La production rentable de lait repose sur la maitrise de la reproduction. Une vache ne commence de produire du lait que lorsqu’elle met bas et cette production diminue graduellement et ne reviens à son niveau que lorsque la vache met bas de nouveau. De ce fait, l’augmentation des intervalles entre vêlages au delà des normes s’accompagne de pertes économiques importantes. La reproduction est, ainsi, d’une grande importance pour la réussite production laitière (Ball et Petters, 2004). Les infections utérines du post-partum (métrites et endométrites) peuvent s’accompagner d’infertilité, d’infécondité et d’augmentation du taux de réforme pour échec à la reproduction (Gautam et al., 2010, Sheldon et al., 2008). Les infections utérines du post-partum sont des infections non spécifiques dont la pathogénie dépend des facteurs non infectieux (des facteurs prédisposant, notamment la rétention placentaire) et des bactéries qui contaminent l’utérus pendant le post-partum (notamment Arcanobacterium pyogenes, Escherichia coli et les anaérobies strictes Gram négatif). Les antibiotiques sont souvent préconisés pour le traitement (LeBlanc et al., 2011). Pour le clinicien, le choix de l’antibiotique est généralement basé sur les études précédentes. Cependant, la sensibilité aux antibiotiques des bactéries en cause peut varier d’une région à l’autre, cette variation pourrait être attribuée aux habitudes d’utilisation des antibiotiques et à l’historique clinique de l’animal (Albihn et al., 2003). En Algérie, peu d’informations sont disponibles concernant les infections utérines du post-partum. Il parait donc utile de réaliser plusieurs études pour, d’une part, cerner le rôle des métrites dans les troubles de reproduction et, d’autre part, permettre une meilleure prise en charge des vaches malades. C’est dans ce contexte que vient s’inscrire le présent travail, visant principalement l’aspect bactériologique des infections utérines du post-partum. Problématique de l’étude Par cette étude on vise à répondre principalement aux questions suivantes : • Quelle est la situation épidémiologique des infections utérines de post-partum dans les élevages laitiers en Algérie? • Les stratégies de traitement appliquées par les vétérinaires sont-elles convenables ? Objectifs de l’étude Nous nous sommes fixés comme objectifs principaux de : 1- Etudier l’épidémiologie des infections utérines de post-partum dans des élevages laitiers, et évaluation de l’évolution avec ou sans traitement des vaches malades. 2- Isoler, puis identifier des principales bactéries. 3- Etudier la sensibilité, in vitro, aux antibiotiques des bactéries identifiées avec possibilité de caractérisation moléculaire.

Amniotic band syndrome (ABS) was first described by Montgomery in Montgomery (1832). It is a poorly known congenital malformation due to strangulation of the organs by an amniotic fibrous band. Several parts of the body can be affected: for instance, skull, face, neck, trunk and musculoskeletal system. It generally associates three types of anomalies namely, amputations, deformities, and malformations. There are two genuine theories covering this syndrome; the Intrinsic Theory associating the syndrome to a germline defect and the Purely Mechanical Extrinsic Theory related to the amniotic band. These theories have thoroughly tried to explain the disease and the organ involvement (Goldfarb et al., 2009). In the current study, we report a rare case of an open fracture of both leg bones with amniotic disease in a 10-day-old neonate who underwent surgical treatment. In our case, it is a surgical emergency where we try to explain its physiopathology and show how to operate it. We discuss likewise the appropriateness of using the expressions “leg fracture” and “congenital pseudarthrosis of the leg”. Finally, we describe a revised classification by Hall (1982) and Weinzweig (1994) of ABS incorporating a stage with bone involvement.

Background

Pediatric Rheumatology (PR) is a young specialty that has not yet gained momentum in Algeria. The aim of this study is the assessment of the perception of PR by pediatric residents in Algeria and the current practice of this young sub-specialty in our country.

Methods

Descriptive cross-sectional study evaluating the perception of PR by pediatric residents was created on Google forms and distributed via email and Facebook to be taken as a self-administered online survey.

The survey is composed of three parts: socio-demographic characteristics of the participant, current practice of PR and perspectives of PR training.

