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To evaluate and compare the performance of NT-proBNP levels, plasma protein concentration, hematocrit, and fluid balance for the preceding 24 h in predicting the outcome of the two steps of weaning: (1) spontaneous breathing trial (SBT), (2) extubation.This was a prospective observational study of 143 patients who were mechanically ventilated for more than 48 h (55% COPD) and were ready to wean. They underwent an SBT and were extubated when they passed the trial. Immediately before the SBT, we measured the evaluated diagnosis tools.Of 143 patients, 80 (56%) passed the SBT and were extubated. Of these, two were reintubated for laryngeal dyspnea, 57 had no respiratory problem during the next 48 h, and 21 developed post-extubation respiratory distress (26%). Rescue noninvasive ventilation (NIV) prevented reintubation in 15 (71%). None of the tested diagnosis tools predicted the outcome of the SBT. Patients who developed post-extubation respiratory distress were older, had lower values of plasma protein concentration and higher values of NT-proBNP than those who did not. Only NT-proBNP was an independent predictor of the occurrence of post-extubation respiratory distress (OR 1.2; 95% CI 1.09-1.4; p = 0.003); the area under the ROC curve for NT-proBNP to predict post-extubation respiratory distress was 0.78 (95% CI 0.67-0.89; p = 0.0001). NT-proBNP was more accurate to rule out (negative likelihood ratio 0.09 for a cutoff of no greater than 1,000 pg/ml) than to rule in the risk of post-extubation respiratory distress (positive likelihood ratio 3.45 for a cutoff of at least 2,000 pg/ml).NT-proBNP levels at SBT help in the prediction of post-extubation respiratory distress and could identify the subgroup of extubated patients requiring close observation and/or prophylactic NIV.

Objectifs : Etudier les effets du tabac sur les concentrations de la TSH et la FT4, la variation de ces concentrations selon les caracteristiques de la consommation (nombre de cigarettes fumees/j et anciennete de l’exposition/an) et leurs associations avec les deux marqueurs biologiques du tabagisme (cotininurie et thiocyanates plasmatiques (SCN -)). Materiel et methodes : Notre etude a concerne 162 fumeurs (F), 27 anciens fumeurs (AF) et 111 non-fumeurs (NF) âges respectivement de 35,4 ± 16 ; 31,6 ± 1,8 et 38,0 ± 14,6 ans. La TSH et la FT4 ont ete determinees par electrochimiluminescence, la cotininurie par immunoenzymologie et les thiocyanates par electrode selective. Resultats : Une diminution significative de la TSH et une augmentation progressive de la FT4 en fonction du statut tabagique ont ete notees avant et apres ajustement. La TSH est significativement plus basse et la FT4 significativement plus elevee chez les F et AF par rapport aux NF. La TSH etait significativement plus basse chez les sujets fumant plus de 40 cigarettes/j par rapport a ceux fumant moins de 20. Elle etait egalement significativement plus basse chez les F dont le tabagisme datait de plus de 5 ans par rapport a ceux fumant depuis moins de 5 ans. La cotininurie et les thiocyanates presentent une correlation negative avec la TSH et une correlation positive avec la FT4. Conclusion : Chez les F, les variations de la FT4 et de la TSH refletent un risque d’hyperthyroidie plus eleve, et sont etroitement correlees aux caracteristiques de la consommation. De plus, l’arret du tabac peut entrainer de legeres reductions de la FT4 et des augmentations de la TSH, par consequent des effets reversibles du tabac sur la thyroide.

Biomonitoring of effects in agricultural workers is necessary to assess the individual risk of handling pesticides. In this study, biochemical and haematological parameters were measured to evaluate the effects of exposure to these compounds in agricultural workers. The study was carried out in 110 workers and 97 control subjects. Several haematological and biochemical parameters were analysed. Assessment of haematological parameters revealed that the mean cell volume and haematocrit levels were significantly lower in workers than in controls (P=0.002 and 0.013, respectively), while mean corpuscular haemoglobin concentrations were higher in workers (P

Elevated osteoprotegerin (OPG) levels have been reported in patients with diabetes complications. We investigated whether plasma OPG levels can be used as a marker of cardiovascular risk in children and adolescents with type 1 diabetes (T1D).Plasma blood samples were obtained from 243 subjects (143 children and adolescents with T1D and 100 healthy controls). OPG concentrations were measured by enzyme-linked immunosorbent assay (ELISA) method. All data were analyzed by using PASW statistics 18.A significant higher plasma OPG level was found in children with T1D compared to controls (p 0.001). A significant increase of OPG levels has been related to the glucose level ≥ 7 mmol/L (2.44 [0.01-6.22] vs. 2.16 [0.13-6.22] pmol/L, p = 0.019), microalbuminuria ≥ 30 mg/24 h (3.71 [0.160-6.03] vs. 2.26 [0.01-6.22] pmol/L, p 0.001), and cystatin-C ≥ 0.789 mg/L (2.64 [0.37-6.22] vs. 2.11 [0.01-5.82] pmol/L, p 0.001). We noted a significant higher frequency of children with increased cystatin-C levels in the group with elevated plasma level of OPG compared with those with normal levels (49 vs. 18%, respectively) with an odds ratio (OR) = 4.42 [1.41-13.84] (p = 0.006). We showed a significant increase of OPG levels when the number of cardiovascular risk factors exceeds 3 (p = 0.001).OPG may be a potential biomarker of cardiovascular risk in T1D. Implementation of OPG determination in the clinical laboratory setting would be useful in order to better stratify patients and to assess the most adequate treatment.

This study aims to investigate the effect of cigarette smoking on paraoxonase 1 (PON1) activity according to PON1 L55M and PON1 Q192R gene polymorphisms. Our sample included 300 voluntary subjects: 138 nonsmokers and 162 current smokers aged 38.47 ± 21.91 and 35.55 ± 16.03 years, respectively. PON1 activity was determined by kinetic methods. L55M and Q192R gene polymorphisms of PON1 were determined by multiplex polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP). We found in smokers a significant decrease of PON1 activity before and after adjustment. We noted a significant association between smoking status and lower PON1 activity [odds ratio (OR) = 3.03, confidence interval 95% = 1.5–5.9, p = 0.001]. In smokers, there was significant association between PON1 activity and PON1 L55M polymorphisms (p = 0.01). Also, the 55MM genotype presented the lowest paraoxonase activity, while the 55LL genotype showed the highest one. After adjustment for confounding variables, smokers with PON1 L55M polymorphism had the highest risk for lower PON1 activity; however, PON1 Q192R genotype might protect smokers from decrease in PON1 activity. We found significant interaction between the effect of cigarette smoking and both PON1 L55M and PON1 Q192R polymorphisms on lower PON1 activity. Cigarette smoking was significantly associated with decrease in PON1 activity. Moreover, PON1 L55M polymorphism predisposes smokers to decreased PON1 activity in contrast to PON1 Q192R genotype.

Aims: The aim of the present study was to investigate hyperhomocysteinemia in Tunisian bipolar I patients according to 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism. Methods: The subjects consisted of 92 patients with bipolar I disorder diagnosed according to DSM-IV, and 170 controls. Plasma total homocysteine, folate and vitamin B12 were measured. MTHFR C677T polymorphism was determined by polymerase chain reaction–restriction fragment length polymorphism. Results: Compared with controls, patients had a significantly higher homocysteine level (16.4 ± 9.8 vs 9.6 ± 4.5 µmol/L; P 12 years. Hypofolatemia was seen in all patients on lithium and in the majority of patients on carbamazepine, and the highest prevalence of hypovitamin B12 was noted in patients taking carbamazepine. Conclusion: Hyperhomocysteinemia was more frequent in bipolar I patients independent of C677T polymorphism. Patients had reduced levels of folate, which modulates homocysteine metabolism. Indeed, this finding indicates that folate supplementation may be appropriate for bipolar patients with hyperhomocysteinemia.

