Antioxidant properties of date seeds extract (Phoenix dactylifera L.) in alloxan induced damage in rats.

The study was conducted to examine the antioxidant activity and evaluate the protective effects of the date seeds powder kentichi against alloxan-induced damage in the liver, kidney, and pancreas in diabetic's rats. Group 1: control group, that did not receive any treatment, Group 2: alloxan was injected intraperitoneally (120 mg/kg body weight) for two days (Diab), Group 3: treated only by date seeds powder added in the diet (300 g/kg) for 6 weeks (DSPK), Group 4: alloxan-diabetic rats treated with date seeds powder (300 g/kg) (DSPK + Diab). Estimations of biochemical parameters in blood were determined. TBARS, SOD, CAT, and GPx activities were determined. A histopathological study was done by immersing pieces of both organs in a fixative solution followed by paraffin hematoxylin-eosin staining. In addition, the antioxidant activities of DSPK were evaluated by DPPH radical scavenging activity, reducing power, and ABTS free radical scavenging. The results revealed that date seeds significantly decreased serum levels of glucose, cholesterol, triglycerides, urea, creatinine, T-protein, ALP, D-bili and T-bili levels. In addition, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities that had been reduced in liver, kidney, and pancreas of the treated group were restored by DSPK treatments and, therefore, the lipid peroxidation level was reduced in the liver, kidney and pancreas tissue compared to the control group. Additionally, the histological structure in these organs was restored after treatment with date seeds powder.

[Characteristics of ocular involvement in Behçet disease in Tunisia: Monocentric study and review of literature]. / Caractéristiques de la maladie de Behçet avec atteinte oculaire en Tunisie: étude monocentrique et revue de la littérature.

BACKGROUND: Behçet's disease is a multisystemic inflammatory disease characterized by recurrent oral and genital ulcers, skin lesions and uveitis. The diagnosis of Behçet's disease is based on clinical criteria. The etiology of the disease is unknown but the wide variations of ethnic prevalence and of the prevalence in the same ethnic group in different geographic areas indicate environmental triggering of a genetically determined disorder. PATIENTS AND METHODS: A retrospective analysis of the medical charts of 150 Behçet's disease patients seen in our internal medicine department between 1995 and 2010 was undertaken. Patients with confirmed ocular involvement were analyzed and compared with those without ocular involvement. RESULTS: Among the 150 medical charts studied, 85 patients were included in the study. Thirty-three patients (38.5%) had ocular involvement. Mean age at ocular BD diagnosis onset were 35.3. Male to female ratio was 5.6. Ocular involvement was bilateral in 26 patients (78.8%). Uveitis was the most common ocular lesion (n=31 patients, 93.9%). Panuveitis was the most common anatomical location (n=21, 63.6%). The comparison of patients treated for BD with or without ocular involvement showed a statistically significant association between ocular and neurological manifestations (p=0.03). All patients with ocular involvement were treated with corticosteroids. Immunosuppressive (IS) treatments were used in 28 patients (84.8%). Cyclophosphamide was the most used as first-line treatment (71.4%). Cyclophosphamide relayed by azathioprine was the most adopted protocol (28.5%). In case of resistance or relapse and depending on the other manifestations of the BD, the IS used in first intention was replaced by another one. Seven of the 33 patients had received treatment with infliximab (IFX) after failure of other therapeutic lines. CONCLUSION: Ocular prognosis in the BD can be improved by early treatment and regular monitoring. It is important to adjust the therapeutic protocol to the anatomic form, to the severity of uveitis and to the extra-ocular manifestations associated.

[SAPHO syndrome]. / Le syndrome SAPHO.

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare entity characterized by the association of heterogeneous osteoarticular and cutaneous manifestations that have for common denominator an aseptic inflammatory process. The etiopathogeny of this disease is still a matter of debate. Although it has been related to the spondylarthritis family, an infectious origin is suggested. Diagnosis is based on the presence of at least one of the three diagnostic criteria proposed by Kahn. The treatment includes NSAIDs, antibiotics, corticosteroids, methotrexate and more recently the bisphosphonates and the TNFα inhibitors.

