Metabolic effects of Ramadan fasting in patients at high risk of cardiovascular diseases.

BACKGROUND AND AIM: The effects of Ramadan fasting on health are a little controversial. The present study is aimed at evaluating the metabolic effects on a group of 517 patients with ≥2 cardiovascular risk factors over a period running from 2012 to 2014. METHODS: Each patient was assessed at three visits: before, during, and after Ramadan. Demographical, clinical and biological tests were performed at each visit. RESULTS: Metabolically, we noted a significant and discrete rise in blood glucose level (+1.2 mmol/L), triglycerides (+0.3 mmol/L), cholesterol (+0.12 mmol/L) and creatinine (+3 µmol/L) during Ramadan. These disturbances decreased significantly after Ramadan. The same variations were observed among diabetics (n=323). However, there was a significant decrease in HbA1c after Ramadan (9.0% vs 7.6%, p<0.001). Our findings also revealed there was no significant correlation between variations of metabolic parameters and dietary intake. No acute metabolic incidents were reported during the study period. CONCLUSION: The current study showed that Ramadan is responsible for a transient but well tolerated disturbance of metabolic parameters followed by a significant post-Ramadan improvement. These changes did not seem to be directly related to dietary intake.

Is low total cholesterol levels associated with suicide attempt in depressive patients?

BACKGROUND: Patients with major depressive disorder (MDD) have a high risk of suicide. Many pathophysiological factors involved in MDD and suicide such us a low cholesterol levels have been associated with MDD and increased vulnerability to suicide. In this study, we investigate the relation between lipid parameters and suicide risk in patients with MDD. METHODS: Plasma levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were determined in 160 patients meeting the DSM-IV-TR criteria for MDD (110 patients without suicidal behavior and 52 suicidal attempters) and 151 healthy controls. RESULTS: A significant decrease in plasma cholesterol levels was observed in the group of suicidal depressive patients compared to those without suicidal behavior (p < 0.001). For the other lipid levels (triglycerides, HDL cholesterol, and LDL cholesterol), there were no significant differences between suicidal and non-suicidal patients. CONCLUSIONS: Our study showed a significant decrease in plasma cholesterol levels in suicidal patients. This result support the hypothesis of the association of low plasma cholesterol level and suicidal behavior in patients with major depressive disorder.

Prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae IgM and IgG antibodies in Tunisian patients presenting with exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: We aimed to assess the prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae acute infections, using serological testing, in patients admitted to the emergency department for acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: We performed a prospective observational study of 100 consecutive patients. Serum specimens were collected at day 0 and day 15. C. pneumoniae and M. pneumoniae antibodies (IgM and IgG) were tested by commercial ELISA and immunofluorescence assay, respectively. RESULTS: We did not observe any acute M. pneumoniae infection; however, 11 patients (11%) showed a profile compatible with a recent C. pneumoniae infection (nine patients with specific IgM and two with an IgG antibody rise). Demographic and clinical parameters did not differ between patients with and without biological profile of recent C. pneumoniae infection. CONCLUSION: C. pneumoniae is a pathogen that requires specific antimicrobial treatment. Its detection must always be performed considering its prevalence in patients presenting with acute COPD exacerbations.

Effect of a probiotic Lactobacillus plantarum TN8 strain on trinitrobenzene sulphonic acid-induced colitis in rats.

This study aimed to investigate the potential effects of an oral treatment by a newly isolated probiotic Lactobacillus plantarum TN8 strain on trinitrobenzene sulphonic acid (TNBS)-induced colitis in Wistar rats. Thus, 18 rats were divided into three groups (n = 6 per group): group 1 (control) - rats not receiving TNBS application; group 2 - rats receiving an intrarectal TNBS infusion (100 mg/kg TNBS dissolved in ethanol); and group 3 - rats treated with intragastrical TN8 strain once per day (for 5 days before TNBS induction). The performance and the effects of the probiotic treatment were evaluated using a series of histological, biophysical and biochemical analyses. The results have shown that the treatment with the L. plantarum TN8 strain improves the body weight and reduces the diarrhoea, colonic mucosal inflammation and colon shortening. TN8-treated rats showed a significant decrease in the total cholesterol content from 1.86 (for group 2) to 1.32 mmol/l and in triglyceride (TG) content from 2.09 (for group 2) to 1.23 mmol/l. Furthermore, the findings revealed that the high-density lipoprotein (HDL) cholesterol contents increased from 0.95 to 1.02 mmol/l. The histological studies have confirmed that the architecture of the liver and kidney tissues of the TN8-treated rats were found to be improved. Overall, the results suggest that the L. plantarum TN8 presents promising perspectives for the development of safe and cost-effective agents for the prevention or alleviation of several intestinal pathologies.