Recent investigations have proved the crucial role of nutritional antioxidants to prevent the damage caused by toxic compounds. In this study, the antioxidant effect of date palm fruit extract on dimethoate-induced oxidative stress and nephrotoxicity in rat is investigated and compared with the effect of the well-known antioxidant vitamin C. Male Wistar rats were randomly divided into six groups of ten each: a control group (C), a group that received dimethoate (20 mg/kg body weight) (D), a group given Deglet Nour extract (DNE), a group treated with DNE 30 min before the administration of dimethoate (DNE + D), a group which received VitC (100 mg/kg body weight) plus dimethoate (Vit C + D), and a group given dimethoate for the first month and DNE 30 min after administration of dimethoate, during the second month (D + DNE). These components were daily administered by gavage for 2 months. After completing the treatment period, blood samples from rats were collected under inhaled diethyl ether anesthesia for serum urea, uric acid, and creatinine levels, while the rat kidneys were obtained for enzyme assays and histology. Oral administration of dimethoate in rats induced a marked renal failure characterized by a significant increase in serum creatinine and urea levels (p

Resume Objectif L’homocysteine (Hcys) est un acide amine soufre, incrimine dans la genese de differentes affections neuropsychiatriques et recemment dans la schizophrenie (SZ). Les objectifs de ce travail etaient de determiner les concentrations plasmatiques de l’Hcys, du folate et de la vitamine B12 (vit B12), d’estimer la frequence et la severite de l’hyperhomocysteinemie chez les patients schizophrenes et de rechercher les associations entre l’Hcys et les caracteristiques de ces patients. Patients et methodes Notre population d’etude comportait 61 patients schizophrenes et 46 temoins sains. La concentration plasmatique de l’Hcys a ete determinee par une methode immunologique utilisant la polarisation de fluorescence (FPIA) adaptee sur AxSYM™ (Abbott). Le dosage de la vit B12 et des folates a ete effectue par electrochimiluminescence sur Elecsys 2010™ (Roche Diagnostics). Resultats Une augmentation statistiquement significative des concentrations plasmatiques de l’Hcys (16,1 μmol/L versus 10,9 μmol/L, p = 0,028) et une diminution statistiquement significative de la folatemie (4,2 μg/L versus 8,2 μg/L, p Conclusion Chez les patients schizophrenes, il existe une hyperhomocysteinemie moderee, associee a l’absence d’antecedents psychiatriques familiaux et a la diminution de la vit B12. L’Hcys devrait etre consideree comme un facteur a prendre en consideration dans le suivi et la prise en charge chez les patients schizophrenes.

Nowadays, people’s exposure to chemical compounds such as organophosphorus insecticides is continuously on the rise more and more. Theses compounds have induced an excessive production of free radicals which are responsible for several cell alterations in the organism. Recent investigations have proved the crucial role of nutritional antioxidants to prevent the damage caused by toxic compounds. In this study, we investigate the role of date palm fruit extract (Phoenix dactylifera L.) in protection against oxidative damage and hepatotoxicity induced by subchronic exposure to dimethoate (20 mg/kg/day). Oral administration of dimethoate caused hepatotoxicity as monitored by the increase in the levels of hepatic markers enzymes (transaminases, alkaline phosphatase, gamma-glutamyl transferase and lactate dehydrogenase), as well as in hepatic malondialdehyde thus causing drastic alteration in antioxidant defence system. Particularly, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were found increased by dimethoate while catalase (CAT) activity was reduced significantly. These biochemical alterations were accompanied by histological changes marked by appearance of vacuolization, necrosis, congestion, inflammation, and enlargement of sinusoids in liver section. Pretreatment with date palm fruit extract restored the liver damage induced by dimethoate, as revealed by inhibition of hepatic lipid peroxidation, amelioration of SOD, GPx and CAT activities and improvement of histopathology changes. The present findings indicate that in vivo date palm fruit may be useful for the prevention of oxidative stress induced hepatotoxicity.

Renal tubular acidosis (RTA) is a tubulopathy characterized by metabolic acidosis with normal anion gap secondary to abnormalities of renal acidification. RTA can be classified into four main subtypes: distal RTA, proximal RTA, combined proximal and distal RTA, and hyperkalemic RTA. Distal RTA (type 1) is caused by the defect of H(+) secretion in the distal tubules and is characterized by the inability to acidify the urine below pH 5.5 during systemic acidemia. Proximal RTA (type 2) is caused by an impairment of bicarbonate reabsorption in the proximal tubules and characterized by a decreased renal bicarbonate threshold. Combined proximal and distal RTA (type 3) secondary to a reduction in tubular reclamation of bicarbonate and an inability to acidify the urine in the face of severe acidemia. Hyperkalemic RTA (type 4) may occur as a result of aldosterone deficiency or tubular insensitivity to aldosterone. Clinicians should be alert to the presence of RTA in patients with an unexplained normal anion gap acidosis, hypokalemia, recurrent nephrolithiasis and nephrocalcinosis. The mainstay of treatment of RTA remains alkali replacement.

The calcium-sensing receptor (CASR), a plasma membrane G-protein coupled receptor, is expressed in parathyroid gland and kidney, and controls systemic calcium homeostasis. Inactivating CASR mutations have previously been identified in patients with familial hypocalciuric hypercalcemia (FHH) and neonatal severe hyperparathyroidism (NSHPT). The aim of the present study is to determine the underlying molecular defect of FHH/NSHPT disease in a consanguineous Tunisian family. Mutation screening was carried out using RFLP-PCR and direct sequencing. We found that the proband is homozygous for a novel 15 bp deletion in the exon 7 (c.1952_1966del) confirming the diagnosis of NSHPT. All the FHH members were found to be heterozygous for the novel detected mutation. The mutation, p.S651_L655del, leads to the deletion of 5 codons in the second trans-membrane domain of the CASR which is thought to be involved in the processes of ligand-induced signaling. This alteration was associated with the evidence of mental retardation in the FHH carriers and appears to be a novel inactivating mutation in the CASR gene. Our findings provide additional support for the implication of CASR gene in the FHH/NSHPT pathogenesis.

Objective This study aims to evaluate the prevalence of thyroid dysfunctions and to explore their association with perturbations in lipid profile in bipolar I patients. Patients and methods Our study included 130 bipolar I patients diagnosed according to the DSM IV, and 124 control subjects aged respectively 37.9 ± 12.1 and 37.6 ± 13.2 years. TSH and FT4 were determined using electrochemiluminescence. Total cholesterol, triglycerides, c-LDL and c-HDL were determined by enzymatic colorimetric methods and ApoA1, ApoB and Lp(a) by immunoturbidimetric techniques on Konelab 30™. Results Patients had significantly higher TSH values than controls and had perturbations in lipid profile. 0.7% and 28.5% of patients had respectively hyperthyroidism and hypothyroidism. Hypothyroidism was associated with obesity and perturbations in lipid profile particularly increase in total cholesterol, c-LDL, ApoB, ApoB/ApoA1 and Lp(a) and decrease in ApoA1 and c-HDL. Moreover, it was associated with lithium and valproic acid treatment. Conclusions Hypothyroidism was frequent in bipolar patients. It was significantly associated with obesity and perturbations in lipid profile. Therefore, bipolar patients require specific care, particularly for thyroid, lipid profile and weight; the effectiveness of this care will be evaluated during follow-up period.

