PSEUDOTUMORAL PRESENTATION OF NEURO-BEHÇET DISEASE: A CONFUSING DIAGNOSIS

A 35-year-old man was referred to the internal medicine department for acute hemiplegia with oral aphthous ulcers. The patient reported recurrent oral and genital ulcers more than 3 times a year. He also experienced one episode of peripheral thrombosis 1 year ago. The physical examination showed left hemiparesis with positive Babinski sign, hyperreflexia, and pseudofolliculitis in legs and trunk. The pathergy test was positive. Cerebral MRI showed a large mass hyperintense in T2 sequence in the regions of basal ganglia and corpus callosum with peripheral contrast enhancement and intensive edema around the lesion. The diagnosis of pseudotumoral neuro-Behçet disease was made on the basis of clinical history, the cerebral MRI result, and the exclusion of other tumoral and infectious diseases. The patient was treated with corticosteroids and cyclophosphamide with favorable outcome

Validity of Strain Elastography in Renal Allograft Infection

Background: Strain elastography is not routinely used by many clinicians to determine allograft dysfunction. Validity of strain elastography and renal histopathologic characteristics especially infected allograft have not been sufficiently evaluated in renal transplant recipients. Objective: To study the correlation between strain elastography and renal allograft infection in Kasr Al Ainy school of medicine -Cairo University. Design/Methods: In a single-center, prospective study involving 109 renal-allograft recipients, the strain elastography was evaluated in 109 renal transplant recipients to be correlated with renal allograft infection that was proved in (64 patients) by the laboratory and histopathological finding and (45 patients) without allograft infection. Results: There was no statistically significant difference between renal allograft infection and strain elastography (P value 0.447). Causes of allograft infection were CMV in (30.3%), UTI in (18.3%),) and BK polyomavirus in (10.1%). Histopathological findings in renal allograft biopsy were active ABMR in (6.4%), acute interstitial nephritis with neutrophils with bacterial infection in (18.3%), Acute TCMR in (6.4%), BK polyomavirus nephropathy with SV40 positive in (10.1%), chronic ABMR in (17.4%), chronic active ABMR in (7.3%), CMV nephropathy in (13.8%), mixed rejection in (3.7%) and tubular injury with viral infection in (16.5%).Conclusion: Strain elastography may not be useful  in renal allograft infection evaluatio

La périartérite noueuse : un diagnostic à ne pas méconnaitre! : Polyarteritis nodosa: a diagnosis not to be ignored!

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis, which typically affects medium-sized muscular arteries. With the decline of hepatitis B virus (HBV) and the evolving definitions of vasculitis, PAN is becoming a rare disease. It's certainly become a rare disease, but it still exists. It has its own clinical and laboratory characteristics. A well-chosen treatment adapted to the severity of the disease allows an improvement in symptoms. We report 3 cases of PAN with different clinical presentations. La périartérite noueuse est une vascularite systémique touchant des artères de petit et moyen calibre . C’est une maladie certes devenue rare, mais elle est bien individualisée des autres vascularites systémiques. Elle reste un diagnostic à ne pas méconnaitre devant un tableau systémique. Elle possède des caractéristiques cliniques et paracliniques bien distinctes. Un traitement bien choisi adapté à la sévérité de la maladie permet une amélioration de la symptomatologie. Les auteurs Nous rapportent cependant, 3 cas de PAN avec des présentations cliniques différentes

Atteinte hépatique au cours de la maladie de Rendu-Osler: à propos d’un cas et revue de la littérature

Patiente âgée de 48 ans était hospitalisée pour une cholestase asymptomatique hépatique. Elle rapportait une histoire personnelle et familiale d’épistaxis récidivante. Le bilan biologique révélait une anémie ferriprive et une cholestase modérée. Les sérologies virales ainsi que les anticorps anti tissu hépatique étaient négatifs. Le scanner abdominal objectivait de multiples shunts artério-veineux dans la région sous-capsulaire du foie. Le diagnostic d’une atteinte hépatique dans le cadre d’un Rendu Osler était retenu. Un traitement martial était prescrit et une surveillance biologique et morphologique du foie était entreprise.The Pan African Medical Journal 2016;2

Rosai-Dorfman Disease With Pure and Multifocal Cutaneous Lesions: A Case Report

A 52‐year‐old woman developed progressive infiltrated purple and hyperpigmented cutaneous lesions in the face, thighs, armpits, chest, and abdomen evolving forone year. Histopathological examination showed large histiocytes exhibiting intact inflammatory cells in their cytoplasm (emperipolesis). Immunohistochemical analyses showed that the histiocyte population was positive for S100 and CD68, but negative for CD1a. Based on the clinical, histopathological, and immunohistochemical findings, we made the diagnosis of Rosai Dorfman disease (RDD). Our patient didn’t manifest any other extra-cutaneous involvement and all the biological and radiological investigations were normal. This form of pure cutaneous RDD (P-CRDD) with multifocal lesions has been rarely reported. RDD is very rare and hardly recognized in the absence of lymphadenopathy. The diagnosis of this entity involves a combination of histology and immunohistochemistry. To date, there is no standard treatment

Poncet rheumatism secondary to ceco-appendicular tuberculosis in systemic lupus erythematosus

Background. Poncet’s rheumatism (RP) is an aseptic reactive arthritis secondary to active tuberculosis. Systemic lupus erythematosus (SLE) and tuberculosis are intricately related with an increase in the risk of tuberculosis in SLE. We present an original case of Poncet’s disease secondary to appendicular tuberculosis in patient with lupus disease. Case report. A 36-year-old female was followed in internal medicine for systemic lupus. In September 2023, she suffered from digestive complaints and polyarthritis. Infectious investigation and microbiologic study of joint fluid was negative. She had tenderness on pressure on the right iliac fossa. The computed tomography (CT) found an appendicular mucocele. She underwent laparotomy with right colectomy. Macroscopic aspect revealed tumorous lesion suggestive for malignancy. Histological study concluded to granulomatous inflammation with epithelioid and gigantocellular granulomas with anhist necrosis. Ceco-appendicular tuberculosis was retained. The patient received the anti-tuberculosis therapy with good progress. Conclusions. Early recognition of atypical location of tuberculosis leads to initiate appropriate treatment especially in immune compromise statue patient

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation