[Metabolic syndrome among people with HIV in central Tunisia: Prevalence and associated factors]. / Le syndrome métabolique chez les personnes vivant avec le VIH dans le centre tunisien : prévalence et facteurs associés.

INTRODUCTION: Metabolic abnormalities are frequently reported in HIV infection. They were mainly related to the chronic infection and the use of antiretroviral therapy. OBJECTIVE: Describe the epidemiological, clinical, laboratory and treatment features of people living with HIV (PLHIV) on antiretroviral therapy and determine the prevalence of metabolic syndrome and its associated factors. MATERIALS AND METHODS: We conducted a cross-sectional, descriptive and analytical study in the service of Infectious Diseases of the University Hospital of Monastir. We included all PLHIV on antiretroviral therapy for at least 3 months. Biological explorations based on metabolic parameters were performed systematically for all patients after informed consent. Metabolic syndrome was assessed according to the definitions of the International Diabetes Federation (IDF) in 2005. We divided the patients into two groups: Group A: PLHIV with metabolic syndrome (n=19) and Group B: PLHIV without metabolic syndrome (n=51). RESULTS: We included in this study 70 PLVIH. The metabolic syndrome was noted in 19 cases (27.1%). The average age was 43.7 years in group A and 36.7 years in group B. Gender distribution were uniform in the two groups (P=0.4). HIV infection has been evolving for 9.7 and 5.8 years respectively in group A and B, P=0.017. Body mass index (BMI) was significantly higher in group A (26.4 vs 23.5kg/m2, P=0.008). Two patients in group A (10.5%) and 14 patients in group B (27.4%) had a low CD4 count (<200/mm3). Protease inhibitor regimens were prescribed in five cases (26.3%) in group A and 26 cases (50.9%) in group B. In multivariate models, Age over 40 (OR=9.9, 95% CI 2.4-40.6, P=0.001) and BMI ≥25 Kg/m2 (OR=8.47, 95% CI 1.94-36.8, p=0.004) were both independently associated with the presence of the metabolic syndrome. CONCLUSION: Metabolic syndrome is common among PLHIV on antiretroviral therapy. The identification of factors associated is a main parameter for early detection of metabolic risk and personalized management.

[Dyslipidemia and suicidal risk in patients with psychiatric disorders]. / Dyslipidémie et risque suicidaire chez des patients avec maladies psychiatriques.

The aim of this work is to study the association between dyslipidemia and suicidal risk in patients with psychiatric pathology. Our study has involved 155 patients suffering from major depressive disorder and 124 schizophrenic patients aged 40.58±12.16 and 43.43±10.60 years, respectively. Total cholesterol (TC), triglycerides (TG) and HDL-c were determined by enzymatic methods, LDL-c was calculated by the Friedewald formula. Plasma cholesterol level was significantly lower among suicidal schizophrenic or depressive patients. There were no significant differences in the others lipid levels. The results of our study suggest that total cholesterol values less than 3.59mmol/L could be an indicator of suicide vulnerability in patients with schizophrenia or major depressive disorder.

In vivo behavior of MIL-100 nanoparticles at early times after intravenous administration.

Metal-organic frameworks have shown interesting features for biomedical applications, such as drug delivery and imaging agents. The benchmarked mesoporous iron(III) trimesate MIL-100 MOF nanocarrier combines progressive release of high drug cargoes with absence of visible in vivo toxicity. Although in a previous study pharmacokinetics and biodistribution of MIL-100 nanoparticles were evaluated in the long term (from 24h to 1 month), the crucial times for drug targeting and delivery applications are shorter (up to 24h). Thus, this work aims to study the blood circulating profile and organ accumulation of MIL-100 nanocarrier at early times after administration. For this purpose, after intravenous administration to rats, both constitutive components of MIL-100 (trimesate and iron) were quantified by high performance liquid chromatography and a spectrophotometric method, respectively. The pharmacokinetic profile suggested that the nanoparticles act as a depot in the blood stream during the first hours before being cleared. Accumulation took mainly place in the liver and, in some extent, in the spleen. Nevertheless, histological studies demonstrated the absence of morphological alterations due to the presence of the particles in these organs. Liver function was however slightly altered as reflected by the increased plasma aspartate aminotransferase concentrations. Finally trimesate was progressively eliminated in urine.

