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Objective: In order to investigate human leukocyte antigen (HLA) genes predisposing to primary Sjögren syndrome (pSS), we conducted an association study using HLA loci (A, B, and DRB1) and 9 polymorphic microsatellite markers spanning the HLA region in pSS patients as compared to healthy individuals. Subjects and Methods: Forty-four patients fitting the European criteria of pSS and 123 healthy controls were analyzed for their HLA class I and class II alleles. HLA class I typing was performed using a standard microlymphocytotoxicity method followed by PCR-SSP. HLA-DRB1 genotyping was performed using PCR-SSP. We studied the polymorphism of 9 microsatellite markers for both groups. Microsatellite genotyping was performed using the PCR fluorescent technique. Results: We observed a positive association between HLA-B15 and pSS in the Tunisian population (p = 0.004, OR 7.57). The comparison of the frequencies of DRB1 alleles in pSS patients and controls confirmed the association of the DRB1*03 allele with pSS (p = 0.02, OR 2.36). On the other hand, the association study of microsatellite markers showed that the a9 allele of D6S265 marker and the a20 of C1.2.C were found to be positively associated with pSS as compared to controls (p =0.0003, OR 10.29, and p =0.001, OR 4.79, respectively). Using the “Haplo.stats” software analysis, we found that the most associated region was located in the HLA class I region and limited by HLA-A and D6S265 loci (p = 0.00056). Conclusion: The results of this study support the hypothesis of the existence of a susceptibility gene for pSS located in the HLA class I and III regions.

Wireless sensor networks offer an interesting solution for problems related to farming resources optimization, decision making support, and land monitoring. They offer real-time information about the changes in the field and about the state of crops and make the harvest better through precision farming. In agricultural applications, the use of spatially distributed WSNs is expected to increase. Thereby, energy-efficiency techniques have been investigated and become much more important as the number of distributed sensor nodes increases. Wireless communication can lead in general to excessive demands of energy. Thus, a routing algorithm is proposed which combines localization and clustering to reduce the energy consumption of the network. A localization-based RSSI algorithm is proposed to determine the nodes position. After that, a fuzzy-based unequal clustering algorithm is developed to balance the energy consumption among all sensor nodes. A real implementation of energy aware routing algorithm is carried out on the wireless sensor node PanStamp NRG 2.0. This network structure can be easily integrated on IoT systems to monitor and control different environmental and agricultural applications.

Vitamin D (VD) cannot be considered as a true vitamin, but rather as a hormone, which exerts its action via a vitamin D receptor (VDR). Many genes have been shown to be involved in the evolution of diabetes in various populations, such as the vitamin D receptor gene. The aim of our study was to investigate if BsmI, TaqI, ApaI, FokI, and Tru9I, polymorphisms of VDR gene have an impact on MODY diabetes and its clinical aspects in a Tunisian population. A total of 95 patients and 153 controls were genotyped using PCR-RFLP. The comparison of the allelic and genotypic frequencies of the five polymorphisms between MODY subjects and control groups revealed the association of MODY diabetes with TaqI, Tru9I and BsmI polymorphisms and no significant differences were observed in the distributions for the ApaI and FokI polymorphisms. After stratification with biochemical and clinical parameters and TaqI, Tru9I and BsmI polymorphisms, we found an association between the three SNPs and different parameters such as age of diagnosis, therapy, hsCRP and HDL-C levels. Our results revealed that TaqI, Tru9I and BsmI polymorphisms may be more related to the progression of MODY diabetes. The possible role of vitamin D in the pathogenesis of MODY is far from being completely understood. Further knowledge on this issue may identify new candidate targets in the treatment and prevention of the disease. Our findings suggest that the TaqI, Tru9I and BsmI polymorphisms may be more related to the progression of MODY diabetes.

