91 results on '"Ennaifer, Rym"'
Search Results
2. Knowledge and Perceptions of the End of Life among Tunisian Medical and Paramedical Staff.
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Khessairi, Nayssem, Bacha, Dhouha, Aouadi, Rania, Ennaifer, Rym, Lahmar, Ahlem, and Slama, Sana Ben
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CROSS-sectional method ,MEDICAL quality control ,ACADEMIC medical centers ,PALLIATIVE treatment ,EMERGENCY medical technicians ,QUESTIONNAIRES ,FISHER exact test ,DESCRIPTIVE statistics ,CHI-squared test ,MANN Whitney U Test ,HOSPITAL medical staff ,PROFESSIONS ,EUTHANASIA ,THEMATIC analysis ,ATTITUDES of medical personnel ,RESEARCH methodology ,TERMINAL care ,QUALITY assurance ,HEALTH promotion ,DATA analysis software ,SOCIODEMOGRAPHIC factors ,PSYCHOSOCIAL factors ,PROFESSIONAL competence - Abstract
Purpose: End-of-life (EOL) care is a vulnerable period in an individual’s life. Healthcare professionals (HPs) strive to balance the preservation of human life with respect for the patient’s wishes. The aims of our study were to assess HPs’ knowledge and perceptions of EOL care and to propose areas of improvement to improve the quality of care. Methods: We conducted a single-center, cross-sectional study involving HPs from a university hospital who encountered EOL care situations. We used a questionnaire divided into four sections: knowledge, practice, perception, and training. We calculated the rate of correct answers and the collective competence index. Results: Eighty-six questionnaires were analyzed, with 82.5% (71/86) completed by medical respondents and 17.5% (15/86) by paramedical respondents. Most of the respondents, 71.8% (51/71), were interns and residents. The study focused on palliative care, medical assistance in dying, aggressive medical treatment, and euthanasia, finding adequate knowledge in the first three areas. Respondents assigned to the intensive care unit and those with more than 8 years of experience had significantly higher correct answer rates than their counterparts. Seventy-five percent of respondents (65/86) reported feeling that they had little or no mastery of EOL care, primarily attributing this to insufficient training and the unavailability of trainers. Conclusion: Based on the findings of our study, which we believe to be the first of its kind in Tunisia, we can conclude that HPs possess an acceptable level of knowledge regarding EOL care. However, they require more exposure and training to develop expertise in this area. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Case Report: Hyperemesis gravidarum, high transaminases level and prolonged prothrombin time: is it an acute liver injury?
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Ennaifer, Rym, primary, El Mouldi, Yosr, additional, Bouchabou, Bochra, additional, Nakhli, Abdelwahab, additional, Hemdani, Nesrine, additional, and Triki, Amel, additional
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- 2022
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4. Green palmar discoloration in a patient with primary sclerosis cholangitis: eccrine chromhidrosis or pompholyx?
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Bouchabou, Bochra, primary, Farhat, Fatma Ben, additional, Ennaifer, Rym, additional, Ennakhli, Abdelwaheb, additional, and nejma, Houda Ben, additional
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- 2021
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5. Value of water enema computed tomography in elderly symptomatic patients
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Romdhane, Heyfa, Marzouk, Imen, Mzoughi, Zeineb, Cheikh, Meriem, Dridi, Meriem, Fadhl, Houcem, Ennaifer, Rym, and Belhadj, Najet
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- 2017
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6. Screening for latent tuberculosis infection prior to biologic therapy in patients with chronic immune-mediated inflammatory diseases (IMID): Interferon-gamma release assay (IGRA) versus tuberculin skin test (TST)
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Sellami, Meriem, primary, Fazaa, Alia, additional, Cheikh, Myriam, additional, Miladi, Saousen, additional, Ouenniche, Kmar, additional, Ennaifer, Rym, additional, Ben Abdelghani, Kaouther, additional, and Laatar, Ahmed, additional
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- 2019
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7. Multiples ileal adenomas in Crohn's disease: Sporadic or ileitis associated dysplasia?
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Ennaifer, Rym, Lahmar, Ahlem, Ben Slama, Sana, Marzouk, Ines, Romdhane, Hayfa, Bayar, Rached, and Bel Hadj, Najet
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- 2017
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8. Gastric Schwannoma: A Case Report
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Romdhane, Hayfa, primary, Cheikh, Myriam, additional, Mzoughi, Zeineb, additional, Ben Slama, Sana, additional, Ennaifer, Rym, additional, and Belhadj, Najet, additional
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- 2016
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9. Ischemic colitis in five points: an update 2013
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Hefaiedh, Rania, Sabbah, Mériam, Ennaifer, Rym, Romdhane, Hyafa, Attaoui, Amine, Bel Hadj, Najet, Gharbi, Lassad, and Taher Khalfallah, Mohamed
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Diagnosis, Differential ,Diarrhea ,Tunisia ,Biopsy ,Incidence ,Humans ,Colonoscopy ,Gastrointestinal Hemorrhage ,Colitis, Ischemic - Abstract
Ischemic colitis is the most common form of intestinal ischemia. The presence of diarrhea and mild lower gastrointestinal bleeding should guide the diagnosis. Although many laboratory tests and radiographic images may suggest the diagnosis, colonic endoscopic with histological analysis of biopsies is the gold standard for identification of colonic ischemia. aim : The aim of this study was to resume in 5 points: the epidemiology, the clinical features, the diagnostic approach and the management of ischemic colitis in five points. methods: Review of literature. results: Incidence of ischemic colitis was between 3 and 10%. The clinical presentation is predominated by the non gangrenous form associating abdominal pain, tenderness, diarrhea and lower gastrointestinal bleeding. The most frequent causes are represented by systemic hypoperfusion. Laboratory tests can orientate the diagnosis but are unspecific. Radiographic images based on computed tomography or more recently magnetic resonance imaging may suggest the diagnosis, but the confirmation will be given by endoscopic visualization of colonic mucosa with histological analysis of biopsies. Conservative treatment is the most often sufficient to improve colonic lesions. Surgical treatment is reserved for perforations and strictures.The incidence of colonic ischemia is difficult to ascertain. The diagnosis is usually made by medical history, examination, and endoscopy which have become the diagnostic procedure of choice. A high index of suspicion and prompt management are essential for optimum outcomes in patients with colonic ischemia.
