[Chemical burns caused by the shrub nerium oleander]. / Les Brulures Chimiques Par Le Laurier Rose.

Nerium Oleander is a shrub that grows naturally in the Mediterranean regions. In Morocco it is found in wet places. It is famous for its risk of systemic toxicity in cases of poisoning because of the presence of two alkaloids, especially oleandrine. The literature describes cases of local use of leaves of this plant against scabies, haemorrhoids, and boils. We report two cases of chemical burns of different gravity due to Nerium Oleander. This should lead to more widely diffused information for the general population and strict regulation of its marketing.

Scale of therapeutic behavior of type 2 diabetic patients. Hierarchical analysis of a questionnaire.

OBJECTIVES: Patient's therapeutic behavior determines the quality of self care in diabetes. The sociological approach can contribute to a better understanding of the internal logic of patient's behavior. The objective of our work is to study patients representations of their illness and its treatment in Moroccan type 2 diabetic patients. Our study concerns 307 type 2 diabetic patients. METHOD: The collection of data has been achieved by means of a questionnaire by investigators with sociological training. The study consists of hierarchical analysis of a questionnaire on representations, attitudes and behavior of patients with the help of Loevinger's coefficient. RESULTS: Test of several groups of hierarchized-answer questions allows to identify a 5 questions scale (scale whose coefficient value is 0.47). Otherwise, different social, psychological and therapeutic variables influence the integration of patients in the scale of therapeutic behavior. CONCLUSION: It is possible to recognize a scale of therapeutic behavior in type 2 diabetes. The use of several other sociological qualitative or quantitative methods, by different authors and in different contexts enables to approach the logic of the therapeutic behavior. Its understanding can allows us to adapt the education, the treatment and the follow-up to every patient.

[Primary lymphoma of the thyroid gland]. / Lymphome malin primitif de la thyroïde.

Malignant primary lymphoma of the thyroid gland is a rare disease generally occurring women in the 6(th) or 7(th) decade of life. The principal clinical sign is giant goiter rapidly leading to sings of compression, raising the question of differential diagnosis with anaplastic cancer. The radiological findings in our patient were suggestive of malignancy due to the locoregional invasion. Immunohistochemistry study of the surgical specimen was required to reach the definitive diagnosis of thyroid gland primary lymphoma. Diagnosis of malignant primary lymphoma of the thyroid gland made at the stage of extensive locoregional extension compromises prognosis. Our patient died after one session of chemotherapy.

[Incidence of factors favoring recurrent foot ulcers in diabetic patients]. / Etude de la fréquence et des facteurs favorisant les récidives des ulcères de pied chez les patients diabétiques.

BACKGROUND: Patients with foot ulcers have a high risk of relapse and amputation. Several studies have reported that 28 to 51% of amputated diabetics will have a second amputation of the lower limb within five years of the first amputation. The purpose of this study was to assess the incidence of factors favoring relapse within two years. MATERIAL AND METHODS: One hundred ten diabetic patients were treated for foot lesions in the Casablanca Ibn Rochd university hospital between 1997 and 2000. Ninety of these patients attended review consultations. RESULTS: There were 42 cases of relapse (46.6%). Male gender predominated in the relapse patients with a sex ratio of 3.2. Mean age at relapse was 55 years; 71.5% of the patients had type 2 diabetes. Lesions observed were neuropathic ulcer (n=23), arterial ulcer (n=6), infected wounds (n=13). Revealing factors were burns and wounds. The main risk factors were neuropathy (n=23, 52%), neuroarteriopathy (n=12, 31%), peur arteriopathy (n=6, 12%). Patients who relapsed (n=42) were significantly different from patients who did not relapse (n=48) for gender, presence or absence of neuropathy, and presence or absence of arteriopathy. DISCUSSION: Secondary preventive measures against these risk factors, medical care, and specialized follow-up were satisfactory in these patients. our findings illustrate the importance of specialized management of diabetic patients with foot lesions. Adequate care of the lesions and preventive measures against risk factors are needed.

Cell cycle regulation of the endogenous wild type Bloom's syndrome DNA helicase.