Nous avons etudie l’influence de certains facteurs sur l’activite de la butyrylcholinesterase (BChE), evalue le statut sanitaire des travailleurs agricoles et l’effet de l’exposition chronique aux pesticides, dans le but de determiner les facteurs a prendre en consideration lors de l’interpretation de l’activite de la BChE dans le cadre de surveillance professionnelle systematique de ces travailleurs agricoles. Notre etude a ete realisee chez 110 travailleurs agricoles et 97 temoins. Chaque individu a beneficie d’un examen clinique. La determination de l’activite de BChE a ete realisee par une methode cinetique spectrophotometrique. L’activite moyenne de la BChE est apparue significativement plus faible chez les travailleurs par rapport aux temoins ( p < 0,001). Parmi les 44 % des travailleurs rapportant au moins un signe neurologique ou neuropsychique, 29 % avaient une activite de BChE inferieure a 6000 UI/L. Les cephalees representent le symptome neurologique le plus souvent mentionne (20 %). La variation de l’activite de la BChE est non seulement liee a la nature du pesticide utilise, mais aussi aux differentes modalites d’exposition. Une anciennete d’exposition excedant dix ans, une exposition depassant 150 heures par an a des melanges de pesticides organophosphores-carbamates interviennent dans la diminution significative de cette enzyme et peuvent etre considerees comme des facteurs de risque des effets toxiques cholinergiques. L’activite de BChE est un biomarqueur pour la surveillance des travailleurs agricoles. Cependant, elle doit etre accompagnee par un examen clinique systematique, prenant en consideration ces facteurs de risque, pour une identification precoce des travailleurs a haut risque.

This study aims to evaluate the anticholinesterase activity of different extracts of Astragalus gombiformis Pomel, a wild desert species of Tunisia flora. The anticholinesterase activity of extracts was measured by the colorimetric method of Ellman et al. using human plasma as enzyme source. The effects of the incubation time and the temperature were also studied. Our finding showed that the anticholinesterase activity can be detected after a shorter incubation time than the time generally used for this assay. The temperature of 37°C seems to be more adequate for the evaluation of anticholinesterase activity. For an incubation time of 15 min, the extracts showed different activity levels. Among them, ethyl acetate aerial part extract was found the most active, with an IC50 of 110µg/ml. Considerable anticholinesterase activity of A. gombiformis extracts was shown and this finding suggests that this species can be a possible source of anticholinesterase natural products.

La clozapine, principal neuroleptique indique dans le traitement de la schizophrenie resistante, est a l’origine de nombreux cas d’intoxications accidentelles ou volontaires, d’ou l’interet de son dosage. Notre travail a pour objectif la mise au point d’une methode de dosage permettant le diagnostic d’une intoxication par la clozapine. La methode est basee sur la lecture de l’absorbance, a 365 nm, du produit de la reaction entre la clozapine et l’iode dans le dichloromethane. Les resultats ont montre que cette methode de dosage est lineaire de 15 a 400 mg/L (r = 0,995), avec une limite de detection de 10,42 mg/L. La precision et l’exactitude ont ete meilleures dans la zone de 120 a 400 mg/L. Le rendement de l’extraction, par l’ether, a partir des urines est en moyenne de 77,7 %. Cette methode permet le dosage de la clozapine dans les urines, les comprimes et dans les echantillons post mortem en cas d’intoxication mortelle a la clozapine.

This study represents a contribution to the phytochemical investigation of Astragalus gombiformis Pomel, a wild desert species belong to family Fabaceae. It describes the phytochemical screening of wild and cultivated A. gombiformis parts and analyzes their volatile fractions by gas chromatography coupled with mass spectrometry. Many chemical groups such as alkaloids, tannins, coumarins, quinones, terpenoids and flavonoids were detected. Leaves were the richest part. Nevertheless, nitro compounds were not found in any part of this species. Twenty seven volatile compounds were detected by chromatographic analysis in differentparts, and fruits seem to be the richest part. Many active volatiles were identified, at relatively high amounts, such as (Z,Z,Z) 9,12,15-octadecatrienoic acid, (Z,Z) 9,12-octadecadienoic acid and butylated hydroxytoluene. The last compound, known by its antioxidant activity, was present in all parts. Further studies should be done to investigate the biological and toxicologic...

L’objectif de ce travail est d’etudier la prevalence de l’obesite et sa correlation avec les parametres lipidiques chez les patients bipolaires. Notre travail a concerne 130 patients bipolaires et 130 temoins âges respectivement de 37,9 ± 12,1 et de 37,2 ± 13,1 ans. L’obesite a ete evaluee par l’indice de masse corporelle (IMC). Le cholesterol total, les triglycerides, le HDLc et le LDLc ont ete doses par des methodes enzymatiques et les ApoA1 et B et la Lp(a) par immunoturbidimetrie. La prevalence de l’obesite chez les patients est de 30,1 % contre 12,3 % chez les temoins. Une augmentation significative de l’IMC a ete notee chez les patients par rapport aux temoins independamment du sexe et du statut tabagique et chez les patients âges de moins de 35 ans et ceux consommateurs d’alcool. La majorite des patients obeses et en surpoids sont traites par l’acide valproique. Nous avons retrouve une augmentation du cholesterol (4,41 ± 1,02 vs 3,90 ± 0,98 mmol/L), du LDLc (2,13 ± 1,09 vs 1,29 ± 0,56 mmol/L) et de la Lp(a) (236 ± 207 vs 163 ± 150 mg/L) et une diminution du HDLc (0,98 ± 0,28 vs 1,09 ± 0,36 mmol/L), plus frequentes chez les patients obeses et ceux en surpoids. La frequence elevee de l’obesite et du surpoids chez les patients bipolaires, et leurs associations a une augmentation du cholesterol total, du LDLc et de la Lp(a), et a une diminution du HDLc, majorent le risque cardiovasculaire.

The aim of this study was to develop an analytical method for the determination of residues of organophosphorus and carbamate pesticides which are widely used in Tunisia. This method involves a liquid-liquid extraction procedure followed by liquid chromatography tandem mass spectrometry (LC/MS/MS) for the identification and quantification of compounds. Ionization of molecules was performed by the electrospray mode. Multiple reactions monitoring (MRM) was the acquisition mode used for the monitoring of two MS/MS transitions for each compound. The average recoveries obtained, at three different fortification levels, ranged between 65% and 106% for most of the pesticides studied, except for methamidophos (lower than 25%).The linearity of the method was in the range of 5 to 50 micro g/L with a correlation coefficient from 0.995 to 0.999, depending on the analyte. The estimated limit of detection and limit of quantification were 2 micro g/L and 5 micro g/L, respectively. The precision of the analytical procedure was satisfactory and the coefficients of variation, evaluated at three concentration levels were lower than 15% for most pesticides studied. The application of the method was investigated in a population of agricultural workers chronically exposed to various pesticides some of which, such as carbofuran, carbendazim, methomyl and pirimicarb, were detected in some serum samples.

Le but de ce travail est d’etudier l’effet du tabac sur l’activite de la (PON1) et le profil lipidique. Notre etude concerne 102 fumeurs âges de 35,5 ± 16,0 ans et 98 non fumeurs âges de 38,5 ± 22 ans. Le cholesterol total (CT), les triglycerides (TG), le cholesterol des HDL (HDLc) et le cholesterol des LDL (LDLc) sanguins ont ete determines par des methodes enzymatiques colorimetriques ; les ApoA1, ApoB et la Lp(a) ont ete mesures par immunoturbidimetrie, sur Konelab 30™ et l’activite de la PON1 par une methode cinetique. Les fumeurs se distinguent des non fumeurs par des parametres lipidiques plasmatiques significativement differents : CT, TG, LDLc, Lp(a) et rapport ApoB/ApoA1 significativement plus eleves et HDLc significativement plus faible. Les TG sont significativement plus eleves chez les sujets fumant plus de 30 cigarettes/jour par rapport a ceux qui fument 5 a 10 cigarettes/jour (2,30 ± 0,96 vs 1,63 ± 1,11 mmol/L). Une diminution significative de l’activite de la PON1 est notee chez les fumeurs (94 ± 104 vs 158 ± 133 UI/L), avec une regression de l’activite en fonction du nombre de cigarettes. En conclusion, l’hypertriglyceridemie, la diminution du HDLc, l’augmentation du rapport ApoB/ApoA1 et la diminution importante de l’activite de la PON1 confirment la majoration du risque cardiovasculaire chez les fumeurs dans la population tunisienne etudiee.

