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Biomedical subjects

Abdelmajid Zahaf

Publications and source records attributed to Abdelmajid Zahaf.

10 recordsLinked to original sources

[Cutaneous metastasis of Crohn's disease].

INTRODUCTION: Involvement of the skin in Crohn's disease is rare. We report the case of a young woman presenting cutaneous nodules revealing a Crohn's disease. CASE REPORT: R. K. a 19 year old woman was admitted the impatient clinic for a 2 week history of nodular lesions of the extremities. Simultaneously, she had watery diarrhoea and abdominal pain associated with a bad general condition and fever. Skin examination showed ulcerated lesions with a non infiltrated inflammatory bader of the left food and the right calf associated with an abscess of the left forearm. Skin biopsy showed an inflammatory infiltrate of the deep dermis with tuberculoid noncaseating granulomas. Colonoscopy demonstrated multiple ulcers, a "globlestone appearance" of the glow and segmental glitis. Colonoscopy was followed by a peritonitis which made steroid therapy questionable. Meanwhile, the patient underwent a colonostomy and was fed intravenously, the skin lesions resolved. A follow up colonoscopy demonstrated colon polyps, and the biopsy of the colon showed features of colitis and "follicular" duodenitis which was in concordance with the diagnosis of Crohn's disease. COMMENTARIES: Usually, cutaneous lesions in Crohn's disease are consistent with nodules and granulomatous fissures of the grain. Involvement of the mucosa is rare. We report the case of "metastatic" localisation of nodular abscesses in Corhn disease. Improvement of cutaneous lesions might be explained by the nonuse of the digestive track allowed by the parenteral supplementation.

Adult↗

[Cutaneous manifestations of chronic hemodialysis. Prospective study of 363 cases].

OBJECTIVE: Chronic hemodialysis patients experience frequent and varied cutaneous manifestations, of often hypothetical pathogenesis. The aim of this work is to assess the prevalence and nature of these cutaneous lesions and discuss some pathogenic mechanisms. METHODS: This prospective study was conducted from 1 February through 30 April 1996. It included 363 hemodialysis patients in seven centers. Each patient was interviewed and examined. RESULTS: There were 210 men and 153 women. Their mean age was 50.6 years. The total duration of hemodialysis ranged from 1 to 192 months, with a mean of 52.4 months. 88% of the patients had cutaneous manifestations. Pruritus was reported by 44.8%. It appeared after hemodialysis began for 82.1% of them. Cutaneous xerosis was observed in 69%. Changes in pigmentation were observed in 17% of cases, primarily involving hyperpigmentation of photo-exposed areas. In 6 patients, skin, hair, and exoskeleton began to turn lighter 10 months to 8 years after hemodialysis. Follicular hyperkeratosis was observed in 15%. One patient had a confirmed case of perforating follicular dermatosis. Disorders of the exoskeleton (18.5% of cases) were represented mainly by thin nails and subungual hemorrhages. Other cutaneous manifestations included petechiae and ecchymoses (66%), folliculitis-type infections (9%), subcutaneous calcifications (2 cases), cutaneous pseudoporphyria (2 cases), and eczema around the fistula (11.5%), due essentially to locally-applied products. CONCLUSION: Cutaneous manifestations in chronic hemodialysis patients are frequent and polymorphous. While most have long been known, lightening of skin, in particular, others have been discovered more recently. Their pathogenesis is most often poorly elucidated. Treatment is often symptomatic. Dialysis and renal transplantation constitute the best treatment.

Female↗

[Ophthalmic manifestations of lipoid proteinosis].

