[Tuberculous pseudotumour, a challenging diagnosis]. / La tuberculose pseudotumorale, un diagnostic difficile.

INTRODUCTION: The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation. METHODS: We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor. RESULTS: Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment. CONCLUSION: Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.

Drug reaction with eosinophilia and systemic Symptoms (DRESS) Syndrome in children: a case report

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Urinary creatine at rest and after repeated sprints in athletes: a pilot study.

Creatine plays a key role in muscle function and its evaluation is important in athletes. In this study, urinary creatine concentration was measured in order to highlight its possible significance in monitoring sprinters. The study included 51 sprinters and 25 age- and sex-matched untrained subjects as a control group. Body composition was measured and dietary intake estimated. Urine samples were collected before and after standardized physical exercise. Creatine was assessed by gas chromatography mass spectrometry. Basal urinary creatine (UC) was significantly lower in sprinters than controls (34±30 vs. 74±3 µmol/mmol creatinine, p < 0.05). UC was inversely correlated with body mass (r = -0.34, p < 0.01) and lean mass (r = -0.30, p < 0.05), and positively correlated with fat mass (r = 0.32, p < 0.05). After acute exercise, urinary creatine significantly decreased in both athletes and controls. UC is low in sprinters at rest and further decreases after exercise, most likely due to a high uptake and use of creatine by muscles, as muscle mass and physical activity are supposed to be greater in athletes than untrained subjects. Further studies are needed to test the value of urinary creatine as a non-invasive marker of physical condition and as a parameter for managing Cr supplementation in athletes.

Aerobic training programs and glycemic control in diabetic children in relation to exercise frequency.

AIM: The aim of this study was to assess the effect of an aerobic training on glycemic control and lipid profile in diabetic children. METHODS: Thirty-three children with type 1 diabetes mellitus (T1DM) were equally divided in three groups. The control group (CG) did not perform any training intervention during the period of the investigation and the subjects were instructed to continue with their daily lifestyle patterns. The second group (G1) and the third group (G2) completed a six-month aerobic training programs. During the period of the investigation, G1 participated in one daily session (~60 min) of aerobic exercise twice weekly, while G2 performed in the form of daily session four times a week (~60 min). HbA1c and lipid profile were measured before training intervention, then after three and six months. RESULTS: The three-month periods was without significant changes of HbA1c in the two groups but significantly increased high-density lipoprotein cholesterol (HDL-C) in G1 (P<0.05). In G2, an increase of HDL-C was accompanied by a decrease of serum triglyceride (TG) (P<0.05). After six months, only HDL-C and TG levels were significantly lower in G1 (P<0.01), while in G2 HDL-C increased (68.8±5.7 mg/dL vs. 56.7 ±7.2 mg/dL; P<0.01), low-density lipoprotein cholesterol (LDL-C) (69.2±8.5 mg/dL vs. 81.6±11.8 mg/dL; P<0.01), TG concentrations decreased (60.7±6.9 mg/dL vs. 77.4±9.3 mg/dL; P<0.01) and HbA1c was significantly lower (6.8±1.1% vs. 8.2±1.5%; P<0.05), comparatively to those before training. CONCLUSION: However, the six-month periods showed that children exercising more than two times weekly significantly improved HbA1c and lipid profile. These results must encourage children with T1DM to regularly practice sporty activities for long periods.

[Comparative effects of oral rehydratation solutions in experimental cholera in the rat]. / Effets comparés de solutions de réhydratation par voie orale dans le choléra expérimental chez le rat.

UNLABELLED: The composition of the World Health Organisation (WHO) solution in oral rehydration therapy has remained controversial because of its total osmolarity (303 mosm/L) and higher sodium concentration (90 mEq/L), increasing the risk of hypernatraemia. AIM OF THE STUDY: To compare the efficacy of two reduced-osmolarity oral rehydration solutions (S1: 268 mosm/L and 50 mEq/L Na(+); S2: 240 mosm/L and 60 mEq/L Na(+) ) with the WHO recommended formula taken as the reference solution. Water, electrolytes and glucose fluxes were directly measured in vivo, in isolated ligated loops of rat jejunum (n=12). Intestinal secretion was induced by exposing jejunum to cholera toxin (CT=20 microg/loop). RESULTS: All three test solutions similarly reversed cholera toxin-induced net water absorption (3.37 +/- 1.35; 3.31 +/- 0.43 and 3.13 +/- 0.66 microL/min.cm(2) for S1, S2 and WHO solutions respectively). However, net Na secretion induced by cholera toxin was observed with S1 and S2 while Na absorption occurred with the WHO solution. CONCLUSION: For a same amount of water absorbed, Na absorption from reduced - osmolarity rehydration solutions is lower than with the WHO solution. Our data may contribute to a better rationale for the use of orally administered hydration solutions in man.

[The effect of nutritional education on the food intake regulation of the young diabetic]. / Incidence de l'education nutritionnelle sur la regulation de la prise alimentaire par le jeune diabetique.

