Obesity-induced impairment of endothelium-dependent vasodilation in Tunisian women.

OBJECTIVE: It is now well recognized that obesity is a major public health concern, and its prevalence has tremendously increased worldwide over the last decades, including Tunisia. As obesity is associated with cardiovascular diseases, the purpose of this study was to investigate the effect of obesity on forearm skin blood flow (FSBF) response to acetylcholine (Ach), an endothelium-dependent vasodilator, in Tunisian women over a wide range of body mass indices (BMIs). SUBJECTS: One hundred and eighty healthy women with an average age of 34+/-6 years, an average height of 162+/-7 cm and an average weight of 78+/-19 kg participated in this investigation. The mean BMIs of the 60 lean, 50 overweight and 70 obese subjects were 22.1+/-0.3, 27.7+/-0.2 and 38.4+/-0.7 kg m(-2), respectively. MEASUREMENTS: The FSBF was measured non-invasively using a laser Doppler flowmeter in response to local infusion of a cumulative dose of Ach. RESULTS: After adjusting for age, the mean response of FSBF to Ach was significantly greater in lean (1168%+/-78) than in overweight (643%+/-38) and obese subjects (323%+/-18) (P=0.002; P<0.0001, respectively), suggesting a reduction of the endothelium-dependent nitric oxide (NO) release by obesity. Our regression analysis also revealed that the maximum FSBF response to Ach (that is, its efficacy) was inversely correlated with BMI, waist and hip circumferences (r=-0.994, P=0.002; r=-0.2, P<0.0001, and r=-0.321, P=0.001, respectively). CONCLUSION: Our data demonstrate a reduction of skin vasodilatory reserve in obese patients and suggest a defect of both endothelial-dependent relaxation and wall compliance associated with obesity.

Obesity induced bronchopulmonary hyperresponsiveness in Tunisian women.

OBJECTIVE: The specific objective of this investigation was to determine whether bronchopulmonary responsiveness (BPR) to methacholine (MCH) was associated with the body mass index (BMI) of Tunisian women. SUBJECTS: In all, 160 healthy nonsmoker women (52 lean, 45 overweight and 63 obese) were recruited and examined in the Clinical Laboratory of Physiology located in the Medical School of Sousse. The average ages (+/-s.e.) of the three categories of lean, overweight and obese subjects were 27.7+/-1.1, 33.2+/-1.7 and 37.5+/-1.3 years, respectively. Their corresponding mean BMIs (+/-s.e.) were 21.9+/-0.3, 27.7+/-0.2 and 36.5+/-0.8 kg m(-2), respectively. MEASUREMENTS: Before their inclusion into the study, subjects were screened for their lung status by measuring their pulmonary function testing parameters using a whole body plethysmograph. BPR was assessed, using a cumulative concentration response curve technique, by measuring with a spirometer the decrease in forced expiratory volume in 1 s (FEV(1)) in response to a cumulative dose of MCH. RESULTS: After adjusting for age, significant differences in both FEV(1) and forced vital capacity (VC) were found between the obese and lean groups (P<0.01), as well as between the obese and overweight groups (P<0.01). In addition, forced expiratory flow between 25 and 75% of VC was significantly different between the obese and lean groups (P<0.001), as well as between the lean and overweight groups (P=0.015). The mean maximum fall of FEV(1) in response to MCH challenge was significantly higher for the obese group (12.0%) than for the overweight (9.8%) or the lean (6.6%) group (P<0.01). Furthermore, the efficacy of the MCH agonist promoting the maximal response (E(max)) and its potency or effective dose producing 50% of the maximal response (ED(50)) were both associated with BMI (the higher the BMI, the higher the E(max) and the lower the ED(50)). CONCLUSION: Our data clearly show that obesity affects pulmonary function performance in Tunisian women by potentially promoting their bronchial hyperreactivity as suggested by the significant correlation between their BMI and the efficacy of the MCH, as well as its potency.

[Impact of occupational noise in the development of arterial hypertension: A survey carried out in a company of electricity production]. / Impact du bruit professionnel sur le développement de l'hypertension artérielle : enquête réalisée au sein d'une centrale de production d'électricité et de gaz en Tunisie.

