A clinical study of non-parkinsonian tremor in Moroccan patients

Objective

To report the characteristics of the most frequent tremors in a population of Moroccan patients.

Background

Tremor is the most common movement disorder. It implies a wide variety of disorders with Parkinson's disease and essential tremor being the most frequent.

Methods

A retrospective study of 148 patients with tremor referred to our movement disorders outpatient clinic was performed. Clinical features and treatment regimens were analyzed. Patients with parkinsonian tremor were excluded.

Results

We included 62 patients with non-parkinsonian tremor. The etiologies were as follows: essential tremor (54.8%), dystonic tremor (19.4%), tremor associated with dystonia (14.5%), enhanced physiological tremor (3.2%), cerebellar tremor (3.2%), psychogenic tremor (3.2%) and Holmes’ tremor (1.6%). The characteristics of essential tremor patients were analyzed. Female patients accounted for 67.6% of patients. Mean age at the onset of tremor was 52.2 ± 16.4 years. Family history of tremor was reported in 17.6% of cases. Tremor affected the arms (94.1%), head (52.9%), voice (35.3%) and legs (8.8%). Tremor was bilateral in 87.5% but was asymmetrical in 50% of patients. Patients had postural tremor (76.5%), kinetic tremor (79.4%) and rest tremor (associated in 11.8%). Treatment relied on propranolol (88.3%), primidone (14.7%), gabapentin (14.7%), clonazepam (14.7%), alprazolam (11.8%), topiramate (5.9%) and, in one patient, radiosurgery.

Conclusions

Essential tremor was the predominant diagnosis, confirming its high prevalence. There was a predominance of female patients and a peak of age at onset in the fifth and sixth decades. Asymmetry of the disease was noted in half of patients.     

Relationship between lymphatic metastasis in breast and cervix cancers and the level of CD44-H expression evaluated by an immunohistochemical method]

Immunohistochemistry has been used to evaluate the relationship between the rate of CD44-H antigen expression in breast invasive intracanalicuar and cervical epidermo?d carcinomas and the presence of node metastasis. A total of 36 cases of breast carcinoma and 20 cases of cervical carcinoma was examined. For the two types of carcinoma, the CD44-H molecule was highly expressed in cases with node metastasis; with 50% and 75% median value of CD44-H positive tumor cells respectively for the breast (p < 0.02) and for the uterine cervix (p < 0.05) compared to respectively 10% and 37.5% in the cases without node metastasis. The expression of this molecule increases with invasive potential of tumor cells and the use of this antigen for prognostic ends may be possible.     

Analytical performance of a sensitive assay for cardiac troponin I with loci™ technology

ObjectivesTo confirm the analytical performance of the Dimension Vista LOCI troponin I assay (cTnI).Design and methodLimit of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ) with a 10% coefficient of variation (CV), linearity, precision, method comparison, and 99th percentile upper reference limits (URL) were analyzed. Endogenous analytes and rheumatoid factor (RF) were tested for assay interference.ResultsThe 99th percentile was 0.022 µg/L (CV = 14%) and the LoQ was 0.036 µg/L. The ratio of 10% CV concentration to 99th percentile was 1.63. Linearity extended from 0 to 44.36 µg/L. The method comparison equation was Dimension® Vista? = 0.94 (Dimension® RxL) + 0.00 µg/L with bias at low levels. No interference was detected.ConclusionsThis study shows acceptable performance characteristics of the LOCI cTnI assay on Dimension® Vista? to diagnosis and risk stratification of patients with acute coronary syndrome symptoms.     

Stroke and syphilis: A retrospective study of 53 patients

Objective

The aim of this study was to describe the clinical, biological and radiological characteristics of patients with syphilitic vasculitis, and to assess the outcome after treatment.

Prise en charge de la violence et du décrochage scolaire à l’école II. Résultats d’une recherche–action sur le modèle triangulaire au sein d’un collège à Grenoble

Background

Violence at school and school dropout constitute a big concern as well for the teachers, for the parents as for the clinicians. Several explanatory factors are proposed: individual, familial, school climate or factors in connection with the group of peers. These factors impact on the psychic, school and social health of the child. Coverages are proposed at the national and international level and seem to give convincing results. Each of these initiatives implied in a differentiated way parents, pupils and teachers. None put in the work a project integrating the educational triangle that is at the same time the parents, the children and the teachers within the school. The objective of this work is to report results of a research–action which took place during 5 years within a college of the academy of Grenoble and which put in the work on this lapse of time, in this college, the pupils, the parents and the teachers.

