Moncef Feki - Academia.edu (original) (raw)
Papers by Moncef Feki
Clinical Biochemistry, 2009
The study was aimed to test the predictive value of several potential cardiovascular factors and ... more The study was aimed to test the predictive value of several potential cardiovascular factors and markers for non fatal cardiovascular events (CVE) and overall mortality in Tunisian patients with renal failure. One hundred and fifteen renal failure patients were followed-up from 2000 to 2006. At enrollment, each patient underwent clinical examination and blood collection for analysis of lipid parameters, albumin, C reactive protein (CRP), parathyroid hormone (PTH), homocysteine and hemoglobin. Multivariate Cox regression models were applied to identify the predictors for non fatal CVE and overall mortality. During the follow up, seventeen patients were lost. Among the 98 remaining patients, 29 presented a non fatal CVE (21.5%) and 15 were deceased (11.1%). In univariate analyses, non fatal CVE were more frequent in smokers and in patients with high PTH concentrations and low HDL levels. Moreover, low albumin concentrations were univariately associated with overall mortality. In the multivariate analysis, non fatal CVE was significantly and independently associated with age [hazard ratio (95% confidence interval), 1.04 (1.01-1.08); p=0.028] and the upper quartile of PTH concentrations [2.68 (1.24-5.81); p=0.013]. Overall mortality was independently predicted by the bottom quartile of albumin concentrations [5.62 (2.02-15.6); p=0.001] and the upper quartile of CRP concentrations [3.20 (1.14-8.79); p=0.027]. Advanced age and high PTH levels are the main predictors of CVE, whereas low albumin and high CRP concentrations are the independent predictors of death in Tunisian renal patients. A better control of these factors would greatly increase the patient's survival rates.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 10, 2015
Annales de biologie clinique
Pregnancy is associated with physiological changes in thyroid function that may result in thyroid... more Pregnancy is associated with physiological changes in thyroid function that may result in thyroid insufficiency, especially in presence of autoimmunity or iodine deficiency. Gestational hypothyroidism has been associated with adverse health outcomes for both the mother and child, including increased miscarriage risk and delayed neuropsychological development in neonate and child. The severity of such complications mainly depends on the precocity and the adequacy of L-thyroxin treatment. There is no consensus regarding systematic thyroid function testing in pregnant women. But, the majority of authors are favorable for systematic screening, especially in iodine deficient or marginally sufficient areas. However, when systematic screening could not be performed for economic reasons, physicians should achieve aggressive case finding for thyroid disease during pregnancy.
Mediators of Inflammation, 2004
BACKGROUND : Peripheral blood CD8 T cells expressing interferon gamma and interleukin-4 (IL-4), a... more BACKGROUND : Peripheral blood CD8 T cells expressing interferon gamma and interleukin-4 (IL-4), and lacking CD28 molecules, were responsible for the dynamic interplay between peripheral blood and inflammatory sites. Introduction : The aim of the current study was to define in Behçet's disease (BD), CD8 T-cell subsets using CD28 and CD11b monoclonal antibodies, and the characterization of the Tc1/Tc2 ratio and perforin expression. Methods : Flow cytometry was used for intracytoplasmic cytokines and perforin expression. Effector cells were investigated by adhesion of CD8 T cells to human microvascular endothelial cells and by chemotaxis using b-chemokine. Results : Interferon-gamma-producing CD8 T cells in active and remission BD patients were increased, which induce a significant increase of the Tc1:Tc2 ratio in BD. CD8 CD28 CD11b T cells were found to be more expanded in BD patients than in agematched healthy controls. The expression of CD11b molecules in active BD allowed to CD8 CD28 / CD8 CD28 subsets to adhere to human microvascular endothelial cells, with more efficiency in BD. Using MIP-1a, we observed that the migratory process of CD28 CD11b is more important in BD. CD28 CD11b exhibited an increased perforin expression in BD patients. Conclusion : Taken together these results suggest the presence of immune activation, probably in response to a profound inflammation affecting BD patients. The physiopathological significance of these results were toward autoimmune diseases and/or infectious process.
Clinica Chimica Acta, 2000
... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methylt... more ... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methyltransferase deficiency: New clinical features, Pediatr Neurol 17 (1997), pp. 155157. ... [6] S. Stöckler, F. Hanefeld and J. Frahm, Creatine replacement therapy in guanidinoacetate ...
