La Tunisie Médicale

ICCO 2024 Congress Abstracts

2024-10-30

COVID-19 obscuring the diagnosis of ciclosporin-related posterior reversible encephalopathy syndrome

Sanda Mrabet — 2024-10-30

Non

Impacts of zinc enriched spirulina as an adjunct to conventional treatment of patients with Chronic Obstructive Pulmonary Disease: Study protocol for a North African randomized controlled trial (SPIRICOPD)

Amani Sayhi — 2024-10-30

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition strongly related to oxidative stress. Recent studies have explored the potential benefits of nutritional supplementation in managing several conditions.

Aim: To investigate the effects of zinc-enriched Spirulina Supplementation (ZSS) on patients with COPD.

Methods: This study is a monocentric randomized controlled clinical trial. COPD-eligible adult male patients under 65 years of age, receiving regular medical treatment, will be included. They will continue their conventional medical treatment following the GOLD 2023 guidelines for COPD. Ninety subjects will be randomly assigned to either the experimental group (G1) or the control group (G2) in a 1:1 ratio. G1 will receive ZSS (1 g/day) for 2 months, while G2 will continue only basic medical treatment. The study will assess oxidant-antioxidant balance, lung function through pulmonary function tests, functional capacity via the 6-minute walking test, lipid profile, dyspnea, and health-related quality of life. All outcomes will be measured at baseline and two months later after supplementation completion. After the 8-week treatment, patients will be followed up for an additional 4 weeks. Ethics approval was obtained from the faculty of medicine of Sousse ethics committee.

Expected results: It is expected that ZSS can positively impact the oxidant/antioxidant balance in patients with COPD after two months of supplementation. The authors anticipate that ZSS may improve various physiological parameters, such as lung function, exercise capacity, endothelial function, and metabolic profile, leading to an overall improvement in the quality of life of patients with COPD.

From Thesis to Publication: Unveiling the Predictive Factors for Cardiology Research at a North African Faculty of Medicine (Tunisia)

Faten Yahia — 2024-10-30

Introduction: The benchmark of a medical thesis’ success is often its acceptance for publication in an indexed journal.

Aim: To determine the publication rate of practice theses in the field of Cardiology at the Faculty of Medicine of Sousse (FMSo) in Tunisia and to identify predictive factors for successful publication.

Methods: We conducted a descriptive bibliometric analysis of Cardiology theses defended at FMSo from 2000 to 2019. Data were extracted from the theses’ cover pages, abstracts, and conclusions. The publication status was ascertained via searches in “MEDLINE”, “Scopus”, and “Google Scholar”. Predictive factors for publication were identified using multivariate analysis with a 90% Confidence Interval (CI).

Results: Of the 111 Cardiology theses defended at FMSo between 2000 and 2019, 36 were published yielding 42 scientific articles (publication rate of 32%). Notably, 86% of these articles were indexed in “MEDLINE” and/or “Scopus”. In 79% of cases, doctoral candidates were co-authors of the resultant publications. Publication was significantly influenced by three factors: scientific mentorship by an Assistant or Associate Professor (aOR=3.021; 90%CI: 1.06-10.14; p=0.082), a prospective study design (aOR=2.536; 90%CI: 1.07-6.02; p=0.076), and a satisfactory quality of writing (aOR=2.384; 90%CI: 1.11-5.11; p=0.061).

Conclusion: The publication of Cardiology theses at FMSo was found to be associated with the prospective design of the study and the quality of writing. Thus, it is imperative to enhance the research methodology and scientific communication skills of medical thesis candidates and their mentors to facilitate the transition from academic dissertations to medical articles.

Assessment of Clinical Reasoning in Healthcare Students via the Script Concordance Test: Situations in Anesthesia and Intensive Care

Kamel Bengayed — 2024-10-30

Introduction-Aim: Clinical reasoning in situations of uncertainty is a skill to be acquired from initial training. The aim of this study was to evaluate the clinical reasoning ability in a context of uncertainty of health science students using the Script Concordance Test (SCT).

