[Trends in the profile of infective endocarditis at a university hospital in Tunis]. / Évolution du profil de l'endocardite infectieuse : expérience d'un centre universitaire à Tunis.

UNLABELLED: Infective endocarditis (IE) is a serious disease for which diagnosis and treatment continue to develop. Purpose of work. To analyze trends in its epidemiologic, clinical, and microbiologic characteristics, as well as its treatment and outcome. METHODS: Retrospective review of data of 135 patients admitted to our adult cardiology department from January 1981 through December 2011. IE was diagnosed according to the modified Duke Criteria. We defined 2 groups of patients according to their date of admission: group A (n = 55), patients admitted before 1995, and group B (n = 80), patients admitted in and after 1995. RESULTS: The entire population was predominantly male, and their mean age was 38.5 ± 16 years, 36 years in group A and 44 years in group B. IE affected mainly native valves (90% group A, 74% group B; p<0.05). Prosthetic IE was more frequent in group B (20% vs 10%, p<0.05), and the portal of entry identified more often (59% vs 22%; p = 0.03). Blood cultures were negative in 78% of patients in group A vs 57.5% in group B (p = 0.04). The principal causative microorganism was streptococcus before 1995 and staphylococcus after 1995, but this difference was not significant. Heart failure was more frequent in group A (p = 0.05). Embolic events affected 27% of the patients in group A vs 32.5% in group B (p = 0.05). The rate of surgery (51% in group A vs 62.5% in group B) did not differ significantly. The in-hospital mortality rate was 53% in group A vs 11% in group B (p<0.001); operative mortality was also higher in group A (p<0.001). CONCLUSION: Our work shows changes in the epidemiologic characteristics of IE that parallel changes in demographic and risk factors. The progress of diagnosis and surgery explains the better prognosis for this pathology today.

Relationship between glutathione S-transferase P1 polymorphisms and chronic obstructive pulmonary disease in a Tunisian population.

Chronic obstructive pulmonary disease (COPD) is a multifactorial disease with possible genetic predisposition and involvement of various environmental factors. Several candidate genes have been reported as potentially associated with this lung disease. The glutathione S-transferase P1 gene (GSTP1) was proposed to be involved in susceptibility to develop COPD. It belongs to the GST family, which is a group of phase II enzymes that catalyze the glutathione conjugation of many endogenous and exogenous electrophilic compounds, such as carcinogens, therapeutic drugs, environmental toxins, and oxidative stress products. We conducted a case-control study to investigate genetic polymorphisms of this enzyme [exon 5 (Ile105Val) and exon 6 (Ala114Val)] in 234 unrelated COPD cases and 182 healthy controls from a Tunisian population. Genotyping was carried out using polymerase chain reaction and restriction fragment length polymorphism methods. GSTP1 Ala114/Val114 and Val114/Val114 genotypes were not found in either patients or healthy controls. However, there were differences in the distribution of various exon 5 GSTP1 genotypes between COPD patients and healthy controls. GSTP1 Val105/Val105 was significantly more common in patients compared to controls (OR = 2.67; 95%CI = 1.45-4.92; P = 0.0013). Multivariate logistic regression analysis confirmed a significant relationship between the mutant genotype and COPD (OR = 2.58; 95%CI = 1.31-5.09; P = 0.026), after adjustment for classic risk factors. Analysis of variance showed no correlation between age, body-mass index, pack-years, percentage of predicted FEV1 values, and any of the GSTP1 genotypes. We conclude that subjects with GSTP1 Val105 allele are at higher risk of COPD.

[Biochemical and molecular diagnosis of alpha 1 antitrypsin deficiency in a Tunisian family]. / Diagnostic biochimique et moléculaire du déficit en alpha 1 antitrypsine dans une famille tunisienne.

Our study investigated alpha 1 antitrypsin deficiency (AATD) diagnosis in a family originated from central Tunisia and showing a familial history of asthma. Biochemical and genetic diagnosis for AATD was performed according to current diagnostic standards. AAT level quantification in affected individuals showed plasma AAT levels consistent with intermediate AATD (ranged from 0.91 to 1.04 g/L). The molecular analysis was assessed using the genotyping of the most prevalent PI*S and PI*Z SERPINA1 mutations and the sequencing of AAT coding exons for rare AATD variants detection. No PI*S or PI*Z deficient variants were seen in this family. Sequencing results showed the inheritance of the deficient rare variant PI*M(wurzburg) (P369S) at the heterozygous state in the mother and two affected siblings. However, AATD status remains unexplained in the third affected case, with no mutations detected in the AAT coding exons.