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- 2014
10. Hepatic sarcoidosis: a case series
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Ennaifer, Rym, primary, Ayadi, Shema, additional, Romdhane, Hayfa, additional, Cheikh, Myriam, additional, Nejma, Houda Ben, additional, Bougassas, Wassila, additional, and Hadj, Najet Bel, additional
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- 2016
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11. Computed Tomographic presentation of obstructive jejunal adenocarcinoma associated with celiac disease and incomplete intestinal malrotation
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Ines, Marzouk Moussa, primary, Ennaifer, Rym, additional, Omrani, Sahir, additional, Ahlem, Lahmar Boufaroua, additional, Ouji, Rym, additional, and Hendaoui, Lotfi, additional
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- 2016
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12. Pancréatite aiguë au cours de la polyarthrite rhumatoïde : quelles étiologies ?
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Ennaifer Rym, Souabni Leila, Jean Sibilia, Zakraoui Leith, Ben Abdelghani Kaouther, and Ben Tekaya Aicha
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Rheumatology ,business.industry ,Medicine ,business - Published
- 2015
13. Budd-Chiari Syndrome: An Unusual Presentation of Multisystemic Sarcoidosis
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Ennaifer, Rym, primary, Bacha, Dhouha, additional, Romdhane, Hayfa, additional, Cheikh, Myriam, additional, Ben Nejma, Houda, additional, and BelHadj, Najet, additional
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- 2015
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14. Downhill oesophageal variceal bleeding: A rare complication in Behçet’s disease-related superior vena cava syndrome
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Ennaifer, Rym, primary, B’chir Hamzaoui, Saloua, additional, Larbi, Thara, additional, Romdhane, Hayfa, additional, Abdallah, Maya, additional, Bel Hadj, Najet, additional, and M’rad, Sander, additional
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- 2015
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15. De novo autoimmune hepatitis following liver transplantation for primary biliary cirrhosis: an unusual cause of late grafts dysfunction
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Ennaifer, Rym, primary, Ayadi, Hend, additional, Romdhane, Haifa, additional, Cheikh, Meriem, additional, Mestiri, Hamouda, additional, Khalfallah, Taher, additional, and Hadj, Najet Bel, additional
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- 2015
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16. Acute pancreatitis in rheumatoid arthritis: Causes
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Ben Abdelghani, Kaouther, primary, Ben Tekaya, Aicha, additional, Ennaifer, Rym, additional, Souabni, Leila, additional, Zakraoui, Leith, additional, and Sibilia, Jean, additional
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- 2014
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17. Encéphalopathie hépatique minime : un diagnostic précoce pour améliorer le pronostic
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Ennaifer, Rym, primary, Cheikh, Myriam, additional, Hefaiedh, Rania, additional, Romdhane, Hayfa, additional, Ben Nejma, Houda, additional, and Hadj, Najet Bel, additional
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- 2014
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18. Overlap Syndrome of Primary Biliary Cirrhosis and Autoimmune Hepatitis with Unusual Initial Presentation as an Acute Hepatic Failure
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Ennaifer Rym, Elleuch Nour, primary
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- 2014
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19. Glucose Metabolism Disorders in Cirrhosis: Frequency and Risk Factors in Tunisian Population. Results of a Cross-Sectional Study
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Ennaifer, Rym, primary, Cheikh, Myriam, additional, Hefaiedh, Rania, additional, Romdhane, Hayfa, additional, Nejma, Houda Ben, additional, and Hadj, Najet Bel, additional
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- 2014
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20. Toxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases
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Hefaiedh, Rania, primary, Cheikh, Mariem, additional, Ennaifer, Rym, additional, Gharbi, Lassad, additional, and Bel Hadj, Najet, additional
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- 2013
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21. Colectomy for Porto-Systemic Encephalopathy: Is It Still Topical?
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Ennaifer, Rym, primary, Hayfa, Romdhane, additional, Hefaiedh, Rania, additional, Marsaoui, Lobna, additional, Bel Hadj, Najet, additional, and Khalfallah, Tahar, additional
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- 2013
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22. Autoimmune diseases in coeliac disease: effect of gluten exposure
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Ouaka-Kchaou, Asma, primary, Ennaifer, Rym, additional, Elloumi, Hela, additional, Gargouri, Dalila, additional, Hefaiedh, Rania, additional, Kochlef, Asma, additional, Romani, Malika, additional, Kilani, Afef, additional, Kharrat, Jamel, additional, and Ghorbel, Abdeljabbar, additional
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- 2008
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23. Is the split dose better than conventional bowel preparation in Tunisian patients?
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Nsibi, Soumaya, Ennaifer, Rym, Bouchabou, Bochra, Romdhane, Hayfa Ben, and Nejma, Houda Ben
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- 2019
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24. Prevalence of Hepatitis B virus markers in patients undergoing biological therapy.
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Nsibi, Soumaya, Ennaifer, Rym, Bouchabou, Bochra, Romdhane, Hayfa Ben, and Nejma, Houda Ben
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- 2019
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25. Le livret de stage durant l'internat: toujours d'actualité?
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ROMDHANE, Hayfa, MZOUGHI, Zeineb, SLAMA, Sana Ben, MALLOULI, TALBI, Ghofrane, BACHA, Dhouha, ENNAIFER, Rym, and BELHAJ, Najet
- Abstract
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- 2017
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26. Pulmonary benign metastasizing leiomyoma in patient with esophageal and anorectal leiomyomatosis.
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Bacha, Dhouha, Ferjaoui, Wael, Zran, Mohamed, Baccouche, Seifeddine, Slama, Sana Ben, Marzouk, Ines, Gharbi, Lassad, Lahmar, Ahlem, Ennaifer, Rym, and Bayar, Rached
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UTERINE fibroids , *SMOOTH muscle , *METASTASIS , *MUSCLE cells , *CELL proliferation - Abstract
Esophageal and anorectal leiomyomatosis association is exceedingly rare. It's characterized by a benign smooth muscle cell proliferation in respectively esophageal and anorectal walls, causing circumferential thickening. To the best of our knowledge, this is the first reported pulmonary BML case associated with esophageal and anorectal leiomyomatosis in a 20-year-old female. [ABSTRACT FROM AUTHOR]
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- 2022
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27. Tunisian consensus on the management of Helicobacter Pylori infection.
