Biomedicine & Healthcare Research

Intranasal pleomorphic adenoma: An unexpected diagnosis

Amina Bani, Salwa Nechi, Amel Douggaz, Imène Noomen, Ghada Kharrat, Emna Chelbi — Fri, 31 Jan 2025 00:00:00 +0000

Pleomorphic adenoma is a heterogeneous benign tumor of the salivary glands, with the parotid gland being the most common site of occurrence. However, its presence in the minor salivary glands is relatively rare. Here, we report the case of a 57-year-old man diagnosed with a nasal pleomorphic adenoma. In this context, we aim to clarify the epidemiological, diagnostic, therapeutic, and prognostic characteristics of nasal pleomorphic adenoma.

Gallstone migration out of circuit: A case report of an intestinal perforation from an ectopic gallstone

Fri, 31 Jan 2025 00:00:00 +0000

Introduction: Entero-biliary fistula is a rare and difficult-to-diagnose complication of cholelithiasis. While spontaneous evacuation may occur with small stones, surgical intervention is required in most cases. This condition presents significant challenges for the surgeon, as complete clearance of the digestive tract, along with cholecystectomy, may be fraught with difficulty. In this case, we report an instance of intestinal perforation caused by a migrating gallstone.

Case Presentation: An 80-year-old woman presented to our surgery department with abdominal pain. Several diagnostic modalities were employed to reach a definitive diagnosis. Abdominal ultrasound confirmed the diagnosis of acute cholecystitis. The patient underwent urgent surgery after brief resuscitation. During exploration of the abdominal cavity, a punctiform perforation of an intestinal loop was identified. Upon bidigital palpation, a mass was felt that rolled over the fingers. The patient underwent segmental resection, double stoma creation, and feeding jejunostomy. A 2 cm gallstone was expressed from the specimen.

Discussion: One of the rare complications of cholelithiasis is the development of an entero-biliary fistula. Small bowel perforation caused by a migrating gallstone is considered uncommon. The surgical challenge lies in managing both the perforation and the causative fistula, as cholecystectomy itself can be risky. Thorough examination of the small intestine during surgery is crucial to check for any additional intraluminal stones.

Conclusion: Despite its rare prevalence and atypical presentations, a high index of suspicion for entero-biliary fistula is essential, particularly in patients with risk factors. With prompt diagnosis and timely intervention, patients can successfully recover from this clinical condition.

Unhabitual presentation of Kimura disease: A case report of gastric localization

Fri, 31 Jan 2025 00:00:00 +0000

Background: Kimura's disease (KD) is a rare, chronic inflammatory disorder with a benign course and an unclear cause. It primarily affects the head and neck regions. KD is often misdiagnosed due to its resemblance to other benign or malignant diseases, especially when it occurs in uncommon sites. In this report, we present a rare case of KD diagnosed in the stomach.

Methods: We report a case of KD localized in the stomach, diagnosed at the Pathology Department of Sahloul University Hospital in Sousse. A 75-year-old female presented with intestinal bleeding. Endoscopy revealed erythematous and hemorrhagic mucosa in the antral and fundic regions of the stomach. A 4 cm antral polyp was identified and subsequently resected.

Results: Initial examination of the biopsy specimen concluded with a diagnosis of a low-grade dysplastic polyp. Partial gastrectomy was performed. Histologically, the polyp was bordered by focally ulcerated epithelium without evidence of dysplasia. The axis was edematous, containing clusters of lymphoid cells dispersed within a moderate inflammatory infiltrate rich in eosinophils. Characteristic multinucleated cells with crown-arranged nuclei were observed. The lesion was well vascularized. Immunohistochemistry for CD117, Dog-1, S100 protein, SMA, and ALK was performed to exclude other diagnoses. The results were negative. After multidisciplinary consultation and expert opinion, a diagnosis of KD was established.

Conclusion: The stomach is an extremely rare localization for KD. Misdiagnosis can result in unnecessary aggressive treatments, making it essential to distinguish KD from other diseases. While KD generally has a good prognosis with no risk of malignant transformation, its high recurrence rate necessitates careful and ongoing monitoring of affected patients.