Atherosclerosis, 2000
Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous p... more Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, the insertion/deletion polymorphism located in the coding part of the signal peptide of apo B, associated with modification of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. No such study in the Tunisian population has been performed. The aim of our study was to assess the effect of insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in a sample of the Tunisian population. A total of 458 unrelated subjects (321 men and 137 women) were included. The insertion/deletion polymorphism was determined by electrophoresis on polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.74 and 0.26, respectively. These frequencies were similar to those found in other Caucasian populations. There was no significant difference in serum TC, TG, and HDL-C levels due to the influence of the genotypes. However, significant variation among the three genotypes was seen for LDL-cholesterol (p<0.001) and apo B (p<0.001) levels. Individuals homozygous for the Del allele had higher levels than individuals homozygous for the Ins allele, while individuals heterozygous for both alleles exhibited intermediate levels. When the data were analyzed in men and women separately, a similar effect was seen in both groups. Our results show that distribution of apo B insertion/deletion polymorphism in Tunisians is similar to other Caucasian population and confirm the reported association with serum LDL-cholesterol and apo B concentrations.
Annals of Nutrition and Metabolism, 2007
The objective was to compare the long-term effects of Artemisia herba-alba Asso decoction with a ... more The objective was to compare the long-term effects of Artemisia herba-alba Asso decoction with a green or black tea decoction, prepared without sugar, on the antioxidant processes in rats. The direct parameters used in the control of antioxidant processes were total antioxidant status, glutathione peroxidase activity and conjugated dienes, as early markers of lipid peroxidation. However, the indirect parameters used in this control were the body weight gains, plasma glucose and lipid concentrations, iron, copper and zinc status. After 9 weeks, artemisia or tea decoctions did not influence the daily food intake of the groups; however, they significantly decreased the weight gains. They significantly increased the total antioxidant status between 83.5 and 111% and the whole blood glutathione peroxidase activity between 23 and 38%. However, only the green tea and artemisia decoctions significantly decreased the plasma conjugated diene levels by 35 and 55.5%, respectively. Regarding the trace element status, artemisia, green or black tea decoctions significantly reduced the blood Fe by 28, 30 and 17%, respectively. Also, liver Fe tended to be lower in all treated groups as compared to the control group. In contrast, artemisia significantly increased both blood and liver Cu by 50 and 28% as compared to the control group. Moreover, they significantly decreased the plasma glucose and triglyceride levels between 29 and 40%. For the cholesterol, only the artemisia decoction significantly reduced the total blood cholesterol by 17%. Artemisia as well as green tea decoctions increased the total antioxidant status, whole blood glutathione peroxidase activity and zinc and copper status, and prevented weight gains and increases in conjugated dienes, plasma glucose, lipids and iron status. The beneficial antioxidant effects were in descending order: artemisia decoction &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = green tea decoction &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; black tea decoction. So, artemisia could constitute a good adjuvant to combat obesity, hyperglycemia, hypertriglyceridemia, hypercholesterolemia and particularly oxidative stress.
Pediatrics and neonatology, Jan 23, 2015
This study aims to assess vitamin A and E concentrations in the premature colostrum of lactating ... more This study aims to assess vitamin A and E concentrations in the premature colostrum of lactating Tunisian women and to identify maternal characteristics that may affect these concentrations. Human colostrum was obtained from 105 mothers who gave birth prematurely in the Centre for Maternity and Neonatology of Tunis (Tunisia). Retinol and alpha-tocopherol were analyzed in the colostrum and in plasma by high-performance liquid chromatography. Retinol and alpha-tocopherol concentrations were 57.5 ± 50.1 μg/dL and 1222 ± 772 μg/dL in the colostrum, respectively, and 51.7 ± 20.0 μg/dL and 1351 ± 772 μg/dL in plasma, respectively. Concentrations of each vitamin in the colostrum were positively correlated with their respective concentrations in plasma (r = 0.415, p = 0.001 for retinol and r = 0.392, p = 0.003 for alpha-tocopherol). In multivariate analysis, colostrum vitamin A was associated with plasma vitamin A and preeclampsia, while colostrum vitamin E was associated with plasma vitami...
Birth defects research. Part A, Clinical and molecular teratology, Jan 17, 2015
This study was conducted to determine whether low folate and vitamin B12 levels, as well as high ... more This study was conducted to determine whether low folate and vitamin B12 levels, as well as high homocysteine levels in pregnant women are associated with neural tube defects (NTDs) in Tunisia. A total of 75 NTDs pregnancies and 75 matched controls were included in the study. Their vitamin B12, folate, and red blood cell folate concentrations were measured using a radio-immunoassay kit and total homocysteine concentrations were determined using a fluorescent polarization immunoassay. Vitamin B12 and folate concentrations were lower in NTD-affected pregnant women than in controls (respectively, p = 0.009 and p < 0.001). Total homocysteine concentration was significantly higher in the NTDs group than in controls (p = 0.008). In the case group, the folate levels were positively related with vitamin B12 levels (r = 0.54; p < 0.001) and negatively correlated with total homocysteine levels (r = -0.19; p = 0.04). Besides, red blood cell folate levels were positively correlated with f...
