The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period.

BACKGROUND: Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends. METHODS: We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants. RESULTS: We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001). CONCLUSION: In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

[Management of scrotal cysts usingCO2 laser: Two cases and a literature review]. / Traitement des kystes épidermoïdes du scrotum par laser CO2 : deux cas et revue de la littérature.

BACKGROUND: Epidermal cyst is a common cutaneous lesion that may be located in the scrotum and is seen especially in young and middle-aged men. This entity is not only chronic but can also affect the patient's appearance, thus having an impact on their quality of life. Surgical excision is the classical procedure to remove such cysts, but it can be time-consuming and leave unpleasant scars. In this report, we included patients with scrotal cysts treated with the CO2 laser. PATIENTS AND METHODS: This study reports on two patients referred with epidermal scrotal cysts in whom CO2 laser was used in superpulse mode at 10 to 10.8W and with a pulse duration of 20ms. The session was performed after local anesthesia with lidocaine. One to two 10-minute sessions were required to treat all cysts. All the patients were satisfied with the cosmetic results and no complications or recurrences were observed at follow-up. We also treated a patient with a single scrotal cyst in the same way, with excellent results. DISCUSSION: A literature review was performed using the Medline database. It revealed only two case reports involving scrotal cysts treated with laser using Nd-YAG laser and Diode Laser. There is no reported use of CO2 laser in the treatment of scrotal cysts. Its use in superpulsed mode in the cases we describe is innovative. This procedure appears to be a safe, tolerable, and efficacious approach for the removal of epidermal scrotal cysts resulting in excellent cosmetic results and without recurrence.