[Neurological soft signs in schizophrenic patients and their nonaffected siblings]. / Signes neurologiques mineurs chez les patients schizophrènes et leurs apparentés non malades.

BACKGROUND: Neurological soft signs (NSS) are subtle neurological signs indicating non specific cerebral dysfunction. Several studies have found an excess of NSS in schizophrenic patients compared to healthy subjects. Although NSS have been consistently reported in schizophrenic patients, their clinical relevance and their relation to functional impairment and severity of this disease are not well-clarified. In addition, the presence of NSS in schizophrenic patient's relatives suggests that they could be associated with the genetic liability. OBJECTIVES: To determine the prevalence and scores of NSS in schizophrenic patients and their nonaffected siblings and to examine the clinical correlates of NSS in the schizophrenic patients. METHOD: Sixty-six schizophrenic patients (50 males and 16 females, mean age=31.16+/-7.17 years), were compared to 31 of their nonaffected siblings (22 males and nine females, mean age=32.19+/-5.88 years) and to 60 controls subjects (40 males and 20 females, mean age=30.70+/-6.54 years) without family psychiatric history. NSS were assessed with Krebs et al.'s neurological soft signs scale. It is a comprehensive and standardized scale consisting of 23 items comporting five factors: motor coordination, motor integration, sensory integration, quality of lateralization and involuntary movements or posture. The Simpson and Angus scale for extrapyramidal symptoms was also rated. Clinical assessment of the schizophrenic patients was conducted using the positive and negative syndrome scale (PANSS), clinical global impressions (CGI) and global functioning evaluation (GAF). Psychiatric disorders were ruled out among siblings of schizophrenic patients and control subjects by psychiatric review evaluation, according to the DSM-IV check list. RESULTS: When the total NSS score of 11.5 was considered the cut-off point, the prevalence of NSS was 96.9% in the schizophrenic patients versus 35.5% in the nonaffected siblings (p<0.0001). Schizophrenic patients had also significantly higher NSS total score and subscores than the siblings and control groups. The NSS total score was 19.51+/-5.28 in the schizophrenic patients, 10.77+/-3.38 in their nonaffected siblings and 4.23+/-2.07 in control subjects (p<0.0001). The NSS total score and subscores in the siblings group were intermediate between those of the schizophrenic patients and those of the control subjects. The motor coordination, motor integration and sensory integration subscores were higher in schizophrenic patients and their nonaffected siblings. The NSS total score correlated positively with the negative (p<0.0001) and disorganization symptoms (p=0.001) subscores and total score of PANSS (p=0.004). The PANSS total score and negative and disorganization subscores also correlated positively with the motor integration and quality of laterality subscores of NSS. The NSS total score was significantly correlated with severity of illness (p<0.0001), lower educational level (p=0.002) and poor global functioning (p=0.003). CONCLUSIONS: The association between NSS with negative and disorganization dimensions of schizophrenia supports that neurological dysfunction is an intrinsic characteristic of the illness and may distinguish a subgroup of patients with poor illness course and outcome. The NSS could be a trait marker useful in phenotypic characterization of schizophrenic patients and identification of vulnerability in genetically high-risk subjects.

[Predictors of increased cardiovascular risk in hypertensive patients in frontline facilities in Sousse, Tunisia]. / Facteurs prédictifs du haut risque cardio-vasculaire chez les patients hypertendus suivis en premiere ligne à Sousse (Tunisie).

We assessed cardiovascular risk factors among 456 hypertensive patients in 7 health centres in Sousse. Cardiovascular risk was estimated according World Health Organization recommendations. Mean age was 65.6 (SD = 9.8) years, male:female sex ratio was 0.18. Cardiovascular risk was not influenced by sex, age or residence. However, patients with longer duration of hypertension and more frequent co-morbidity had a significantly higher cardiovascular risk. In addition 45.9% of patients on monotherapy had high cardiovascular risk compared with 40.6% of those treated with 2 or more drugs (P = 0.02). Non-compliance was not found to be associated with high risk.