Effect of cigarette smoking on insulin resistance risk.

OBJECTIVES: Smoking is one of the main risk factors for cardiovascular disease (CVD). The mechanism(s) of the effects of smoking on CVD are not clearly understood; however, a number of atherogenic characteristics, such as insulin resistance have been reported. We aim to investigate the effects of cigarette smoking on insulin resistance and to determine the correlation between this parameter with smoking status characteristics. STUDY DESIGN: This study was conducted on 138 non-smokers and 162 smokers aged respectively 35.6±16.0 and 38.5±21.9 years. All subjects are not diabetic. METHODS: Fasting glucose was determined by enzymatic methods and insulin by chemiluminescence method. Insulin resistance (IR) was estimated using the Homeostasis Model of Assessment equation: HOMA-IR=[fasting insulin (mU/L)×fasting glucose (mmol/L)]/22.5. IR was defined as the upper quartile of HOMA-IR. Values above 2.5 were taken as abnormal and reflect insulin resistance. RESULTS: Compared to non-smokers, smokers had significantly higher levels of fasting glucose, fasting insulin and HOMA-IR index. These associations remained significant after adjustment for confounding factors (age, gender, BMI and alcohol consumption). A statistically significant association was noted between the smoking status parameters, including both the number of cigarettes smoked/day and the duration of smoking, and fasting insulin levels as well for HOMA-IR index. Among smokers, we noted a positive correlation between HOMA-IR index and both plasma thiocyanates and urinary cotinine. CONCLUSION: Our results show that smokers have a high risk to developing an insulin resistance and hyperinsulinemia, compared with a matched group of non-smokers, and may help to explain the high risk of cardiovascular diseases in smokers.

[Is PON1 a factor of cardiovascular risk in type 2 diabetes?]. / La PON1 est-elle un facteur du risque cardiovasculaire chez les diabétiques de type 2 ?

OBJECTIVE: We evaluate the association between the decrease of serum paraxonase 1 activity and the risk of cardiovascular disease in type 2 diabetes. METHODS: One hundred and fourteen patients with type 2 diabetes were included in the present study. Seventy-one of them have significant coronary disease. The control group consisted of 53 healthy adults. RESULTS: PON1 activity was significantly reduced in diabetic patients compared to controls (P=0.021), especially in those with significant coronary disease (P=0.013). No significant variation in PON1 activity according to age was observed both in controls and in patients. When HDLc≥1.03mmol/L, the PON1 activity was significantly higher in patients without significant coronary disease compared to those with significant coronary disease (0.030). In case of significant coronary disease, a decrease of 12.23% in PON1 activity was observed in smokers compared with non-smokers, but without statistical significance. The PON1 activity did not very significantly according to the presence or absence of hypertension in patients with significant coronary disease. CONCLUSION: The implication of diabetes in the decrease of PON1 activity seems highly probable but PON1 activity seems not to be in itself a marker of cardiovascular disease.

Zearalenone-induced changes in biochemical parameters, oxidative stress and apoptosis in cardiac tissue: Protective role of crocin.