BACKGROUND: Noise pollution is one of the major environmental pollutants that can adversely affect public health. Cardiovascular diseases are the primary out-auditory adverse outcome caused by occupational noise exposure. AIMS: To investigate the association between occupational exposure to high level of noise and blood pressure among a group of workers in a company of electricity production in the Centre of Tunisia. MATERIAL AND METHODS: A total of 120 occupational noise-exposed workers and 120 non-exposed employees were recruited to conduct a cross-sectional survey exploring the association between occupational noise-exposed and arterial hypertension. Data collection was based on a questionnaire, a clinical exam and biomarkers. Blood pressure was measured using a mercury sphygmomanometer following a standard protocol. The occupational noise level was measured with a portable calibrated sound meter. Multiple logistic regression was used to calculate the odds ratio (OR) and 95 % confidence interval (CI) of noise exposure adjusted by potential confounders. RESULTS: The noise level to which our population was exposed ranged from 75dB to 103dB with an average noise level of 89dB. Mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and the prevalence of hypertension were significantly higher in exposed individuals than in non-exposed. In multivariate analysis, elevated SBP in exposed workers was associated with high-salt diet (OR adjusted=1.71, 95% CI adjusted [1.14-1.98]) and occupational seniority more than 8 years (adjusted OR=5.31, 95% CI [2.22-12.72]). The factors associated with high BP in the exposed group were diabetes (OR adjusted to 15.31; 95% adjusted CI [2.61-89.58]), history of hypertension in the family (OR adjusted to 11.46; 95% adjusted CI [5.18-83][1.58-83.05]), mean of age (OR adjusted to 6.65; 95% adjusted CI [1.87-23.59]) and high-salt diet (OR adjusted to 0.29; 95% adjusted CI [0.09-0.95]). CONCLUSION: Occupational chronic noise exposure was associated with higher levels of SBP, DBP, and the risk of hypertension. These findings indicate that effective and feasible measures should be implemented to reduce the risk of hypertension caused by occupational noise exposure in companies of electricity production.

Self-healing Langerhans cell histiocytosis (Hashimoto-Pritzker disease): two Tunisian cases.

Self-healing Langerhans cell histiocytosis (SHLCH) is a rare self-limited variant of Langerhans cell histiocytosis that presents at birth or during the neonatal period. It was first described by Hashimoto and Pritzker in 1973. Subsequently, more than 70 cases have been reported in the literature. Regarding age of onset, SHLCH should be divided into congenital SHLCH and rare late-onset type. We report here two additional cases of SHLCH in Tunisian infants. We emphasize the need for long-term follow-up in such patients.

Polio outbreak in Algeria: epidemiological, virological and vaccinational aspects.

During a poliomyelitis outbreak (October 1983) in El Oued territory (Algeria) 28 cases were diagnosed. All the patients were under 4 years old. The ratio of females to males was 0.33. No deaths occurred during this epidemic. 25 of the 28 polio cases were diagnosed by cell culture and 81% were polio type 1. The epidemiological survey established that the epidemic was due to the insufficiency of vaccination coverage, since the consumption of antipolio vaccine in the epidemic area had dropped by 25% from 1982 to 1983. 7 of the 28 polio cases had been given at least 3 injections of vaccine at the correct intervals. 5 of 8 vaccine samples from the epidemic area had an insufficient titre of polio type 1. These observations showed that the nature of the vaccine, whether killed or live virus, was less important for controlling poliomyelitis than providing medical and sanitary facilities to ensure good vaccination coverage.

[Varicocele: endoscopy versus surgery]. / La varicocèle: coelioscopie versus chirurgie.

Varicocele is a frequent and benign pathology, well known since the antiquity, his treatment has progressed by a better acquaintance of physiology and the effects on fertility. In the surgery department of FSI hospital, we compared the results of 2 surgical methods: the Ivanisevich's technique (open surgery) and the laparoscopic approach. The objective was to compare morbidity, recurrence rate, hospital stay, and effects on pains and fertility. From May 1993 to December 1998 we treated 72 patients with symptomatic varicocele: 40 patients by laparoscopy and 32 by open surgery. The recurrence rate was of 32% for surgery and 21% for laparoscopy. But duration of surgical operation was longer for laparoscopy: 50 mn against 30 mn for unilateral cure and 70 mn against 55 mn for bilateral cure. We did not observe a difference between the 2 groups in hospital stay, morbidity, pains and fertility. At the end of the study we propose laparoscopy for bilateral cure and open surgery for unilateral. Decrease of recurrences needs the realisation of a phlebography before surgery, but this investigation weight routinely "take charge" of patients; we reserve it to recurrences. Echography coupled to Doppler is essentially used for preoperative diagnosis of varicocele and for surveillance of postoperative recurrences.

Targeting proapoptotic protein BAD inhibits survival and self-renewal of cancer stem cells.

