Imen HALLOUL

Introduction: Diabetic neuropathy is the most common chronic complication of diabetes. It is a heterogeneous condition including various types of nerve damage. The most prevalent form is symmetrical distal polyneuropathy, which is diagnosed clinically. It involves symmetric and bilateral impairment of nerves, mainly in the distal parts of the lower limbs. Pain associated with diabetic neuropathy is a major health issue and significantly impacts quality of life. The aim of our study is to examine podiatric disorders and quality of life in elderly diabetic patients with and without neuropathy. Patients and Methods: This is a case-control study involving 70 elderly diabetic patients (35 with neuropathy and 35 without), selected through non-probabilistic sampling over a 4-month period. Assessment included the SF-36 quality of life questionnaire, the DN4 score, and a complete clinical podiatric examination in an off-load podiatry assessment. Data entry and statistical analysis were conducted using SPSS version 25. Results: Our analysis revealed that elderly diabetic patients with neuropathy had significantly more comorbidities, trophic disorders, and podiatric issues. Comparison of average SF-36 scores and global quality of life scores between cases and controls showed significant differences across all assessed parameters. The overall score indicated a marked deterioration in both physical and mental health among cases compared to controls, with mean scores of 37.09 and 69.82, respectively (p

Background : Diabetes mellitus is a public health problem. Diabetic foot is one of its major complications and is secondary to neuropathy, arteriopathy, infectious and mechanical foot involvement. It is a major cause of lower limb amputation and thus of motor disability. Material and methods We propose a descriptive study of the main anomalies found in the examination of thefeet in 40 patients with type 1 diabetes. Results: The median age of our population was 34.5 years. The average duration of diabetes was 25.35 years. 15% of people have neuropathic pain, and about one third describe the pain as severe. Hallux valgus and claw toes were observed in 35% of patients and a Charcot foot was found in 2 patients. 10% of subjects already had stage 4 arterial disease and 10% had intermittent claudications. The results of the care of 3 patients through telemedicine are encouraging. Management was early and further damage was prevented. Conclusion: Foot involvement in diabetes mellitus is common and often severe. Early intervention, via telemedicine, could improve outcomes.

Introduction: Treatment of Graves' disease (GD) is based on the triad of antithyroid drugs (ATD), radioactive iodine and surgery (total or subtotal thyroidectomy). ATD remains the first-line treatment. Aim: To determine predictors of GD remission after treatment with ATD. Methods: Cross-sectional study for analytical purposes including 105 patients followed for GD treated with ATD for 12 to 18 months. The collection of clinical and biological data was done through the consultation of medical records. Patients were divided to two groups according to their outcome. The "Remission" group included patients with durable euthyroidism after treatment withdrawal. The "Failure" group included patients who did not achieve euthyroidism at the end of treatment or who had relapsed after treatment withdrawal. Results were compared using Chi-Square test and t-test and logistic regression model with significance at p Results: Patients in the "Remission" group were 43 (40.95%) and patients in the "Failure" group were 62 (59.05%). Factors that were significantly associated with remission at univariate analysis were: a shorter duration of symptom progression, a shorter duration of treatment, a lower initial anti-TSH receptor antibodies level, methimazole use compared to Benzylthiouracil use and better therapeutic adherence. Multivariate analysis showed that only shorter treatment duration (p = 0.01, OR = 0.90, IC95% [0.87 0.97]), lower initial anti-TSH receptor antibodies level (p = 0.016; = 0.93, IC95% [0.87-0.98]) and methimazole use (p = 0.048, OR = 2.4, IC95% [1.00-5.74]) were significant predictors of remission. Conclusion: A lower initial level of anti-TSH receptor antibodies, the use of methimazole compared to Benzylthiouracil as well as a shorter duration of treatment are factors of better prognosis in the outcome of Graves’ disease after Antithyroid drug treatment.

INTRODUCTION: Regular monitoring of growth and weight in children is crucial for effective child health surveillance. Growth retardation is suspected when a child's height falls below -2 standard deviations (SD) for age and sex, or when there is an abnormal growth velocity. Whereas endocrine causes account for less than 10% of growth retardation cases, they are essential to identify, as they require specific treatment. Growth Hormone Deficiency (GHD) is one such endocrine cause, with a prevalence ranging from 1 in 4,000 to 1 in 10,000 in Europe and the U.S. Advancements in diagnostic methods have improved early detection, allowing more children to benefit from treatment. The objective of this study is to investigate the therapeutic aspects and outcomes for children followed for GHD to identify the factors influencing the results of GH treatment. METHODS: A descriptive retrospective study was conducted on patients hospitalized or followed for GHD at the Endocrinology Department of Farhat Hached University Hospital in Sousse from January 2000 to December 2020. Data were collected using a form that included epidemiological data, familial and personal history, clinical data at first consultation, bone age assessment, initial biological assessment, and substitutive treatment details. RESULTS: The study enrolled 102 children (63 boys and 39 girls), with a mean age of 12±3.83 years at diagnosis. The mean height at diagnosis was 128±17 cm. GH deficiency was classified as complete in 63.7% and partial in 36.3% of cases. Associated deficits were found in thyrotropic (14.7%), corticotropic (19.6%), and gonadotropic (18.6%) axes. The average weekly dose of recombinant human growth hormone (rh-GH) was 0.7±0.12 IU/kg, and the mean stature gain under treatment was 17.5±14.5 cm, with a final height of 148±14 cm on average. Notably, younger children at the start of treatment showed greater stature gains, and regular adherence to treatment significantly correlated with improved outcomes. Overall, definitive stature gain was primarily associated with the frequency of GH injections and treatment regularity. The multivariate study showed that definitive stature gain was only associated with the frequency of GH injection and the regularity of treatment. CONCLUSION: The study concludes that GH treatment can significantly enhance growth in children with GHD, but various factors, including timing of initiation, adherence to therapy, and individual patient characteristics, can affect whether the final adult height aligns with parental expectations. Stature gain can also be improved by emphasizing early diagnosis, patient education, and treatment adherence.