Graves' Disease Associated with Cerebrovascular Disease and Antiphospholipid Antibody Syndrome

Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome

Micro adénome à prolactine à l’âge de la ménopause

L'adénome à prolactine est rare chez la femme âgée. Le tableau clinique peut être confondu avec les manifestations de la ménopause, rendant son diagnostic parfois difficile. Nous rapportons une observation sur les particularités d'un micro adénome à prolactine survenant chez une femme âgée de 57 ans, qui a présenté une aménorrhée secondaire sans bouffées de chaleur associée à une galactorrhée évoluant depuis 2 ans. L’examen physique confirme la galactorrhée et la biologie montre une hyperprolactinémie à 2735 mUI /L, FSH = 15,1 UI/L et LH = 4,1UI/L. L’IRM hypophysaire montre un adénome gauche de 8mm. L'évolution sous traitement dopaminergique était marqué par la reprise transitoire des cycles et apparition de bouffées de chaleur, normalisation de la prolactinémie et diminution de la taille de l'adénome.Mots clés: Prolactinome, péri ménopause, agoniste dopaminergiqueEnglish Title: Prolactin-secreting microadenoma in menopausal womenEnglish AbstractProlactin-secreting adenoma is rare in elderly women. Patient’s clinical picture may be confused with that of menopause, making diagnosis sometimes difficult. We report the case of a 57-year old woman with a 2-year history of secondary amenorrhea without hot flushes associated with galactorrhea in order to highlight the peculiarities of prolactin-secreting microadenomas. Physical examination confirmed the diagnosis of galactorrhoea and biology showed hyperprolactinemia at mIU/L, FSH = 15.1 IU/L and LH = 4,1 IU/L. Pituitary MRI showed left adenoma measuring 8 mm. Patient’s evolution under dopaminergic treatment was marked by the recovery, for a transitional period, of mestrual cycles and the occurrence of hot flushes, normalization of prolactin levels and reduction of adenoma size.Keywords: Prolactinoma, perimenopause, dopaminergic agonis

Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien

La cétose est une complication aiguë du diabète qui consiste en une accumulation de corps cétoniques sanguins. Malgré la haute prévalence du diabète cétosique décrite, il existe très peu d’informations concernant l’épidémiologie de cette complication inaugurale du diabète en Tunisie. L’objectif était de déterminer les caractéristiques épidémiologiques et clinico-biologiques des cétoses inaugurales dans un hôpital du Centre-Est tunisien. Il s’agit d’une étude rétrospective, transversale et exhaustive, à propos de patients admis pour une cétose inaugurale sur une période allant de janvier 2010 à août 2016. La population d’étude a été divisée en 2 groupes selon la présence ou pas d’une auto-immunité anti pancréatique: groupe DAI (diabète de type 1 auto-immun) regroupe tous les patients avec une auto-immunité, et le groupe DNAI (diabète cétosique non auto-immuns) sans auto-immunité. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’âge moyen de 34±14,33 ans. La prédominance masculine était nette: 68% dans la population générale. L’âge de la cétose était significativement plus précoce dans le groupe DAI. Un facteur précipitant la cétose était retrouvé chez 77,7% de la population globale d’étude, significativement plus fréquent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouvé était les infections virales. Les Anticorps anti thyroïdiens étaient significativement importants dans le groupe DAI. La cétose est un facteur de décompensation inaugurale fréquent du diabète en Tunisie. La population la plus importante a été décrite chez l’adulte jeune masculin, avec l’absence d’une auto-immunité, et un profil clinique du diabète de type 2

Case Report Graves' Disease Associated with Cerebrovascular Disease and Antiphospholipid Antibody Syndrome

Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome

Contribution of type 2 diabetes associated loci in the Arabic population from Tunisia: a case-control study

