Ectopic thyroid tissue: unusual differential diagnosis of cervical paraganglioma

Ectopic thyroid tissue (ETT) lateral to the midline is rare. Its occurrence in the carotid bifurcation is exceptional. We present a 45 years woman who consulted with a slow growing right cervical swelling. Clinical examination Ultrasonography, contrast enhanced CT and cervical MRI concluded to a paraganglioma. Intra-operatively, the tumor didn't have the characteristic aspect of a paraganglioma. Complete excision was performed. Histology concluded to an ectopic micro-vesicular thyroid adenoma.Previous literature was reviewed to summarize clinical and radiologic characteristics of such rare entity. Despite its rarity, ETT must be included in the differential diagnosis of cervical paraganglioma.Keywords: Ectopic thyroid, MRI, paraganglioma, surger

How does serum brain natriuretic peptide level change under nasal continuous positive airway pressure in obstructive sleep apnea-hypopnea syndrome?

Background: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with cardiovascular morbidity and mortality, which can be improved by using continuous positive airway pressure (CPAP) therapy. However, the pathophysiological links between the two kinds of disease and the mechanism of the CPAP effect remain incompletely understood. We aimed to inquire into the myocardial involvement in this relationship. We suggested that serum brain natriuretic peptide (BNP) is sensitive enough to detect myocardial stress caused by OSAHS.Design and methods: Sixty-four subjects without cardiovascular disease (21 controls, 24 normotensive OSAHS patients, and 19 hypertensive OSAHS patients) were analyzed for serum BNP at baseline and serially over 6 months. CPAP was applied to 23 patients with severe OSAHS.Results: At baseline, the serum BNP levels were significantly higher (p0.0001) in the OSAHS group (22.3914.79 pg/ml) than in the control group (9.296.75 pg/ml). Increased serum BNP levels were significantly associated with mean transcutaneous oxygen saturation (SpO2) (pB0.0001), minimal SpO2 (p0.002), oxygen desaturation index (p0.001), and total sleep time spent with SpO2 lower than 90% (p0.002). All patients with elevated BNP levels (]37 pg/ml) had moderate or severe OSAHS (11/43 OSAHS patients). The more severe the OSAHS, the higher the BNP levels were. However, only the difference between severe and mild OSAHS was statistically significant (p0.029). Hypertensive OSAHS patients had the highest baseline BNP levels (27.7916.74 pg/ml). They were significantly higher (p0.001) than in normotensive OSAHS patients (18911.72 pg/ml) (p0.039) and the controls (9.296.75 pg/ml). As compared with baseline, treatment with CPAP significantly decreased BNP levels in both hypertensive and normotensive OSAHS patients (respectively, from 36916.10 to 29.7914.29 pg/ml, pB0.001, and from 20910.09 to 1698.98 pg/ml, pB0.001). In contrast, the BNP levels slightly increased in the controls (from 9.296.75 to 9.597.02 pg/ml, p0.029), but there was no statistically significant difference in comparison with the baseline value. The effect of CPAP on BNP levels was more marked in patients with higher baseline BNP levels and those with the most prolonged nocturnal desaturation (p0.001, r0.65). It was also more marked in hypertensive OSHAS patients (p0.015, r0.72) in comparison with normotensive OSAHS patients (p0.03, r0.62).Conclusion: BNP seems to be sensitive enough to detect myocardial stress caused by OSAHS. As such, it is a potential marker for screening of preclinical cardiovascular damage in patients with untreated OSAHS. Application of CPAP decreases levels significantly in normotensive and particularly in hypertensive OSAHS. These findings are consistent with previous results suggesting the potential benefits of CPAP on cardiovascular outcome in OSAHS patients.Keywords: sleep apnea; brain natriuretic peptide; positive airway pressure therapy; myocardial stress; hypertensio

Obésité, activité physique et temps de sédentarité chez des adolescents scolarisés, âgés de 15 à 18 ans de la ville de Sfax (Tunisie)