Introduction Le diabete de type 1 (DT1) de l’adolescent bouleverse la vie des parents. Patients et methodes Il s’agit d’une etude transversale, ayant inclus un des parents de 50 adolescents diabetiques de type 1 âges entre 12 et 18 ans. Pour chaque parent nous avons releve les donnees sociodemographiques et pour chaque patient nous avons releve les donnees en rapport avec l’histoire et l’equilibre de son diabete. La qualite de vie des parents a ete evaluee a l’aide du questionnaire PedsQL™ Family Impact Module valide en arabe. Resultats Le genre feminin du parent alterait la sante physique (p = 0,012). Et les parent vivant seuls avait un fonctionnement familial altere (p = 0,025). Une meilleure communication etait correlee avec le niveau d’etude de la mere (p = 0,035) ainsi qu’un meilleur fonctionnement familial avec le niveau scolaire du patient (p = 0,025). Le temps de travail du pere avait un impact positif sur les scores de l’inquietude, du fonctionnement familial, du fonctionnement cognitif et des relations familiales. Les hypoglycemies frequentes alteraient significativement la sante emotionnelle du parent (p = 0,036). L’auto surveillance reguliere de la glycemie etait significativement associee a un meilleur score de communication (p = 0,046). A l’analyse multivariee, seuls les hypoglycemies frequentes et le genre feminin du parent etaient associes a une alteration de la qualite de vie. Conclusions Le diabete ne se reduit pas a la condition clinico-biologique de l’adolescent. Il important d’inclure des programmes d’education therapeutique centres sur le patient et son entourage.

Pilot contamination is known to seriously limit the performance of massive MIMO systems due to degradation of channel estimation. Channel Zooming Algorithm (CZA) has been proposed as an efficient iterative algorithm to ensure the mitigation of the pilot contamination effect. This algorithm is able to zoom through iterations on the signal of the strongest user by taking advantage of the difference in space signatures and transmitted data sequences. CZA has been proved to be efficient for pilot contamination in the massive MIMO systems in the case of large number of antennas and long data packets. In this paper, we propose a novel version of CZA that utilizes the benefits of retransmitted packets combining. We consider a truncated Hybrid Automatic Repeat reQuest (HARQ), where the number of retransmissions is limited using Chase combining (CC). We evaluate the Packet Error Rate (PER) performance of the proposed approach for different order modulations as BPSK, QPSK, 16-QAM and 64-QAM. Simulation results show that very good performances can be achieved after very few transmission attempts with our HARQ scheme using CC and CZA, despite possible different contamination during each retransmission.

Introduction: Aging lung decrease in pulmonary functions is related to age. Lung volumes and capacities are reduced particularly the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC). Male sex, tobacco, high blood pressure and heart diseases can accelerate this decline in lung function as well. The aim of this study is to consider obesity as one of these factors and to highlight its impact in aging of the pulmonary parenchyma. Methods: Our study is retrospective and comparative. We included Male patients aged≥ 65 years who did not smoke for at least one year. Patients with respiratory disease were excluded. Our population was divided into two groups: G1: patients with a body mass index (BMI) Results: Twenty-two patients were included. G1 included 12 patients and G2 included 10 patients. Age and size were comparable: age(years) (G1: 74,7; G2: 73,7); size(m) (G1: 166,3; G2: 162,5). The average of BMI was 24.5 kg / m² in G1 and 32.7 kg / m² in G2. The average of FEV1 was higher in G1: FEV1(L) (G1 :2,29; G2: 2,02). The average of the FVC was higher in G1: FVC(L) (G1: 3,17; G2: 2,88) and the average of the inspiratory capacity was higher in G2(IC) (G1: 2,11; G2 :2,41). The average of lung age was significantly lower in G2 (G1 :85,64; G2 :137,3; p=0,001) Conclusion: Obesity is a factor that significantly accelerates the decline in respiratory function and the aging of the pulmonary parenchyma.

Water management offers an effective solution to satisfy the world’s growing demand for water. Precision irrigation (PI), as an advanced concept in agriculture, has great promise to improve the efficiency of water use, as well as maintain or increase crop yield. PI involves different cutting-edge technologies such as the Internet of Thing (IoT), wireless sensor networks (WSN), and cloud computing. In this chapter, we present an overview of the PI concept and architecture including the most common wireless technologies used. Then, as a proof of concept, a real-time IoT-based smart irrigation system is designed. A number of wireless sensor nodes are deployed to monitor both soil moisture and temperature. Sensed data are transmitted to the gateway through the Queuing Telemetry Transport (MQTT) communication protocol. A Web interface and mobile application are provided to users to control the level of water in the soil in real time. Users can take immediate action to open or close the pump through the mobile application.

