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The effect of the molecular structure of three dyes such as methyl orange (MO), indigo carmine (IC) and phenol red (PR) on the surface of Tunisian HDPy+-modified clay has been studied. Batch sorption experiments were carried to evaluate the influence of pH, contact time, initial dye concentration, and temperature. All studies showed a difference in the adsorption capacity suggesting that the retention of dyes was influenced by structure and functional groups of dyes. The pH results suggested that the adsorption of MO dye on HDPy+-clay was pH-independent and the IC and PR adsorption capacity decreased slightly along with the increasing solution pH of 6.0. These results provided that dye adsorption onto modified clay should be mainly controlled only by hydrophobic interaction mechanism for MO dye, along with a considerable contribution of the anionic exchange mechanism for IC and PR dyes. The adsorption onto HDPy+-clay attained equilibrium quickly within 30 min for IC, PR and 60 min for MO. Four adsorption kinetics equations (pseudo-first-order, pseudo-second-order, intraparticle diffusion and Elovich) were employed to evaluate experimental kinetics data. The adsorption kinetic followed the pseudo-second order kinetic model. The monolayer adsorption capacity of the adsorbent, predicted by the Langmuir model, was 227.27, 326.40, and 344.82 mg/g for MO, IC, and RP, respectively. The adsorption isotherms suggeted that HDPy+-clay could be employed as low-cost material for the removal of dyes from wastewater. Thermodynamic parameters indicated the feasibility and spontaneity of the adsorption process. Its process was exothermic in nature for MO dye and endothermic in nature for IC and PR dye.

Colored clays are prepared by a solid state reaction of dried leaves of flowers with a Tunisian clay used for pharmaceutical and cosmetic applications. The structural properties, photo- and thermal stability of the resulting samples were characterized by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, Differential scanning calorimetry analysis (DSC) and UV–visible spectroscopy. The mineralogical structure, physicochemical properties and pharmacopoeial tests of the purified clay suggested that this clay mineral can function in cosmetic products. The XRD results of colored clays revealed a slight difference in values of basal spacing d001 when compared to values obtained from purified clay. FTIR analysis confirmed changes in functional groups and surface properties of purified clay. DSC results proved a high thermal stability for purified and modified clays. UV–visible spectra of colored materials displayed a new band compared to purified clay in 400–700 nm wavelength region. The microbiological tests revealed the suitability of all clays for the cosmetic products.

Objectif Evaluer la frequence des maladies auto-immunes chez les diabetiques type 1. Patients et methode Il s’agit d’une etude retrospective incluant 100 malades diabetiques type 1 hospitalises au service A a l’Institut national de nutrition de Tunis. Resultats L’âge moyen de nos patients etait de 28 ± 19 ans avec un sex-ratio H/F = 0,7. La duree moyenne d’evolution du diabete etait de 10 ± 8 ans. La frequence des maladies auto-immunes etait 22 % avec une incidence plus elevee chez les femmes : 82 % contre 18 % hommes. L’hypothyroidie etait en tete de liste avec une frequence de 16 %. La frequence de la maladie cœliaque etait 6 %. La frequence de l’hyperthyroidie etait 3 %. La frequence de la maladie d’Addison etait 1 %. Les associations suivantes ont ete notees : – hypothyroidie et maladie cœliaque avec une frequence de 2 %, – hyperthyroidie et maladie cœliaque avec une frequence de 1 %, – hypothyroidie et maladie d’Addison avec une frequence de 1 %. Le diabete type 1 a precede la dysthyroidie dans 95 % et les autres maladies auto-immunes sus-citees dans 100 % des cas. Conclusion Vu la frequence des maladies auto-immunes chez le diabetique type 1, le praticien est incite a les depister au minimum, des la decouverte du diabete et devant des signes evocateurs.

