Management of esophageal atresia and early predictive factors of mortality and morbidity in a developing country.

The aim of this study is to investigate management and outcome in esophageal atresia (EA) and to identify early predictive factors of morbidity and mortality in a developing country. Charts of neonates with repaired EA from 2007 to 2016 were reviewed. Patients' characteristics, operative details, and postoperative outcomes were collected. Statistical analyses were performed to identify predictors of complicated evolution. Forty-two cases were collected. There were 14 girls and 28 boys. Only one patient had antenatal diagnosis (2.3%). The mean gestational age was 38 weeks. Nine patients (21.4%) weighed less than 2.5 kg. Seventeen (40.4%) patients had associated malformations most commonly cardiac (9/17). Thirteen patients had delayed diagnosis (30.9%). Thirty-nine (92.8%) patients underwent primary esophageal anastomosis. Overall survival was 76.2%. Nineteen patients (57% of survivals) had complicated evolution before the age of one year and 15 patients (46.8% of survivals) developed complications after the age of one year. Perinatal variables associated with mortality were prematurity (p = 0.004, OR = 5.4, IC95% = [1.13-25.80]), low birth weight (p = 0.023, OR = 7, IC95% = [1.38-35.47]), cardiac malformations (p = 0.006, OR = 10.5, IC95% = [2.03-54.27]) and delayed diagnosis (p = 0.005, OR = 10.11, IC95% = [2.005-50.980]). Variables associated with short-term and middle-term complications were duration of intubation (p = 0.019, OR = 0.118, IC95% = [0.019-0.713]) and the presence of short-term complications (p = 0.016, OR = 7.33, IC95% = [1.467-36.664]) respectively. These factors may be used to identify patients who will benefit from more intensive follow-up program.

The role of procalcitonin and N-terminal pro-B-type natriuretic peptide in predicting outcome after cardiac surgery.

OBJECTIVE(S): Determine the thresholds of procalcitonin (PCT) and N-terminal pro-B-type natriuretic peptide (Nt-pro-BNP) associated with poor prognosis after heart surgery with CPB. DESIGN: Prospective observational study. SETTING: Academic Medical Center Habib Bourguiba. PARTICIPANTS: Adult patients consecutively operated for coronary or valve surgery with CPB, elective or semi-urgent. INTERVENTIONS: Serum concentrations of PCT and Nt-pro-BNP were determined before and after CPB, in the fourth postoperative hour (H4) and every day during the first 4 days. Receiver-operating characteristic curves and cut-off values were used to assess the ability of these markers to predict length of intensive care unit (ICU) stay >3 days. MEASUREMENTS AND MAIN RESULTS: Forty patients were included in the study. Systemic inflammatory response syndrome (SIRS) occurred in 35 (87.5%) patients. Seventeen of them (42.5%) showed severe SIRS. Significantly higher serum concentrations of Nt-pro-BNP and PCT were found in patients with severe SIRS. Receiver operating characteristic (ROC) analysis showed that the threshold of PCT was 0.737 ng/mL and that of Nt-pro-BNP was 1235 pg/mL on day 1 could predict an ICU stay of more than 3 days. The association of Nt-pro-BNP to procalcitonin (p=0.009) better predicted the ICU stay than PCT alone (p=0.02) or Nt-pro-BNP alone (p=0.03). The best combination is Nt-pro-BNP + PCT + C-reactive protein (CRP) (p=0.007). CONCLUSIONS: PCT and Nt-pro-BNP on day 1 may be associated with severe SIRS and predict the length of stay. A biomarker approach combining PCT, CRP and BNP is superior to a traditional single marker for predicting ICU stay.

[Evaluation of the antibiotics consumption in a Tunisian university hospital]. / Evaluation de la consommation des antibiotiques dans un hôpital universitaire tunisien.

