Echocardiographic parameters of the right ventricle in chronic hemodialysis.

INTRODUCTION: Right ventricular (RV) dysfunction is one of the leading predictors of mortality and heart failure in chronic hemodialysis (HD) patients. AIM: To describe the different echocardiographic abnormalities of the RV in subjects with HD. METHODS: We performed a descriptive cross-sectional study covering the period from July to October 2018; involving 42 patients treated with chronic HD. Patients underwent a conventional transthoracic echocardiographic (TTE) study supplemented with tissue Doppler between two hemodialysis sessions. RESULTS: We included 42 patients. The sex ratio of our population was 1.6 with a male predominance, the average age of patients was 62.7 ± 12.4 years. The most important cardiovascular risk factor was arterial hypertension (78.6%). The most important causative nephropathy was nephroangisclerosis (31% of cases). The average age of dialysis was 34.5±30 months. Forty-two percent of our patients had RV dilation, 38% had right atrium dilatation, 7% had Right ventricular outflow tract dilatation, and 59.5% had RV hypertrophy. We noted RV systolic dysfunction in 66.7% of cases, a predominant normalized tricuspid profile with an average E / A ratio of 1.11 ± 0.5. CONCLUSION: Our study is consistent with the various echocardiographic data already raised in the literature, showing a high prevalence of RV dilatation and systolic dysfunction. It is one of the leading predictors of mortality and heart failure in chronic hemodialysis patients.

Two-Dimensional Isoelectric Focusing OFFGEL, Micro-Fluidic Lab-on-Chip Electrophoresis and FTIR for Assessment of Long-Term Stability of rhG-CSF Formulation.

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) has been increasingly recognized from among one of the most abundant families of biosimilars. Upon long-term storage, the rhG-CSF is subject to subtle chemical modifications that rapidly occur and, in particular, produce deaminated variants with divergent charge. Indeed, changes in charge from glutamine deamination may alter the way rhG-SCF will refold and the structure of resulting molecule. To assess this charge heterogeneity, 2-D gel electrophoresis has limited application. Recent micro-fluidic- based technical advances offer a great alternative method to better control liquid volumes on a minute scale. Here, we used IEF OFFGEL-lab-on-chip electrophoresis for 2-D separation of the rhG-CSF peptides according to their isoelectric point (pI) and molecular weight (kDa). We used an rhG-CSF commercial therapeutic formulation, kept refrigerated 24 months after expiry. The samples were analyzed for particulate matter and charge variants. Subsequently, the secondary structure was assessed by FTIR spectroscopy and residual biological activity was recorded. Interestingly, we showed an additional band in the acidic gel area above and below the most intense protein band (fractions 10, 11, and 12 at 22.84s). This observation reveals the presence of the rhG-CSF variant charges without any additional high molecular weight impurity or biological activity decrease. We conclude that after two years of storage, the rhG-CSF solution maintained its native secondary structure with little -sheet deviation, as reflected in the 1622 cm-1 and 1695 cm-1. These data demonstrated that a combined strategy is a more suitable and accurate analytical assessment of the rhG-CSF and recombinant protein-based biosimilars.

Prenatal diagnosis of hemoglobinopathies in Tunisia: an 18 years of experience.

UNLABELLED: Hemoglobinopathies are the most common genetic disease in Tunisia with a total carrier prevalence of 4.48%. OBJECTIVE: The aim of this study was to report an 18-year fully achieved experience of prenatal diagnosis (PND) of hemoglobinopathies (1994-2012) and to assess the impact of this prevention program. PATIENT AND METHODS: A total of 461 fetuses of 340 at-risk couples have been the subject of PND for beta-thalassemia major risk (41%), for sickle cell anemia risk (40.3%), for S/beta-thal risk (14.7%). The remainder fetuses were at risk for a compound heterozygote hemoglobinopathies (S/O, O/beta-thal, S/C….). Fetal DNA was studied by PCR procedure including the reverse dot-blot technique and the amplification refractory mutation system and direct sequencing. RESULTS AND DISCUSSION: Only 13.8% of the fetal samplings were conducted by chorionic villus sampling. The molecular result for beta-thalassemia risk has shown 13 beta-thal mutations, with two common: codon 39 (C>T) and IVS1-110 (G>A). The last 3 years, STR study has permitted to reduce the problems of maternal cell contamination. Among the 461 tested fetuses, 121 were affected, and then the pregnancy was terminated except for 13 cases, because of religious considerations and this despite the abortion legality in Tunisia. The conducted PND is only about 30 PND per year corresponding essentially to the couples living in Tunis City and surrounding area. PND number has increased from 1994 to 2009. This evolution has brutally decreased after the Tunisian revolution (2010). CONCLUSION: Although the good running of the PND, it covers only the Tunis city with low impact because it prevent apparition of only a mean of 7.3% of new cases. The reduced number of PND is not a technical inconvenience but rather a lack of a preventive program.