Methods: This was a cross-sectional and descriptive study which included students in the third year of the National License in Anesthesia-Resuscitation, with their consent, and a panel of experts made up of ten members. The tool chosen was a TCS composed of 60 items which dealt with frequent and serious themes in general Anesthesia-Resuscitation.

Results: We included 16 students. The average time to complete the test was 46.7 minutes±12.42 [95% CI; 37.81 -55.59] for experts and 54.38 minutes ±8.92 [95% CI; 49.62-59.13] for students. The average score obtained by the experts, reported out of 100, was 80.8±4.09 [95% CI; 77.90-83.75]. The average score of the students was 54.78±9.14 [95% CI; 49.91-59.65].

Conclusion: With the implementation of TCS as an assessment tool in health sciences, students demonstrated an increased capacity for reasoning in complex situations, as reflected in their average scores.

Evaluation of learning abilities after role-playing method: Comparing outcomes of Active and Observer

Olfa Hammami — 2024-10-30

Introduction: During a role-play simulation session, despite supporting observer learning, educators disagree about whether the learning outcomes of observers are like those of active participants.

Aim: Evaluation of the degree of knowledge acquisition by these two types of learners during the same role-play session.

Methods: We carried out a quasi-experimental pre-post intervention study to identify the learning outcomes among learners serving in observer (group 1) and active (group 2) roles during a role-play simulation session.

Results: The role play involved 29 learners. In both groups, 65% of learners improved their overall score. The median post-test score was significantly higher in both groups (p=0.0001).

Likewise, learners in group 1 (p=0.023) and in group 2 (p=0.008) showed an improvement in the overall score in the within-group evaluation study.

The between-group evaluation study showed no statistically significant difference in overall score improvement (p=0.58), number of learners improving (p=0.05) or percentage improvement (p=0.3).

Conclusion: Based on these findings, it is suggested that role-playing method is effective in achieving student-learning outcomes regardless of their status as active or observer.

Biologics prescription for chronic inflammatory rheumatic diseases in Tunisia

Saoussen Zrour — 2024-10-30

Aims: To analyse the prescription of biologics (bDMARDs) in chronic inflammatory rheumatic diseases (CIRD) from Tunisian National Health Insurance (CNAM) data and to estimate their direct costs and associated factors.

Methods: One hundred and nine consecutive patients who received at least one bDMARDs during a six-month period from January to June 2022 were analysed. Clinical and therapeutic parameters as well as data related to the choice of bDMARDs were identified. Direct costs were assessed. Excess costs were considered if the monthly costs exceeded 2200 Tunisian dinars (TD) per patient.

Results: The most common CIRD was axial spondylarthritis (AS) in 44% and rheumatoid arthritis (RA) in 37.6% of cases. Juvenile idiopathic arthritis represented 2.7% of cases. In Tunisia, prescribing of bDMARDs is concentrated in the coastal regions and follows the distribution of rheumatologists. Certolizumab pegol was the most prescribed agent in 45% of cases. No significant association was found between the choice of bDMARD and the characteristics of patients, CIRD or prescribers. The total monthly cost of bDMARDs was 225,535 ± 1269 TD. Overspending was significantly associated with initial high DAS28 in RA and young age and total hip replacement in AS.

Conclusion: Prescription of bDMARDs in CIRD is mainly for AS and in the coastal regions of Tunisia. The burden is considerable, partly due to the high cost of biologics. Data from this study may enable public health managers to better allocate the limited resources available for patient care and to develop medico-economic strategies to reduce health care costs.

Acute severe pain in emergency department: morphine or low-dose ketamine?

khedija Zaouche — 2024-10-30

Introduction: Severe pain is a therapeutic emergency that can be life-threatening by its location, its repercussions or the misdiagnosis it can cause.

Aim: To investigate the efficacy of analgesia by morphine versus that by low-dose ketamine in severe pain in emergency department.

