[Congenital analbuminemia complicated by relapsing acute coronary syndrome : A case report and literature review]. / Analbuminémie congénitale compliquée d'un syndrome coronarien aigu récidivant : à propos d'un cas et revue de la littérature.

Congenital analbuminemia (CAA) is a very rare disorder with an estimated prevalence of less than one in one million. This anomaly can be lethal at birth and in early infancy but it's not very symptomatic in adulthood. The clinical signs are edema, lipodystrophy, fatigue… Hypercholesterolemia is the main biological disorder and it predisposes to cardiovascular complications. The mild symptoms of CAA leads to delay diagnosis. That's why clinical and biological signs of this disorder should be known by both of biologist and clinician to establish an early diagnosis in order to prevent cardiovascular complications. We report a new case of congenital analbuminemia complicated by recurrent acute coronary artery disease in 34-year-old man. This complication has been reported only once according to the register of analbuminemia cases.

Ochratoxin A levels in human serum and foods from nephropathy patients in Tunisia: where are you now?

Ochratoxin A is a natural mycotoxin with nephrotoxic properties that can contaminate food products. It has been detected in high amount in human serum collected from nephropathy patients, especially those categorized as having a chronic interstitial nephropathy of unknown etiology. In the present study, ochratoxin A levels were measured in commonly consumed food items and in serum samples from nephropathy and healthy subjects in Tunisia. To assess ochratoxin A, a high performance liquid chromatography method was optimized. The ochratoxin A assay showed very different scales of ochratoxin A serum and food contamination from 0.12 to 1.5 ng/mL and 0.11 to 6.1 ng/g respectively, and in healthy subjects and 0.11 to 33.8 ng/g for food and 0.12 to 3.8 ng/mL for serum in nephropathy patients suffering from chronic interstitial nephropathy of unknown etiology. The disease seems related to ochratoxin A serum levels and food contaminations, since the healthy group was significantly different from the nephropathy group (P<0.001) for both food and serum ochratoxin A contamination. Those results combined with data published already, emphasize the likely endemic aspect of ochratoxin A-related nephropathy occurring in Tunisia.

[CRP and micro-albumin: new markers of cardiovascular risk in type 2 diabetes]. / CRP et micro-albuminurie : nouveaux marqueurs du risque cardiovasculaire chez les diabétiques de type 2.

INTRODUCTION: Type 2 diabetes is a chronic disease associated to the presence of multiple risk factors. Among recently studied factors we cite PCR and micro-albumin. OBJECTIVE: In the present study we intend to determine the correlation between urine albumin excretion rate, CRP levels and type of vascular complications in type 2 diabetes. PATIENTS AND METHODS: We recruited 48 type 2 diabetic subjects subdivided into three groups according to the type of vascular complications (GI: type 2 diabetics without complications, GII: type 2 diabetics with microvascular complications and GIII: type 2 diabetics with macrovascular complications). RESULTS: We found a significant elevated levels of CRP and micro-albumin (P<0.05) when we compared diabetics with vascular complications to those without any complications. Diabetics with macrovascular complications have the highest levels of CRP and micro-albumin. Significant positive correlation was found between CRP and micro-albumin levels in a total group of diabetics (r=0.32; P<0.05). CONCLUSION: The determination of CRP and microalbumin levels represents an interest in the screening of cardiovascular disease in type 2 diabetics.

Total homocysteine levels and cardiovascular risk factors in healthy Tunisians.

Hyperhomocysteinaemia is considered as an important independent risk factor for atherosclerosis and thrombotic disease. This study determined the distribution of homocysteine (Hcy) levels in healthy Tunisian subjects and evaluated the relationship between Hcy levels and some cardiovascular risk factors. Randomly selected subjects (592 men and 114 women) were recruited from different regions of Tunisia. The overall mean Hcy level was 12.6 (SD 5.4) micromol/L. Hcy levels in subjects with hyperhomocysteinaemia varied according to geographical region. Subjects with hyperhomocysteinaemia had significantly elevated total cholesterol, LDL cholesterol, apolipoprotein A and apolipoprotein B and lower vitamin B12 levels compared with subjects with normohomocysteinaemia. Hcy levels correlated with total cholesterol (r = 0.09), apolipoprotein A (r = 0.012), and B (r= 0.013) levels and total/HDL cholesterol ratio (r = -0.085). Further epidemiological studies are needed to determine the precise role of Hcy in cardiovascular disease.