Non-Orthogonal Multiple Access (NOMA) is an interesting candidate to tackle the massive access challenges in Beyond 5G (B5G) systems. However, arranging Machine Type Devices (MTDs) into NOMA clusters and allocating resources to these clusters is a non-trivial task. In this paper, we consider a Hybrid NOMA system where every NOMA cluster is allocated an orthogonal sub-carrier and propose a game theoretical framework based on a bi-level game in order to achieve joint channel selection and power allocation for MTDs. Indeed, the proposed approach is composed of a non-cooperative power control game underlying a cooperative Hedonic game that enables MTDs to self-organize into coalitions. Furthermore, we propose two low-complexity algorithms that enable us to obtain a Nash-Stable partition where MTDs decide autonomously the appropriate Resource Block (RB) and the transmit power to use in order to deliver their packets. Our simulation results show that the proposed bi-level game allows the devices to achieve a high successful packet transmission rate while consuming less energy.

Resume But Le but de l’etude etait d’evaluer les correlations entre la sensibilite a l’insuline et l’insulinosecretion avec les parametres anthropometriques et metaboliques chez les diabetiques de type 2. Materiels et methodes Nous avons mene une etude transversale chez des patients diabetiques de type 2 traites par des antidiabetiques oraux. L’evaluation de l’insulinoresistance et de l’insulinosecretion a ete basee sur le calcul des indices HOMA-IR et HOMA-s. Resultats L’âge moyen des 100 diabetiques recrutes etait de 56,4 ± 8,4 ans. Les moyennes de l’indice de masse corporelle (IMC) et du tour de taille (TT) etaient de 30,5 ± 5,7 kg/m2 et de 101,2 ± 11,9 cm, respectivement. Les indices HOMA-IR et HOMA β etaient de 3,5 ± 2,8 et 48,9 ± 45,5, respectivement. Nous avons trouve une correlation significativement positive entre l’indice HOMA-IR et le poids (r = 0,406, p Conclusion L’insulinoresistance etait tres liee a la surcharge ponderale, en particulier a la distribution androide des graisses d’ou la necessite d’une prise en charge adequate de cette obesite androide. Il serait egalement interessant d’evaluer les effets de la perte de poids sur les parametres de l’insulinoresistance.

Summary Objectives To reappraise the respective involvement of small- and large-fiber damage in carpal tunnel syndrome (CTS) and to determine the diagnostic sensitivity of autonomic tests compared to conventional nerve conduction study (NCS). Methods Thirty-two manual workers complaining of at least unilateral CTS were enrolled. They underwent clinical interview and completed the symptom severity scale of the Boston CTS Questionnaire (sssBCTQ) and the Neuropathic Pain Symptom Inventory (NPSI). In addition, transcarpal NCS was performed to investigate large sensory and motor fibers of the median nerve, while small autonomic fibers were assessed by recording sympathetic skin reflexes (SSR) at the palm and by grading skin wrinkling in response to eutectic mixture of local anesthetic (EMLA) cream application at the pulp of the index finger. For each neurophysiological variable, sensitivity and specificity values for the diagnosis of CTS were calculated and clinical correlations were studied. Results Among 64 hands examined, 36 were clinically symptomatic, while 22 were clinically asymptomatic and served as controls. Among all the neurophysiological variables studied, only the values of transcarpal sensory nerve conduction velocity and the EMLA test grade were found to be more altered in clinically symptomatic hands, with also a trend towards prolonged distal motor latency. Overall, for the diagnosis of clinically symptomatic CTS, NCS, SSR, and the EMLA test had a sensitivity of 66.7%, 22.2%, and 69.4%, respectively, and a specificity of 72.7%, 90.9%, and 50%, respectively. Combining NCS and the EMLA test led to a sensitivity of 88.9% and a specificity of 45.4%. The sssBCTQ (r = −0.34, P = 0.009) and the total NPSI score (r = −0.41, P = 0.001) correlated to a more altered EMLA test grade, but not to any NCS or SSR variables. In symptomatic hands, burning sensation was associated with more severe small-fiber lesion, while other pain and sensory symptoms were rather found to be reduced in case of large-fiber damage, evidenced by NCS alteration. Conclusions This study confirms the discrepancy between conventional NCS results and clinical presentation of CTS, but still suggests a major involvement of Aβ fibers in the positive sensory symptoms of CTS, excepting burning sensation. On the other hand, the EMLA test was found to correlate with clinical data and to be able to improve sensitivity of neurophysiological investigation in diagnosing CTS.

