Role of metalloproteinases MMP-2 in asthma.

Background - Many metalloproteinases (MMPs) play a role in the pathogenesis and modulation of the severity of asthma. MMP-9 is the predominant in asthma but other MMPs are involved such as the MMP-2. Aim - To determine the role of single nucleotide polymorphism of the gene MMP2 in susceptibility to asthma and its severity. Methods - Study case-control with prospectively enrolled patients with asthma and healthy subjects. We determined within two groups genotypes corresponding to the MMP2 polymorphism in -735C / T position, using a polymerase chain amplification technique associated with a polymorphism in the length of restriction fragments. Results - We included 150 patients with asthma and 150 healthy controls. Comparison of allele and genotype frequencies of the studied polymorphisms between patients and controls showed that there was no association between the SNP-735C / T and susceptibility to asthma and its severity. Conclusion - The role of MMP 2 in asthma remains unclear and no study has been conducted till date, to determine the role of MMP-2 -735C/T gene polymorphism in asthma. This study does not disprove such association. Further studies are needed to clarify the exact role the pathogenesis of asthma.

Contribution of fixed-dose combinations in the treatment of tuberculosis.

Background - The introduction of fixed-dose combinations (FDCs) of TB treatment in Tunisia is recent (July 2009). WHO and the National Tuberculosis Programme recommend the use of fixed-dose combination (FDC) tablets for the treatment of tuberculosis (TB). The effectiveness of ADF has been demonstrated, however the risk of relapse and tolerance were controversial. Objective - Through a retrospective study, we evaluate, the contribution of FDCs compared with dissociated treatment (TD) (efficacy, tolerance and the occurrence of relapses). Patients and methods - This is a retrospective study conducted in the Department of Pneumology la Rabta. Are included patients with pulmonary tuberculosis (TB) first attack. Two groups were studied: Group I (TC) treated between July 2009 and June 2011 who received ADF. Group II (TD) treated between July 2008 and June 2009 who received TB dissociated treatment. Results - One hundred and seventy one patients were included: 122 in the TC group with an average age of 39.2 years and 49 patients in the TD group with an average age of 38.2 years. Male predominance was observed in the two groups (82/75.5%). The period of apyrexia was below 7 days at more than 80% of patients in the two groups. Sputum smears conversion were obtained between one and two months (median 52,8 vs 55,8 days) in both groups with no significant difference (p = 0.06). The rate of smears conversion at 2 months was 74% in TC group versus 65.3 % (p = 0.12). Eighty patients (65%) of the TC group and 29 patients (59%) of the TD group had one or more adverse effects to treatment without significant difference (p = 0.270). The most common adverse effects were those related to digestive system (17.2% vs 6.1%), liver toxicity (7.4% vs 4.1 %) and urticaria (9.8% vs 8.1%). The treatment successful rate was: 73.7 % in TC group and 77.5 % in TD group. There was no significant difference in treatment compliance, neither in relapse rate nor in the death rate. Conclusion - This study demonstrated non-inferiority of the effectiveness of ADF with a comparable safety. Its effects in the prevention of relapse and resistance BK remain unproven.

[Diagnosis approach of pulmonary embolism]. / Strategie diagnostique au cours de l'embolie pulmonaire.

BACKGROUND: Pulmonary embolism (PE) is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not helpful in diagnosis of PE.Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization ofa confirming examination. AIM: To precise the confirming examinations of PE and propose analgorithm based on clinical prediction rules in combination with D-Dimers. METHODS: A Pub Med search was conducted using the following keywords: pulmonary embolism,computed tomogramphy pulmonary angiography, scintigraphy and D Dimer. The study was based on are view of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. RESULTS: Ventilation/perfusion scan is a type of examination that is used less often because it is not a widespread technology. However,it may be useful in patients who have an allergy to iodinated contrast.Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis (DVT) may help the diagnosis approach particularly when other exams are not available or contraindicated.This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive.A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE. CONCLUSION: D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

[Sarcoidosis in Tunisia: epidemiologic and clinical study]. / Sarcoïdose en Tunise: partcularités épidémiologiques et cliniques.