Introduction: Le but de notre étude était d'évaluer la prévalence du surpoids et de l'obésité chez des adolescents scolarisés dans la ville de Sfax mais aussi, d'étudier son association avec le temps de sédentarité et l'activité physique (AP). Méthodes: La population étudiée était composée de 1695 adolescents âgés de 15-18 ans. Tous les participants avait rempli un questionnaire porté sur leurs activités physiques et temps de sédentarité, donné lors d'un entretien direct. Le niveau d'AP était évalué avec l'International Physical Activity Questionnaire (IPAQ) version courte. Résultats: Notre étude comportait 43,7% de garçons et 56,3% de filles. L'âge moyen était de 16,78 ± 1, 1 an. Dans notre échantillon, 23,4% des adolescents étaient en surpoids ou obèses. Le score de l'IPAQ nous a montré que le niveau d'AP de nos participants était faible dans 6,4%, modéré dans 65,4% et élevé dans 28,2% des cas. Nos résultats avaient démontré que l'augmentation du temps de sédentarité (plus de 2 h / jour) est associée à une augmentation significative de l'indice de masse corporelle (IMC) et du tour de taille (TT) (P <0,001). Alors qu'un niveau d'AP élevé et/ou la participation aux séances d'AP structurées dans le cadre scolaire et hors scolaire est accompagnée par une diminution significative de l'IMC et du TT (P <0,001). Conclusion: Nos résultats apportent une preuve supplémentaire sur la nécessité de promouvoir la vie active chez les jeunes Tunisiens.Pan African Medical Journal. 2015; 2

Occurrence of IMP-8, IMP-10, and IMP-13 metallo-β-lactamases located on class 1 integrons and other extended-spectrum β-lactamases in bacterial isolates from Tunisian rivers

BACKGROUND: Antibiotic-resistant bacteria have been surveyed widely in water bodies, but few studies have determined the diversity of antibiotic-resistant bacteria in river waters. This study was undertaken to investigate the origin of resistance among polluted river bacterial isolates in Tunisia. METHODS: In this study 128 isolates resistant to β-lactam antibiotics were obtained from 2 polluted rivers in the north of Tunisia. Isolates were identified using Phoenix phenotyping criteria. The occurrence of bla(TEM), bla(SHV), bla(CTX-M), bla(CMY), bla(VIM), and bla(IMP) was studied by polymerase chain reaction (PCR) amplification and sequencing, and the genetic relatedness of the 16 IMP-producing Klebsiella pneumoniae isolates was analyzed by comparison of XbaI pulsed-field gel electrophoresis (PFGE) profiles. RESULTS: Using Phoenix phenotyping criteria, diverse genera of bacteria were identified with different rates of prevalence and with different minimum inhibitory concentrations against different antibiotics. The occurrence of bla(TEM), bla(SHV), bla(CTXM), bla(CMY), bla(VIM), and bla(IMP) genes was confirmed. The DNA sequences upstream and downstream of bla(IMP) genes were determined, revealing that all IMP-encoding genes constituted the first cassette of class 1 integrons, followed by aacA gene cassettes encoding aminoglycoside resistance. Comparison of PFGE profiles showed that only 2 of the isolates were clonal, the other 14 displaying unique profiles. The bla(CTX-M) gene was the most dominant of the extended-spectrum β-lactamase (ESBL) genes, while the bla(TEM) gene was the second-most dominant. CONCLUSION: The discovery of highly diverse ESBL-producing bacteria and metallo-β-lactamases, particularly bla(IMP), in polluted river water raises alarms with regard to the potential dissemination of antibiotic-resistant bacteria in communities through river environments.This work was supported and fi nanced by the Ministry of Higher Education and Research of Tunisia and the Ministry of Sciences, Technology and Higher Education of Portugal.publishe

RNA polymerase II degradation in response to rapamycin is not mediated through ubiquitylation

International audienceIn Saccharomyces cerevisiae, the immunosuppressor rapamycin engenders the degradation of excessive RNA polymerase II leading to growth arrest but the regulation of this process is not known yet. Here, we show that this mechanism is dependent on the peptidyl prolyl cis/trans isomerase Rrd1. Strikingly this degradation is independent of RNA polymerase II polyubiquitylation and does not require the elongation factor Elc1. Our data reveal that there are at least two alternative pathways to degrade RNA polymerase II that depend on different type of stresses

A functional autophagy pathway is required for rapamycin-induced degradation of the Sgs1 helicase in Saccharomyces cerevisiae

International audienceIn yeast Saccharomyces cerevisiae, the immunosuppressant rapamycin mimics starvation by inhibiting the kinase Tor1. We recently documented that this treatment triggers a rapid degradation of Sgs1, a helicase involved in several biological processes such as the prevention of genomic instability. Herein, we show that yeast strains deleted for genes ATG2, ATG9, and PEP4, encoding components of the autophagy pathway, prevent rapamycin-induced degradation of Sgs1. We propose that defects in the autophagy pathway prevent degradation of key proteins in the rapamycin response pathway and as a consequence cause resistance to the drug