Erythema multiforme reactions following Pfizer/BioNTech (tozinameran) vaccination: two case-reports with positive rechallenge and review of the literature.

AIM: Pfizer/BioNTech (BNT162b2) is a COVID-19 vaccine with a reassuring safety profile. The main adverse reactions are mild local reactions. Cutaneous reactions are generally minor. The most common cutaneous reaction reported was a local injection-site reaction. CASE STUDY: Here we present 2 cases of erythema multiform (EM) following BNT162b2 vaccination with positive rechallenge. The 1st case was about a 51-year-old woman who developed 5 days after the 1st dose of the mRNA Pfizer/BioNTech (BNT162b2) a macular, erythematous, round-shaped lesions on the hands, knees and soles. She experienced a positive rechallenge one month later. In the 2nd case, a 55-year-old man presented 6 days following the 2nd shot of the mRNA Pfizer/BioNTech (BNT162b2), targetoid eruption on the upper and lower members. The patient reported that he had the same skin lesions in ankles and soles few days following the 1st shot of the same vaccine. CONCLUSION: Few cases of EM following COVID-19 vaccination were reported in the literature and positive rechallenge in only one case. Rechallenge was not performed in most cases. Our two cases are particular because of the positive rechallenge in both patients. This is the gold standard to confirm that the vaccine was the culprit agent in inducing EM.

Trachyonychia in childhood: Clinical aspects and outcome.

INTRODUCTION: Trachyonychia means rough, longitudinally ridged nails with a sandy, brittle and thin aspect. It is a rare condition that occurs mainly in children. Studies on trachyonychia are rare. We aimed to describe the clinical aspects and outcome of trachyonychia, as well as its treatment. CASES: Two boys aged 11 and 14 years old and a girl aged 6 years presented with nail dystrophy of the fingers and toes. Patient 1 had also a scaly patch on the glans penis, and patient 2 was atopic. Trachyonychia associated with psoriasis was suspected in patient 1 and the idiopathic form was retained in the other two patients. All patients were treated with topical steroids for a few months. The patients did not show any improvement at the six-month follow-up. Only one patient was contacted again after two years and showed spontaneous healing. COMMENTARIES: The diagnosis of trachyonychia is mainly clinical. In the literature, 62% of pediatric patients had an idiopathic form. However, a strong association was observed between trachyonychia and alopecia areata. Trachyonychia of childhood appears to have a good prognosis, with spontaneous improvement within six months to two years. Therapeutic abstention is the rule.

Skin Tests for the Exploration of Hypersensitivity Reactions Associated with Iodinated Contrast Media.

BACKGROUND: Iodinated contrast media (ICM) are responsible for multiple side effects, especially hypersensitivity reactions. These reactions can either be authentic allergies or non-allergic hypersensitivity reactions. Skin tests (prick and intradermal tests) are simple to perform and can be of great help, especially if the ICM needs to be re-used. The aim of the study was to assess the characteristics of the patients in whom skin tests were performed and the results of these tests. METHODS: This is a retrospective study from June 2014 to June 2019. All included patients had at least one episode of hypersensitivity reaction to ICM and underwent skin tests. RESULTS: We included 35 patients aged 18 to 85 years. The iopromide was the most implicated ICM. The reactions were mainly cutaneous (n=30) and immediate (n=27). The skin tests were negative, except for two patients. The re-use of ICM occurred in 11 patients: 9 with an ICM other than the one suspected and two patients with the same ICM. Among these patients, 5 did not have any premedication. Two of them had a second hypersensitivity reaction, the first with another ICM and the second with the same ICM. CONCLUSION: One of the main pillars of allergic exploration is ICM skin testing, not only to prevent a recurrence, but also to allow patients to benefit from ICM re-use, which are sometimes essential.

Primary and isolated cutaneous precursor B-lymphoblastic lymphoma in an infant.

Cutaneous lesions may represent the initial sign of various neoplasms in children, including histiocytosis, neuroblastomas, and lymphomas. Primary cutaneous lymphoblastic lymphomas are rare and involve mostly the B-cell phenotype. Herein, we report a case of isolated, primary B-lymphoblastic lymphoma in a 7-month-old infant and emphasize the importance of early diagnosis.

Sexual disorders in patients with vitiligo.

Vitiligo is a dermatosis that alters the quality of life, self-esteem and body image We evaluated, through a review of the literature sexual disorders (SD) in patients with vitiligo. Few studies were available. Those most likely to have "sexual difficulties", among persons with vitiligo, would be those with low self-esteem. Relational problems with the opposite sex are mainly related to feelings of shame and embarrassment. Large depigmented skin area and genital involvement seem predictive of the occurrence of sexual disorders. All items of the sexual function (desire, excitement, vaginal lubrication / erection, ability to reach orgasm, and satisfaction from orgasm) may be affected.