[Supraventricular tachycardia in infants]. / Les troubles du rythme supraventriculaires chez le nourrisson et l'enfant. À propos de six cas.

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.

Left ventricular thrombus complicating tachycardia-induced cardiomyopathy.

A 45 day old new-born with arrhythmia-induced cardiomyopathy complicated by thrombus formation is presented. Drug treatment produced immediate symptomatic relief and subsequent reversion to normal cardiac function. The thrombus disappeared a few days later.

[Cardiac involvement in Steinert myotonic dystrophy]. / Les anomalies cardiaques au cours de la dystrophie myotonique de Steinert.

INTRODUCTION: Myotonic dystrophy type 1 (DM1) is an autosomal dominant multisystemic disease with frequent cardiac involvement that may cause sudden death. This study was performed to determine the various cardiac manifestations in DM1, their frequency and the relevance of cardiac electrophysiological study in this disease. METHODS: Ten patients with DM1, five men and five women, mean age 44.3+/-7.8 years underwent neurological and cardiac assessments. RESULTS: The most frequent electrocardiographic findings were conduction abnormalities, essentially by intraventricular conduction defects (eight out of ten cases) such as bundle branch or fascicular blocks. Echocardiography showed alterations in systolic left ventricular function in two cases. Invasive electrophysiology testing showed sub-hisien block in three patients, requiring cardiac pacemaker implantation. These three patients had normal duration of PR interval and normal width of QRS complex. CONCLUSIONS: We recommend that all patients with DM1 should undergo cardiac investigation to detect subclinical cardiac involvement.

Prosthetic valve endocarditis: management strategies and prognosis: A ten-year analysis in a tertiary care centre in Tunisia.

BACKGROUND: Prosthetic valve endocarditis (PVE) is a rare and serious complication after heart valve replacement; its optimal management strategy, though, still needs to be defined. OBJECTIVE: To study the clinical, microbiological and echocardiographic characteristics of PVE and to analyse the influence of the adopted therapeutic strategy (medical or surgical) on short- and midterm outcome in a tertiary care centre in a developing country (Tunisia). METHODS: All cases of PVE treated in our institution between 1997 and 2006 were retrospectively analysed according to the modified DUKE criteria. RESULTS: A total of 48 PVE episodes were diagnosed (30 men and 18 women), mean age was 37.93 years. Twenty-eight patients (58.33%) were exclusively medically treated, whereas 20 (41.66%) were treated by a combined surgical and medical strategy. Indications for surgery were haemodynamic deterioration in eight patients (40%), annular abscess in six (30%) and persisting sepsis in six (30%). In comparison with those from the medical group, operated patients had a longer delay to diagnosis (p=0.025), were more frequently in heart failure (p=0.04) and experienced more early complications (p=0.011); they also more frequently had prosthetic dehiscence (p=0.015), annular abscesses (p=0.039) and vegetations >10 mm (p=0.008). Conversely, no differences were found between the groups in terms of age, sex, or nature of involved organisms. In-hospital mortality for the medical group was 14.28% and for the surgical group 35% (p=0.09). CONCLUSION: PVE is a very serious condition carrying high mortality rates regardless of the adopted strategy. Our study demonstrates that, in selected patients, medical treatment could be a successful and acceptable approach. (Neth Heart J 2009;17: 56-60.).

[Papillary fibroelastoma of mitral leaflet revealed by a cerebrovascular accident. Case report]. / Fibroélastome papillaire de la valve mitrale révélé par un accident vasculaire cérébral ischémique. A propos d'un cas opéré.

Papillary fibroelastoma is a benign primitive cardiac tumour, which can be associated with serious embolic complications. We report on a 37-year-old woman admitted for a cerebrovascular accident. Transthoracic and transesophageal echocardiography revealed a small and pedunculated mass attached to the anterior mitral leaflet. Because of the severity of its symptoms and its high embolic potential, the tumour was surgically excised and histologically diagnosed as a papillary fibroelastoma. The postoperative period was uneventful and the patient was discharged at the third day. Papillary fibroelastoma must be surgically treated because of its high embolic potential and its severe prognosis.

[Prosthetic valve thrombosis in pregnancy. A single-center study of 12 cases]. / Thromboses de prothèses valvulaires cardiaques chez la femme enceinte.