Hydatic liver cyst fistulized in the duodenum: A case report

Fri, 31 Jan 2025 00:00:00 +0000

Background: Hydatic cyst is a zoonosis that is endemic in developing countries. The most frequent complication of a hydatic liver cyst is communication with the biliary tract. Communication with the duodenum is an uncommon complication.

Case presentation: A 60-year-old woman presented with abdominal pain and vomiting. There was no jaundice or fever. A biological inflammatory syndrome was identified. An abdominal computed tomography (CT) scan revealed a fistula between a centro-hepatic hydatid cyst and the first portion of the duodenum. The subject underwent disconnection of the fistula and a pericystectomy, followed by placement of a tube duodenostomy for the fistula and a subhepatic drain. The postoperative period was uneventful.

Conclusion: Despite the benign nature of hydatic cysts, duodenal fistula is a unusual complication. Surgical treatment is determined by the size of the duodenal defect.

Editorial by the Honorary Editor-in-Chief

Honorary Editor-in-chief — Fri, 31 Jan 2025 00:00:00 +0000

With the release of the fourth volume of Biomedicine & Healthcare Research, the official scientific journal of the Faculty of Medicine of Sousse, we are excited to highlight several key milestones that reflect the growth and global recognition of our journal.

First, in partnership with the Tunisian DOI Consortium and the National Center for Scientific and Technical Documentation (CNUDST), our journal has successfully obtained a Digital Object Identifier (DOI). This achievement guarantees that each article published is uniquely and permanently identifiable, enhancing its visibility, traceability, and citation within the international research community.

In another significant development, Biomedicine & Healthcare Research has been selected by the Union of Arab Scientific Research Councils for support in its indexing on Scopus, one of the world’s most prestigious bibliographic databases. This inclusion will elevate our journal’s global reach and credibility, reinforcing our commitment to upholding the highest standards of scientific excellence.

Additionally, our Faculty has achieved ISO 21001:2018 certification, recognizing our dedication to quality management in higher education and scientific research. This certification underscores our ongoing efforts to cultivate innovative and impactful research practices across medical studies, professional programs, and doctoral research.

These accomplishments reflect our steadfast commitment to advancing scientific knowledge and expanding our global presence. We are deeply grateful to our partners, authors, and readers for their continued support.

As we celebrate the publication of the fourth volume of Biomedicine & Healthcare Research, we invite you to explore its content, which includes seven papers: three original articles and four case reports, contributed by talented biomedical teams from Tunis, Ariana, Nabeul, Sousse, and Sfax. These contributions highlight the excellence of our national research community and showcase the diversity and impact of research in biomedicine and healthcare.

We look forward to your continued readership and eagerly anticipate your future contributions to Biomedicine & Healthcare Research.

Pr. Mohamed Ben Dhiab

Clinical characteristics and management outcomes of acromegaly in a Tunisian university hospital: A retrospective study

Fri, 31 Jan 2025 00:00:00 +0000

Introduction: Acromegaly is a rare endocrine disorder characterized by excessive growth hormone (GH) secretion, primarily caused by pituitary adenomas. If untreated, it leads to significant morbidity and increased mortality. This study investigates the clinical characteristics and treatment outcomes of acromegaly patients in a Tunisian University Hospital.

Methods: We conducted a retrospective review of medical records for patients diagnosed with acromegaly in the Endocrinology Department of a University Hospital in Central Tunisia over 20 years. Data on clinical features, imaging, comorbidities, and treatment outcomes were collected and analyzed.

Results: Among 41 patients included, the mean age at diagnosis was 37±11 years. MRI revealed macroadenomas in 93.9% of cases, with 58% displaying invasiveness. Adenomas co-secreting GH and prolactin were larger (35 mm vs. 21 mm; p=0.031) and more invasive (80% vs. 23%; p=0.02) compared to GH-only adenomas. Diabetes mellitus was the most common comorbidity (43%), and affected patients were older (42 vs. 34 years; p=0.03). Surgical treatment, primarily via the transsphenoidal route, was performed in 78% of patients. Medical therapy, including somatostatin analogs and dopamine agonists, was administered to 48%, with Lanreotide being the most frequently used agent. Multimodal therapy achieved a cure rate of 29%.