Prenatal diagnosis of cystic fibrosis: 10-years experience.

PURPOSE: We present in this study our 10years experience in prenatal diagnosis of cystic fibrosis performed in the Tunisian population. PATIENTS AND METHODS: Based on family history, 40 Tunisian couples were selected for prenatal diagnosis. Fetal DNA was isolated from amniotic fluid collected by transabdominal amniocentesis or from chronic villi by transcervical chorionic villus sampling. The genetic analysis for cystic fibrosis mutations was performed by denaturant gradient gel electrophoresis and denaturing high-pressure liquid phase chromatography. We performed microsatellites analysis by capillary electrophoresis in order to verify the absence of maternal cell contamination. RESULTS: Thirteen fetuses were affected, 21 were heterozygous carriers and 15 were healthy with two normal alleles of CFTR gene. Ten couples opted for therapeutic abortion. The microsatellites genotyping showed the absence of contamination of the fetal DNA by maternal DNA in 93.75%. CONCLUSION: Our diagnostic strategy provides rapid and reliable prenatal diagnosis at risk families of cystic fibrosis.

[Paraneoplastic cerebellar degeneration as the presenting manifestation of breast carcinoma: a case report]. / Dégénérescence cérébelleuse paranéoplasique révélant un cancer du sein : à propos d'un cas.

INTRODUCTION: Paraneoplastic cerebellar degeneration may be a manifestation indicative of lung, gynecological or breast cancer. Nevertheless, breast cancer is rarely revealed by the occurrence of a paraneoplastic syndrome. CASE REPORT: We report a 38-year-old patient who presented a paraneoplastic cerebellar degeneration with anti-Yo antibodies as the presenting manifestation of a breast cancer. CONCLUSION: The diagnosis of a paraneoplastic neurological syndrome (PNS) should lead to urgent and comprehensive screening for cancer oriented by the type of PNS and the nature of the anti-neuronal antibody.

Antibody response for L1, E6, E7 HPV 16, and HPV 18 antigens in Tunisian women with cervical cancer.

Results obtained in the present work indicated that the Luminex assay is more sensitive than ELISA. The reactivity to the early antigens E6 and E7 was 37% versus 42% for HPV 16 and 21% versus 20% for HPV 18 among cervical cancer cases using ELISA. However, these ratios were 44% and 61%, respectively, for E6 and E7 HPV 16 versus 28% and 21% for E6 and E7 HPV 18 when using the Luminex technique. Data also indicated that HPV 16 and HPV 18 showed distinct profiles for the different antigens tested. Finally, the differences in antibody responses between cervical cancer cases and benign cases toward the different antigens were significant.

[Comparison of breast cancers diagnosed in and outside of the large scale mammography program of the Ariana area of Tunisia]. / Comparaison des cancers du sein (CS) issus et non issus du programme mammographique à grande échelle du gouvernorat de l'Ariana en Tunisie.