Results

Seventy-seven residents responded to the online questionnaire, with an average age of 30.40 ± 3.13 years and 65% of participants being female. Participation included different regions of Algeria (Batna, Annaba, Setif, Constantine, Algiers and Oran) and different levels of training (from the first year to the fifth year of residency)

Ninety-two percent (92%) of participants had managed PR consultations, with a frequency of once a week in 75.3% of cases and twice a week in 15.6% of cases. In 81% of cases, it was not the initial presentation. The patients were mainly referred by a general practitioner or a general pediatrician. The Management of these patients was provided by a general pediatrician in 69.4% of cases and only in 37.7% by a specialized pediatrician. In 71.4% of cases, there was no pediatric rheumatologist in the establishment where the resident was being trained.

The level of knowledge in PR was admitted to be poor by 59.7% of the respondents. Seventy-five percent of the residents wanted to have rotations dedicated to this sub-specialty during their training. Seventy percent thought that PR is equally as important to know as the other subspecialties in pediatrics (pediatric endocrinology, pediatric pneumology ...). Interest in further PR training was expressed by 80.5% of participants, given the chance.

Conclusion

This survey reinforces the perception that PR training needs to be improved in Algeria, especially as the number of PR consultations is on the rise.

The creation of specialized training in PR is becoming a necessity.

Background

Gourgerot-Sjögren syndrome (GSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands leading to dryness of the mucous membranes. It may also involve other organs and organ systems. GSS can be primary (pGSS) or secondary due to other autoimmune diseases. pSGS mainly affects women over 40 years old, but can occur at any age. GSS is rare in children and is often secondary to other diseases. We report the case of a 12-year-old girl with primary Gougerot-Sjögren Syndrome

Methods and results

A 12-year-old girl from Batna (Algeria) presented to her pediatrician in 2016 for a rash with arthralgia. She had no relevant past medical history and is the child of a non-consanguineous marriage. Clinical examination found a well-nourished child with a purpuric rash on her lower limbs. She complained of arthralgia without clinical signs of arthritis. The child also complained of a sensation of a foreign body and burning in both eyes. The eye exam was normal except for a positive Schirmer's test. There were no signs of parotitis. Laboratory tests showed an erythrocyte sedimentation rate (ESR) of 84 mm the first h and a negative C-reactive protein (CRP). She was also Leukopenic. Serological testing resulted in a positive Anti SS-A and Anti SS-B. The abdominal pelvic ultrasound was normal.

The patient was diagnosed with primary Gougerot-Sjögren Syndrome. Artificial tears and hydroxychloroquine were started as initial therapy. One year later we added an immunosuppressant (Methotrexate) due to the persistence of clinical signs.

Conclusion

Our case is particular in that primary Gougerot-Sjögren Syndrome is rare in children. Routine follow- up with this patient is important to determine whether it is indeed pGSS with pediatric onset or GSS secondary to another autoimmune disease.

Background

Pediatric Rheumatology is an orphan specialty in Africa which is gradually gaining importance across the continent.

Main body

This commentary discusses the current state of affairs in the sphere of Pediatric Rheumatology across Africa and offers practical strategies to navigate the challenges encountered in research, models of care, education and training. We outline the establishment, opportunities of growth and achievements of the Pediatric Society of the African League Against Rheumatism (PAFLAR).

Conclusion

This commentary lays the foundation for establishment of a formidable framework and development of partnerships for the prosperity of Pediatric Rheumatology in Africa and beyond.

Juvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA.

Contrairement à l'abstention-surveillance, la surveillance active est une modalité de prise en charge curative. Elle vise à retarder le traitement d'une tumeur peu agressive jusqu’au moment où elle le deviendra tout en restant dans la fenêtre de curabilité de la maladie. À travers une lecture de littératures, nous allons essayer de maitre la lumière sur la place et les modalités de la surveillance active, dans les groupes favorables des cancers de la prostate et de répondre aux questions suivantes : Pourquoi la surveillance active ? Pour qui ? Comment l’instauré ? et quand doit-on l’arrêter ? La majorité des essais, cliniques publiés s’accordent à dire, que la surveillance active est une attitude parfaitement adaptée aux patients du groupe favorable d’AMICO, voire même une partie du groupe intermédiaire bas risque. Les résultats en matière de survie globale et d’évènement métastatiques, sont similaires à ceux des patients traités d’emblée par chirurgie et ou radiothérapie, avec en plus moins de toxicité. La surveillance est basée essentiellement sur le dosage périodique du PSA, rebiopsie selon des protocoles propres à chaque équipe. La décision du passage aux traitements invasifs, sera conditionnée par la progression du score Gleason, selon des algorithmes dont certains, sont déjà validés à l’international. La surveillance active, doit faire partie intégrante des décisions de prise en charge des adénocarcinomes prostatiques localisés favorables. Cette attitude nous permet, d’éviter de surtraiter un grand nombre, de petites lésions non évolutives, tout en ayant la possibilité et les moyens, de rattraper les lésions qui progressent.

