Evaluation of daily Laurus nobilis tea consumption on anxiety and stress biomarkers in healthy volunteers.

Laurus nobilis is known in the field of herbal medicine and in vitro studies for its antibacterial, antifungal, anti- diabetes, and anti-inflammatory beneficial effects. Laurus nobilis tea consumption was investigated with regard to its effects on anxiety and stress in healthy individuals, measured by subjective tools and by plasmatic cortisol levels. The study included thirty healthy Tunisian volunteers aged between 20 and 57 years consuming Laurus nobilis infusion, prepared from 5g of dried Laurus nobilis leaves in 100 ml boiled water, once a day during 10 days. Plasma concentrations of serum cortisol were measured before Laurus nobilis consumption and at the end of the experiment. Laurus nobilis tea consumption significantly decreased the concentration of plasmatic cortisol ([cortisol] D0= 93.5± 43.01ng/mL, D11=72.23± 25.37, p=0.001). A statistically significant decrease in PSS and STAI scores (p=0.006 and p=0.002 respectively) was also noted.These findings highlight the decrease in blood cortisol levels, which means a possible positive effect on reducing the risk of stress related-diseases in healthy volunteers consuming Laurus nobilis tea. However, more powerful studies with extended treatment periods are required.

Modelling of seasonal influenza and estimation of the burden in Tunisia.

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness (ILI) per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A(H3N2) 15.5%; A(H1N1)pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza.

Modelling of seasonal influenza and estimation of the burden in Tunisia

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness [ILI] per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A[H3N2] 15.5%; A[H1N1] pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza

En Tunisie, la charge de la grippe a été estimée à partir des données de surveillance, en utilisant les paramètres épidémiologiques de la transmission avec les outils classiques de l'OMS et la modélisation mathématique. Les taux d'incidence des syndromes de type grippal [STG] associés à la grippe étaient 18 735 pour 100 000 pour la saison 2012-2013 ; 5 536 pour 2013-2014 et 12 602 pour 2014-2015. La part estimée de STG associés à la grippe pour la charge totale de patients externes était respectivement de 3,16%, 0,86% et 1,98% pour les trois saisons. Parmi les patients positifs au virus de la grippe, la répartition était la suivante pour la saison 2014-2015 : 15,5% pour le virus A[H3N2] ; 39,2% pour le virus A[H1N1]pdm2009 ; et 45,3% pour le virus B. A partir du nombre estimé de cas symptomatiques, nous avons calculé que la proportion critique de la population devant être vaccinée était respectivement de 15%, 4% et 10%. L'exécution du modèle avec les différentes valeurs de R0 nous a permis de déterminer le nombre de cas cliniques symptomatiques, les taux d'attaque clinique, les taux d'attaque clinique pour les cas symptomatiques et le nombre de décès. Des versions plus réalistes de ce modèle ainsi que des estimations améliorées des paramètres issus des données de surveillance permettront d'accroître l'utilité des modèles mathématiques

Implications of metabolic parameters of carbamazepine in the therapeutic monitoring of Tunisian patients with epilepsy.

Carbamazepine (CBZ) is widely used in the control of simple and complex focal seizures and generalized tonic-clonic seizures in patients with epilepsy. The toxic effects of CBZ are not easily predicted, and this is due to the difficulty of delivering the optimal dose and/or plasma concentration of CBZ necessary to achieve beneficial effects, and especially to prevent the onset of toxicity associated with its use. Our study aimed to determine the relationship between the administered daily dose of CBZ and its pharmacokinetic parameters, including concentrations of CBZ and carbamazepine-10,11-epoxide (CBZ-E) plasma levels, and the metabolic ratio of CBZ-E to CBZ, in Tunisian patients with epilepsy. To accomplish this, a high-performance liquid chromatography method with ultraviolet detection was used for quantification in the simultaneous analysis of CBZ and one of its active metabolites, CBZ-E, in human plasma. A statistically significant positive correlation was found between the daily doses administered (mg/kg/day) and plasma concentrations of CBZ and CBZ-E, and the CBZ-E/CBZ ratio increased significantly as a function of the specific dose (in mg/kg/day). The increase in plasma concentrations of CBZ-E was non-linear in relation to plasma concentrations of CBZ, and there was no correlation between the CBZ-E/CBZ metabolic ratio and CBZ plasma concentrations. Our findings suggest that monitoring of CBZ as well as CBZ-E blood levels should be considered, as it may play a useful role in the therapeutic management of patients with epilepsy.