OBJECTIVE: To report the anatomoclinical comparison of BC issued from the large scale mammography program in Ariana state of Tunisia to those of the cases "classically" diagnosed in patients consulting for breast symptoms. METHODS: This retrospective study was done between April 2004 and June 2007. We have included 58 women issued from the large scale mammographic program of the state of Ariana in Tunisia (Group 1) and 100 symptomatic women who came to our out patient clinic (Group 2). We have compared epidemiological characters (age, delay of diagnosis...), tumoral size, histological size and type, grade, hormonal receptors and therapeutic protocols. RESULTS: In the large scale mammographic program, BC are insitu carcinomas in 11.1% and invasive carcinomas in 88.9% of the cases. The mean age was 48 years old in the group 1 versus 46 years in group 2. In the first group, the mean clinical and histological tumoral size was 20mm and 22 mm versus 45mm and 36 mm for the group 2. The invasive canalar carcinoma was the most frequent histological type in both groups. The lymph nodes were negative in 58.1% of the cases in group 1 versus 34% in group 2. 80% of the patients in group 2 had mastectomy versus 42.8% in the first one. The mortality was 10% in the screened women versus 6.8% in the other group 2. CONCLUSION: The results of large scale mammographic BC program were favourable for the management of breast cancer in terms of clinical and histological tumoral size, number of positive nodes, number of mastectomies and the survival rates.

[Patient satisfaction of women involved in the pilot program of large scale mammography in the Ariana area of Tunisia]. / Enquête de satisfaction auprès des femmes du projet pilote de dépistage du cancer du sein du gouvernorat de l'Ariana en Tunisie.

OBJECTIVE: Evaluate the degree of satisfaction of women included in the large scale mammography program of breast cancer screening in the state of Ariana in Tunisia. MATERIAL AND METHODS: [corrected] Within the women explored by mammography, we have contaced 112 patients who had a positif screening requiring histological checking. We have established a questionnaire concerning: the invitation, the clinical examination, the result announcement and the therapeutic management. RESULTS: The average age of patients was 49 years. 64% had a primary education level. 80 women or 71.4% were satisfied with the process of screening and the method of announcement. The main cause of dissatisfaction for patients with cancer diagnosis was delay and difficult access to adjuvant treatments. Among patients who had histological diagnosis: 47.3% had a malignant disease (53 cases) against 37.5% of benign (42 cases). 100% of patients who had a pathological result reassuring are satisfied at the end of the screening program. DISCUSSION: The psychosocial impact of screening must be considered for the development of new programs. The waiting and announcement of results are essential factors that allow us to judge the success of the project, because of patient satisfaction will depend the quality of monitoring and adherence to screening.

Serological study in Tunisian cervical cancer patients.

OBJECTIVE: The aim of this study is to use a novel ELISA, based on five recombinant HPV-16 and HPV-18 proteins, for detection HPV-specific antibodies in a case-control study. PATIENTS AND METHODS: L1, E6 and E7 genes have been over expressed in Escherichia coli as double fused proteins. These recombinant proteins were used in a GST-capture ELISA as coating antigens. Human sera were collected from women with cervical cancer. Negative human sera were collected from patients apparently healthy and may be affected by other infectious agents. RESULTS: Most of the sera showed a positive reactivity to at least one of the HPV-16 or HPV-18 proteins (52/71). A percentage of 39.50% of the sera from HPV-16 infected women and 21.12% of the sera from women infected by HPV-18 genotype recognised at least one of the HPV-16 or HPV-18 proteins. Sera showed different reactivity to L1, E6 and E7 antigens, and only a few serum samples reacted to L1, E6 and E7 HPV-16, E6 and E7 HPV-18 (co-infection). Differences of reactivity between cases and controls were significant (P<0.0001). CONCLUSION: This novel ELISA, based on recombinant HPV-16 and HPV-18 antigens, is able to detect antibodies in women infected by HPV genotypes. The assay is easy to perform and has low cost, making it suitable for monitoring the natural history of HPV infections as well as for detecting pre-existing HPV antibodies in women who receive vaccination.

Antibody response for L1, E6 and E7 HPV 16 and HPV 18 antigens in Tunisian women with cervical cancer and controls.

Results obtained in the present work indicated that the Luminex assay is more sensitive than ELISA. The reactivity to the early antigens E6 and E7 was 37% versus 42% for HPV 16 and 21% versus 20% for HPV 18 among cervical cancer cases using ELISA. However, these ratios were 44% and 61%, respectively, for E6 and E7 HPV 16 versus 28% and 21% for E6 and E7 HPV 18 when using the Luminex technique. Data also indicated that HPV 16 and HPV 18 showed distinct profiles for the different antigens tested. Finally, the differences in antibody responses between cervical cancer cases and benign cases toward the different antigens were significant.

[Usefulness of colposcopy in inflammatory cervico-vaginal smears: apropos of 140 cases]. / Apport de la colposcopie dans les frottis cervico-vaginaux inflammatoires: a propos de 140 cas.

BACKGROUND: The cervical cancer is the second most frequent cancer of the woman in Tunisia. It is considered as a sexual transmissive desease due to the involvement of the HPV. AIM: The purpose of our study is to proove that an inflammatory cervical smear should be considered as a positive test and must lead to other investigations. METHODS: It is a prospective study over 140 cases of inflammatory cervical smears (without atypical cells) diagnosed during a year period from june 2001 to june 2002. These patients had a systematic colposcopy with the biopsy of suspicious lesions. RESULTS: The mean age of our patients is 42 years. 68.57% of them are in active genital period. The colposcopy was normal in 10% of our patients. It showed benign lesions such as: ectropion in 22.85%, colpitis in 14.28%, cervical polypus in 5%, normal transformation zone in 8.57%, but also suspicious lesions such as : atypical transformations grade I (ATGI) in 25.71% and atypical transformations grade II (ATGII) in 13.57%. The biopsies made on 89 patients showed dysplasia and carcinoma in 18.57% of them. A case of in situ carcinoma, a microinvasif epidermoid carcinoma and an invasif glandular carcinoma were diagnosed. CONCLUSION: Colposcopy is an ambulatory investigation. It makes a minutious study of the cervix and diminishes the rate of false negative made by the cervical smear.

[Endometrioid carcinoma of the Fallopian tube arising in tubo-ovarian endometriosis. A case report]. / Carcinome endométrioïde in situ et primitif de la trompe développé sur une endométriose tubo-ovarienne. A propos d'une observation.

The primitive endometrioid carcinoma of the fallopian tube is exceptional. Only three cases have been reported in the literature. Its rise on tubal endometriosis like for the ovary needs to meet the strict histological criteria established by Sampson and Scott in 1953. We report one case observed on a patient aged 45 years, who needed a total hysterectomy with bilateral annexectomy for menometrorrhagias associated to uterine leiomyomas which resisted to medical treatment. The finding of a primitive intra-epithelial endometrioid carcinoma of the left fallopian tube developed on bilateral tubo-ovarian endometriosis was fortuitously found during histological examination. Our observation seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and the adjoining endometrioid carcinoma contrary to the similar unique case reported in the literature where the link between the two lesions has not been demonstrated.

Prenatal diagnosis of chromosome disorders in Tunisian population.

Cytogenetic prenatal diagnosis (PND) is under national health program in most developed countries, while it concerns a small part of population at risk in developing countries. Finance is common reason of absence of PND development, but socio-cultural believes play an important role in Arab Muslim countries. In this paper we report results of 3110 fetal karyotypes carried out in a Tunisian population, by cultured amniocytes analysis. It is the largest report in a Muslim Arab country in our Knowledge. Abnormal karyotypes rate was 4.18% classified in two groups: bad prognosis (3.05%) and good prognosis (1.13%). Common amniocentesis indication was maternal age. The highest predictive value was observed in balanced karyotype and fetal ultrasound findings indications. Maternal serum markers were not commonly used for trisomy 21 screening. Pregnancy termination that is permitted by legal and religious authorities was accepted by 94,74% parents. Information about PND outcomes was given by genetic counselling prior to fetal sampling, pregnancy interruption was discussed with parents at cytogenetic result announcement. The authors conclude that in order to prevent mental and physical handicap related to cytogenetic disorders we have to promote PND by education for population, genetic counselling and fetal ultrasound screening; all three methods available in Tunisia.

[Medical termination of pregnancy. Indications, techniques and complications. Report of 55 cases]. / Les interruptions medicales de grossesse (IMG). Indications, techniques et complications. A propos de 55 cas.

We tried through this study to reassemble the cases of medical termination of pregnancy for foetal or maternal anomalies and analyse the epidemiological characteristics of our population and the procedures of induction of labour. We report a retrospective study about 55 cases of medical termination of pregnancy during 20 months indexed in service "C" of the centre of maternity and neonalogy in collaboration with the service of fetopathology. 12.73% of our patients were older than 38 years. The incidence of medical termination of pregnancy during the same period was about 1.90 cases/100 deliveries. Maternal indications was reported in 34.55% of cases and neurological malformations dominate the foetal anomalies (47.22%). Extra-amniotic saline infusion was used in 52.72% of cases and was responsible of all the complications observed (16.36%).