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Medhioub M, Chtourou L, Kchaou M, Khsiba A, Zakhama M, Ben Ameur W, Moalla M, Yacoub H, Ayadi S, Bouchabou B, Battikh H, Zribi M, Siala N, Azouz MM, Amouri A, Abdelli MN, Safer L, Bibani N, Ben Mustapha N, Hammami A, Abdelwaheb M, Ennaifer R, Jomni T, and Fekhi M
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- Humans, Consensus, Anti-Bacterial Agents therapeutic use, Duodenum, Helicobacter Infections complications, Helicobacter Infections diagnosis, Helicobacter Infections epidemiology, Helicobacter pylori
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Helicobacter pylori infection is the most common infectious disease worldwide. It is associated with duodenal and gastric ulcer disease and the risk of gastric neoplasia. The management of helicobacter pylori infection currently represents a real challenge for clinicians, given the ever-increasing rate of resistance of Helicobacter pyolori to various antibiotics. In this consensus document, we present recommendations adapted to the Tunisian context, including indications for the detection of helicobacter pylori infection, indications for the use of different diagnostic methods, and a therapeutic strategy for the management of Helicobacter pylori infection.
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- 2023
28. Estimation of the prevalence of obstructive sleep apnea in non alcoholic fatty liver disease.
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Romdhane H, Ayadi S, Cheikh M, Bouchabou B, Ben Nejma H, and Ennaifer R
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- Female, Humans, Hypertension complications, Male, Middle Aged, Prevalence, Prospective Studies, Sleep Apnea, Obstructive diagnosis, Surveys and Questionnaires, Non-alcoholic Fatty Liver Disease complications, Sleep Apnea, Obstructive complications
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Introduction: The prevalence of non alcoholic fatty liver disease is increasing in parallel with the epidemic of obesity and metabolic syndrome. Recent data have shown frequent association between non alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea., Aim: To estimate the prevalence of sleep disorders, to search an obstructive sleep apnea syndrome by conducting a ventilator polygraphy and to search the particularities of obstructive sleep apnea when its exists, in patients with NAFLD., Methods: A prospective study, conducted over a period of 6 months, including patients followed for non-alcoholic fatty liver disease. We performed in all patients a Berlin questionnaire that assesses the risk of obstructive sleep apnea syndrome, an Epworth score that estimates the degree of daytime sleepiness and a ventilator polygraphy., Results: We collected 37 patients. The mean age was 50,41±13,7 years. The sex ratio (M/F) was 0,42. Type 2 diabetes mellitus, arterial hypertension or dyslipidemia were recorded respectively in 37,8%, 40,5% and 37,8% of cases. Snoring was noted in 75,7% of cases and excessive daytime sleepiness in 34,2% of cases. Obesity was observed in 73% and metabolic syndrome in 43,2% of cases. The Berlin Questionnaire was positive in 64,9% of cases. The average score of Epworth scale was 9,22±4,02 and 43,2% of patients had a score> 10. Ventilatorypolygraphy was positive in 13 cases (35,1%) with a mean AHI of 7,02±10,08.In these patients, obstructive sleep apnea was mild, moderate and severe in respectively 61,5%, 15,4% and 23,1% of cases. In univariate analysis, subjects with positive ventilator polygraphy had a significantly higher waist circumference (118,00 versus 109,58, p=0,05). Arterial hypertension was significantly associated with increased daytime sleepiness (p=0,018). In multivariate analysis, the only independent variable associated with excessive daytime sleepiness was arterial hypertension (OR=5,33 p=0,021)., Conclusion: In our study, the prevalence of obstructive sleep apnea syndrome is high in patients with non alcoholic fatty liver disease. The only independent variable associated with excessive daytime sleepiness was arterial hypertension.
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- 2018
29. Cardiovascular risk estimation in non alcoholic fatty liver disease.
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Romdhane H, Cheikh M, Ennaifer R, Mahmoud Y, Bougassas W, Ben Nejma H, and Bel Hadj N
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- Adult, Aged, Cardiovascular Diseases diagnosis, Coronary Artery Disease diagnosis, Coronary Artery Disease etiology, Exercise Test, Female, Humans, Hypertension diagnosis, Hypertension epidemiology, Male, Metabolic Syndrome diagnosis, Metabolic Syndrome epidemiology, Middle Aged, Prospective Studies, Risk Assessment methods, Risk Factors, Cardiovascular Diseases etiology, Non-alcoholic Fatty Liver Disease complications
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Background: Nonalcoholic fatty liver disease is rising to the growing epidemic of metabolic syndrome. Recent data suggest that this liver disease may represent a real marker of cardiovascular risk. The aim of our study was to calculate cardiovascular risk and to estimate the frequency of subclinical coronary artery disease by conducting an exercise testing., Methods: This is a prospective study conducted over a period of one year including all patients followed for non alcoholic fatty liver disease. We realized in all patients an exercise testing and we calculated the ACC / AHA score that estimates the risk of developing atherosclerotic cardiovascular disease. This risk is considered very high if the score> 7.5., Results: We included 103 patients. The mean age was 52 years. The sex ratio (M/F) was 0.3. Diabetes, dyslipidemia and hypertension were present respectively in 45.6%, 48.5% and 38.8% of cases. Obesity was noted in 69.9% of our patients. Metabolic syndrome was found in 78.6% of patients. The ACC / AHA average score was 8.03 ± 9 and a score> 7.5 was noted in 35.9% of cases. The exercise testing was positive in 12 patients (11.65%). Of these, 11 underwent coronary angiography which was normal in 10 cases and showed a coronary artery infiltration without significant stenosis in only one case, and 2 patients underwent coro-scanner which was without significant anomalies. In univariate analysis, the presence of metabolic syndrome (p = 0.05), waist circumference ≥ 94 cm in men and ≥ 80 cm in women (p = 0.019), diabetes (p = 0.03) were associated with a high risk of developing cardiovascular events. In multivariate analysis, the only independent variable associated with a positive exercise testing was diabetes (OR 4.5, p = 0.03)., Conclusion: During non alcoholic fatty liver disease, there is an increased cardiovascular risk. It would be necessary to consider this excess risk in the surveillance of patients followed for non alcoholic liver disease to early detection of any cardiovascular disease.
