Screening for celiac disease,by endomysial antibodies,in patients with unexplained articular manifestations

Celiac disease (CD) is an autoimmune systemic disease characterized by not only gastrointestinal but also extraintestinal manifestations. The aim of our study was to do a serological screening for CD, by IgA endomysial antibodies (EmA), in patients with unexplained articular manifestations. Two hundred and eleven patients suffering from arthritis or arthralgia without evident cause were studied. EmA were determined by indirect immunofluorescence on human umbilical cord. Two thousand and five hundred blood donors served as control group. Out of 211 patients, 5 had EmA (2.37 %). The frequency of EmA in our patients was significantly higher than in the control group (2.37 vs. 0.28 %, p < 0.01). All patients with positive EmA were female. EmA were significantly more frequent in female patients than in female healthy subjects (3 vs. 0.4 %, p < 0.01). Medical records revealed: diarrhea (one patient), short size (one patient), anemia (three patients), weight loss (two patients) spontaneous abortion (three patients), secondary amenorrhea (one patient), early menopause (one patient) and early baby death (one patient). Biochemical analysis showed decreased level of calcium (one patient), vitamin D (one patient) and cholesterol (one patient). Unexplained liver cytolysis was observed in two patients. Radiological examination showed demineralization of two hands in one patient. Bone osteodensitometry done in one patient out of five revealed lumbar osteopenia. The articular manifestations of the five patients did not respond to corticosteroid treatment. CD must be considered among the differential diagnosis in a patient with arthritis or arthralgia.     

EpCAM (MOC-31) – immunohistochemical expression in papillary thyroid carcinoma and non invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)

Introduction : Ep-CAM, is a cell adhesion glycoprotein located on the basolateral cell membrane surface and in the cytoplasm of most normal epithelial cells. It has also been described to be expressed in several malignancies such as lung, digestive, prostate and renal carcinomas suggesting it has a potential role in carcinogenesis. In thyroid carcinoma, Ep-CAM expression has rarely been studied especially in papillary thyroid carcinoma. Objective: We sought to describe and compare the immunohistochemical expression of MOC31 in papillary thyroid carcinoma and in non invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Methods: We have retrospectively collected 33 cases of PTC diagnosed in the pathology department of the Security forces hospital during a period of 13 years (2008–2021). We have microscopically reviewed all cases and reclassified 9 of 33 cases as NIFTP. An immunohistochemical automated study have been performed with MOC-31 antibody. The immunostaining was considered positive when it was membranous and/or cytoplasmic. The intensity of staining was scored as weak (score 1), moderate (score 2), and strong (score 3). We have used an immunoscore for assessing level of expression of MOC31 as follows: 0 for <5% of positive cells, 1 for 5-30%, 2 for 31-50%, 3 for 51-70%.The total score resulted by summing the percentage score with the intensity score; the final score was varying from 0 to 7, considered low between 1-4 and high 5–7. Results: The mean age of patients was 45,2 years-old for PTC cases and 48,1 years-old for NIFTP cases. A net female predominance was found in both groups (male to female ratio of respectively 0,4 and 0,3). MOC31 expression was found in 19 cases of PTC with a percentage of positive cells varying from 5 to 90%. Percentage of positive cells was variable from 5 to 90%. The immunoscore for positive cells was: 0 in 5/24cases, 1 in 4/24cases, 3 in 9/24cases and 4 in 6/24cases. The intensity of staining was assessed score2 (moderate) in 8 cases and score 3 (high) in 7cases (Figure 1, Figure 2 ). Final MOC31 staining score was low in 37,5% (9/24) and high in 62.5% (15/24). Patients with advanced pt2-pt3 stages mostly showed high score of MOC31 staining (61,5%).One case was associated with lymph node involvement and was of a high score. 6 cases showed vascular invasion and was of high MOC31 score. MOC31 was expressed in all NIFTP cases with variable proportion of positive cells (5%-80%). The immunoscore for positive cells was: 0 in 1/9cases, 1 in 2/9cases, 2 in 3/9cases, 3 in 1/9cases and 4 in 2/9cases. The intensity of staining was assessed score 1 (weak) in one case, score 2 (moderate) in 6 cases and score 3 (high) in one case (Figure 3, Figure 4 ). The final combined score was low in 66,7 (6/9) and high in 33,3% (3/9).Open in a separate windowIHC X 40: Score 3 intense and circumferential membranous staining of PTC for MOC31.Open in a separate windowIHC X 40: Score 2 moderate and circumferential membranous staining of PTC for MOC31.Open in a separate windowr 3. IHC X 40: Score 2 moderate and circumferential membranous staining of NIFTP for MOC31.Open in a separate windowIHC X 20: Score 1 membranous staining of NIFTP for MOC31. Conclusion: Our study revealed different immunohistochemical profile of MOC31 in benign and malignant tumors. It has somewhat a diffuse and marked staining in the first group. The changes of MOC31 location as well as its score of staining in PTC and NIFTP could hence be helpful in the differential diagnosis. Our findings also support the potential prognostic value of this molecule that deserves further investigations.     

