[Metabolic profile of Tunisian obese adult]

obesity is associated with multiple comorbidities such us metabolic and cardiovascular diseases. Evaluate metabolic profile and to determinate the frequency of metabolic syndrome in Tunisian obese adult. It's a prospective study realized in the unit of obesity research in the national institute of nutrition between April 2003 and March 2005 .This study concerned two groups of subjects aged between 20 and 60 years old: Group 1 [n = 100]obese [BMI >/= 30 kg/m[2] and group 2 [n= 60] controls with normal weight [BMI between 18.5 and 24.9 kg/m[2]. Mean number of metabolic complications is significantly higher [P < 10[-3]] in obese [3.28 +/- 2] than in controls [1.16 +/- 1.2]. Impaired fasting glucose and type 2 diabetes mellitus are respectively more frequent in obese [37% and 16%] than in non obese [5% et 1.7%]. Hyperinsulinemia is significantly [P<10[-3]] more frequent in obese. hypertriglyceridemia, hypercholesterolemia and hyperapolipoproteinaemia B are significantly [P = 0.01, P < 10[-3] et P < 10[-3] more frequent in obese than in no overweight subjects. The prevalence of hyperuricemia increased significantly [P = 0.01] in overweight subjects than in normal weight subjects. Metabolic syndrome is significantly more frequent [P < 10[-3]] in obese [48%] than in control [1.7%]. Obesity, especially visceral obesity, is associated with a cluster of metabolic complications increasing the risk of coronary heart disease. We stresson the importance of primary prevention and early management of obesity

[Latent autoimmune diabetes in Tunisian adults [LADA]: identification of autoimmune markers]

LADA or type 1.5 diabetes is a slowly progressive form of autoimmune diabetes of adults. The aim of this study is to evaluate the frequency of autoimmmune markers and to identify patients with LADA among diabetics diagnosed initially as having type 2 diabetes. Our study concerned 100 diabetics, aged between 31 and 77 years [age at onset > 30 years], with short term diabetes [duration < 6 years] and who required insulin therapy after 6 months from diagnosis of diabetes. All patients were screened for antibodies to Glutamic Acid Decarboxylase [GAD65], the Tyrosine Phosphatase [IA2] and Islet Cell antibodies [ICA]. Mean age of patients is 53 +/- 10.5 years. Mean age at onset of diabetes was 43.3 +/- 10 years. Insulin treatment required after 3.1 +/- 1.8 years. Positivity of at least one of the auto-antibodies was found in 78% of patients. ICA were detected in 48.5% of cases. IA2 and GAD antibodies were positive respectively in 42% and 18% of tested patients. There was no significant difference of gender. Anti-GAD positive patients had statistically significant higher initial fasting blood glucose and HDL-cholesterol serum [p = 0.01 and 0.007] than those with anti-GAD negative. Patients with anti-lA2 were characterized by more important frequency of autoimmune diseases and low rate of triglycerides. The frequency of macrovascular complications was lower in ICA positive diabetics than those with ICA negative. Patients initially diagnosed as type 2 diabetes may in many cases suffer from LADA. Auto-antibodies screening may be of interest to identify LADA at the earliest stage. Frequency of type I diabetes in adults is underestimated. The identification of LADA may help to classify diabetes and to indicate the moment of insulinotherapy

[Fetal and maternal prognosis of breech presentation at term]

Introduction: Breech presentation is associated with increased fetal, neonatal and maternal risk. The purpose of this study was to assess the prognosis of this presentation near or at term

Patients and methods: This retrospective study included all deliveries with a breech presentation and a gestational age over 34 weeks in our service between January 2000 and December 2005

Results: 243 deliveries were indexed throughout the study period.141 patients delivered by prelabor planned cesarean section and 47 by cesarean section during labor. 2 cord prolapses were found [0.8%]. 8 babies [3,3%] had a 5 minute Apgar scores < 7 and we observed 5 admissions to the neonatal unit. There were 2 birth trauma and 2 perinatal deaths

Conclusion: Breech delivery is a risk for mother and newborns. Development of measures and standards for obstetric practice would help improve its prognosis

[Fetal pleural effusions-A case report]

Foetal pleural effusion in a rare situation. Diagnosis is normally easy to do by obstetrical sonography. The pleural effusions can be primary, caused by a pleural lymphatic vessels disorder, which have generally a good prognostic. In the other situations, they can be secondary to an other general immune or non-immune disorder. It can be compressive or associated to an hydrops fetalis, and needs in these cases an intra-uterine treatment based on decompression of hydrothorax. We report a case of bilateral pleural effusion diagnosed at nineteen weeks of pregnancy and spontaneously resolved at the 28[th] week. We treat the different clinical aspects of this anomaly and modalities of intra-uterine management