Primary Gingival Melanoma: An Important Entity

Primary melanoma of the mandibular gingiva is extremely rare. It is often misinterpreted as a benign pigmented process. The prognosis of this entity is very poor. We report here the first case of primary gingival melanoma described in the Tunisian literature about a 55-year-old smoker having cerebral and pulmonary metastases from gingival melanoma at diagnosis. Our patient underwent brain radiotherapy at a dose of 18 Gy in three sessions but he died with a decline of 3 months before starting systemic therapy. Therefore, each new case should be illustrated to make clinicians aware about the importance of the early diagnosis to improve the poor diagnosis of this entity.     

Cardiac valve prostheses, anticoagulation, and pregnancy

The course of 76 pregnancies is reported in 51 women who became pregnant after replacement of one or more heart valves. Age at conception ranged from 17 to 39 years (mean 25). There have been 71 deliveries and five women are still pregnant at the time of writing. In the 71 pregnancies, oral anticoagulants were given during 53, heparin during five, and no anticoagulants during 13. Fetal complications consisted of 12 spontaneous abortions (eight in pregnancies in which oral anticoagulants were given, three in which heparin was given, and one in which no anticoagulants were given), of 12 premature deliveries with seven stillbirths (three on oral anticoagulants and four without anticoagulants), and there were three neonatal deaths (in all all three instances oral anticoagulants had been given during pregnancy). The maternal complications were as follows. Two women with mitral valve prostheses on heparin had thromboembolic episodes. Four women on oral anticoagulants died and 11 developed haemorrhage or systemic embolism. Two of the deaths were caused by bacterial endocarditis, one was the result of obstruction of a mitral valve prosthesis, and one was due to haemorrhage. One patient developed pulmonary oedema during delivery which rapidly resolved. Seven patients had uterine bleeding after delivery (three of them were on heparin and one was on an antiplatelet agent).     

Rare association between rheumatoid arthritis and Vogt-Koyanagi-Harada syndrome: A case-based review

IntroductionVogt-Koyanagi-Harada (VKH) syndrome is a systemic autoimmune disorder that targets tissues containing melanocytes such as the eye, inner ear, meninges and skin. Despite a common genetic susceptibility, the association between VKH syndrome and rheumatoid arthritis (RA) has been rarely reported.Aim of the workTo report a rare case with RA who developed incomplete VKH syndrome. The case is described and a review of the literature on similar cases is presented.Case reportA 26 year-old Tunisian woman, with a medical history of Hashimoto’s thyroiditis, was diagnosed on 2011 with seropositive and erosive RA treated with Leflunomide. She presented to the emergency department on June 2018 with bilateral blurred vision associated with photophobia, vomiting and severe headache that had gradually progressed over the preceding five days. Ophthalmological examinations showed typical findings of VKH syndrome. The patient received intravenous infusions of methylprednisolone at a daily dose of 1000 mg for 3 days that was followed orally with 2 mg/kg of prednisone equivalent. Given the lack of improvement in visual acuity after 3 weeks of treatment, azathioprine was added and VKH remission was achieved on September 2018 as confirmed on optical coherence tomography. However, the patient passed away on October 2018 due to infectious complications of the immunosuppressant agents.ConclusionTreatments and outcomes of VKH are variable. Pharmacological management of such an association between RA and VKH may be challenging, so care must be taken to balance treatment escalation with adverse events in patients at risk.     

Intracardiac thrombus in Behçet's disease. A report of three cases

Intracardiac thrombus formation is exceptional in Beh?et's disease (less than 50 cases had been reported). Among 180 patients with Beh?et's disease (according to the criteria of the international study group for Beh?et's disease), three were diagnosed as having intracardiac thrombus. All were male, the mean age at the time of the diagnosis of the intracardiac thrombus was 27 years and the mean disease duration was 4.8 years. The presenting symptom was hemoptysis in two patients and heart failure in the third. Surgery was the first attempted treatment in two patients but thrombus recurred and resolved after medical treatment. The third patient was given corticosteroids and anticoagulants as the first line treatment. The thrombus did not resolve and the patient declined surgery. Intracardiac thrombus formation should be considered when a young Beh?et's disease patient presents with an intracardiac mass. Medical treatment including corticosteroids, immunosuppressive drugs and anticoagulants should be considered as the first line treatment and surgery should be considered when there is no resolution of the thrombus or when it becomes massive and extensive. In certain cases, thrombolytic treatment becomes an interesting alternative to surgery.     