Objectif L’association diabete-HTA est frequente, elle augmente le risque cardio-vasculaire. Le but de ce travail est de decrire les habitudes de prescription des anti-hypertenseurs chez les patients diabetiques et evaluer leur efficacite. Materiels et methodes Etude retrospective descriptive portant sur 100 patients diabetiques type 2 et hypertendus. Resultats L’âge moyen des patients etait de 63,14 ± 10,5 ans avec un sexe-ratio H/F de 0,4. La duree moyenne d’evolution du diabete etait de13,73 ± 6,8 ans. Le BMI moyen etait de 30,52 kg/m2, 22,5 %sont tabagiques. L’HbA1c moyenne etait de 11,16 % et la clairance moyenne de la creatinine est de 84,73 ml/min. Pour le traitement de l’HTA:42. 5 % sont sous monotherapie, 36,25 % bitherapie, 20 % tritherapie et 1,25 % quadritherapie. Les Inhibiteurs de l’enzyme-de-conversion(IEC) sont prescrits en premiere ligne (71,25 %), suivis des inhibiteurs calciques(IC)(35 %), Antagonistes-des-recepteurs-de-l’angiotensine2(ARAII) (23,75 %) et des diuretiques (22,5 %). La bitherapie la plus frequente est IEC-IC (55,17 %) suivi des IEC-beta-bloquants(24,13 %). La tritherapie la plus frequente est l’association ARAII-beta bloquant-diuretiques dans 31. 25 % et IEC-IC-Betabloquants 25 % des cas. La quadritherapie a consistee en l’association d’un IC-ARAII-beta bloquants-diuretique. Soixanete cinq pour cent de nos patients ont un controle optimal de la pression arterielle [1] . Discussion Les anti-hypertenseurs prescrits a nos patients sont conformes aux dernieres recommandations. Le choix du traitement anti-HTA chez les diabetiques doit tenir compte de la presence des comorbidites et du cout. Ce dernier critere est fondamental dans le traitement de l’hypertension arterielle dans les pays a faibles ressources financieres.

The aim of this study is to assess the suitability of purified Tunisian clay for its possible pharmaceutical and cosmetic uses. Mineralogical, chemical and physicochemical characterization was performed with the aid of tools like X-ray diffraction (XRD), Chemical composition, DTA/TGA analysis, Cation exchange capacity (CEC), particle size distribution by laser dispersion (PSD), surface area (BET method), Point of zero charge (PZC) and surface charge density σ H . Pharmacopoeia tests were also carried: Swelling capacity, sedimentation volume and pH measurement. For microbiological tests, the absence of Salmonella species, Escherichia coli , Staphylococcus aureus and Pseudomonas aeruginosa was tested. The X-ray diffraction data revealed that the Tunisian sample is an interstratified illite-smectite. The percentage of smectitic fraction is estimated to be 78%. The chemical, textural and porosimetric results show important values suggesting that this mineral clay can function in creams, powders and emulsions. In view of the fundamentals of major pharmacopoeias for use of bentonite in pharmacy and considering the swelling capacity and sedimentation volume values, and microbiological results we could designate a pharmaceutical acceptable denomination for Tunisian purified clay.

El cancer de mama inflamatorio representa una entidad agresiva de cancer de mama, clasificada como T4d, relativamente frecuente en Tunez y en el norte de Africa (5-7%) y mas rara en Europa y Estados Unidos (1-2%). El diagnostico clinico se basa en la presencia de signos inflamatorios cutaneos: dolor, edema, piel de naranja y/o eritema. El diagnostico positivo es histologico y se efectua despues de la biopsia de la afeccion cutanea y/o del tumor mamario subyacente. La histologia, la inmunohistoquimica y la genomica muestran una frecuencia mas elevada de cancer triple negativo o que sobreexpresa HER2. El estudio de extension locorregional y a distancia se basa en la exploracion fisica, la mamografia y la ecografia mamaria bilateral, la resonancia magnetica mamaria, la tomografia computarizada de cuerpo entero y la tomografia por emision de positrones con fluorodesoxiglucosa. El proceso diagnostico y terapeutico es multidisciplinario y se basa en la quimioterapia neoadyuvante, asociada a la terapia dirigida anti-HER2 en caso de sobreexpresion del oncogen HER2, seguida de una cirugia radical oncologica y, despues, una radioterapia locorregional. Por otra parte, el tratamiento comporta la continuacion de la terapia dirigida anti-HER2 con una duracion total de 1 ano y el inicio de un tratamiento hormonal si los receptores hormonales son positivos. La aportacion de la quimioterapia neoadyuvante secuencial con antraciclinas y taxanos asi como las terapias dirigidas anti-HER2 han mejorado considerablemente el porcentaje de control locorregional, asi como la supervivencia global y sin enfermedad del cancer de mama inflamatorio, actualmente superior al 40% a los 5 anos.

