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Introduction: Multiple drug hypersensitivity (MDHS) is defined as confirmed drug hypersensitivity (DHS) to 2 or more drugs that are not chemically related. The objective of our study is to describe the cases of MDHS with antibiotics notified to the regional pharmacovigilance service (SRPV) of Sfax (Tunisia)., Methods: Our study is of a descriptive cross-sectional type, focusing on patients who consulted at the SRPV in Sfax during the period between 2013 and 2020 and who presented at least two episodes of DHS occurring at different times (at least one month apart)., Results: In our study, we included 29 patients (18 women and 11 men with a mean age of 59 years) who presented 69 sequential MDHS reactions documented either by a positive re-administration in 29 cases or by allergological exploration in 20 case, or by a highly suggestive clinical history in 20 cases. The frequency of MDHS was 1.13%. The drugs involved in the occurrence of these 69 DHS reactions were antibiotics in 55 cases (80%), antiepileptics in 6 cases (9%), NSAIDs in 4 cases (6%) and other drugs in 4 cases (6%) (one case with allopurinol, one case with strontium ranelate and two cases with gliclazide)., Conclusion: MDHS pose a real problem of therapeutic management. Indeed, these reactions can lead to a difficult choice of drugs with the impossibility of prescribing optimal first-line therapies., (Copyright © 2022 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Circumcision is the most performed surgical procedure in the world. This removal of the foreskin answers most often to an obligatory ritual practice in the Jewish and Muslim religions. In Tunisia, this act, formerly practiced by customary circumcisers, is mainly performed by nurses. In case of complications, the responsibility of the latter remains unclear, in the absence of regulations specific to this ancestral practice, with the exception of two ministerial circulars., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: Drug-induced vasculitis is reported in almost 10-20 % of vasculitis. Several drugs may be incriminated in their occurrence. Our study aimed to study the epidemiological, clinical, histopathological and evolutionary characteristics of drug-indced vasculitis from a series of cases and to specify the different drugs involved., Methods: We conducted a retrospective study during the period from January 2006 to December 2015 from the cases notified to the regional pharmacovigilance center of Sousse, Tunisia. The diagnosis was established according to the criteria proposed by the group of the American college of rheumatology (ACR)., Results: Our study included thirteen cases of drug-induced vasculitis over a ten-year period, with an mean incidence of 1.3 new cases per year. Mean age of patients was 40.84 years. The mean delay from the treatment onset was 14.46 days with extremes ranging from 5 days to six weeks. Most patients had pure skin involvement. Association with other extracutaneous complaints was present in five cases. Cutaneous biopsy was performed in all patients showing a pathological pattern of leukocytoclastic vasculitis, associated with fibrinoid necrosis, extravasation of red blood cells and allergic capillaritis. The outcome was favorable for all patients. The offending drugs in our series were amoxicillin, pristinamycin, rifampicin, fluconazole, metformin, glimepiride, phenobarbital, gabapentin, fenofibrate, ibuprofen, allopurinol, rituximab and tinzaparin., Conclusion: Anamnestic, clinical, biological and histopathological findings allow the early recognition of drug-induced vasculitis. Adequate treatment prevents systemic spreading and a worse prognosis., (Copyright © 2018. Published by Elsevier Masson SAS.)

Violence against health professionals is a global public health problem. A study carried out of hospital emergency departments in Tunis sought to analyse assaults on nurses. It reveals high levels of violence, particularly at weekends and during night shifts. Under-reporting of such incidents is observed, revealing a sort of 'culture of silence' which, over time, can lead to suffering in the workplace and a deterioration in the quality of care., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Childhood adversity rates would be higher in subjects at ultra-high risk of psychosis than in the general population. In addition to reference ideas, magical thoughts and social dysfunction, subjects at ultra-high risk of psychosis with a history of childhood trauma would experience more severe and specific symptoms. Childhood trauma, especially sexual abuse, was associated with the transition to psychosis. Several models have been cited to explain the link between trauma and the subsequent onset of psychosis or prepsychotic states: dysfunctional cognitive patterns, affective dysregulation, attachment styles, biological mechanisms, and epigenetic regulation. No methods of trauma assessment has been developed or validated in subjects at ultra-high risk of psychosis. Current interventions aim to prevent or reduce the adversities of childhood and improve their coping skills. Neuroleptic prescription is only recommended if there is a significant increase in prepsychotic symptoms., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: Colonic occlusion is the mode of discovery of 8 to 29% of colonic neoplasms. Our objective is to compare the placement of stent versus colostomy in the management of obstructing cancer of the left colon., Material and Methods: We have carried out a systematic search of literature from MEDLINE, EMBASE and Cochrane Library database to identify articles related to the comparison of stent versus colostomy published between 2000 and 2016., Results: We have identified 6 studies. Only one study was prospective comparative. Three studies were for curative purposes. The total number of patients was 7205. In the "stent" group, there was a decrease in the average length of hospital stay compared to the "stoma" group and there was a decrease in cost with a statistically significant relationship. There was no difference between the two groups in terms of 4 hospital mortality and early morbidity., Conclusion: In case of neoplastic occlusion of the left colon, the choice between colostomy or colonic stent