Family medicine: attractiveness, constraints and prospects as perceived by residents of the specialty.

INTRODUCTION: Medical studies reform in Tunisia was conducted to upgrade general medicine, depreciated by the population and experienced by practitioners as a path of failure, thus elevated to the rank of family medicine (FM). AIM: To determine the factors of attractiveness of the FM, the prospects and career aspirations of future family physicians. METHODS: We conducted a cross-sectional survey by an anonymous questionnaire distributed via an online questionnaire platform from February 11th to April 13th, 2018 that targeted students in the 2nd year of FM at the Faculty of Medicine of Tunis. RESULTS: We included 68 students. The median age was 26 years. The sex ratio was 0.4. The initial reason for choosing FM was the short course leading up to doctoral degree in medicine in 81% of students. The main factors of attractiveness of the FM were the overall approach of the patient (59%), the richness and the variety of the discipline (57%) and the rich human contact (37%). The main training constraints were the imprecise status (85%), the absence of a college of FM (59%) and the insufficient training (50%). Forty-three students (63%) wanted to continue their career abroad. The main reasons for this exodus were the search for a better quality of life (98%), better working conditions (81%), better training and supervision (67%) and acceptable remuneration (41%). The main expectations of the students were personal and family development (69%), the possibility of exercising at best their job (66%) and acceptable remuneration (59%). CONCLUSION: Family medicine must have a defined status, an adapted curriculum, an should be attractive financially and scientifically.

[Hypercalcemia related to PTH-rP revealing malignant hepatic epithelioid hemangioendothelioma]. / Une hypercalcémie humorale maligne révélant un hémangioendothéliome épithélioïde du foie.

Hypercalcemia caused by tumor production of PTH-rp occurs most often in cases of squamous cell carcinoma of the lung, aerodigestive tract cancer, gynecological cancer and lymphoma. We report an exceptional case of PTH-rp related to a hepatic hemangioendothelioma. A 70 years-old male admitted for deterioration of the general state. The laboratory investigations revealed hypercalcemia, related to tumor production of PTH-rp. Imaging revealed tumoral hepatic lesions. Histopathological study and immunohistochemistry showed diffuse response for CD31 marker, CK20 (+) with CK7 (-) and hepatocyt antigen (-). The diagnosis of PTH-rp related to hepatic hemangioendothelioma was make. The patient died with recurrence of fatal hypercalcemia. Management of patients presenting with humoral hypercalcemia includes a vigorous search for tumor lesions. Elevated PTH-rp can be a bad prognostic factor. In front of tumoral liver lesions, a hepatic epithelioid hemangioendothelioma must be considered. Immunohistochemistry is necessary to make diagnosis.

[Chronic disseminated intravascular coagulation caused by aortic dissection]. / Coagulation intravasculaire dissiminee revelant une dissection de l'aorte.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a severe disease. It can be caused by loss of pathology. CASE REPORT: We report the case of chronic aortic dissection discovered during the evaluation of disseminated intravascular coagulation (DIC). This case is characterised by the severity of clinical presentation, challenging diagnosis and difficulty of therapeutic approach. Low dose of heparine may reduce the severity of this situation; but vital prognosis remains obscure. CONCLUSION: aortic dissection is a rare but a severe cause of disseminated intravascular coagulation

[Renal amyloidosis during Behçet's disease. Study of one case]. / Amylose compliquant une maladie de Behçet: a propos d'un nouveau cas.

BACKGROUND: Amyloidosis in Behçet's disease is rare and has a poor outcome. AIM: Report a new case. CASE: We report a case of a 38-year-old Tunisian woman who presented with Behçet's disease and nephrotic syndrome. Renal biopsy showed amyloid deposition consistent with AA type. She had not any associated disease that might be an additional cause of secondary amyloidosis. She was treated by colchicine. After 3 years, proteinuria had disappeared and persisted negative 11 years after the diagnosis. A second renal biopsy showed the persistence of amyloidosis. CONCLUSION: As amyloidosis is one of the prognostic factors affecting survival in Behçet's disease, patients with this disease should be screened for amyloidosis. Administration of colchicine to these patients may be beneficial.

Spontaneous ovarian hyper stimulation syndrome and deep vein thrombosis in a non pregnant woman: case report.

AIM: To assess aetiological factors and complications in a patient with severe ovarian hyperstimulation syndrome (OHSS) and internal jugular vein thrombosis. CASE: A 27-year-old non pregnant woman with bilateral ovarian masses who had underwent laparotomy for suspicion of malignant tumor. The pathological examination disclosed malignancy and the diagnosis of OHSS were confirmed. The postoperative evolution was complicated by internal jugular, subclavian vein thrombosis and pulmonary embolism. All biological parameters were negative. The evolution was good. CONCLUSION: The incidence of thromboembolism in women with OHSS is low and the typical finding is deep venous thrombosis in the neck area. Preventive measure of OHSS is very important, and the patients must be treated timely and correctly once OHSS occurs.