Subcutaneous sarcoidosis with thoracic involvement: A very rare presentation of the disease.

Subcutaneous sarcoidosis is a very rare manifestation of sarcoidosis and its association with parenchymal lung involvement is rarer. We report the twentieth case in the literature published on PubMed. It is the case of a 61-year-old caucasian, non-smoker lady, who presented to a dermatology department with a 7-month history of asthenia, anorexia, weight loss, fever, exertion dyspnea, dry cough, arthralgia of the large joints and non-tender multiple subcutaneous tumefactions. Biopsy of the nodules established the diagnosis of subcutaneous sarcoidosis. Bronchioloalveolar lavage revealed alveolitis with lymphocyte predominance and the CD4/CD8 ratio was 8.5. Chest computed tomography scan revealed peribronchovascular thickening, micronodules of lymphatic distribution and mediastinal lymphadenopathies which were bilateral, asymmetric, and non-compressive. We therefore concluded the involvement of the lung and the mediastinal lymph nodes. The angiotensin-converting enzyme level was high. The patient was successfully treated with prednisone at the dose of 1mg/kg/day.

Writing the title, abstract, and keywords for a medical article: to be concise and accurate.

The title and abstract are the first contact of a reader with a given article. Therefore, drafting these parts should be done carefully. The final version of the title and abstract is only made at the end of the process of manuscript writing. The title must be catchy for the reader so that he wants to read the whole article. It must also be simple, clear and informative. It can be descriptive, affirmative or interrogative. The title's length is 10 to 12 words reflecting the main information the article contains. If more information is needed, the author can add a subtitle. Articles with short titles are the most likely to be read and cited. The abstract is a condensed version of a scientific research and must be understood independently of the rest of the article. It gives to the reader an overall idea of the article, and conditions his decision to continue reading. The abstract can be structured or unstructured. Keywords are expressions reflecting the main aspects of the study. They allow the indexation of articles, and must be checked in the Medical subject headings. The main keywords should appear in the title.

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.

Sexuality during the postpartum period: study of a population of Tunisian women.

INTRODUCTION: The birth of a child is a milestone in a woman's life. Sexual health concerns are common in postpartum as women face psychological and physical difficulties. However, studies about sexuality during postpartum are rare in Tunisia. AIM: To evaluate the sexual function of a population of women in postpartum, and identify possible particularities and associated factors of the studied population. METHODS: This was a cross-sectional, descriptive study of women who gave birth in the six months preceding the study. A questionnaire was sent viaa social networking service. RESULTS: Our population of 100 women had an average age of 31.4 years. Women lived in urban areas, were married, have gone to university, were mostly primiparous (73%), and had vaginal delivery (53%). The average time to have sex again after delivery was nine weeks. In postpartum, sexuality showed modifications such as a change in sexual practices and a decreased frequency of sexual intercourse (73% of cases). Some factors influenced the resumption of sexuality, such as instrumental vaginal delivery, breastfeeding, body image disturbances (37%), fatigue (24%) and lack of availability (60%). The major sexual dysfunctions reported during postpartum were: desire disorders (31%), altered vaginal lubrication (31%), painful intercourse (14%) and decreased sexual satisfaction (33%). CONCLUSION: Our study highlights the importance of identifying the sexual disturbances faced by women during postpartum.

Plantar Psoriasis Associated with Olmesartan.

BACKGROUND: Psoriasis is a chronic inflammatory skin disorder that may be initiated or exacerbated by some drug intakes. Some of the most common medications known to trigger or worsen existing psoriasis include lithium, gold salts, beta blockers and antimalarials. CONCLUSION: We report an exceptional case of plantar psoriasis in a woman who was treated by olmesartan for 3 years.

Neuroblastoma-like schwannoma with giant rosette: A potential diagnostic pitfall for hyalinizing spindle cell tumor.

Neuroblastoma-like schwannoma (NLS) is a rare variant of a common tumor. The aim of this study is to discuss, through a literature review, the differential diagnoses of NLS while emphasizing the importance of ancillary studies. So far, 24 cases have been reported. We describe an additional case in a 64-year-old woman who had a 3-cm subcutaneous tumor on her flank. The histological examination showed an encapsulated neoplasm. Most of the tumor was made of giant rosettes. These rosettes had several sizes reaching 2.6 mm. They showed a palisade of rounded cells. Nuclei were hyperchromatic but bland. The center was made of eosinophilic cores of collagenous radiating fibrils. Neoplastic cells stained strongly for S-100 protein. In the capsule, perineural cells stained for epithelial membrane antigen (EMA). No expression of Mucin 4 (MUC4) was present. This was consistent with NLS. The same peculiar appearance of giant rosettes has been described in hyalinizing spindle cell tumor with giant rosettes (HSCT). We propose the term "neuroblastoma-like schwannoma" when there are small rosettes, "HSCT-like schwannoma" for tumors with giant rosettes and "collagen-rich schwannoma" when there are "ill-defined" structures reminiscent of rosettes. Immunohistochemical panel containing S100, EMA, and MUC4, as well as molecular testing when needed should be performed.

