Urinary creatine at rest and after repeated sprints in athletes: a pilot study.

Creatine plays a key role in muscle function and its evaluation is important in athletes. In this study, urinary creatine concentration was measured in order to highlight its possible significance in monitoring sprinters. The study included 51 sprinters and 25 age- and sex-matched untrained subjects as a control group. Body composition was measured and dietary intake estimated. Urine samples were collected before and after standardized physical exercise. Creatine was assessed by gas chromatography mass spectrometry. Basal urinary creatine (UC) was significantly lower in sprinters than controls (34±30 vs. 74±3 µmol/mmol creatinine, p < 0.05). UC was inversely correlated with body mass (r = -0.34, p < 0.01) and lean mass (r = -0.30, p < 0.05), and positively correlated with fat mass (r = 0.32, p < 0.05). After acute exercise, urinary creatine significantly decreased in both athletes and controls. UC is low in sprinters at rest and further decreases after exercise, most likely due to a high uptake and use of creatine by muscles, as muscle mass and physical activity are supposed to be greater in athletes than untrained subjects. Further studies are needed to test the value of urinary creatine as a non-invasive marker of physical condition and as a parameter for managing Cr supplementation in athletes.

[Myasthenia gravis and hyperthyroidism: two cases]. / Myasthénie et hyperthyroïdie: à propos de deux observations.

It is well known that hyperthyroidism occurs in approximately 2 to 17.5% of patients with myasthenia gravis. Hyperthyroidism may influence the clinical course of myasthenia gravis. We report the cases of two patients, a 53-year-old man and an 18-year-old woman, who had both severe myasthenia gravis and hyperthyroidism due to Graves' disease. Myasthenia gravis affected in particular facio-ocular areas with diffuse myopathy and signs of neuromuscular block on the electromyogram. In one patient, the diagnosis of thyroid disease was made three months before the diagnosis of myasthenia gravis while in the other, thyroid disease was recognized four months after myasthenia gravis. Myasthenia gravis worsened after the development of hyperthyroidism in the second patient. Both patients were given anti-cholinesterase drugs. One underwent thymectomy. Radioiodine used for the treatment of hyperthyroidism improved the symptoms of myasthenia gravis in the first patient. The association of myasthenia gravis and hyperthyroidism is more than a coincidence; our cases illustrate the difficult diagnosis and management of these diseases. Clinicians should look for myasthenia gravis in hyperthyroid patients and vice versa, especially when symptoms of myasthenia gravis or hyperthyroidism worsen.

[MRI pituitary stalk abnormalities: etiology aspects in 11 patients]. / Anomalies de la tige pituitaire à l'IRM: aspects étiologiques à propos de 11 cas.

Newer techniques of magnetic resonance imaging (MRI) describe more accurately pituitary stalk abnormalities such as infections, infiltrative lesions and tumors. In absence of all the above mentioned etiological factors, genetics defects are suspected, mainly when other malformations are equally present. We attempt to show through 11 observations the variability of pathologies involving the pituitary stalk with their respective clinical and radiological features and associated endocrine abnormalities. This is a retrospective study of 7 men (67%) and 4 women (33%), mean age of 28 year (range: 15 to 53) in whom pituitary MRI was performed for hypopituitarism, diabetes insipidus or hyperprolactinemia. Three patients had brain MRI for an extra-pituitary condition. The pituitary MRI showed a stalk section in 3 cases (27%), atrophy in 1 case and thickening in 7 cases (67%). The pituitary stalk anomaly was associated with hyperprolactinemia in 3 cases (27%), central diabetes insipidus in 4 cases (36%), growth hormone deficiency in 4 cases (36%), adrenal insufficiency in 5 cases (45%), hypogonadism in 5 cases (45%) and hypothyroidism in one case (9%). Established diagnoses were: sellar metastasis in 2 cases (18%), Langerhans' histocytosis, tuberculosis and autoimmune hypophysitis respectively in 3 cases (9%). In 6 cases (54%), no clear etiology was found. Given the multitude of pituitary stalk pathologies, a detailed etiologic inquiry must be performed in order to detect elements able to reclassify an initially idiopathic disorder.

[Pituitary tuberculosis: a case report]. / La tuberculose hypophysaire: à propos d'un cas.

Through a case of sellar and suprasellar tuberculoma which presented with central diabetes insipidus, the authors report the frequency of pituitary tuberculoma, its physiopathology, clinical presentation hormonal and radiological findings thus management and evolution. A 42 years old woman, with a history of erythema nodosum, presented with polyuria polydipsia (PUPD), amenorrhea and galactorrhea. Endocrine investigations showed central diabetes insipidus, elevated serum prolactin levels and cortisol failure. Magnetic resonance imagining scans (MRI) revealed a nodular thickening of the pituitary enlargement and loss of posterior pituitary hypointensity signal. Etiologic inquiry has removed the diagnosis of sarcoidosis, Langerhan's histosis, autoimmune hypophysitis and sellar metastasis. The history of erythema nodosum, the positivity of tuberculin skin test and the presence of koch bacillus in the bronchial fluid after culture led to a diagnosis of tuberculosis. Treatment was started with four drug antitubercular chemotherapy regimen for 2 months, and tow drug antitubercular chemotherapy regimen for 16 months. This treatment is associated with hydrocortisone, desmopressin nasal spray and bromocriptine. Under treatment, there was an improvement in clinical condition, disapearence of headache, PUPD and galactorrhea thus normalization of prolactin. A follow-up MRI, 8 months later, showed that pituitary lesion has been completely removed, suggesting our clinical and biology presumption. Pituitary tuberculosis is rare, however, when encountered, they may present a diagnostic difficulty. Accurate diagnosis and management is important because pituitary tuberculoma is curable.