Bloom's syndrome (BS) is a rare human autosomal recessive disorder characterized by an increased risk to develop cancer of all types. BS cells are characterized by a generalized genetic instability including a high level of sister chromatid exchanges. BS arises through mutations in both alleles of the BLM gene which encodes a 3' - 5' DNA helicase identified as a member of the RecQ family. We developed polyclonal antibodies specific for the NH2- and COOH-terminal region of BLM. Using these antibodies, we analysed BLM expression during the cell cycle and showed that the BLM protein accumulates to high levels in S phase, persists in G2/M and sharply declines in G1, strongly suggestive of degradation during mitosis. The BLM protein is subject to post-translational modifications in mitosis, as revealed by slow migrating forms of BLM found in both demecolcine-treated cells and in mitotic cells isolated from non-treated asynchronous populations. Phosphatase treatment indicated that phosphorylation events were solely responsible for the appearance of the retarded moieties, a possible signal for subsequent degradation. Together, these results are consistent with a role of BLM in a replicative (S phase) and/or post-replicative (G2 phase) process. Oncogene (2000).

[Screening for diabetic retinopathy with ophthalmoscopy: the contribution of non-ophthalmologist practitioners seems possible]. / Dépistage de la rétinopathie diabétique par l'ophtalmoscopie: la contribution du médecin non ophtalmologiste paraît possible.

Diabetic retinopathy is a severe and frequent complication of diabetes. Screening and early treatment of retinal lesions avoid blindness, but diagnosis is often established too late. The purpose of our study was to compare the concordance between the results of examination of fundus oculi whether performed by a previously trained non ophthalmologist physician at diabetes day center or during a routine ophthalmology consultation. Results were classified a posteriori in order to have binary response (presence of the lesion, absence of the lesion). Ninety six eyes were examined. Results of these examinations were compared using the kappa test agreement (kappa). The concordance was good for the majority of retinal lesions. The concordance in the results suggests that the contribution of non ophthalmologist physicians to the screening of diabetic retinopathy is possible and could facilitate the selection of patients who require specialized and elaborate ophthalmologic exploration.

ATM-dependent phosphorylation and accumulation of endogenous BLM protein in response to ionizing radiation.

Bloom's syndrome (BS), a rare genetic disease, arises through mutations in both alleles of the BLM gene which encodes a 3'-5' DNA helicase identified as a member of the RecQ family. BS patients exhibit a high predisposition to development of all types of cancer affecting the general population and BLM-deficient cells display a strong genetic instability. We recently showed that BLM protein expression is regulated during the cell cycle, accumulating to high levels in S phase, persisting in G2/M and sharply declining in G1, suggesting a possible implication of BLM in a replication (S phase) and/or post-replication (G2 phase) process. Here we show that, in response to ionizing radiation, BLM-deficient cells exhibit a normal p53 response as well as an intact G1/S cell cycle checkpoint, which indicates that ATM and p53 pathways are functional in BS cells. We also show that the BLM defect is associated with a partial escape of cells from the gamma-irradiation-induced G2/M cell cycle checkpoint. Finally, we present data demonstrating that, in response to ionizing radiation, BLM protein is phosphorylated and accumulates through an ATM-dependent pathway. Altogether, our data indicate that BLM participates in the cellular response to ionizing radiation by acting as an ATM kinase downstream effector.

Comparison of NovoPen 3 and syringes/vials in the acceptance of insulin therapy in NIDDM patients with secondary failure to oral hypoglycaemic agents.

This open, randomised, cross-over study compared the acceptance and safety of NovoPen 3 with that of conventional syringes and vials when initiating insulin treatment in 96 NIDDM patients with secondary failure to oral hypoglycaemic agents. These patients had not previously been treated with insulin. All patients used each insulin administration system for 12 weeks. Group A started therapy using NovoPen 3 and crossed over to syringe/vial administration; Group B started with syringe/vial administration followed by NovoPen 3. In total, 78 patients completed the study. Most patients in Group A initially found the insulin injections very easy or easy and many of those who found injections easy at first found them very easy by the end of week 12. During the first period, patients in Group B found insulin administration more difficult than those in Group A. Injection pain was significantly lower with NovoPen 3 than with syringes and vials (P = 0.0018). Patients in Group B reported a significantly lower level of injection pain after the switch to using NovoPen 3 (P = 0.0003). Acceptance of insulin injections was significantly higher by patients using NovoPen 3 than by those using syringes and vials (P = 0.0059). Setting and drawing up the dose of insulin was also easier for patients using NovoPen 3 (P = 0.0490). At the end of the study, most patients (89.5% (68/76 replies)) said that they preferred NovoPen 3 to syringes and vials. Glycaemic control improved compared with baseline after starting insulin therapy, with no differences between Groups A and B, or between the two injection systems. The number of reported hypoglycaemic episodes was very low and was not significantly different between Groups A and B, or between the two administration systems. No treatment-related adverse events were reported. We conclude that use of NovoPen 3 provides better acceptance of insulin injection than use of conventional syringes and vials during initiation of insulin therapy in NIDDM patients with secondary failure to treatment with oral hypoglycaemic agents.