Objectives

To identify the changes in rheumatology service delivery across the five regions of Africa from the impact of the COVID-19 pandemic.

Methods

The COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for reporting results of internet e-surveys was adhered to.

Results

A total of 554 completed responses were received from 20 countries, which include six in Northern Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.5 ± 10.3 years of experience. A total of 77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal protective equipment continued to be held in only 293 (52.9%) rheumatologists’ practices. Teleconsultation modalities found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a national rheumatology COVID-19 registry in their country.

Conclusion

COVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and regional disparities are more apparent in the availability of local protocols and registries.

L’arthrite juvénile idiopathique (AJI) est la cause la plus fréquente du rhumatisme chez l’enfant. L’AJI est un terme générique qui regroupe toutes les formes d'arthrite chronique d'origine inconnue apparaissant avant l’âge de 16 ans. La classification des différentes entités de l’AJI était et reste toujours un sujet de discussion et de raffinement. La distinction de groupes plus homogènes permettra une thérapeutique plus ciblée. Le diagnostic de l’AJI est un diagnostic d’exclusion et il est purement clinique. Aucun test biologique n’est spécifique. Les explorations sont utiles dans le diagnostic différentiel et dans la définition de la sous-classification de la maladie. Établir le diagnostic d’une forme d’AJI est un défi qui nécessite parfois la demande d’avis d’expert pour une meilleure prise en charge diagnostique et thérapeutique. Il n’existe aucun traitement curatif pour l’AJI jusqu’aujourd’hui. Les avancées de connaissances de mécanismes physiopathologiques ont permis une meilleure approche thérapeutique de l’inflammation. L’avènement de la biothérapie ces dernières décennies a révolutionné la prise en charge de l’AJI et a nettement amélioré le pronostic.

Introduction. Des études ont fait émerger l’existence de risque de prédiabète chez les patients qui ont une combinaison, profil glycémique normal et une glycémie à 1 heure supérieure à 1,55 g/L. Nous avons étudié les effets des combinaisons glycémie 1 heure (Gly 1h) après une hyperglycémie provoquée par voie orale HGPO avec un profil glycémique normal. Méthode. Une HGPO standardisée a été réalisée chez 100 femmes obèses. 46 avaient un profil glycémique normal. Une GAJ <1,00 g/L et une glycémie à 2 heures, Gly 2h <1,40 g/L. Elles étaient classées en deux groupes. Le groupe 1 (G1) ayant une GAJ <1,00 g/L, subdivisé en (G1a) ayant une Gly 1h <1,55 g/L et G1b ayant une Gly 1h ≥ à 1,55 g/L. Le groupe 2 (G2) avec une Gly 2h <1,40 g/L, subdivisé en (G2a) ayant une Gly 1h <1,55 g/L et (G2b) ayant une Gly 1h ≥1,55 g/L. Les tests de sensibilité – spécificité et l’Odds ratio ont été calculés à la recherche d’éventuelles corrélations.

Résultats. Une corrélation très significative existait entre la Gly 1h ≥1,55 g/L chez les sous-groupes G1b (n=11, p=0,0001) et G2b (n=11, p=0,0007) et la valeur de 1,55 g/L. Cette valeur est hautement spécifique (spécificité 0,79) et moins sensible (sensibilité 0,64-0,54). L’Odds ratio était de [G1b=5,85 et G2b=3,41].

Conclusion. La Gly 1h à la valeur seuil de 1,55 g/L peut mieux mettre en évidence des profils glycémiques à risque cardiométabolique.