The epidemiology of renal stones has changed all over the world toward a predominance of calcium oxalate stones. However, studies evaluating the influence of age and gender on the distribution of the various types of urinary calculi are scarce. We will present the results of a study based on 205 calculi (from 122 boys and 83 girls) analyzed by infrared spectroscopy between 1993 and 2007. 90% of stones were collected by surgery, whereas only 6% by spontaneous passage. The biological exploration was performed in only 126 cases. Etiology was metabolic in 13.5%. 10.7% of stones were infectious, 13.1% were endemic and 54.9% were idiopathic. 7.8% were secondary to urinary stasis with malformation but no infection. Calcium oxalate (CaOx) was the predominant constituent in 54.7% of stones, followed by calcium phosphate and purines 14.6% in each of the cases. We found an increasing prevalence of calcium oxalate stones with age in both genders (42.9% in infant vs. 59.3% in child) (P < 0.05). Struvite stones were more frequent in infant than children. Purine stones were predominant in 20% of cases, but its prevalence decreases with age. The increase in calcium oxalate stone in school age children and the decrease in struvite and purine stones confirm the change on the etiology of urolithiasis according to age.

Resume Buts Les caracteristiques epidemiologiques sont importantes a prendre en consideration afin de cerner l’etiologie des enfants lithiasiques. Dans cette etude nous avons etudie la composition des calculs en fonction du sexe et de l’âge. Patients et methodes Notre travail portait sur 205 enfants lithiasiques tunisiens âges de trois mois a 16 ans, admis dans notre service entre 1993–2007. Un bilan metabolique urinaire, de premiere intention, a ete realise chez 126 patients. L’analyse physique et chimique des calculs a ete realisee respectivement par un stereomicroscope et par spectroscopie infrarouge. L’analyse statistique des resultats a ete faite a l’aide du logiciel SPSS 11.0. Resultats La localisation des calculs urinaires a ete vesicale dans 30,7 % des cas. Elle a ete plus frequente chez les nourrissons que chez les enfants de plus de dix ans ( p p Conclusion La prevalence plus importante des calculs d’oxalate de calcium et plus faible des calculs de purines chez les grands enfants a suggere la presence de facteurs de risque lithogenes differents en fonction de l’age. Une modification des habitudes alimentaires est probablement en cause.

Resume Introduction Le cholesterol libre (CL) est le marqueur d’atherosclerose le moins demande malgre sa mise en evidence dans la plaque d’atherome et dans les vaisseaux des sujets coronariens. L’objectif de notre travail est d’evaluer et de valider une technique enzymatique de dosage du CL afin de l’appliquer en pratique quotidienne dans l’exploration du bilan lipidique et ceci vue la rarete des kits de dosage de ce parametre. Methodes Le CL est oxyde, en presence de cholesterol oxydase, en cholestenone avec liberation de peroxyde d’hydrogene ; ce dernier oxyde l’amino-4-antipyrine, en presence de phenol et de peroxydase en une quinone imine coloree dont l’intensite de la coloration evaluee a 510 nm est proportionnelle a la quantite de CL. Resultats Une parfaite linearite entre l’absorbance et la concentration du CL a ete notee avec une droite d’etalonnage du type Y = aX. Des coefficients de precision et d’exactitude inferieurs a 5 % sont enregistres jusqu’a une concentration de 4,1 mmol/L. Les resultats de l’etude de la repetabilite et de la reproductibilite sont tres satisfaisants avec des CV Conclusion La technique enzymatique colorimetrique pour le dosage du CL est precise, exacte et rapide. Elle peut etre introduite en routine quotidienne pour la determination du CL. Son adaptation au dosage du CL des HDL constitue un second sujet d’etude.

Renal tubular acidosis are forms of metabolic acidosis characterized by an impairment of urinary acidification due to a lack of urine excretion of protons or loss of bicarbonates. Primary distal renal acidosis (dRTA) is characterized by hyperchloremic metabolic acidosis due to failure in proton excretion, variably severe nephrocalcinosis and/or nephrolithiasis associated with hypercalciuria and hypocitraturia. When the metabolic acidosis is compensated, dRTA can be diagnosed by the failure of urinary acidification after oral ammonium chloride or furosemide administration. dRTA is inherited as either an autosomal dominant or autosomal recessive trait. An autosomal dominant form results from a SLC4A1 gene mutation leading to dysfunction of the anionic exchanger type 1 (AE1). Otherwise, recessive forms are due to mutations of ATP6V1B1 gene encoding the B1-subunit of H+-ATPase expressed in the apical membrane of the alpha intercalated cells in collecting duct and in the cochlea. Those mutations lead to dRTA accompanied by sensorineural deafness. Also, mutations in ATP6V0A4 gene encode the accessory subunit a4 of the H+ATPase, leading to recessive forms of dRTA with preserved hearing or delayed signs of deafness. Molecular approach can identify mutations which are responsible for this pathology. The medical treatment is simple and involves an alkali load which allows curing the metabolic acidosis. Long-term outcome is usually good unless the patient's compliance is low or alkalizing treatment is insufficient.

Resume Introduction Contrairement aux effets systemiques de la corticotherapie generale qui sont bien connus, ceux des infiltrations locales de glucocorticoides sont peu etudies. Le but de notre etude est de rechercher les effets systemiques des infiltrations de glucocorticoides et de comparer ces effets chez les sujets diabetiques et non diabetiques et selon le siege. Methodes Notre etude a porte sur 29 patients (11 hommes et 18 femmes, âges de 18 a 86 ans). Dix-huit souffraient de sciatique discale (quatre diabetiques et 14 non-diabetiques) et ont beneficie de trois infiltrations epidurales de 1,5 ml de cortivazol (soit 5,625 mg de cortivazol, equivalant a 85 mg de prednisone) espacees de trois jours (soit un total d'environ 250 mg d'equivalent prednisone). Onze souffraient de capsulite retractile (huit diabetiques et trois non-diabetiques) et ont egalement beneficie de trois injections d'une meme quantite de cortivazol en intra-articulaire, espacees de trois jours (soit un total d'environ 250 mg d'equivalent prednisone). Parmi les patients diabetiques, 16,6 % requeraient une insulinotherapie. Avant la premiere infiltration (j0), puis a j1, j7 et j21 apres la troisieme infiltration, nous avons realise les examens de laboratoire suivants : cortisolemie et ACTH plasmatique le matin a 8 h, cortisol libre urinaire (CLU) de 24 heures, glycemie a jeun et post-prandiale, cholesterol, triglycerides, natremie et kaliemie. Les patients ont beneficie d'une mesure de la pression arterielle a chaque visite. Resultats La pression arterielle systolique moyenne des 29 patients a cru de maniere significative entre j0 (123 ± 10 mmHg), et tant j1 (127 ± 9 mmHg), que j7 (128 ± 10 mmHg). La glycemie post-prandiale des 29 patients a egalement cru de maniere significative entre j0 (7,5 ± 2,9 mmol/l) et j1 (10,1 ± 5,4 mmol/l). Toutefois, les changements sont restes minimes pour les variations tensionnelles, avec un retour a la normale a j21, y compris dans le groupe des diabetiques. En revanche, les variations de glycemie ont ete plus marquees et plus durables chez les 12 diabetiques, avec persistance d'une elevation significative de la glycemie post-prandiale a j7 (encore a 13,9 ± 4,8 versus 9,4 ± 3,3 mmol/l a j0). Dans la population generale d'etude et dans les differents groupes, un effondrement de la cortisolemie, de l'ACTH et du CLU a j1 et j7, et se poursuivant a j21, a ete observe, sauf dans le groupe infiltrations intra-articulaires, nous avons note une normalisation plus precoce de la cortisolemie et de l'ACTH a j21. Aucune variation significative n'a ete notee pour la glycemie a jeun, la triglyceridemie, la cholesterolemie, la natremie, la kaliemie et la pression arterielle diastolique. Conclusion Apres trois infiltrations de cortivazol, on observe une depression prolongee de l'axe corticotrope qui persiste au-dela de 21 jours. Cette depression disparait plus rapidement dans le groupe infiltrations intra-articulaires que dans le groupe infiltrations epidurales. On note aussi une augmentation transitoire de la tension arterielle systolique et de la glycemie post-prandiale de facon plus prolongee chez les patients diabetiques.