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- 2016
30. Incidental gallbladder cancer diagnosed on cholecystectomy specimens: a study of 30 cases.
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Ben Slama S, Ennaifer R, Bacha D, Bayar R, Bouraoui S, Gharbi L, and Lahmar A
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- Adenocarcinoma complications, Aged, Female, Gallbladder Neoplasms complications, Gallstones complications, Gallstones surgery, Humans, Male, Prognosis, Retrospective Studies, Adenocarcinoma diagnosis, Cholecystectomy, Gallbladder Neoplasms diagnosis, Incidental Findings
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Background - The gallbladder cancer is a rare cancer with poor prognosis. The association with gallstone disease is the main risk factor of this cancer. Aim - Describe the demographics, clinic-pathologic and therapeutic management of incidentally gallbladder cancer diagnosed on cholecystectomy specimens. Methods - retrospective study including 30 cases of gallbladder cancer incidentally detected on cholecystectomy specimens. Results - The incidence of gallbladder cancer incidentally discovered was 0.83%. The sex ratio M/F was 0.5 and the average age was 68 years. The main risk factor was cholelithiasis (38%). Adenocarcinoma was the most frequent histological type found in 86.6% of cases and it was biliary-type in 56.6% of cases. 76,7% of the tumors were classified in early stages (stages 0, I and II) and 23,3% were in advanced stages (III and IV). A simple cholecystectomy was curative in 66.7% of cases. Overall survival rate was 56.7% at one year. The best survival rate was for the early stages: 100% stages 0-I and 45.4% stage II. Conclusions - The gallbladder cancer has poor prognosis because of its late diagnosis. Thorough sampling and careful attention on histological examination of all parts of cholecystectomy specimens allows detection of early cancer with better prognosis.
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- 2016
31. Hyponatremia in cirrhosis: Risk factors and prognostic value.
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Ennaifer R, Cheikh M, Romdhane H, El Elj R, Ben Nejma H, Bougassas W, and Bel Hadj N
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Hyponatremia etiology, Liver Cirrhosis mortality, Liver Cirrhosis physiopathology, Liver Function Tests, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index, Sodium blood, Survival Rate, Young Adult, Hepatic Encephalopathy epidemiology, Hepatorenal Syndrome epidemiology, Hyponatremia epidemiology, Liver Cirrhosis complications
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Background Hyponatremia is the most common electrolyte abnormality encountered in cirrhotic patients. Recent studies have shown that hyponatremia was correlated with severity of cirrhosis and associated with increased risk of complications and mortality. However this relationship is still unclear. The aims of the present study were to search predictive factors for hyponatremia in cirrhosis and to assess its prognostic value. Methods We performed a retrospective study, including consecutive cirrhotic patients admitted to our department between January 2011 and April 2014. Patients and cirrhosis characteristics were studied. Serum sodium levels were determined at admission. The cutoff level of 130 mmol/l was chosen because it is widely accepted to define hyponatremia in patients with cirrhosis. Predictive factors of hyponatremia development and its impact on the outcome (cirrhosis complications and survival) were evaluated. Results We included 143 cirrhotic patients: 67 females (46.9%) and 76 males (53.1%) with a mean age of 58 years. Etiology of cirrhosis was mainly viral (56.7%). Child-Pugh stage was B in 41.2% and C in 25.9%. Mean MELD score was 15 [6-40]. The prevalence of dilutional hyponatremia as defined by a serum sodium concentration ≤130 mmol/L or ≤135 mmol/L was 10.5% and 31.4% respectively. Serum sodium level ≤130 mmol/L was strongly associated with severity of liver function impairment as indicated by Child-Pugh C (OR=7.84;p<0.001), and MELD score> 16 (OR=6.76; p=0.001). Survival without complications was reduced in patients with hyponatremia but was only significant if a serum sodium concentration ≤135 mmol/L was considered (p=0.012). Survival without hepatic encephalopathy and without hepatorenal syndrome was significantly reduced in patients with hyponatremia (p<0.001 for both). Global survival was also reduced in patients with hyponatremia at 1 year: 22.5% versus 68.7%, as well as mean global survival: 8.3 versus 32.8 months (p<0.0001). Conclusion Low serum sodium level was correlated with severity of cirrhosis. Hyponatremia was a negative prognostic factor associated with increased short-term morbi-mortality.
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- 2016
32. Does protein energy malnutrition affect the outcome in Tunisian cirrhotic patients?
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Ennaifer R, Cheikh M, Romdhane H, Sabbagh S, Ben Nejma H, Bougassas W, and Bel Hadj N
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Background: Malnutrition is commonly seen in cirrhotic patients and has been shown to adversely affect outcome. However, it remains associated with the severity of cirrhosis. Therefore, its role as an independent prognostic factor is still under debate. The aims of our study were to determine the prevalence of malnutrition in cirrhotic patients and determine whether this condition was an independent prognostic factor., Patients and Methods: We prospectively analyzed the nutritional status of 104 consecutive patients with cirrhosis Subjective global nutritional assessment (SGA) and anthropometry [dry body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC)] were used for the evaluation of the nutritional status. Complications of cirrhosis during follow-up and patient's survival were recorded. Global survival and survival without complications was studied by Kaplan Meier method and using Log Rank test., Results: Prevalence of malnutrition ranged from 16.3 and 62.5% according to the method of nutritional assessment used. Survival without complications was reduced in malnourished patients. This difference was significant when assessing malnutrition by dry BMI (p=0.001). In multivariate analysis, malnutrition defined by dry BMI<18.5 kg/m2 was an independent predictor of complications (p<0.001; RR 3.2) especially hepatic encephalopathy (p=0.001; RR 2.66). In univariate analysis, global survival was worse in malnourished patients (by BMI and SGA; p=0.03 and p=0.0014 respectively), but this trend was lost in multivariate analysis., Conclusion: In our study, malnutrition was an independent predictor of complications in cirrhosis. However, it did not appear as an independent prognostic factor for global survival. These results raise again difficulties to clarify whether malnutrition influence itself the prognosis of cirrhosis or if it is only related to the severity of cirrhosis.