[Epidemiology of diabetes in a school children population in Tunisia]. / Epidémiologie du diabète chez l'enfant en milieu scolaire à Sousse, Tunisie.

OBJECTIVE: Study the diabetes prevalence on children because, in Tunisia there are not any available data concerning the epidemiological profile of diabetes in the population aged less than 19 years. MATERIAL AND METHODS: We undertook an epidemiological survey on a representative sample of 1,569 pupils from Sousse in Tunisia aged between 13 and 19 years with a global answer rate of 95.4%. Fasting blood glucose was measured by the glucose oxidase method. RESULTS: The main results showed that prevalences of the moderate hyperglycaemia on an empty stomach (2%) and of the mellitus diabetes (0.4%) did not reveal any significant statistical difference between girls and boys. The moderate hyperglycaemia prevalence varied according to the existence of other cardiovascular risk factors such as hypercholesterolemia (3.3%), arterial hypertension (2.1%) and overweight (3.4%). CONCLUSION: Our survey has provided a first evaluation related to a population of youngsters on the diabetes prevalence and other cardiovascular risk factors. This would help to sensitise health authorities on the importance of primary prevention and its setting in health clubs at schools.

[Cardiovascular risk in schoolchildren in rural Sousse, Tunisia]. / Risque cardiovasculaire chez l'enfant en milieu scolaire rural à Sousse, Tunisie.

There is no data available on the cardiovascular risk of children under 18 years of age in Tunisia, although it is well known that these risk factors present themselves in childhood. The authors performed an epidemiological study based on a representative sample of 793 schoolchildren in the rural region of Sousse, in Tunisia, to determine the incidence of the following risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and smoking. The main results show that the prevalence of hypertension is 11.2% with no statistically significant difference between the sexes. The prevalence of hypercholesterolaemia (2.9%), of hyper-LDL cholesterolaemia (0.6%) and hypertriglyceridaemia (1%) were comparable in boys and girls. Obesity (BMI > 30) was observed in 1.8% of the study population and was as common in girls (1.7%) as in boys (1.9%). Smoking was recorded in 4% of the study population and was commoner in boys (7.3%) than in girls (1.2%). This cardiovascular risk profile is encouraging and efforts should be made to maintain these levels until adulthood. This data will form the basis of a regional programme for the promotion of cardiovascular health in schools.

[Smoking among school children in Sousse, Tunisia]. / Le tabagisme en milieu scolaire à Sousse, Tunisie.

In order to study smoking habits of children and adolescents from Sousse in Tunisia, we undertook an epidemiological survey on a representative sample of 1569 pupils aged between 13 and 19 years with a global answer rate of 95,4%. The objective of the study was both to describe Tunisian adolescent smoking behaviour and also to evaluate the influence of the home environment, friends and the different socio-demographic factors on acquiring or maintaining the habit. Students were surveyed in schools using a self-administered, anonymous questionnaire. Overall 7,6% of our sample smoked tobacco with prevalence amongst boys being much higher than in girls: 14,7% versus 1,1%; X(2)=103,4, p=0,00001. The smoking prevalence rose with age: in boys it increased from 3,4% at 13 years to 32,3% at 19 years; X(2)=40,9, p=0,0001. 60,6% of youngsters interrogated were exposed to passive smoking at home. Peer smoking behaviour has a clear effect on the tobacco habits of boys. These findings suggest school and medical authorities should design specific programs to limit the spread of the tobacco phenomenon in youngsters.

Study of cardiovascular disease risk factors among rural schoolchildren in Sousse, Tunisia.

We undertook an epidemiological survey based on a representative sample of 793 rural schoolchildren in Sousse, Tunisia to assess the prevalence of certain cardiovascular disease risk factors. The prevalence of hypertension (11.2%), hypercholesterolaemia (2.9%), hypertriglyceridaemia (1.0%), high levels of low-density lipoprotein cholesterol (0.6%) and obesity (4.0%) showed no statistically significant difference based on sex. However, smoking (4%) showed a significant gender difference (boys: 7.3%; girls 1.2%). The relatively low cardiovascular disease risk factor profile of Tunisian children needs to be encouraged through to adulthood. Thus a school programme of heart health promotion should be established.