Zearalenone (ZEN) is a mycotoxin from Fusarium species commonly found in food commodities and is known to cause reproductive disorders. Several in vivo studies have shown that ZEN is haematotoxic and hepatotoxic and causes several alterations of immunological parameters. Meantime, the available information on the cardiotoxic effects of ZEN is very much limited. In the present study, we investigated the toxic effects of ZEN in heart tissues of Balb/c mice. We demonstrated that ZEN (40 mg kg(-1) body weight (b.w.)) increased creatine phosphokinase, lactate dehydrogenase, aspartate transaminase, alanine transaminase, total cholesterol and triglyceride levels and induced oxidative stress as monitored by measuring the malondialdehyde level, the generation of protein carbonyls, the catalase and superoxide dismutase activity and the expression of the heat shock proteins (Hsp 70). We also demonstrated that acute administration of ZEN triggers apoptosis in cardiac tissue. Furthermore, we aimed to evaluate the safety and efficacy of crocin (CRO), a natural carotenoid, to prevent ZEN-induced cardiotoxicity in mice. In fact, combined treatment of ZEN with different doses of CRO (50, 100, and 250 mg kg(-1) b.w.) showed a significant reduction of ZEN-induced toxicity for all tested markers in a dose-dependent manner. It could be concluded that CRO was effective in the protection against ZEN-induced toxicity in cardiac tissue.

[Stone composition in the central coast Tunisian population]. / Étude de la composition des calculs urinaires en fonction de l'âge dans la population du centre tunisien.

BACKGROUND: Studies that evaluated the effect of age and gender on the stone composition were scarce. The aim of this study was to identify the stone composition in Tunisian patients and to highlight their modification according to patients' sex and age. PATIENTS AND METHODS: We studied 1200 urolithiasic patients, from the urologic and the pediatric surgery departments, ranging from six months to 92years old and known as having urinary stones (729 males and 471 females). Stone analysis was performed respectively using a stereomicroscope and infrared spectroscopy to determine, respectively, the morphological type and the molecular composition of each. RESULTS: Kidney stones were encountered in 48.6% of calculi. Children and old men were more affected by bladder stone. Whewellite was the main component in 51.8% of the stones and 39.6% of the stone core, its frequency fell according to age from 61.4% in young adults to 47.7% in elderly in favor of the increase of uric acid stones, from 16.4% in young adults to 35.6% in elderly (P<0,02). Struvite stones were rare (3.2%) and more frequent in boys. CONCLUSION: The analysis of these data shows that urinary stones in Tunisia were tending to evolve in the same direction as in industrialized countries.

[Ochronosis: report of two familial cases]. / L'ochronose: a propos de deux cas familiaux.

BACKGROUND: Ochronosis of alkaptonuria is a rare hereditary autosomal recessive disease in which there is an absence of homogentisic acid oxidase resulting in accumulation of homogentisic acid in tissues. AIM: To report a new case of alkaptonuria CASE REPORT: A 49-year-old man had been followed for 4 years for chronic lombalgia and arthropaty of two knees. He is married to his cousin and father of 4 girls. His parents are also cousins. The clinical examination has found a cutaneuous pigmentation and a lumbar stiffness. At biological checking, creatininemia was at 190 µmol/L and there are not inflammatory indicators. The radiography have shown a discal dorsolumbar calcifications, anterior inter somatic bridges and bilateral arthritis of knees without articular chondrocalcinosis. The diagnosis of ochronosis have been suspected and confirmed by the blackness of urine and the dosage of alkaptonuria. The patient has been treated symptomatiquely. Familial investigation have revealed that his daughter suffered from the same disease with the notion of blackness of urine. She is 12 year old and she's asymptomatic on the osteoarticular level. CONCLUSION: Alkaptonuria causes a degenerative arthropaty which can endanger functional prognosis. Early diagnosis and scanning of this innate error of metabolism by genetic study play a fundamental interest, especially for molecular and genetic advisement.

Metabolic syndrome in Tunisian bipolar I patients.