Annales de medecine interne
To assess prolactin level and its possible role in the pathogenesis and disease expression of pat... more To assess prolactin level and its possible role in the pathogenesis and disease expression of patients with Behçet's disease (BD). Twenty-eight patients with the diagnosis of Behçet's disease were selected. They all fulfilled the international criteria for BD. The control group consisted of 17 males and 6 females. Patients are divided into subgroups according to the clinical and paraclinical characteristics such as disease duration, ocular, articular and neurological involvement. Serum prolactin was measured by ELISA using Merck Kits on a Maggia 7000 Analyser. The normal range in males was<17ng/ml in males and<18ng/ml in females. The mean PRL level in each group and subgroup was calculated and compared with Student's t test. The mean prolactin level in the BD group (mean=13.76, SD=6.82), was higher than in the control group (mean=10.13, SD=5.46) with no statistically significant difference. The mean prolactin levels in all subgroups of patients with BD were higher than normal, but no statistically significant difference was shown between these subgroups. Hyperprolactinemia occurred in a small number of patients with BD and its significance remained unclear. Serum PRL level did not correlate with disease manifestations and activity.
Clinical Chemistry
Background: Vitamin E (VE) is thought to be effective in preventing atherosclerosis. However, to ... more Background: Vitamin E (VE) is thought to be effective in preventing atherosclerosis. However, to date no consistent relationship has been identified between VE and coronary heart disease (CHD). This study was designed to assess the degree of association between VE and CHD in a sample of the Tunisian population. Methods: Sixty-two angiographically confirmed coronary atherosclerotic patients and 65 age-and sexmatched controls were included. VE was measured in plasma and in the LDL fraction by HPLC. Cholesterol, triglycerides, and phospholipids were measured by enzymatic methods. Results: A trend toward a meaningful decrease of plasma VE was observed in affected patients compared with controls (P ؍ 0.06). VE concentrations standardized for cholesterol and lipid concentrations were significantly lower (P <0.02) in coronary patients than in controls (4.35 ؎ 1.03 vs 4.82 ؎ 1.23 mmol/mol for cholesterol-adjusted VE and 2.35 ؎ 0.56 vs 2.66 ؎ 0.65 mmol/mol for lipid-adjusted VE, respectively). In the LDL fraction, only cholesterol-standardized VE was significantly lower in cases than controls (3.84 ؎ 1.13 vs 4.41 ؎ 1.16 mmol/mol). This association between VE and CHD remained unchanged independent of age, sex, smoking habit, hypertension, and diabetes. In CHD patients, lower lipid-adjusted VE was associated with enhanced LDL susceptibility to oxidation but without alteration of the serum fatty acid profile.
Physiological research / Academia Scientiarum Bohemoslovaca
Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous p... more Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, the insertion/deletion polymorphism located in the coding part of the signal peptide of apo B, associated with modification of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. No such study in the Tunisian population has been performed. The aim of our study was to assess the effect of insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in a sample of the Tunisian population. A total of 458 unrelated subjects (321 men and 137 women) were included. The insertion/deletion polymorphism was determined by electrophoresis on polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.74 and 0.26, respectively. These frequencies were similar to those found in other Caucasian populations. There was no significant difference in serum TC, TG, and HDL-C levels due to the influence of the genotypes. However, significant variation among the three genotypes was seen for LDL-cholesterol (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and apo B (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) levels. Individuals homozygous for the Del allele had higher levels than individuals homozygous for the Ins allele, while individuals heterozygous for both alleles exhibited intermediate levels. When the data were analyzed in men and women separately, a similar effect was seen in both groups. Our results show that distribution of apo B insertion/deletion polymorphism in Tunisians is similar to other Caucasian population and confirm the reported association with serum LDL-cholesterol and apo B concentrations.
Annales de medecine interne
Oxidative stress is suspected to intervene in certain chronic diseases. Much research has been de... more Oxidative stress is suspected to intervene in certain chronic diseases. Much research has been devoted to the relationship between vitamin E, a major lipid-soluble antioxidant, and certain widespread diseases. Experimental and epidemiological proof supports a protective effect of vitamin E in a number of pathological processes such as coronary heart disease, cancer, cataract, diabetes mellitus, and Alzheimer disease. Randomized clinical trials have not confirmed a beneficial effect of vitamin E supplementation on the progression of these diseases. Certain methodological biases could however have affected these studies, explaining conflicting results. These biases include inaccuracy of vitamin E intake estimates and changes in eating habits during the course of the survey. An insufficient supplementation period using an insufficient dose and inclusion of aged and high-risk patients are the main limitations of the reported clinical trials. Large scale randomized clinical trials including healthy and low-risk subjects, along with prolonged administration of high-dose natural vitamin E, associated with synergetic compounds, and testing on morphological or biological features, will allow a better understanding of the relationship between vitamin E and chronic diseases.
