Dépression et niveau de fardeau chez les aidants familiaux des sujets déments en Tunisie

Introduction: La démence peut retentir lourdement sur les aidants familiaux du patient. Les objectifs de notre étude étaient de déterminer le niveau de fardeau et de la dépression chez les aidants familiaux de sujets déments, et d’identifier les facteurs associés à un niveau de fardeau élevé. Méthodes: Il s’agissait d’une enquête auprès de 65 aidants tunisiens. Les niveaux de fardeau et de la dépression ont été évalués par, respectivement, l’inventaire de Zarit et l’échelle de Beck. Résultats: Le taux des aidants qui avaient un niveau de fardeau élevé était de 52,3 %. Une dépression modérée ou sévère a été relevée chez 46,2 %. Un niveau de fardeau élevé était corrélé, du côté de l’aidant, avec le niveau socioéconomique moyen à élevé, la cohabitation avec le patient, le fait d’être son conjoint, la réduction des activités quotidiennes et la sévérité de la dépression, et, du côté du dément, avec l’agressivité. Conclusion: Les facteurs corrélés à un niveau de fardeau élevé orientent vers les cibles d’intervention et sont susceptibles d’être améliorés par la prise en charge, ce qui contribuerait à alléger la détresse des aidants

Maternal chronic oral infection with periodontitis and pericoronitis as a possible risk factor for preeclampsia in Egyptian pregnant women (microbiological and serological study).

Background: Several studies have hypothesized that oral infection may increase the risk of preeclampsia. We explore the relationship between chronic oral infection and the risk of preeclampsia in Egyptian pregnant women. Methodology: Forty preeclamptic women with periodontitis and/or pericoronitis (group I) and 40 control subjects having periodontitis and/or pericoronitis (group II) were subjected to microbiological assessment of subgingival plaque, pseudo-pocket and placental samples. TNF-a was determined in gingival crevicular fluid (GCF), saliva and serum by ELISA and real time PCR. Results: There was no statistically significant difference between the two groups as regards to subgingival plaque and pericoronal pseudo-pocket organisms revealed by culture and PCR. The total number of anaerobes in blood and placental samples was higher in preeclamptic group than controls. There was a statistically significant difference between the two groups as regards to the level of TNF-a by ELISA in serum (P-value ¼ 0.021). Conclusion: There was a relationship between chronic oral infection and preeclampsia, so treatment of oral infection during pregnancy may represent a novel approach and preventive strategy that reduce oral bacterial load which would decrease the incidence of preeclampsia

Quantitative chemical-shift MR imaging cutoff value: Benign versus malignant vertebral compression – Initial experience

Purpose: To evaluate the diagnostic accuracy of in-phase/opposed-phase quantitative chemical shift magnetic resonance (MR) imaging of the spine and to determine the cutoff value that enables differentiation of malignant from benign compression fractures, in patients with known primary malignancy. Patients and methods: Prospective assessment of thirty-two patients with known primary malignancy who presented with vertebral compression fractures, MR imaging of the spine at 1.5 Tesla with standard conventional MR sequences and additional chemical shift (in-phase/opposed-phase) imaging was done. Quantitative image analysis by drawing regions of interest (ROI) on the abnormal marrow of compressed (study group) and adjacent normal vertebra (control group) was also performed in each patient. The signal intensity ratio (SIR) of the marrow was determined by dividing the mean signal intensity on the opposed-phase to the mean signal intensity on the in-phase images and statistical analysis was performed. Results: Mean SIR of benign vertebral compression [0.73 ± 0.07 (range 0.12–1.2)] was significantly lower than malignant SIR values [1.72 ± 0.14 (range 0.8–2.96)] (p < 0.0001; area under the ROC curve, 0.97). The optimal SIR cutoff value for separating benign and malignant vertebral compression was found to be 0.91 with a calculated sensitivity of 93%, specificity of 82% and accuracy of 88%. Conclusion: Quantitative chemical shift MR imaging could be a valuable addition to standard MR imaging techniques and represent a rapid problem solving tool in differentiating benign from malignant vertebral compression, especially in patients with known primary malignancies

Pioglitazone versus metformin in two rat models of glucose intolerance and diabetes

Insulin resistance has been implicated in the pathogenesis of type 2 diabetes. High fat diets cause insulin resistance. Both metformin and pioglitazone are considered "insulin sensitizers" and used as antihyperglycemic agents for type 2 diabetes treatment. The aim of this study is to Compare pioglitazone and metformin effects on carbohydrate metabolism and insulin sensitivity in diabetic and glucose intolerant rats on high fat diet. Male albino rats were randomized to seven groups. The 1st group received high carbohydrate diet (control). The 2nd, 3rd and 4th groups received high sunflower oil diets for 6 weeks and either left untreated, or given pioglitazone or metformin during the last 3 weeks. The 5th, 6th, and 7th groups were made diabetic by STZ injection on day 15 of the 6 weeks-high fat diet regimen. They were either left untreated, or given pioglitazone or metformin during the last 3 weeks. High-fat diet induced glucose intolerance; represented by increase of serum glucose associated with increase in liver glucose-6-phosphatase and decreases in liver glucose-6-phosphate dehydrogenase and glucokinase activities. No significant differences were observed between pioglitazone and metformin. In diabetic rats, both pioglitazone and metformin decreased elevated serum glucose by ~30%. Only metformin increased hepatic glycogen, and normalized glucose-6-phosphatase activity. On the other hand, pioglitazone normalized elevated renal glycogen content and increased glucose-6-phosphate dehydrogenase activity. High sunflower oil diet impaired glucose tolerance. Pioglitazone and metformin had comparable effects on estimates of carbohydrate metabolism and insulin sensitivity in high-fat fed rats, but different effects in diabetic rats

