[Usefulness of serum procalcitonin in the early diagnosis of maternal-fetal bacterial infection. A prospective study]. / Apport de la procalcitonine dans le diagnostic précoce de l'infection materno-fœtale bactérienne. Étude prospective.

UNLABELLED: Early diagnosis avoiding unnecessary treatment of maternal-fetal bacterial infection remains one of the greatest challenges for obstetricians and pediatricians. To meet these objectives, many inflammatory mediators were used, including procalcitonin (PCT). The aim of our study was to determine the usefulness of PCT in early diagnosis and management of neonatal infection. SUBJECTS AND METHODS: Over a period of 8 months, all living newborns with highly suspected maternal-fetal bacterial infection who were to receive antibiotic treatment according to our neonatal unit protocol were included in this prospective study. Serum PCT concentrations were determined at birth and after 12h of life using a specific immunoluminometric assay. Two distinct populations were defined based on clinical, biological, and bacteriological criteria: group 1: infected neonates, and group 2: noninfected neonates. STATISTICAL METHODS: We compared PCT means in different groups and determined the cut-off value correlated with maternal-fetal bacterial infection by analyzing the receiver operating characteristics curve (ROC). RESULTS: A total of 130 neonates were included in the study: 38 (29%) were classified in group 1 with 29 possible infections and 9 defined infections, including 5 cases of septicemia. The average PCT at birth in group 1 was significantly higher than in group 2 (3.52 ± 8.19 ng/ml vs 0.43 ± 0.73 ng/ml; P<0.001). The PCT threshold value at birth found by the ROC curve with the highest sensitivity (71.1%) and highest specificity (62%) was 0.215 ng/ml. The negative predictive value (NPV) was 83.8%, making it possible to avoid unnecessary treatment in the majority of the cases. The PCT threshold value within 12h of birth was 3.78 ng/ml, for a sensitivity of 89.5% and 1 NPV of 94.4%. CONCLUSION: PCT is a valuable biological examination because it can be administered early, it is sensitive, and it has a NPV. These characteristics make PCT a biological argument that can be used in the initial decision on whether to administer antibiotics. Another study will be conducted to establish the cut-off value.

[Biochemical and molecular diagnosis of primary hyperoxaluria type 1: Tunisian study about 15 cases]. / Diagnostic biochimique et moléculaire de l'hyperoxalurie primaire de type 1: étude tunisienne à propos de 15 cas.

BACKGROUND: The primary type 1 hyperoxaluria (HP1) is the most frequent and severe form of the primary hyperoxaluriae. It is related to an enzymatic deficit in alanine glyoxylate aminotransferase (AGT). It is a recessive autosomic disease. Rare in Europe, it is responsible for 13% of the end stage renal failure in the Tunisian child. AIM: The aim of this work is to evaluate the biological and molecular examinations contributing with the early diagnosis and the follow-up of the HP1 patients and to test their response to pyridoxin. PATIENTS AND METHODS: A prospective study of 15 children who have oxaluria lower than 500 µmol/l and normal renal function is carried out. The cristalluria study, oxaluria and the glycolate-glycerate urinary ratio were carried out on all the patients. The so-called mutation maghrebean T853 (Ile244 Thr) was detected by direct sequencing of the exon 7 gene AGXT. The response to pyridoxin was tested among 13 patients. RESULTS: The oxaluria concentration was greater or equal to 1000 µmol/l in nine cases (60%) and ranging between 600 and 1000 µmol/l in the remaining cases. The oxaluria flow was significantly high depending on the age. The glycolaturia was high among eight patients (57%). In 61,5% of the cases, the most frequent crystalline species was whewellite (C1). The "maghrebin" mutation was identified in nine patients at the heterozygous state, showing 25% allelic frequency. The response to pyridoxin was observed in the 13 tested cases. CONCLUSION: The HP1 is frequent in our country from where the need for an early diagnosis. The use of simple biochemical tools such as the study of the cristalluria, the morphological analysis of stones and the oxaluria allow to direct the diagnosis towards a HP1, confirmed by the glycolaturia determination. The molecular biology is required in the atypical forms.

[Urinary stones in Tunisian children, based on series of 187 cases]. / La lithiase urinaire chez l'enfant tunisien. Etude à propos de 187 cas.