Introduction Whereas the systemic effects of glucocorticoid therapy have been extensively reported, little is known about those of local glucocorticoid injections. The objective of this study was to look for systemic effects of local glucocorticoid injections at two sites in diabetic and non-diabetic patients. Methods We studied 29 patients (18 women and 11 men with an age range of 18–86 years). The injection site was the epidural space in 18 patients (4 with and 14 without diabetes) with disk-related sciatica and the shoulder in 11 patients (8 with and 3 without diabetes) with frozen shoulder. Each patient was given three injections of 1.5 ml cortivazol (5.625 mg of cortivazol or about 85 mg prednisone-equivalent per injection and about 250 mg prednisone-equivalent in all), at 3-day intervals. Of the 12 patients with diabetes, 2 were on insulin therapy. At baseline and at the post-treatment visits 1, 7, and 21 days after the third injection, the following tests were done: plasma cortisol and ACTH at 8 am, urinary free cortisol excretion in 24 hours, fasting and postprandial blood glucose, serum cholesterol and triglycerides, and serum sodium and potassium. Blood pressure was measured at each visit. Results Mean systolic blood pressure increased significantly between baseline (123 ± 10 mmHg) and the first two post-treatment visits (day 1, 127 ± 9 mmHg; and day 7, 128 ± 10 mmHg) but returned to baseline values by the third post-treatment visit (day 21). Mean postprandial blood glucose was significantly higher at the day 1 post-treatment visit (10.1 ± 5.4 mmol/l) than at baseline (7.5 ± 2.9 mmol/l). At the day 7 post-treatment visit, blood glucose remained significantly elevated compared to baseline in the 12 diabetic patients (13.9 ± 4.8 mmol/l versus 9.4 ± 3.3 mmol/l at baseline). In both the overall population and the various subgroups, plasma cortisol and ACTH and urinary free cortisol were markedly reduced at the day 1 and day 7 post-treatment visits, compared to baseline. At the day 21 visit, these variables were diminished in the group given epidural injections, whereas plasma cortisol and ACTH were normal in the group treated intra-articularly. No significant variations were noted for fasting blood glucose or for serum levels of cholesterol, triglycerides, sodium, and potassium. Conclusion The administration of three local cortivazol injections was followed by suppression of the corticotropic axis that persisted beyond 21 days after epidural injection and recovered more rapidly after intra-articular injection. Systolic blood pressure increased transiently. Elevations in postprandial glucose levels lasted longer in diabetic than non-diabetic patients.

A multiresidue method was assessed for the determination of several pesticides (organochlorine, organophosphorus, pyrethroids, triazole, amidine) using gas chromatography/mass spectrometry. The extraction of pesticides was carried out by liquid-liquid extraction (LLE) and solid-phase extraction (SPE) using two types of columns (CN and C18). The extracts were cleaned by the addition of florisil, the pesticides were separated by capillary column gas chromatography and detected by mass spectrometry in the electron impact mode. The extraction using C18 column provided the best results for most of the analyzed pesticides. The majority of pesticides recoveries from the four fruits and vegetables (apples, pears, tomatoes and pepper) were greater than 60%. Linearity and precision were satisfactory. The estimated limits of detection and limits of quantification ranged from 0.01 to 0.1 mg/kg and from 0.02 to 0.3 mg/kg, respectively. The proposed procedure was found to be useful for the multiresidue analyses of pesticides in agricultural products for routine monitoring programs.

Introduction: Paraoxonase 1 (PON1) polymorphisms have been largely involved in diabetes complications. The aim of the study is to evaluate the effects of PON1 polymorphisms (L55M and Q192R) on diabetic nephropathy (DN). Material and methods: The study involved 116 children and adolescents with type 1 diabetes (T1D) and 91 healthy subjects. Albumin excretion rate (AER) was determined by immunoturbidimetry. PON1 activity was measured by a spectrophotometric method, and genotyping of PON1 gene was assessed by multiplex PCR followed by RFLP. Results: PON1 activity was inversely correlated to AER (r = –0.245, p = 0.008). A significant decrease (p = 0.037) in PON1 activity was shown between patients with nephropathy and those without (162 [57–618] vs. 316 [37–788] IU/L, respectively). The distribution of AER was, for L55M polymorphism MM > LM > LL (p = 0.002), and for Q192R polymorphism QQ > QR > RR (p < 0.001). The opposite distribution was noted for PON 1 activity (p < 0.001). LMQQ and MMQQ haplotypes seem to increase AER (p = 0.004, p = 0.003, respectively) and to reduce PON1 activity (p = 0.011, p = 0.052, respectively) in youths with T1D. However, LLRR haplotype seems to have the opposite effect. Conclusions: This study demonstrated that PON1 polymorphisms L55M and Q192R seem to be genetic markers involved in the development of DN in T1D. (Endokrynol Pol 2017; 68 (1): 35–41)

Mycotoxins are bioactive compounds that are noxious to human. Their effects on oncogenesis have been satisfactorily elucidated, and some of mycotoxins have been classified as carcinogenic to humans. Nevertheless, patulin (PAT) is considered by the International Agency of Research on Cancer as 'not carcinogenic to humans'. The present study was designed to understand the effect of this mycotoxin on melanoma cells (B16F10) by measuring cell proliferation and assessing the anti-tumour effect in vivo in Balb/c mice. Our results revealed that intraperitoneally administration of PAT for 20 days significantly induces tumour regression in B16F10 cell-implanted mice. This effect was evidenced by the activation of apoptosis which is supported by the increase in p53 and Bax expressions, the downregulation of the protein levels of Bcl2, and the increase in caspase-3 activity. Moreover, systemic toxicity analysis demonstrated that there is no potential toxicity following PAT treatment unlike untreated melanoma mice which suffer from anaemia, inflammation and liver dysfunction. Remarkably, this is the first published report demonstrating the therapeutic efficacy of PAT in vivo models.

The increasing use of organophosphorus pesticides in the environment constitutes an ecotoxicological hazard especially for humans and non-target animals. Hereby, we analyzed the toxic effects of malathion on the histological structure of liver and biochemical parameters in male rats. Three groups received daily different amounts of malathion: 1/1000, 1/100, and 1/10 LD50 for 30 days. The weights of treated rat’s liver have increased. Analyzed tissues showed centrilobular and sinusoidal congestion, hepatocyte hypertrophy, cellular vacuolization, anucleated hepatocytes, depletion of organelles affecting the majority of cells, and presence of necrotic foci into the hepatic parenchyma. Histological sections of the liver showed important hepatocyte glycogen storage. We conclude that malathion stimulates the filing of glycogen in a dose-dependent manner. Biochemical parameters showed that alanine transaminase (ALT), aspartate transaminase (AST), gamma glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), and alkaline phosphatase (ALP) levels increased in the treated groups when the level of total protein decreased in intoxicated groups.

