La tuberculose digestive dans la région de Marrakech. Aspects épidémiologiques, diagnostiques et thérapeutiques

Gastrointestinal tuberculosis is still a public problem of health in Morocco. The aim of our study is to analyze the epidemiological, clinical, paraclinical, diagnostic, therapeutic and developmental aspects of gastrointestinal tuberculosis in the hospital complex university Mohammed-VI of Marrakech. It is a retrospective study including all the cases of gastrointestinal tuberculosis admitted to the gastroenterology unit of HCU Mohammed-VI of Marrakech over 9 years. The diagnosis was based on histological tests. In the absence of histological tests, diagnosis was based on a range of arguments. 120 patients were included in the study. The average age was 38.3 years (12–90 years). 62.5% of the patients were female. Different forms of abdominal tuberculosis were reported (peritoneal, intestinal, peritoneo-intestinal, peritoneal lymph node, intestinal lymph node, deep isolated lymph node, liver and pancreatic forms). The diagnosis was confirmed by the histological study of biopsies performed during laparoscopy, laparotomy or panendoscopy. The diagnosis of gastrointestinal tuberculosis was definite in 42.3%, and presumptive in 57.7% of the cases. Antituberculosis treatment was initiated in all patients. The clinical picture of gastrointestinal tuberculosis was polymorphic, dominated by the peritoneal form. Polymerase chain reaction (PCR) and the determination of adenosine deaminase activity (ADA) and interferon-γ are the other ways to make the diagnosis of gastrointestinal tuberculosis easier and less invasive. Treatment was based on antituberculosis drugs. The outcome was generally good under early and subtle treatment.     

Indications de la désensibilisation en fonction des données épidémiologiques récentes

In most cases, hymenoptera venom allergy is caused by bees or wasps, but also occasionally by hornets, bumblebees or other members of the Vespidae family. The prevalence of sensitisation to venom in adults who have not had an allergic reaction following an insect sting but who have a positive skin test and/or specific IgE is estimated to be between 9.3% and 28.7%. The prevalence of systemic reactions in the general population reported in the literature ranges from 0.15% to 3.3%. The risk of having another systemic reaction following a subsequent sting depends on a number of factors: (1) the severity of the preceding reaction, (2) age, (3) the responsible insect, (4) occupation, (5) interval since the previous reaction. The risk of having a particularly severe reaction also depends on several other factors: the presence of cardiovascular disease, treatment with a beta-blocker, an elevated serum tryptase, and the presence of mastocytosis. The indications for venom immunotherapy in patients with positive skin and/or blood tests must take include consideration of the risk factors for a severe reaction with a new sting.     

Un ou plusieurs syndromes somatiques fonctionnels ? Comparaison de l’état de santé de personnes fibromyalgiques et électro-hypersensibles

IntroductionFunctional somatic syndromes, grouping somatic symptoms without an organic explanation, are defined either by their predominant symptoms or by an attribution to an, often hypothetical, cause. Due to many similarities, some authors consider that there is only one FSS due to a general phenomenon of “somatization”. The objective of this work was to compare two functional somatic syndromes, one defined by its symptoms, fibromyalgia, and the other by a specific contested attribution, electro-hypersensitivity.MethodFibromyalgia or electro-hypersensitive participants (EHS) were recruited from September 2016 to April 2017 through associations of patients in Auvergne-Rhône-Alpes. Home interviews included the collection of medical, psychopathological, and symptom histories. The assessment of psychological distress, quality of life and the search for other functional somatic syndromes was performed through structured questionnaires, self-administrated scales, and clinical examination.ResultsSixteen fibromyalgia subjects and sixteen EHS subjects were included. There are differences in symptomatology, although many symptoms are common to both conditions. Lifetime history of psychiatric disorders and current psychological distress and psychopathology are frequent in both groups but more prevalent in fibromyalgia subjects. The experience of the symptoms, their interpretation, the diagnostic itineraries and the therapeutic behaviours differ radically according to the group, even if for all socio-professional impact is high and quality of life are altered.ConclusionThe health status of fibromyalgia persons is overall worse than the health status of electro-hypersensitive individuals in this small sample. Despite the overlap in symptoms and a similar impact on daily functioning, this exploratory study suggests that heterogeneous mechanisms of “somatization” may be at stake in functional somatic syndromes.