Resume Objectif de l’etude Identifier retrospectivement les eventuels facteurs pronostiques des sarcomes mammaires primitifs et faire le point sur ses modalites therapeutiques. Materiel et methodes Il s’agit d’une etude descriptive de 30 cas de sarcome mammaire primitif. Nous avons recherche par une analyse unifactorielle et multifactorielle des correlations entre les parametres cliniques, pathologiques et therapeutiques et la survie sans recidive et a la survie globale. Resultats L’âge moyen etait de 46,8 ans. La taille tumorale moyenne etait de 10 cm. Les 30 cas etaient repartis en 18 sarcomes phyllodes, huit angiosarcomes, trois liposarcomes et un sarcome granulocytaire. Seize patientes ont recu une radiotherapie adjuvante et sept une chimiotherapie adjuvante. Le suivi moyen etait de 64 mois. Les probabilites de survie globale a 3 et 5 ans etaient de 49 % et 34 %, celles de survie sans recidive de 23 % et 15 %. L’etude analytique des parametres, taille tumorale et developpement ou non de metastases ganglionnaire ou a distance, ne montrait de correlation ni avec la survie globale, ni avec la survie sans recidive. La radiotherapie adjuvante n’a influence ni la survie sans recidive (p = 0,61 ; HR [hazard ratio] = 0,942 [0,862–1,029]), ni la survie globale (p = 0,298 ; HR = 1 [0,982–1,04]). En analyse unifactorielle, les facteurs pronostiques de la survie globale etaient les marges d’exerese de plus de 1 cm (p = 0,005 ; HR = 3,4 [1,217–9,919]) et la necrose tumorale (p = 0,028 ; HR = 0,099 [0,014–0,682]). Aucun facteur pronostique independant de la survie globale n’a ete retenu en analyse multifactorielle. Conclusion Il ressort de cette etude que le pronostic des sarcomes mammaires primitifs dependrait essentiellement d’une exerese chirurgicale satisfaisante (marges de plus de 1 cm). Le seul parametre histologique qui pourrait etre correle avec le pronostic est la presence de necrose tumorale. Le sous-type histologique n’aurait pas d’influence sur le pronostic.

The role of IGF-1 in promoting cancer has been investigated for many years. The aim of this study is to explore the relationship between rates of IGF-1 and NPC and to evaluate association of IGF-1 with clinical parameters.IGF-1 levels was measured by Elisa test among 82 NPC patients and 60 healthy controlsOur results showed, for the first time, a significant increased levels of IGF-I in NPC by in comparison with healthy controls (p0.01). According to the age, sex and tumor size of NPC patients, we demonstrated that IGF-1 concentrations are significantly higher in NPC aged over 30 years compared to patients aged less than 30 years (p0.01). The IGF-1 levels are, also, higher among women compared to men (p0.01). The concentrations of IGF-1 were positively correlated with tumor size of NPC patients (p0.01).IGF-I could be a good nasopharyngeal cancer diagnostic marker.