PURPOSE: To estimate the consumption of antibiotics in our hospital and to determine the points at which will be targeted the recommendations of good practice of antibiotherapy. PATIENTS AND METHODS: Our study is a one day prevalence study where antibiotic's prescriptions are analyzed by a group of 6 doctors referents in antibiotherapy. RESULTS: During the study day, 443 patients were studied. Means age was 44.2 +/- 23.3 years (range: 1 and 102 years). 101 infections were diagnosed in 48 patients (10.8%). 192 patients (43.3%) received antibiotics. Antibiotherapy was curative in 44% of cases. The most prescribed antibiotics were gentamicin (85.2 DDD/1000 patients), metronidazole (79 DDD/1000 patients), and cefotaxime (73.9 DDD/1000 patients). According to the evaluation group, 30.7% of the antibiotic's prescription was considered unjustified. The antibioprophylaxis represents the category most often unjustified (49%). The molecules in which prescription was frequently considered unjustified are the ciprofloxacin (67%), the amoxicilline-clavulanate (40%) and the cefotaxime (40%). CONCLUSION: Our results suggest that an action of good practice should be targeted at the antibioprophylaxis and should concern especially molecules in which prescription was frequently unjustified.

Polymorphism of the human immunoglobulin heavy chain locus in rheumatoid arthritis.

The genetic origin of Rheumatoid Arthritis (RA) is largely unknown. The purpose of this investigation was to assess the potential genetically determined involvement of the immunoglobulin (Ig) heavy chain variable region (VH) locus in the pathogenesis of RA. We tested the hypothesis of whether there is a genetic linkage between a structural abnormality of the VH gene complex and autoantibody hyperproduction in RA. We used restriction endonuclease generated polymorphism with human VH gene-family-specific probes to examine genomic DNA from a RA family and from unrelated RA patients from both the Tunisian and the European populations. The use of DNA samples from these ethnic origins permitted a further evaluation of the polymorphism of the human VH locus. While we found that the polymorphism of the VH locus was lower in the Tunisian population, we could not detect a restriction site polymorphism pattern restricted to RA. Together, our results do not support the involvement of major abnormalities of the Ig VH locus as a primary source in the development of RA.

Antibody epitopes probed by immunoselected phage-display library peptides in members of a family with various rheumatic manifestations.

OBJECTIVE: The random peptide combinatorial phage library approach overcomes the problem of lack of structural information about the aetiological agent or the antigen responsible for a given disease. Here, we used such a strategy to gain insight into the aetiology of rheumatoid arthritis (RA). METHODS: We analyzed the reactivity of serum antibodies from a family with various rheumatic manifestations against RA-immunoselected nanopeptides displayed on phage particles. RESULTS AND CONCLUSION: We found that within the same family, there was a difference in antibody reactivity against the peptides tested. The IgG isotype of the peptide reactive antibodies indicated that the observed reactivities were not related to the presence of polyreactive IgM antibodies. Furthermore, it is unlikely that the observed reactivity was due to rheumatoid factors (RF), since two patients who were positive for the immunoselected Pep3 peptide (LSSREPQAR) were RF negative. We also found that the serum of one patient with polyarthralgias also reacted with the same peptide bound by the RA serum, which may suggest the implication of a common aetiological agent in the apparition of this antibody reactivity. Finally, we noted that one patient with Sjögren's syndrome had antibodies to the RA peptide, which may indicate a potential relationship between these two autoimmune diseases.

[Arterial thrombosis in Behcet's disease. Report on three cases]. / Thromboses artérielles dans la maladie de Behcet. A propos de 3 cas.

Three patients with Behcet's disease developed arterial thromboses affecting the external iliac, middle superficial femoral, and radial arteries respectively. Arterial thrombosis occurs mainly in affected males, is predominant in the upper limbs, and usually appears several years after the onset of the disease: it is probably more frequent in the familial forms.

[Intrathoracic localization of Behçet's disease]. / Localisations endothoraciques de la maladie de Behçet.

Five case histories of intra-thoracic involvement occurring in the course of Behcet's disease were studied. These included a superior vena caval obstruction, an obstructive syndrome, transitory infiltrates, repeated lung infections and a case of haemoptysis. A review of the literature was carried out "à propos" of each case. The blood results seemed to be the involved as a manifestation of all the varied clinical presentations. The advantage of specialised investigations such as pulmonary angiography, perfusion scintigraphy and bronchial arteriography is underlined.

[Prevention of complications of severe arterial hypertension in pregnancy using platelet antiaggregants]. / Prévention des complications de l'hypertension artérielle gravidique par les antiagrégants plaquettaires.