Conclusion: Despite therapeutic advances, managing acromegaly remains challenging. Early diagnosis and individualized treatment strategies are essential to improve patient outcomes.

Prevention of postoperative atrial arrhythmias in major broncho-pulmonary cancer surgery: A pilot study of Celiprolol vs. Diltiazem

Fri, 31 Jan 2025 00:00:00 +0000

The incidence of postoperative arrhythmia (POA) after bronchopulmonary cancer (BPC) surgery reaches 50% and is associated with increased morbidity and mortality. The role of pharmacological prevention of POA remains controversial. This study aims to compare the efficacy of the beta-blocker celiprolol versus the calcium channel blocker diltiazem in preventing POA following pneumonectomy and bilobectomy for BPC.

Material and Methods: We conducted a randomized, single-blind, prospective study including patients older than 18 years with preoperative sinus rhythm undergoing major pulmonary resection for BPC. Patients were randomized into two groups: the beta-blocker (BB) group received daily oral celiprolol (Céliprol®) 200 mg and the calcium channel blocker (CCB) group received daily oral diltiazem (Monotildiem® LP) 200 mg postoperatively.

The primary endpoint was the occurrence of early postoperative atrial fibrillation (POAF). Secondary outcomes included the incidence of late POAF, other cardiac arrhythmias, arrhythmia duration, length of intensive care unit (ICU) and hospital stay, drug-related adverse effects, and 30-day mortality. Statistical analysis was performed using SPSS software version 19.0.

Results: Thirty patients were enrolled. The two groups were comparable in demographic characteristics, surgical and anesthetic parameters, and baseline biological data. The overall incidence of POA was 17%. The incidence of POAF was 7%, with no significant difference between groups. All arrhythmias were transient, lasting less than 48 hours, and without recurrence. Supraventricular extrasystoles were the only other observed arrhythmias. Postoperative arrhythmias were significantly associated with bilobectomy, prolonged anesthesia duration, and extended surgical time compared to patients without arrhythmias. The most common postoperative complication was pneumonia. No drug-related adverse effects were observed, and no deaths occurred within 30 days.

Conclusion: Prophylactic treatment reduces the incidence of POAF, but identifying the optimal agent remains challenging. An individualized approach, considering patient comorbidities and surgical factors, is essential for effective prevention.

Polyphenolic characterization and antifungal properties of Urtica urens L. extracts against Candida strains: A natural approach to fungal control

Massara MZID, Sourour Neji, Ali Ayedi, Tarek Rebai — Fri, 31 Jan 2025 00:00:00 +0000

Urtica urens is classified within the Rosales subfamily and belongs to the Urticaceae family. Its well-documented health benefits are primarily attributed to its phenolic compounds. This study investigates the polyphenol, flavonoid, and condensed tannin content of Urtica urens L. (U. urens L.) extracts obtained using aqueous ethanol and water as solvents. The antifungal activity of ethanol and aqueous extracts derived from the aerial parts of Urtica urens L. was assessed in vitro against various Candida species (C. parapsilosis, C. albicans, C. tropicalis, C. metapsilosis, C. orthopsilosis, C. glabrata). Three methods were employed: the well diffusion method, disc diffusion method, and microdilution method. The findings revealed that the ethanol extract contained the highest levels of polyphenols. Both ethanol and aqueous extracts exhibited antifungal activity against the Candida strains tested. However, the aqueous extract demonstrated superior antifungal efficacy compared to the ethanol extract. The sensitivity of the strains to the extracts was concentration-dependent, with inhibition observed from a concentration of 1 g/mL. The ethanol extract displayed significant inhibitory activity (90.58%, 92.24%, and 91.33%, respectively) against C. metapsilosis, C. glabrata, and C. orthopsilosis, surpassing its activity against other strains. These findings suggested that U. urens L. extracts have potential as natural alternatives to chemical additives for controlling fungal diseases in plants.