Introduction Les patients diabetiques sont a risque accru de formes graves du COVID-19, et donc ont ete juges prioritaires durant les differentes campagnes vaccinales contre ce virus. Patients et methodes On a mene une etude transversale, a travers un questionnaire ; 80 patients, ayant consulte a l’institut de nutrition, ont ete inclus. Les donnees generales, le desir de se faire vacciner ainsi que differents facteurs associes ont ete releves. Resultats L’âge moyen de patients etudies etait de 56,9 ans. Cinquante-cinq pour cent des patients interroges ont manifeste le desir de se faire vacciner. La raison principale etait l’efficacite percue (32 %). Quarante-cinq pour cent des patients ont refuse de se faire vacciner avec pour raison principale declaree la dangerosite (72 %). Le principal facteur associe a la decision du patient etait un encouragement ou une dissuasion. Les informations positives provenaient en majorite des medias (37 %), suivis du personnel de sante (30 %). Les informations negatives etaient notamment percues des medias (49 %) et de l’entourage (30 %). L’âge, le niveau d’education ou socioeconomique ainsi que l’usage de reseaux sociaux et les prejuges concernant le COVID-19 n’etait pas associes a la decision de se faire vacciner. Conclusion La decision de se faire vacciner est tributaire de l’entourage des patients et des medias. Une bonne campagne d’information et une meilleure implication des autorites sanitaires permettraient de convaincre cette population a risque de se faire vacciner.

Objectif Les analogues de la GnRH constituent le traitement de reference des puberte precoce (PP) centrales evolutives. L’objectif de ce travail etait d’evaluer les resultats de ce traitement dans une serie tunisienne. Patients et methodes Etude retrospective analysant les cas de puberte precoce diagnostique entre 1998 et 2017. Resultats Nous avons collige 7 cas, tous de sexe feminin, dont l’âge chronologique moyen a la 1re consultation etait de 6,5 ans. Le delai moyen de consultation etait de 1,2 ± 1,4 ans. L’examen physique montrait un developpement mammaire et une avance staturale ≥ +2DS chez 5 patientes, une pilosite pubienne chez 6 filles. L’âge osseux moyen etait de 8,2 ± 2,3 ans. Le diagnostic de puberte precoce centrale idiopathique etait confirme avec un pic moyen de LH sous GnRH a 29,65 ± 18,44 mUI/mL et une IRM hypothalamohypophysaire normale. Le traitement par decapeptyl a la dose moyenne de 2,95 ± 0,55 mg etait instaure apres un delai moyen de 3,33 ± 3,38 mois. Le traitement etait regulier chez seulement 2 patientes. Le suivi moyen etait de 3,4 ± 2,4 ans, avec amelioration du stade de TANNER (3 cas), l’âge statural (5 cas) et l’âge osseux (5 cas). L’âge chronologique moyen etait de 9,6 ± 2,2 ans et l’âge osseux moyen etait de 10,4 ± 1,3 ans en fin du suivi. La taille moyenne en fin de suivi etait de 145,5 ± 9,8 cm soit une avance staturale moyenne de 2,5 ± 1 en DS. Conclusions Le traitement par analogues de la GnRH semble efficace chez nos patientes ayant une PP centrale malgre le suivi insuffisant. Le retard de consultation et l’irregularite du traitement seraient les principaux facteurs d’echec therapeutique.