Magnesium sulphate optimises surgical field without attenuation of the stapaedius reflex in paediatric cochlear implant surgery

Background and Aims: The anaesthesia technique for paediatric cochlear implantation should be modified to achieve an optimised surgical field and allow neuromonitoring. Total intravenous anaesthesia (TIVA) provides good surgical condition without affecting intraoperative electrical stapaedial reflex threshold (ESRT). Though magnesium sulphate (MgSO4) is a cheap, readily available drug for controlled hypotension, it can decrease the amplitude of motor-evoked potentials. This study aimed to evaluate the effect of MgSO4 infusion on quality of surgical field, intraoperative ESRT, and anaesthetic requirements in paediatric cochlear implant surgery performed under TIVA. Methods: In this randomised controlled trial, 66 children (1-6 years) undergoing cochlear implant under TIVA were randomly assigned to control group or MgSO4 group. The primary outcome was quality of surgical field, and the secondary outcomes were mean arterial blood pressure (MAP), heart rate (HR), ESRT, and the intraoperative anaesthetic requirements. The incidence of adverse events was recorded as well. Results: The quality of surgical field was better in group M than group C, P < 0.02. The number of children who achieved optimum surgical conditions (scores ≤2) was significantly better in the group M (n = 23/33, 70%) compared with group C (n = 13/33, 39%), P < 0.001. MAP, HR, and anaesthetic requirements were significantly lower in group M, P < 0.05. There were no differences between both groups regarding ESRT response. Conclusion: Magnesium sulphate IV infusion optimised surgical field and decreased anaesthetic requirements without attenuating the ESRT in paediatric cochlear implant surgery performed under TIVA

Is vancomycin monitoring of real value in pediatric cancer patients?

Vancomycin is not nephrotoxic by itself but many patients using it with other nephrotoxic agents show nephrotoxicity to some extent. Whether to monitor or not to monitor vancomycin needs further study. The aim of the present study was to investigate the significance of monitoring vancomycin serum levels in pediatric patients treated from different malignancies. 150 newly diagnosed pediatric patients, with various types of malignancy treated with different nephrotoxic agents including vancomycin, were recruited in the study. All patients had normal renal functions at the start of the study and were divided into three groups; Group I included 50 (21 females) patients received vancomycin without monitoring (VWOM group); Group II included 50 (19 females) patients received vancomycin with monitoring (VWM group); Group III (Control group) included 50 (23 females) patients received vancomycin-free antimicrobial agents (VF group). Vancomycin trough level was determined only for VWM group. The effectiveness of monitoring was estimated by the ability to achieve more rapid response, decrease hospital stay and nephrotoxicity and its effect on total dose of vancomycin. There was a significant decrease in nephrotoxicity in VWM and VF groups, 9 subjects (18%), compared to 15 subjects (30%) in VWOM group (p=0.016). The time needed to show a response achievement was significantly decreased in VWM group compared to VWOM group with mean (SD) of 6.5 (2.5) and 8.7 (3.6) days, respectively (p=0.015). That led to shorter hospital stay in VWM group compared to VWOM group with mean (SD) of 10.1 (3.4) and 12.4 (4.2) days, respectively (p=0.003). Monitoring vancomycin level was important in the examined high risk groups of pediatric cancer patients studied. [Med-Science 2018; 7(1.000): 54-57

Bovine herpesvirus-4-vectored delivery of nipah virus glycoproteins enhances T cell immunogenicity in pigs

Nipah virus (NiV) is an emergent pathogen capable of causing acute respiratory illness and fatal encephalitis in pigs and humans. A high fatality rate and broad host tropism makes NiV a serious public and animal health concern. There is therefore an urgent need for a NiV vaccines to protect animals and humans. In this study we investigated the immunogenicity of bovine herpesvirus (BoHV-4) vectors expressing either NiV attachment (G) or fusion (F) glycoproteins, BoHV-4-A-CMV-NiV-GΔTK or BoHV-4-A-CMV-NiV-FΔTK, respectively in pigs. The vaccines were benchmarked against a canarypox (ALVAC) vector expressing NiV G, previously demonstrated to induce protective immunity in pigs. Both BoHV-4 vectors induced robust antigen-specific antibody responses. BoHV-4-A-CMV-NiV-GΔTK stimulated NiV-neutralizing antibody titers comparable to ALVAC NiV G and greater than those induced by BoHV-4-A-CMV-NiV-FΔTK. In contrast, only BoHV-4-A-CMV-NiV-FΔTK immunized pigs had antibodies capable of significantly neutralizing NiV G and F-mediated cell fusion. All three vectored vaccines evoked antigen-specific CD4 and CD8 T cell responses, which were particularly strong in BoHV-4-A-CMV-NiV-GΔTK immunized pigs and to a lesser extent BoHV-4-A-CMV-NiV-FΔTK. These findings emphasize the potential of BoHV-4 vectors for inducing antibody and cell-mediated immunity in pigs and provide a solid basis for the further evaluation of these vectored NiV vaccine candidates