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Le diabète entraîne fréquemment une altération de l'équilibre et la stabilité des patients de par la rétinopathie et la neuropathie accroissant ainsi risque de chutes. Notre objectif était d'étudier la relation entre les anomalies de la statique plantaire et l'équilibre chez les patients diabétiques et d'identifier les facteurs de risque d'instabilité chez cette population. L'objectif principal était de démontrer la corrélation entre les anomalies de la statique plantaire et les troubles de l'équilibre chez les patients diabétiques. Le second objectif est d'identifier les facteurs de risque liés à l'instabilité et à l'augmentation du risque de chutes dans cette population. Il s'agissait d'étude transversale descriptive sur 3 mois. Nous avons procédé a un interrogatoire, un examen clinique, un examen podoscopique et un examen des chaussures. Nous avons procédé à une évaluation instrumentale de l'équilibre sur un appareil type WINPOSTURE, permettant d'évaluer les oscillations du centre de gravité dans le plan frontal et sagittal. Une analyse bivarié a été effectuée pour rechercher les facteurs favorisants les troubles de l'équilibre. Le seuil de signification a été fixé pour un p ≤ 0,05. Notre travail a inclus 30 patients diabétiques âgés de 60 ± 7,8 ans. Concernant le stade d'évolution : deux patients avaient une rétinopathie diabétique et trois avaient une neuropathie diabétique L'absence de contrefort dans les chaussures a été observée dans 73 % des cas, et 30 % des patients avaient une usure latérale des chaussures. Les examens cliniques ont révélé des hyperkératoses plantaires, des onychomycoses mycosiques, des griffes des orteils, et des talalgies dans 23 % des cas. L'examen sur podoscope a objectivé des troubles statiques dans 80 % des patients, notamment des pieds plats et valgus de l'arrière-pied dans 40 % des cas. L'instabilité de l'appui monopodal a été observée chez 64 % des patients. Le test de Tinetti a évalué le risque de chutes chez 11 patients. L'évaluation instrumentale a montré une exagération de la surface d'oscillation en condition yeux fermés et une déviation latérale accrue chez 26 patients. Une analyse statistique a révélé une relation significative entre le type d'assise plantaire et l'oscillation en condition yeux fermés (p = 0,036). Ces résultats suggèrent que les troubles de la statique plantaire sont associés à une diminution de la stabilité et augmentent le risque de chutes. Les anomalies de la statique plantaire sont fréquentes chez les diabétiques ce qui impacte significativement leur équilibre. Les anomalies plantaires tels que les pieds plats et valgus sont fortement liés à l'instabilité posturale et au risque augmenté de chutes. Ainsi une évaluation podologique et des interventions spécifiques pour améliorer l'équilibre et réduire les risques de chutes dans cette population seraient nécessaires. [ABSTRACT FROM AUTHOR]

Introduction: Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. Falls are a serious health concern for persons with MS (PwMS)., Aim: To determine the frequency and associated factors of falls in PwMS., Methods: A cross-sectional study was conducted in the Physical Medicine and Rehabilitation and Neurological Departments at the Military Hospital of Tunis between July and December 2022. Participants meeting the inclusion criteria completed a survey focusing on the prevalence and related factors of falls. In addition to the survey and a thorough clinical and functional examination, we used the 12-item MS Walking Scale (MSWS-12), the Fall Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB), and the 10-meter walk test for clinical assessment of balance. A baropodometric platform was employed for instrumental assessment., Results: Thirty individuals with an average age of 33,6 [SD: 7,7], completed the survey with a mean Expanded Disability Status Scale = 2,5. Twenty-one patients reported falling at least once since the diagnosis. The MSWS-12 mean score was 61 % and the FES-I scored an average of 33.8. The average total score of the SPPB was 8. Total boli of corticosteroids prescribed during disease flare-ups (p=0,022), magnetic resonance imaging lesions of the basal ganglia (p=0,047), vestibular syndrome (p=0,048), MSWS-12 score (p=0,022), and the chair lift test of SPPB (p=0,018) were significantly associated with the prevalence of falling. No significant differences were observed for the instrumental assessment., Conclusion: Falls are frequent in PwMS. MSWS-12, the FES-I, and the SPPB, can be used by clinicians to predict potential fallers of the PwMS.