Annales de medecine interne
ABSTRACT
Gastroentérologie Clinique et Biologique
The study was aimed to evaluate osteoporosis prevalence in a group of Tunisian patients with infl... more The study was aimed to evaluate osteoporosis prevalence in a group of Tunisian patients with inflammatory bowel disease (IBD), to determine its risk factors, and to describe its mechanisms. We included 67 IBD patients, 43 patients with Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD) and 24 with ulcerative colitis (UC). Bone mineral density was measured at the lumbar spine and left femoral neck by dual-energy X-ray absorptiometry. We used T score to express bone loss (osteopenia: -2.5 SD&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;T&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;- 1 SD, osteoporosis: T&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; -2.5 SD). Biochemical assessment of serum total alkaline phosphatases, osteocalcin, parathyroid hormone, vitamin D, interleukin-6, and urinary degradation products of C-telopeptide of type I collagen (CrossLaps), was also performed. Prevalence of femoral osteoporosis was 31.8% and 13% in CD and UC patients, respectively and that of lumbar osteoporosis 40.9% and 8.7%, respectively. Femoral neck osteoporosis tended to be more frequent in CD (odds-ratios-OR=3.13 [95% CI: 0.79-12.5], P=0.09), in females (OR=2.20 [0.69-6.72], P=0,18) and in patients with active disease (OR=3.13 [0.94-10.00], P=0.06). Lumbar osteoporosis was significantly associated with CD (OR=7.14 [1.52-33.33], P&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Low body mass index&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 kg/m2, disease course &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 years and active disease tended to be associated with lumbar osteoporosis; the ORs were respectively 4.87 [0.92-25.80] (P=0.06), 4.21 [0.87-20.57] (P=0.06), and 2.33 [0.78-6.67] (P=0.13). No association was found with cumulated dose of steroids even when considering only CD. Patients with osteoporosis showed significant increased CrossLaps and interleukin-6 levels that indicate both high bone resorption and inflammatory activity. Osteoporosis is frequent in IBD patients, especially in CD patients. Female gender, malnutrition (body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 kg/m2), disease course (&amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 years) and active disease would be risk factors of bone mineral loss in IBD. Osteoporosis is associated with enhanced bone resorption, that seems be linked to excessive intestinal inflammation.
Annales de medecine interne
Vitamin E deficiency is frequently observed in human pathology. In most cases, deficiency is mode... more Vitamin E deficiency is frequently observed in human pathology. In most cases, deficiency is moderate and asymptomatic. Severe deficiency is rare and presents as a progressive neurological syndrome including cerebellar ataxia and posterior cord injury. Neuropathological and electrophysiological features confirm spinocerebellar degeneration. The pathophysiology of vitamin E deficiency nervous dysfunction is still unknown. Oxidative alterations due to the lack of the main lipid-soluble antioxidant could be involved. A few causes of vitamin E deficiency are recognized (malnutrition, impaired lipid absorption, specific anomaly of hepatic or intestinal secretion of vitamin E, excessive endogenous consumption), but diseases associated with vitamin E deficiency are numerous and divers. Symptomatic severe deficiency is constantly observed in ataxia with vitamin E deficiency and abetalipoproteinemia. Intestinal, hepatobiliary, and pancreatic diseases are often associated with more or less marked deficiency. Other pathological circumstances such as malnutrition, alcoholism, hemolytic anemia, renal failure and hemodialysis could be associated with moderated and asymptomatic vitamin E deficiency. Oral or regular administration of high-dose vitamin E is required for patients with symptomatic severe deficiency. An adapted supplementation is recommended for patients with a marginal vitamin E status.
Clinical laboratory
This study was aimed to determine the prevalence of several classical and non-classical cardiovas... more This study was aimed to determine the prevalence of several classical and non-classical cardiovascular risk factors, and to test their association with cardiovascular events in Tunisian patients with end-stage renal disease. A total of 35 chronic renal failure, 50 hemodialysed and 30 renal transplant recipient patients and 31 healthy subjects were included. Hypertension, elevated plasma concentrations of total homocysteine, fibrinogen, C-reactive protein, and lipoprotein(a) were highly prevalent in patients, whereas, smoking, hypertriglyceridemia, hypercholesterolemia, hypoHDLemia, and hypoalbuminemia were less common. In univariate analysis, cardiovascular events were associated with age, hypertension, and the top quartile of the total homocysteine and C-reactive protein values. When controlling for several potential confounding factors, cardiovascular events remained associated with age, hypertension (OR, 7.07; 95% CI, 1.76-28.34; P=0.01), and the top quartile of total homocysteine (OR, 10.41; 95% CI, 2.61-41.55; P=0.001) and C-reactive protein (OR, 3.99; 95% CI, 1.06-14.99; P=0.04).
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All pa... more The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged > 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. Beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group.
Clinical laboratory
... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methylt... more ... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methyltransferase deficiency: New clinical features, Pediatr Neurol 17 (1997), pp. 155157. ... [6] S. Stöckler, F. Hanefeld and J. Frahm, Creatine replacement therapy in guanidinoacetate ...