[Septic cavernous sinus thrombosis following ethmoiditis: a case report]. / Thrombose du sinus caverneux compliquant une ethmoïdite aiguë

Acute ethmoiditis is a rare infection of ethmoidal cells. The pathognomonic sign is an edema of the internal corner of the eye. Imaging may be necessary to verify the absence of orbital or endocranial complications. Thrombophlebitis of the cavernous sinus is a serious complication of this infectious process. We report the case of an 11-year-old boy who presented with ethmoiditis complicated with thrombophlebitis of the cavernous sinus, with right hemiplegia and left Bell palsy sequelae. Early diagnosis of this disorder and urgent therapy are essential. Treatment is based on the antibiotic therapy.

[Multiple cerebral cavernomatosis in a 1-year-old child]. / Cavernomatose cérébrale chez une fille de 1 an.

Cavernous malformations are vascular lesions of the central nervous system. They are very rare in childhood. We report the case of sporadic cavernous cerebral angioma in a 1-year-old girl without pathologic antecedents revealed by a partial seizure. With this case and a review of the literature, we show the clinical and therapeutic characteristics of cerebral cavernomatosis in childhood.

[Use of recombinant factor VII in Glanzmann thrombasthenia: a case report]. / Intérêt du facteur VII recombinant dans la thrombasthénie de Glanzmann: à propos d'une observation.

Glanzmann thrombasthenia (TG) is a congenital platelet function disorder characterized by frequent and occasionally severe bleeding events. Treatment is based on platelet transfusion at the time of bleeding. We report a case of GT revealed in the neonatal period, a severe hemorrhagic syndrome refractory to transfusions, treated at the age of 6 years. Activated recombinant factor VII (Novoseven) injections were necessary. The advantages of recombinant activated factor VII in GT patients with platelet antibodies and/or platelet transfusions refractoriness are discussed.

Antifungal activity from polar and non-polar extracts of some Chenopodiaceae wild species growing in Tunisia.

Nine plants belonging to Chenopodiaceae family were collected around salt marshes near Monastir, located in the east Mediterranean coast of Tunisia. They were tested for their antifungal activities against six plant pathogenic fungi: Botrytis cinerea, Fusarium oxysporum f. sp. niveum, F. solani f. sp. cucurbitae, Phytophthora cactorum, Rhizoctonia solani and Nattrassia mangiferae. Data of this study showed that the highest inhibition of Botrytis cinerea growth was observed with the petroleum ether extract of Atriplex inflata fruits (F) (24.5 mm). The in vitro growth of F. oxysporum f. sp. niveum was reduced only with A. inflata whole plant (WP) petroleum ether extract (32.3 mm). The most important inhibition zones were obtained against F. solani f. sp. cucurbitae with Atriplex semibaccata methanol and acetone extracts (34.7 and 31.0 mm, respectively). This work revealed that fungitoxic compounds were probably present in the petroleum ether extract obtained from A. portulacoides (WP), since it has suppressed the growth of F. s. cucurbitae. Our investigation proved that many Chenopodiaceae species adapted to saline soils may contain phytochemical compounds with fungicidal properties.

Epidemiology of cardiovascular risk factors among schoolchildren in Sousse, Tunisia.

BACKGROUND: In Tunisia, where the epidemiological transition phenomenon is well established, there are no data available at the population level on the cardiovascular disease (CVD) risk profile for children, although it is well known that risk factor development takes place in childhood. METHODS: We report an epidemiological survey based on a representative sample of 1569 urban schoolchildren of Sousse in Tunisia to assess the following CVD risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and tobacco consumption. RESULTS: The main results showed that girls had significantly higher levels of body mass index (BMI), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol than boys, who however had significantly higher levels of systolic blood pressure (SBP). Total cholesterol was significantly correlated to BMI and decreased with age. Obesity (BMI = 27) was found in 7.9% of the study population and was significantly higher for girls (9.7%) than for boys (6%): chi 2 = 9.02, DF = 2, P = 0.011. Overweight (BMI = 25) was also significantly higher for girls (16%) than for boys (11.1%): chi 2 = 8.21, DF = 1, P = 0.0041. Smoking habit concerned 7.6% of the study population; it was significantly higher for boys (14.7%) than for girls (1.1%): chi 2 = 103.4, DF = 1, P < 0.00001. CONCLUSION: This study showed to some extent that Tunisia's urban population of schoolchildren is exposed early to CVD risk factors and all should be done to avoid the worsening of this profile. These results will serve as a baseline for assessment of future trends in the risk factors studied.

Study of cardiovascular disease risk factors among rural schoolchildren in Sousse, Tunisia

We undertook an epidemiological survey based on a representative sample of 793 rural schoolchildren in Sousse, Tunisia to assess the prevalence of certain cardiovascular disease risk factors. The prevalence of hypertension [11.2%], hypercholesterolaemia [2.9%], hypertriglyceridaemia [1.0%], high levels of low-density lipoprotein cholesterol [0.6%] and obesity [4.0%] showed no statistically significant difference based on sex. However, smoking [4%] showed a significant gender difference [boys: 7.3%; girls 1.2%]. The relatively low cardiovascular disease risk factor profile of Tunisian children needs to be encouraged through to adulthood. Thus a school programme of heart health promotion should be established