[Central nervous system involvement in systemic sclerosis]. / Une atteinte du système nerveux central au cours de la sclérodermie systémique.

Systemic sclerosis is a connective disease usually known to spare the central nervous system. This has been much debated by recent imaging studies. We report a 56-year-old woman followed-up for systemic sclerosis since 2005. Four years later, she presented with cerebellar and pyramidal syndrome. Magnetic resonance imaging showed signs of cerebral vasculitis. The patient was treated by corticosteroids and cyclophosphamide pulses followed by azathioprine for maintenance therapy. Clinical and radiological outcomes were favourable. In patients with systemic sclerosis and neurological symptoms, abnormalities in the cerebral magnetic resonance imaging may, in the absence of another obvious etiology, indicate a central nervous system involvement associated with this systemic disorder.

[Cerebral actinomycosis pseudotumor: a case report]. / Actinomycose cérébrale d'aspect pseudotumoral: à propos d'un cas.

INTRODUCTION: Cerebral actinomycosis is rare and difficult to diagnose. CASE REPORT: We report a case of a 45-year-old man hospitalized for seizures associated with fever and left hemiparesis. The white cell count and C-reactive protein were elevated. HIV serology was negative. Blood cultures remained sterile. The CT scan revealed hyperdense nodular lesions in the occipital area, with annular contrast uptake and peripheral edema causing a mass effect, suggestive of brain metastasis. The pathology examination of a surgical specimen disclosed cerebral actinomycosis. A dental origin of the infection was suspected. Hemiparesis remained after a 12-month antibiotic regimen associated with dental care and short-term corticosteroid therapy. CONCLUSION: Actinomycosis should be discussed as a possible diagnosis for all cerebral lesions, particularly in patients with a potential dental infection. Histology is required for positive diagnosis. Antibiotic therapy alone is generally sufficient; surgery is often performed for diagnostic purposes.

[Etiological profile of digital necrosis of the upper limbs: analysis of 25 cases]. / Profil étiologique des nécroses digitales des membres supérieurs : analyse de 25 observations.

AIM: To investigate the etiologies of the upper limb digital necrosis based on a retrospective analysis of 25 cases. PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients treated for digital necrosis of the upper limb in four departments of internal medicine from January 1997 to December 2003. RESULTS: There were 16 women and nine men, mean age 55 years. Eleven patients were smokers. Raynaud's phenomenon was noted in 12 cases. Connective tissue diseases were the most common cause (nine cases), all of them were women. The second cause was atherosclerosis (five cases) and Buerger's disease (five cases). In the other cases, the following diagnoses were found: vasculitis (three cases) and neoplasm (two cases). No cause could be identified in one female smoker. CONCLUSION: Digital necrosis is a common symptom, revealing a vascular pathology. Its causes are diverse. In women, it first suggests a connective tissue disease whereas in men, a diffuse arteriopathy. The etiological diagnosis strategy should consider drug intake, anamnesis and Raynaud's phenomenon history. However, in all cases the etiology investigations should not delay the treatment in order to preserve functional prognosis.

[Brain tuberculomas: six cases]. / Tuberculomes cérébraux : à propos de six cas.

INTRODUCTION: Despite the resurgence of tuberculosis, partly due to HIV infection, central nervous system involvement remains rare, accounting for only 2 to 5% of all tuberculosis forms. PATIENTS ET METHOD: We report six cases of brain tuberculomas occurring in patients free of HIV infection and hospitalized between 2001 and 2006 in the internal medicine department of a Tunisian military hospital (Tunis). RESULTS: Four patients had an underlying defect. Headache, fever, consciousness disorders, deficit disorder or cerebellar syndrome are the main symptoms. Tuberculomas were multiple and disseminated in four cases and localized in the brain stem in two cases. Positive diagnosis could be established in two cases on the basis of the pathology results of a brain biopsy or detection of Mycobacterium tuberculosis in the cerebrospinal fluid; the diagnosis was presumptive in the other cases. Five patients recovered under antituberculosis treatment maintained on average 13 months (11 to 16 months). Steroid treatment was associated in five patients and tapered off for four to six weeks. One 78-year-old diabetic patient died in a context of cachexia with multiple organ failure.

