Paysages naturels dans la basse vallée de l’oued Tamri (Maroc): proposition de l’approche paysagère pour une valorisation touristique

The lower valley of the Tamri contains significant natural landscape potential that could make in this mountainous area a competitive touristic territory. The geographical analysis of these landscapes is necessary for a better valorization, in order to guarantee the local development of this zone of the South-West Morocco. The geographical and landscape approach seems most relevant for the evaluation of the natural landscapes of the lower valley of Tamri, in order to better respond to their conservation, in a perspective of its valorization and the development of rural tourism. The aim of this article is to analyze these landscapes and to establish some ideas for the valorization of landscape heritage and to maintain the development of mountain areas. This work is an appeal to the various actors to associate around the landscape as a communication base, and to integrate its conservation and valorization into the decision-making process in the region. As a result, we plan to develop a landscape-trail map of the Tamri Valley that could serve as an example of large-scale generalization

Metabolic syndrome and chronic kidney disease

To determine the prevalence of metabolic syndrome (MS) in chronic kidney disease (CKD) patients as well as its effects on the progression of CKD, we conducted a prospective, longitudinal study including 180 patients with chronic renal failure followed at the outpatient service of Nephrology at the Saloul′s University Hospital of Sousse (Tunisia) over six months. Our study population consisted of 101 men and 79 women. Chronic glomerulonephritis (36.6%) was the most frequent nephropathy. The mean serum creatinine was 249 ± 200 mmol/L and the mean estimated glomerular filtration rate (eGFR) was 55.8 ± 49.2 mL/min. Cardiovascular (CV) impairment was found in 27.2% of the patients. The prevalence of MS was 42.2%. Women had significantly more abdominal obesity than men. Subjects with MS were significantly older and predominantly females who had higher blood pressure and body mass index (BMI). CV complications were more frequent among the MS subjects than among the controls. Glycemia, triglycerides, total cholesterol and low-density lipoprotein-cholesterol (LDL-c) were significantly higher in the group of CKD patients with MS. However, the occurrence of MS was not influenced by the nature of nephropathy, the degree of the CKD and the use of renin-angiotensin blockers or statins. In multivariate analysis, predictors of occurrence of MS in our series included older age, female gender and higher BMI and LDL-c levels. The prevalence of MS in patients with CKD is higher than the general population. These patients should receive special multidisciplinary care to limit CV complications

Trends of incident dialysis patients in Tunisia between 1992 and 2001

International audienceBackground: Reliable information about the burden of end-stage renal disease (ESRD) is still scarce in the developing world. Study Design: Observational study of a national dialysis registry. Setting & Participants: Patients incident to dialysis therapy captured in the Tunisian registry of renal replacement therapy (RRT). Predictor: Intervals from 1992 to 2001. Outcomes: Incidence rates of patients beginning dialysis therapy by age, sex, primary cause of ESRD, and region. Results: The incidence of treated ESRD dramatically rose in Tunisia during the 10-year period to reach 158.8 cases/million people in 2000 to 2001. We hypothesize that the Tunisian population is experiencing better access to RRT, a decrease in mortality from other causes, and an increase in chronic kidney diseases from chronic disease causes. Chronic diseases that develop with aging and economic development prevailed in urban environments, with diabetic nephropathy rising at the rate of 16.1%/y, whereas renovascular diseases, which include hypertensive nephropathy, rose by 7.6% annually. Interestingly, tubulointerstitial nephropathies increased by 10.4% each year, which may be related to such environmental risk factors as dietary exposure to ochratoxin A, especially in rural settings. ESRD from unknown causes or with missing information about cause increased by 12.7% yearly. Large regional differences in total incidence persist despite constant efforts to level off inequalities in access to health care facilities and RRT treatment. Limitations: Possible underreferral for RRT, underreporting of cases, and misdiagnosis. Conclusions: The growing incidence of patients on dialysis therapy in Tunisia emphasizes that preventing chronic kidney disease and its progression should be a public health priority

Membranous nephropathy succeeding autologous hematopoietic stem cell transplant: a case report