Background: Vitamin D defiiency may increase the risk of various autoimmune diseases. But few studies focused on its role in Behcet syndrome. Objectives: The aims of our study were to assess the vitamin D status of Behcet patients and to analyze the correlation of this status with the activity and the severity of the disease as well as the quality of life of patients. Patients and methods: The vitamin D status was assessed in 40 patients with Behcet syndrome (average age: 37.5 years, sex ratio: 1.85) in comparison with 40 healthy control subjects matched by age, sex and by season of assessment. A correlation study was realized between vit D levels and duration of disease progression, its activity, its severity as well as the quality of life of patients. Results: The average rate of vit D was 14.64 ng/ml (3-44.29 ng/ml). 94.6% of them had hypovitaminose D. Vit D defiiency has been attested in 35.1% and insuffiiency in 59.5% of the cases. There was no signifiant difference between rates of vit D in Behcet patients and those of healthy controls. There was also no signifiant association between vit D levels in Behcet patients and duration of disease progression, activity and severity as well as their quality of life. Conclusion: we made the evidence of hypovitaminose D in Behcet patients. Even if its role in the determination of Behcet syndrome is not obvious, this track remains to be explored.

Cardiac biomarkers are used to distinguish acute dyspnea due to left-heart dysfunction from that of pulmonary origin. However, they have not been assessed in the specific setting of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), where they might be released without left-heart impairment.To assess the accuracy of troponin T and of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of AECOPD associated with left ventricular (LV) dysfunction.Both biomarkers were measured in 148 consecutive patients on intensive care unit admission for AECOPD. A panel of physicians adjudicated blindly the cause of AECOPD to be unlikely, possibly associated, or definitely associated with LV dysfunction.The final diagnosis was AECOPD definitely associated with acute left-heart dysfunction in 31.1%, possibly associated with LV dysfunction in 13.5%, and probably not associated with LV dysfunction in 55.4%. Both NT-proBNP and troponin T levels were significantly different among the three groups. The area under the receiver operating characteristic curve was greater for NT-proBNP (0.95 vs. 0.67). A cutoff of 1,000 pg/ml was accurate to rule out left-heart involvement in AECOPD (sensitivity, 94%; negative predictive value, 94%; negative likelihood ratio, 0.08). A cutoff of 2,500 pg/ml had the best operating characteristics to rule in the diagnosis (positive likelihood ratio, 5.16). Left-heart involvement in AECOPD was the only variable independently associated with increased secretion of NT-proBNP (odds ratio, 74; 95% confidence interval, 15-375; p = 0.0001).NT-proBNP and troponin T are useful in excluding AECOPD associated with left ventricular dysfunction. NT-proBNP was the more accurate of the two.

Resume La mesure de l'hemoglobine plasmatique est utilisee dans l'evaluation de divers phenomenes hemolytiques, particulierement au moment du prelevement. En outre, les methodes employees pour quantifier l'hemoglobinemie, parametre d'un grand interet en chirurgie cardiaque, doivent etre tres precises, du fait des concentrations mesurees plus basses dans le plasma que dans le sang total. Le but de ce travail est d'illustrer les avantages d'une technique d'exploration spectrale pour la determination directe de l'hemoglobine plasmatique. La methode spectrale etudiee est lineaire, precise, de sensibilite appropriee pour l'usage clinique et n'est pas affectee par la presence ni de la bilirubine, ni des triglycerides. La correlation a ete evaluee avec une methode spectrophotometrique en utilisant la 3;3′,5,5′-teramethylbenzidine (TMB), un reactif non cancerogene. La reaction de l'hemoglobine avec la TMB a ete etudiee avec un spectrophotometre UV-Visible Hitachi U-2000. La methode est precise (CV 0,95). Les coefficients de variation pour l'analyse manuelle sont inferieurs a 1 %.

L’objectif de ce travail est d’etudier les details de la phase pre-analytique (PPA) en microbiologie afin de determiner les ecarts avec les exigences du Guide de bonnes pratiques de laboratoire (GBPL), les causes de dysfonctionnement et les actions a entreprendre pour ameliorer la qualite de la PPA dans notre etablissement. Materiels et methodes : L’etude a ete realisee dans le laboratoire de microbiologie de l’hopital de Monastir. Une grille d’auto-evaluation et une enquete de satisfaction aupres du personnel preleveur du laboratoire ont ete etablies. Une revue documentaire a ete realisee conformement aux exigences des textes normatifs (Norme ISO 15189) et reglementaires (GBPL). Les analyses des non-conformites et des risques ont ete effectuees respectivement par la methode des 5M et la methode d’analyse preliminaire des risques (APR). Resultats : Les resultats montrent que le dysfonctionnement reside essentiellement au niveau de la gestion des ressources humaines. L’analyse des causes et l’APR mettent le point sur un manque de sensibilisation et de formation du personnel responsable, une insuffisance dans la communication cliniciens-laboratoire et dans la formulation des methodes (procedures, instructions…). Conclusion : L’etude de la PPA en detail montre que toutes les etapes sont critiques. En effet, la maitrise de cette phase passe par l’application des exigences du GBPL et par la prise de conscience d’une gestion totale de la qualite.

The role of alpha-tocopherol on nephrotoxicity and hepatotoxicity induced by methamidophos (MT) was investigated in wistar rats. Animals were given via gavage, for four weeks, a low dose of MT (MT1), a high dose of MT (MT2), vitamin E (200 mg/kg of bw) or both MT2 plus vitamin E (Vit E) and control group was given distillate water. MT treatment resulted in a significant decrease in the body weight of MT2-treated group. Moreover, MT-treated groups had significantly lower butyrylcholinesterase (p 0.01) and paraoxonase 1 (PON1) activities compared with the control group (p 0.05). However, MT2-treated group had significantly higher alkaline phosphatase activity compared with untreated rats (p 0.05). Both MT-treated groups had significantly higher urea (p 0.01) and uric acid levels (p 0.05) compared with the control group. However, significant low uric acid level (p 0.05) was noted in MT2 plus vit E-treated rats compared with MT2-treated group. Histopathological changes in organ tissues were observed in both MT-treated groups and MT2 plus vit E-treated rats. However, the damage was reduced in MT2 plus vit E-treated rats. Therefore, this study deduces that alpha-tocopherol administration may ameliorate the adverse effects of subacute exposure to MT on rat liver and kidney and this antioxidant can protect PON1 from oxidative stress induced by this organophosphorus pesticide. © 2014 Wiley Periodicals, Inc. Environ Toxicol 31: 842-854, 2016.

We purpose to verify if paraoxonase 1 (PON1) activity may be a marker of cardiovascular risk in a young Tunisian population with type 1 diabetes (T1D).PON1 activity was measured by a kinetic method using paraoxon as substrate. The other parameters were determined by automated methods.One hundred and nine children and adolescents with T1D and 97 healthy subjects were involved in this study. PON1 activity and PON1/HDL-cholesterol ratio were significantly decreased in diabetics (303 ± 174 vs. 372 ± 180 U/L and 221 ± 139 vs. 298 ± 20 1U/mmol, P=0.006, P=0.002, respectively) compared to controls. A significant increase in total cholesterol, LDL-c and microalbuminuria was observed in diabetics compared to controls. PON1 activity was decreased by 9.5% in patients with diabetes duration ≥ 6 years, by 28.4% for those with fasting glycemia ≥ 7 mmol/L (P0.001), by 14% in those with HbA1c ≥ 8% and by 12.3% for diabetics with dyslipidemia. PON1 activity is reduced when the number of cardiovascular risk factors increases (P0.001).PON1 seems to be associated to cardiovascular risk markers in T1D. This result remains to be seen. Nevertheless, improving PON1 activity could be a significant target for reducing cardiovascular risk.