depends on the therapeutic strategy. Indeed, for curative strategy or administration of anti-angiogenics, it is recommended to practice a colostomy. However, for palliative treatment, colonic stenting is the treatment to follow., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Magnetic resonance cholangiopancreatography is a non-invasive imaging, highly performant in detecting and locating biliary stenosis and in predicting its malignancy. The combination of two and three-dimensional MRI sequences is recommended to assess a biliary obstacle. Cholangiopathies are the main differential diagnosis of cholangiocarcinomas. In addition to bile duct abnormalities beyond the stenosis, the predictive signs of malignancy are: asymmetric irregular luminal narrowing (longer than 3mm and thicker than 13mm), abrupt discontinuation of stenosis, and enhancement superior to that of the adjacent hepatic parenchyma during arterial and portal acquisitions. Diffusion sequences improve the sensitivity of biliary stenosis detection. Moreover, restriction of diffusion is useful for distinguishing malignant from benign stenosis. Combining Magnetic resonance cholangiopancreatography, late LAVA and diffusion sequences improves the sensitivity of detection of a possible biliary extension without significant specificity. MRI with gadolinium chelate injection is efficient in assessing vascular extension of cholangiocarcinomas. However its accuracy remains lower than that of Ct-scan. To assess hepatic, lymphatic and peritoneal extensions of cholangiocarcinomas, it is fundamental to combine diffusion and dynamic MRI sequences., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Cognitive remediation is today afforded a significant place in the treatment of neurodevelopmental disorders. A hospital team, comprising in particular a nurse offering consultations in a child psychiatry unit in a public hospital in Tunis, shares its experience with regard to this technique which aims to restore impaired cognitive functions in order to improve the efficiency and quality of life of young patients., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Aim: To evaluate the modalities of administration of antiepileptic drugs (AED) with nasogastric tube (NGT) by nurses and to draw up recommendations., Methods: Our study consisted on investigating the modalities of administration of AED's with NGT by nurses during four months. We prepared 10 questions including demographic information. Participation was voluntary and anonymous. The questionnaire was distributed in seven intensive care departments after authorization of each head of the department. Thus, 45 nurses were included., Results: Nurses sex ratio was 1.5 and mean age was 31 years (25 to 37 years). Among the nurses, 60% mentioned that the NGT were silicone made and 4% that they were PVC made. The mean duration before replacing the NGT was thought to be 5±3 days. Among the nurses, 91% affirmed to clear the NGT after each use. All the nurses had agreed that the solid form is the most commonly used pharmaceutical form in the NGT. AED were associated with the enteral feeding solution in 56%. The AED should be crushed before administration for 98% of the nurses even in case of polymedication. Among them, 62% recommended to crush all of the associated drugs together. Before introducing the AED into the NGT, 93% of the nurses reported mixing with tap water. We have noticed that 62% of nurses felt the need to improve their knowledge AED administration with NGT., Conclusion: To optimize AED therapy, modalities of administration by NGT in epileptic comatose patients should be enhanced., (Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Ultrasound imaging may have an impact in management patients with rheumatoid arthritis. Through technological improvements, ultrasonography, has become an established imaging technique for the diagnosis and the follow up of this inflammatory chronic disease. In fact, ultrasounds, allow follow up during treatment by evaluating synovitis count and assessment of synovial vascularization by Power Doppler. Besides, erosions are found sooner and more frequently by ultrasonography than with conventional radiography. Rheumatologist training in sonography is essential, this technique has become indispensable in the management of inflammatory rheumatism, to avoid more invasive or more expensive imaging procedures., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Antiepileptic drugs are widely used and are associated with numerous side effects including skin eruptions. Epicutaneous tests have been used with variable success in skin drug reactions. The purpose of this study was to evaluate the profitability of epicutaneous tests in delayed hypersensitivity reactions induced by antiepileptic drugs., Methods: We analyzed all cases of allergic skin reactions to antiepileptic drugs notified in regional pharmacovigilance center of Sfax (Tunisia) between June 1, 2014 and April 30, 2016. The imputation score, determined using the French imputation method, should be at least doubtful. Patch-tests were performed in accordance with the general Europen network on Drug Allergy/European Academy of Allergy and Clinical Immunology (ENDA/EAACI) guidelines. Patch-tests were read according to the generally accepted criteria of the International contact dermatitis research group (ICDRG)., Results: In our study, 20 patients were included, among which 23 events were observed. The drug involved in delayed hypersensitivity reactions was carbamazepine in 11 cases, phenobarbital in 10 cases and valproic acid in 4 cases. The clinical reactions caused by the drug were classified as maculopapular exanthema (11 cases), DRESS syndrome (6 cases), Stevens-Johnson syndrome (2 cases), fixed drug eruption (2 cases) and erythroderma (2 cases). Patch-tests were positive in 19 patients (95 %). Cross-reactivity between antiepileptic drugs was observed in 4 cases: between valproic acid and carbamazepine in 2 cases between valproic acid and phenobarbital in 1 case and between phenobarbital and carbamazepine in 1 case., Conclusion: In this study, patch testing was a safe and useful method in confirming the culprit drug in delayed hypersensitivity reactions induced by antiepileptic drugs., (Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)