Introduction Le pied diabetique est une complication frequente, grave et couteuse du diabete. La plupart des plaies du pied diabetique sont la consequence d’un traumatisme externe qui serait, le plus souvent, evitable. D’ou l’importance de l’education therapeutique. L’objectif de notre travail etait de decrire, suite a un examen clinique des pieds, l’etat des lieux en matiere de pied diabetique chez nos patients, et de determiner les facteurs associes au risque podologique. Materiels et methodes Il s’agit d’une etude descriptive, transversale, ayant interesse 100 diabetiques hospitalises a l’institut national de nutrition de Tunis, recrutes pendant une periode de trois mois allant du 1er septembre jusqu’au 30 novembre 2020. Resultats L’âge moyen etait de 54,84 ± 12,69 ans [20 a 79]. Le sex-ratio (H/F) etait de 0,61. Quatre-vingt-cinq pour cent des patients avaient un diabete de type 2. L’anciennete moyenne du diabete etait de 12,24 ± 7,72 ans. Soixante-deux pour cent des patients avaient un grade 0 du risque podologique, tandis que 23% etaient classes de haut grade. Un risque podologique plus eleve etait associe a un âge ≥ 60 ans (p Conclusion Notre etude avait conclu que plus le niveau de connaissances etait eleve, meilleur etait le niveau de grade podologique, d’ou le besoin de renforcer l’education therapeutique pour une meilleure prevention.

Introduction L’hypochondroplasie est une osteo-chondrodysplasie caracterisee par un nanisme rhizomelique, nous rapportons le cas d’une association d’une hypochondroplasie a un deficit en hormone de croissance (GH). Observation Il s’agit d’une patiente issue de parents consanguins de premier degre aux antecedents de retard de croissance intra-uterin qui consulte pour un retard statural a un âge de 4 ans et 11 mois, sa taille etait a 83 cm ( Conclusion L’hypochondroplasie est une cause de petite taille definitive chez les patients avec deficit somatotrope par mauvaise reponse au traitement par GH malgre un traitement substitutif et une observance optimale.

Introduction Les tumeurs cerebrales peuvent etre responsables de diabete insipide central mais la potomanie est rare. Observation Nous rapportons le cas d’un patient de 15 ans, sans antecedents pathologiques notables, qui consultait pour un syndrome polyuropolydipsique de 4 a 5 litres par jour. L’examen physique etait normal. La glycemie, la calcemie, l’ionogramme ainsi que le bilan antehypophysaire etaient normaux. Le test de restriction hydrique montrait une concentration des urines en faveur d’une potomanie. Devant la persistance de la symptomatologie et la nycturie perturbant le sommeil, avec vomissements, une IRM hypophysaire etait demandee. Elle montrait une tumeur pineale de 13 mm avec absence d’individualisation de la posthypophyse. Le diagnostic de germinome non secretant metastatique a ete retenu devant l’apparition, trois mois apres, de nouvelles localisations cerebrales a l’imagerie de controle. Le patient a beneficie de radiotherapie en IMRT delivrant 36 Gy a raison de 1,8 Gy, 5 fractions par semaine, sur l’ensemble de l’encephale et du nevraxe, avec amelioration progressive des signes fonctionnels mais apparition d’un panhypopituitarisme. L’IRM hypophysaire de controle un mois apres radiotherapie ne trouve aucune image lesionnelle intracrânienne. Le controle radiologique annuel pendant 3 ans note une stabilite des sequelles post-radiques avec absence de recidive. Conclusion Les tumeurs intracrâniennes posent souvent un probleme de retard diagnostique. En cas de SPUPD genant non explique par une anomalie metabolique ou endocrinienne, une imagerie cerebrale trouve son indication meme si l’epreuve de restriction hydrique montre une potomanie.

