Background: Iodinated contrast media (ICM) are responsible for multiple side effects, especially hypersensitivity reactions. These reactions can either be authentic allergies or non-allergic hypersensitivity reactions. Skin tests (prick and intradermal tests) are simple to perform and can be of great help, especially if the ICM needs to be re-used. The aim of the study was to assess the characteristics of the patients in whom skin tests were performed and the results of these tests.Methods: This is a retrospective study from June 2014 to June 2019. All included patients had at least one episode of hypersensitivity reaction to ICM and underwent skin tests.Results: We included 35 patients aged 18 to 85 years. The iopromide was the most implicated ICM. The reactions were mainly cutaneous (n=30) and immediate (n=27). The skin tests were negative, except for two patients. The re-use of ICM occurred in 11 patients: 9 with an ICM other than the one suspected and two patients with the same ICM. Among these patients, 5 did not have any premedication. Two of them had a second hypersensitivity reaction, the first with another ICM and the second with the same ICM.Conclusion: One of the main pillars of allergic exploration is ICM skin testing, not only to prevent a recurrence, but also to allow patients to benefit from ICM re-use, which are sometimes essential.

Background: Probiotics can modulate the microbiota and decrease uric acid levels. Objectives: This meta-analysis aimed to assess the effects of probiotics on uric acid levels. Methods: The keywords “probiotics”, “uric acid”, “gout”, “hyperuricemia” were searched in PubMed Medline, EMBASE, Web of Science, and Google Scholar. The search was limited to the English, French, Italian, and Spanish languages, and to the period between 1 January 2000 to 30 August 2024. We included RCTs and observational studies comparing probiotics to placebo. We excluded studies reporting (1) prebiotics, symbiotics, or postbiotics, (2) animal studies, and (3) case reports, commentaries, or reviews. Two independent reviewers performed quality assessment and data extraction. This meta-analysis was performed according to the PRISMA 2020 and AMSTAR 2 guidelines. The main outcome measure was uric acid levels “after–before” probiotic versus placebo interventions. Forest plots summarized the data using a random model. Results: Nine studies included 394 patients, of whom 201 were treated with probiotics and 193 with placebo. There was a statistically significant difference in favor of the probiotic group compared with the control group regarding the main outcome measure. However, substantial heterogeneity was noted, explained (after applying subgroup analysis and meta-regression) by the following moderators: continent, diseased/healthy, male sex, and monostrain probiotics. Conclusions: This meta-analysis demonstrates that probiotics reduced uric acid levels in Asian males who had disease and were treated with monostrain probiotics.

Background: Acenocoumarol is an anticoagulant with numerous drug reactions. We report here, an unusual interaction between acenocoumarol and azathioprine. Case Presentation: A 35-year-old woman, treated with acenocoumarol for thrombosis of the superior mesenteric vein, was prescribed azathioprine for Crohn’s disease. Three days later, INR values decreased from 2.36 to 1.48. The dose of acenocoumarol had to almost be doubled to reach an INR value of 2.56. The interaction between azathioprine and acenocoumarol was then suspected. Few similar cases of interactions between azathioprine and another coumarin derivative, warfarin, have been reported. To our knowledge, this is the second case of such interaction reported with acenocoumarol in literature. Conclusion: Thus, despite the rarity of this interaction reporting, we draw attention to the importance of close monitoring of INR values in patients treated with acenocoumarol associated with azathioprine.

A high intra and interindividual pharmacokinetics variability characterize Tacrolimus. Data regarding factors influencing its pharmacokinetics and pharmacodynamics in liver transplantation are limited. This study aimed to assess tacrolimus therapeutic response, pharmacokinetics and adherence in liver transplant recipients. The study was conducted at the Clinical Pharmacology Department for 12 years, from January 2009 to March 2021. We included liver transplant patients treated with tacrolimus referred to our department for tacrolimus therapeutic drug monitoring. Secondly, we assessed tacrolimus adherence in liver transplant recipients using a prospective Morisky questionnaire. We included 894 tacrolimus trough concentration C0 from 76 patients. The mean age was 24.4 ± 10.2 years. The sex ratio M/F was 1.3. The median C0 was 8.53 ± 4.7 ng/mL. In 48.2% of cases, the C0 was in the therapeutic range. Children required higher weight doses of tacrolimus compared to adults. C0 and C0/dose ratios of tacrolimus were higher in adults and in male patients. Bilirubinemia, polypharmacy, and adherence were weakly correlated with C0. Mycophenolate mofetil, prednisolone, mehylprednisolone, amphotericin B, fluconazole, and omeprazole were associated with increased tacrolimus C0, while irbesartan was associated with decreased tacrolimus C0. The intraindividual coefficient of variability (CV) ranged from 20.4 to 119%. The interindividual CV was 46.1%. The tacrolimus index of variability ranged from 1.6 to 15.1. Age greater than 18 years increased tacrolimus adherence by 3.892-fold in liver transplant patients. Tacrolimus bioavailability was higher in adults and men. Adherence increased by 3.892-fold in liver transplant adults.

Tunisia continues to experience tuberculosis at an intermediate level of endemicity. Isoniazid (INH) is a critical element in TB therapy. INH metabolism involves, mainly, the arylamine N-acetyltransferase 2 (NAT2) enzyme which is subject to genetic polymorphism. The determination of NAT2 acetylation profiles is highly recommended for dose adjustment and predicting side effects in tuberculosis patients. Traditionally, acetylator status has been assessed through phenotyping tests. Recently, faster and simpler genetic methods have been proposed as an alternative for use in clinical practice. This work provides a comprehensive review of main NAT2 phenotyping and genotyping results based on Tunisian experiences. In Tunisia, several studies have demonstrated the predominance of slow acetylator (SA) genotypes and phenotypes with the NAT2*5, being the most prelevant. When comparing acetylation phenotype with NAT2 genotype, a concordance value of 75% was observed. The choice of method for determining NAT2 acetylation profile primarily depends on the laboratory's technical capabilities and expertise. Prospective clinical trials are essential to further evaluate the benefits of NAT2 genotyping specifically within the Tunisian population.