[Pneumocystis pneumonia in 3 non HIV patients]. / Pneumocystose pulmonaire chez les patients non VIH: à propos de trois cas.

We report 3 cases of pneumocystis pneumonia (PCP) in 2 female and 1 male patients (mean age=50 years) free of human immunodeficiency virus (HIV) infection. One female patient presented with breast neoplasm the other with Wegener's granulomatosis, the male patient with lymphoma. All patients were taking immunosuppressive treatment at the time of infection. Persistent cough, dyspnea, and severe hypoxemia were the most characteristic clinical signs. All patients presented with lymphopenia (average CD4-cell count=275/mm3), two with hypoalbuminemia, and one with renal failure. In all cases, the microscopic analysis of bronchoalveolar lavage was used to establish the diagnosis. All patients were treated with trimethoprim and sulfamethoxazole and a tapering dose of corticosteroids. Outcome was favorable for 1 patient, 1 was transferred to the intensive care unit for acute respiratory failure, and 1 died.

[Legionnaire's disease complicated by acute renal failure due to rhabdomyolosis: a case report]. / Pneumonie à Légionelle compliquée d'une insuffisance rénale aiguë par rhabdomyolyse : à propos d'un cas.

The infectious origin of non-traumatic rhabdomyolysis is rare (5% of cases). An elevated muscle enzyme level is often reported in the legionnaire's disease. We report the case of a 39-year-old male, with no previous medical history, admitted for renal failure (creatininemia=977 micromol/l) secondary to rhabdomyolysis and a twelve-day history of infectious syndrome with pneumonia in the left base. Legionella pneumophila was considered responsible for these symptoms because of a positive serology. The other microbial assessments were negative. After rehydration and three weeks of antibiotics, the outcome was favorable: the renal failure resolved completely and the muscle enzyme level returned to normal.

[Cytomegalovirus myelitis in immunocompetent adult]. / Myélite à cytomégalovirus chez un adulte immunocompétent.

INTRODUCTION: Cytomegalovirus (CMV) infection occurs in 40 to 100% of general population. It is often asymptomatic in immunocompetent subject but may induce neurological syndromes such as encephalitis and myelitis. CASE RECORD: We reported a case of a 64-years-old woman immunocompetent, with acute proximal upper and lower limb weakness, paresthesias and two episodes of urinary retention. MRI of the spine showed abnormal enhancement from cervical to lumbar spine indicative for myelitis. Diagnosis of CMV associated myelitis was confirmed by a positive CMV serology. Administration of ganciclovir was followed by a partial improvement in five months. DISCUSSION: Few cases of CMV acute myelitis in immunocompetent patients have been reported in the literature. The pathogenesis is not well known, however, immune-mediated central nervous system damage may be attributed to the pathogenesis of the disease. Early diagnosis and treatment improves the prognosis.

[Systemic lupus erythematosus in Tunisia. A multicentric study. About 295 cases]. / Le lupus érythémateux systémique en Tunisie. Etude multicentrique nationale. A propos de 295 observations.