BACKGROUND: The metabolic syndrome is a growing global public health problem which is frequently associated with psychiatric illness. OBJECTIVES: To evaluate the prevalence of metabolic syndrome and to study its profile in Tunisian bipolar I patients. METHODS: Our study included 130 patients with bipolar I disorder diagnosed according to the DSM-IV and assessed for metabolic syndrome according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria. The mean age was 37.9 ± 12.1 years, 45 were women (mean age 37.5 ± 13.4 years) and 85 were men (mean age 38.1 ± 11.4 years). RESULTS: The prevalence of metabolic syndrome was 26.1%.The highest prevalence of this syndrome was obtained by association between obesity, low c-HDL and hypertriglyceridemia (44.1%). In the total sample, 59.2% met the criteria for low c-HDL, 53.1% for hypertriglyceridemia, 33.8% for obesity, 16.1% for high fasting glucose and 5.4% for hypertension. Gender, age, illness episode and treatment were not significantly associated with metabolic syndrome, while patients under lithium had higher prevalence of metabolic syndrome than those under valproic acid, carbamazepine or antipsychotics. Patients with metabolic syndrome had significant higher levels of HOMA-IR and uric acid than metabolic syndrome free patients (p< 0.001). CONCLUSIONS: Bipolar patients have high prevalence of metabolic syndrome which is associated with insulin resistance and an increase of uric acid values that raise the risk of cardiovascular disease.

False bisalbuminemia and hyperalphafetoproteinemia.

The capillary electrophoresis is a very powerful separation method offering a high degree of resolution. However, certain interferences can be detected giving transitory shoulders or peaks. We report the case of a serum protein electrophoresis performed with Capillarys (Sebia) in a 68-year-old patient, hospitalized for cancer of the head of the pancreas, which showed an important shoulder in the migratory range of albumin, simulating bisalbuminemia. An interference with alphafetoprotein was proven explaining this electrophoretic aspect.

[Complex metabolic disorders revealing a gastric ulcer of the bulb. A case report]. / Troubles métaboliques complexes révélateurs d'un ulcère gastrique sténosant du bulbe. A propos d'un cas.

We report the case of a 54-year-old man, without particular pathological antecedents admitted to the emergency of the university hospital of Monastir, for right renal colic. Radiography of the urinary tract without preparation and renal echography showed bilateral renal lithiasis and a right ureteral lithiasis. The interrogation revealed concept of vomiting after which the patient felt relieved. The biological assessment objectified an hypochloremic metabolic alcalosis, an increase in the anion gap, a severe impaired renal function of obstructive origin and an hypokaliemia. The presence of the lithiasis did not explain on its own the metabolic disorders of this patient. The other investigations showed that initial pathology was an evolutionary bulb ulcer into pre-stenosis justifying treatment by omeprazole and explaining the biological disorders.

[Mercury impregnation in dentists and dental assistants in Monastir city, Tunisia]. / L'imprégnation mercurielle des dentistes et de leurs assistants dans la ville de Monastir, Tunisie.

INTRODUCTION: The property of mercury to amalgamate with other metals is used to create a material for filling teeth. This material remains the cheapest and most efficient in tooth restoration. Mercurial toxicity has been documented since Antiquity but the metal remains widely used in some countries. This study compared mercury impregnation in dentists and dental assistants in Monastir (Tunisia) to another population not exposed professionally. SUBJECTS AND METHODS: A cross-sectional study was made on 52 dentists and dental assistants working in private offices and in the stomatology unit of the Monastir teaching hospital, with a control group of 52 physicians and nurses working in the Monastir Fattouma Bourguiba hospital. The groups were paired according to age and gender. The study lasted three months. A questionnaire investigated the socioprofessional features of the study population, non professional mercury exposure, work environment, the various amalgam handling and preparation techniques, and preventive hygiene measures. Urinary and salivary sampling was performed so as to prevent any accidental mercurial contamination. Mercury level was assessed by atomic absorption spectroscopy in an automatic sampler, urine creatinine with Jaffé's colorimetric reaction. The results of mercury level assessment were expressed in microg/g of creatinine, salivary mercury in mug/l. The statistical analysis was made with the Epi.info 6 software. Khi(2) and Fisher tests were used to compare qualitative variables. The ANOVA test was used to compare averages with a statistic significance threshold at 0.05. RESULTS: Sixty-one percent of individuals with risk exposure worked in a dental clinic. Bruxism and onychophagia were more important in the control group with a significant statistical difference (respectively, p=0.01 and p<0.0001). The urinary and salivary mercury levels were significantly increased in the exposed group, with respective values of 20.4+/-42.4microg/g of creatinine and 10.6+/-13.02microg/l versus 0.04+/-0.3microg/g of creatinine and 0microg/l in the control group. Disposing of amalgam waste was inadequate in 94% of the cases. The variation of mercury in urine was significantly influenced by the presence of fabric curtains (p=0.04). Eating lunch at meals at the work place was also linked to a significant increase of mercury levels in urine (p=0.04). The storage mode of mercury in open containers was a significant factor for variation of mercury level (p=0.03). DISCUSSION: Most dentists' private offices in Monastir do not comply or comply weakly with prevention measures linked to risk of mercury poisoning. Awareness campaigns were launched as well as actions for the improvement of work conditions: efficient aspiration of offices containing fixed sources of mercury, adequate storage of mercury and waste, and compliance to occupational hygiene rules.