Introduction Le jeune de ramadan est un des piliers de l’islam. Il peut, par sa nature eprouvante, etre responsable, chez le diabetique, de complications parfois graves. Il reste, toutefois, largement pratique. Le but de cette etude est d’elucider les aspects lies a cette pratique chez les diabetiques ainsi que les facteurs associes. Patients et methodes Nous avons mene une etude transversale comportant 60 patients diabetiques suivis a l’institut national de nutrition et ayant jeune le mois du ramadan. Les donnees liees au patient a la pratique du jeune ont ete prelevees. Resultats Notre population comportait 37 % de patients traites par antidiabetiques oraux, et 63 % traites par insuline. Soixante pour cent des patients ayant jeune ont demande avis a leur medecin, La tolerance au jeune etait bonne dans de 48 % des cas, avec une duree moyenne de jours. Le motif principal de l’arret a ete l’hypoglycemie (26 %). Les facteurs associes a la bonne tolerance au jeune etaient la demande de conseil aupres du medecin, la pratique d’une autosurveillance reguliere. L’equilibre glycemique, la sollicitation ou non de l’avis du medecin, le niveau socioeconomique ou d’education n’ont pas ete associes a une meilleure tolerance du jeune. Conclusion La pratique du jeune du ramadan, si autorisee, doit etre plus discutee et plus encadree par les medecins afin de minimiser le risque de complications et garantir une bonne tolerance.

Introduction L’usage de plantes a vertus medicinales est courant chez le patient tunisien. Le but de cette etude etait la determination des differents aspect lies a cet usage chez les diabetiques de type 2 dans le traitement du diabete, ainsi que les facteurs associes. Patients et methodes Il s’agit d’une etude transversale ayant inclus 60 patients diabetiques type 2 suivis a l’institut national de nutrition. Un questionnaire mentionnant les donnees cliniques, paracliniques, lies au theme etudie a ete utilise. Resultats La population etudiee avait un âge moyen de 59,6 ans. La duree moyenne d’evolution du diabete etait de 12,4 ans. Trente huit pour cents des patients ont declare avoir essaye les plantes medicinales. La principale raison invoquee etait un complement du traitement medical (79 %). Les plantes utilisees etaient notamment le fenugrec (38,3 %) et les feuilles d’olive (21 %). L’usage de ce moyen a ete suivi d’une efficacite percue par 57 % des patients. Pas de correlation n’etait constatee avec ce constat et l’hemoglobine glyquee. L’usage de plantes medicinales etait associe a une moindre observance de la metformine, et une moindre autosurveillance. Pas d’association n’etait constatee avec le niveau socioeconomique, le niveau d’education et la presence ou non de complications degeneratives. Conclusion Les diabetiques utilisent les plantes a vertus medicinales de facon frequente, souvent en complement au traitement medical. Leur usage, d’efficacite douteuse, non codifie, doit etre encadre par les praticiens afin d’eviter leurs effets nocifs potentiels.

Introduction L’adrenoleucosystrophie (ALD) est une maladie liee a l’X caracterisee par une alteration de beta-oxydation des acides gras a tres longue chaine (AGTLC). Elle se manifeste souvent par l’association de divers deficits neurologiques et une insuffisance surrenalienne (IS) peripherique. Les patients presentant une IS sont plus a risque d’etre infectes par le SARS-COV2. Observation Patient âge de 9 ans qui presentait depuis 18 mois une symptomatologie faite d’une baisse de l’acuite visuelle et auditive avec difficultes scolaires et regression cognitive rapide. Le patient etait hospitalise initialement en unite de soins intensifs pour une alteration profonde de l’etat general en rapport avec une decompensation surrenalienne confirmee par un dosage effondre de la cortisolemie de base. Comme facteur de decompensation, on a retrouve une infection au virus SARS-COVID 19. Apres avoir jugule le cap aigu, l’examen retrouve une hyperpigmentation cutaneo-muqueuse, une hypertonie spastique au niveau des membres, une demence partielle. L’imagerie cerebro-medullaire par resonnance magnetique a montre des images de type hyper signal en ponderation T2 observees dans la substance blanche profonde et sous-corticale de l’etage supra-tentoriel jusqu’au splenium du corps calleux et aux capsules internes faisant evoquer en premier lieu une adrenoleucodystrophie cerebrale. Le dosage des AGTLC retrouvait un profil compatible avec une ALD liee a l’X. Conclusion Les manifestations psychocognitives du debut de l’ALD continuent a mystifier les medecins. Cette affection doit toujours etre discutee surtout chez les garcons presentant une IS peripherique associee a de troubles neurologiques meme dans un contexte de COVID-19.