Background: Whether land- or aquatic-based rehabilitation is more effective in improving knee osteoarthritis (OA) is still unclear. This study assessed the effectiveness of aquatic-based treatments in patients with knee OA., Methods: The participants were divided into a land-based exercise group (G1, n=30) and a water-based exercise group (G2, n=30). The exercises were performed for 8 weeks. The primary endpoint was a response to physical therapy, defined as a 20% decrease in the summed score for the Western Ontario and McMaster Universities-Osteoarthritis Index (WOMAC) pain subscale from T1 (before the start of the rehabilitation program) to T2 (8 weeks later). The secondary endpoints included the Visual Analog Scale (VAS) for pain, WOMAC functional and stiffness subscales, Lequesne Index, and Medical Outcome Study Short Form (SF-12) for physical and mental health., Results: A 20% decrease in the summed WOMAC pain subscale score was noted in 33% of patients in G1 (n=10) and 93% in G2 (n=28) (P<0.001). VAS scores at walking decreased by 14% in G1 vs. 37% in G2 (P<0.001), WOMAC stiffness subscale decreased by 18% in G1 vs. 53% in G2 (P<0.001), and the Lequesne index decreased by 10% in G1 vs. 33% in G2 (P<0.001). Quality of life improvement was greater in G2 than in G1; SF-12 (physical) increased by 2.3 in G1 vs. 5.4 in G2 (P=0.023), and SF-12 (mental) increased by 6.3 in G1 vs. 10.9 in G2 (P=0.022)., Conclusion: Both aquatic and land-based exercises improved pain intensity, functional impairment, degree of handicap, and quality of life impairment caused by OA. However, the improvement was more significant in the aquatic-based exercises group.

Introduction: Chronic low back pain is a public health problem in view of its functional repercussions and the functional rehabilitation is an integral part of its management., Aim: To compare the evolution of muscle strentgh of spinal extensors and flexors in chronic low back pain patients after an isokinetic rehabilitation protocol and a conventional rehabilitation one., Method: This was a prospective and comparative study carried out in the Physical Medicine Department of the Tunis Military Hospital over a period of 7 months. Fifty patients were included, randomly divided into two groups of 25. The first group (G1) benefited from an isokinetic rehabilitation protocol and the second one (G2) from a classic active physiotherapy. We performed a clinical (Sorensen test and Shirado test) and isokinetic evaluation of the trunk muscles before and after rehabilitation., Results: The mean age of the general population was 42±8.6 years old. Clinical evaluation showed a deficit in the extensor and flexor muscles of the spine, more important in the extensors in both groups. After rehabilitation, there was a significant improvement in clinical tests of muscular endurance in G1 and G2. Isokinetic assessment showed a greater muscle deficit in the extensors in both groups. After isokinetic rehabilitation, peak torque for flexors and extensors increased by 21% and 23% respectively, power was 34% and 37% higher, and total work increased by 26% and 47%. On the other hand, the (F/E) ratios were unchanged for all three speeds. In Group 2, peak torque values for flexors and extensors increased by 22 and 15% respectively, power was higher by 31 and 23% and total work was also up by 29 and 17%, while F/E ratios were also unchanged. Group 1 showed the greatest improvement in extensor strength at 60°/s, and in power at 90°/s for the various muscles., Conclusion: In our study, we concluded that endurance and muscular strength improved the most after isokinetic rehabilitation.

Introduction: Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment., Aim: This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis., Methods: A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months., Results: Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment., Conclusion: Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

Introduction: Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture causing activity limitation., Aim: To evaluate the epidemiological, clinical, and radiological profile of children with CP and to study the therapeutic modalities in daily clinical practice., Method: This was a retrospective, descriptive study, carried out in a physical medicine and rehabilitation department, including all the patients referred with the diagnosis of cerebral palsy between January 2000 and December 2016. We used pre-established records to collect data. The missing data were collected from the files of the pediatric department. To classify cerebral palsy, we used a motor impairment classification, topographic classification according to the affected limb and the GMFCS - ER., Results: Fifty patients were included with a gender ratio of 1.23. The mean age of patients was 7.8 years old. The risk factors for CP were mainly represented by perinatal asphyxia (55%) and prematurity (37%). The spastic form was predominant (74%). Quadriplegia was the most severe clinical form (61%). Neuro-orthopedic deformations were found in 78% of cases. Half of the children had GMFCS score between 1 and 2. Brain MRI lesions were dominated by anoxic-ischemic sequelae (34%). Physical therapy was prescribed for all patients. The most prescribed devices were the dynamic ankle foot orthosis (60%). Baclofen was prescribed in 5% of cases and botulinum toxin injection was performed in 30% of children., Conclusion: The cerebral palsy defines the clinical and functional disorders caused by non-progressive developmental damage to the brain of the infant which requires a multidisciplinary management.