The aim of our study is to evaluate the effect of nutritional education (applied during young diabetic camps) on the nutrition knowledge acquisition and the effective application of this knowledge by young diabetics in their dietary intake composition. This study included ten volunteers pupils, aged from 12 to 15 years. Each meal provided was quantified before and after consumption to determine during three consecutive days the exact amount of food consumed. Our results showed that the young diabetic could regulate his energetic intake in accordance with his needs. He didn't modify the proposed food when it was normocaloric (2615 +/- 390 Kcal), but he increased his food intake near the recommended needs when the proposed food was hypocaloric (1766 +/- 283 Kcal) and decreased his consumption when the proposed food was hypercaloric (4271 +/- 511 Kcal). Moreover, this study showed a significant negative correlation between the total energy intake and the amount of carbohydrates (r = -0.46, p < 0.01) and proteins (r = -0.70, p < 0.01), while it was positive between the first and lipid intake (r = 0.63, p < 0.01).

[Zincemia, cupremia and infection in malnourished children]. / Zincémie, cuprémie et infection chez l'enfant malnutri.

BACKGROUND: Serum copper and zinc levels are decreased in malnourished and infected children. The role of either malnutrition or infection remains undetermined. POPULATION AND METHODS: Serum zinc and copper concentrations were measured by atomic absorption spectrophotometry in 31 malnourished infants aged 1 to 26 months and 28 eutrophic infants aged 3 to 22 months. Fourteen infants of the first group and 10 of the second were infected at the time of study. RESULTS: Serum zinc and copper levels were significantly decreased in infants with malnutrition (zinc: 66 +/- 32 micrograms/dl and copper: 81 +/- 51 micrograms/dl versus 108 +/- 26 and 185 +/- 21, respectively, in eutrophic infants) (p < 0.001). These levels were still lower in those malnourished infants who were infected (zinc: 49.5 +/- 18 micrograms/dl and copper: 63.5 +/- 37 micrograms/dl versus 81.56 +/- 35 and 94 +/- 56 in non infected patients) (p < 0.02). CONCLUSIONS: Infection increases the risk of low serum zinc and copper concentrations seen in malnourished children. This factor must be taken in account when treating malnutrition.

[Characteristics of persistent diarrhea in pediatric services in Tunis]. / Caractéristiques de la diarrhée persistante dans un service de pédiatrie à Tunis.

BACKGROUND: Persistent diarrhea (PD) is recognized as a major cause of morbidity and mortality in the developing world. PATIENTS AND METHODS: The files of all children, less than 5 years of age, admitted in 1990 and 1991 for diarrhea persisting from 14 to 30 days have been retrospectively analysed. Socio-economic factors, history of disease, changes in feeding, nutritional status and clinical data of the DP have been specially recorded. RESULTS: During these 2 years, 74 children were admitted (93% of them were less than 12 months old). Two-thirds of the patients were issued from suburban-living poor families. DP was more frequent during September and October (42%), the usual period of malnutrition. Although only 23% of the mothers had reported history of acute diarrhea, 35% of them did not exclude it. Sixty-nine percent of the children were breast-fed and 82% were bottle-fed before 12 months of age. Dietary intake was stopped during the acute episode in 52% of cases. There were no chronic malnutrition, but 69% of patients were suffering from acute malnutrition. Dehydration was present in most cases and was severe in 33% of them. Death occurred in three children. CONCLUSIONS: These results show that, among usual risk factors of PD bottle-feeding, diet errors and history of acute diarrhea seem to be particularly frequent in this Tunisian population.

In vitro effects of tetrodotoxin and hexamethonium on electrolyte transport in rabbit ileum treated with cholera toxin.

To determine if there was a role for the submucosal nerves in cholera toxin (CT)-induced secretion, we studied the effects of serosal addition of two neurotoxins, the nerve conduction blocking agent, tetrodotoxin (TTX), and the nicotinic ganglionic blocking agent, hexamethonium (HXM), on electrolyte secretion in control isolated rabbit ileum and in that stimulated by CT. 1). In the absence of CT, the short circuit current (Isc) decreased after TTX (10(-7) M) (P less than 0.01) and was unaltered by HXM (10(-5) M). In the presence of CT, Isc increased but was not modified by 10(-7) M TTX or 10(-5) M HXM. 2) In control tissues the mean isotopic Na+ and Cl- fluxes were not significantly altered by TTX addition. Cl- absorption alone was significantly reduced by HXM (delta JCl- = 1.95 +/- 0.81 microEq.hr-1.cm-2; P less than 0.02). After stimulation with CT, TTX significantly inhibited Na+ and Cl- secretion (delta JNa+ = 2.15 +/- 0.61 and delta JCl- = 2.15 +/- 0.76 microEq.hr-1.cm-2; P less than 0.01). Similarly, HXM significantly inhibited CT-stimulated Na+ and Cl- secretion (delta JNa+ = 1.73 +/- 0.70 and delta JCl- = 1.46 +/- 0.62 microEq.hr-1.cm-2; P less than 0.02). 3) In TTX and HXM treated tissues there was no difference in the increase in Isc caused by cAMP (2 x 10(-3) M), calcium ionophore A 23187 (4 x 10(-6) M) and glucose (10(-3) M) compared to the untreated tissues in the presence or absence of CT.(ABSTRACT TRUNCATED AT 250 WORDS)

Luminal antisecretory effects of a beta-casomorphin analogue on rabbit ileum treated with cholera toxin.