In this letter, we consider an uncoordinated access to the uplink of MU-MIMO cellular networks. Based on randomly rotated modulation constellations, we propose an efficient approach to blind identification of active users and estimation of all involved channels, up to a discrete phase ambiguity. To eliminate this ambiguity, we use short orthogonal pilot sequences. To improve the obtained channel estimates, we also rely on a combination of pilot-based and blind channel estimates. Moreover, since no coordination is assumed with the base station the problem of pilot contamination can occur when some active users use the same pilot sequence. As a solution for this problem, we propose an efficient semi-blind recovery of all contaminated channel estimates.

Objectives During the menstrual cycle, the influence of hormonal variations on dietary habits in women has been suggested by several studies. In this context, our work aimed to assess the spontaneous food intake and the anthropometric parameters of women at different periods of their menstrual cycles. Methods This prospective study included 30 healthy women with regular periods (28 to 30 days), aged between 18 and 45. We assessed the spontaneous food intake and the anthropometric measurements (weight and waist circumference) of the participants, during the follicular, peri-ovulatory and luteal phases of their menstrual cycles. Results Our results showed a slight but significant increase in body weight during the luteal phase (P = 0.022) and the follicular phase (P = 0.017) compared with the peri-ovulatory phase, without any significant change in waist circumference. The caloric intake increased during the peri-ovulatory (P

Introduction Le diabete maturity-onset diabetes of the young (MODY) est un groupe heterogene d’affections hereditaires monogeniques rares caracterisees par une dysfonction de la secretion d’insuline par la cellule βpancreatique. Nous rapportons deux cas de diabete MODY confirmes par etude genetique. Observations La premiere patiente âgee de 26 ans presentait un diabete non cetosique a l’âge de 19 ans. Elle avait des antecedents familiaux charges de diabete sucre sans syndrome metabolique. Son IMC etait a 28,6 kg/m2 avec une HbA1c a 9,2 %, sans autres anomalies metaboliques. Elle etait traitee par metformine seule puis en association avec le gliclazide. Elle avait plusieurs episodes d’hyperglycemie sans cetose ni signes d’insulinopenie. L’etude genetique objectivait une variation nucleotidique non sens a l’etat heterozygote, responsable d’un codon stop au niveau de l’exon 7 du gene HNF4A (MODY-1). La deuxieme patiente âgee de 31 ans presentait un diabete gestationnel a l’âge de 25 ans. Elle avait des antecedents personnels d’hypertriglyceridemie et d’hypothyroidie avec notion de diabete sucre dans la famille. Elle etait mise sous insuline pendant la grossesse. Apres l’accouchement, elle gardait une hyperglycemie severe sans cetose. Son IMC etait a 26,5 kg/m2. Elle etait traitee par insuline et metformine avec bonne evolution (HbA1c = 5,9 %). L’etude genetique montrait une variation nucleotidique faux sens a l’etat heterozygote au niveau de l’exon 2 du gene HNF1A (MODY-3). Conclusion Ces observations illustrent les difficultes diagnostiques du diabete MODY. En cas de suspicion clinique, la confirmation genetique permet l’adaptation therapeutique et la prise en charge precoce des autres membres atteints de la famille.

The channel access technique of LoRaWAN hinders the thorough utilization of channel capacity since it was not designed to exclusively limit or even avoid collisions, but rather with simplicity and energy consumption in mind. As a consequence, in presence of plenty of active nodes, the overall performance offered by a LoRaWAN Network can be poor. In this paper, we propose a new synchronized Uplink transmission scheme to improve the performance of data transmissions for LoRaWAN class B end-devices which are suitable for IoT applications with low latency requirements and regular traffic. In contrast to related works, our proposal is defined without modifying the fundamentals of the original ALOHA based channel access technique, but simply takes advantage of Class B downlink synchronization. Our preliminary analysis based on an analytic model shows an enhancement of performances regarding data transmission success.