- Published
- 2016
33. Prognosis of refractory ascites in cirrhosis.
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Ennaifer R, Elleuch N, Romdhane H, Hefaiedh R, Cheikh M, Chaabouni S, Ben Nejma H, and Bel Hadj N
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- Ascites drug therapy, Diuretics therapeutic use, Female, Humans, Liver Cirrhosis mortality, Male, Middle Aged, Prognosis, Retrospective Studies, Ascites etiology, Hepatic Encephalopathy etiology, Liver Cirrhosis complications, Peritonitis etiology
- Abstract
Background: Ascitic decompensation is a common major complication of cirrhosis and is associated with a poor outcome. In 5-10% of patients, ascites become resistant to treatment (either do not respond to a high dose of diuretics or because these drugs induce complications), which is called refractory ascites (RA). RA is associated with poor survival: 20-50% at 1 year. The aim of this study was to investigate the outcome of RA., Methods: Retrospective study including consecutive cirrhotic patients admitted for controlling ascites between January 2010 and April 2013. Patients and cirrhosis characteristics were studied. Development of RA during follow-up was investigated. The impact of RA on the outcome (cirrhosis complications and survival) was evaluated., Results: We included 124 cirrhotic patients: 59 females (47.6%); mean age was 58 years. Ascites was grade 3 in 38.5% and was the first episode in 45.1% of patients. Etiology of cirrhosis was mainly viral (57.3%). Child-Pugh score was B in 39.5% and C in 28.2%. Mean MELD score was 16 [6-40]. During follow-up, 27 patients developed RA, meaning a prevalence of 21.8%. RA type was diuretic intractable in all cases. Survival without complications was significantly reduced in patients with RA (4 vs 17 monthsp<10-3). RA was an independent predictive factor of global complications, spontaneous bacterial peritonitis and hepatic encephalopathy. Global survival was reduced in patients with RA (12 vs 16 months, p=0.069). One year survival was 45% for patients with RA vs 63% for other cirrhotics. In multivariate analysis, only Child-Pugh score, but not RA was an independent prognostic factor., Conclusion: In this Tunisian sample we confirm that RA reduces survival and increases risk of cirrhosis complications, especially hepatic encephalopathy and spontaneous bacterial peritonitis. Therefore, these patients should be promptly listed for liver transplantation, over and above the MELD score.
- Published
- 2016
34. Appropriateness of indication for upper gastrointestinal endoscopy in a Tunisian endoscopy unit.
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Ennaifer R, Elleuch N, Cheikh M, Hefaiedh R, Romdhane H, Ben Nejma H, and Bel Hadj N
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- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Gastrointestinal Neoplasms diagnosis, Humans, Male, Middle Aged, Prospective Studies, Unnecessary Procedures statistics & numerical data, Young Adult, Endoscopy, Gastrointestinal
- Abstract
Background: Upper gastrointestinal endoscopy (UGE) is an increasing and reliable procedure. Given the high costs and potential risks, appropriate indication of UGE may be facilitated by referring to qualifying criteria such as those devised by the European Panel (EPAGE). This prospective study evaluates the applicability and efficacy of these criteria in clinical practice., Methods: Cross sectional study. Consecutive patients were referred to our unit endoscopy for diagnostic upper gastrointestinal endoscopy between January 2011 and June 2011. Demographic data, indication of the procedure, and endoscopic diagnosis were collected. The appropriateness of UGE was assessed based on EPAGE II criteria before the procedure., Results: EPAGE criteria were applicable in 89.1% of cases. They were 78 men (48.1%) and mean age was 49 years [14 - 91]. Indications for UGE were extremely appropriate, appropriate, inappropriate and uncertain in 21.6%, 47.4%%, 8.8% and 22.2% respectively. Among patients with clinically significant lesions detected by UGE, 70.7% had an appropriate indication. Clinically significant lesions were disclosed in 59% of the appropriate group and 54% of the inappropriate group. All cancers were observed in patients with appropriate indications. Patients with appropriate indication were older than patients belonging to the inappropriate group (53.6 years versus 39.9 years, p =0,0001)., Conclusion: In this present study, EPAGE criteria were applicable in 89.1% and indication was judged appropriate in more than two-third of cases. However, clinical significant lesions were observed in a proportion of patients with inappropriate indication, and in some relevant clinical situations EPAGE criteria were not applicable. Therefore, even if these criteria are helpful for decision-making, final decision must however rely upon practitioner. Qualifying criteria for an appropriate selection of endoscopical procedure adapted to our population are advisable.
- Published
- 2015
35. Complete radiological response after sorafenib treatment for advanced hepato-cellular carcinoma.
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Elleuch N, Ennaifer R, Romdhane H, Cheikh M, Hefaiedh R, Bougassas W, Ben Nejma H, and BelHadj N
- Subjects
- Aged, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular pathology, Female, Hepatitis C, Chronic complications, Humans, Liver Cirrhosis virology, Liver Neoplasms diagnostic imaging, Liver Neoplasms pathology, Neoplasm Staging, Niacinamide therapeutic use, Radiography, Remission Induction, Sorafenib, Treatment Outcome, Antineoplastic Agents therapeutic use, Carcinoma, Hepatocellular drug therapy, Liver Neoplasms drug therapy, Niacinamide analogs & derivatives, Phenylurea Compounds therapeutic use
- Abstract
Introduction: Sorafenib, an oral multikinase inhibitor, has recentlybeen shown to improve overall survival in patients with advanced hepatocellular carcinoma (HCC) but only a handful of reports of complete remission on sorafenib have been issued., Case Report: We report an intriguing case of advanced HCC complicating HCV infection with cirrhosis, in which the patient achieved complete remission by prolonged administration of sorafenib., Conclusion: Identifying factors that could be associated with good response to this therapy are needed.
- Published
- 2015
36. Surgical treatment of Crohn's disease: indications, results and predictive factors of recurrence and morbidity.
- Author
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Hefaiedh R, Sabbeh M, Miloudi N, Ennaifer R, Romdhane H, Belhadj N, Gharbi L, and Khalfallah T
- Subjects
- Adolescent, Adult, Cecum surgery, Constriction, Pathologic, Crohn Disease epidemiology, Crohn Disease pathology, Female, Humans, Ileum surgery, Incidence, Male, Middle Aged, Postoperative Complications epidemiology, Predictive Value of Tests, Recurrence, Reoperation, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Tunisia epidemiology, Colectomy, Crohn Disease surgery, Quality of Life
- Abstract
Background: Crohn's disease management represents a major problem in gastroenterology and general surgery because it affects young subjects and has a major impact on their quality of life. The aims of our study were to identify the indications for surgery in Crohn's disease, the results and the complications of surgery in our series, and to identify possible predictive factors of recurrence and postoperative morbidity., Methods: A retrospective descriptive study including 38 cases of patients with Crohn's disease who underwent surgical treatment in the department of surgery in Mongi Slim Hospital, during the period between January 1992 and December 2011 was performed., Results: The occurrence of stenosis was the most common indication for surgical treatment in Crohn's disease in our series, and ileocecal resection was the most performed surgery. Twenty six patients (58%) received maintenance therapy after surgery. Twenty two patients relapsed and 13 had surgical management for recurrence. In univariate analysis, predictive factors of post operative morbidity in our study were leukocytosis, penetrating phenotype and intraabdominal sepsis. Ileocecal location was the only factor that significantly improved the incidence of recurrence. In multivariate analysis, only penetrating phenotype was a predictive factor or post operative morbidity., Conclusion: Despite the development of medical treatment, surgical treatment keeps large indications for the management of complications of Crohn's disease. The surgery should be an alternative to immunosuppressive therapy. Currently, prevention postoperative recurrence is well codified, reducing the risk of complications.
