Rheumatoid arthritis and Kartagener syndrome: a rare combination.
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Adult↗
Biomedical subjects
Mohamed Younes
Publications and source records attributed to Mohamed Younes.
Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia.
BACKGROUND: Disk-related sciatica (DRS) creates a public health burden because of its high incidence and considerable socioeconomic costs. We are not aware of previous epidemiological studies of the prevalence and risk factors of DRS in Tunisia or other Arab countries, and few studies have addressed these issues elsewhere. OBJECTIVES: To determine the prevalence and incidence of DRS in Monastir, Tunisia; to look for risk factors; and to evaluate socioeconomic costs. METHODS: Data on a cross-section of 5000 individuals aged 15 years or older living in Monastir were collected by interviewers using a previously developed 51-item questionnaire. RESULTS: The study participation rate was 87.6%. The annual prevalence of DRS was 2.21% and the incidence was 1.44%. Among the patients with DRS, 94.8% received healthcare interventions, 64% had plain radiographs taken, and 45.4% underwent computed tomography of the lumbar spine. Sick leaves were given to 77.7% of patients, and mean sick leave duration was 9 weeks. A change in job was required in 5.5% of cases. Factors associated with DRS included male gender (P<0.001), obesity (P<0.0001), smoking (P<0.0001), a history of low back problems (P<0.0001), anxiety and depression (P<0.0001), a job requiring prolonged standing and bending forward (P<0.03), heavy manual labor (P<0.005), heavy lifting (P<0.0001), and exposure to vibrations (P<0.0001). CONCLUSION: The prevalence of DRS in Monastir is 2.2%. We identified a number of patient- and occupation-related risk factors. The high socioeconomic cost should encourage preventive measures.
Adolescent↗
Primary hypertrophic osteoarthropathy with bilateral destructive hip arthritis.
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Adult↗
Lipoma arborescens affecting multiple joints.
Lipoma arborescens is a rare benign intra-articular lesion of unknown etiology that usually involves the suprapatellar pouch of the knee joint. Clinically, the most common finding is a slow-growing painless swelling, accompanied by intermittent effusion of the joint. We report a case of a multifocal lipoma arborescens localized in the knees and the hips in a 24-year-old man, initially mimicking an inflammatory arthropathy. The diagnosis of lipoma arborescens was made by magnetic resonance imaging of the hips and the knees. Under arthroscopic guidance, the synovial biopsy of the right knee disclosed the specific histological signs of lipoma arborescens. As far as we know, this is the third case of multifocal lipoma arborescens reported in the English literature.
Adult↗
Correlations between high-resolution computed tomography of the chest and clinical function in patients with rheumatoid arthritis. Prospective study in 75 patients.
INTRODUCTION: The contribution of computed tomography (CT) to the assessment of rheumatoid lung disease is universally recognized. Our objective was to define the usefulness of high-resolution CT (HRCT) in evaluating lung abnormalities in unselected patients with rheumatoid arthritis (RA) and to determine whether HRCT findings were correlated with clinical and lung function test (LFT) abnormalities. PATIENTS AND METHODS: We prospectively investigated HRCT findings in 75 consecutive RA patients and looked for correlations with clinical, radiological, blood gas, and LFT variables. The 63 women and 12 men had a mean age of 48+/-14 years and a mean disease duration of 8+/-88 months (2 months-27 years). Most of the patients (77.3%) had no known history of respiratory disease. RESULTS: Respiratory symptoms were noted in one third of patients. HRCT findings were abnormal in 49.3% of patients, showing interstitial disease in 28% and bronchiectasis in 18.7%. Advanced fibrosis was not noted. One patient had bronchiolitis obliterans with organizing pneumonia and another had constrictive bronchiolitis. Smaller proportions of patients had emphysema (13.3%), alveolar involvement (12%), pleural involvement (9.3%), or rheumatoid nodules (4%). HRCT findings were abnormal in 48.6% of the patients with no respiratory symptoms. Factors significantly associated with HRCT abnormalities were age older than 40 years, positive tests for IgM rheumatoid factors, hypoxia at rest, and LFT evidence of distal airway disease. Neither Sjogren's syndrome nor RA duration was significantly associated with the risk of HRCT abnormalities. CONCLUSION: In our population of unselected RA patients, HRCT proved sensitive in detecting abnormalities that were clinically silent and missed by plain radiography. Correlations between HRCT abnormalities and results of other investigations were inconsistent. Thus, these various investigations may complement one another.
Adult↗
Prevalence and factors associated to low back pain among hospital staff.