Pregnancy in women with mechanical prosthetic heart valves carried an increased risk of thromboembolic complications due to changes in haemostasis. Prosthetic valve thrombosis is a serious complication resulting in high mortality. Ten patients from 20 to 38 years of age had 12 thromboses of mechanical heart prostheses during pregnancy. The prosthesis was mitral in 8 cases and aortic in 4 cases. The prosthesis was a ball valve in 1 case, a tilting disc in 3 cases and bi-leaflet in 8 cases. Initial emergency treatment was surgical in 3 cases and medical in 9 cases (thrombolysis in 7 cases and simple heparin therapy in 2 cases). Secondary surgery was carried out in one patient after failure of heparin therapy. There was one death in the surgical group (4 cases, 25%) and 30% foetal mortality in the surviving women. In the thrombolysis group (7 cases), two women died (28%) after failure of treatment. Both patients had mitral valve prostheses and were in cardiogenic shock. Three women, of the other 5 thrombolysed cases, were able to complete their pregnancies and had healthy babies with no foetal mortality. No per-thrombolytic embolic complications were observed. However, there was one severe bleeding complication which was successfully managed by surgical drainage. Finally, a global success rate of 75% (9 out of 12 patients) and a mortality of 30% (3 maternal deaths in the 10 patients--all with mitral valve protheses) were observed irrespective of the therapeutic protocol used. Thrombosis is the most life-threatening complication for women with prosthetic heart valve during pregnancy. Emergency surgery for valve replacement or thrombectomy is the commonest treatment. Trombolysis is classically limited by the risk of haemorrhagic and thromboembolic complications reported in the literature. In this study, thrombolysis was effective in the 71% of cases with a low risk of haemorrhagic complications.

[Percutaneous mitral commissurotomy. 5-year results]. / La commissurotomie mitrale percutanee. Resultats a 5 ans.

Long-term results of percutaneous mitral commissurotomy were evaluated in 410 patients with mean age of 31 years (18 to 68 years). 48% of patients had mean thickened leaflets, 35% had calcified valves and 17% had flexible leaflets and subvalvular apparatus. Procedure was performed with a double balloon in 57% and with Inoue's balloon in 43% patients. A good immediate results was obtained in 77% of patients. A good result was defined as a mitral valve area > or = 1.5 cm2 without mitral regurgitation. Clinical follow-up concern 378 patients. The actuarial 5 years rate were 84% in our serie, without surgery or new percutaneous mitral commissurotomy and good functional results (NYHA class I or II) were 71%. Valvular anatomy, immediate results (mitral valve area), history of mitral commissurotomy, old patients, atrial fibrillation can influence strongly the results.

[Acute dissection of the ascending aorta complicating aortic coarctation successfully treated with surgery]. / Dissection aiguë de l'aorte ascendante compliquant une coarctation de l'aorte opérée avec succès.

Vascular complications and arterial hypertension are major risk factors in the evolution of disease connected with coarctation of the aorta. Supra- and sub-stenotic aortic aneurysms are classical findings, whereas a dissecting aneurysm is a rare occurrence. In this study, we report on a case of acute dissection of the ascending aorta complicating a poorly followed-up coarctation of the aorta in a ten-year-old girl. The diagnosis, determined by X-ray of the thorax, was confirmed by echocardiography and magnetic resonance imaging. The first operative stage consisted of treating the aneurysm. After resection of the latter, an impregnated dacron prosthesis was inserted in termino-terminal. The immediate result is satisfactory, and a second operation is planned for the aortic coarctation.

Oral hygiene levels and behaviour in pre-clinical and final-year dental students.

The oral hygiene levels and behavior in pre-clinical and final-year dental students attending Birmingham University 1977 were investigated. Gingival inflammation, bacterial plaque and calculus accumulations were clinically recorded. Tooth cleaning habits were assessed by a questionnaire. Oral hygiene habits differed between the two groups and an improvement in oral hygiene levels was evident in the final-year students. Statistically significant differences (P is less than 0.05) were found between the plaque index scored of the pre-clinical and final-year students, and for the gingival and calculus index scores of the male students. Thus in this investigation it was possible to show that improvement in oral hygiene does occur between the pre-clinical and final year of the undergraduate course.

Oral hygiene levels and behavious in pre-clinical and final-year dental students.

The oral hygiene levels and behaviour in pre-clinical and final-year dental students attending Birmingham University 1977 were investigated. Gingival inflammation, bacterial plaque and calculus accumulations were clinically recorded. Tooth cleaning habits were assessed by a questionnaire. Oral hygiene habits differed between the two groups and an improvement in oral hygiene levels was evident in the final-year students. Statistically significant differences (P less than 0.05) were found between the plaque index scores of the pre-clinical and final-year students, and for the gingival and calculus index scores of the male students. Thus in this investigation it was possible to show that improvement in oral hygiene does occur between the pre-clinical and final year of the undergraduate course.