Scintigraphic findings in hungry bone syndrome following parathyroidectomy

La hipocalcemia prolongada tras paratiroidectomía, conocida como síndrome del hueso hambriento, es una complicación presente en 13–30% de pacientes tras cirugía paratiroidea. Presentamos el caso de una paciente de 48 años de edad con dolor óseo y múltiples tumores pardos como primera manifestación de hiperparatiroidismo primario por gran adenoma paratiroideo. Tras paratiroidectomía, la paciente presentó signos clínicos de hipocalcemia sugestivos de síndrome del hueso hambriento. Se describen las alteraciones radiológicas y gammagráficas observadas tras la paratiroidectomía(AU)

Prolonged hypocalcemia following parathyroidectomy, called hungry bone syndrome, is a common complication of parathyroid surgery seen in 13–30% of cases. In this article, we report the case of a 48-year-old woman with bone pain and multiple brown tumors as the first manifestation of primary hyperparathyroidism due to a large parathyroid adenoma. After parathyroidectomy, the patient presented clinical signs of hypocalcemia consistent with hungry bone syndrome. Scintigraphic and radiographic modifications following parathyroidectomy are described(AU)

Captopril renography as a prognostic factor in obstructive hydronephrosis with preserved renal function

El riñón hidronefrótico con una función renal diferencial mayor del 55% se define como supranormal. El significado de este hallazgo sigue siendo controvertido. En este artículo, los autores comunican un caso de función supranormal dentro de una hidronefrosis obstructiva. Se evaluaron las funciones diferenciales del riñón después de la administración de captropril y después de una pieloplastia. Se examina el papel de la renografía con captopril como un factor de prognosis para la cirugía(AU)

Hydronephrotic kidney with a differential renal function greater than 55% is defined as supranormal. The signification of this finding remains controversial. In this article, the authors reported a case of supranormal function in obstructive hydronephrosis. Differential renal functions were evaluated after administration of captopril and after pyeloplasty. The role of captopril renography as a prognostic factor for surgery is discussed(AU)

Captopril renography as a prognostic factor in obstructive hydronephrosis with preserved renal function.

Hydronephrotic kidney with a differential renal function greater than 55% is defined as supranormal. The signification of this finding remains controversial. In this article, the authors reported a case of supranormal function in obstructive hydronephrosis. Differential renal functions were evaluated after administration of captopril and after pyeloplasty. The role of captopril renography as a prognostic factor for surgery is discussed.

Scintigraphic findings in hungry bone syndrome following parathyroidectomy.

Prolonged hypocalcemia following parathyroidectomy, called hungry bone syndrome, is a common complication of parathyroid surgery seen in 13-30% of cases. In this article, we report the case of a 48-year-old woman with bone pain and multiple brown tumors as the first manifestation of primary hyperparathyroidism due to a large parathyroid adenoma. After parathyroidectomy, the patient presented clinical signs of hypocalcemia consistent with hungry bone syndrome. Scintigraphic and radiographic modifications following parathyroidectomy are described.

Role of the peritoneopleural pressure gradient in the genesis of hepatic hydrothorax. An isotopic study.

SUMMARY: Hepatic hydrothorax is defined as the development of significant pleural effusion in a patient with cirrhosis without primary pulmonary or cardiac disease. This complication is seen in 4-10% of patients with cirrhosis. The pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm. We report two patients with posthepatitis cirrhosis presenting with a significant pleural effusion. The peritoneopleural communication was demonstrated by peritoneal scintigraphy. The role of the peritoneopleural pressure gradient is discussed.