- Published
- 2015
37. Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma.
- Author
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Hefaiedh R, Sabbeh M, Ennaifer R, Romdhane H, Ben Nejma H, Belhadj N, Gharbi L, and Khalfallah MT
- Subjects
- Aged, Aged, 80 and over, Catheter Ablation, Ethanol therapeutic use, Female, Hepatectomy, Humans, Injections, Male, Middle Aged, Retrospective Studies, Tunisia epidemiology, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular therapy, Liver Neoplasms mortality, Liver Neoplasms therapy
- Abstract
Background: Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas., Material and Methods: A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment., Results: Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 54% cases while percutaneous treatment was proposed for 46%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. The corresponding 6 months and 1- year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different., Conclusion: Our results showed the efficacy and safety of percutaneous ablation treatments (radiofrequency ablation and ethanol injection) in patients with small hepatocellular carcinoma.
- Published
- 2015
38. Quality indicators for colonoscopy in a Tunisian endoscopy unit.
- Author
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Ennaifer R, Elleuch N, Sabbagh S, Romdhane H, Hefaiedh R, Ben Nejma H, and Belhadj N
- Subjects
- Female, Hospital Units, Humans, Male, Middle Aged, Retrospective Studies, Tunisia, Colonoscopy standards, Quality Indicators, Health Care
- Abstract
Background: Colonoscopy is a powerful tool for prevention and early diagnosis of colorectal cancer. However, the effectiveness of colonoscopy is dependent on the quality of the procedure, which is assessed by a number of key quality indicators. Among them, cecal intubation and adenoma detection rate are historically the most commonly used indicators of quality of colonoscopy. The aim of our study was to evaluate these two indicators of quality of colonoscopy in a Tunisian endoscopy center., Methods: We conducted a retrospective study from January 2009 to March 2013. Data were collected from colonoscopies reports. Demographic data, indication of the procedure, and endoscopic diagnosis were collected. The quality of bowel preparation was subjectively classified at the time of the examination by each endoscopist as good, fair, or poor. Procedure related quality indicators considered for analysis were: cecal intubation rate (CIR) and polyp detection rate., Results: During the period of the study, 859 colonoscopies were performed without sedation. The average age was 54.76 ± 17.5 years. Males represented the majority of our population (50.2%). Colic preparation was judged good, fair and poor in respectively 24 %, 61% and 15% of cases. The cecal intubation rate was 61.1 %. Causes of incomplete colonoscopy were especially poor preparation (47.3%) and poor tolerance (34.4%). Univariate analysis disclosed 3 predictive factors of CIR : the quality of bowel preparation (good vs fair or poor( (67.2 % vs 31.3%, p = 0.0001,OR: 4.5, 95% CI: 3.3-6), the screening indication (72.9% vs 60.1% , p = 0.03, OR: 1.7, 95% CI: 1-3) and the presence of alarming signs (55% vs 43%, p=0.04; OR: 1.1, 95% CI:0.9-2.5). By multivariate analysis, the factors influencing independently the CIR were the quality of bowel preparation (p=10-3, OR=2.23, 95% CI: 1.47-3.3) and the screening indication (p=0.02, OR: 1.9, 95% CI: 1.1-3.4). The polyp detection rate was 21% and was correlated, in univariate analysis with: age over 47 years (p=10-3, OR:3.2, 95 % CI:2-4.9), male gender (25.1% vs 16.8%, p=0.001, OR:2.36, 95% CI: 1.4-4), the quality of the preparation (26.5% vs 19.1%, p=0.03 OR:1.4, 95% CI:0.9 -2), the presence of colorectal cancer (50.9% vs 18.2%, p=0.0001, OR:4.6, 95% CI: 2.6-8) and the screening indication (35.7% vs 19%, p=0.001 OR: 2.36, 95% CI: 1.4- 4). By multivariate analysis, 3 independent factors associated with polyp detection rate were identified: age over 47 years (p=10-3, OR: 3.5 95% CI:2-5.9), bowel preparation (p=10-3 OR=5, 95% IC:2.7-9.6) and the screening indication( p=0.01, OR 2.5, 95% IC 1.4-4.7)., Conclusion: In our cohort, the quality of bowel preparation, tolerance of the procedure, age and the indication of colonoscopy were significantly associated with the indicators of quality. Bowel preparation and tolerance are targets on which we should act to improve performance.
- Published
- 2015
39. Misdiagnosed anorectal malignant melanoma.
- Author
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Ennaifer R, Elleuch N, Romdhane H, Hefaiedh R, Marsaoui L, Gharbi L, Belhadj N, and Khalfallah T
- Subjects
- Aged, Anus Neoplasms surgery, Fatal Outcome, Female, Hemorrhoidectomy, Hemorrhoids pathology, Humans, Melanoma surgery, Neoplasm Metastasis, Anus Neoplasms pathology, Diagnostic Errors, Melanoma pathology
- Published
- 2015
40. [Solitary rectal ulcer syndrome. A Tunisian monocentric Survey].
- Author
-
Ennaifer R, Elleuch N, Hefaiedh R, Romdhane H, Miloudi N, Ben Nejma H, Bel Hadj N, and Khalfallah T
- Abstract
Background: Solitary rectal ulcer syndrome is an uncommon and benign defecation disorder. Occidental series are scarce and to our knowledge, Tunisian data are not available., Aims: The aim of this study was to evaluate the clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome., Methods: All the patients diagnosed with solitary rectal ulcer syndrome from January 2001 to 2012 were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic, histological and therapeutic findings., Results: A total of 15 patients were evaluated: 7 males; mean age 42.6 years. Bleeding per rectum was present in 66% and dyschezia in 73%. Endoscopically, solitary lesion was present in 66% patients. The most frequent dynamic abnormalities shown by defecography were of rectal intussusception (53%). Anorectal manometry was performed in seven cases disclosing dyssynergia in 2 cases. Thirty patients underwent surgery, always after failure of medical treatment and one patient was treated with biofeedback. Rectopexy was the most utilized technic. After a mean follow-up of 29 months, total regression of symptoms was noted in 50% of patients who underwent surgery., Conclusion: In this cohort, diagnostic and therapeutic spectrum of solitary rectal ulcer syndrome was comparable to occidental features. Nevertheless, accesses to manometry and defecography as well as biofeedback were limited.