Methods: We conducted a randomized open study. We included patients over 18 years-old who consulted for severe pain defined by numeric rating scale (NRS) ≥6. Patients of M group received a titration of 10 mg morphine while those of LDK group, received a bolus of 30 mg of ketamine. The primary endpoint was obtaining a NRS of less than 4 within 10 minutes.

Results: We included 120 patients, 66 in the M group and 54 in the LDK group. The mean baseline NRS was 8.8 ± 1.3 in the M group and 8.6 ± 1.4 in the LDK group (p₌ 0.7). At 10 minutes, the same number of patients in both groups achieved a NRS less than 4 (p = 0.09). However, the mean NRS was significantly lower in the LDK group (p = 0.008). More adverse effects were noted in the LDK group (p <10^-3).

Conclusions: Low-dose ketamine appears to be non-inferior to morphine in achieving effective analgesia for severe pain in the emergency department.

Study of the knowledge, practices and attitudes of students at Mohammed First University in Oujda regarding viral hepatitis in Morocco

Asmae Lekfif — 2024-10-30

Introduction: Globally and in Morocco, viral hepatitis is a major public health priority, and knowledge and awareness are essential in the combat against this disease.

Aim: To assess the knowledge, attitudes and practices of university students regarding viral hepatitis.

Methods: A descriptive and analytical cross-sectional study was conducted among students enrolled at Mohammed Premier University in Oujda, for the 2023-2024 academic year, using a self-administered and anonymous online questionnaire.

Results: 503 students completed the online questionnaire. The results showed that hepatitis B (73.6%) and C (67.4%) are better known than hepatitis A (52.0%) and E (24.3%). The majority of students (78.0%) knew that HBV can be transmitted by blood, and 62.0% by sexual transmission. For the main mode of transmission of hepatitis C, around two-thirds of respondents (69.0%) indicated transmission by contact with infected blood. Transmission of HVA and HVE viruses was known by 43.5%. The level of knowledge about hepatitis was significantly associated with education levels, medical school affiliation and socio-economic status. Students' preventive practices were positive, but their attitudes towards people with viral hepatitis were negative.

Conclusion: Our results suggest that knowledge of hepatitis needs to be improved through awareness and education campaigns, in order to combat these diseases, especially as Morocco has committed to a global movement to eliminate viral hepatitis by 2030.

Epistaxis in children with allergic rhinitis: Clinical features and risk factors depending on the allergen profile

Amani Hachicha — 2024-10-30

Introduction: Epistaxis in children is a very common reason for consultation in ENT and pediatric emergencies. Most of these epistaxis are benign, but it is their recurrence that motivates anxious parents, to consult. Allergic rhinitis is a common pathology among children in Tunisia, it seemed interesting to us to study the association between allergic rhinitis and epistaxis.

Aim: Identify the clinical features and the risk factors for epistaxis in children with allergic rhinitis.

Methods: Retrospective descriptive cohort study over a period of 4 years, including children, who consulted for epistaxis at the ENT and CCF department of FSI Hospital, La Marsa Tunis. All cases were divided into 2 groups: ERA+ Group: epistaxis with allergic rhinitis versus ERA- Group: epistaxis without allergic rhinitis.

Results: 79 children were included, including 21 (26.6%) meeting the diagnostic criteria for allergic rhinitis. A female predominance was noted in the ERA+ group. In the ERA+ group, epistaxis mainly occurred in summer and autumn (38% and 28%) while it predominated in winter and summer in the ERA- group. Rhinorrhea and nasal pruritus were factors significantly associated with epistaxis in children with allergic rhinitis.

Conclusion: the ENT doctor must think about allergic rhinitis in case of Repetitive epistaxis in a child, and look for suggestive symptoms, particularly rhinorrhea and nasal prurit.

Prevalence and Associated Factors of Falls in Persons with Multiple Sclerosis: A Cross-Sectional Study

Soumaya Belghith — 2024-10-30

Introduction: Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. Falls are a serious health concern for persons with MS (PwMS).