OBJECTIVES: Because of its frequency and consequences on professional life, low back pain (LBP) represents a real health care problem. Our study is aimed at determining the prevalence of LBP among hospital staff, analyzing the medical and professional consequences as well as investigating into the factors associated to this health problem. METHODS: We have conducted an inquiry among 350 employees at Fattouma Bourguiba teaching hospital. The employees have answered a pre-established questionnaire including 51 items. RESULTS: The cumulative life-prevalence was 57.7% of the cases. The annual prevalence was 51.1% of the cases. Chronic LBP prevalence was 12.8% of the cases. Medical care was required in 61.9% of the cases. Radiological explorations were performed in 45% of the cases. Sick leave was observed in 26.1% of the cases and an occupational change was necessary in two cases. Factors associated to LBP were age (P <0.01), female gender (P = 0.024), high BMI (P = 0.01), the fact of being married or divorced (P < 0.01), smoking (P = 0.016), past medical LBP history (P < 0.0001), extra professional activity (P < 0.01), migraine (P < 0.001), years' service (P = 0.007) as well as heavy weight lifting (P = 0.008). Exercise is rather a protecting factor against LBP (P = 0.019). CONCLUSION: The prevalence of LBP among hospital staff as well as the socio-professional drawbacks is important. Many factors are associated to LBP urging medical teams to take some preventive measures to reduce this affliction.
Adolescent↗
[Pelvic morphology and lumbar spondylolisthesis].
Pelvic morphology is involved in the genesis of spondylolisthesis. The mean age of patients with spondylolisthesis was 57.9 +/- 9.5 years (40-81). 14 were complaining of low back pain and 12 had sciatica. Spondylolisthesis was in stage 1 in 75% of the cases and in stage 2 in 25% of the cases. Low lordosis was observed in patients and controls in 73% and 100% of the cases respectively. Sacral slops was slightly higher in patients than in controls and was higher than 40 degrees in patients and controls at a rate of 35% and 25% respectively. The incidence was higher in patients than in controls. There was a high pelvic retroversion in patients than in controls. High incidence and pelvic retroversion were found in patients with spondylolisthesis and pelvic morphology was probably involved in the genesis of spondylolisthesis.
Adult↗
Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study.
Low back pain (LBP) in children was considered for many years to be a rare condition revealing a serious disease, but in the last two decades, epidemiological studies have shown that the prevalence of nonspecific LBP in children is high. This study was aimed at analyzing the prevalence, severity, consequences and associated factors of LBP in children. A cross-sectional study was undertaken in two preparatory schools in the city of Monastir, Tunisia, in April 2002. This study included a total of 622 children and adolescents--326 females and 296 males--with a mean age of 14 years (range: 11-19 years). They completed the questionnaire in the presence of the physician. For the first 201 questionnaires collected, the corresponding children and adolescents underwent a spine medical examination, with evaluation of pain by visual analog scale if LBP was present. A stepwise logistic regression analysis was carried out to determine the risk factors associated with LBP and chronic LBP. The cumulative lifetime prevalence of LBP was 28.4%. Eight percent of the subjects suffered from chronic LBP. LBP was responsible for 23% of school absenteeism and 29% for sports absenteeism. Medical care requirement was observed in 32.2% and psychological symptoms in 75%. Stepwise logistic regression analysis showed that three factors were associated with LBP: school failure (held back 1 year), odds ratio (OR) =2.6 (95% confidence interval [CI], 1.96-3.44), family history of LBP (parental or sibling LBP), OR=3.80 (95% CI, 2.94-5.92), dissatisfaction with school chair (in height and comfort), OR=3.40 (95% CI, 2.24-5.29). Two factors were associated with chronic LBP: dissatisfaction with school chair, OR=1.62 (95% CI, 1.46-3.32) and football playing, OR=3.07 (95% CI, 2.15-5.10). The prevalence of LBP among Tunisian schoolchildren and adolescents is high. This requires preventive measures and longitudinal studies, which are very important from the standpoint of public health.
Absenteeism↗
Validation of the Tunisian version of the Roland-Morris questionnaire.
Our aim was to validate a culturally adapted, Tunisian-language version of the Roland-Morris Disability Questionnaire (RMDQ), which is a reliable evaluation instrument for low-back-pain disability. A total of 62 patients with low back pain were assessed by the questionnaire. Reliability for the 1-week test/re-test was assessed by a construction of a Bland Altman plot. Internal construct validity was assessed by Cronbach's alphatest. External construct validity was assessed by association with pain, the Schober test and the General Function Score. Sensitivity to change was determined using a t-test for paired data to compare RMDQ scores at inclusion and at completion of the therapeutic sequence of local corticosteroid injections. We also compared the questionnaire score with the General Function Score, both taken after completion of the therapeutic sequence. The constructed Bland Altman plot showed good reliability. Internal consistency of the RMDQ was found to be very good and the Cronbach's alpha test was 0.94, indicating a good internal construct validity. The questionnaire is correlated with the pain visual analogue scale (r=33; p=0.0001), with the Schober test (r=0.27; p=0.0001) and the General Function Score (r=56; p=0.0001) indicating an adequate external construct validity. The RMDQ administered after the therapeutic sequence is sensitive to change (r=0.83; p=0.000). Comparison of the questionnaire score to the General Function Score, after completion of the therapeutic sequence, was satisfactory (r=0.75; p=0.000). We conclude that the Tunisian version of the Roland-Morris questionnaire has good reliability and internal consistency. Furthermore, it has a good internal- and external construct validity and high sensitivity to change. It is an adequate and useful tool for assessing low-back-pain disability.