INTRODUCTION: Lipoid proteinosis (LP), also known as hyalinosis (or lipoidosis) cutis et mucosae or Urbach-Wiethe disease, is a rare autosomal recessive disorder. It is associated with deposits of protein-lipid complexes in various tissues including the skin and mucous membranes. Ophthalmologic manifestations are frequent and can affect visual prognosis. CASE: This 28-year-old patient presented vesiculobullous lesions of the face that developed into varioloid scars associated with hoarseness. Ophthalmologic examination revealed unilateral lesions including hyaline deposits on the palpebral margins, iris, and trabecular zone, complicated by uveitis, cataract, and glaucoma, which caused the functional loss of the left eye. Histological examination of a cutaneous biopsy confirmed the diagnosis. DISCUSSION: Involvement of the eyelids is characteristic, and moniliform blepharosis is pathognomonic and frequent. This case featured a rare intraocular form (uveitis). Deposits may be found on the conjunctiva, cornea, trabecula and Bruch membrane. Conjunctival or cutaneous biopsy confirms the diagnosis. Available treatment is quite limited.

Adult↗

Risk factors for erysipelas of the leg in Tunisia: a multicenter case-control study.

BACKGROUND: Risk factors for erysipelas (cellulitis) were rarely evaluated in controlled studies. Regional variations of these risk factors have never be assessed. OBJECTIVE: To assess risk factors for erysipelas of the leg in Tunisia. SUBJECTS AND METHODS: Case-control study in seven hospital centers in Tunisia. Cases were 114 consecutive patients with erysipelas of the leg [sudden onset (<24 h) of a well-demarcated dermo-hypodermatitis with fever or chills]. Two controls were matched to each case for age, sex, and hospital (n = 208). Main outcome measures are local and general suspected risk factors for erysipelas of the leg. RESULTS: In multivariate analysis, disruption of the cutaneous barrier (i.e. traumatic wound, toe-web intertrigo, excoriated leg dermatosis or plantar squamous lesions) and leg edema were independently associated with erysipelas of the leg, with respective odds ratios of 13.6 (95% confidence interval: 6.0-31) and 7.0 (1.3-38). No association was observed with diabetes, alcoholism, or smoking. CONCLUSIONS: We confirmed the major role of local risk factors and the minor role of general risk factors for erysipelas of the leg, in a setting different than the one previously studied. Detecting and treating toe-web intertrigo and traumatic wounds should be considered in the prevention of erysipelas of the leg.

Case-Control Studies↗

[Beneficial effects of antimalarials in the treatment of generalized granuloma annular in children].

Granulma annulare is a polymorphic granulomatous disease of the skin. It has a chronic course and affects mainly children and young adults. We report two cases of generalized granuloma annulare in children successfully treated with antimalarials. Two children, 6 and 12 years of age, without clinical history, presented with multiple granuloma annulare lesions which did not respond to potent topical steroids. Blood glucose level was normal. These lesions responded to small doses of antimalarials. No side effects were noticed. Compared with other drugs, with potential important side effects for children. Small doses of antimalarials might be beneficial in the treatment of generalized granuloma annulare.

Antimalarials↗

[Mal de Meleda. 16 cases].

Mal de Meleda is a recessive transgression palmoplantar keratoderma. We report the epidemiological, clinical and progressiveness aspects of the disease in 16 patients of a large consanguineous tunisian family. The age ranged from 3 to 90 years. Nine were male and 7 female patients. Onset in early infancy was characterized by erythema of the palms and soles, followed by a diffuse yellowish hyperkeratosis. Thickness of the dorsal aspect of the fingers started in childhood. Extension of hyperkeratosis to the dorsal of the hand were reported only in adults and usually precede the involvement of the feet Palmoplantar hyperhidrosis with fetid odor between the toes was frequently seen as well as conical distal phalanges. In some adults keratoderma gave contracture of the fingers leading to limitation of movements Mal de Meleda must be differentiated from other recessive palmoplantar keratoderma such as Papillon-Lefévre syndrome and Mal de Naxos. the remaining inherited palmoplantar keratoderma being autosomal dominant. Mal de Meleda is a rare disease but is still relatively frequent in some tunisian regions, due to the high rate of consanguinity Mal de Meleda remains an afflicting and disabling disease.

Adolescent↗

[Kaposi' s sarcoma. A series of 65 cases].