[Cardiac sarcoidosis revealed by ventricular tachycardia]. / Sarcoïdose cardiaque révélée par une tachycardie ventriculaire: a propos d'une observation.

Cardiac sarcoidosis is a multisystem granulomatous disease of unknown etiology, that is more seen in younger adults. The prognosis of myocardial sarcoidosis is poor and depends on arrhythmia, conduction disorders. We report the case of 35 years old woman with cardiac sarcoidosis and pulmonary involvement who presented acutely with sustained ventricular tachycardia well tolerated. She made a good recovery after steroid therapy and administration of antiarrhythmic agent.

Genetic Structure of the Phytophthora infestans Population in Morocco.

ABSRACT In 1996 to 1998, a late-blight survey was conducted in potato- and tomato-growing regions of Morocco. A total of 149 isolates of Phytophthora infestans were collected and analyzed for the glucose-6-phosphate isomerase (Gpi) and peptidase (Pep) alleles, mating types, and metalaxyl sensitivities. Four genotypes were identified: MO-1 (mating type A1, Gpi 100/100, Pep 92/100), MO-2 (mating type A1, Gpi 86/100, Pep 92/100), MO-3 (mating type A2 Gpi 100/100, Pep 100/100), and MO-4 (mating type A1, Gpi 100/100, Pep 100/100). The potato isolates were MO-1 (1996 & 97), MO-3 (1998), and MO-4 (1998). The frequencies of A1 (MO-4) and A2 (MO-3) mating types in potato fields in 1998 were 26 and 74%, respectively. Potato isolates were pathogenic to both potatoes and tomatoes. The isolates collected from tomatoes in 1997 and 1998 were MO-2. Potato and tomato isolates were insensitive and sensitive to metalaxyl, respectively. The change of genotype population in 1998 was probably caused by migration of a new genotype from Europe associated with importation of potato seed. The detection of A1 and A2 mating types in the same potato field indicates the potential for sexual reproduction of P. infestans in Morocco.

[Prognosis of intraventricular septal rupture in myocardial infarct: apropos of 13 cases]. / Pronostic des ruptures septales interventriculaires dans l'infarctus du myocarde: a propos de 13 cas.

The authors report the experience about 13 cases of postinfarction ventricular septal rupture. Patients (9 men and 4 women) aged 60 to 76 years average 68 years. The site of necrosis was the anterior wall in 8 cases and the posterior wall in 5 cases. The diagnosis of septal rupture was confirmed by echocardiography and/or angiography. 6 patients died after averages: 7 days. Surgical intervention was performed in 7 cases after a mean of 51 days following the date of the myocardial infarction after an intensive care. We emphasize to demonstrate the helpful of intensive care and the role of early surgery for a good prognosis.

First Report from Morocco of Phytophthora infestans Isolates with Metalaxyl Resistance.

Late blight of potato (Solanum tuberosum L.) caused by Phytophthora infestans (Mont.) de Bary first appeared in Africa in 1941. It has been observed sporadically in Morocco for decades but only recently became a major problem. Significant losses have been recorded in the last two growing seasons in spite of the use of various disease control programs that included combinations of systemic and protectant fungicides. Phytophthora infestans was cultured from diseased foliage collected from commercial potato fields near Larache, Morocco. Isolates were analyzed to determine pathogenicity on several potato and tomato cultivars, mating type, genotype at two allozyme loci (2), and relative sensitivity to metalaxyl. Responses of the isolates to metalaxyl were assayed by mycelial radial growth on metalaxyl-amended agar, by floating leaves inoculated with P. infestans on metalaxyl solutions, and via potato tuber disks placed on filter paper saturated with metalaxyl solutions (1). Koch's postulates were completed; all isolates were pathogenic to potato and tomato cultivars tested, are consistent with the A1 mating type, and have the same allozyme pattern (Gpi 100/100, Pep 92/100) as US-6 genotype. All tests indicated resistance to metalaxyl up to 250 ppm. References: (1) K. L. Deahl et al. Am. Potato J. 70:779, 1993. (2) S. B. Goodwin et al. Plant Dis. 79:1181, 1995.