[Consequences of early in the month of ramadan diabetic type 2 initially mal control]

Consequences of fasting in Ramadan on the metabolic control of previously poorly. Controlled diabetics are obvious but little described. We followed 20% type 2 diabetic patients with no known complications. They were receiving oral antidiuretic treatment and were poorly controlled with a HhAlc of 9, 6 +/- 2, 1%. They insisted on fasting even when advised not to do it. Clinical parameters, glycaemic and lipoproteins levels were evaluated three times: 20-30 days before Ramadan, between 20 - 27 day in Ramadan and 20 days after the end of Ramadan. Fasting did not change their- weight nor there. Blood pressure. But it worsened the glycaemic control fasting glycemia increased by 2, l mmol/l [p < 0, 01] and fructosamine by 93 rmol/l [p < 0, 03]. However glycated hemoglobin remained unchanged. A 39% reduction in the HDL-cholesterol [p<0,003] was associated with a 24% increase in LDL cholesterol [p < 0, 02]. These parameters returned to their initial levels 20 days after the end of Ramadan. Ramadan, fasting may significantly worsen glycemic and lipoprotein control in initially poorly controlled type 2 diabetic patients

[Giganto-acromegaly: a report of a case]

The occurrence of acromegaly before the end of the growth period is very rare. We report a case of a patient who presented an acromegalo-gigantism. His height reached 2.45 m and his weight 145 kg. He had a typical facial dysmorphy and an insulin requiring diabetes mellitus. There was no sign of cardio-respiratory failure or of endocrine deficiencies. The echocardiography showed that the left ventricule was moderately dilated and hypertrophied but the systolic function was preserved. Hormonal investigation revealed high growth hormone [GH] levels without suppression after oral glucose load. Other pituitary secretions were normal. Initial tomodensitometry revealed an invasive macroadenoa. The patient had two trans-sphenoidal resections of the tumor completed by radiotherapy [45 Gy]. Afterwards, because of still unsuppressed GH levels, the patient was treated with Octreotide. This first published case of acromegalo-gigantism in Tunisia is particular not only by its rarity but also by its moderated effects on vital functions in spite of along spontaneous evolution

[Metabolic effects of Ramadan fasting on type 2 diabetes]

We assessed the effects of Ramadan fasting on metabolic control, particularly change of HDL-cholesterol in 25 type 2 diabetic patients treated with diet or oral agents, with good metabolic control. Clinical and biochemical parameters and food intake were evaluated 3 weeks before Ramadan, in the fourth week of Ramadan and 3 weeks after Ramadan.There were no changes in body weight and blood pressure nor any metabolic complications. The mean plasma fasting glucose, serum fructosamin and haemoglobin A1c did not change. We found a negative relation between cholesterol intake during Ramadan and the change of HDL-cholesterol. When cholesterol intake was lower than 400 mg/day, plasma HDL-cholesterol increased by 13% at the end of Ramadan and by 23% 3 weeks after Ramadan

[ surgery in hemodialysis patients]

The experience of the hemodialysis unit in the university hospital lbn Rochd Casablanca since its beginning in 1983 rest on 20 patients who underwent at least one surgical operation, that is 16 percent, of the population undergoin hemodialysis in our unit. The study of age and sex-ratio showed; 13 men [65%] and 7 women [35%] with an average age equal to 42 years. The frequency of untercurrent surgical pathology unrelated to renal failure is 4 percent. The analysis of the nature of operation in terms of kind of kidney disease shows a high frequency of urological surgery in chronic pyelonephritis. Regarding glomerulonephretis it is rather question of general surgery. Consequences of operation were simple in 90 percent of cases. We didn't deplore any decease after surgery

Nephrotic syndrome with minimal charge

On 230 cases of nephrotic syndrome treated between 1982 and 1988, 40 nephrotic syndromes were with minimal charge. The average of age was 22 years with a light male predominance [56%]. Oedema was the first motive of consultation, no case of arterial hypertension was seen. While hematuria was noted in 16% of the cases, proteinuria was between 3 g/24h and 22g/24h, protidemia average was 42.5 g/l, albuminemia was 17g/l. Corticosensibility was observed in 95.5% of cases. Relapse were frequent, the infection was the principal reason

Hepatitis B vaccination. Evaluation of efficacy in a high risk hospital personnel population

B. Viral hepatitis endemo-epidemiological potencial in hospital practice remains a preoccupyng problem. The study of serological status in an order of an active protection has been realised in a group of 100 of the medical staff in university hospital of Casablanca. 49 of the subjects had at least one of the markers of B. hepatitis among them one is chronical carrier of H.B.S. antigen. 51 seronegative and volonteers subjects [51%] have received 3 injections of the vaccine Hevac B [R] of Pasteur Institute, at one month interval. The evolution controls of Anti H.B.S. antibodies have been realised a month later after each injection. At the end of this vaccination 86.2% of the subjects have acquired a protection with rates of anti H.B.S. superior to the minimal protective rate. 5 bad responders have received a forth injection of the vaccine. The control of the antibodies H.B.S. was realised one year after, in 30 subjects [58.8%], 29 have kept Anti H.B.S. antibodies, among them 25 at protective rates

[Diagnostic value of antibody coated bacteria in the site diagnosis of urinary tract injection]

The clinical and radiologic data cannot always differentiate between upper urinary tract and lower tract infections. The antibody coated bacteria test has been performed in 12 cases and has proved to be a sensitive and specific indicator of renal infection

Value of determination of the aminoglycoside serum levels in severe infectious diseases

The authors have used a simple and cheap microbiological method for the determination of the aminoglycoside serum levels of four patients. The clinical situation where these monitoring may be useful are emphasized