BACKGROUND: The epidemiologic study of sarcoidosis is problematic and differing incidences across the world are reported. In Tunisia, the incidence of this affection is yet unknown. This is at least attributable to the lack of large series and the overshadowing presence of tuberculosis. AIM: To determine presenting signs, symptoms and investigations particularities. METHODS: We report a retrospective series patients with sarcoidosis followed up in the Rabta university hospital between 1991 and 2005 and try to determine presenting signs, symptoms and investigations particularities. RESULTS: 131 patients (79 women and 52 men) with a median age of 47 ± 14 years were reviewed. They were symptomatic in 95 % of cases. Cutaneous symptoms were present at onset in 56.8 %, respiratory symptoms in 48.6 % and general symptoms in 41.6 %. Thoracic presentation was observed in 81.3%. Chest X-ray changes and tomodensitometry showed that type II and III were predominant. Lung function was disturbed in 58.5% of the cases. Extrathoracic involvement, observed in 89.3 % of the cases, was largely dominated by cutaneous lesions. Histopathological lesions provided diagnosis in 66.6%. CONCLUSION: The relative high frequency of dermatological lesions suggests genetic or even environmental predisposition to develop sarcoidosis such as sunlight exposition.

[Sugar tumor]. / Tumeur sucre.

BACKGROUND: Clear cell tumor of the lung is a rare and very unusual benign pulmonary tumor. This tumor is called sugar tumor because of the abundance of glycogen on its cells. AIM: To report a case of sugar tumor and discuss clinical, evolutive features and diagnosis difficulties of this tumor. CASE REPORT: A case of 75 years old woman presenting as a round pulmonary opacity. Computed tomography (CT) scans showed in the left lower lobe a solitary pulmonary solid tumor with central calcifications. The patient underwent tumor resection. Pathologic examination, including immunohistochemical studies, revealed a benign clear cell tumor, so-called "sugar tumor". CONCLUSION: It's the second case reported in Tunisia. This very rare tumor of the lung is characterized by some immunohistological features. Its evolution is favourable after surgery.

[Exercise induced anaphylaxis]. / L'anaphylaxie induite par l'effort.

BACKGROUND: Exercise-induced anaphylaxis (EIA) is a rare physical allergy, sometimes severe, triggered by exertion following specific food intake. Although described several years ago, this condition is not well known; the diagnosis is frequently made several years after follow up. THE AIM: To describe the physiopathologic mechanism, etiologic factors, clinical manifestations and diagnostic means. METHODS: Review of the literature. RESULTS: It is likely that execise induce the release of a sufficient amount of mediators from mast IgE dependant cells exceeding a certain threshold. A number of food trigger have been suggested in EIA, the most commonly reported agent is wheat which has to be systematically looked for. A range of physical activities have been associated with EIA. Intensive physical activities are more likely to provoke an attack than less strenuous ones. The recognition of specific food causative role do not indicate the avoidance of food intake but exercise is forbidden within the four hours following specific aliment ingestion. CONCLUSION: Further studies seem to be necessary to clarify the mechanism of food dependent exercise-induced anaphylaxis.

[Isoniazid acetylation in a group of Tunisian patients. Report of 620 patients]. / Profil acétyleur d'une population de tuberculeux Tunisiens. A propos de 620 cas.