A prospective study conducted between January, 1985 and September, 1987 involved 60 pregnant women who had previously suffered from hypertension in pregnancy with or without foetal and maternal complications. Thirty women received aspirin 250 mg every other day and dipyridamole 300 mg per day, starting from the 3rd month of pregnancy (group I); 30 women were examined regularly from the onset of pregnancy and received the conventional symptomatic treatment of complications that occurred (group II). Women in these two groups were similar in age, parity and previous obstetrical complications. Twenty-five women of group I had a perfectly normal pregnancy, as against 5 women of group II (P less than 0.001). Hypertension and/or proteinuria were observed in 5 women of group I and 15 of group II (NS). The 13 severe complications recorded (foetal death, eclampsia, retroplacental haematoma) occurred exclusively in women of group II. The duration of pregnancy and weight of the newborn were significantly greater in group I than in group II. Thus, antiplatelets appear to have an uncertain preventive effect on hypertension of pregnancy and a much more obvious prophylactic effect on major foetal and maternal complications.

[Predisposition to thyroid autoimmune diseases]. / Prédisposition aux maladies autoimmunes thyroïdiennes.

OBJECTIVES: Genetic predisposition is required for the expression of thyroid autoimmune disorder addition to the immune dysfunction and the environmental factors. METHODS: In order to evaluate the role of this genetic factor, we reported the results of immunological and hormonal investigations of 62 members (TD), belonging to a large Akr family, who are related to 40 patients with Graves' disease or Hashimoto's thyroiditis. RESULTS: The hormonal analyses showed that 19 subjects exhibited an infraclinical hypothyroidism, subdivided into 7 members with pathological rates of TSH evocative of thyroid insufficiency and 12 others with compensative thyroid insufficiency. Seventeen subjects of the Akr family who had solely antithyroid autoantibodies were considered as potential candidates to develop thyroid autoimmune diseases. The clinical follow-up, during two years, confirmed the diagnosis of Hashimoto's thyroiditis in 3 members among 19 subjects with infraclinical hypothyroidism (TD05, TD28 and TD54) and in only 1 member out of the 17 potential candidates (TD03). CONCLUSION: Our results showed that a serological study of hormones and/or autoantibodies directed against thyroid antigens, could allow the detection of predisposed subjects to develop a thyroid autoimmune pathology. The Akr family seems to be suitable for the study of the localization of susceptibility genes to TAID.

[Host-parasite interactions between Coccus hesperidum L. (Hom. Coccidae) and its parasite Coccophagus scutellaris Dalman (Hym. Aphelinidae)]. / Contribution à l'étude des interactions hôte-parasite chez Coccus hesperidum L. (Hom. Coccidae) et son parasite Coccophagus scutellaris Dalman (Hym. Aphelinidae). II. Action du parasite sur l'hôte.

The eggs laid in the host gut will develop normally. The larva resulting from those eggs penetrate the hemocele through the gut wall. The structure of the cells near the entry point is not affected because of the continuous renewal of those cells. On the other hand, development of the ovaries is most seriously affected. In fact, ovogenesis is stopped and vitellogenesis slowed down. But this phenomenon is related to the initial level of ovary development. If the attack takes place when the host is young, the effect on the ovaries is more serious. In extreme cases gonad development is annihilated. Otherwise, the host will still be able to lay eggs, but its reproduction capacity is diminished. Factors reducing development of gonads or maintaining them at a juvenile stage are discussed.

[Host-parasite interactions in Coccus hesperidum L. (Hom. Coccidae) and its parasite Coccophagus scutellaris Dalman (hum. Aphelinidae). III. Effect of the number of hosts and their sanitary conditions on the oviposition of the parasite]. / Contribution á l'étude des interactions hôte-parasite chex Coccus hesperidum L. (Ham. Coccidae) et son parasite Coccophagus scutelaris Dalman (Hym. Aphelinidae).

Intensity of egg laying of Coccophagus scutellaris depends on the number of hosts available. It is found to be more important when the female has several hosts. Furthermore a better distribution of eggs is observed in that case. When parasited and parasiteless hosts are available, the female of Coccophagus deposits more eggs on the latter. This discriminating ability in relation to number and kinds of hosts available is discussed.