Takayasu’s arteritis occurring under TNF blockers in a patient with spondyloarthritis: is it an association or a paradoxical effect?

Coexistence of spondyloarthritis (SpA) and Takayasu’s arteritis is not a common finding, but such cases have been discussed, particularly in the context of choice of therapy. Inhibition of inflammation by tumor necrosis factor inhibitors (TNFi) is a key aspect of the treatment of SpA and also positive effects of such treatment in concomitant large vessel vasculitis have been reported. However, TNFi is also associated with the possibility of initiating vasculitis.The present article based on a case study and the available literature is an attempt to discuss coexistence of these two diseases and the impact of treatment with biological drugs from the anti-TNF group in the course of SpA with Takayasu’s arteritis.     

A tool for the management of personal protective equipment during COVID-19 pandemic: Abderrahmen Mami Hospital case study

Introduction: The COVID-19 pandemic is causing management difficulties in the Tunisian healthcare system inventory management and the supply of Personal Protective Equipment (PPE). Aim : Calculate the number of PPE needed for MAMI Hospital Ariana (dedicated hospital to COVID patients) to avoid stock-outs. Methods: This study proposed a calculation method of the PPE needs for the intensive care and pneumology departments. We developed a mathematical formulation of the number of PPE needed according to the number of visits per medical and other teams, their types, the number of patients, and the validity of each type of PPE. Results: Considering as input data: the number of visits for the different intervening teams (medical, paramedical, worker or other), the capacity of the different services (number of beds), the average length of stay of patients, the validity duration of an equipment and urgent visits, the developed model generates the required number of PPE (especially surgical masks, FFP2 masks, disposables gowns and coveralls). This allows to calculate the number of personal protective equipment (PPE) needed by the Mami hospital’s pharmacy in this period of COVID-19 crisis. Conclusion: Our configurable application allowed us to calculate PPE requirements for the intensive care and pneumology departments and estimate their use duration.     

Targeting the histone demethylase LSD1 prevents cardiomyopathy in a mouse model of laminopathy

LMNA mutations in patients are responsible for a dilated cardiomyopathy. Molecular mechanisms underlying the origin and development of the pathology are unknown. Herein, using mouse pluripotent embryonic stem cells (ESCs) and a mouse model both harboring the p.H222P Lmna mutation, we found early defects in cardiac differentiation of mutated ESCs and dilatation of mutated embryonic hearts at E13.5, pointing to a developmental origin of the disease. Using mouse ESCs, we demonstrated that cardiac differentiation of Lmna^H222P/+ was impaired at the mesodermal stage. Expression of Mesp1, a mesodermal cardiogenic gene involved in epithelial-to-mesenchymal transition of epiblast cells, as well as Snai1 and Twist expression, was decreased in Lmna^H222P/+ cells compared with WT cells in the course of differentiation. In turn, cardiomyocyte differentiation was impaired. ChIP assay of H3K4me1 in differentiating cells revealed a specific decrease of this histone mark on regulatory regions of Mesp1 and Twist in Lmna^H222P/+ cells. Downregulation or inhibition of LSD1 that specifically demethylated H3K4me1 rescued the epigenetic landscape of mesodermal Lmna^H222P/+ cells and in turn contraction of cardiomyocytes. Inhibition of LSD1 in pregnant mice or neonatal mice prevented cardiomyopathy in E13.5 Lmna^H222P/H222P offspring and adults, respectively. Thus, LSD1 appeared to be a therapeutic target to prevent or cure dilated cardiomyopathy associated with a laminopathy.     

An Apical Mass of the Left Ventricle After a Myocardial Infarction: Imaging Contribution

Intramyocardial dissecting hematoma (IDH) is a rare complication of myocardial infarction (MI). It can affect the left ventricular free wall, the right ventricle, or the interventricular septum. We report a case of a 58-year-old man with an IDH following an acute anterior wall myocardial infarction detected by echocardiography and confirmed by Cardiac magnetic resonance (CMR).     

Effect of Genetic Polymorphism +294T/C in Peroxisome Proliferator-Activated Receptor Delta on the Risk of Ischemic Stroke in a Tunisian Population

PPARδ +294T/C polymorphism was investigated in diabetics, in normolipidemic healthy controls, in dyslipidemic and nondyslipidemic coronary artery disease patients but never in ischemic stroke patients. The aim of this study was to explore, for the first time, the relationship between the genetic polymorphism of PPARδ and the risk of ischemic stroke among patients with diabetes. The study group consisted of 196 patients with ischemic stroke and 192 controls. Plasma concentrations of total cholesterol, triglycerides, low-, and high-density lipoprotein did not differ significantly between subjects carrying the TT genotype and those carrying the CC/TC genotype in both ischemic stroke patients (with or without diabetes) and control groups. The +294C allele (CC + CT genotypes) as compared with TT genotypes was found to be higher in total ischemic stroke patients than in controls. On the other hand, no interaction between diabetes and PPAR +294T/C polymorphism on the risk of ischemic stroke was found (p?=?0.089). The PPARδ +294T/C polymorphism was associated with the risk of ischemic stroke in Tunisian subjects. This polymorphism has no influence on plasma lipoprotein concentrations and body mass index either in healthy subjects or in ischemic stroke patients with or without diabetes both in males and females.     

Inflammatory pseudotumor of the spleen: two case reports

Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with debated etiology, characterized by a mixture of inflammatory cells and a component of myofibroblastic spindle cells. This lesion needs to be distinguished from the follicular dendritic cell tumor and the inflammatory myofibroblastic tumor. We report two cases of splenic PTI in a 69-year old and a 62-year old women. The tumors measured respectively 80 and 30 mn in greatest dimension. An inflammatory pseudotumor was histopathologically diagnosed following a splenectomy.