[Prevalence and risk factors for fatty liver in Tunisian adults with obstructive sleep apnea]. / Prévalence et facteurs de risque de stéatose hépatique chez les adultes tunisiens atteints de syndrome d'apnées hypopnées obstructives du sommeil.

INTRODUCTION: Obstructive sleep apnoea (OSA) is commonly associated with non-alcoholic fatty liver disease (NAFLD). Early identification of NAFLD in OSA patients is important in order to try to prevent its evolution to advanced stages. The objective of this study was to determine the prevalence and risk factors for the occurrence of NAFLD in OSA patients. METHOD: A cross-sectional analysis including 124 OSA patients examined in the pulmonology department of Abderahmane Mami Hospital between January 2017 and March 2018 was undertaken. NAFLD was diagnosed using an abdominal ultrasonography. Data were analysed in a univariate and multivariate fashion in order to determine the characteristics of OSA patients with and without NAFLD. RESULTS: NAFLD was found in 62.9 % patients, with a frequency according to OSA severity of 51.3 %, 56.5 % and 72.6 % in mild, moderate and severe OSA, respectively. Severe OSA multiplies by 2.32 the risk of having NAFLD. The comparison between groups with and without NAFLD reveals that patients with the disease were younger, more obese, had more severe OSA, lower nocturnal oxygen saturation during sleep, and higher ALAT levels. Multivariate analysis showed a statistically significant link between NAFLD and serum ALAT elevation and the oxygen desaturation index. CONCLUSIONS: NAFLD is a frequent comorbidity in OSA, correlated to the severity of the disease. Thus, early screening of the disease in OSA patients especially in younger obese patients with high ALAT serum levels and a high oxygen desaturation index is proposed.

Adrenal epithelial cyst: a case report.

Epithelial-lined or true cysts of the adrenal gland are exceedingly rare accounting for only 9% of all adrenal cysts. A 55-year-old woman with a medical history for cholecystectomy and liver hydatidosis presented with an 8-month history of abdominal pain in the upper left quadrant. Physical examination was unremarkable and laboratory tests were within normal range. Computed tomography displayed a homogeneous and finely calcified cystic mass of the left adrenal gland measuring 12 x 10 cm. A hydatid cyst of the adrenal gland was suspected preoperatively and the patient underwent uneventful excision of the cyst. Histological examination of the surgical specimen revealed that the cyst wall was lined by cuboidal to flattened cells with bland cytologic features. Immuohistochemically, the cyst lining expressed intensely cytokeratin but was negative for CD 34 and calretinin. The final pathological diagnosis was epithelial adrenal cyst.

Pancreatic heterotopia in the gallbladder neck associated with chronic cholecystitis.

The gallbladder is an unusual location of pancreatic heterotopia defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of the gland. A 55-year-old previously healthy male patient presented with repeated attacks of right hypochondriac pain and vomiting. On physical examination, the right upper abdomen was tender to palpation with a positive Murphy's sign. Abdominal ultrasonographic examination showed multiple gallstones within a thin-walled gallbladder. Laparoscopic cholecystectomy was performed with uneventful recovery. Macroscopic examination of the surgical specimen revealed a yellowish intramural nodule measuring 7 mm close to the neck of the gallbladder. Histological examination revealed chronic cholecystitis and subserosal foci of heterotopic pancreas made up of exocrine acinar and ductal elements without islet cells corresponding to incomplete heterotopia. Heterotopic pancreas is usually detected as an incidental microscopic finding in a gallbladder specimen removed by cholecystectomy. Pre-operative diagnosis is difficult primarily due to its non-specific clinical features.

Localized ileal giant pseudopolyposis in Crohn's disease: a case report.

Localized giant pseudopolyposis is a rare complication in inflammatory bowel disease defined as a pseudopolyp (isolated or clustered) larger than 1.5 cm in size. Giant pseudopolyps are more commonly found in ulcerative colitis compared to Crohn's disease and mainly involve the left colon. A 26-year-old male patient with a two-year history of Crohn's disease was admitted with increasing abdominal pain, vomiting, anorexia, weight loss and fever. On physical examination, the abdomen was diffusely tender. Computed tomography showed diffuse irregular thickening of the ileal wall and stenosis of the terminal ileum. The patient underwent ileo-cecal resection with re-anastomosis. The ileal portion of the resected specimen harboured multiple finger-like pedunculated polyps, with the smallest measuring 0.5 cm and the largest measuring 1.8 cm. Histologically, the polyps were consistent with granulation tissue. No evidence of dysplasia or malignancy was found. The post-operative course was uneventful considering one month follow-up. This report illustrates an unusual case of giant pseudopolyposis involving the ileum in a patient with Crohn's disease. The natural history of these lesions, as well as their optimal management, remain uncertain.