<p>Abstract</p> <p>Background</p> <p>Candidate gene and genome-wide association studies have both reproducibly identified several common Single Nucleotide Polymorphisms (SNPs) that confer type 2 diabetes (T2D) risk in European populations. Our aim was to evaluate the contribution to T2D of five of these established T2D-associated loci in the Arabic population from Tunisia.</p> <p>Methods</p> <p>A case-control design comprising 884 type 2 diabetic patients and 513 control subjects living in the East-Center of Tunisia was used to analyze the contribution to T2D of the following SNPs: E23K in <it>KCNJ11/Kir6.2</it>, K121Q in <it>ENPP1</it>, the -30G/A variant in the pancreatic β-cell specific promoter of Glucokinase, rs7903146 in <it>TCF7L2 </it>encoding transcription factor 7-like2, and rs7923837 in <it>HHEX </it>encoding the homeobox, hematopoietically expressed transcription factor.</p> <p>Results</p> <p><it>TCF7L2</it>-rs7903146 T allele increased susceptibility to T2D (OR = 1.25 [1.06–1.47], <it>P </it>= 0.006) in our study population. This risk was 56% higher among subjects carrying the TT genotype in comparison to those carrying the CC genotype (OR = 1.56 [1.13–2.16], <it>P </it>= 0.002). No allelic or genotypic association with T2D was detected for the other studied polymorphisms.</p> <p>Conclusion</p> <p>In the Tunisian population, <it>TCF7L2</it>-rs7903146 T allele confers an increased risk of developing T2D as previously reported in the European population and many other ethnic groups. In contrast, none of the other tested SNPs that influence T2D risk in the European population was associated with T2D in the Tunisian Arabic population. An insufficient power to detect minor allelic contributions or genetic heterogeneity of T2D between different ethnic groups can explain these findings.</p

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Diabète de type 1 post-traumatique chez un soldat de l’armée

L'influence du stress comme facteur précipitant l'apparition du diabète de type 1 est un sujet largement étudié dans la littérature. La relation entre les traumatismes physiques et psychologiques et le diabète ont été un sujet rarement étudié en milieu militaire. Le diabète post-traumatique reste toujours un sujet controversé. Nous rapportons le cas d'un soldat tunisien, sans antécédents personnels ou familiaux d’auto-immunité, qui a été diagnostiqué pour un diabète de type 1 au décours d’une agression physique lors de conflits sociaux entre les forces de l’ordre et les citoyens

Common polymorphisms of calpain-10 and the risk of Type 2 Diabetes in a Tunisian Arab population: a case-control study

Abstract Background Genetic variations in the calpain-10 gene (CAPN10), in particular the at-risk diplotype (112/121), were previously implicated with increased risk of type 2 diabetes (T2D). Methods We examined the association of CAPN10 UCSNP-43 (rs3792267), UCSNP-19 (rs3842570), and UCSNP-63 (rs5030952) SNPs with T2D in 917 Tunisian T2D patients and 748 non-diabetic controls. CAPN10 genotyping was done by PCR-RFLP. Results Enrichment of UCSNP-19 2R (minor) allele and 2R/2R genotype was found in T2D patients; the allele and genotype distribution of UCSNP-43 and UCSNP-63 alleles and genotypes were not significantly different between patient groups and non-diabetic control subjects. Regression analysis demonstrated progressive increases in T2D risk in 3R/2R [OR (95% CI) = 1.35 (1.08 - 1.68)] and 2R/2R [OR (95% CI) = 1.61 (1.20 - 2.18)] genotypes. Of the six haplotypes detected, enrichment of haplotype 111 (UCSNP-43/UCSNP-19/UCSNP-63) was seen in patients (Pc = 0.034); the distribution of the other haplotypes was comparable between patients and control subjects; neither haplotype 211 nor haplotype 212 was observed. Furthermore, the frequency of all CAPN10 diplotypes identified, including the "high-risk diplotype (112/121) reported for Mexican-Americans and Northern Europeans, were comparable between patients and controls. Conclusions CAPN10 UCSNP-19 variant, and the 111 haplotype contribute to the risk of T2D in Tunisian subjects; no significant associations between CAPN10 diplotypes and T2D were demonstrated for Tunisians.</p