[Predictors of increased cardiovascular risk in hypertensive patients in frontline facilities in Sousse, Tunisia]

We assessed cardiovascular risk factors among 456 hypertensive patients in 7 health centers in Sousse. Cardiovascular risk was estimated according World Health Organization centres Mean age was 65.6 [SD = 9.8] years, male: female sex ratio was 0.18. Cardiovascular recommendations risk was not influenced by sex, age or residence. However, patients with longer duration of hypertension and more frequent co- morbidity had a significantly higher cardiovascular risk. In addition 45.9% of patients on monotherapy had high cardiovascular risk compared with 40.6% of those treated with 2 or more drugs [P = 0.02]. Non- compliance was not found to be associated with high risk

[Distribution of anthropometrical parameters in infants in the Monastir region, Tunisia]. / Distribution des paramètres anthropométriques des nourrissons dans la région de Monastir (Tunisie).

We evaluated the distribution of anthropometrical parameters in infants in Monastir and compared them with the National Center of Health Statistics reference. Our prospective study included 3033 infants attending primary health care centres for vaccinations who were followed for 18 months. In each visit, we measured weight-for-age, height-for-age and weight-for-height. We found a difference between our distribution curve and the NCHS reference. The prevalence of growth retardation increased with age. The prevalence of under-weight and of wasting were less than 10%. Obesity was seen 6.2% of infants aged 3 months and 11.6% aged 9 months.

[Anthropometrical parameters in infants in Monastir region, Tunisia]

We evaluated the distribution of anthropometrical parameters in infants in Monastir and compared them with the National Center of Health Statistics reference. Our prospective study included 3033 infants attending primary health care centres for vaccinations who were followed for 18 months. In each visit, we measured weight-for-age, height-for-age and weight-for-height. We found a difference between our distribution curve and the NCHS reference. The prevalence of growth retardation increased with age. The prevalence of under-weight and of wasting were less than 10%. Obesity was seen 6.2% of infants aged 3 months and 11.6% aged 9 months

[The quality of first line management of arterial hypertension in the sanitary region of Sousse]. / La qualité de prise en charge de l'hypertension artérielle en première ligne dans la région sanitaire de Sousse.

The aim of the study is to value determinants of the quality of management of hypertension in structures of primary health care, a medical audit has been achieved on a representative sample of 456 hypertensive patients followed in the sanitary region of Sousse during the year 2002. It takes out again this work that the global quality of management of hypertension in primary health care have been considered satisfactory at only 28,7% of the hypertensive patients. It was statistically differential according to surroundings (farming: 40,5%, urban: 24,9%) and categories of the seniority of follow-up in primary health care (< or = five years: 34,6%, > five years: 23,9%). A survey multi varied by logistical regression controlling the other factors of confusion (kind, seniority of the illness, geographical and financial accessibility) kept these two factors: the farming middle (ORa: 1,97; P = 0,003) and the lower seniority to five years (ORa: 1,64; P = 0,023). So, the hypertensive patients followed in the urban health centres since more that five years should constitute the population targets a program of improvement of the quality of health care dispensed to hypertensive patients in extra hospital structures of health.

[Lipoprotein (a) and ischemic heart diseases in patients with type 2 diabetes]. / Lipoprotéine (a) et cardiopathies ischémiques chez les patients diabétiques de type 2.

Lipoprotein (a) is a new independent coronary risk factor, but the role of lipoprotein (a) in type 2 diabetes remains controversial. The objective of this study was to demonstrate the relationship between the level of lipoprotein (a) and the coronary artery diseases (CAD) in type 2 diabetes. Recruitment was carried out in 3 groups of patients: Group 1: 110 control subjects, Group 2: 115 diabetics (D), Group 3: 105 diabetics with CAD (DC). The mean age was, 51 + 7; 52 + 6; 56 + 6 respectively. Total cholesterol, triglyceride, HDL-C, LDL-C, Apo A-I, Apo B and lipoprotein (a) were measured for the patients. The Lp (a) level was significantly higher in the diabetic groups as compared to the controls (p < 0.05), but this level was different between D and DC: 312 + 232 vs 347.8 + (NS). However, when the Lp (a) level is higher than 300 mg/ml, there is a significant difference between DC and D (53% vs 42% p = 0.05). There is no correlation between Lp level and total cholesterol; however, there is a significant variation of Lp (a) level with LDL-C (r = -0.14, P = 0.01). There is a negative correlation between Lp (a) and HDL-C (r = -0.13, p = 0.03), Lp (a) and ApoA-I (r = - 0.11, p = 0.05); but there is a positive correlation between Lp (a) and ApoB (r = 0.14, p = 0.02). Lp(a) level higher than 300 mg/L constitutes a coronary risk factor in type 2 diabetes. This contributes, with the other lipid disorders, to the increase of the coronary risk factors in diabetes.