[A case of hypernatremic dehydration due to breast-feeding]. / Déshydratation hypernatrémique au cours d'un allaitement maternel.

The authors report an 11-day-old exclusively breast-fed female, with a birth weight of 3 300 g, who had suffered from dehydration stage I, with acute renal failure and metabolic acidosis, with 170 mmol/L of serum sodium. Renal ultrasounds were normal but the rate of sodium in mother's milk was three times higher than controls (87 versus 21 mmol/L). Intravenous rehydration allowed the correction of hydroelectrolytic disorders.

[Evaluation of a spectrophotometric technique for plasmatic haemoglobin determination on Konelab 30]. / Evaluation d'une technique spectrophotométrique pour le dosage de l'hémoglobine plasmatique sur Konelab 30(TM).

INTRODUCTION: the measurement of plasma haemoglobin is utilized in the evaluation of various haemolytic phenomenons, especially at the time of sampling. Besides, the methods used to titrate plasmatic haemoglobin, an analysis which is of great interest to cardiac surgery, must be very accurate, because plasmatic levels are much lower than those found in whole blood. BACKGROUND: the purpose of this work is to present a new technique for direct determination of plasmatic haemoglobin. MATERIAL AND METHODS: this method was studied and adapted on a multiparametric analyzer Konelab 30 (Thermo Electron Corporation). The correlation was assessed with a Sigma Diagnostics spectrophotometric method, using the 3,3',5,5'-tetramethylbenzidine (TMB), a non carcinogenic reagent. The reaction of haemoglobin with TMB was studied with a SECOMAM S500P UV-Visible spectrometer. RESULTS AND DISCUSSION: the method demonstrates linearity, precision, and sensitivity suitable for clinical use and not affected by the presence of bilirubin, nor triglycerides. The method was precise (CV < 1,00%), accurate (CE < 5,00%) and showed excellent recovery of haemolysis (R > 0,95). The CV for the automated assay was less than 1%. Reference ranges were studied and lithium heparinate seems to be the best anticoagulant to use so as to minimize haemolysis. CONCLUSION: the studied technique is practical, specific, accurate, fast, reliable and inexpensive, and was adopted in emergency as in daily routine in our laboratory for plasmatic haemoglobin determination in various situations.

[Adaptation of Biomerieux enzymatic UV ammonia on Konelab analysers]. / Adaptation de l'ammonium enzymatique UV de BioMérieux sur automates Konelab.

