Smoking during pregnancy and postpartum among Tunisian women.

OBJECTIVE: The validity of self-reported smoking in population surveys remains an important question yet to be answered. This has been of particular concern in a situation where there is a strong social pressure against pregnant and postpartum women. An associated question is what would be the value of measuring urinary cotinine concentrations in such surveys to obtain validated smoking data. METHODS: Cross-sectional analysis of data on self-reported smoking and urinary cotinine among a sample of 398 pregnant women and recently pregnant, mothers of infants under the age of 2 months, who came to the Family Planning Clinic in Tunis urban area for either prenatal or newborn care. We used quantitative colorimetric urine test based on the könig reaction, in which pink-red chromophores formed from nicotine and its metabolites condensation with barbituric acid were extracted into acetate buffer. RESULTS: The smoking prevalence among Tunisian pregnant women or mothers of newborn infants was 4%. The validity of self-reported daily smoking was relatively low. Among women reporting no smoking at the interview 16% misreported active smoking. According to urinary cotinine values, the smoking prevalence was 18.8%. CONCLUSIONS: These results substantiate the unreliability of self-report on smoking status among women in prenatal and postnatal period and have implications in clinical and education practice.

An animal model of testicular toxicity by cyclosporine: evaluation and protection.

CyclosporineA (CsA) improves the survival of patients who benefited from transplantation. However, its use is generally limited by its side effects. The aim of our study was to measure, in an experimental model, the changes of the testosterone plasma levels after 21 days of CsA treatment and to explain the mechanism of this modification. After treatment, the levels of CsA, testosterone, corticosterone, transaminases were measured. The cytotoxic effect of CsA was evaluated by microscopic observation. The experimental study showed that CsA had no effect on the plasmatic levels of hepatic enzymes - alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl-transferase - because their plasma concentrations in treated rats did not differ from those of the sham group. The plasma concentration of corticosterone was not modified, the plasma level of testosterone decreased when the dose of cyclosporine was increased to 4 mg/kg/day. The photonic microscope observation showed that the number of Leydig cells was increased and the electronic microscope observation showed mitochondria alteration. The treatment by CsA and trimetazidine did not correct the alteration caused by CsA. N-benzyl-N'-(2-hydrox-3, 4-dimethyloxybenzyl)-pipeazine did not protect the mitochondrial function but partially protected mitochondria structure from the deleterious effect induced by CsA. The decrease of the plasma level of testosterone induced by CsA was due to the inhibition of the mitochondrial 20-22 desmolase which blocked the formation of the testosterone precursor and the destruction of the mitochondria structure.

Recurrent dysosmia induced by pyrazinamide.

Pyrazinamide can have adverse effects such as hepatic toxicity, hyperuricemia or digestive disorders. In rare cases, alterations in taste and smell function have been reported for pyrazinamide when combined with other drugs. We report a case of reversible olfactory disorder related to pyrazinamide in a woman, with a positive rechallenge. The patient presented every day a sensation of smelling something burning 15 min after drug intake. Dysosmia disappeared completely after pyrazinamide withdrawal and recurred after its rechallenge. The case was reported to the Tunisian Centre of Pharmacovigilance.

[Photosensitivity induced by metformin: a report of 3 cases]. / Photosensibilité induite par la metformine: à propos de 3 cas.

BACKGROUND: Metformin is an oral antihypoglycemic drug. Its cutaneous side effects are rare and photosensitivity had not been reported. AIM: Case report. CASE REPORT: We report 3 cases (a man and two women) of photosensitivity induced by metformin, notified to the Tunisian National Centre of Pharmacovigilance. Onset of the reaction was respectively 22 days, 4 months and 4 years. Daily dose of metformin varied from 1 to 2 tablets. Cutaneous lesions were located in sun-exposed sites in all cases with extension to the back in one case. Lesions were eczematous in two cases and erythematous in one case. Lesions healed after stopping metformin in all cases with positive rechallenge in the 1st case. CONCLUSION: In patient treated by metformin, occurrence of photosensitivity can be related to this drug.

Orofacial dyskinesia associated with tiemonium.

Tiemonium, an anti-spasmodic drug, can have adverse effects related to its anti-muscarinic effect. Dyskinesia is described with other anti-cholinergic drugs, but there are no reports of dyskinesia associated with tiemonium. We report a reversible orofacial dyskinesia following tiemonium intake (contained in Viscéralgine forte) in a woman with positive rechallenge. She presented these symptoms two times after two separate injections with an interval of 2 months. The case was reported to the Tunisian Centre of Pharmacovigilance.

[Fixed drug eruption : about 13 cases]. / Erytheme pigmente fixe. A travers une serie hospitaliere de 13 cas.

AIM: To discuss, through a retrospective study, the epidemiological and clinical aspects and the causative agents of fixed drug eruption. METHODS: Thirteen cases were collected retrospectively during 11 years. There were 10 females and 3 males with a mean age of 44 years. RESULTS: The lesions correspond to erythematous plaques which fade to leave slate-brawn macules in all cases. The most frequent localizations were limbs (12 cases), trunk (6 cases), face (3 cases) ans external genitals (3 cases). Sulfonamides were the most frequent responsible drugs in our series (7 cases). CONCLUSION: Fixed drug eruption is characterized by one or more erythematous plaques which recur in the same places after challenge. Sulfonamides are actually the most frequent causative drugs in the different series.

[Drug tendon disorders]. / Tendinopathies medicamenteuses.

Tendinitis is a rare adverse reaction described after drugs use. It's described with drug belonging to the same class. Physiopathology is still unknown. Fluoroquinolones especially pefloxacine, were the most incriminated. This drug induced tendinitis in older people aged more than 60 years. Approximatively one case out of five leads to tendon breaking off. The others lead to a favourable outcome after drug withdrawal. In three cases, tendinitis was described with statines, and concerned 2 men and 1 woman, aged more than 50 years. Simvastatine was suspected in two cases and the outcome was favourable in all cases after drug withdrawal. Other drugs, like corticosteroids, can exceptionally induce this side effect that can be serious. Consequences of drug tendinitis can then be dangerous and prescription of this class, and especially fluoroquinolones, must be cautions.

[Halothane-induced hepatitis. 8 case reports]. / Atteintes hepatiques à l'halothane. A propos de 8 cas.

Halothane (Fluothane) is a halogenic volatile anaesthetic used in therapeutic since 1956. His adverse effects are generally moderate with the exception of hepatitis that is usually severe and sometimes fatal. In our study, we analyze 8 cases of halothane-induced hepatitis, notified in the Centre National de Pharmacovigilance between 1994 and 1999 and validate according to B. Bégaud and collaborators method of imputability. It concerns 5 women and 3 men, aged between 26 and 65 years. The injury was cytolytic in 6 cases and cholestatic in the 2 others. It was fulminant in 3 cases of which 2 leaded to death. These injuries are usually graves, with an unforeseeable appearance and a hypothetical mechanism. In our opinion, a liver function control is necessary at the time of utilization of this drug.