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Galectin-3 is a new biomarker assumed to reflect fibrogenesis and inflammation. We aimed to investigate the relation of Gal-3 with the severity of coronary artery disease in patients with ST elevation myocardial infarction.The prospective study enrolled 62 patients with ST elevation myocardial infarction who underwent coronary angiography. The burden of atherosclerosis was assessed by the number of involved vessels, the number of coronary lesions with a stenosis diameter more than 50% and the Gensini score. Gal-3 levels were measured on admission on miniVIDAS (BioMérieux).The mean age of the patients was 56±11 years old; 93.5% were males. Diabetes, hypertension and hyperlipidemia were respectively 29%, 35.5% and 24.2%. Among patients, 80.6% were active smokers. Mean level of Gal-3was 17±11 ng/ml and didn't differ significantly from the number of involved coronary vessels (p=0.82) and the Gensini score (p=0.4). There was a positive correlation between the number of coronary lesions with a stenosis diameter greater than 50% and Gal-3 (p=0.04).In patient with ST elevation myocardial infarction we found a positive correlation between the number of coronary stenosis and Gal-3 level.

In the total analytical process of clinical specimens, there are many possible preanalytical sources of error. The objective of this work was to evaluate the overall level of conformity of the internal preanalytical phase according to ISO 15189: 2012 and the guideline of laboratories practice in the laboratory of clinical biochemistry of Charles Nicolle hospital, Tunis. In order to identify and understand the failures in the preanalytical process, we have established an internal audit methodology to verify the accordance of different process with the requirements of the quality management systems. The nonconformities noted by the internal audit were mostly related to the execution of sampling, the medical prescription and the transmission of laboratory samples. To improve and ensure quality we have used quality tools, implemented corrective actions and re-evaluated the frequency of nonconformities to verify the effectiveness of the actions implemented. The total number of nonconformities was reduced by 52% after the application of quality tools. The results of the corrective action investigation showed a highly significant difference (P=0,004) of the percentage of nonconformities before and after corrective actions. The application of an internal audit methodology was a promising method to contribute to the enhancement of patient safety and produce valuable benefits for the entire healthcare system. However, the actions put in place remain insufficient on some nonconformities. Thus, the laboratory must ensure human and financial mobilization and full commitment and cooperation of the entire laboratory staff.

Brown tumors are rare and severe manifestations of secondary hyperparathyroidism. We propose in this study: to define and illustrate brown tumors observed in our hemodialysis center; to show the frequency for 20 years in our center; to identify risk factors compared to the rest of dialysis patients; and finally to offer improved support for reducing the incidence.We conducted a retrospective and descriptive study, over a period of 20 years (1993-2013), including 311 cumulative patients which are chronic hemodialysis in our unit.Twenty-one patients had brown tumors (6.75%). The average age was 36.1 years and the sex ratio M/F is of 0.6. The average time between the start of hemodialysis and the diagnosis of brown tumor was 87.6 months. Clinical symptoms were dominated by bone pain, found in 76.1% of cases. The most frequent locations were costal (28.5% of cases), while spinal involvement was less frequent (4.76% of cases). The location was multifocal in 57.1% of cases. The mean serum calcium was of 2.08 mmol/L, the serum phosphate of 2.25 mmol/L, alkaline phosphatase of 1709 IU/L and the average value of parathyroid hormone of 1934 pg/mL. Radiography was the key of diagnostic. Resonance magnetic imaging and computed tomography had an interest in the exploration of spinal locations and maxillo-mandibular locations. All patients underwent parathyroidectomy and it was total in one patient. Tumorectomy was necessary in three patients (14.2% of cases). The outcome was favorable in 85.7% of cases.Our work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors.

Objectif La nephropathie diabetique est la premiere cause d’insuffisance renale chronique et de recours a l’hemodialyse dans plusieurs pays. L’objectif de notre etude est de determiner la prevalence de la nephropathie ainsi que ses principaux facteurs de risque chez un groupe de diabetiques de type 2 recent. Patients et methodes Etude prospective portant sur 60 patients diabetiques de type 2 nouvellement diagnostiques et consultant a l’institut national de nutrition de Tunis. Resultats L’âge moyen de nos malades etait de 52,28 ± 8,85 ans. Vingt patients soit 35 % de la population etudiee, presentaient une nephropathie ; 6,66 % de ces patients avaient une macroalbuminurie, alors que 26,6 % avaient une microalbuminurie. La tension arterielle systolique (TAS) etait significativement associee a la presence d’une nephropathie et nettement plus elevee chez les diabetiques ayant une nephropathie : 139 ± 19,44 vs 128,65 ± 15,12 mmHg pour les patients ne presentant pas de nephropathie (p 8 %) a ete note chez 40 % des diabetiques presentant une nephropathie versus 27,5 % chez ceux sans nephropathie. La frequence de la dyslipidemie etait comparable dans les 2 groupes (avec et sans nephropathie) sans difference significative. Discussion Nos resultats soulignent le role incontestable de l’hypertension arterielle comme facteur de risque majeur de la nephropathie. De meme, un controle glycemique strict est primordial dans la prevention de la nephropathie diabetique.