Isoniazid is a first line antituberculosis drug metabolized mainly in the liver by the Nacetyltransferase. There are differences between individuals in acetylation metabolism. Subjects are thereby characterized as being rapid or slow acetylators. The purpose is to study the distribution pattern of acetylation in patients with tuberculosis followed up at the teaching Hospital of La Rabta. The determination of acetylator phenotype was carried out on 620 tuberculosis patients during a period of 12 years. There were 483 men and 137 women with a median age of 40.3 years. The test was investigated before drug regimen administration at the dose of 5 mg/kg. A blood sample was taken three hours after the first administration. The determination of acetylation profile was worked out by Vivien hypothesis. In our population 391 were low and 229 were fast acetylators. The median dose recommended within the test was 3.04 mg/kg/day. 56% of our patients were initially receiving high dose of isoniazid. An increase in serum transaminase was initially observed in 60 patients among whom 47 slow acetylators. After dose adaptation, 53 patients had improved their biological abnormalities. The majority of Tunisian population seem to belong to slow acetylators modal. The frequency of hepatotoxicity suggests reducing the recommended dose of isoniazid from 5 to 3 mg/kg/day.

[Respiratory effects of diesel exhaust emission]. / Impact des emissions diesel sur l'appareil respiratoire.

Adverse effects of diesel exhaust is being now a subject of many recent studies. These various outcomes and especially respiratory changes are due to high concentration of different polluants within diesel exhaust particles. To date, it have been demonstrated that diesel emission increase the airway allergic reaction as rhinitis and asthma. In addition, to those side effects, it is proved that diesel exhaust is a probable human carcinogen based on evidence. Many epidémiologic evidence found a significant increase in lung cancer risk. However, some studies have provided contradictory results due to concomittant exposure to other polluants, tobacco exposure and difficulties to extrapolate findings in animal models into humans.

[Bronchopulmonary aspergillosis: study of 17 cases]. / L'aspergillose broncho-pulmonaire: etude de 17 cas.

Aspergillosis is a fungic infection depending on the local or general physiologic and immunologic state of the host. We report the result of retrospective five year study (1995-1999) about 17 cases in the laboratory of Parasitology-Mycology of Rabta hospital in Tunis. Six aspergillomas were observed, they occurred after a pulmonary tuberculosis, two cases of allergic broncho-pulmonary aspergillosis described in two asthmatic patients, nine cases of invasive pulmonary aspergillosis complicating two cancers, one leukaemia, six chronic granulomatous disease. Aspergillus fumigatus is the most frequent species (67%). The clinical and biological characteristic of those will be studied, and compared with those of the literature.

[Frequency of Pneumocystis carinii pneumonia in HIV-infected patients in Tunisia]. / Frequence des pneumopathies a Pneumocystis carinii chez le sujet infecte par vih en Tunisie.

In Tunisia, as in most african countries, Pneumocystis carinii pneumonia (PCP) is considered to be rare in HIV-infected patients. Frequencies of 8.6% and 21% have been reported. We examined 27 broncho-alveolar lavage specimens collected from HIV-infected tunisian individuals with respiratory symptoms over 4 years (1994-1997), by cyto centrifugation, Giemsa and Gomori-Grocott stain. Pneumocystis carinii (P carinii) was present in 9 cases, accounting for 33.3% of all specimens. Investigation of the reasons for the differences between african reports is necessary to establish appropriate therapeutic management. Technical difficulties of direct recognition of P carinii and selection bias may account for differences between african reports. However, differences still remain between the frequencies recorded in Africa and in other parts of the world, and recent advances seems to correlate this with geographical biodiversity of human-derived strains of P carinii and with differences in host ethnic background.

[Anti-IGE therapy in asthma]. / L'anti-IgE thérapie dans l'asthme.

Immunoglobulin E (IgE) is the hallmark of allergic diseases and asthma. Regulating IgE production has been the focus over several years as an important strategy in the treatment of allergic diseases. Recently, nonanaphylactogenic antihuman IgE antibodies have been under clinical evaluation as a therapeutic agent against atopic disease. In asthmatic subjects, the administration of these monoclonal anti-IgE antibody has been shown to reduce plasma IgE levels, reduce early and late phase allergic responses after allergen provocation, improve symptoms and reduce rescue medication. No serious side effects were reported. Thus, the clinical effectiveness of these medications supports the viability of anti-IgE therapy as a potentially effective treatment option for asthma.