Aim: To determine the frequency and associated factors of falls in PwMS.

Methods: A cross-sectional study was conducted in the Physical Medicine and Rehabilitation and Neurological Departments at the Military Hospital of Tunis between July and December 2022. Participants meeting the inclusion criteria completed a survey focusing on the prevalence and related factors of falls. In addition to the survey and a thorough clinical and functional examination, we used the 12-item MS Walking Scale (MSWS-12), the Fall Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB), and the 10-meter walk test for clinical assessment of balance. A baropodometric platform was employed for instrumental assessment.

Results: Thirty individuals with an average age of 33,6 [SD: 7,7], completed the survey with a mean Expanded Disability Status Scale = 2,5. Twenty-one patients reported falling at least once since the diagnosis. The MSWS-12 mean score was 61 % and the FES-I scored an average of 33.8. The average total score of the SPPB was 8. Total boli of corticosteroids prescribed during disease flare-ups (p=0,022), magnetic resonance imaging lesions of the basal ganglia (p=0,047), vestibular syndrome (p=0,048), MSWS-12 score (p=0,022), and the chair lift test of SPPB (p=0,018) were significantly associated with the prevalence of falling. No significant differences were observed for the instrumental assessment.

Conclusion: Falls are frequent in PwMS. MSWS ...( abstract truncated at 250 words).

Assessment of body mass index, lifestyle and health perception among female university students in Morocco

Souad Rahim — 2024-10-30

Objective: The objective of this study was to assess the relationship between Body Mass Index (BMI), dietary habits, physical activity, and health perception among female university students in Morocco.

Methods: The study was conducted at a Moroccan university among female students from the Faculty of Sciences Ain-Chock in Casablanca. Participants were given a self-administered questionnaire that evaluated sociodemographic factors, dietary habits, food group consumption, physical activity, and self-assessed health status. Data collection took place from February 2023 through the end of April 2023.

Results: A total of 335 students aged 18 to 29 years participated in the survey. The study revealed that 72.5% of the participants were within the normal weight range (BMI 18.5-24.9 kg/m²), while 15.9% were classified as overweight and 3.9% as obese. Additionally, 47.9% of the participants engaged in physical activity, with 30.2% dedicating more than 45 minutes to their activities. The health perception was found to be related to weight classification, with poor health perception most commonly associated with the "18.5-25" BMI range (57.8%).

Conclusion: The study sheds light on the intricate interaction between weight, health, and lifestyle in Morocco. The frequency of normal-weight persons and active participation indicates university students' health awareness. The prevalence of overweight and obesity, on the other hand, need ongoing health measures. These findings help to build focused methods for promoting healthier lives in Morocco, utilizing educational institutions as health promotion platforms.

Impact of therapeutic education on quality of life in coronary patients: Interventional study

Hela Ghali — 2024-10-30

Aim: To determine the impact of a therapeutic patient education (TPE) program on the quality of life of coronary patients at the Sahloul University Hospital in Sousse.

Methods: an interventional study was conducted over a period of seven months from May 2022 to November 2022, with patients hospitalized in the cardiology department of the Sahloul University Hospital. Participants were divided into two groups, intervention and control. The task force benefited from a TPE program. The control group followed the usual consultations at the hospital. The health-related quality of life assessment was done three months after the end of the educational program, using the validated Tunisian version of SF-12.

Results: Of the 129 patients included, 38 followed the education program while 91 were in the control group. Sociodemographic characteristics revealed a male predominance in the study population, with a similar average age between the two groups. The main cardiovascular risk factors identified were smoking, hypertension and diabetes. This program has led to an improvement in the quality of life of patients. Thus, patients who participated in the TPE program had significantly higher scores than the control group in the headings of physical role, emotional role, body pain, social function, and physical health and mental health scores with statistically significant differences.