INTRODUCTION: Circulating ammonia in normal patients is relatively low, despite the fact that ammonia is continually produced from endogenous amino acid metabolism. The physiopathological interest of plasmatic ammonia determination lies primarily in its relationships to hepatic insufficiency (cirrhotic or neoplasic), or the diagnosis and the forecast of the Reye's syndrome. OBJECTS: This study describes an evaluation of plasmatic ammonia determination by the UV end point enzymatic method using GLDH on KONELAB(TM) analyzers. METHODS: The glutamate dehydrogenase (GLDH : EC.1.4.1.3) catalyses the reducing amination of alpha-cetoglutarate in the presence of NH(4)(+) and of NADPH, H(+) to form glutamate and NADP(+). The reduction of NADPH,H(+)'s concentration, directly proportional to ammonia rates, is evaluated at 340 nm. All the conditions were met to optimize the method, while covering a satisfying field of measurement. RESULTS AND COMMENTS: The evaluation of the modified method showed a good precision (repeatability: CV < 4 %; interserial reproducibility: CV from 2.01 to 2.93 %; Intraserial reproducibility: CV equal to 0.67%) and a very good accuracy. The field of measurement extends from 27 to 250 micromol/L, with a limit of detection (L(D)) lowered to 0.325 micromol/L. CONCLUSION: The adapted technique is simple, fast, inexpensive and especially automatizable. It is in addition reliable and chiefly more sensitive, adapting particularly to the determination of plasmatic ammonia in urgency as in routine within our laboratory.

[Determination of urinary citrates by an alternative of Millan's method]. / Détermination des citrates urinaires par une variante de la méthode de Millan.

INTRODUCTION: the physiopathological interest of the determination of urinary citrate lies primarily in its relationships to the lithiasic processes. Indeed, the citrate is a powerful complexing agent of calcium able to lower urinary supersaturation of oxalate and phosphate of calcium. OBJECTS: this study describes a revaluation of the determination of urinary citrates by the colorimetric method of Millan. METHODS: the principle of the method rests on the quantification of the yellow complex formed with iron chloride III and the urinary citric acid, measurable at 390 nm in acidic medium. All the conditions were combined to optimize it, while covering a satisfying field of measurement. RESULTS AND COMMENTS: the evaluation of the modified method showed a good precision (repeatability: CV from 0,18 to 3,42%; intraserial reproducibility: CV from 1,87 to 3,44 %; interserial reproducibility: CV from 2,15 to 5,52%) and a very good accuracy. The field of measurement extends up to 17,0 mmol/L, with a limit of detection (L(D)) lowered to 0,2 mmol/L (Vs 1,48 mol/L for the original method). All analytical performances are improved by automation with a L(D) = 0,09 mmol/L and a limit of linearity extended to 18 mmol/L. CONCLUSION: this modified, simple, fast, inexpensive and easily automatizable technique, seems to be reliable and especially more sensitive, adapting particularly to the detection of subjects suffering a deficit of citrate secretion, one of most significant inhibiting agent of lithiasis kidney formation.

Effect of hyperprotidic diet associated or not with hypercalcic diet on calcium oxalate stone formation in rat.

The aim of this study was to determine whether protein, administered alone or simultaneously with a hypercalcic diet, was able to aggravate calcium oxalate stone formation in rats. Thirty-two male Wistar rats were randomly divided into four groups of 8 rats each and assigned a calcium oxalate lithogenic diet added to their drinking water for 3 weeks. One group, used as reference, received a standard diet prepared in our laboratory. The second was assigned the same diet but supplemented with 7.5 g animal proteins/100 g diet. The third received a diet containing 500 mg calcium more than the standard group. The diet given to the last group was supplemented with calcium and protein at the same doses indicated previously. One day before the end of treatment, each animal was placed in a metabolic cage to collect 24-hour urine samples and determine urinary creatinine, urea, calcium, magnesium, phosphate, uric acid, citric acid and oxalate levels. Immediately thereafter, aortic blood was collected to determine the same parameters as in urine. The kidneys were also removed to determine calcium oxalate deposits. Our results showed an increased 24-hour urinary excretion of calcium, oxalate and uric acid and decreased urinary citric acid excretion only in groups that received protein supplementation. At the same time, calcium oxalate deposits were found significantly higher in hyperprotidic diets than reference or calcium-supplemented groups. According to these findings, glomerular filtration, fractional excretion of urea and reabsorption of water, calcium and magnesium were found significantly lower in hyperprotidic diets compared to other groups. These results demonstrate that proteins could seriously aggravate calcium oxalate stones and cause renal disturbances.