Adenomatous transformation in a giant solitary Peutz-Jeghers-type hamartomatous polyp.

Solitary Peutz-Jeghers-type polyp is a rare hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers Syndrome. It is usually encountered in the small intestine, but rarely involves the rectum. A 27-year-old previously healthy female patient presented with a two-month history of rectal bleeding. The patient had neither mucocutaneous pigmentation nor a family history of gastro-intestinal polyposis. Endoscopic examination revealed a solitary lobular polypoid lesion in the lower rectum. The polyp was sessile and measured 15 cm in diameter. As histological examination of the biopsy specimen was suggestive of adenoma, endoscopic polypectomy was performed. Histologically, this polyp had an arborizing muscular network originating from the muscularis mucosa, and was covered by well organized mucosa with several foci of dysplastic glands. The final pathological diagnosis was solitary Peutz-Jeghers type hamartomatous polyp with adenomatous transformation.

Dogs L. infantum infection from an endemic region of the north of Tunisia: a prospective study.

A follow-up study of 917 dogs was undertaken between 1994 and 1995 in the focus of visceral leishmaniasis in northern Tunisia. It permitted to assess the demography of the dog population, the importance of canine leishmaniasis (CL) and the determinants of seropositivity and mortality of dogs. Canine population was stable through time with an input of 231 dogs and an output of 218 dogs per year. The prevalence of seropositivity was 18% and 22.3% in 1994 and 1995 respectively and 90% of dogs were asymptomatic. Among 525 negative dogs in 1994 and reassessed in 1995, 78 seroconverted revealing an annual cumulative incidence of 14.74%. On the other hand, 23.47% (27/115) of seropositive dogs became negative in 1995. Age, presence of symptoms and density of dogs were independently associated with CL seropositivity. These results demonstrate the difficulty of control strategies of visceral leishmaniasis targeting the dog population.

[Graded classification of acute chloralose poisoning. 509 cases]. / Classification en grades des intoxications aiguës par le chloralose. 509 cas.

OBJECTIVE: The annual incidence of chloralose poisoning has exceeded 3 cases per 100,000 inhabitants in Tunisia since 1997. The purpose of this study was to analyze clinical features of chloralose poisoning. METHODS: We reviewed patients admitted to the intensive care unit during the last 5 years to search for chloralose poisoning. The identified cases were classed into 5 grades by clinical features: depth of coma, characteristics of the myoclonia, and cerebral trunk reflex response. RESULTS: We identified 509 cases of chloralose poisoning over the last 5 years. Seventy-five patients (14.7%) were in grade 1: drowsiness alone. Four hundred ten patients (80.8%) were in grades 2 and 3: hypertonic coma and myoclonus. The clinical course was favorable after sedation, tracheal intubation and mechanical ventilation. Twenty-three patients (4.6%) were in grades 4 and 5: hypertonic coma (Glasgow coma score = 3). Three of them died. CONCLUSION: The clinical features of chloralose poisoning depend on the ingested dose. Despite the gravity of the initial clinical presentation, prognosis is excellent if symptomatic treatment is given early, even in grade 5 cases which simulate brain death.

[Evaluation of two DNA probes specific for Leishmania infantum in the diagnosis of canine leishmaniasis]. / Evaluation de deux sondes ADN spécifiques de Leishmania infantum dans le diagnostic de la leishmaniose canine.

This study reports on the evaluation of two L. infantum specific DNA probes for the diagnosis of canine leishmaniasis. The probes presented very satisfying performances in terms of specificity (100%) and predictive value of the positive result (100%). However, their sensitivity (35.3%) and the clinical complexity of canine infections render their use difficult in epidemiological surveys of visceral leishmaniasis aiming at measuring the prevalence of the dog infection by L. infantum. The sensitivity of these tools has improved (66.7%) when dogs presenting patent leishmaniasis were considered. Such probes constitute appropriate tools to confirm suspected cases of leishmaniasis. Unlike the classical parasitological and serological tools, this kind of tools allows a concomitant detection and identification of the causative agent. Therefore, despite their low sensitivity, these probes can still be of importance in epidemiological investigations.