Assessment of the quality of the change of surgical wound dressings by the nursing staff in a university hospital of Tunis.

BACKGROUND: Infection of surgical wounds is the main cause of nosocomial infections. In the event of a defect in the care chain, in particular, during the change of the postoperative dressings, the infectious risk would be increased. AIM: To evaluate the gestures of change of dressing practiced by nurses of a university hospital department of surgery, in order to observe the insufficiencies. METHODS: We conducted a two-month-duration prospective, descriptive study having a qualitative approach, consisting of a protocol for observing nursing procedures carried out during the implementation of postoperative dressings in a university hospital surgery department from Tunis. A five-item observation grid was developed based on the nursing procedures that should be performed during dressing rehabilitation. RESULTS: This observation was made on 48 changes of dressings made by 13 nurses (eight women and five men). Inadequacies were noted during the preparation of the gesture, the preparation of the equipment, the execution of the act, the storage of the equipment and the transmission of the care to the rest of the nursing staff. CONCLUSION: The results of our study are consistent with a deficiency of the quality of repair of wounds by the nurses. They show a poor application of the rules of asepsis when repairing surgical wounds. This would be only partly due to inadequate staff training, as the majority of participating nurses were found to be familiar with the basics of the means and methods used to prevent infection of a wound. Other causes are lack of staff and work overload, lack of adequate material for the given care as well as lack of self-responsibility for its nursing practice. The resolution of these problems requires the setting up of an epidemiological surveillance system and the in-service training of the staff involved.

Atopic dermatitis and mother-child interaction: a comparative study of 48 dyads.

BACKGROUND: Psychological factors and family environment may play a role in the pathogenesis and the persistence of atopic dermatitis (AD). AIM: To evaluate the interactions between mothers and their children suffering from AD and to look for the presence of maternal depression and anxiety. METHODS: A sample of 24 children with AD and their mothers and 24 matched control dyads participated in the study. Maternal depression and anxiety were assessed using the Beck Depression Inventory-short form (BDI) and the Hamilton Anxiety Rating Scale (HAM-A). The mother-child interaction was evaluated by video recording, and through scores established after analyses of the video: M-score for the mother's attitude towards the child and C-score for the child's behavior. RESULTS: AD group mothers showed significantly higher scores on the HAM-A,but not on the BDI. The analysis of the video recording conveyed a significant difference in M-scores between the two groups but no difference in C-scores.. M-score was correlated with the mother's anxiety. CONCLUSION: Our study found evidence in favor of a disturbance of the mother- child interaction in the case of AD, noted on the mother's side, and more anxiety in AD group mothers than in the control group. Our findings suggest the need for psychological support for mothers of children suffering from AD.

Impact of pregnancy on sexuality : a cross-sectional study of 100 tunisian women.

BACKGROUND: Pregnancy is a period during which anatomical, physiological and psychological changes may affect couple sexuality. AIM: To determine the knowledge and practices in sexuality, and identify the particularities of the sexual function during pregnancy. METHODS: A cross-sectional, descriptive and analytical study of pregnant women who responded to a questionnaire sent by Internet through a social network. RESULTS: Ninety-one percent of the 100 enrolled women were aged 25 to 34 years; 97% had a university education, and 66% were in the third quarter. Ninety-four percent of women thought that sexual intercourse is possible during pregnancy. The main reason to continue having sex during pregnancy was to have pleasure for either partner (87%). The reasons not to have sex were mainly fatigue (63%) and discomfort (51%). The main sources of information were the Internet (82%) and physicians (70%). During pregnancy, 92% of women continued to have sex with, however, a reduced frequency compared to the period before pregnancy. Fifty-five percent of women had a decreased desire level, and sexual satisfaction was also decreased in 43% of women. Sexual desire and lubrication were present half the time or more in the second quarter in, respectively, 69% and 55% of pregnant women. The difference with pregnant women in the first and third quarters was statistically significant. CONCLUSION: Our study focused on women who had most often access to scientific information about pregnancy and sexuality. The pleasure was the main reason to continue having sexual activity. The second quarter was the most sexually "rich" period.