- Published
- 2015
41. Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma.
- Author
-
Hefaiedh R, Sabbegh M, Ennaifer R, Romdhane H, Ben Nejma H, Belhadj N, Gharbi L, and Khalfallah T
- Subjects
- Aged, Aged, 80 and over, Carcinoma, Hepatocellular surgery, Female, Humans, Liver Neoplasms surgery, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Carcinoma, Hepatocellular therapy, Catheter Ablation, Hepatectomy methods, Liver Neoplasms therapy
- Abstract
Background: Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas., Methods: A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment., Results: Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 53.5% cases while percutaneous treatment was proposed for 46.5%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. Overall survival was significantly lower in the surgical resection group. The corresponding 6 months and 1-year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different., Conclusion: Our results showed the efficacy and safety of percutaneous ablation treatments which were better than those of surgical treatment in patients with small hepatocellular carcinoma.
- Published
- 2014
42. Risk factors of psychological disorders in inflammatory bowel disease in a tunisian survey. Results of a cross-sectional study.
- Author
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Ennaifer R, Elleuch N, Cheikh M, Hefaiedh R, Romdhane H, Ben Nejma H, and Belhadj N
- Subjects
- Adolescent, Adult, Aged, Anxiety prevention & control, Colitis, Ulcerative, Cross-Sectional Studies, Depression prevention & control, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Tunisia epidemiology, Young Adult, Anxiety epidemiology, Depression epidemiology
- Abstract
Background: Little is known in inflammatory bowel disease (IBD) regarding risk factors for psychological distress. The aims of our work were to evaluate the frequency of anxiety and depression among patients with IBD and to determine the factors associated with these psychological disorders in Tunisian patients., Methods: From June 2012 to April 2013, 60 consecutive patients with IBD answered a questionnaire about psychological and socioeconomic factors and adherence to treatment. In this study we focused the analysis on the characteristics of IBD (type, localization, severity, treatment) and socioeconomic factors (professional, educational, and marital status). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS)., Results: According to the HADS, 25 patients (41.6%) were anxious while 4 (6.6%) were depressed. Three had anxiety and depression at the same time. Twelve patients had a probable anxiety, 2 patients had a probable depression and 3 patients had a probable depression and anxiety at the same time. By univariate analysis, factors associated with anxiety and depression were: female gender (p<0.03), rent (p<0.03), high school graduation (p<0.009), IBD type ulcerative colitis (p<0.05). By multivariate analysis, independent factors associated with these emotional disorders were: female gender (p=0.005, OR 11.3), the high school graduation (p=0.004, OR 12.1)., Conclusion: In our cohort, risk factors for anxiety and depression were the high school graduation and IBD type ulcerative colitis. Consequently, psychological interventions would be useful when these factors are identified.
- Published
- 2014
43. Small intestinal metastases: an unusual initial manifestation of lung carcinoma.
- Author
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Kwas H, Zendah I, Ennaifer R, Lahmar-Boufaroua A, Neji H, and Ghédira H
- Subjects
- Carcinoma, Non-Small-Cell Lung diagnosis, Delayed Diagnosis, Humans, Intestinal Neoplasms diagnosis, Lung Neoplasms diagnosis, Male, Middle Aged, Peritoneal Neoplasms diagnosis, Peritoneal Neoplasms secondary, Tumor Burden, Carcinoma, Non-Small-Cell Lung pathology, Intestinal Neoplasms secondary, Lung Neoplasms pathology
- Published
- 2014
44. [Minimal hepatic encephalopathy: a better diagnostic to improve prognostic].
- Author
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Ennaifer R, Cheikh M, Hefaiedh R, Romdhane H, Ben Nejma H, and Hadj NB
- Subjects
- Adult, Aged, Early Diagnosis, Female, Hepatic Encephalopathy complications, Hepatic Encephalopathy epidemiology, Humans, Liver Cirrhosis complications, Male, Middle Aged, Prevalence, Prognosis, Prospective Studies, Risk Factors, Severity of Illness Index, Hepatic Encephalopathy diagnosis
- Abstract
Background and Aims: Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. The aim of this study is to evaluate the prevalence of MHE in patients with liver cirrhosis and analyze risk factors., Methods: Between September 2011 and December 2012, consecutive cirrhotic patients seen in our department were evaluated. Patients included were screened by the psychometric hepatic encephalopathy score (PHES) battery comprising 5 tests: number connection test A and B, line tracing test, serial dotting test and digit symbol test. Patients included were regularly followed-up for the development of overt hepatic encephalopathy, driving accidents, falls and death., Results: We included 45 cirrhotic patients. Etiology of cirrhosis was viral in half of cases. Child-Pugh score was A in 55.6 %, B in 26.7 % and C in 17.8 %. Median Meld score was 14. According to the PHES score, MHE was detected in 44.4 % of patients. Univariate analysis identified 4 variables significantly associated with the presence of MHE: age ≥ 55 years (P=0.031), poor educational status with years of study< 9 years (P=0.007), MELD score ≥ 15 (P=0.002) and Child-Pugh ≥ 7 (P=0.001). At multivariate analysis, the only independent risk factor of MHE was a MELD score≥15 (OR=15.4; P<0.001). During the follow-up, patients with MHE developed more often overt encephalopathy, falls and driving accidents, and had a lower survival, although the difference was not statically significant., Conclusion: In this preliminary small series, prevalence of MHE in Tunisian cirrhotic patient was 44.4 %. A MELD score ≥ 15 was the only independent risk factor. MHE had a negative impact on the outcome, justifying an early diagnostic. Adequate therapy may improve cognitive function., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)
- Published
- 2014
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45. Severe autoimmune hemolytic anemia in a patient with chronic hepatitis C during treatment with Peg interferon alfa-2a and ribavirin.