Clinical Biochemistry, 2009
The study was aimed to test the predictive value of several potential cardiovascular factors and ... more The study was aimed to test the predictive value of several potential cardiovascular factors and markers for non fatal cardiovascular events (CVE) and overall mortality in Tunisian patients with renal failure. One hundred and fifteen renal failure patients were followed-up from 2000 to 2006. At enrollment, each patient underwent clinical examination and blood collection for analysis of lipid parameters, albumin, C reactive protein (CRP), parathyroid hormone (PTH), homocysteine and hemoglobin. Multivariate Cox regression models were applied to identify the predictors for non fatal CVE and overall mortality. During the follow up, seventeen patients were lost. Among the 98 remaining patients, 29 presented a non fatal CVE (21.5%) and 15 were deceased (11.1%). In univariate analyses, non fatal CVE were more frequent in smokers and in patients with high PTH concentrations and low HDL levels. Moreover, low albumin concentrations were univariately associated with overall mortality. In the multivariate analysis, non fatal CVE was significantly and independently associated with age [hazard ratio (95% confidence interval), 1.04 (1.01-1.08); p=0.028] and the upper quartile of PTH concentrations [2.68 (1.24-5.81); p=0.013]. Overall mortality was independently predicted by the bottom quartile of albumin concentrations [5.62 (2.02-15.6); p=0.001] and the upper quartile of CRP concentrations [3.20 (1.14-8.79); p=0.027]. Advanced age and high PTH levels are the main predictors of CVE, whereas low albumin and high CRP concentrations are the independent predictors of death in Tunisian renal patients. A better control of these factors would greatly increase the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s survival rates.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 10, 2015
Annales de biologie clinique
Pregnancy is associated with physiological changes in thyroid function that may result in thyroid... more Pregnancy is associated with physiological changes in thyroid function that may result in thyroid insufficiency, especially in presence of autoimmunity or iodine deficiency. Gestational hypothyroidism has been associated with adverse health outcomes for both the mother and child, including increased miscarriage risk and delayed neuropsychological development in neonate and child. The severity of such complications mainly depends on the precocity and the adequacy of L-thyroxin treatment. There is no consensus regarding systematic thyroid function testing in pregnant women. But, the majority of authors are favorable for systematic screening, especially in iodine deficient or marginally sufficient areas. However, when systematic screening could not be performed for economic reasons, physicians should achieve aggressive case finding for thyroid disease during pregnancy.
Mediators of Inflammation, 2004
BACKGROUND : Peripheral blood CD8 T cells expressing interferon gamma and interleukin-4 (IL-4), a... more BACKGROUND : Peripheral blood CD8 T cells expressing interferon gamma and interleukin-4 (IL-4), and lacking CD28 molecules, were responsible for the dynamic interplay between peripheral blood and inflammatory sites. Introduction : The aim of the current study was to define in Behçet's disease (BD), CD8 T-cell subsets using CD28 and CD11b monoclonal antibodies, and the characterization of the Tc1/Tc2 ratio and perforin expression. Methods : Flow cytometry was used for intracytoplasmic cytokines and perforin expression. Effector cells were investigated by adhesion of CD8 T cells to human microvascular endothelial cells and by chemotaxis using b-chemokine. Results : Interferon-gamma-producing CD8 T cells in active and remission BD patients were increased, which induce a significant increase of the Tc1:Tc2 ratio in BD. CD8 CD28 CD11b T cells were found to be more expanded in BD patients than in agematched healthy controls. The expression of CD11b molecules in active BD allowed to CD8 CD28 / CD8 CD28 subsets to adhere to human microvascular endothelial cells, with more efficiency in BD. Using MIP-1a, we observed that the migratory process of CD28 CD11b is more important in BD. CD28 CD11b exhibited an increased perforin expression in BD patients. Conclusion : Taken together these results suggest the presence of immune activation, probably in response to a profound inflammation affecting BD patients. The physiopathological significance of these results were toward autoimmune diseases and/or infectious process.
Clinica Chimica Acta, 2000
... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methylt... more ... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methyltransferase deficiency: New clinical features, Pediatr Neurol 17 (1997), pp. 155157. ... [6] S. Stöckler, F. Hanefeld and J. Frahm, Creatine replacement therapy in guanidinoacetate ...
Atherosclerosis, 2000
Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous p... more Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, the insertion/deletion polymorphism located in the coding part of the signal peptide of apo B, associated with modification of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. No such study in the Tunisian population has been performed. The aim of our study was to assess the effect of insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in a sample of the Tunisian population. A total of 458 unrelated subjects (321 men and 137 women) were included. The insertion/deletion polymorphism was determined by electrophoresis on polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.74 and 0.26, respectively. These frequencies were similar to those found in other Caucasian populations. There was no significant difference in serum TC, TG, and HDL-C levels due to the influence of the genotypes. However, significant variation among the three genotypes was seen for LDL-cholesterol (p<0.001) and apo B (p<0.001) levels. Individuals homozygous for the Del allele had higher levels than individuals homozygous for the Ins allele, while individuals heterozygous for both alleles exhibited intermediate levels. When the data were analyzed in men and women separately, a similar effect was seen in both groups. Our results show that distribution of apo B insertion/deletion polymorphism in Tunisians is similar to other Caucasian population and confirm the reported association with serum LDL-cholesterol and apo B concentrations.