Conclusion: Our study highlights the crucial importance of therapeutic education in improving the health status and quality of life of coronary patients. It calls for its widespread integration into cardiovascular care protocols, highlighting its central role ...(abstract truncated at 250 words).

Overweight and Obesity in School Children: Prevalence and Associated factors

Faten Mahjoub — 2024-10-30

Introduction: Childhood obesity, a true international epidemic, is a multifactorial pathology including genetic and environmental factors.

Aim: Determine the prevalence and risk factors of overweight in Tunisian schoolchildren in the Bardo region, an urban department of the Tunis governorate.

Methods: Descriptive and cross-sectional study involving schoolchildren aged between 10 and 12 years old. All students received questioning, anthropometric measurements and a food survey. According to the International Obesity Task Force (IOTF) body weight curves by gender, a Body Mass Index (BMI) in children ≥ 97th percentile defined overweight, and a BMI ≥ IOTF-30 defined obesity.

Results: The mean age of the 105 schoolchildren was 10.8±0.5 years. The average BMI was 19.68±3.86 kg/m². More than a third of students (35.3%) were overweight. Overweight affected 45% of girls and 29.2% of boys. The prevalence of obesity was 8.6% (7 boys and 2 girls). 55.6% of girls and 47.4% of the overweight boys had a high calorie diet. TV eating was reported in 40.5% of overweight students versus 19.4% of normal weight students. Prandial overeating increases the risk of overweight in children by 18.48 (p=0.0001). Parental obesity multiplies by 2.69 the risk of overweight in their offspring (p=0.023).

Conclusion: In addition to genetic heritability, children share rating habits with their parents. Therefore, management based on hygienic-dietary measures must involve the whole family.

Status Epilepticus in Children: Risk Factors and Clinical Evaluation

Asma Marzouk — 2024-10-30

Introduction and aim: Status epilepticus (SE) in children is a critical condition that can be life-threatening. The objective of this study was to identify factors associated with the occurrence of SE after a first convulsive seizure in children.
Methods: A retrospective study was conducted at the pediatric department of BEN AROUS regional hospital between January 2015 and December 2019.
Results: A total of 300 patients admitted for a first epileptic seizure were included in this analysis. The mean age of the patients was 33 months. Seizures were generalized in 92.7%, with tonic-clonic seizures being the most common (54.8%). SE was diagnosed as inaugural in 29% of cases. Abnormalities in EEG were observed in 36.5% of cases, while MRI revealed abnormal results in 32.8% of patients. Factors associated with a risk of SE recurrence were age younger than 1 year (p = 0.003), neuromotor retardation (p = 0.001), EEG abnormalities (p < 0.001), MRI abnormalities (p = 0.001), and abrupte discontinuation of antiepileptic treatment (p < 0.001). Simple febrile seizure was identified as a protective factor (p = 0.038).
Conclusion: The study identified that age under 1 year, neuromotor delay, and abnormalities in EEG and MRI are significant risk factors for the recurrence of status epilepticus after a first epileptic seizure in children. These findings suggest targeted preventive strategies to improve the management and prognosis of these patients.

Chronic immune thrombocytopenic purpura in children : Clinical presentations and management

Ines Maaloul — 2024-10-30

Objective: the aim of this study is to report epidemiological data, clinical presentations and management of chronic immune thrombocytopenic purpura (ITP) in a single center in south of TUNISIA.

Methods: retrospective study collecting all cases of chronic ITP among children aged less than 14 years, in a department of pediatrics in south of Tunisia during a period of 13 years (from 1st January 2010 to 31 December 2022)

Results: during the study period, 72 newly diagnosed ITP were recorded; 11 patients evolves chronic ITP (12 ,5%). They were 6 boys and 5 girls. Two patients were aged more than 10 years at the onset of the disease. Symptoms in the chronic stage were mucocutaneous bleeding. One patient developed post traumatic cerebral hemorragia. Three patients had severe form, and required second-line therapy. Two patients requested Eltrombopag with good response.

One patient had spontaneous recovery after 3 years of follow up.

