[Management of anorexia nervosa in a Tunisian case]

Anorexia nervosa is a complex psychiatric illness that can lead to severe physical complications. This work aimed to study the approach taken by the child psychiatry service of Razi hospital in the management of anorexia nervosa and to compare it with international recommendation. We propose to illustrate by a case report the management of anorexia nervosa in its typical form and review international recommendations on this topic while undertaking a review of the literature based on a Medline search using the following keywords: anorexia nervosa, adolescence, management, guidelines. Case report: AS, 16 years old, addressed to us by the school doctor for management of anorexia nervosa evolving for two years without improvement through outpatient care. His condition was considered precarious requiring urgent care in a medical hospital. She was then hospitalized at the Institute of Nutrition with a weight contract to achieve. She received a gradual refeeding strongly denied. We have provided a psychological support by moving on site three times a week to help establish a good therapeutic alliance. After three weeks, the teenager has reached an acceptable weight for its output to the hospital and additional support at the outpatient child psychiatry with supportive psychotherapy. Two months later, she developed depression because of the weight gain. The appointment at the dietician was continued three months after hospitalization. At 10 months of the hospitalization, the girl At 10 months of the hospitalization, the girl had good grades and was not amenorrheic. However, on the psychological level she kept the same traits and intrafamilial relationships were marked by the seal of the manipulation. Subsequently, the teenager has spaced the consultations then lost sight. Currently, at 15 months of the hospitalization, parents describe a

relapse, with a dietary restriction without amenorrhea and a refusal to take weight. [asterisk] In management of this patient, we followed the recommendations of the literature namely those of the High Authority of Health and NICE

[National Institute for Clinical Excellence] which recommend a target tracking of anorexia nervosa, the establishment of a multidisciplinary team care, a long hospitalization with a weight contract, support and cognitive therapy of the body image when the initial outpatient care is not effective. Similarly, for children and adolescents, family therapy is recommended as an outpatient after hospitalization. In our country, the prevalence of anorexia nervosa is gradually increasing although we have not an idea concerning the frequency or prevalence of this disease which has serious and unpredictable complications. For what, It requires a multidisciplinary and prolonged surveillance to prevent recurrence

Efficacy and safety statins in the treatment of diabetic dyslipidemia

The Adult Treatment Panel III recommends 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors or statins as first-line-lipid-altering therapy for all adult patients with diabetes mellitus. This is based on the well-characterized efficacy and safety profiles of this class of agents as well as several clinical trials demonstrating that statin treatment reduces the risk of cardiovascular events. The objective of our study was to investigate the efficacy and safety of statin therapy in patients with diabetes type 2. We analyzed data from 120 individuals with diabetes type 2. For all patients, the mean baseline LDL-cholesterol level was 4, 26 +/- 0, 82 mmol per liter, the total cholesterol level was 6, 52 +/- 0, 75 mmol/l, HDL-cholesterol level was 1, 15 +/- 0, 31 mmol/l and triglyceride level was 1, 77 +/- 0, 67 mmol/l. There was a significant reduction in total cholesterol [P=2.10-3] and LDL-cholesterol [P=5.10-4] with statins; the mean LDL-cholesterol level was reduced from 4, 26 +/- 0, 82 mmol/l at baseline to 2, 8 +/- 0, 59 mmol/l at 12 months. The percentage variation of LDL-cholesterol was between 24 and 35%; in addition, the percentage reduction of total cholesterol was between 22 and 28%, the mean reduction in TG levels was between 11 and l6%.There was a no significant increasing in HDL cholesterol. Among these 120 patients, 5, 1%had a moderate CK elevation. Moreover 2%had a significant elevation of transaminase levels. Statins have also been associated with muscle-related adverse events; so milder complaints [myalgia] are reported by approximately 3, 6%of patients who take statins. Statins as highly efficacious agents for the lowering of low-density lipoprotein-cholesterol [LDL-C] revolutionized treatment of hypercholesterolemia, a long established risk factor for premature coronary heart disease and they are not only exhibit a remarkely high benefit to risk ration, but are equally characterized by a safety profile with excellent tolerance

[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

[Ocular manifestations of diabetics about 285 cases]

Diabetes is one of the principal cause of blindness in adults. The aim of the study is to evaluate the frequency of ocular complications and risk factors of diabetes. It's a multicentric prospective study on a representative sample of 285 diabetics. We performed a general and an ophthalmologic exam for all patients with retinal angiography and appropriate laboratory tests. Chi 2, Fisher, Mann and Whitney tests were used as statistical methods. Diabetic retinopathy was observed in 45, 2% of patients, cataract in 22%, glaucoma in 5%. Diabetic retinopathy frequency rises especially with duration of diabetes and bad glycaemic control. Blindness related to diabetic retinopathy was observed in 6, 25% and visual deficency in 12, 5%. The authors compared their results with litterature data. They emphasize on the great value of regular better glycaemic control and other associated metabolic disorders. We concluded that a regular ophthalmologic follow up is necessary for early diabetic retinopathy detection and treatment

[Breast feeding: can protect against childhood obesity?]

Obesity is a multifactorial disease resulting from complex interaction between genes and environment. Early infant nutrition constitutes one of the environmental determinants of infantile obesity. The effect of breast-feeding on the development of obesity in the child was the subject of many studies the results of which are still controversial. We realized this case-control study to search for an association between breastfeeding and obesity in childhood. Our study included 92 children [46 obese and 46 with normal weight]. Age, sex, socio-economic level and birth weight were comparable in the two groups. Our results show a significant relationship between obesity and breastfeeding [Odds Ratio=0.23, p=0,01]. This protective effect of breastfeeding persists after adjustment for the family history of obesity [OR=0.18, P<0,01]. Although this association is not an evidence for a link of causality, the promotion of breastfeeding is recommended for the prevention of childhood obesity

[ incidence of nutritional education on the food intake regulation of young diabetics]

The aim of our study is to evaluate the effect of nutritional education [applied during young diabetic camps] on the nutrition knowledge acquisition and the effective application of this knowledge by young diabetics in their dietary intake composition. This study included ten volunteer pupils, aged from 12 to 15 years. Each meal provided was quantified before and after consumption to determine during three consecutive days the exact amount of food consumed. Our results showed that the young diabetic could regulate his energetic intake in accordance with his needs.He didn't modify the proposed food when it was normocaloric [2615 +/- 390 Kcal], but he increased his food intake near the recommended needs when the proposed food was hypocaloric [1766 +/- 283 Kcal] and decreased his consumption when the proposed food was hypercaloric [4271 +/- 511 Kcal]. Moreover, this study showed a significant negative correlation between the total energy intake and the amount of carbohydrates [r = -0.46, p < 0.01] and proteins [r= -0.70, p< 0.01], while it was positive between the first and lipid intake [r=0.63, p<0.01]