PURPOSE: Systemic lupus erythematosus (SLE) is an autoimmune disease with a great clinical polymorphism. Wide variety of genetic, hormonal, immunological and environmental contributes to release the disease. Our objective was to describe and precise the epidemiological, clinical and immunological profile of this disease in Tunisia. METHOD: It is a retrospective study conducted by the Tunisian society of internal medicine during the period from January 1990 to December 1999. All patients fulfilled at least four of the revised American Rheumatism Association's criteria for SLE. RESULTS: Two hundred and ninety-five SLE have been examined (271 women, 24 men). The most frequent clinical manifestations were: articular 90%, malar rash 62%, photosensitivity 46%, seritis 32% and glomerulonephritis 56%, dominated by WHO class III and IV: 60 cases (renal biopsy was performed in 95 patients). Neurological features were observed in 14.5%. The abnormal laboratory findings were leucocytopenia 45%, lymphopenia 47%, thrombocytopenia 16% and hemolytic anemia in 6.7%. Antinuclear antibodies, anti-ds DNA and anti-Sm were at 92%, 74% and 57%, respectively. Eighty-three percent of patients were treated by steroids, and in 52 cases (18%), we added immunosuppressive drugs. Two hundred and eighteen patients were followed up with a mean follow-up duration of 51 months. Twenty-eight percent were in complete remission and in 60%, the SLE was active. In contrast, death occurred in 29 cases. CONCLUSION: Our study confirmed the clinical polymorphism of SLE, the great similarity with other studies apart the world, the gravity of renal and cardiac features and the infectious complications induced by corticosteroids.

[Systemic lupus erythematosus in 24 tunisian males: clinico-biological analysis and clinical course]. / Lupus systémique chez 24 hommes tunisiens: analyse clinicobiologique et évolutive.

PURPOSE: The systemic lupus erythematosus (SLE) is rare at the male. The clinic and biological characteristics and the evolution are variable between different studies. From 24 Tunisian observations we try to contribute to the precision of these characteristics on this ground. METHOD: It's a tunisian, multicentric, retrospective study of 24 males lupus, follow-up from 1990 to 1999 within a total lupus cohort of 295 patients. RESULTS: The sex-ratio female/male is 11/29, mean age at diagnosis is 31.75 years (range 10 to 63). The most frequent clinical manifestations are: arthritis (95%), malar rash (71%), photosensitivity (41%), glomerular nephropathy (66%) (classes III and IV = 7 cases/9), the serositis (37.5%) and Raynaud phenomenon (25%). Comparing these characteristics of two patient groups (24 males and 271 females), significant difference was observed : vascular thrombosis in male (16% vs 4% p : 0,027) and alopecia in female (12.5% vs 4% p : 0.03). For the other manifestations as nephropathy and serositis which are frequent in male the difference was not significant. The overall survival rate at 5 years 93% is and it was nearly the same in woman SLE patients. CONCLUSION: SLE in male is rare. In SLE male patients vascular thrombosis and nephropathy are more frequent without survival's influence.

[Mediastinal fibrosis combined with Behçet's disease. Three case reports]. / Fibrose médiastinale et maladie de Behçet. A propos de trois observations.

PURPOSE: Intrathoracic manifestations other then vascular aneurysm and thrombosis are rare in the course of Behçet's disease. Mediastinal fibrosis is also unusual. METHODS: Three cases of Behçet's disease with initial mediastinal fibrosis are reported. Diagnosis means, pathogenic mechanisms and therapeutic modalities are also more precisely defined. RESULTS: Three male patients (21, 25 and 27 years of age, respectively) were hospitalized for progressive vena cava superior syndrome accompanied by mediastinal fibrosis demonstrated by MRI and/or CT scan which both showed infiltration of the mediastinal fat. Multiple calcifications were also present in one patient. Histology was performed in one case. Thrombosis of the vena cava superior and innominata veins was associated with fibrosis in all three cases. Thrombosis of venae subclavia and left jugularis was also present in one case. Other manifestations leading to the diagnosis of Behçet's disease were demonstrated by the patient's history and, in one case, occurred on the fourth day of hospitalization. After initiation of a treatment including corticoids, anticoagulants and colchicine, the outcome was favorable in two cases. The third patient died. CONCLUSION: Mediastinal fibrosis combined with Behçet's disease has rarely been described. However, it should be included in manifestations of the disease. The causative process which might be vasculitis has to be demonstrated.