ESOTROPIE PRECOCE : RESULTATS DE PRISE EN CHARGE ET FACTEURS PRONOSTIQUES

BACKGROUND: Infantile esotropia is characterized by a significant deviation angle and a marked sensory perversion. Although the motor surgical results are satisfactory, the sensory results remain disappointing. AIM: Our work aims to describe the methods of surgical management, its motor and sensory results as well as its prognostic factors. METHODS: Retrospective study of 68 cases of infantile esotropia. All patients underwent a complete ophthalmologic examination and sensorimotor assessment. They were operated on, under general anesthesia, by the same surgeon. We assessed the motor and sensory results. The prognostic factors studied were age of onset, treatment delay, amblyopia severity, strabismus deviation angle, and presence of a vertical element. RESULTS: The mean minimum angle of deflection was 38.6 ± 13.2D. Inferior oblique muscle hyper action was noted in 73.5% and a dissociated vertical deviation in 5.8%. Bilateral medial rectus muscle recession was the most performed surgery (60.2% of cases). The overall success rate was 94.11%. No patient acquired stereoscopic vision. Multivariate logistic regression analysis showed that preoperative nail (p = 0.007), immediate postoperative outcome (p <0.001) and surgical dosage (p = 0.009) were associated with long-term motor success. CONCLUSION: The motor results of early esotropia surgery are generally satisfactory; the sensory results are often disappointing. Detecting poor prognostic factors improves operative results.     

CARD15/NOD2 in a Tunisian Population with Crohn’s Disease

Crohns disease (CD) is a heterogeneous disorder. A genetic linkage to chromosome 16 (IBD1) has been previously observed and replicated in unrelated populations. Recently, in this region, NOD2/CARD15 has been identified as a susceptibility gene. The aim of this report is to determine whether this gene is implicated in CD in a Tunisian population. One hundred thirty patients with CD and 90 healthy individuals were genotyped for the three common NOD2 variants (C2104T in exon 4, G2722C in exon 8, and 3020insC in exon 11). Furthermore, the 11 exons of the NOD2 gene were sequenced in 20 patients with CD. Results showed that the frequency of the CARD15 variants in the Tunisian population is significantly lower than that observed in the European and American population. Direct sequencing of CARD15 did not permit us to identify a characteristic mutation in our population. No association was confirmed between CD and the NOD2 gene in our Tunisian population. Furthermore, the NOD2/CARD15 gene has a variable association with CD in different populations. These results indicate the genetic variation of CD in different ethnic groups.     

Endoscopic treatment of residual lithiasis. 661 cases

AIM: Endoscopic sphincterotomy is a well-established procedure for treating choledocolithiasis and particularly residual lithiasis. The aim of this study is to expose our experience with this method and to evaluate his safety and efficacy. METHODOLOGY: It is a retrospectively collected series of 661 patients with residual choledocolithiasis. RESULTS: Endoscopic retrograde cholangio-pancreatographies were performed in 651 patients (98.5%). Standard sphincterotomy was realized in 633 patients (95%) and a pre-cut technique was done in 15 (2%). Bile duct clearance was achieved in 583 cases (91%). Overall, the complication rate of sphincterotomy was about 8.4%. CONCLUSION: Endoscopic sphincterotomy is a safe and effective procedure for patients with residual choledocolithiasis.     

Manifestations of rifampicin-induced hypersensitivity

The side effects of rifampicine due to an immunoallergic mechanism are rare and usually observed during discontinued treatment or administration of high doses.     

Effect of E670G Polymorphism in PCSK9 Gene on the Risk and Severity of Coronary Heart Disease and Ischemic Stroke in a Tunisian Cohort

The association of E670G (rs505151) polymorphism in PCSK9 gene with an increased risk of coronary artery disease (CAD) and ischemic stroke (IS) was reported in previous studies. We investigated the effect of the E670G (rs505151) on the risk of CAD and IS in a Tunisian cohort. Genotyping of the PCSK9 E670G was performed using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) and then confirmed by direct sequencing. The frequency of the 670G allele was significantly higher in the CAD than in the no-CAD subgroup (0.132 vs. 0.068, p?=?0.030). As expected, the incidence of E670G was significantly important in IS subgroup than control group (0.122 vs. 0.073, p?=?0.032). Furthermore in CAD patients, the 670G carriers showed significantly increased plasma total cholesterol and LDL-cholesterol levels compared to E670 carriers (6.78 [6.47–7.00] vs. 4.92 [4.02–5.46] mmol/l, p?<?0.0001 and 4.60 [4.00–5.04] vs. 3.00 [2.22–3.70] mmol/l p?=?0.001, respectively). The risk and severity of CAD were significantly increased in 670G carriers between no-CAD subgroup and CAD patients presenting a stenosis ≥50 % in two or three major coronary arteries (0.068 vs. 0.198, p?=?0.001, OR?=?3.39 [1.55–7.37]). The E670G polymorphism of the PCSK9 gene is mainly associated with a increased risk and severity of CAD and IS in Tunisian cohort.