[Management of pregnancies beyond forty-one week's gestation with an unfavorable cervix]. / Prise en charge obstétricale des grossesses prolongées au-delà de 41 semaines d'aménorrhée avec un score de Bishop défavorable.

OBJECTIVE: Our purpose was to determine the optimal management of pregnancies beyond 41 week's gestation with a cervix unfavorable for induction. MATERIAL AND METHOD: All uncomplicated pregnancies that reached 41 weeks'gestation with a Bishop score of< or =4, were randomly assigned to one of two groups RESULTS: The duration of labor was shorter in the group "prépidil" compared with the control group (P=0.002). Identification of an unfavorable cervix at 41 weeks was unlikely to change by 42 weeks and cervical ripening was required in 40% cases. There was no significant difference in caesarean section rates. Rates of admission into the neonatal unit and fetal outcomes were similar in the two groups. CONCLUSION: Cervical ripening with prostaglandin gel at 41 week's gestation for uncomplicated singleton pregnancies is safe and should be advocated.

[Uterine rupture of the unscarred uterus. About 28 cases]. / Rupture utérine sur utérus sain gravide. A propos de 28 cas.

OBJECTIVES: To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication. PATIENTS AND METHODS: The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia. RESULTS: Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%). DISCUSSION AND CONCLUSION: Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.

[Breast cancer prognosis in Tunisian women: analysis of a hospital series of 729 patients]. / Pronostic du cancer du sein chez les femmes tunisiennes: analyse d'une série hospitalière de 729 patientes.

The objective of this study was to identify the anatomical-clinical aspects and determine the prognostic factors for breast cancer in the central region of Tunisia. This retrospective study involved 729 patients suffering from breast cancer, proven either by histology or cytology, diagnosed and treated between January 1990 and June 1998 at the F. Hached University Hospital in Sousse, Tunisia. The patients' average age was 50 years (ranging from 22-91). The average size of the cancer at the time of diagnosis was 49.1 mm; 90% were invasive duct carcinoma with high histo-prognostic SBR grade (level II-III: 86%). The overall survival rate was 50.5% after five years, and 50% after seven years. Using univariate analysis, significant predictive value was found with the following factors: tumor size, the clinical ganglionic level, metastases at diagnosis, the number of nodes invaded, nodal capsular rupture and lymphatic embolism, SBR grade and the delay in seeking consultation. The multivariate analysis (Cox model) isolated two prognostic factors: the initial size of the tumor (p = 0.001) and metastases at the time of diagnosis (p = 0.01). The study's results indicated that breast cancer prognosis in Tunisia remains poor primarily due to late diagnosis.

[Bilateral hydatid cyst of the fallopian tubes: a case report]. / Kyste hydatique bilatéral des trompes: à propos d'un cas.

We report an exceptional case of bilateral hydatid cysts that developed solely in the fallopian tubes of a young girl. The diagnosis was suggested by the clinical history, the patient's residence in an endemic area, and the ultrasound findings and was confirmed peroperatively. Due to the extensive damage bilateral salpingectomy was required compromising future reproduction potential. We discuss the pathogenesis of pelvic localizations and the ultrasound aspects of pelvic hydatid cysts.

[Contribution of intracervical PGE2 administration in premature rupture of the membranes at term. Prospective randomised clinical trial]. / Apport de l'administration intracervicale de PGE2 dans les ruptures prématurées des membranes à terme. Essai clinique prospectif randomisé.