L’insulinotherapie fonctionnelle (IF) est une methode therapeutique anticipatrice qui vise a se rapprocher le plus possible de l’insulinosecretion physiologique. Plusieurs etudes ont montre ses benefices sur l’equilibre glycemique et sur le risque des complications aigues. Notre objectif etait d’evaluer l’impact de l’IF sur le risque de survenue des hypoglycemies et des cetoses diabetiques dans un groupe de diabetiques de type 1. Etude retrospective, longitudinale menee aupres de 30 patients diabetiques type 1 ayant beneficie d’une insulinotherapie fonctionnelle, au service « A » de diabetologie et de maladies nutritionnelles. L’interrogatoire nous a permis de recenser les episodes des hypoglycemies et de decompensations cetosiques un an avant l’application de l’IF et trois mois apres. L’âge moyen etait de 21,83 ± 7,95 ans. Plus du tiers de la population (37 %) etaient des adolescents. L’anciennete moyenne du diabete etait de 7,23 ± 6,02 ans. Le pourcentage de patients ayant eu moins d’un episode d’hypoglycemies mineures par mois est passe de 13 % avant IF a 50 % apres (p = 0,001). Le tiers des patients (33 %) a eu des hypoglycemies severes dans l’annee qui a precede l’hospitalisation contre seulement 7 % apres (p = 0,21) et 50 % ont rapporte des hypoglycemies nocturnes avant IF versus 20 % apres (p = 0,12). La moitie des patients ont presente des decompensations cetosiques avant application de l’IF contre 10 % apres (p = 0,002). Dans notre etude, l’application de l’IF etait associee a une reduction du risque des complications aigues du diabete.

Intercalation of cationic surfactants hexadecylpyridinium (HDPy + ) and hexadecyltrimethylammonium (HDTMA + ) into the interlayer space of homoionic (Na + -, Ca ++ - and Zn ++ -) illites/smectites using three methods (solution intercalation, solid–solid reaction and microwave irradiation) was investigated in this study. The changes in the surfaces and structures of the organo-illites/smectites with cationic surfactant were characterized using X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The results showed that the intercalation of surfactant cations was complete within 24 h, 15 min and 2 min by conventional method, solid–solid reaction and microwaves irradiation, respectively. HDPy + t and HDTMA + surfactants were retained by Zn ++ -illites/smectites suggesting important surface properties (CEC = 80 meq/100 g clay, S BET = 116.5 m 2 /g) and developed acid–base properties (point of zero proton charge PZC, density charge σ H ). HDPy + cation loading was effective suggesting that the aromatic polar group is favored for intercalation. Different configurations of surfactants within interlayer space of clay mineral were proposed based on the basal spacings which increased with surfactant loading. The presence of symmetrical and asymmetrical vibration bands of the –CH 2 group in the IR spectrum of the modified illites/smectites and the variation of their frequencies and their intensities confirmed the results obtained by XRD.

Resume Introduction Le depistage du cancer du sein a permis la decouverte de plus en plus frequente de cancers de petite taille. Ces tumeurs ont un potentiel metastatique ganglionnaire faible d’ou l’introduction de la technique du ganglion sentinelle (GS) pour connaitre l’atteinte ganglionnaire axillaire. Objectifs Rapporter les resultats preliminaires de la technique du GS dans le cancer du sein a l’institut Salah-Azaiz. Materiels et methodes Il s’agit d’une etude prospective entre janvier 2004 et decembre 2005 au cours de laquelle 115 patientes ont ete incluses, porteuses d’un cancer du sein de moins de 3 cm justiciable d’un traitement conservateur sans antecedents de chirurgie mammaire. Toutes ces femmes onteu une recherche de GS par une methode colorimetrique, et 30 % ont eu une methode combinee. Resultats Le taux de detection etait de 97,3 % ( n = 112). Un examen extemporane a ete realise chez 91 patientes. Le taux de faux-negatifs (FN) de l’examen extemporane etait de 4,3 % et la sensibilite de 95,7 %. Aucun faux-positif n’a ete trouve a l’examen extemporane. Le GGS etait le seul ganglion envahi du creux axillaire chez 15 patientes (44 %). Chez trois patientes, le GGS etait sain alors que le reste du curage comportait des ganglions atteints, soitun taux de FN de 2,6 %. Conclusion La technique du GS est une technique fiable et faisable. Elle necessite cependant un apprentissage du chirurgien, de l’anatomopathologiste et du medecin nucleaire. Elle permet de reduire la morbidite du traitement du cancer du sein en evitant des curages « inutiles » chez des patientes sans envahissement ganglionnaire. L’augmentation du nombre des petits cancers decouverts au cours du depistage permet d’augmenter le nombre de patientes qui peuvent beneficier de cette technique.