Conclusion: Management of chronic ITP represents a real challenge for pediatrician. Currently, there are some recommendations and guidelines which can guide management strategy of severe forms of Chronic ITP.

Pelvic incidence in thoracolumbar fractures : Is there an impact

Mourad Aoui — 2024-10-30

Introduction : In trauma, we can perform a lateral radiography of the lumbosacral hinge taking the femoral heads if we include it in the initial lesion assessment. Thus, the pelvic incidence informs about the type of back as described by Roussouly.

Aim: To describe the clinical and radiological results of these types of back which are operated on for a thoracolumbar fracture.

Methods : We recorded the clinical, radiological data and the characteristics of the fracture of 120 patient operated on for a thoracolumbar spine fracture over a period of 14 years between February 2005 and July 2019. We studied the deformation according to Regional traumatic angulation (ART), Sagittal Farcy Index (SIF), Gardner Segment Kyphotic Deformity (GSKD). Functional evaluation was carried out according to the Denis Pain Scale. Radiological evaluation was based on relative gain and loss.

Results : In individuals with low pelvic incidence, a prevalence of 72% was observed for type A fracture, whereas types B and C accounted for 45.9% (P<0.05) for backs with high pelvic incidence. The Denis Pain Scale score indicated that 90% of individuals with low incidence backs had scores below 3, whereas only 65.6% of those with high incidences had scores below 3 (P<0.05). The loss of correction for backs with low incidences was measured at 1.2°, while for backs with high incidences, it was 3° (p<0.05).

Conclusion : Fractures on backs with low pelvic incidence considered as stiff backs are more frequently of type A, with better functional results and less losses.

Lung stereotactic radiation therapy: Early results from the Salah Azaiez Institute

Alia Mousli — 2024-10-30

Introduction: Stereotactic Body Radiation Therapy (SBRT) has transformed lung cancer care, delivering precise treatment with minimal harm to healthy tissue.

Aim: This study examined the experience at the Salah Azaiez Institute (SAI) in lung cancer patients.

Methodology: we conducted a retrospective study on patients treated with SBRT from 2019 to 2022. Planification imaging included four-dimensional CT scans and delineation of target volumes and organs-at-risk was done as per international guidelines. Treatment doses were tailored based on tumour location.

Results: A total of 10 cases were included. The male-to-female sex ratio was 4:1, with a median age of 69.5 years. Three had unconfirmed primary lung tumours, while five had inoperable stage I-IIA adenocarcinomas primarily due to compromised respiratory function. Two had oligometastatic lung diseases. All underwent recent thoracic-CT and PET-CT evaluations to exclude pulmonary fibrosis. The median lesion size was 40mm. Karnofsky’s performance status ranged from 70 to 90, with no contraindications to the supine position. Eight out of 10 patients received 8 fractions of 7.5 Gy at the 80% isodose. For that regimen, the D95%, D99%, and Dmax were respectively, 60 Gy, 56 Gy, 73 Gy. All organs-at-risk dosimetric criteria were met. Acute toxicities included worsened coughs in 2 patients and fatigue in 6. After a mean follow-up of 23 months, no rib fractures or haemoptysis were observed, and no local recurrence was reported on the last chest CT scan.

Conclusion: SBRT demonstrates promise for lung cancer treatment, though challenges persist in precise targeting ...(abstract truncated at 250 words).

Letter to the Editor “Occupational elbow musculoskeletal disorders in Tunisia: Epidemiology and socio-professional consequences”

Imene Magroun — 2024-10-30

COVID-19 is more likely to be complicated by autoimmune encephalitis than PRES

Josef Finsterer — 2024-10-30

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Ethics and Practices of the Pharmacist

Fatma Sellami — 2024-10-30

Introduction: In their practice, pharmacists are confronted with situations that may pose ethical problems. They must make decisions based on scientific knowledge as well as the principles of bioethics.

Aim: To evaluate pharmacists' attitudes towards specific ethical dilemmas.