Amyotrophic lateral sclerosis syndrome of syphilitic origin. 5 cases

We studied 5 cases of syphilitic lateral amyotrophic sclerosis. The diagnosis was based on the presence of a lymphocytic reaction in the CSF and positive VDRL and TPHA reactions in both blood and CSF. Clinically, the disease affected the arms in 3 cases and produced paraplegia in 2 cases. The gradual extension of amyotrophy over several months, the diffusion of electromyographic abnormalities and the finding of spinal cord atrophy at myelography and CT suggested a subacute ischemic mechanism with meningo-myelic arteritis involving the anterior horns. After treatment with penicillin G in high doses, the outcome was constantly favourable, with improvement of motor deficit in 4 cases and stabilisation in 1 case in a 5 to 13 years' follow-up.     

Circulation and Molecular Epidemiology of Enteroviruses in Paralyzed,Immunodeficient and Healthy Individuals in Tunisia,a Country with a Polio-Free Status for Decades

This report is an overview of enterovirus (EV) detection in Tunisian polio-suspected paralytic cases (acute flaccid paralysis (AFP) cases), healthy contacts and patients with primary immunodeficiencies (PID) during an 11-year period. A total of 2735 clinical samples were analyzed for EV isolation and type identification, according to the recommended protocols of the World Health Organization. Three poliovirus (PV) serotypes and 28 different nonpolio enteroviruses (NPEVs) were detected. The NPEV detection rate was 4.3%, 2.8% and 12.4% in AFP cases, healthy contacts and PID patients, respectively. The predominant species was EV-B, and the circulation of viruses from species EV-A was noted since 2011. All PVs detected were of Sabin origin. The PV detection rate was higher in PID patients compared to AFP cases and contacts (6.8%, 1.5% and 1.3% respectively). PV2 was not detected since 2015. Using nucleotide sequencing of the entire VP1 region, 61 strains were characterized as Sabin-like. Among them, six strains of types 1 and 3 PV were identified as pre-vaccine-derived polioviruses (VDPVs). Five type 2 PV, four strains belonging to type 1 PV and two strains belonging to type 3 PV, were classified as iVDPVs. The data presented provide a comprehensive picture of EVs circulating in Tunisia over an 11-year period, reveal changes in their epidemiology as compared to previous studies and highlight the need to set up a warning system to avoid unnoticed PVs.     

Genetic factors and multiple sclerosis in the Moroccan population: A role for HLA class II

Background and objective

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system that mainly affects young adults. The association between susceptibility to MS and HLA class II genes, in particular the DRB1*15 allele, has been reported in diverse ethnic groups. The aim of our study was to investigate the distribution of HLA-DRB1* and -DQB1* alleles in Moroccan population and their implication in the susceptibility to the disease.

Methods

Fifty-seven MS patients were compared to 172 healthy controls unrelated to one another and matched by age, sex and ethnic origin. HLA class II (DRB1* and DQB1*) typing was performed by PCR-SSP and/or Luminex (PCR-SSO). Allelic and haplotypic frequencies, P-values, odds ratio (OR) and 95% confidence interval (CI) were calculated using the software SPSS.

Results

A significant increase of DRB1*15 allele frequency (17.6% vs 8.4%, OR = 2.67, 95% CI = 1.36–5.23, P = 0.004) and HLA-DRB1*15-DQB1*06 haplotype (8.8% vs 4.08%, OR = 2.78, 95% CI = 1.41–5.48, P = 0.002) were observed in Moroccan MS patients. No association of the DR15 allele with sex or age at onset was appreciated. Concerning HLA-DQB1* alleles, no significant difference between patients and controls was found.

Conclusions

Our results reveal a role for HLA-DRB1*15 allele molecules in the predisposition of Moroccan patients to MS. Although this study should be confirmed on a larger sample size, it analyzes for the first time the possible role of a genetic marker for susceptibility to MS in Moroccan population.