OBJECTIVE: The aim of this study is to define epidemiologic and structural particularities of urinary stones in Tunisian children. PATIENT AND METHODS: Between 1995 to 2007, 187 stones of Tunisian children were studied. Structural analysis was performed by infrared spectrophotometry. RESULTS: We analyzed 187 stones from 122 boys and 65 girls. Their age ranged from two months to 18 years. Our study shows a male predominance with a sex ratio of 1,88. Stones were renal in 64.8%, ureteral in 20.6% and 14.6% were vesical. Whewellite was the main component (49,2% of stones) with a female predominance. Among phosphatic stones, carbapatite was in the lead (10.7%) followed by struvite (7%), which predominate in male. CONCLUSION: The epidemiological profile of urinary stones in children in Tunisia is situated between that observed in developed countries and that observed in developing countries.

[Cystine lithiasis: retrospective study about 25 cases]. / La lithiase cystinique : etude rétrospective à propos de 25 cas.

INTRODUCTION: cystinuria is a severe form of renal which is exposed the patient at multiple recurrent. OBJECTIVE: Report and identify the clinical and biochemical characteristic of cystinuria in Tunisian region. METHODS: It is a study of 25 cases of cystinuria, concerning at 16 adults and 9 children from 1995 to 2006. Cystinuria is recognized on the basis of spectrophotometric analysis of the stones (24/1586), by study of urinary crystals completed with brands test (5 cases) or by the two types of explorations. RESULTS: the frequence of cystinuria is 1.5% (25/1586). 89% stones were renal and 23% were bilateral. The stones have a diameter between 15/30 mm and classified type V at morphology. CONCLUSION: Our data will improve the management based on early diagnosis, regular follow up and respect of dietetic rules.

[Maternal mortality at the Maternity and Neonatology Center in Rabta of Tunis from 1986 to 1989]. / La mortalité maternelle au Centre de Maternité et de Néonatologie de la Rabta de Tunis de 1986 à 1989.

We studied 29 cases of maternal death occurring over a period of 3 years in the "Centre de Maternité et de Néonatologie de La Rabta-Tunis"; managed by the same staff. 42,028 live births occurred during the study years with 43,220 total births from April 24th 1986 to April 23rd 1989. The maternal mortality rate was 69 per 100,000 live births. A maternal age of under 35, nulliparity and grand multiparity were found, as is well known, to be risk factors. Maternal transfer in obstructed labour from rural maternity units raises the maternal death risk 12 times: 14 deaths out of 29 occurred in transferred patients. Haemorrhage represents a quarter of the causes of death (8 cases) while anaesthetic accidents were responsible for one in six maternal deaths. Some factors were not found such as abruptio placentae, while others such as eclampsia were reduced. We concluded that the maternal mortality rate even though it has been reduced over the last 3 decades it is still high compared with developed countries. We can cut it in half by avoiding maternal transfer in labour.

[Lipid evolution during normal pregnancy]. / Evolution des lipides au cours de la grossesse normale.

We analyzed the relationship between the evolution of pregnancy and the amplitude of the lipid disorders in order to evaluate their chronologic transformations. This research concerned 83 pregnancies aged between 19-40 years during the 3 periods of gestation and 31 healthy control women in the same range of age. Our results showed an increased triglyceride in the 2nd period and an earlier decrease of both, cholesterol, phospholipid and apolipoproteins. These parameters showed a progressive increase of their blood concentrations during the 2nd and the 3rd period of pregnancy, in an other hand we evidenced a good correlation between gestational aged and these variations i.e.: triglyceride and mother's weight; this phenomenon could suggest an eventual role of the nutrition and the hygienic habitude in the lipid metabolism. The correlation between our observed lipid disorders and the mother's age or the parity were not significant.

[Iron status and pregnancy in Tunisian women]. / Statut martial et grossesse en Tunisie.

PIP: The authors studied hematological and iron status in 83 pregnant, Tunisian women during each trimester of pregnancy, and compared them with a group of 31 control women of childbearing age. The incidence of anemia (hemoglobin 11 g/100 ml) was 2-3 times higher among the pregnant women that the controls. In the group of pregnant women, the proportion of women with iron deficiency (serum ferritin 12 mcg/1) gradually increased, from 65% in the 1st trimester to 83% in the 2nd, and 95% in the 3rd. Over 1/2 of the controls (52%) were also found to have iron deficiency. In view of the risks relating to anemia and the possible repercussions of iron deficiency on the maternal and fetal health, systematic iron supplementation is recommended during the 3rd trimester of pregnancy. (author's modified)^ieng