Methods: We conducted our study using a validated English questionnaire, containing 9 ethical scenarios to be rated by participants on a 5-point Likert scale. The questionnaire was distributed via Google Forms on Facebook pages and Messenger and WhatsApp groups. The data were processed with Microsoft Excel and statistical tests were performed using SPSS version 23.

Results: The participants in our study achieved 70% of the total score for all encountered situations. We found that in response to the non-maleficence scenario of "Dispensing amphetamines to a medical student," pharmacists exhibited the most ethical attitude compared to other studied situations. In general, confidentiality scenarios received the highest number of "disagree" responses, while the least ethical attitude concerned justice scenarios. We also found a significant correlation between supplementary ethics training and the dimensions of confidentiality and non-maleficence .Conclusion: Our study, the first of its kind in Tunisia, highlighted the need to strengthen medical ethics training for pharmacists.

Anterior Segment Optical Coherence Tomography-Assisted Surgical Planning for Removal of a Corneal Foreign Body: A Case Report and Literature Review

Hassan Moutei — 2024-10-30

Introduction: Corneal foreign bodies account for nearly one-third of all eye injuries and are a common emergency in ophthalmology. While many cases are straightforward, involving clear diagnosis and treatment, some present significant challenges due to the complexity of the foreign body involved.

Observation: A 20-year-old male presented with discomfort in his right eye following an accident while cutting a tree without wearing protective eyewear. Examination using slit-lamp biomicroscopy revealed a reed foreign body embedded in the cornea. Anterior Segment Optical Coherence Tomography (AS-OCT) provided detailed images, showing the foreign body embedded 300 µm beneath the corneal epithelium but not affecting deeper layers. The foreign body was surgically removed under topical anesthesia, followed by thorough cleansing and suturing of the wound.

Conclusion: AS-OCT is invaluable in the diagnosis and management of complex corneal foreign bodies, enabling precise treatment planning and successful outcomes, as demonstrated in this case.

Ear, Nose, and Throat sarcoidosis: An etiology that should raise a flag? About two case reports

Ines Naceur — 2024-10-30

Introduction: Sarcoidosis is a chronic inflammatory disease characterized by non-caseous necrotizing epithelial cell granulomas that can affect any organ. Ear, nose, and throat (ENT) involvement is rare. We report two cases of systemic sarcoidosis with ENT onset.

Observation: A 39-year-old woman with no medical history, presented with right submaxillary lymphadenopathy, associated with a nasopharyngeal swelling on the nasopharyngoscopy. Lymph node biopsy revealed numerous granulomas with epithelioid and giant cells. The computed tomography (CT) showed multiple lymph nodes along with interstitial lung disease. The diagnosis of sarcoidosis with pulmonary, mediastinal, lymph node, and nasopharyngeal involvement was retained and the patient was treated with glucocorticoids with disappearance of the submaxillary swelling and of the lymph nodes on the CT. Another 39-year-old woman, with no medical history, presented to the ENT clinic with a three-month history of bilateral nasal obstruction. Nasal endoscopy revealed hyperemia of the nasal mucosa. She was treated with antibiotics without clinical improvement. CT scan of the cranial and facial bones revealed a focal bulge at the nasopharynx's posterior wall, associated with a mucosal thickening of maxillary, frontal, and ethmoid sinuses. A nasal and a lymph node biopsy were then performed, revealing granulomatous inflammation without caseous necrosis. The diagnosis of sarcoidosis with pulmonary, lymph node, and sinonasal involvement was established. The patient was treated with glucocorticoids with clinical improvement.

Conclusion: Nasopharyngeal and sinus involvement may be rare in sarcoidosis but can be part of the initial clinical picture of the disease. Therefore, it should put the flea in the ear in case ..(abstract truncated at 250 words)

Predictive factors of persistent/recurrent pediatric obstructive sleep apnea-hypopnea syndrome after adenotonsillectomy

Sameh Msaad — 2024-10-30