Objectif Le diabete est la principale cause de cecite dans les pays developpes. L’objectif de notre etude est d’etudier la prevalence de la retinopathie diabetique dans un groupe de diabetiques de type 2 ainsi que de preciser les principaux facteurs de risque de cette atteinte retinienne. Patients et methodes Il s’agit d’une etude prospective portant sur 60 patients diabetiques type 2 nouvellement diagnostiques et consultant a l’institut national de nutrition de Tunis. Resultats Environ deux tiers (60 %) des patients etaient de sexe masculin. L’âge moyen etait de 52,28 ± 8,85 ans. Pres de la moitie de la population etudiee (48,3 %) avait une hypercholesterolemie. Le fond d’œil a revele une retinopathie (RD) chez 9 malades, soit 15 % de la population etudiee. Il s’agit d’une retinopathie non proliferative pour tous les cas. La frequence de la retinopathie etait de 19,4 % chez les hommes (7 patients) et 8,3 % chez les femmes (2 patientes). Parmi les diabetiques porteurs d’une RD ; 55,6 % presentaient une hypertension arterielle contre 45 % sans RD. La frequence du tabagisme etait plus elevee chez les patients avec retinopathie (55,6 % versus 37,3 %) mais sans difference significative. Parmi les diabetiques atteints de retinopathie ; 66,6 % presentaient un mauvais controle glycemique (HBA1C > 8 %) versus 23,5 % pour les diabetiques sans retinopathie. Discussion Notre etude a montre que l’hyperglycemie predisposait a l’atteinte retinienne au moment du diagnostic d’ou l’importance d’un controle glycemique optimal a la decouverte du diabete.

Introduction Le diabete type 2 est un probleme de sante publique notamment par les complications cardiovasculaires qu’il engendre. Objectifs L’objectif de notre travail est d’evaluer l’interet du depistage precoce de l’ischemie myocardique silencieuse (IMS) chez les diabetique de type 2 et de la correler aux facteurs de risque cardiovasculaire classique et non traditionnels. Patients et methodes Etude prospective portant sur 60 patients diabetiques type 2 nouvellement diagnostiques traites par regime et/ou antidiabetiques oraux et consultant a l’INNTA. Ces patients ont beneficie initialement d’un interrogatoire, d’un examen clinique (IMC, TT, examen cardiovasculaire…), d’explorations biologiques (GAJ, HbA1c, bilan lipidique, bilan hepatique, bilan renal, uricemie, CRPus, apolipoproteine A1 et B, lipoproteine a, BNP, homocysteine…) et para-cliniques : epreuve d’effort… Resultats L’âge moyen etait 52,28 ± 8,85 ans, 60 % etaient des hommes. Le diagnostic d’IMS a ete retenu sur les resultats de l’epreuve d’effort : douze patients soit 20 % presentaient une IMS. Les facteurs de risque cardiovasculaire significativement associes a l’IMS etaient l’âge (p = 0,044), la tension arterielle systolique (p = 0,007), la tension arterielle diastolique (p = 0,001) et la presence de micro-albuminurie de 24 h (p = 0,016). Il n’y avait pas de correlation positive entre l’IMS et les parametres de l’equilibre glycemique. Les diabetiques ayant une IMS avaient un taux moyen d’HDL significativement plus bas (p = 0,013), l’etude des autres parametres lipidiques (cholesterol total, triglyceride, LDL cholesterol, Apo A1, ApoB, Lp [a]) n’a pas montre de difference significative entre les 2 groupes, neanmoins l’IMS etait significativement correlee avec le rapport apoB/apoA1 (p = 0,047). Il n’y avait pas de correlation significative entre l’IMS et les autres parametres de risque cardiovasculaires non traditionnels (BNP, CRPus, homocysteine). Conclusion Le diabete type 2 de decouverte recente n’est pas epargne des complications cardiovasculaires. D’ou l’interet du depistage systematique de l’ischemie myocardique silencieuse au moment du diagnostic.