Introduction: Traditionally, the ERS/ECSC1983 references, are the most used in Tunisia. Unlike, the performance of the GLI 2012 equations; on interpreting Tunisian spirometric values are currently not well known. We aimed in this study to assess whether the GLI 2012 references are appropriate for adults in a Tunisian population, by comparing with the ERS/ECSC1983 equations. Methods: We carried out a retrospective study, including patients (age > 18 years old) who performed spirometry at the functional exploration department SFAX. Obstructive ventilatory defect (OVD) was defined by a FEV1/FVC ratio Results: 301 adults (137M/164 F) were enrolled. The mean of age was 53,4±14,89 years. Over all, diagnostic discordance, was observed in 16 % of patients ( p Conclusion: GLI references values provided reasonable estimates but caution should be taken when classifying the OVD severity

Introduction: Because of similar risk factors, concomitant cardiovascular diseases (CVD) are common among patients with chronic obstructive pulmonary diseases (COPD). Strong scientific evidences; show that this association CVD/COPD leads to an increase of the mortality, however its impact in the quality of life is still not well understood. We aimed in this study to evaluate how CVD affect the respiratory function and the quality of life in patients with COPD. Methods: Our study is a cross-sectional study comparative conducted over 6 months, including patients whose diagnosis of COPD was confirmed according to GOLD guidelines. We analysed demographic (age, BMI), lung function (FEV1%), modified medical research council (MMRC) dyspnea scale, COPD asseassement test (CAT) and exacerbations/ year (ex/y) in 2 groups of patients with stable COPD : G1 : without CVD ; G2 : with CVD Results: The mean age (years old) of the 2 groups (G1 : 21 vs G2 : 19) was respectively 64.2 ± 5,9 vs G2 : 66.2 ± 5.4. No significant difference has been seen between G1 and G2 when compared the BMI and the consumption of tobacco. Patients with CVD (G2) had a higher CAT score (G1 : 18.2 ± 6 vs G2 : 23.8 ± 3.7 ; P=0.001) and presented more exacerbations in the last year (G1 : 1.1 ± 0.9 vs G2 : 2.2 ± 0.6 ; P Conclusion: To conclude, the coexistence of COPD and CVD is associated with worse outcomes and more altered quality of life than COPD alone.

Introduction: Obstructive Sleep apnea-hypopnea syndrome (OSAHS) is defined by the repetitive occurrence of brief apneas during sleep. The best treatment remains the Continuous Positive Airway Pressure (CPAP). The Objective of our study was to evaluate the efficacity of the CPAP in the improvement of the sub-maximal exercise capacity in obese patients with (OSAHS). Patients and Methods: 31 obese patients with OSAHS were included. We did a plethysmography and a 6-MWT for every patient. We specified anthropometric data and Clinical symptoms. Results: Our population was divided into 2 groups: patients treated by the CPAP G1 (n=18) and patients not treated G2 (n=13). The sex-ratio, body mass index and the average age were similar in both groups. We didn’t find a significant difference in daytime sleepiness, night snoring, exercise dyspnea and chronic cough. There was no difference between the 2 groupes regarding the forced expiratory volume in 1s, the FEV1 / FVC and the lung residual volume. The 6MWT profile was as follows: 11% of patients in G1 had a dyspnea at the end of the test vs 23% in G2; 16.7% of the patients in G1 had a chronotropic insufficiency vs 15% in G2. We didn’t find a difference regarding the walking distance or the desaturation during the test. Conclusion and Discussion: Our study shows that the treatment by CPAP in obese patients with severe OSAHS doesn’t improve the function of the muscular and cardiorespiratory chain. In addition to CPAP, a pulmonary rehabilitation program training and weight reduction can help us in the care of those patients.