OBJECTIVE: To compare the clinical effectiveness and safety of intracervical dinoprostone versus conservative management of term prelabor rupture of membranes. SUBJECTS AND METHODS: 88 women with term prelabor rupture of membranes were assigned randomly to one of two groups RESULTS: 44 women were allocated in each group. The means (+/- S. D) intervals from PROM to delivery and from inclusion to start of labour were significantly shorter in the dinoprostone group (19.5+/-6.2 vs 25.5+/-7.7 hours p<0.01 and 8.7+/-5.5 hours vs 14+/-6. 8; p=0.32 respectively). No significant differences were observed in the mean duration of labour (4.5+/-1.6 hours vs. 4.9+/-1.67 p=0.32). The rates of clinical amniotits were 15.9% in the dinoprostone group and 6.8% in the control group; difference is not statistically significant (p=0.17). The mode of delivery and Apgar score were similar in the two groups. Uterine tachysystole occurred more frequently in the dinoprostone group (6.8 vs 0%) but did not reach statistical significance. CONCLUSION: Intracervical administration of dinoprostone with prelabor rupture of membrane at term and unripened cervix shortens the interval to delivery without a significant increase of maternal or neonatal morbidity.

[Antibiotic prophylaxis in a priori cesarean sections without a high risk of infection. Experiences of a Tunisian maternity department]. / L'antibioprophylaxie dans les césariennes a priori sans "haut risque infectieux". Expérience d'une maternité tunisienne.

OBJECTIVE: This study was conducted to evaluate the effect of antibiotic prophylaxy on decreasing the frequency of postoperative infections after cesarean sections performed in cases with no prior indication of a high risk of infection. METHODS: A prospective randomized study included 269 cesarean sections without a high risk of infection performed in the Maternity and Neonatology Ward of the Sousse Hospital from February 1991 to July 1991. The patients were randomly divided into two groups. One group received an antibiotic prophylactic treatment including cephapirine, gentamicin and metronidazole) and the second group was given no treatment. RESULTS: Antibiotic prophylactic therapy led to a reduction of infectious morbidity after cesarean section in patients without high risk o infection from 33% to 11%. A 66% rate of efficacy was observed. In addition, antibiotics given in this context led to substantial cost reduction both by reducing the cost of antibiotics prescribed in the postoperative period and by reducing the number of days of hospitalization, and thus total cost. CONCLUSION: This study demonstrated the effectiveness of antibiotic prophylaxy for cesarean sections in patients without a high risk of infection. Nevertheless, a reevaluation of the antibiotic protocols and a rigorous operative procedure are essential.

[Rupture of the excretory urinary tract due to a lithiasis of the pelvic ureter]. / Rupture de la voie excrétrice urinaire sur lithiase de l'uretère pelvien.

A case of rupture of the urinary tract related to lithiasis of the pelvic ureter is reported. Outcome was favorable after percutaneous drainage of the urinoma and removal of the stone using a Dormia catheter. Clinical diagnosis was readily established on the patient's history and on ultrasound and intravenous urogram findings.

[Vesico-uterine fistulas. Apropos of 2 cases]. / Les fistules vésico-utérines. A propos de deux cas.

Vesico-uterine fistulas (VUF) are an increasingly rare entity (5% of all urogenital fistulas). The authors report two cases of VUF following cesarean section. The literature is reviewed briefly, indicating that Youssef syndrome is the commonest presentation. This lesion is certainly benign but is a source of discomfort for sexually active women. Treatment is above all preventive. It is based per-partum on perfect management of all cases of difficult labour. Peroperatively, the technique used during each cesarean section must be carefully defined and followed. Treatment of a confirmed VUF is essentially surgical.

[Pseudo-tumoral xanthogranulomatous pyelonephritis. Apropos of a case]. / Pyélonéphrite xanthogranulomateuse pseudo-tumorale. A propos d'un cas.

The authors report the case of a 20 year old patient in whom the clinical findings combined with the radiological signs, suggested the diagnosis of renal cancer. The histological findings after nephrectomy established the diagnosis of xanthogranulomatous pyelonephritis. This disease may rarely give the appearance of a renal tumor. This points out the importance of identifying this lesion in preoperative staging to avoid carcinologic surgery and all of its difficulties.