Abstract Background Membranous nephropathy (MN), the leading cause of nephrotic syndrome in adults, is characterized by the deposition of subepithelial immune deposits. Most of the cases are primary, while only approximately 25% of the cases are secondary to some known diseases. Recently, MN has been considered to be a possible presentation of chronic graft-versus-host disease (GVHD) of the kidney in allogeneic hematopoietic stem cell transplantation (HSCT) patients. In autologous HSCT populations, there have been scarce reports of associated MN, as a result of immune dysregulation leading to systemic autoimmunity and miming chronic GVHD. Case presentation We report an exceptional case of MN associated to an acute renal failure occurring within days following an autologous HSCT indicated by multiple myeloma. There was no evidence of GVHD or myeloma relapse. A complete remission of nephrotic syndrome with normalization of renal function were rapidly obtained by corticosteroid therapy. Conclusion This is the first published case of acute renal failure due to MN occurring in the acute phase of an autologous HSCT. These findings support the antibodymediated autoimmune glomerular disease

Ochratoxine A et néphropathie humaine en Tunisie : dix ans d'étude

L'ochratoxine A (OTA) est une mycotoxine connue essentiellement pour ses effets néphrotoxiques. Des études réalisées dans les régions balkaniques ont fortement soupçonné l'OTA d'être le principal agent causal de la Néphropathie Endémique des Balkans (NEB). Cependant, malgré les nombreuses investigations réalisées, l'implication de l'OTA dans cette néphropathie humaine est encore sujette à controverse. En Tunisie, une néphropathie interstitielle chronique (NIC) à étiologie indéterminée, similaire à la NEB, où l'OTA semble également être impliquée, a été bien caractérisée. Dans ce travail, nous nous proposons d'apporter des preuves supplémentaires impliquant davantage l'OTA dans cette néphropathie. Nous présentons le bilan d'une étude rétrospective de dix ans (1991-2001) engageant 954 néphropathes et 205 individus sains. Dans ce bilan, nous comparons les contaminations sériques en OTA dans trois groupes : un groupe d'individus sains ne présentant aucune pathologie (205 sujets), un groupe de néphropathes présentant une NIC inexpliquée (383 sujets) et un groupe de néphropathes à étiologie connue (571 sujets). La détection et le dosage de l'OTA sont réalisés après extraction à partir des échantillons sériques suivie d'une analyse par chromatographie liquide haute performance (HPLC) avec détection de fluorescence. Nous montrons que l'incidence la plus importante de la contamination sérique en OTA est trouvée dans le groupe présentant une NIC inexpliquée. En effet, dans ce groupe, le pourcentage d'individus OTA-positifs est de 97 % et il n'est que de 73 % et de 86 % respectivement chez les individus sains et chez ceux présentant d'autres néphropathies à étiologie connue. Les concentrations moyennes sont également plus élevées dans le groupe de NIC d'étiologie inconnue (50.77 ± 4.75 ng/ml) que dans les autres groupes de contrôle (2.35 ± 0.90 ng/ml) ou de néphropathes à etiologies connues (9.96 ± 3 ng/ml). Notre étude renforce davantage le rôle de VOTA dans cette néphropathie et la désigne comme agent causal très probable

Selected <it>AGXT </it>gene mutations analysis provides a genetic diagnosis in 28% of Tunisian patients with primary hyperoxaluria

Abstract Background Primary hyperoxaluria type I (PH1) is a rare genetic disorder characterized by allelic and clinical heterogeneity. Four mutations (G170R, 33_34insC, I244T and F152I) account for more than 50% of PH1 alleles and form the basis for diagnostic genetic screening for PH1. We aimed to analyze the prevalence of these specific mutations causing PH1, and to provide an accurate tool for diagnosis of presymptomatic patients as well as for prenatal diagnosis in the affected families. Methods Polymerase chain reaction/Restriction Fragment Length Polymorphism, were used to detect the four mutations in the AGXT gene in DNA samples from 57 patients belonging to 40 families. Results Two mutations causing PH1 were detected in 24 patients (42.1%), with a predominance of the I244T mutation (68% of patients) and 33_34insC (in the remaining 32%). In 92% of cases, mutated alleles were in homozygous state. The presented clinical features were similar for the two mutations. The age of onset was heterogeneous with a higher frequency of the pediatric age. In 58.3% of cases, the presentation corresponded to advanced renal disease which occurred early ( Conclusion Limited mutation analysis can provide a useful first line investigation for PH1. I244T and 33_34insC presented 28.2% of identified mutations causing disease in our cohort. This identification could provide an accurate tool for prenatal diagnosis in the affected families, for genetic counselling and for detection of presymptomatic individuals.</p