A 75-year-old Caucasian lady known case of Hodgkin’s lymphoma presented to A&E Department complaining of acute onset right sided pleuritic chest pain, sweating, dyspnoea and shivering four hours following discharge from hospital after an elective PCI for coronary artery stenosis. The patient denied night sweats, recent weight loss or anorexia. On examination, the patient was found to have a blood pressure of 112/55 mmHg, heart rate of 70 bpm, respiratory rate of 15/min and temperature of 37.5 8C. Heart sounds were slightly muffled and chest auscultation revealed right basal fibrotic crackles. JVP was noted to be raised with a steep Y descent wave form (positive Friedreich’s sign) which increased on inspiration (positive Kussmaul’s sign) and pulsus paradoxus was noted on measurement of the blood pressure on inspiration (drop of >10 mmHg systolic BP on inspiration). This shows that clinically there were signs of impaired diastolic filling of the right ventricle, i.e. a degree of cardiac tamponade. This implies that the accumulation of pericardial fluid had a rapid acute onset (if it were a long-standing pericardial effusion which had accumulated slowly accommodation would not cause any significant haemodynamic change). ECG showed diffuse, concave upwards (saddle-shaped) ST elevations (2 mm). CXR revealed an enlarged cardiac shadow and mild bilateral pleural effusions. A CT pulmonary angiography was done that excluded pulmonary embolism but revealed a concentric pericardial effusion of 17 mm and bilateral mild pleural effusions. Serological tests revealed a mild rise of troponin (0.07 ng/mL) and a CRP of 205 mg/l. The WBC was elevated at 14.6 g/dl. Serial troponin levels were not significantly elevated and the ST elevations remained concave upwards and diffuse in almost all leads.

PURPOSE To analyse the management and clinical outcome of patients treated for retroperitonal soft tissue sarcoma and to identify prognosis factors. PATIENTS AND METHODS This is a retrospective study of 20 adults ; 11 women and nine men treated between 1980 and 2000 in our institution. RESULTS There were seven liposarcomas and 13 leiomyosarcomas. The mean tumor size was 26 cm. Three patients underwent a complete resection (R0), 14 patients an incomplete resection (R1/R2) with microscopic or macroscopic tumour remained after surgery. Only three patients had a surgical biopsy. Median follow-up was 18 months. Overall survival rates was 45%, 10% at two and five years, respectively. Among the following factors, sex, age, symptom duration, tumor size, histologic type, histologic grade, resection type, mitotic index, necrosis extension, histologic differentiation, and AJCC stage, only mitotic index factor (scale 1,2 versus scale 3) significantly influenced patient survival (p = 0.02). CONCLUSIONS This study re-emphasizes the poor outcome of patients with retroperitoneal sarcoma. Survival rates appeared low when compared with other studies. These results incite for a more aggressive approach.

The fast of Ramadan is a dilemma for diabetic patients due to the complexity of the management of diabetes during this holy month and the multiple risks they face (hypoglycemia, etc.). Objectives Evaluate the impact of a structured protocol of therapeutic education in a sample of type 2 diabetes, who were authorized by their doctors to fast, on metabolic and anthropometric profiles. Methods This prospective study was conducted among 54 type 2 diabetic patients (28 men and 26 women) aged 36–65 years, recruited from National Nutrition Institute. Patients were divided into two groups: the first group ( n = 26) received an education session one to two weeks before the month of Ramadan; the second group ( n = 28) did not have appropriate therapeutic education except therapeutic adjustments. All our diabetic patients benefited from anthropometric measurements, determination of body composition and metabolic assessment (HbA1c, cholesterol, triglycerides, etc.) before and after the month of Ramadan. Results The fast was completed without complications in 25 diabetic patients educated group and 22 control patients. We found that weight loss was greater among educated diabetic patients (−1.05 kg) than in controls (−0.58 kg), but without statistical significance. Body composition has not undergone significant changes in both diabetic groups. Therapeutic education has led to a decline of 0.27% in HbA1c in the educated group while glycemic control in diabetic patients uneducated remained stable. Furthermore, we observed a better lipid profile in diabetic patients educated than those who did not have education. Conclusion Our results justify the interest of patient education centered on the month of Ramadan in all type 2 diabetic patients observing the fast of the holy month. This education should be continued during Ramadan in order to fulfill this religious rite safely.