Annals of Nutrition and Metabolism, 2007
The objective was to compare the long-term effects of Artemisia herba-alba Asso decoction with a ... more The objective was to compare the long-term effects of Artemisia herba-alba Asso decoction with a green or black tea decoction, prepared without sugar, on the antioxidant processes in rats. The direct parameters used in the control of antioxidant processes were total antioxidant status, glutathione peroxidase activity and conjugated dienes, as early markers of lipid peroxidation. However, the indirect parameters used in this control were the body weight gains, plasma glucose and lipid concentrations, iron, copper and zinc status. After 9 weeks, artemisia or tea decoctions did not influence the daily food intake of the groups; however, they significantly decreased the weight gains. They significantly increased the total antioxidant status between 83.5 and 111% and the whole blood glutathione peroxidase activity between 23 and 38%. However, only the green tea and artemisia decoctions significantly decreased the plasma conjugated diene levels by 35 and 55.5%, respectively. Regarding the trace element status, artemisia, green or black tea decoctions significantly reduced the blood Fe by 28, 30 and 17%, respectively. Also, liver Fe tended to be lower in all treated groups as compared to the control group. In contrast, artemisia significantly increased both blood and liver Cu by 50 and 28% as compared to the control group. Moreover, they significantly decreased the plasma glucose and triglyceride levels between 29 and 40%. For the cholesterol, only the artemisia decoction significantly reduced the total blood cholesterol by 17%. Artemisia as well as green tea decoctions increased the total antioxidant status, whole blood glutathione peroxidase activity and zinc and copper status, and prevented weight gains and increases in conjugated dienes, plasma glucose, lipids and iron status. The beneficial antioxidant effects were in descending order: artemisia decoction &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = green tea decoction &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; black tea decoction. So, artemisia could constitute a good adjuvant to combat obesity, hyperglycemia, hypertriglyceridemia, hypercholesterolemia and particularly oxidative stress.
Pediatrics and neonatology, Jan 23, 2015
This study aims to assess vitamin A and E concentrations in the premature colostrum of lactating ... more This study aims to assess vitamin A and E concentrations in the premature colostrum of lactating Tunisian women and to identify maternal characteristics that may affect these concentrations. Human colostrum was obtained from 105 mothers who gave birth prematurely in the Centre for Maternity and Neonatology of Tunis (Tunisia). Retinol and alpha-tocopherol were analyzed in the colostrum and in plasma by high-performance liquid chromatography. Retinol and alpha-tocopherol concentrations were 57.5 ± 50.1 μg/dL and 1222 ± 772 μg/dL in the colostrum, respectively, and 51.7 ± 20.0 μg/dL and 1351 ± 772 μg/dL in plasma, respectively. Concentrations of each vitamin in the colostrum were positively correlated with their respective concentrations in plasma (r = 0.415, p = 0.001 for retinol and r = 0.392, p = 0.003 for alpha-tocopherol). In multivariate analysis, colostrum vitamin A was associated with plasma vitamin A and preeclampsia, while colostrum vitamin E was associated with plasma vitami...
Birth defects research. Part A, Clinical and molecular teratology, Jan 17, 2015
This study was conducted to determine whether low folate and vitamin B12 levels, as well as high ... more This study was conducted to determine whether low folate and vitamin B12 levels, as well as high homocysteine levels in pregnant women are associated with neural tube defects (NTDs) in Tunisia. A total of 75 NTDs pregnancies and 75 matched controls were included in the study. Their vitamin B12, folate, and red blood cell folate concentrations were measured using a radio-immunoassay kit and total homocysteine concentrations were determined using a fluorescent polarization immunoassay. Vitamin B12 and folate concentrations were lower in NTD-affected pregnant women than in controls (respectively, p = 0.009 and p < 0.001). Total homocysteine concentration was significantly higher in the NTDs group than in controls (p = 0.008). In the case group, the folate levels were positively related with vitamin B12 levels (r = 0.54; p < 0.001) and negatively correlated with total homocysteine levels (r = -0.19; p = 0.04). Besides, red blood cell folate levels were positively correlated with f...
