[Associated factors and sub-clinical myocardial dysfunction in obese patients with masked hypertension]. / L'hypertension artérielle masquée chez les obèses : facteurs associés et atteinte myocardique infraclinique.

INTRODUCTION: Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. METHODS: It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. RESULTS: A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. CONCLUSION: It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.

[Impact of socioeconomic factors on blood pressure control: Observational study about 2887 hypertensive patients]. / Impact des facteurs socioéconomiques sur l'équilibre de la pression artérielle : étude observationnelle à propos de 2887 hypertendus.

INTRODUCTION: Despite therapeutic progress, less than half of hypertensive patients are controlled. The objective of this study was to examine the links between blood pressure control and socioeconomic factors. METHODS: We used data collected in the cardiology department of Sfax University Hospital as part of the Tunisian national hypertension registry. We studied the associations between the socio-economic variables (educational level, profession, medical insurance) and optimal blood pressure control (SBP<140mmHg and DBP<90mmHg) using logistic regression models. RESULTS: The average age of our population was 65 and the sex ratio was 0.95. We found, as expected, the clinical and behavioral factors associated with a good blood pressure control, namely: female sex, low-sodium diet, therapeutic compliance, and regular physical activity. However, obesity and an increased number of antihypertensive drugs have been associated with poor blood pressure control. The study of the effect of socio-economic variables on BP control finds a significant gradient against the most disadvantaged social categories for our three social variables in the univariate analysis. The inclusion of clinical and behavioral factors in the multivariate analysis attenuated these associations but did not fully explain them. CONCLUSION: Our study shows that there are social inequalities in the control of blood pressure. Social justice and improving living conditions are probably the real solutions to the problem of these social inequalities in health.

A comparison of low versus high radioiodine administered activity in patients with low-risk differentiated thyroid cancer.

Post-surgical therapeutic management of differentiated thyroid cancer (DTC) is still a controversial subject. Indeed, there is no consensus on the dose of 131I to be administered, although the current trend towards therapy easing through mini-cures for patients with good prognosis. To confirm the non-inferiority in terms of effectiveness of an ablative mini-cure from 1.11 to 1.85 GBq, over a cure of 3.7 GBq, in patients with DTC operated for low and very low risk. We retrospectively studied 157 patients with very low and low risk DTC, followed in the Nuclear Medicine Department of the Salah Azaiez Institute between 2002 and 2012. These patients had a complementary radioiodine therapy with either low dose (group A) or high dose (group B) with an evaluation at 6 months post treatment and in long-term. The study took place at a referral center. The average age was 42.8 ± 13.7 years with a female predominance (86.7 %). The DTC papillary represented the most common etiology (95 %) with a predominance of pure papillary (68 %) on the follicular variant (27 %). The first cure evaluation did not show statistically significant difference between the two approaches in terms of therapeutic ablative efficiency (p = 0.13). The overall success rate was 77 % (121/157), with 83 % (54/65) in group A and 72.8 % (67/92) in group B. The likelihood of having a remission from the first cure was 1.83 times greater for patients treated with low doses (OR = 1.83, 95 % CI 0.23-1.29). At the end of follow, we have noted one case of refractory disease. The male gender (adjusted OR = 2.71, 95 % CI 0.51-4.23, p = 0.03), and the baseline Tg ≥ 10 (ng/ml) (adjusted OR = 3.48, 95 % CI 1.25-9.67, p = 0.01) were significantly independent predictors of successful first cure ablation. The results provide that mini-dose protocol is not less effective for ablation of the thyroid remnant than 3.7 GBq activity.

Relation between male obesity and male infertility in a Tunisian population.

Obesity is associated with significant disturbance in the hormonal milieu that can affect the reproductive system. Male infertility affects approximately 6% of reproductive-aged men. It has been suggested that overweight men or men with obese body mass index (BMI) experience prolonged time to pregnancy, although the influence of male BMI on fertility remains understudied. We hypothesised that BMI is inversely correlated with fertility, manifested by reduced sperm concentration and varicocele. Males of mean age 32.74 ± 6.96 years with semen analyses and self-reported BMI were included (n = 98). Patient parameters analysed included age, BMI, pubertal timing, the development of varicocele, and leutinizing hormone, follicle-stimulating hormone and testosterone (n = 18). The mean age of the study population was 32.74 ± 6.96 years. The incidence of azospermia, oligozoospermia, normospermia and the development of varicocele did not vary across BMI categories. Male obesity is not associated with the incidence of sperm concentration and the development of varicocele.

Modeling ventilation time in forage tower silos.

The fermentation process in forage tower silos produces a significant amount of gases, which can easily reach dangerous concentrations and constitute a hazard for silo operators. To maintain a non-toxic environment, silo ventilation is applied. Literature reviews show that the fermentation gases reach high concentrations in the headspace of a silo and flow down the silo from the chute door to the feed room. In this article, a detailed parametric analysis of forced ventilation scenarios built via numerical simulation was performed. The methodology is based on the solution of the Navier-Stokes equations, coupled with transport equations for the gas concentrations. Validation was achieved by comparing the numerical results with experimental data obtained from a scale model silo using the tracer gas testing method for O2 and CO2 concentrations. Good agreement was found between the experimental and numerical results. The set of numerical simulations made it possible to establish a simple analytical model to predict the minimum time required to ventilate a silo to make it safe to enter. This ventilation time takes into account the headspace above the forage, the airflow rate, and the initial concentrations of O2 and CO2. The final analytical model was validated with available results from the literature.

Screening of ΔF508 mutation and IVS8-poly T polymorphism in CFTR gene in Tunisian infertile men without CBAVD.

It is well established that cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations are involved in congenital bilateral absence of the vas deferens (CBAVD), causing obstructive azoospermia and male infertility. Also, several studies reported a relatively high prevalence of CFTR gene mutations in healthy men presenting reduced sperm quality. In this study, we investigate ΔF508 mutation and IVS8-polyT polymorphism in CFTR gene in Tunisian infertile men without CBAVD. Genetic analyses were performed in 148 infertile patients and 126 fertile individuals. The polymorphic IVS8-polyT tract in CFTR gene was analysed in only 129 infertile patients and 54 individuals of control group. As well, we screened for Y chromosome microdeletions in all infertile patients. No ΔF508 mutation was diagnosed either in infertile patients or in control group. 5T allele of IVS8-polyT tract was found in both infertile men (4.26%) and fertile individuals (8.33%). 5T/5T genotype was observed only in two azoospermic patients without Y microdeletions. The most frequent genotype of IVS8-polyT tract in infertile men and controls was 7T/7T (69.75% and 59.25% respectively). There was no association between IVS8-polyT polymorphism and reduced semen quality. Neither ΔF508 mutation nor 5T allele is involved in pathogenesis of male infertility in Tunisian infertile patients without CBAVD.

Does kidney transplantation with multiple arteries affect graft survival?

INTRODUCTION: We compared short- and long-term outcomes of renal transplants with single versus multiple arteries. PATIENTS AND METHODS: We retrospectively analyzed data from kidney transplants from 208 living donors performed between 1994 and 2010. Renal grafts were divided into two groups: single renal artery (n = 164) versus multiple renal arteries (n = 44). The groups were compared regarding early and late vascular and urological complications. Patient and graft survivals were compared using Kaplan-Meier survivorship curves with comparisons using the log-rank test. RESULTS: Both groups were comparable regarding acute rejection episodes, posttransplant hypertension, postsurgery renal artery stenosis, and urologic complications. Only hemorrhagic complications and renal artery thrombosis were significantly higher in the multiple renal arteries group (P = .027 and .03, respectively). Warm ischemia time was significantly longer in the multiple renal arteries group without any influence on the incidence of acute tubular necrosis (P = .2). Mean creatinine clearance at 1 year was 65 versus 50 mL/min/1.73 m(2) (P = .5) and at 5 years, 60 versus 55 mL/min/1.73 m(2) (P = .1) for the single versus multiple renal arteries groups, respectively. Return to hemodialysis was necessary for 18.8% of the single and 16.1% of the multiple renal arteries group. CONCLUSION: The use of an allograft with multiple renal arteries is a safe, successful surgical procedure, that does not influence patient or graft survivals or increase surgical complication rates provided the surgical team is evolved with technical skill.

Evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle).

OBJECTIVE: To study the evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle) (ECUD-M) associated with ileocystoplasty. PATIENTS AND METHODS: Over 18 years from 1992 to 2009, ECUD-M with ileocystoplasty was performed in 120 patients with mean age of 25.5 years. Renal impairment was evident in 43 patients (17 children and 26 adults). RESULTS: Ninety percent of patients demonstrated a neurologic bladder and mild to moderate renal failure. Initially, all patients underwent continuous bladder drainage for a mean of 3 weeks. Renal function improved in 35 patients, although with persistent mild renal insufficiency. The other patients demonstrated moderate persistent residual renal insufficiency. During a mean follow-up of 10 years (range, 1-18 years), renal function returned to normal in 13 patients, stabilized at lower values in 15, and remained moderate in 5. After a mean follow-up of 8 years (range, 6-12 years), renal failure gradually worsened, increasing to higher values in 6 patients and leading to hemodialysis in 4. One patient underwent living-donor kidney transplantation, with good evolution. CONCLUSION: ECUD-M with ileocystoplasty can lead to normalization unless stabilizationof impaired residual renal function by eliminating the obstructive factor provides self-adequate management of the diversion. The procedure delays for the need forhemodialysis therapy, and enables patients to prepare for kidney transplantation into a previously reconstructed lower urinary tract.

Primary Plasmacytoma of the Testis with no Evidence of Multiple Myeloma: a New Case Report and Literature Review

Plasmacytomas of the testis are extremely rare tumours; especially when occurring in the absence of a previous or concurrent diagnosis of multiple myeloma. We report a new case of solitary testicular plasmacytoma; with immunohistochemical studies showing monoclonal cytoplasmic production of IgG lambda light chains; in a 51-year-old man who had no evidence of multiple myeloma 3 years after the orchiectomy

Semen quality decline among men in infertile relationships: experience over 12 years in the South of Tunisia.

Concerns about the worldwide decline in semen quality over the past 50 years are increasing. Western countries have shown a decline in semen quality. However, in non-Western countries studies are sparse. We investigated trends in semen parameters between 1996 and 2007 in the Sfax area of southern Tunisia in a sample of 2940 men in infertile relationships. Age at semen collection, duration of sexual abstinence, volume of seminal fluid, the sperm count, percentages of motile and morphologically normal spermatozoa, and semen leukocyte concentration were determined. Linear regression was used to examine trends over time in sperm count, sperm motility, normal morphology, and semen leukocyte concentration. Mean age and semen volume did not change between 1996 and 2007. Data adjusted for age and abstinence showed a decreasing trend in sperm count and percentage of normal morphology over the last 12 years (R(2) = 0.71, P = .0004, and R(2) = 0.87, P < .0001, respectively). There was no significant change in sperm motility. However, semen leukocyte concentration increased significantly over time (R(2) = 0.38, P = .03). These results coincide with the high prevalence of genital infectious diseases in the Sfax area, suggesting that infection may be a potential contributing factor in semen quality decline.

118 cas de tuberculose urogenitale dans le Sud Tunisien

Objectif : Etudier les caracteristiques epidemiologiques; cliniques; therapeutiques et evolutives de la tuberculose urogenitale dans la region du Sud Tunisien. Patients et methodes : Etude retrospective de 118 cas de tuberculose urogenitale issus des regions du Sud et du Centre tunisiens. Le diagnostic a ete confirme chez tous les malades par un faisceau d'elements cliniques; biologiques; radiologiques; et/ou histologiques. Resultats : Il s'agissait de 81 hommes et 37 femmes ages en moyenne de 38 ans. Les manifestations cliniques revelatrices etaient dominees par les signes irritatifs du bas appareil urinaire (57;6). Les signes generaux ont ete observes dans 25;4des cas. Le diagnostic de certitude a ete obtenu par preuve bacteriologique (49;2); biopsie vesicale positive (12;7); et analyse anatomopathologique d'une piece d'exerese operatoire (68;6). Le traitement a consiste en une chimiotherapie anti-bacillaire chez tous les patients; en association avec une chirurgie d'exerese (70;3); une chirurgie de reconstruction (18;6); et/ou des manoeuvres endoscopiques (13;6). 80des patients etaient suivis regulierement avec un recul moyen de 6 ans. L'evolution a ete favorable dans 85;3des cas. Conclusion : La tuberculose urogenitale reste une maladie d'actualite; elle represente une maladie grave du fait des risques multiples qu'elle peut engendrer; particulierement sur la fonction renale.). Les signes generaux ont ete observes dans 25;4des cas. Le diagnostic de certitude a ete obtenu par preuve bacteriologique (49;2); biopsie vesicale positive (12;7); et analyse anatomopathologique d'une piece d'exerese operatoire (68;6). Le traitement a consiste en une chimiotherapie anti-bacillaire chez tous les patients; en association avec une chirurgie d'exerese (70;3); une chirurgie de reconstruction (18;6); et/ou des manoeuvres endoscopiques (13;6). 80des patients etaient suivis regulierement avec un recul moyen de 6 ans. L'evolution a ete favorable dans 85;3engendrer; particulierement sur la fonction renale

[Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. / Dérivation urinaire de Mitrofanoff. Mécanismes physiques et explication urodynamique de la continence.

OBJECTIVE: To analyze the urodynamic parameters and the mechanisms of continence of Mitrofanoff urinary diversion. MATERIAL AND METHODS: Urodynamic assessment was performed via the stoma in 11 patients with continent urinary diversion according to the Mitrofanoff principle. The mean age of the patients at the time of the operation was 29 years. The appendix, used as conduit in all cases, was anastomosed to the skin of the right iliac fossa. Ileocystoplasty was performed in 10 patients. The urodynamic assessment was performed after a mean follow-up of seven years (range: five to 12 years). RESULTS: Reservoir pressures after filling did not exceed 20 cm H2O in nine cases. Uninhibited contractions were recorded in two patients with an enlarged bladder with pressures not exceeding 30 cm H2O. Appendix pressures during filling were always higher than bladder pressures. The mean pressure measured at the end of filling was 75 cm H2O (range: 45 to 90 cm H2O). After the Valsalva maneuver, these pressures were between 80 and 150 cm H2O with good transmission. The mean conduit closing pressure was 70 cm H2O (range: 40 to 90 cm H2O). The mean functional length of the conduit was 5 cm (range: 2.6 to 7.2 cm). CONCLUSION: The Mitrofanoff diversion is mainly characterized by the high intraluminal pressure in the continent conduit. A low bladder pressure is essential to maintain a perfectly continent diversion.

Successful Treatment of Homozygous Cystinuria with Captopril

Objective : Cystinuria is an autosomal recessive hereditary disorder associated with nephrolithiasis and its attendant complications. Traditional management using oral alkali; D-penicillamine; or mercaptopropionyglycine in an attempt to increase urinary cystine solubility is often unsuccessful due to intolerable side-effects. The aim of this study was to determine; if captopril could reduce urinary cystine excretion in homozygous cystinuric patients. Patients and methods : Three cystinuric patients with a history of multiple cystine stones despite previous traditional therapy were treated with 150 mg captopril daily for 3 years after determination of their baseline 24-hour urine cystine excretion. Cystine excretion studies were repeated subsequently at 6-month intervals. Results : The baseline 24-hour urine cystine excretion was within the expected limits for homozygous cystinuria in all patients (1072; 862 and 959 mg cystine per gm creatinine per 24 hours). After institution of captopril treatment; all patients had a significant decrease in urinary cystine levels (374; 313 and 451 mg cystine per gm creatinine per 24 hours). No patient experienced recurrent nephrolithiasis or adverse drug effects. Conclusion : We conclude that captopril can significantly decrease urinary cystine excretion in patients with homozygous cystinuria. Captopril should be considered an alternative to traditional drug management of cystinuria

Screening of Y chromosome microdeletions in Tunisian infertile men.

The aim of this study was to establish the prevalence of Y chromosomal microdeletions in infertile Tunisian men. Three groups of infertile men, 65 normospermic, 53 oligozoospermic and 45 azoospermic, were tested for Yq microdeletions detection by multiplex polymerase chain reaction (PCR) using specific Y chromosome AZF regions tagged site markers (STS). One group of 13 healthy men was used as the control group. Six STS were tested (2 in each AZF region). The general prevalence of AZF microdeletions was 16%; in azoospermia and severe oligospermia groups, it was higher (29% and 30.5%, respectively). Significant differences were found with moderate oligospermic and normospermic groups (p < 0,05). AZFc microdeletions were the most frequent, and 55% of AZFc deleted patients were oligospermic. No deletions were detected in the control group. These results add to the growing literature data, showing that microdeletions of the Y chromosome is an important cause of severe spermatogenetic defect and confirm that deletion in AZFc region is the most common and is compatible with residual spermatogenesis.

High androgen receptor immunoexpression in human "Sertoli cell only" testis.

Our purpose was to evaluate cellular androgen receptor (AR) distribution and intensity of immunostaining in the human azoospermic testis. Thirty six biopsy specimens from azoospermic men were immunostained, using a monoclonal antibody of human AR. The localization and the intensity of AR immunostaining was evaluated in Sertoli Cell Only (SCO) testis (G1, n = 21), in spermatogenesis arrest testis (G2, n = 11) and in histologically normal testis (G3, n = 4). We found an AR immunostaining in Sertoli, peritubular myoid and Leydig cells, but not in germ cells. The intensity of the immunostaining varied substantially between biopsy specimens of different patients. Sertoli and Leydig cells AR immunostaining (score and intensity) in SCO group was higher than in the other groups. For Sertoli cells, the score means of AR immunoreactivity were 20 +/- 2.36, 10.18 +/- 1.0 and 1 +/- 1, for G1, G2 and G3 groups, respectively. For Leydig cells, the score means were 10.24 +/- 1.37, 6 +/- 0.71 and 0, for G1, G2 and G3 groups, respectively. We found significant differences between G1 and G2 (p = 0.0008), between G1 and G3 (p = 1.54 10-7) and G2 and G3 (p = 0.00032). These results suggest that in the testis AR is located exclusively in somatic cells and its expression is higher in SCO syndrome than in normal and in arrest spermatogenesis testes.

Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men.

Numerous studies have reported beneficial effects of antioxidant drugs on semen quality, but there is no well-defined therapeutical protocol in male infertility. This study aimed to test the effects of vitamin E and selenium supplementation on lipid peroxidation and on sperm parameters. The study included 54 voluntary and infertile men who produced semen samples for spermiogram and for spectrophotometric measurement of a lipid peroxidation marker, the malondialdehyde (MDA), and produced blood samples for high-performance liquid chromatography assessment of serum vitamin E level. The trial was randomized and open. Twenty-eight men were supplemented daily by vitamin E (400 mg) and selenium (225 microg), during 3 months. The remaining 26 patients received vitamin B (4,5 g/day) for the same duration. Only 20 patients achieved their treatment and returned for control analysis. MDA concentrations in sperm were much less than in seminal plasma and motility and viability were inversely correlated with semen MDA levels. In contrast to vitamin B supplementation, vitamin E and selenium supplementation produced a significant decrease in MDA concentrations and an improvement of sperm motility. The results confirm the protective and beneficial effects of vitamin E and selenium on semen quality and advocate their use in male infertility treatment.

Roles of Escherichia coli histone-like protein HU in DNA replication: HU-beta suppresses the thermosensitivity of dnaA46ts.

The HU protein is a small, basic, heat-stable DNA-binding protein that is well-conserved in prokaryotes and is associated with the bacterial nucleoid. In enterobacteria, including Escherichia coli, HU is a heterotypic dimer, HUalphabeta, composed of two closely related sub-units encoded by the hupA and hupB genes, respectively. HU was shown to participate in vitro in the initiation of DNA replication as an accessory factor to assist the action of DnaA protein in the unwinding of oriC DNA. To further elucidate the role of HU in the regulation of the DNA replication initiation process, we tested the synchrony phenotype in the absence of either one or both HU sub-units. The hupAB mutant exhibits an asynchronous initiation, the hupA mutant shows a similar reduced synchrony, whereas the hupB mutant shows a normal phenotype. Using a thermosensitive dnaA46 strain (dnaA46ts), an initiation mutant, we reveal a special role of HUbeta. The presence of a plasmid overproducing HUbeta in a dnaA46ts lacking HU (hupAB background) compensates for the thermosensitivity of this initiation mutant. Moreover, the overproduction of HUbeta confers to dnaA46ts a pattern of asynchrony similar to that of a dnaAcos, the intragenic suppressor of dnaA46ts. We show that the relative ratio of HUalpha versus HUbeta is greatly perturbed in dnaA46ts which accumulates little, if any, HUbeta. Therefore, the suppression of thermosensitivity in dnaA46hupAB by HUbeta may be caused by an unexpected absence of HUbeta in the dnaA46ts mutant. Visibly the HU composition is sensitive to the different states of DnaA, and may play a role during the regulation of the initiation process of the DNA replication by affecting subsequent events along the cell cycle.

[Multifocal tubulopapillary tumors of the kidney. Morphologic features and prognosis. Three cases]. / Tumeurs tubulopapillaires multifocales du rein. Aspects morphologique et pronostique. Trois observations.

Tubulopapillary tumors of the kidney represent a particular group of renal tumors characterized by their less aggressive behavior. These tumors are distinguished from non papillary tumors by their morphologic, cytochemical and genotypic features. They correspond to a continuous spectrum of tumors ranging from papillary renal cell adenoma to papillary renal cell carcinoma. These TTPR show multifocal, bilateral development and chronic lesions of the kidney parenchyma in nearly all cases. The authors report three cases of multifocal TTPR, including one bilateral case. Based on analysis of these cases and a review of the literature, they discuss the histogenetic features and prognosis of TTPR.