Kaposi sarcoma (SK) is characterized by proliferation of vascular and spindle-shaped cells with variable clinical presentations. The association with AIDS modifies the profile of this disease. The pathophysiology seems to be based on the major role HHV-8. The goal of this work was to specify the profile of this disease in our region through a retrospective study of 65 cases of SK over a 23-year period (1981-2003). In our series, the classic form prevailed 163 cases (96.9%)]. One patient had a secondary form due to steroid therapy and another patient had a KS associated with AIDS. A male prevalence was noticed (M/F: 2.8). Cutaneous lesions were dominated by papulo-nodular lesions (90.9%) of the lower limbs (92.3% of the cases). Mucous lesions were present in 15.4% of the cases. Therapeutic abstention was decided in 38.4%. Surgical excision was indicated in 35.4% of cases, radiotherapy in 4.6% of the cases and chemotherapy in 23% of the cases. The classic form of KS is the most frequent in our area; the other forms remaining rare.

Acquired Immunodeficiency Syndrome↗

Dermatomyositis and malignancy in Tunisia: a multicenter national retrospective study of 20 cases.

OBJECTIVE AND METHODS: The aim of our study was to report the epidemiologic, clinical, and biologic profiles of dermatomyositis (DM) associated with malignancy in patients from Tunisia. From January 1982 to January 2000, we collected retrospectively 20 case reports of DM associated with cancer from the different university hospital centers of Tunisia. Initial workup included anamnesis, clinical examination, cancer staging and classification, serum muscle enzymes (creatine phosphokinase, lactate dehydrogenase, aldolase, and transaminases), electromyography, and muscular biopsy. We calculated the median survival and mean value of all the variables. Comparisons of statistical tests were done with the Kruskal-Wallis test. RESULTS: Among the 130 DM cases of our study, 20 were associated with cancer (15.38%). The mean age of our patients was 49.6 years and the sex ratio (female/male) was equal to 3. Cancers were mainly those of the breast (35%) and nasopharynx (25%). DM followed a paraneoplastic course in 90% of the cases. The profile of seric muscular enzymes showed a significant statistical difference (P =.05) between a group of patients with severe muscular weakness and a group with moderate muscle weakness only for creatine kinase. The median survival was 36.5 months after diagnosis of DM and 48.6 months after that of cancer. The 5-year actuarial survival was 38% as related to cancer and 16% as related to DM. Mortality was 45%, in 90% as a result of cancer. CONCLUSIONS: In our study, nasopharyngeal carcinoma represents the second cancer associated with DM, after breast neoplasm, demonstrating the frequency of these 2 cancers in our country. Despite our reduced number of study samples, our study also suggests a relationship between severe muscle weakness and high seric muscle enzymes.

Adolescent↗

Possible relation of Tunisian pemphigus with traditional cosmetics: a multicenter case-control study.

Pemphigus is a severe, autoimmune, blistering disorder with a high incidence among young women in rural Tunisia. The authors investigated explanatory environmental factors. A multicenter case-control study was conducted prospectively from 1992 to 1996 in Tunisia. Sixty-eight incident female cases of pemphigus and 166 controls matched on age, hospital, and geographic area were included. Data collected concerned socioeconomic status, medical history, drug intakes, lifestyle, and environment. Several factors were significantly associated with pemphigus in multivariate logistic regression analyses: traditional cosmetics (odds ratio (OR) = 4.0, 95% confidence interval (CI): 1.1, 14.8); Turkish baths (OR = 3.2, 95% CI: 1.4, 7.3); cutting up raw poultry (OR = 5.1, 95% CI: 1.3, 19.4); contact with ruminants (OR = 2.7, 95% CI: 1.3, 5.8); and wasp, bee, and spider stings (OR = 3.1, 95% CI: 1.5, 6.4). A dose-dependent relation was observed for traditional cosmetics. All risks except insect bites were higher when analysis was restricted to younger women, the demographic group with higher incidence. The strength of the associations, the dose-dependent relation for traditional cosmetics, and the increase of risk estimates for younger women support a causal relation. Traditional cosmetics widely used by Tunisian women could play a major role in excess of cases of pemphigus.

Case-Control Studies↗