Annales de medecine interne
To assess prolactin level and its possible role in the pathogenesis and disease expression of pat... more To assess prolactin level and its possible role in the pathogenesis and disease expression of patients with Behçet's disease (BD). Twenty-eight patients with the diagnosis of Behçet's disease were selected. They all fulfilled the international criteria for BD. The control group consisted of 17 males and 6 females. Patients are divided into subgroups according to the clinical and paraclinical characteristics such as disease duration, ocular, articular and neurological involvement. Serum prolactin was measured by ELISA using Merck Kits on a Maggia 7000 Analyser. The normal range in males was<17ng/ml in males and<18ng/ml in females. The mean PRL level in each group and subgroup was calculated and compared with Student's t test. The mean prolactin level in the BD group (mean=13.76, SD=6.82), was higher than in the control group (mean=10.13, SD=5.46) with no statistically significant difference. The mean prolactin levels in all subgroups of patients with BD were higher than normal, but no statistically significant difference was shown between these subgroups. Hyperprolactinemia occurred in a small number of patients with BD and its significance remained unclear. Serum PRL level did not correlate with disease manifestations and activity.
Clinical Chemistry
Background: Vitamin E (VE) is thought to be effective in preventing atherosclerosis. However, to ... more Background: Vitamin E (VE) is thought to be effective in preventing atherosclerosis. However, to date no consistent relationship has been identified between VE and coronary heart disease (CHD). This study was designed to assess the degree of association between VE and CHD in a sample of the Tunisian population. Methods: Sixty-two angiographically confirmed coronary atherosclerotic patients and 65 age-and sexmatched controls were included. VE was measured in plasma and in the LDL fraction by HPLC. Cholesterol, triglycerides, and phospholipids were measured by enzymatic methods. Results: A trend toward a meaningful decrease of plasma VE was observed in affected patients compared with controls (P ؍ 0.06). VE concentrations standardized for cholesterol and lipid concentrations were significantly lower (P <0.02) in coronary patients than in controls (4.35 ؎ 1.03 vs 4.82 ؎ 1.23 mmol/mol for cholesterol-adjusted VE and 2.35 ؎ 0.56 vs 2.66 ؎ 0.65 mmol/mol for lipid-adjusted VE, respectively). In the LDL fraction, only cholesterol-standardized VE was significantly lower in cases than controls (3.84 ؎ 1.13 vs 4.41 ؎ 1.16 mmol/mol). This association between VE and CHD remained unchanged independent of age, sex, smoking habit, hypertension, and diabetes. In CHD patients, lower lipid-adjusted VE was associated with enhanced LDL susceptibility to oxidation but without alteration of the serum fatty acid profile.
Physiological research / Academia Scientiarum Bohemoslovaca
Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous p... more Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, the insertion/deletion polymorphism located in the coding part of the signal peptide of apo B, associated with modification of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. No such study in the Tunisian population has been performed. The aim of our study was to assess the effect of insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in a sample of the Tunisian population. A total of 458 unrelated subjects (321 men and 137 women) were included. The insertion/deletion polymorphism was determined by electrophoresis on polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.74 and 0.26, respectively. These frequencies were similar to those found in other Caucasian populations. There was no significant difference in serum TC, TG, and HDL-C levels due to the influence of the genotypes. However, significant variation among the three genotypes was seen for LDL-cholesterol (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and apo B (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) levels. Individuals homozygous for the Del allele had higher levels than individuals homozygous for the Ins allele, while individuals heterozygous for both alleles exhibited intermediate levels. When the data were analyzed in men and women separately, a similar effect was seen in both groups. Our results show that distribution of apo B insertion/deletion polymorphism in Tunisians is similar to other Caucasian population and confirm the reported association with serum LDL-cholesterol and apo B concentrations.
Annales de medecine interne
Oxidative stress is suspected to intervene in certain chronic diseases. Much research has been de... more Oxidative stress is suspected to intervene in certain chronic diseases. Much research has been devoted to the relationship between vitamin E, a major lipid-soluble antioxidant, and certain widespread diseases. Experimental and epidemiological proof supports a protective effect of vitamin E in a number of pathological processes such as coronary heart disease, cancer, cataract, diabetes mellitus, and Alzheimer disease. Randomized clinical trials have not confirmed a beneficial effect of vitamin E supplementation on the progression of these diseases. Certain methodological biases could however have affected these studies, explaining conflicting results. These biases include inaccuracy of vitamin E intake estimates and changes in eating habits during the course of the survey. An insufficient supplementation period using an insufficient dose and inclusion of aged and high-risk patients are the main limitations of the reported clinical trials. Large scale randomized clinical trials including healthy and low-risk subjects, along with prolonged administration of high-dose natural vitamin E, associated with synergetic compounds, and testing on morphological or biological features, will allow a better understanding of the relationship between vitamin E and chronic diseases.
