of the renal condition; however, the patient died from worsening of his pulmonary neoplasia.