Total homocysteine levels and cardiovascular risk factors in healthy Tunisians

Hyperhomocysteinaemia is considered as an important independent risk factor for atherosclerosis and thrombotic disease. This study determined the distribution of homocysteine [Hcy] levels in healthy Tunisian subjects and evaluated the relationship between Hcy levels and some cardiovascular risk factors. Randomly selected subjects [592 men and 114 women] were recruited from different regions of Tunisia. The overall mean Hcy level was 12.6 [SD 5.4] micromol/L. Hcy levels in subjects with hyperhomocysteinaemia varied according to geographical region. Subjects with hyperhomocysteinaemia had significantly elevated total cholesterol, LDL cholesterol, apolipoprotein A and apolipoprotein B and lower vitamin B[12] levels compared with subjects with normohomocysteinaemia. Hey levels correlated with total cholesterol [r= 0.09], apolipoprotein A [r = 0.012], and B [r= 0.013] levels and total/HDL cholesterol ratio [r- =0.085]. Further epidemiological studies are needed to determine the precise role of Hcy in cardiovascular disease

[Procalcitonin in invasive candidosis]. / Procalcitonine et candidoses invasives en milieu de réanimation.

The use of reliable and specific diagnosis tools in patients of intensive care unit constitutes the best way to follow up these patients and to take charge of severe infections. It is in the context that the measuring of procalcitonin should be considered in order to prove its role in invasive candidosis. This prospective study included 52 patients from an intensive care unit. Blood samples for serum procalcitonin were drawn on days 1, 3, 5. Our results showed that on the one hand, procalcitonin levels have significantly increased in cases of confirmed and probable candidosis. On the other hand, this parameter has a certain prognosis value. In conclusion, an increase in procalcitonin level does not only imply a bacterial infection but it should also evoke a case of invasive candidosis especially in intensive care units.

[Consequences of insulin resistance on lipid profile in type2 diabetics group: study of 118 cases]. / Conséquences de l'insulinorésistance sur le bilan lipidique chez un groupe de diabétiques de type 2: à propos de 118 cas.

Insulin is a hormone which has an essential role in lipids metabolism by modulating the activity of many key enzymes and by its intervention on the production and the catabolism of lipoproteins. The aim of this study was to determine the influence of insulin resistance on lipid profile in a diabetic group. The study group consists of 118 diabetic patients. We assayed for each patient total cholesterol, high density lipoprotein cholesterol, triglycerides and insulin. Insulin resistance was determined by HOMA index. Insulin was found correlated to body mass index, triglycerides, waist circumference, and glycated haemoglobin. Triglycerides and glycated haemoglobin were significantly more elevated in insulin resistant group than in insulin sensitive group. Insulin resistance may be the initial anomaly in type 2 diabetes and incite us to search on molecular anomalies in the insulin action.

Anticoagulant profile of iopamidol and meglumine amidotrizoate and their lack of thrombin generation: an in vitro study.