Annales de medecine interne
ABSTRACT
Gastroentérologie Clinique et Biologique
The study was aimed to evaluate osteoporosis prevalence in a group of Tunisian patients with infl... more The study was aimed to evaluate osteoporosis prevalence in a group of Tunisian patients with inflammatory bowel disease (IBD), to determine its risk factors, and to describe its mechanisms. We included 67 IBD patients, 43 patients with Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (CD) and 24 with ulcerative colitis (UC). Bone mineral density was measured at the lumbar spine and left femoral neck by dual-energy X-ray absorptiometry. We used T score to express bone loss (osteopenia: -2.5 SD&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;T&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;- 1 SD, osteoporosis: T&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; -2.5 SD). Biochemical assessment of serum total alkaline phosphatases, osteocalcin, parathyroid hormone, vitamin D, interleukin-6, and urinary degradation products of C-telopeptide of type I collagen (CrossLaps), was also performed. Prevalence of femoral osteoporosis was 31.8% and 13% in CD and UC patients, respectively and that of lumbar osteoporosis 40.9% and 8.7%, respectively. Femoral neck osteoporosis tended to be more frequent in CD (odds-ratios-OR=3.13 [95% CI: 0.79-12.5], P=0.09), in females (OR=2.20 [0.69-6.72], P=0,18) and in patients with active disease (OR=3.13 [0.94-10.00], P=0.06). Lumbar osteoporosis was significantly associated with CD (OR=7.14 [1.52-33.33], P&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Low body mass index&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 kg/m2, disease course &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 years and active disease tended to be associated with lumbar osteoporosis; the ORs were respectively 4.87 [0.92-25.80] (P=0.06), 4.21 [0.87-20.57] (P=0.06), and 2.33 [0.78-6.67] (P=0.13). No association was found with cumulated dose of steroids even when considering only CD. Patients with osteoporosis showed significant increased CrossLaps and interleukin-6 levels that indicate both high bone resorption and inflammatory activity. Osteoporosis is frequent in IBD patients, especially in CD patients. Female gender, malnutrition (body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 kg/m2), disease course (&amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 years) and active disease would be risk factors of bone mineral loss in IBD. Osteoporosis is associated with enhanced bone resorption, that seems be linked to excessive intestinal inflammation.
Annales de medecine interne
Vitamin E deficiency is frequently observed in human pathology. In most cases, deficiency is mode... more Vitamin E deficiency is frequently observed in human pathology. In most cases, deficiency is moderate and asymptomatic. Severe deficiency is rare and presents as a progressive neurological syndrome including cerebellar ataxia and posterior cord injury. Neuropathological and electrophysiological features confirm spinocerebellar degeneration. The pathophysiology of vitamin E deficiency nervous dysfunction is still unknown. Oxidative alterations due to the lack of the main lipid-soluble antioxidant could be involved. A few causes of vitamin E deficiency are recognized (malnutrition, impaired lipid absorption, specific anomaly of hepatic or intestinal secretion of vitamin E, excessive endogenous consumption), but diseases associated with vitamin E deficiency are numerous and divers. Symptomatic severe deficiency is constantly observed in ataxia with vitamin E deficiency and abetalipoproteinemia. Intestinal, hepatobiliary, and pancreatic diseases are often associated with more or less marked deficiency. Other pathological circumstances such as malnutrition, alcoholism, hemolytic anemia, renal failure and hemodialysis could be associated with moderated and asymptomatic vitamin E deficiency. Oral or regular administration of high-dose vitamin E is required for patients with symptomatic severe deficiency. An adapted supplementation is recommended for patients with a marginal vitamin E status.
Clinical laboratory
This study was aimed to determine the prevalence of several classical and non-classical cardiovas... more This study was aimed to determine the prevalence of several classical and non-classical cardiovascular risk factors, and to test their association with cardiovascular events in Tunisian patients with end-stage renal disease. A total of 35 chronic renal failure, 50 hemodialysed and 30 renal transplant recipient patients and 31 healthy subjects were included. Hypertension, elevated plasma concentrations of total homocysteine, fibrinogen, C-reactive protein, and lipoprotein(a) were highly prevalent in patients, whereas, smoking, hypertriglyceridemia, hypercholesterolemia, hypoHDLemia, and hypoalbuminemia were less common. In univariate analysis, cardiovascular events were associated with age, hypertension, and the top quartile of the total homocysteine and C-reactive protein values. When controlling for several potential confounding factors, cardiovascular events remained associated with age, hypertension (OR, 7.07; 95% CI, 1.76-28.34; P=0.01), and the top quartile of total homocysteine (OR, 10.41; 95% CI, 2.61-41.55; P=0.001) and C-reactive protein (OR, 3.99; 95% CI, 1.06-14.99; P=0.04).
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All pa... more The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged > 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. Beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group.
Clinical laboratory
... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methylt... more ... [3] V. Ganesan, A. Johnson, A. Connely, S. Eckhardt and RAH Surtees, Guanidinoacetate methyltransferase deficiency: New clinical features, Pediatr Neurol 17 (1997), pp. 155157. ... [6] S. Stöckler, F. Hanefeld and J. Frahm, Creatine replacement therapy in guanidinoacetate ...