Medical studies in Tunisia

In this report, the author analyses the Tunisian medical studies following their main stages of evolution, since the creation of the first medical university (1963), and focus on the major reforms. A great interest was designed to evaluate the comity findings reforms, held during the 1990, which has lead to undertake many measures for the medical studies. The author expose the measures applied, since 1990 in his report.     

Cocaine activates platelets and increases the formation of circulating platelet containing microaggregates in humans

OBJECTIVE—To determine whether there is evidence of platelet activation following in vivo cocaine administration in humans, as cocaine abuse is associated with myocardial infarction and stroke, and platelet activation leading to thrombosis is a possible mechanism.
SETTING—University hospital.
DESIGN AND SUBJECTS—Following a randomised, double blind crossover design, 14 healthy volunteers were studied twice, receiving cocaine (2 mg/kg intranasally) once and placebo once. Flow cytometric analysis of P-selectin expression (an α granule membrane protein found on the surface of activated platelets), quantification of the platelet specific proteins platelet factor 4 and β thromboglobulin, and measurement of platelet containing microaggregate and platelet microparticle (fragment) formation were used to assess platelet activation. Circulating von Willebrand factor antigen (vWF) was measured to evaluate a possible role of endothelial stimulation concurrent with platelet activation.
RESULTS—There was an increase in both platelet factor 4 (mean (SD), 16 (7) to 39 (22) IU/ml, p = 0.04) and β thromboglobulin (70 (20) to 98 (26) IU/ml, p < 0.01) at 120 minutes following cocaine administration. Platelet containing microaggregate formation was increased at 40 minutes (from 47 (3.2)% to 54 (2.0)%, p < 0.001) and 80 minutes (55 (2.5)%, p = 0.04). Bleeding time decreased following cocaine from 10 (1) to 9 (1) minutes (p = 0.07). No changes in any of the measured variables were noted following placebo administration.
CONCLUSIONS—Cocaine exposure causes platelet activation, α granule release, and platelet containing microaggregate formation. These data support the view that cocaine, even at the relatively low doses commonly self administered by occasional abusers, may promote thrombosis and predispose healthy individuals to ischaemic events. Platelet inhibitors should be considered early in any patient with suspected cocaine related ischaemia.


Keywords: platelets; cocaine; flow cytometry; myocardial infarction     

BEK and FLG, two receptors to members of the FGF family, are amplified in subsets of human breast cancers

Tumor DNA samples from 387 breast carcinomas have been investigated for amplification of BEK and FLG genes, both of which have been shown to code for cell surface receptors to FGFs. BEK and FLG were found amplified in 11.5 and 12.7% of breast tumors respectively. Statistical analysis, performed on the subset of 297 primary cancers without presurgical therapy, showed for BEK a trend of preferential amplification in patients above 50 years (P = 0.055), whereas amplification of FLG could significantly be correlated with nodal involvement (P = 0.032) and seemed prevalent in steroid hormones receptor positive tumors. Since the same tumors were previously analysed for the amplification of MYC, ERBB2 and HST/INT2/BCL1 possible associations with BEK and FLG amplifications were looked for. BEK was found significantly correlated with MYC and FLG with HST/INT2/BLC1. The amplification of these two FGF receptor genes may therefore represent additional steps in the molecular phenotyping of breast cancer.     

Dietetic approach to renal lithiasis]

Because of the diversity and importance of dietary factors in the pathogenesis of renal stones, a nutritional survey must be carried out in order to determine the quantity of protein, calcium, oxalate, sodium, sugar, vitamin D, vitamin C, ingested and the fluid intake and the quality of the drinking water. Although defects are observed in all parameters, it is essential to reduce the intake of protein, calcium, oxalate, sodium, vitamin D, vitamin C as well as increase the sucrose intake and recommend dietary therapy based on mineral water rich in bicarbonate.     

Comparative study between the anti-lithogenic action of zinc and copper against oxalic lithiasis in the rat]

Intraperitoneal injection of sodium oxalate, at the dose of 8 mg/100 g of body weight, induced into rats oxalate and calcium deposits in renal tissue, compared to animals which received distilled water (respectively P less than 0.05; P less than 0.05). However, when a zinc solution was administered previously, at the dose of 24 micrograms/100 g of body weight, oxalate and calcium accumulation was found to be significantly lower than in the group treated exclusively with sodium oxalate. Similar results were found when the metal used was copper, but oxalate accumulation was found to be significantly higher in this group than in the group treated with zinc (P less than 0.01). Compared to reference animals, which received distilled water, oxalate accumulation was found to be significantly decreased in the groups treated with both zinc (P less than 0.001) and copper (P less than 0.01), whereas calcium accumulation was found to be similar. Microscopic examination showed calcium crystals only in the group treated with sodium oxalate, preferentially localized in the renal papilla. These results suggest that zinc and copper, when administered at the dose of 24 mu/100 g of body weight, completely protect against experimental lithiasis induced by oxalic acid. However, the inhibitory effect of zinc was more pronounced than that of copper, especially against oxalate accumulation.     

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population

AIMS: Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. METHODS: We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. RESULTS: ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. CONCLUSIONS: Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).     

Serological study in Tunisian cervical cancer patients

Objective

The aim of this study is to use a novel ELISA, based on five recombinant HPV-16 and HPV-18 proteins, for detection HPV-specific antibodies in a case-control study.

Patients and methods

L1, E6 and E7 genes have been over expressed in Escherichia coli as double fused proteins. These recombinant proteins were used in a GST-capture ELISA as coating antigens. Human sera were collected from women with cervical cancer. Negative human sera were collected from patients apparently healthy and may be affected by other infectious agents.

Results

Most of the sera showed a positive reactivity to at least one of the HPV-16 or HPV-18 proteins (52/71). A percentage of 39.50% of the sera from HPV-16 infected women and 21.12% of the sera from women infected by HPV-18 genotype recognised at least one of the HPV-16 or HPV-18 proteins. Sera showed different reactivity to L1, E6 and E7 antigens, and only a few serum samples reacted to L1, E6 and E7 HPV-16, E6 and E7 HPV-18 (co-infection). Differences of reactivity between cases and controls were significant (P < 0.0001).

Conclusion

This novel ELISA, based on recombinant HPV-16 and HPV-18 antigens, is able to detect antibodies in women infected by HPV genotypes. The assay is easy to perform and has low cost, making it suitable for monitoring the natural history of HPV infections as well as for detecting pre-existing HPV antibodies in women who receive vaccination.