Emerging evidence suggests that the resistance of cancer stem cells (CSC) to many conventional therapies is one of the major limiting factors of cancer therapy efficacy. Identification of mechanisms responsible for survival and self-renewal of CSC will help design new therapeutic strategies that target and eliminate both differentiated cancer cells and CSC. Here we demonstrated the potential role of proapoptotic protein BAD in the biology of CSC in melanoma, prostate and breast cancers. We enriched CD44(+)/CD24(-) cells (CSC) by tumorosphere formation and purified this population by FACS. Both spheres and CSC exhibited increased potential for proliferation, migration, invasion, sphere formation, anchorage-independent growth, as well as upregulation of several stem cell-associated markers. We showed that the phosphorylation of BAD is essential for the survival of CSC. Conversely, ectopic expression of a phosphorylation-deficient mutant BAD induced apoptosis in CSC. This effect was enhanced by treatment with a BH3-mimetic, ABT-737. Both pharmacological agents that inhibit survival kinases and growth factors that are involved in drug resistance delivered their respective cytotoxic and protective effects by modulating the BAD phosphorylation in CSC. Furthermore, the frequency and self-renewal capacity of CSC was significantly reduced by knocking down the BAD expression. Consistent with our in vitro results, significant phosphorylation of BAD was found in CD44(+) CSC of 83% breast tumor specimens. In addition, we also identified a positive correlation between BAD expression and disease stage in prostate cancer, suggesting a role of BAD in tumor advancement. Our studies unveil the role of BAD in the survival and self-renewal of CSC and propose BAD not only as an attractive target for cancer therapy but also as a marker of tumor progression.

North African reference equation for peak nasal inspiratory flow.

AIM: To assess, in healthy North African subjects, the applicability and reliability of a previously published reference equation and normal values for peak nasal inspiratory flow, and to calculate a peak nasal inspiratory flow reference equation in this population. SUBJECTS AND METHODS: Anthropometric data were recorded in 212 volunteers (100 females and 112 males) aged 13-27 years. Peak nasal inspiratory flow was measured several times. Univariate and multiple linear regression analyses were used to determine the reference equation. RESULTS: The previously published reference equation and normal values did not reliably predict peak nasal inspiratory flow in the study population. In our subjects, the reference equation (r2 = 30 per cent) for peak nasal inspiratory flow (l/min) was 1.4256 × height (m) + 33.0215 × gender (where 0 = female, 1 = male) + 1.4117 × age (years) - 136.6778. The lower limit of normal was calculated by subtracting from the peak nasal inspiratory flow reference value (84 l/min). CONCLUSION: This is the first published study to calculate a reference equation for peak nasal inspiratory flow in North African subjects. This equation enables objective evaluation of nasal airway patency in patients of North African origin.

[Rheumatic manifestations of Gougerot-Houwers-Sjögren syndrome]. / Les manifestations rhumatismales du syndrome de Gougerot-Houwers-Sjögren.

The authors retrospectively survey the concept of the Gougerot-Houwers-5jögren syndrome which links articular disease with the "dry" syndrome (pharyngitis sicca) and then go on to study the rheumatic conditions found in the Gougerot-Houwers-Sjögren syndrome. They point out that the association between the "dry" syndrome and rheumatic appearances varies in frequency according as whether the problem is seen from a rheumatological, dermatological, ophthalmological or stomatological point of view. They establish the frequency of the various rheumatic conditions, stressing the importance of the association with rheumatoid polyarthritis. They study the associated biological and visceral backgrounds, the thyroid, renal, digestive, blood, neural, allergic and immunological conditions and describe the rheumatic appearances of the other collagenoses associated with the "dry" syndrome. They conclude with the current difficulty of restricting the scope of the Gougerot-Houwers-Sjögren syndrome when histological and scintigraphic techniques have broadened it. They would like to see exact criteria adopted to define this syndrome.

[Introduction to a study of specific antibodies (IgG and IgM) detection with ELISA in the diagnosis of poliomyelitis]. / Introduction à une étude sur la détection des anticorps spécifiques (IgG et IgM) par ELISA dans le diagnostic de la poliomyélite.

Samples of single sera collected from 38 patients with different clinical diagnosis were studied in order to perform ELISA techniques with the purpose of detecting poliomyelitis IgG and IgM antibodies. The résults were compared through antibody titration by neutralization test. 21 pairs of sera from infants suffering from acute flaccid paralysis were studied by ELISA-IgM, ELISA-IgG and neutralization test. Stool samples were collected from 20 of the latter patient. Wild poliovirus type 1 was isolated in 8 cases. ELISA-IgM technique was positive in 14 cases. The true positive poliomyelitis diagnosis was based on the persistence of flaccid paralysis 60 days after the onset and on wild poliovirus isolation with significant increase in antibody level. 16 cases were classified as poliomyelitis, 2 cases as non poliomyelitic paralysis and 3 cases as undetermined. 16 out of the 18 well established diagnosis were in agreement (88.8%) with the detection or not of IgM antibodies by ELISA. The specificity of these IgM ELISA antibodies was examined by studying 11 cases of lymphocytic meningitis. Cross reaction in serological responses between polioviruses and coxsackieviruses was observed. These cross reactions should be evaluated by studying a greater number of cases. The poliovirus ELISA-IgM is a sensitive, economical and rapid method to be used in poliomyelitis diagnosis to complete the neutralizing test and virus isolation.