Capillary electrophoresis of serum proteins is a fast, reliable and simple technique, but many interference exist. The objective of our work is to study the interference of bilirubin on this technique; 70 icteric sera were analysed on Capillarys ™ (Sebia). A second electrophoresis was performed on 40 samples after bilirubin photodegradation. The bilirubin and serum proteins were determinated respectively by Jendrassik and Grof and biuret methods on Konelab 20i ™ (Thermo Electron Corporation). We found abnormal spreading of the albumin fraction of the anode side wich constitute sometimes an isolated fraction in the traditional area of pre-albumin migration. This fraction varies from 2.0 ± 2.0% (0.0 to 7.3%) or 0.98 ± 1.53 g/L (0 to 5.3 g/L) and it seems to be related to the direct bilirubin since, following overloading sera with a solution of bilirubin, no further fraction was recovered. An average decrease of bilirubin after photodegradation of 58 ± 17% (26-89%) is followed by a decrease in the same order 64 ± 38% (10-100%) of the additional fraction. Acetate cellulose electrophoresis of the same samples showed no variation. The high bilirubin levels seem modify slightly the electrophoretic profile. However the impact of the interference on the interpretation of electrophoretic trace is negligible.

Objectives: Our study aimed to examine the effects of salicylic acid on paraoxonase activity in healthy volunteers. Methods: Plasma from healthy volunteers was spiked with salicylic acid drug. The working solutions were then diluted with plasma to obtain concentrations that covered the therapeutic margin. Specimens were incubated at 25 and 37°C, and we measured PON1 activities in the presence of different drug concentrations after 1 h, 3 h, and 24 h and after one week. Results: After incubation in vitro, a significant increase of paraoxonase 1 activity according to salicylic acid concentration and incubation duration, regardless of temperature incubation was showed. This increase was marked especially after 24 h of incubation. The stimulatory effect of salicylic acid is concentration and incubation durationdependent and does not seem to be related to temperature incubation. Conclusion: The tested Salicylic acid significantly stimulated PON1 activity in a concentration dependent manner. This result shows that acetyl salicylic acid treatments have a beneficial effect dose and time dependent that may contribute to prevent atherosclerosis.

The aim of this study was firstly to investigate the correlation between bone parameters and grip strength (GS) in hands, explosive legs power (ELP), and hormonal parameters; second, to identify the most determinant variables of bone mineral density (BMD) among adolescent combat sport athletes. Fifty combat sport athletes aged 17.1 ± 0.2 year were compared with 30 sedentary subjects matched for age, height, and pubertal stage. For all subjects, the BMD in deferent sites associated with anthropometric parameters were measured by dual-energy X-ray absorptiometry. The growth hormone (GH) and testosterone (TESTO) concentrations were tested. The GS in dominant (GSDA) and nondominant arms (GSNDA) and ELP were evaluated. All BMD measured were greater in athletes than in sedentary group (p

Screening for diabetic nephropathy is usually done by albuminuria/24h and the use of creatinine clearance. The objective of this study was to evaluate the renal function in Type 2 diabetes by using different formulas of creatinine clearance and to assess the contribution of cystatin C; 83 adults with type 2 diabetes (23 men and 60 women) and 83 adult controls (40 men and 43 women) were studied. Biochemical parameters were determinated on Coba 6000™ (Roche diagnostics). Diabetics showed a significant increase in blood glucose, cholesterol, triglycerides, LDLc, the ApoB, Lp(a), urea, uric acid, creatinine and cystatin C and lower HDLc. Cystatin was increased in patients with degenerative complications and in hypertensive patients. We found strong correlations of cystatin C with creatinine (r = 0.9454), urea (r = 0.8999) and uric acid (r = 0.8325). We found a significant exponentially increase of creatinine and cystatin C from one stage to another. Cystatin C has a strong association with MDRD (r = 0.8086) and CG (r = 0.7915) and a low one with creatinine clearance (r = 0.1044). In conclusion, the use of cystatin C for screening and early treatment of incipient diabetic nephropathy appears to be adequate. CG and MDRD formulas still hold their place, in regards to the classical determination of creatinine clearance, to monitor patients.

BACKGROUND Paraoxonase 1 (PON1) is important in organophosphates and xenobiotic metabolism and as an antioxidant bio-scavenger. PON1 activity was shown to significantly decrease in depressed patients after antidepressant treatment instauration. Our aim was to investigate the in vitro inhibitory effects of three antidepressants (imipramine, amitriptyline and fluoxetine) on PON1 activity. METHODS Plasma from healthy volunteers was spiked with antidepressant drugs. The working solutions were then diluted with plasma to obtain concentrations that covered the therapeutic margin. PON1 was tested by a kinetic method in triplicate after incubation at 37°C for 2 h. RESULTS Tricyclic antidepressants significantly inhibited PON1. Fluoxetine had no effect. The inhibition percentage for imipramine was 15.6% at 100 μg/L after incubation for 1 h (131±1 vs. 155±2 IU/L; p

Bone loss in celiac disease (CD) is important and is associated to increased risk of fractures. The determining factors of this Bone loss and the osteoporosis fracture during this disease remain still unknown. The bone remodeling parameters seem to play it an important role.Through a transverse study including 30 patients with adult CD and 30 witnesses, we estimated bone mineral density (BMD) profile of these patients and determined associated factors to the bone loss.Patients and witnesses benefited from an BMD measure, serum calcium and phosphore, alkaline phosphatasis, parathormone and hydroxyvitamin D dosage, bone remodeling parameters containing the osteocalcin, Propeptide N-terminal of the type I procollagen, BTélopeptide C-terminal ( B-CTX) of the type I procollagen I (bloody and urine CrossLaps). The patients benefited from a malabsorption bilan, a radiological examination of spine and an evaluation of the adhesion to the regime without gluten with a histological control.Our population consists of 3 men (10 %) and 27 women (90 %) with an average age of 30.4 years (19-50 years). The average delay of the diagnosis of the MC is of 46.7 months. The alkaline phosphatases, the P1NP and the bloody crossLaps were more raised at the patient's with regard to the witnesses with respectively p=0.038, p=0.041 and p=0.021. The parathormone was also more raised at the patients but without significant difference 67.8 vs 53.8 ng / l. The DMO is low at 21 patients (70 %) versus 2 witnesses only (6.6 %), with an osteoporosis in 3 patients (10 %) and an osteopenia in 18 patients (60 %). Factors associated to the BMD decline are low body mass index, nulliparity, diagnostic delayto 2 years, the malabsorption syndrome, exaggerated intraepithelial lymphocytosis at the time of the histological control, an increase of bone remodeling parameters notably the alkaline phosphatasis, osteocalcin and bloody CrossLaps. While the BMD is more raised at the patient's having followed gluten regimens during more than 5 years. The age, the sex, the symptomatic character or not of the disease, the parathormone, hydroyviamin D and fractures are not correlated to the BMD profile patients.The bone loss is more frequent during the adult CD than in the general population. His research has to become integrated into the coverage of this disease notably in the presence of risk factors. The absence of correlation between BMD loss and fractures underlines the importance of others factors in determining of bone fragility during this affection.

Objectif : ce travail a pour objectif de preciser le profil sociodemographique des consommateurs de cannabis, ainsi que les caracteristiques et les effets de la consommation. Methodes : notre etude transversale et descriptive a concerne 205 sujets (191 hommes et 14 femmes), âges de 25,9 ± 7,9 ans. La consommation des medicaments psychotropes et/ou de cannabis a ete confirmee par une analyse toxicologique. Resultats : dans notre population d’etude, 61 % des sujets etaient consommateurs de cannabis avec une predominance masculine de 94,4 %. Les consommateurs etaient des adultes jeunes, âges de 25,8 ± 8,8 ans en moyenne, celibataires (81,6 %), de niveau scolaire primaire (62,4 %), ayant une activite professionnelle (72 %) et residant dans des zones urbaines (77,6 %). Au total, 28,8 % avaient des antecedents personnels psychiatriques. L’âge moyen du debut de consommation etait de 20 ans. La consommation associait frequemment l’alcool et le tabac (72 %). La consommation de cannabis etait quotidienne chez 40 % des sujets. La majorite de ceux qui ont consomme de la drogue l’ont fait au cours de reunions entre amis. Dans la plupart des cas, le recours au cannabis etait considere comme un moyen de fuir les problemes (29,3 %), de relaxation (20,2 %), d’experimentation (18,2 %) et de recherche de plaisir (16,7 %). Conclusion : ces donnees suggerent l’importance d’une prevention primaire de l’usage precoce, associee a une prise en charge rapide des personnes engagees tres jeunes dans la consommation de cannabis.