Because the physiologic significance of the presence of the opioid peptides beta-casomorphins (beta-CMs) in enzymatic digestion of milk proteins is still undetermined, the effect of the nonmetabolized beta-CM analogue beta-[DAla2,4,Tyr5]CM-5-NH2 on water and electrolyte movements was studied in vivo and in vitro in rabbit ileum untreated or treated with cholera toxin (CT). When this analogue was introduced in vivo at a concentration of 10(-3) M into the lumen of rabbit ileal loops, it significantly stimulated net water absorption in untreated loops and reduced net water secretion in CT-treated loops. In vitro addition of this analogue (10(-4) M) to the serosal compartment of untreated ileum in an Ussing chamber reduced Isc (delta Isc = 0.44 +/- 0.05 muEq.h-1/cm2) and stimulated net Na and Cl absorption to the same extent. In CT-treated ileum, both serosal (10(-4) M) and mucosal (5.10(-4) M) addition of the analogue did not further modify the rise in Isc caused by CT but also stimulated net Na and Cl absorption. On the mucosal side, the effect of the analogue was accompanied by its transfer from the luminal to the blood side of the tissue. The transferred analogue was intact as shown by HPLC (Jm----s = 2.4 +/- 0.8 nmol.h-1/cm2). These results demonstrated that the beta-CM analogue stimulates intestinal absorption of electrolytes in rabbit ileum both in the basal state and after its stimulation by CT.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuromediated action of beta-casomorphins on ion transport in rabbit ileum.

beta-casomorphins (beta-CMs) are opioid peptides derived from milk beta-casein. The beta-casomorphin analog beta-[DAla2,4, Tyr5] CM-5-NH2 reduced short-circuit current (lsc) and stimulated electrolyte absorption by an opioid effect in rabbit ileum in vitro. This effect was inhibited by 10(-7) M tetrodotoxin, 10(-6) M epinephrine and 10(-5) M naloxone. Atropine in the 10(-7)-10(-5) M range and 10(-5) M hexamethonium did not inhibit the action of the peptide on lsc. In comparison the muscarinic effect of 10(-3) M carbachol was inhibited by atropine in the 10(-8)-10(-5) M range. These results indicate that the action of the beta-casomorphin analog was neuromediated and suggest that this peptide acted on the submucosal plexus located on the blood side of the intestinal epithelium. A physiological role of the food-derived beta-CMs peptides implies the passage of the active sequences from the lumen to the blood side of the intestine.

[Risk factors in cancer of the endometrium]. / Les facteurs de risque du cancer de l'endomètre.

The authors evaluate the incidence of the main risk factors in endometrial cancer by comparing a continuous series of 101 patients with a matched reference series. Among these factors, obesity and multiparity are significantly more frequent in patients with endometrial cancer. All of these risk factors are related to a hyperestrogen level. Their knowledge may contribute to a policy of prevention of endometrial cancer, but does not permit its screening by limiting to women presenting these risk factors.

Anticholeraic effect of methylated casein in rat jejunum.

To explore the antisecretory effect of methylated casein (MC) cholera toxin was placed in isolated jejunal loops, and in vivo water fluxes were measured 3 h later in the presence or absence of MC. Secretion was observed in the loops filled with Ringer's solution only, but net absorption was observed in all 10 loops to which MC was added. Its actions was evident within 20 min, and was exerted directly on the luminal side of the epithelium. This response was dose-dependent and the antisecretory effect vanished after boiling MC and after ultrafiltration. In vitro, the antisecretory effect of MC consisted of reversing net Na and Cl fluxes from secretion to absorption (delta JNanet = 6.18 +/- 1.25 and delta JClnet = 5.10 +/- 1.66 microEq . h-1 . cm-2). This change was due to the enhancement of mucosal to serosal flux. Transepithelial potential difference and tissue conductance did not alter. Interestingly, MC did not interfere with intestinal function in the absence of stimulation by cholera toxin. In the presence of cholera toxin, MC and glucose both stimulated ionic absorption by different mechanisms, MC stimulating neutral NaCl absorption, and glucose stimulating electrogenic Na absorption. MC did not alter basal adenylate cyclase activity but it inhibited the cholera toxin-stimulated increase in activity. The present results indicate that methylated casein inhibits water and electrolyte secretion induced by cholera toxin in rat jejunum. Its availability, low cost, and curative effect from the luminal side constitute compelling indications for further investigation.