Oxidative stress in patients with asthma and its relation to uncontrolled asthma

This study aims to evaluate markers of oxidative stress in Tunisian asthmatic patients and investigate whether their markers are correlated with uncontrolled asthma.This prospective cohort study was conducted on 48 healthy subjects and 60 patients with asthma (34 patients with controlled asthma and 26 patients with uncontrolled asthma). The levels of malondialdehyde (MDA), advanced oxidation protein products (AOPP), and glutathione (GSH), as well as the activities of glutathione peroxidase (GPx) and superoxide dismutase (SOD), were estimated in plasma by spectrophotometry.Asthmatic patients have significantly higher plasmatic levels of MDA and AOPP than healthy controls (p < 0.001). Lower GSH level and GPx activity were found in patients with asthma compared to controls (p < 0.001). In contrast, higher SOD activity was noted in asthmatic patients (p < 0.001).The comparison among the patients with controlled asthma and uncontrolled asthma revealed increased MDA and AOPP levels and SOD activity (p < 0.001) as well as a decreased GSH level and GPx activity (p = 0.004, p = 0.019) in patients with uncontrolled asthma. Spirometry level was significantly correlated with SOD activity (r = 0.447; p = 0.010), whereas no significant correlations were found with the other parameters (MDA, AOPP, GSH, and GPx).Asthmatic patients, especially those with uncontrolled asthma, suffer a high degree of reactive oxygen species (ROS) formation causing considerable oxidative stress. Increased MDA level and SOD activity and reduced GPx activity were predictors of poorly controlled asthma.     

Une cause inhabituelle d’hypertension artérielle

Secondary hypertension is relatively rare. Its etiologies are essentially renal or endocrine. The adrenocortical carcinoma, a rare malignant tumor, is one of the most exceptional causes of hypertension. We report the case of a young woman presenting with hypertension and ascites of great abundance. She had hypokalemia, hepatic cytolysis and cholestasis. Thoracic, abdominal and pelvic CT scans showed adrenal mass, liver and lung nodules, osteolytic lesions of the sacrum. The biopsy of liver nodules confirmed the diagnosis of a metastatic malignant adrenocortical carcinoma. The hormonal investigations revealed cortisol and testosterone hypersecretion. The evolution was quickly fatal, the patient passed out a few days after her hospitalization.     

Echocardiography Detects Elevated Left Ventricular Filling Pressures in Heart Transplant Recipients

Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E′ lateral) parameters, and the Doppler‐estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E′ lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography.     

Primary hyperoxaluria in children in central Tunisia

AIM: The goal of this work is to analyze clinical and therapeutics particularities of primary hyperoxaluria in children in Tunisian centre. METHODS: We studied retrospectively 15 cases of primary hyperoxaluria enrolled during 9 years period (1994-2002). RESULTS: It is about 2 boys and 13 girls (sex - ratio = 4.5) aged 2 month to 13 years (mean age: 4 years). Six patients presented the infantile form and nine the juvenile form of HP. At the moment of diagnosis, renal function was normal in one patient, moderately altered in another and severely altered in the other patients. All patients had nephrocalcinosis and 6 among them radio-opaque renal calculi associated. Diagnosis of HP was established in 11 cases by hyperoxaluria and/or important hyperoxalemia or on the data of the renal biopsy and biochemical analysis of renal calculi in 4 cases. The so-called "maghrebin" mutation (Ile244Thr) sought-after in 9 children, has cannot be identified that in 2 among them. Eight patients died of the continuations of their illness. The seven other patients again in life present a terminal renal insufficiency treated by haemodialysis. No patient could benefit from organ transplantation. CONCLUSION: Primary hyperoxaluria is a very heterogeneous disease on the plan clinic that genetic. In Tunisia where it constitutes a frequent cause of end stage renal failure, prenatal diagnosis of this disease is of a big interest.     

Comparison of Peri‐Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non‐Smokers: 5‐Year Follow‐Up Results

Background: The aim of this study is to compare peri‐implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non‐smokers. Methods: Thirty‐one patients with IL implants (16 smokers and 15 non‐smokers) and 30 patients with DL implants (17 smokers and 13 non‐smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri‐implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05). Results: All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non‐smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non‐smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non‐smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants. Conclusions: Tobacco smoking enhances peri‐implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri‐implant hard and soft tissue status in healthy smokers and non‐smokers.