A novel extended-spectrum TEM-type beta-lactamase, TEM-138, from Salmonella enterica serovar Infantis

A novel natural TEM beta-lactamase with extended-spectrum activity, TEM-138, was identified in a ceftazidime-resistant clinical isolate of Salmonella enterica serovar Infantis. Compared to TEM-1, TEM-138 contains the following mutations: E104K, N175I, and G238S. The bla(TEM-138) gene was located on a 50-kb transferable plasmid. Expression studies with Escherichia coli revealed efficient ceftazidimase and cefotaximase activities for TEM-138.     

−1154G/A and −2578C/A polymorphisms of the vascular endothelial growth factor gene in Tunisian Alzheimer patients in relation to β-amyloid (1–42) and total tau protein

Recent evidences indicate that polymorphisms within the promoter region of the vascular endothelial growth factor (VEGF) gene may elevate the risk for Alzheimer's disease (AD). To further investigate, we have analyzed association between promoter polymorphisms of the VEGF gene in 93 AD patients and age and sex matched 113 controls from Tunisian population. The distribution of genotype and allele frequencies of the VEGF (−2578C/A) and (−1154G/A) polymorphisms did not differ significantly between AD and control groups (p > 0.05). In the subgroup of ApoE ?4 carriers, the −2578A was observed to be significantly higher in the AD patients than in the control individuals. After adjusting the data by gender, age and the ApoE ?4 status using logistic regression, the −2578A allele was found to increase the risk for sporadic AD by 1.7-fold. The present study provides the evidence that the −2578A allele may be associated with the development of AD in the individuals with ApoE ?4 allele. In addition, AD patients carrying the −2578A allele had lower Aβ42 (p = 0.029) levels than those without this allele, particularly in subjects with ApoE ?4 allele.     

Bone mineral density of young boy soccer players at different pubertal stages: relationships with hormonal concentration

ObjectivesTo examine the effects of soccer in relation with the hormonal concentration, on the bone mass of young Tunisian players at different pubertal stages.MethodsTwo groups of 152 young boys (age: 13.3 ± 0.9 years) participated in this study: (1) 91 soccer players, and (2) 61 non-athletic boys used as control subjects. The bone mineral density (BMD) and the bone mineral content (BMC) were measured by dual-energy X-ray absorptiometry (DXA). Pubertal stages were assessed, and serum concentrations of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), growth hormone (GH) and the total testosterone were measured.ResultsThe BMD and BMC for whole body, lumbar spine, femoral neck, pelvis and lower limbs were higher in soccer players than in controls (p < 0.001). In early puberty, the soccer players also exhibited significantly greater BMD and BMC in the whole body and in weight-bearing bones compared with the controls (p < 0.001). However, there was no intersubject variability due to puberty in either BMD or BMC. The pubescent soccer players had significantly higher hormonal concentrations of IGF-1 and IGFBP-3 than their counterpart controls (p < 0.05). Moreover, the whole body BMD was significantly (p < 0.001) correlated with GH, IGF-1 and IGFBP-3 but not with the testosterone concentrations.ConclusionThe soccer participation of boys is generally associated with the improvement of their bone mass which is mainly marked at early and late puberty. The relationships between somatotropic axis hormones and BMD of the players may be linked to the parallel development of these two parameters during puberty.     

Crohn's disease and polymorphism of heat shock protein gene HSP70-2 in the Tunisian population

BACKGROUND AND AIMS: Crohn's disease is a multifactorial disorder with a pivotal role of the genetic component. HSP70-2 gene, located in IBD3 region, has a PstI polymorphic site associated recently with Crohn's disease especially with a perforating form. In this study, we sought to determine whether this polymorphism was associated with Crohn's disease in the Tunisian population and its correlation with clinical manifestation of the disease. METHODS: In all, 148 patients with Crohn's disease and 81 healthy individuals were genotyped for the HSP70-2 PstI polymorphism by restriction fragment length polymorphism analysis. RESULTS: The allele and genotype frequency of the PstI polymorphism did not differ between patients and controls. Furthermore, this polymorphism was not associated with specific disease behavior. CONCLUSION: This study reported the absence of association between Crohn's disease and HSP70-2 gene in the Tunisian population. The allele A of PstI polymorphism was not associated with phenotype of the disease.