Epidemiologic profile of Haemophilus influenzae infection in Tunisia

Haemophilus influenzae, a commensal bacteria, is frequently incriminated in broncho--pulmonary surinfections and severe diseases as meningitis, pneumonia and septic arthritis, particularly in young children. A multicenter study was conducted to establish the epidemiological profile of Haemophilus influenzae diseases, to determine the rate of antibiotics resistance for guide therapeutic and preventive strategies. The identification was based on the requirements for X and V factors, and the serotype b determined by agglutination. The betalactamase production was done by nitrocefin test. Antimicrobial susceptibility testing was determined on Muller Hinton chocolate agar with isovitalex. During the two year period, (January 1998 December 1999), 192 isolates of H. Influenzae were collected, 61% were recovered from invasive infections (44 meningitis, 8 bacteremia, 2 arthritis). The serotype b was identified in 55.7% of cases, 67.3% were invasive strains. 24.5% of isolates were producing betalactamase particularly invasive serotype b strains. All isolates of H. influenzae were susceptible to cefotaxim and to ofloxacin. Resistance rates to other antibiotics were: erythromycin 56.2%, tetracyclin 10.3%, rifampin 12%, chloramphénicol 1%, cotrimoxazole 16.5%, 11.5% amikacin and 20% gentamicin. The incidence of meningitis remained frequent in our country, involving the introduction of the vaccination in official calendar. Nevertheless, the surveillance of H. influenzae invasives infections and the serotyping of isolates were necessary to evaluate the impact of the immunization.     

Molecular events associated with arsenic-induced malignant transformation of human prostatic epithelial cells: aberrant genomic DNA methylation and K-ras oncogene activation

Numerous studies link arsenic exposure to human cancers in a variety of tissues, including the prostate. Our prior work showed that chronic arsenic exposure of the non-tumorigenic, human prostate epithelial cell line, RWPE-1, to low levels of (5 microM) sodium arsenite for 29 weeks resulted in malignant transformation and produced the tumorigenic CAsE-PE cell line. The present work focuses on the molecular events occurring during this arsenic-induced malignant transformation. Genomic DNA methylation was significantly reduced in CAsE-PE cells. A time course experiment showed that during malignant transformation DNA methyltransferase activity was markedly reduced by arsenic. However, DNA methyltransferase mRNA levels were not affected by arsenic exposure. Microarray screening showed that K-ras was highly overexpressed in CAsE-PE cells, a result further confirmed by Northern blot and Western blot analyses. Since ras activation is thought to be a critical event in prostate cancer progression, further detailed study was performed. Time course experiments also showed that increased K-ras expression preceded malignant transformation. Mutational analysis of codons 12, 13, and 61 indicated the absence of K-ras mutations. The K-ras gene can be activated by hypomethylation, but our study showed that CpG methylation in K-ras promoter region was not altered by arsenic exposure. Arsenic metabolism studies showed RWPE-1, CAsE-PE, and primary human prostate cells all had a very poor capacity for arsenic methylation. Thus, inorganic arsenic-induced transformation in human cells is associated with genomic DNA hypomethylation and K-ras overexpression. However, overexpression of K-ras occurred without mutations and through a mechanism other than promoter region hypomethylation.     

Alpha interferon in children with Philadelphia chromosome-positive chronic myeloid-leukaemia

The present work focuses on the therapeutic efficacy and the toxicity of alpha interferon in patients younger than age 18 years. 5 patients younger than 18 years were treated and followed up between 1990 and 1999 at the department of haematology (Aziza Othmana Hospital) Hydroxyurea was given as initial treatment to all patients. After a median period of 8 months, these patients received alpha interferon (5 millions units/m2 once). Six months after the beginning of the alpha interferon a complete hematologic response was obtained in all patients. The median overall survival was of 66 months: 3 patients are still alive (2 patients in an advanced stage and one patient in chronic phase) and 2 patients died after transformation. The most common reported side effects of alpha interferon were asthenia, weight loss, fever, myalgia, chills and headaches--these toxic manifestations were mild and were noticed in all our patients. Myelosuppression was noted in two patients. Interferon is well tolerated in patients younger than age years 18 old, with CML. It may offer an alternative to bone marrow transplantation in children in the chronic phase of CML without histocompatible donor. The role of new agents such as STI 571 needs to be evaluated as well.     