[Antenatal diagnosis and contribution of fetopathologic examination in the management of omphalocele]. / Diagnostic antenatal et apport de l'examen foetopathologique dans la prise en charge de l'omphalocele.

The omphalocele is an average coelosomie, frequency of which is estimated at 1/5000 births. We confront diagnosis antenatal with the exam foetopathologic in purpose of 41 cases of omphalocele brought together over a period going from January 1, 1991 till December, 2000 in the unity of foetopathologie from the CMNT. The frequency of omphaloceles is 4.88% of the children malformed and of 1.64% of the set (group) of the performed an autopsy children. An association malformative was found in 85.4% of cases and a karyotype typical aberration trisomie 13.18 and 21 was identified in 17% of cases. The preview of the children bearers of this deformation is especially bound (connected) to the existence and to the gravity of associated abnormalities. The omphalocele required a multidisciplinary making coverage intervernir obstetriciens, néonatologistes, surgeons pediatre and foetopathologistes.

[Diagnosis of holoprosencephalia. Report of 17 cases]. / Diagnostic de l'holoprosencephalie. A propos de 17 cas.

OBJECTIVE: To establish the epidemiologic profile of holoprosencephalia and determine benefits of ultrasound and foetopathologic examination to the diagnostic. METHODS AN MATERIAL: [corrected] Retrospective study about 17 cases of holoprosencephalia observed in CMNT between Janaury 1992 and September 2000. RESULTS: Ultrasound diagnosis was made in 13 cases (75%). Ultrasound criteria were; absence of median structure of the brain and unique ventricule. The prognosis was always bad. Foetopathologic examination revealed 7 cases of lobar holoproencephalia and 10 of semi lobar. Fascial dysmorphia were noted in 82% of cases. CONCLUSION: The foetopathology and genetic counselling looking for fascial, dysmorphia in family's members gives a good evaluation of recurrences.

[Prolonged pregnancy: apropos of a series of 102 cases]. / Grossesses prolongées: a propos d'une série de 102 cas.

UNLABELLED: It was a retrospective and continuous prospective study about 102 post-term pregnancy recensed on a 14 months period. The aim of this study is to evaluate our management of post term pregnancy and the peto-maternal morbidity and mortality. RESULTS: Frequency of post-term pregnancy in our study is 5.92%, in rate of session sector is not higher it is of 18.62. There is no maternal mortality. Neonatal mortality is a about 19/1000, the rate of neonatal morbidity is 2.9%.

[Value of ambulatory diagnostic hysteroscopy. A review of a series of 292 cases]. / Intérêt de l'hystéroscopie diagnostique en ambulatoire. A propos d'une serie de 292 cas.

This is a retrospective study including 292 ambulatory diagnostic hystéroscopies realised during a period of 1 year and a half. The mid age of our patients is 44 years. The main indications are haemorrhage, infertility and abnormal ultrasound findings. The exams are carried out under analgesia. Its sensibility is good concerning the endométrial pathology. As a matter of fact, it equals 100% for adénocarcinomas, it varies from 56.5 to 77.3% for hyperplasia, 100% for endométrial polyps and from 88 to 90% for endométrial atrophy. In contrast, it is worse for the myométrial pathology such as adénomyose and sub mucosal myomas. Besides its sensibility, the tolerance of this exam allows its ambulatory realisation permitting a considerable economy.

[Fetal pathology study of 88 cases of letal spina bifida]. / Etude foeto-pathologique de 88 cas de spina bifida létaux.

Lethal spina bifida continue to be frequent in Tunisia; we report 88 cases of letal spina bifida: 1.05 per thousand births. This pathology was more frequent with women. The up letal spina bifida situated is predominant with female and the dow spina bifida situated is frequent with male. We have noted an association with anencephalia (46 cases) and hydrocephaly (21 cases). Prevention is based on obstetric health care and hygiene dietetic advices to avoid alimentary deficit.