The aim of this in vitro study was to sketch the subtle anticoagulant profile of iopamidol 300 mg l/ml (low osmolality non ionic contrast medium) and meglumine amidotrizoate 370 mg l/ml (high osmolality ionic contrast medium) in situations where variable amounts of clotting factors are observed and to check whether thrombin-generation significantly occurred in non anticoagulated blood-contrast materials mixtures. In the first experiment, mixtures of deficient plasmas with a routine plasma pool provided different ranges with variable amounts of clotting factors II, V, VIII, X, XI and XII. For each clotting factor level studied within these ranges, an activated partial thromboplastin time was determined with either contrast material loaded thromboplastin (5% v/v) or glucose loaded thromboplastin (5% v/v) used as a control. In the second experiment fibrino-peptide A (FpA) or modified antithrombin III (ATM) assays were performed in either (9:1) non anti-coagulated blood contrast materials mixtures or blood-glucose mixtures (control). Differing aPTT prolongation profiles were observed when clotting factors V, VIII, XI and XII were lowered in the plasma. However, neither iopamidol nor amidotrizoate induced an aPTT prolongation with decreasing clotting factor II. In the second experiment no significant thrombin generation was observed as both blood-contrast materials mixtures showed significantly lower FpA and ATM levels (p < 0.001) than glucose control after 5 minutes and 10 minutes incubation at room temperature. These findings provide evidence that the use of iopamidol in angiographic procedures does not increase risk of clotting or hemorrhage.

Antiphospholipid antibodies: lupus anticoagulants, anticardiolipin and antiphospholipid isotypes in patients with sickle cell disease.

Antiphospholipid antibodies were investigated in 37 individuals with sickle cell disease and compared to a control group of 30 healthy subjects. Sickle cell patients included 18 homozygous sickle cell patients, 8 S/beta thalassemic patients and 11 sickle cell trait subjects. In all individuals, antiphospholipid antibodies were explored by lupus anticoagulant (LA) detection and the quantification of IgG and IgM anticardiolipin (aCL) isotypes, total antiphospholipid antibodies (APA) and IgM, IgG and IgA antiphospholipid classes. In homozygous sickle cell patients, mean level of IgG aCL and total APA were significantly increased (17.02 +/- 8.88 GPL/ml, p < 0.05 and 10.64 +/- 10.58 UPL/ml, p < 0.05 respectively). The IgG aCL, total APA and LA frequencies were 22.2%, 44.4% and 62.2%, respectively. APA isotypes were mostly IgG or IgG and IgA. In S/beta thalassemic patients, mean levels of APA were significantly increased (10.81 +/- 7.82 UPL/ml, p< 0.05). Their frequency was 71.4% and they were mostly IgG or IgG and IgA. In patients with sickle cell trait, mean levels of APA were significantly increased (10.84 +/- 5.84 UPL/ml, p < 0.01). Their frequency was 72.7% and mostly of IgG isotype. Our study showed a close association between high APA levels and sickle cell syndrome, however there was no relationship between high levels of antiphospholipid antibodies and the major complications of sickle cell disease.

Fibrinolytic response to venous occlusion in patients with homozygous sickle cell disease.

The fibrinolytic potential was evaluated in 37 patients with homozygous sickle cell disease and compared to a control group of 30 age- and sex-matched healthy volunteers. In all individuals, the euglobulin clot lysis time and plasma antigen levels of t-Pa and PAI-1 were measured before and after venous occlusion (v.o) for 10 min. The global fibrinolytic activity was normal in 4 patients (good responders to v.o), while it was decreased in 33 patients (poor responders to v.o). Among the latter, 22 patients had significantly increased baseline levels of PAI-1 Ag (82.6 +/- 27.5 ng/ml, p < 0.001) and a normal release of t-Pa Ag after v.o. In contrast, 11 patients had basal values of PAI-1 Ag comparable to those in controls with a defective release of t-Pa Ag after v.o (11.4 +/- 5.2 ng/ml, p < 0.01). These data provide evidence for reduced fibrinolytic capacity resulting from either increased basal levels of PAI-1 or defective release of t-PA.

[Extra-adrenal gland pheochromocytoma. Apropos of 3 cases and review of the literature]. / Le phéochromocytome extrasurrénalien. A propos de trois observations et revue de la littérature.

The authors report three new cases of ectopic pheochromocytoma: latero-aortic, bladder and near the kidney. From the review of the literature, they propose a diagnostic and therapeutic strategy for the management of ectopic localisation of pheochromocytoma.