Objectives: Our work aimed to translate Ditrovie scale into standard Arabic and to verify its validity and reliability in the Tunisian population., Materials: The translation-retro-translation method was the chosen translation method. The committee of experts analyzed these versions and elaborated a pre-final version The Arabic version obtained was conducted on a sample of 100 patients with idiopathic overactive bladder. The reliability of the scale was verified by Cronbach's alpha coefficient and intraclass correlation coefficient., Results: The feasibility and acceptability of the scale was good. The Cronbach's alpha was 0.86. The reproducibility of our scale as well as of each domain were very good (intraclass correlation coefficient>0.9) with a mean of the differences centered and homogeneous in the Bland and Altman graph., Conclusion: The standard Arabic version of the Ditrovie scale is a reliable instrument with satisfactory psychometric properties allowing evaluation of quality of life of patients with idiopathic overactive bladder., Level of Evidence: B., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

MK-8591 (4'-ethynyl-2-fluoro-2'-deoxyadenosine) is a novel nucleoside analog that displays a differentiated mechanism of action as a nucleoside reverse transcriptase translocation inhibitor (NRTTI) compared to approved NRTIs. Herein, we describe our recent efforts to explore the impact of structural changes to the properties of MK-8591 through the synthesis and antiviral evaluation of carbocyclic derivatives. Synthesized analogs were evaluated for their antiviral activity, and the corresponding triphosphates were synthesized and evaluated in a biochemical assay. 4'-Ethynyl-G derivative (±)-29 displayed a promising IC 50 of 33 nM in a hPBMC cell-based antiviral assay, and its triphosphate (TP), (±)-29-TP, displayed an IC 50 of 324 nM in a biochemical RT-polymerase assay. Improved TP anabolite delivery resulting in improved in vitro potency was achieved by preparing the corresponding phosphoramidate prodrug of single enantiomer 29b, with 6-ethoxy G derivative 34b displaying a significantly improved IC 50 of 3.0 nM, paving the way for new directions for this novel class of nucleoside analogs.

Introduction: functional restoration of the spine is a proven method in the short-term management of chronic low back pain. The aim of our study  was to evaluate the effect of a functional restoration program at two years of evolution., Methods: retrospective study of patients enrolled in a functional restoration program during 2014 and summoned after two years,  in 2016. Patients have had the same clinical and functional evaluation before the program, at five weeks and  at two years., Results: Thirty patients were enrolled in the study. The average age was 45 years. Eighty % of the patients were overweight. Significant improvement for all clinical and functional parameters at five weeks was noted. This gain was maintained significantly for some parameters at two years., Conclusion: The results of the functional rehabilitation of the spine are satisfactory at two years of evolution.

Herein we describe the discovery of IDX21437 35b, a novel R P d-aminoacid-based phosphoramidate prodrug of 2'-α-chloro-2'-β-C-methyluridine monophosphate. Its corresponding triphosphate 6 is a potent inhibitor of the HCV NS5B RNA-dependent RNA polymerase (RdRp). Despite showing very weak activity in the in vitro Huh-7 cell based HCV replicon assay, 35b demonstrated high levels of active triphosphate 6 in mouse liver and human hepatocytes. A biochemical study revealed that the metabolism of 35b was mainly attributed to carboxyesterase 1 (CES1), an enzyme which is underexpressed in HCV Huh-7-derived replicon cells. Furthermore, due to its metabolic activation, 35b was efficiently processed in liver cells compared to other cell types, including human cardiomyocytes. The selected R P diastereoisomeric configuration of 35b was assigned by X-ray structural determination. 35b is currently in Phase II clinical trials for the treatment of HCV infection., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Exploration of the P2 region by mimicking the proline motif found in BILN2061 resulted in the discovery of two series of potent HCV NS3/4A protease inhibitors. X-ray crystal structure of the ligand in contact with the NS3/4A protein and modulation of the quinoline heterocyclic region by structure based design and modeling allowed for the optimization of enzyme potency and cellular activity. This research led to the selection of clinical candidate IDX320 having good genotype coverage and pharmacokinetic properties in various species., (Copyright © 2015 Elsevier Ltd. All rights reserved.)