Leishmania infantum species-specific kDNA probes: isolation and evaluation.

The study refers to the isolation of specific DNA probes to the parasite species Leishmania (L) infantum according to different strategies using recombinant minicircles isolated from L. infantum kinetoplast DNAs. A first probe was identified following a classical procedure. One mini-circle selected for strong reactivity to L. infantum total DNA was used to identify specific subfragments to this species among which the 95bp fragment, 3B8HaeIII-2 was selected. For the obtention of the second probe, a strategy based on sequential screenings for specificity and sensitivity was applied. This allowed identification of a set of minicircles showing an increased specificity to L. infantum as compared to other species, and an increased sensitivity of reaction as compared to the other minicircles. Subclonings and screenings allowed a final selection of a 137bp-minicircle fragment: 3E9HaeIII-12. Reactivities of the 2 probes were assessed on a panel of total DNAs and promastigotes from 74 isolates pertaining to 9 species encountered in the Old World. Parasites isolated in Tunisia from different foci, different hosts after different transmission seasons were included. Hybridizations have shown the exquisite specificity of these probes to L. infantum in this country. Probe 3E9HaeIII-12 was found to be the more sensitive where down to 10 ng of total DNA and 10(3) promastigotes could be detected. From this study and as compared to data provided in the literature, the second procedure allowed at least 10-fold increase in sensitivity.

[Comparison of three methods to evaluate microalbuminuria in insulin-dependent diabetics: radioimmunoassay, laser-nephelometry and Laurell electroimmunodiffusion]. / Comparaison de trois techniques de dosage de la microalbuminurie chez les diabétiques insulino-dépendants: radioimmunologie, néphélémétrie-laser et électro-immuno-diffusion de Laurell.

The early detection of microalbuminuria in insulin dependent diabetes is considered as a sign of initial stage of nephropathy possibly reversible if glycemic balance is well maintained. This detection requires very accurate methods as radio-immuno-assays. Yet, they are so slow that they represent an obstacle to systemic detection. We report in this work an apparaisement of an immuno-nephelemetric and electro-immuno-diffusion of Laurell methods. Results reveal that immuno-nephelemetry and electro-immuno-diffusion are a sensitive and accurate methods (threshold of sensitivity of Laurell method is : 2.5 mg/l and nephelemetry is 1.5 mg/l). Moreover, RIA, immunonephelemetry and Laurell methods are significantly well correlated (r = 0.903: Laurell/Radio-immuno-assay, r = 0.907: Nephelemetry/Laurell). In conclusion immuno-nephelemetry and electro-immuno-diffusion of Laurell are a choice methods to test great lines of samples. Radio-immuno-assay can be used as a reference method of detection of microalbuminuria.

[Hepatitis and pregnancy in Tunis. 103 cases compared with 100 cases who were not pregnant (author's transl)]. / Hépatite et grossesse à Tunis. A propos de 103 cas comparés à 100 cas en dehors de la grossesse.

The authors have reviewed the notes of 103 pregnant women who contracted hepatitis during pregnancy and compared it with a controlled series of hepatitis occurring in 100 women who were not pregnant but were of reproductive age. The mortality rate in the pregnant group was considerably higher than in those who were not pregnant--27 deaths out of 103 cases as against 4 deaths in the control series of 100 cases. The fetal prognosis was very bad in the group of women who died. 3 out of 4 pregnancies resulted in loss of the fetus. It was less bad in those who had mild hepatitis--39.3% lost the fetus and one out of two pregnancies had a premature labour. Loss of consciousness was a very bad prognostic sign. The prognostic value of marked drop in prothrombin and raised white blood counts is emphasized in the cases who died. When the series of women who were pregnant and who survived is compared with those who survived in the control group, the authors found that judgment had to be used carefully in evaluating the prodromal signs in the pregnant women. They found in the two groups that the haemoglobin level and the serial levels of protein and albumen are comparable to those found in developed countries. They conclude that their maternal mortality due to hepatitis was comparable to that reported in underprivileged countries but that "malnutrition" in the broader sense of the term does not explain the serious state of affairs.