Agnès Hamzaoui

L'objectif de notre travail tait de d montrer l'int r t d'une prise en charge personnalis e de l'asthme difficile de la femme.Etude prospective incluant 50patientes. Des interventions th rapeutiques ont t r alis es. Nous avons valu le contr le apr s trois mois.L' ge moyen tait de 55ans. Au moins trois facteurs aggravants taient identifi s dans 64% des cas. Les mesures qui ont cibl ces facteurs taient: ducation th rapeutique(66%), r gles hygi no-di t tiques et inhibiteur de la pompe(52%), corticoth rapie nasale et antihistaminiques (72%), entretien psychologique(68%) et pression positive continue(10%). Le contr le de l'asthme tait alors obtenu chez 25patientes. Le ph notypage des autres patientes a identifi une inflammation TH2 chez 18patientes et nonTH2 chez 7patientes. Le traitement en fonction du ph notypage a consist en: majoration de la corticoth rapie inhal e en cas d' osinophilie bronchique, ajout d'un anticholinergique en cas d'obstruction s v re et d'un anti-leucotri nes en cas d'intol rance l'aspirine. Le score ACT s'est am lior de 15,7 20,2(p=0,0001).Une prise en charge personnalis e des asthmes difficiles semble tre efficace dans notre contexte.

Beh et's disease (BD) is currently considered an "auto-inflammatory disease" triggered by infection and environmental factors in genetically predisposed individuals. Although the disease is characterized by recurrent oral and genital aphthous ulcers and ocular involvement, it can affect multiple organ systems. Complex aphthosis is characterized by recurrent oral and/or genital aphthous ulcers. It is important to evaluate the patient with complex aphthosis for Beh et's disease and related systemic disorders. Helper T (Th) cells, cytokines, neutrophils and antigen-presenting cells are particularly important in the immuno-pathogenesis of BD. Along with human leukocyte antigen gene encoding B*51 (HLA‐B*51) and areas including the major histocompatibility complex class I, genome‐wide association studies have recognized numerous other BD susceptibility genes including vascular endothelial growth factor (VEGF) polymorphism. VEGF takes on major importance essentially at the level of the barriers between the endothelium and the various vital systems during the inflammatory process as inflammation is a stimulus for VEGF production.