Association of systemic lupus erythematosus and dermatopolymyositis

Systemic lupus erythematosus (SLE) associated with dermatopolymyositis (DM). This association is rare. Diagnosis may be difficult because of their common clinical findings. We report here a case. A 22-year-old man was admitted for arthritis with fever, diffuse myalgia and periorbital skin heliotrope rash. Electromyogram and muscular biopsy were suggestive of DM. The patient was treated with oral prednisone. Two months and a half later, he was admitted for impure nephrotic syndrome in relation with diffuse proliferative glomerulonephritis. Antibodies against native double-stranded- DNA were positive, and normal skin biopsy showed immune complex deposit on dermo-epidermic junction, suggestive of SLE. The patient was treated with high doses of prednisone and 6 monthly intravenous pulses of cyclophosphamide. Skin lesions and nephrotic syndrome improved. Presently, the patient remains asymptomatic. While being of different pathogenesis, SLE and DM may coexist in the same patient.     

Embolization of head and neck hypervascular lesions. A retrospective study of 5 cases

Embolisation of head and neck hypervascular tumours and arterioveinous malformations (AVMs) is now a well-established therapeutic procedure. The purpose of this study was to analyse the technique and to evaluate the safety and value of preoperative embolization of hypervascular lesions. We retrospectively reviewed the records of 5 patients, agged between 14 and 47 years, with hypervascular tumours and AVMs in the head and neck. Lesions were distributed as follow: nasal angiofibroma (n = I), nasal angioleiomyoma (n = I), nasopharyngeal angiofibroma (n = I), aneurysmal bone cyst in the posterior element of the second cervical vertebra (n = I) and AVM of the inferior lip (n = I). Angiography and embolization were carried out at the same time. Complete exclusion of lesions was obtained without any complications. Complementary surgical resection was performed with not notable blood loss.     

Pathomimia in upper limb

Pathomimia, or factitious disorders, are characterized by producing symptoms voluntarily with the intention of playing the role of the patient. Inspite of being considerd as a psychatric disorder, pathomimuia is often encountered in the daily professional life of doctors without being recognized or diagnosed. There are various clinical aspects of pathomimia. The items that decide the orientation of the diagnosis are essentially the uncommon and odd expression of the reported symptoms, A capricious evolution as well as the multiplicity of the past medical cases. We report a group of five patients who were followed and treated between the years 2000 and 2003. This group was composed of three men and two women with an average age of 30 years. In three cases, we found the notion of skin injury. In one case, we noted a median nerve lesion in the elbow and once in the right upper member. The evolution was performed towards recidives of the initial symptomatology with more or less long periods of improvements.     

Cryoglobulinemia in chronic hepatitis C virus infection. About 76 cases

Cryolobulines are immunoglobulins that persist in the serum, precipitate with cold temperature and resolubilize when rewarmed. There are 3 types of cryoglobulinemia. Type II and III define mixed cryoglobulinemia. 40% approximately of patients with chronic hepatitis C virus (HCV) infection had cryoglobulinemia. OBJECTIVE: To evaluate the frequency of cryoglobulinemia in a chronic hepatitis virus (CHV) infection group and determine the characteristics of positive cryoglobulinemia patients. RESULTS: 76 patients were included. There were 53 women an 23 men. The mean age was 59.45 years. Mixed cryoglobulinemia was detected in 65 patients (85.5 %). Cirrhosis, old age and the long duration of CHV infection were the 3 factors associated with cryoglobulinemia positivity. CONCLUSION: Mixed cryoglobulinemia is a frequent manifestation during chronic hepatitis C infection virsus especially in patients with cirrhosis.     

Acute pancreatitis revealing Behçet disease

We report here a case of acute pancreatitis revealing Behcet's disease in an 18-year-old woman. Pancreatitis was due to ischemia secondary to severe abnormalities of the celiac trunk arteries with pseudo-aneurysms. The outcome was favourable after the administration of corticosteroids and cyclophosphamide. The patient did not experience relapse of pancreatitis 2 years after diagnosis.