- Author
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Ennaifer R, Cheikh M, Romdhane H, Hefaiedh R, Ben Nejma H, and Bel Hadj N
- Subjects
- Anemia, Hemolytic, Autoimmune immunology, Antiviral Agents administration & dosage, Female, Humans, Interferon-alpha administration & dosage, Middle Aged, Polyethylene Glycols administration & dosage, Recombinant Proteins administration & dosage, Recombinant Proteins adverse effects, Ribavirin administration & dosage, Severity of Illness Index, Anemia, Hemolytic, Autoimmune etiology, Antiviral Agents adverse effects, Hepatitis C, Chronic drug therapy, Interferon-alpha adverse effects, Polyethylene Glycols adverse effects, Ribavirin adverse effects
- Published
- 2014
46. Liver cirrhosis localized in the left lobe: an unusual presentation of small duct primary sclerosing cholangitis.
- Author
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Ennaifer R, Souabni L, Hefaiedh R, Romdhane H, Ben Nejma H, and Bel Hadj N
- Subjects
- Adult, Cholangitis, Sclerosing complications, Cholangitis, Sclerosing pathology, Diagnosis, Differential, Female, Humans, Liver Cirrhosis, Biliary etiology, Liver Cirrhosis, Biliary pathology, Cholangitis, Sclerosing diagnosis, Liver Cirrhosis, Biliary diagnosis
- Published
- 2013
47. Gender difference in patients with hepatocellular carcinoma.
- Author
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Hefaiedh R, Ennaifer R, Romdhane H, Ben Nejma H, Arfa N, Belhadj N, Gharbi L, and Khalfallah T
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Sex Ratio, Survival Analysis, Tumor Burden, Tunisia epidemiology, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular virology, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Neoplasms virology
- Abstract
Background: Hepatocellular carcinoma represents the fifth most common cancer worldwide and account for approximately 90% of primary liver cancer. Men have a higher prevalence than women; the sex ratio varies between 2:1 and 4:1, depending on the geographic region., Aim: To determine the influence of gender on the clinicopathologic characteristics and survival of patients with hepatocellular carcinoma., Methods: A retrospective analysis of medical records was performed in 63 patients with hepatocellular carcinoma and their clinicopathologic features and survival were compared in relation to gender. The data was summarized by descriptive statistics and analysed with SPSS version 11.5., Results: Among these patients, 36 were men (57.1%) with male-to female ratio of 2:1.5, the mean female age was 59.8 years (p=0.054). Serum albumin level was significantly lower in women (p=0.0061).The average size of the tumor was 45.8mm and the difference was not significant (p=0.638). Hepatocellular carcinoma was significantly more prevalent among 16 men with post viral B cirrhosis (p=0.04). The main reason for therapeutic abstention was multifocal character of the hepatocellular carcinoma. The median survival time (6.52 months) was not different between the 2 groups., Conclusion: At diagnosis, men were younger than women. The viral C etiology was statistically more frequent in women than in men. Hepatocellular carcinoma was more aggressive in male but median survival time was not significant between groups. Screening and early treatment can limit this problem.
- Published
- 2013
48. The Budd-Chiari syndrome.
- Author
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Hefaiedh R, Cheikh M, Marsaoui L, Ennaifer R, Romdhane H, Ben Nejma H, Bel Hadj N, Arfa N, and Khalfallah MT
- Subjects
- Budd-Chiari Syndrome etiology, Humans, Prognosis, Budd-Chiari Syndrome diagnosis, Budd-Chiari Syndrome therapy
- Abstract
Background: The Budd-Chiari syndrome is a rare disease, often fatal if not treated optimally. It is characterized by a blocked hepatic venous outflow tract. aim: This review attempted to present pathophysiology, aetiologies,diagnosis and therapeutic modalities of the Budd-Chiari syndrome., Methods: Review of literature., Results: Budd-Chiari syndrome is a complex disease with a wide spectrum of aetiologies and presentations. Hematologic abnormalities, particularly myeloproliferative disorders, are the most common causes of the Budd-Chiari syndrome. The clinical presentation is governed by the extent and rapidity of the hepatic vein occlusion. Doppler-ultrasound, computed tomography or magnetic resonance imaging of hepatic veins and inferior vena cava are usually successful in demonstrating non-invasively the obstacle or its consequences. A therapeutic strategy has been proposed where anticoagulation, correction of risk factors, diuretics and prophylaxis for portal hypertension are used first; then angioplasty for shortlength venous stenosis; then Transjugular Intrahepatic Portosystemic Shunt (TIPS); and ultimately liver transplantation. Treatment progression is dictated by the response to previous therapy. This strategy has achieved 5-year survival rates approaching 70%. Medium-term prognosis depends on the severity of liver disease., Conclusion: The diagnosis of the Budd-Chiari syndrome must be considered in any patients with acute or chronic liver disease. Management of this syndrome should follow a step by step strategy.
- Published
- 2013
49. [Bowel preparation : what's new ?].
- Author
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Romdhane H, Ben Ali Z, Ennaifer R, Hefaiedh R, Ben Nejma H, and Bel Hadj Brik N
- Subjects
- Colonoscopy, Humans, Cathartics administration & dosage, Preoperative Care
- Abstract
Background: The efficiency of bowel preparation directly affects the quality and the reliability of total colonoscopy. Inadequate bowel cleansing is a common cause of incomplete colonoscopy with a risk of ignoring pre-neoplastic lesions represented primarily as adenomas with a size below centimetre. Due to the numerous factors interfering with preparation, an adapted choice of the type of preparation and the follow-up of diverse methods to optimize bowel preparation allows to improve diagnostic accuracy and to reduce costs while guaranteeing to the patient good tolerabilty and safety., Aim: To report the news about the terms of the bowel preparation for colonoscopy quality and to propose practical ways to optimize it., Methods: Review of literature and lecture of recommendations., Results: The pre-colonoscopy consultation, prescription of a split dose bowel preparation and a brief time between the last dose of preparation and colonoscopy are the means currently available to optimize bowel preparation., Conclusion: A better understanding of terms of bowel preparation and the factors influencing the degree of preparation improve the diagnostic efficacy of colonoscopy especially in the detection and treatment of colorectal cancer.
- Published
- 2012
50. [Liver neuroblastoma in an adult].
- Author
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Ouakaa-Kchaou A, Khalfallah T, Kharrat J, Romani M, Kilani A, Kochlef A, Gargouri D, Hefaiedh R, Elloumi H, Ennaifer R, and Ghorbel A
- Subjects
- Fatal Outcome, Female, Humans, Middle Aged, Neoplasm Recurrence, Local pathology, Liver Neoplasms pathology, Neuroblastoma pathology
- Published
- 2010
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