Actualités dans le syndrome de Susac

Susac syndrome is a rare disease affecting mainly young women, characterized by a microangiopathy limited to the cerebral, retinal, and cochlear vessels. Although the pathophysiology of Susac syndrome is not yet fully elucidated, recent advances favour a primitive vasculitis affecting the cerebral, retinal and cochlear small vessels. Susac syndrome must be recognized in the presence of the pathognomonic clinical triad associating: 1/subacute encephalopathy with unusual headache and pseudopsychiatric features associated with diffuse white matter, grey matter nuclei and specifically corpus callosum lesions on brain MRI; 2/eye involvement that may be pauci-symptomatic, with occlusions of the branches of the central artery of the retina at fundoscopy and arterial wall hyperfluorescence on fluorescein angiography; and 3/cochleo-vestibular damage with hearing loss predominating at low frequencies on the audiogram. Relapses are frequent during an active period lasting approximately 2 years. Eventually, the disease resolves but isolated retinal arterial wall hyperfluorescence without new occlusions may recur, which should not lead to treatment intensification. First-line treatment consists of a combination of anti-aggregants and high dose corticosteroids. In refractory patients or in case of relapse, immunomodulatory molecules such as intravenous immunoglobulins or immunosuppressive drugs such as mycophenolate mofetil, cyclophosphamide or rituximab should be started. Unfortunately, sequelae-mostly hearing loss- remain frequent in these young patients.     

Nouveaux outils d'évaluation pour le contrôle de l'asthme : apport de l'expectoration induite

Asthma is an inflammatory disease of the airways, as demonstrated by bronchoalveolar lavage and bronchial biopsy. The diagnosis and monitoring of asthma are usually based on the results of pulmonary function tests. It has been demonstrated that examination of induced sputum is a non-invasive, reliable technique for monitoring bronchial inflammation in patients with asthma. Induced sputum reveals aspects of inflammation that are distinct from those measured by functional assessment. In particular, enumeration of eosinophils in induced sputum provides useful information on the status of an asthmatic patient, independent of functional tests, and can be repeated in the long-term follow-up of patients. Recent studies suggest that induced sputum can be used as a guide to therapy, with the aim of preventing exacerbations of asthma. Nevertheless, additional studies are needed to determine in which asthmatic populations induced sputum monitoring could be useful.     

Co-infection par le virus de l’immunodéficience humaine et le virus de l’hépatite C au Burundi

Aim

To estimate the prevalence of the co-infection by the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) from a patients?? representative sample of patients infected by the HIV.

Methods

Retrospective study over 5 years (2004?C2009) carried out in the ??Turiho Center?? of the National Association of Support for HIV-Seropositive and AIDS-patients. We included patients HIV positive who had HCV antibodies dosed and results clearly recorded in the medical files.

Results

A total of 1053 patients had HCVantibodies dosage (722 were females, 331weremales).Among the 1053 patients, the co-infection was found at 112 patients that is to say the prevalence rate of 10,6% CI95 % = [0,09; 0,13]. The middle age of the co-infected patients was 48 years. In the feminine population, the rate of co-infection was 9,4% IC95%= [0,07;0,12], and among men, it was 13,2% IC95%= [0,10;0,17]. No significant difference: X² = 2.51, p = 0,15

Conclusion

This high co-infection prevalence strengthens the recommendation of a systematic screening of the HCV in patients infected by the HIV.     

Rôle du bruit dans le développement de l’hypertension artérielle en milieu aéroportuaire

ObjectivesThe authors have tried to assess the noise annoyance and its relation with the development of hypertension for the staff working at the civilian airport of Algiers. This population is constantly subject to aircraft noises. The noise, through creating stress, acts on the central nervous system and on the autonomic nervous system and is likely to cause hypertension by increasing peripheral resistance, total cholesterol, fatty acids, adrenaline, cortisol and blood glucose. A number of studies revealed that starting from 65 decibels, the noise causes hypertension for patients of more than 40 years following 5 years of exposure.MethodsAn analytical study was conducted in 2000, which made the comparison between two groups of men working at Air Algérie company. There were 91 officers belonging to air crew, whose number was estimated at that time at 547, and whose average age was 49 years, compared with 111 officers of the ground crew on a total of 1200 persons and whose average age was 56 years. All those officers have received work medical consultation. Patients with suspected hypertension were systematically oriented to cardiologist. Similarly, everyone has had a biological assessment, an ophthalmologic consultation and ENT consultation as well.ResultsHypertension was found in 9.25% of the ground crew and in 16.63% of the air crew (P < 0.001). Hypertension is more common among air crew, subject to a more important noise nuisance, at a younger age and with less risk factors than the ground crew, who develops hypertension with similar prevalence to general population's but at a younger age. The air crew gives more importance to treatment due to the risk of losing their navigation license. The ENT examination was abnormal in 39% of the air crew versus 8% of the ground crew.ConclusionIn the light of these results, the noise seems to really interfere in the development of hypertension in airport environment. It would be more interesting to identify the number of strokes and particularly acute coronary syndromes which are far from being rare in this population subject to this noise annoyance. Preventive measures are of course extremely important.     

Faim et satiété, contrôle de la prise alimentaire

Food intake is a complex periodical behaviour through which a living organism can extract vital nutrient and energy substances from the environment. Hunger and satiety are psycho-physiological states that, respectively, elicit or inhibit food intake. Homeostatic (glucostatic or lipostatic) and non-homeostatic (environmental conditions) mechanisms contribute to the periodic initiation of food intake. Once a meal has started, the stimulation to eat is progressively antagonized by the cumulative effects of the ingested foods. This satiation process brings the eating episode to an end before the ingested nutrients have been absorbed. Meal size is determined by an interaction of sensory (food quality and variety), gastro-intestinal, and neuroendocrine responses. A Pavlovian learning mechanism allows the metabolic consequences of ingesting a particular food to become associated with the sensory characteristics of the food; as a consequence, a unique repertoire of food acceptance and rejection responses is shaped for each individual eater. Satiety, the post-meal phase of inhibition of eating, depends on the nutrient composition of the meal and, mainly, on its energy density. The selection of high energy-density foods induces little satiety and favours “passive over-consumption”. In humans, culture, socio-economical status, family context, and even the physical characteristics of the environment affect food choices and energy intake. The mechanisms selected by Evolution in order to allow survival under environmental conditions of food shortage seem more efficient at correcting for energy needs than excesses. In the present context of food plethora, the obesity epidemic reflects both a biological bias and the potent stimulation from the environment.