Frequency of serological markers of rheumatoid arthritis in adult patients with active celiac disease

BackgroundCeliac disease (CD) and rheumatoid arthritis (RA) are multisystem autoimmune diseases affecting 1% of general populationa. Both diseases share genetic and immunological features.AimIn this retrospective study, we aim to determine the frequency of auto‐antibodies of RA in adult patients with CD.Materials and methodsSeventy seven adult patients with active CD were included in the present study. Ninety healthy blood donors (HBD) served as control group. Anti‐cyclic citrullinated peptides antibodies (CCP‐Ab) and rheumatoid factors (RF; IgA, IgG and IgM) were determined by enzyme linked immunosorbent assay (ELISA) for patients and control group. For statistical analysis, we used Chi‐square or Fisher''s exact test.ResultsOur study included 77 adult patients with active celiac disease (57 female, 20 male). Twenty‐four (31.2%) active celiac patients and 7 (7.8%) blood donors had CCP‐Ab or RF (31.2% vs 7.8%, p < 10–4). Only two patients (2.6%) had both CCP‐Ab and RF. IgA was the predominant isotype of RF in celiac patients (n = 18; 23.4%) while none of healthy blood donors had RF‐IgA (23.4% vs 0.0%, p < 10–4).ConclusionThe current study has shown that CD is associated with a high frequency of RF‐IgA suggesting that celiac patients could be at a higher risk of developing RA.     

Enterococcus faecalis: a multicenter study on antibiotic resistance]

676 E. faecalis strains were listed over a period of 2 years from the Charles Nicolle hospital of Tunis (167 strains), the Habib Bourguiba hospital of Sfax (350 strains) and the National Centre of Bone marrow Transplantation of Tunis (159 strains). Antibiotic sensibility study was realized by the method of the antibiogram, E-test method and the search of penicillinase by cefinase. E. faecalis resulted essentially from services of onco-haematology (24%), external consultations (23%), surgery (18%) and medicine (15%). These strains were isolated especially from urines (54%), coprocultures (15%), bloodcultures (11%) and from pus (9%). Resistance acquired with these strains is raised for erythromycin, tetracyclin and chloramphenicol (81% to 86%), followed by high level resistance to gentamicine (37%). 0.1% of E. faecalis strains have a low level resistance to amoxicillin without production of penicillinase. No resistance to vancomycin was observed.     

Spinal anesthesia for endoscopic urological surgery--low dose vs. varying doses of hyperbaric bupivacaine

BACKGROUND AND OBJECTIVE: The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures. METHODS: Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 (Gr I), 7.5 (Gr II) or 10 mg (Gr III) of hyperbaric bupivacaine 0.5% combined with 25 microg of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons satisfaction, were noted. RESULTS: The maximum number of blocked segments was 14 +/- 1 (Gr I), 15 +/- 2 (Gr II) and 16 +/- 2 (Gr III). Time to T12 regression was significantly shorter for Gr I (53 +/- 13 min) than for Gr II (69 +/- 20 min) or Gr III (94 +/- 14 min). Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1(51 +/- 18 min) than in Gr II (86 +/- 19 min) and in Gr III (138 +/- 21 min). Ephedrine was used for 16 patients in Gr III (9.8 +/- 12.2 mg), 5 patients in Gr II (3.7 +/- 7.8 mg) and 2 patients in Gr I (0.5 +/- 1.5 mg). The difference is statistically significant between Gr III and the other groups. CONCLUSIONS: These results suggest that the use of a low dose of bupivacaine (5 mg) added to fentanyl (25 microg) for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 microg fentanyl.     

Association of benign prostatic hyperplasia and hernia inguinale. A report of 55 cas

THE AIM: of this study is to evaluate the results of combined surgery of prostatic disease and inguinal hernia repair. METHODS:We report a retrospective study of 55 patients operated in the same operating time for benign prostatic hyperplasia and hernia inguinale, and present our criteria for patient selection, operative technique, and postoperative results. RESULTS:The mean age of our patient was 69 years with a range of 56 to 85 years. Open suprapubic prostatectomy was done in 53% of cases, transurethral prostatic resection in 47% of cases and prothetic hernioplasty in 60% of cases. The incidence of postoperative wound infection and recurrent hernia was 5,4 % and 6% respectively, witch compares favorably to results of herniorraphy and prostatectomy performed separately. Simultaneous repair of inguinal hernias and surgery of prostatic disease is effective and technically feasible.