This study aims to investigate the variation of pseudocholinesterase activity (BuChE) in bipolar patients and to explore its relation to the clinical and therapeutic characteristics of this disease. Our study included 105 patients with bipolar disorder and 100 control subjects aged 38.7 ± 12.2 and 36.4 ± 15.7 y, respectively. BuChE was determined by kinetic methods on Cobas Integra 400 plus™. Compared with controls, patients had a significantly higher pseudocholinesterase activity. Moreover, this increase was significantly associated (p = 0.001) with bipolar disorder with sensibility of 58% and specificity of 62% at threshold of 7392 IU/L. There was no significant change in pseudocholinesterase activity in relation to illness episodes and treatment, whereas the lowest values of this activity were seen in euthymic patients and those taking psychotics. Therefore, this activity is a real interest in the biological monitoring of patients as a risk factor for neurodegenerative diseases associated with bipolar disorder. But it would be most useful to evaluate their interest as a predictor of bipolar disorder in patients at risk.

Many species of the genus Astragalus have been long used in folk medicine because of their biological properties. The aim of this study was to investigate the antibacterial and cytotoxic activities of extracts from the leaves of wild Astragalus gombiformis Pomel. Antibacterial activity was assayed against several common human pathogenic bacterial strains using the paper disk-agar diffusion method. Cytotoxicity was measured against human lung carcinoma cells using the colorimetric MTT assay. The strongest cytotoxic activity against the human A549 lung epithelial carcinoma cell line was detected for dichloromethane extracts at IC50 = 85 ± 21.7 µg/mL. The best incubation time for this extract was 48 h. Most of the tested extracts were active against the tested bacterial strains. The methanol extract was found to be the most active against Pseudomonas aeruginosa and Salmonella typhimurium. This study is the first report on the biological activity of leaf extracts of Astragalus gombiformis with respect to antibacterial activity as well as cytotoxicity.

We evaluated the metabolic and the nutritional aspects of 134 urolithiasic children, in order to outline the risk factors that contribute to idiopathic stone formation in children.In this prospective study 134 children (56 females, 78 males) with renal calculi were evaluated. The age of the patients ranged 6 months to 16 years. A dietary survey was performed on every child. All patients were investigated with respect to stone localization, serum and urine risk factors. Statistical analysis of data was carried out using software SPSS 11.0 for Windows. Statistical significance was determined using chi-square test.Hypercalciuria was the commonest risk factor detected in this group (28.3%). A decrease of water intake was noted in all age group specially in the rural area (549.6 vs 1150.6 ml/day), and an increase in animal protein intake in 17 cases (mean 1.9 g/kg). In addition, increased intake of starchy foods and food with high oxalate content (sorgum) was observed in our 10-16 years group (51%). Calcium oxalate monohydrate represents the principal component of idiopathic stone (58.2%), which is more frequent in children (68%) than infants (51.7%) (P0.02).The high frequency of idiopathic urolithiasis highlights the influence of dietary habit in stone formers in our country. The increase in calcium oxalate stones in school-age children confirms the change in the etiology of urolithiasis according to age.

The aim of the present study was to investigate hyperhomocysteinemia in Tunisian bipolar I patients according to 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism.The subjects consisted of 92 patients with bipolar I disorder diagnosed according to DSM-IV, and 170 controls. Plasma total homocysteine, folate and vitamin B12 were measured. MTHFR C677T polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism.Compared with controls, patients had a significantly higher homocysteine level (16.4 ± 9.8 vs 9.6 ± 4.5 µmol/L; P0.001) and a significantly lower folate level (3.2 ± 0.9 vs 6.5 ± 3.2 µg/L; P0.001). C677T MTHFR polymorphism genotype frequencies were in Hardy-Weinberg equilibrium. After adjustment for MTHFR C677T genotypes, hypofolatemia, hypovitamin B12 and for potential confounding factors, the odds ratio (OR) of hyperhomocysteinemia associated with bipolar disorder remained significant (OR, 5.53; 95% confidence interval: 1.92-15.86; P = 0.001). In patients, there was no significant change in hyperhomocysteinemia, hypofolatemia and hypovitamin B12 with regard to the clinical and therapeutic characteristics, whereas the highest prevalence of hyperhomocysteinemia was found in depressive patients and when illness duration was12 years. Hypofolatemia was seen in all patients on lithium and in the majority of patients on carbamazepine, and the highest prevalence of hypovitamin B12 was noted in patients taking carbamazepine.Hyperhomocysteinemia was more frequent in bipolar I patients independent of C677T polymorphism. Patients had reduced levels of folate, which modulates homocysteine metabolism. Indeed, this finding indicates that folate supplementation may be appropriate for bipolar patients with hyperhomocysteinemia.

La butyrylcholinesterase (BChE) est une enzyme incriminee dans la genese de differentes affections neurodegeneratives et probablement neuropsychiatriques. Dans ce travail, nous avons etudie les variations de l’activite de cette enzyme chez des patients schizophrenes dans l’objectif de preciser son implication dans la schizophrenie (SZ) et l’interet de la determination de son activite dans cette pathologie. Notre etude cas-temoins a concerne 131 patients schizophrenes âges de 38,0 ± 11,4 ans et 90 sujets temoins âges de 37,1 ± 15,9 ans. L’activite de la BChE plasmatique a ete determinee par une methode cinetique sur l’automate Integra 400 plus™ (Roche diagnostics). L’activite moyenne de la BChE etait significativement plus elevee chez les patients schizophrenes par rapport aux temoins ( p < 0,0001). Elle etait egalement significativement plus elevee dans le sexe feminin et significativement plus basse chez les fumeurs par rapport aux non-fumeurs, aussi bien pour les patients que pour les temoins. Chez les patients schizophrenes, il n’y avait pas de variation significative de l’activite de la BChE en fonction de l’âge, du statut alcoolique, du sous-type clinique de la maladie et de l’anciennete de la maladie. L’activite moyenne de la BChE etait plus elevee chez les patients traites par des antipsychotiques en monotherapie par rapport a ceux traites par une association antipsychotiques et anticholinergiques, sans difference significative ( p = 0,196). Les patients schizophrenes presentent une augmentation de l’activite plasmatique de BChE, qui pourrait etre en relation avec la physiopathologie de la SZ.

Objective Since 1980s, the clinical and biological characteristics of urolithiasis in Tunisian children have continuously evolved. This retrospective study defines the current status of urolithiasis among children and adolescents in Tunisia. Methods We retrospectively reviewed the records of 310 children and adolescents (age: 3 months - 19 years) between 2003 and 2010, holding urolithiasis. A first-line metabolic, urine and plasma work-up was performed in all patients. Physical and chemical analysis of the stones was performed respectively by stereomicroscopy and infrared spectroscopy. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. Findings Our study shows a male predominance of urolithiasis with a sex ratio of 1.5. Stones were located in the upper urinary tract in 70.7% of cases. Calcium oxalate was the predominant constituent in 52.6% of stones. There was an increasing prevalence of calcium oxalate stones according to age in both genders (48.6% in infants vs 68.5% in teenagers (P