Disability Evaluation↗
Familial calcium pyrophosphate dihydrate deposition disease. A Tunisian kindred.
INTRODUCTION: Familial calcium pyrophosphate dihydrate deposition disease (CPDD) is uncommon, with about 50 affected families identified to date in the world. Genetic studies in familial CPDD are focusing on the ANKH gene. We report a new Tunisian kindred with CPDD. PATIENTS AND METHODS: The development of CPDD in a patient who was only 35 years of age prompted a family study. A medical history, physical examination, and radiographs were performed in 103 family members older than 18 years. RESULTS: Fifteen family members had CPDD. There were 10 men and five women, with a mean age of 59.4 years. Onset was usually in the third or fourth decade. Four clinical patterns were found: Five patients had pseudogout, five had pseudoosteoarthritis, three had asymptomatic disease, and two had pseudorheumatoid arthritis. Inheritance was autosomal dominant with low penetrance. No associations with specific HLA antigens were found. The disease was mild. These characteristics fit the description of Gaucher type 1 familial CPDD. CONCLUSION: Inherited autosomal dominant CPDD with low penetrance was found in 15 members of a Tunisian kindred. The disease was mild. We are planning a genetic study including tests for ANKH gene mutations in this kindred.
Adult↗
Factors predicting outcomes of mechanical sciatica: a review of 1092 cases.
UNLABELLED: As an extremely common symptom and major source of lost productivity, mechanical sciatica places a heavy burden on public health. METHODS: We retrospectively reviewed 1092 medical records to determine the epidemiological, clinical, imaging study, and therapeutic characteristics of mechanical sciatica. We also looked for factors associated with adverse outcomes. RESULTS: Mean patient age was 45.0 +/- 13.3 years, and 61.8% of patients were women. A history of low back pain was noted in 35.2% of cases. A single nerve root was involved in 68% of cases, and L5 was the most commonly affected root. Disk herniation was the cause in 58.4% of patients. First-line conservative treatment provided relief in 75% of cases, and the overall 6-month outcome was favorable in 76.5% of cases. CONCLUSION: The multivariate analysis conducted in the overall patient population showed that factors associated with adverse 6-month outcomes were heavy labor (odds ratio (OR) = 1.69; 95% confidence interval (95% CI) = 1.01-2.86; P = 0.049) and obesity (OR = 1.5; 95% CI = 1.01-2.47; P = 0.05).
Adolescent↗
Can the calcitonin used for a shoulder-hand syndrome have a role in the revelation of a cerebral meningioma?
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Adult↗
Monoarthritis secondary to joint metastasis. Two case reports and literature review.
Synovial metastases from neoplasms are uncommon. We report two cases of knee monoarthritis due to joint metastasis. Joint fluid cytology established the diagnosis. In one patient, an epidermoid carcinoma of the ureter metastasized to the left knee. The other patient had chronic monoarthritis of the left knee unresponsive to conventional treatment and was found to have distal femoral metastases from a lung adenocarcinoma. Only 28 cases of synovial metastases from solid tumors have been reported in the literature. The knee is the most common target, the lung the most common site of the primary (12 cases), and adenocarcinoma the most common histological type (12 cases). Joint metastasis carries a poor prognosis with a mean survival of less than 5 months.
Adenocarcinoma↗
Hip involvement in patients with familial Mediterranean fever. A review of ten cases.
Hip involvement is uncommon in familial Mediterranean fever (FMF) and can result either from a process specific to this disease or from a coexisting chronic inflammatory joint disease, usually suggestive of ankylosing spondylitis (AS). We report ten cases of FMF with radiologically-documented inflammatory hip disease. Five patients had AS and one had juvenile idiopathic arthritis. There were six men and four women, with a mean age of 34.4 years +/- 17.6 (range, 15-70 years). Onset of the inflammatory hip disease occurred after bouts of acute hip symptoms in one of the patients with isolated FMF and after protracted hip arthritis in another; the two other patients had no history of hip symptoms. The HLA-B27 antigen was looked for in two of the five patients with FMF and AS, with negative results in both; another patient in this subgroup had severe ulcerative colitis. Total hip replacement or replacement of the acetabulum was required in six patients, including two with isolated FMF. Chronic joint disease has been estimated to contribute fewer than 5% of the joint manifestations in FMF. In previous studies, the hips and knees were affected in 75% of patients with chronic joint disease related to FMF. The association of FMF and AS (usually without the HLA-B27 antigen) has been well documented, although the pathogenic mechanisms that link these two conditions remain unknown.
Adolescent↗