L’hyperglycémie provoquée par voie orale (HGPO) est indiquée et effectuée chez les patients pour lesquels on suspecte des anomalies du métabolisme du glucose. Les critères de diagnostic du diabète sont assez codifiés. Cependant l’état prédiabétique est associé à une perturbation moins prononcée de la glycémie à jeun et/ou de celle après 2 heures. Pour réaliser une HGPO, il faut mesurer la glycémie avant l’administration de 75 g glucose et deux heures après. Des prélèvements à 30, 60 et 90 minutes sont souvent réalisés en plus des deux prélèvements des temps obligatoires. Depuis quelques années, la mesure de la glycémie 60 minutes après l’administration de 75 g de glucose, est devenue une pratique de plus en plus courante. Cette pratique semble être plus fiable en post HGPO chez des sujets dont le profil glycémique normal et qui ont une glycémie à 60 minutes supérieure ou égale à la valeur de 1,55 g/L.

The new coronavirus infection COVID-19 has quickly become a global health emergency. Mortality is principally due to severe Acute Respiratory Distress Syndrome (ARDS) which relays only on supportive treatment. Numerous pathological, clinical and laboratory findings rise the similarity between moderate to severe COVID-19 and haemophagocytic lymphohistiocytosis (HLH). Etoposide-based protocol including dexametasone is the standard of care for secondary HLH. The protocol has been successfully used in HLHs that are secondary to EBV and H1N1 infections by inducing complete response and prolonged survival. These observations prompt to consider this cytotoxic therapy in HLH associated to moderately severe to severe forms of COVID-19.

Context: This is the first study on the phytochemistry, antioxidant, anticholinesterase, and antibacterial activities of Sedum caeruleum L. (Crassulaceae).

Objective: The objective of this study is to isolate the secondary metabolites and determine the antioxidant, anticholinesterase, and antibacterial activities of S. caeruleum.

Materials and methods: Six compounds (1–6) were isolated from the extracts of S. caeruleum and elucidated using UV, 1D-, 2D-NMR, and MS techniques. Antioxidant activity was investigated using DPPH^•, CUPRAC, and ferrous-ions chelating assays. Anticholinesterase activity was determined against acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) enzymes using the Ellman method. Antibacterial activity was performed according to disc diffusion and minimum inhibitory concentration (MIC) methods.

Results: Isolated compounds were elucidated as ursolic acid (1), daucosterol (2), β-sitosterol-3-O-β-d-galactopyranoside (3), apigenin (4), apigetrin (5), and apiin (6). The butanol extract exhibited highest antioxidant activity in all tests (IC₅₀ value: 28.35 ± 1.22 µg/mL in DPPH assay, IC₅₀ value: 40.83 ± 2.24 µg/L in metal chelating activity, and IC₅₀value: 23.52 ± 0.44 µg/L in CUPRAC), and the highest BChE inhibitory activity (IC₅₀ value: 36.89 ± 0.15 µg/L). Moreover, the chloroform extract mildly inhibited (MIC value: 80 µg/mL) the growth of all the tested bacterial strains.

Discussion and conclusion: Ursolic acid (1), daucosterol (2), β-sitosterol-3-O-β-d-galactopyranoside (3), apigenin (4), apigetrin (5), and apiin (6) were isolated from Sedum caeruleum for the first time. In addition, a correlation was observed between antioxidant and anticholinesterase activities of bioactive ingredients of this plant.

Four previously undescribed and one known oleanolic acid glycosides were isolated from the roots of Weigela stelzneri, and one previously undescribed and three known hederagenin glycosides were isolated from the leaves. Their structures were elucidated mainly by 2D NMR spectroscopic analysis and mass spectrometry as 3-O-β-D-glucopyranosyl-(1 → 2)-[β-D-xylopyranosyl-(1 → 4)]-β-D-xylopyranosyl-(1 → 4)-β-D-xylopyranosyl-(1 → 3)-α-L-rhamnopyranosyl-(1 → 2)-α-L-arabinopyranosyloleanolic acid, 3-O-β-D-glucopyranosyl-(1 → 2)-[β-D-xylopyranosyl-(1 → 4)]-β-D-xylopyranosyl-(1 → 4)-β-D-xylopyranosyl-(1 → 3)-α-L-rhamnopyranosyl-(1 → 2)-β-D-xylopyranosyloleanolic acid, 3-O-β-D-glucopyranosyl-(1 → 2)-[β-D-glucopyranosyl-(1 → 4)]-β-D-xylopyranosyl-(1 → 4)-β-D-xylopyranosyl-(1 → 3)-α-L-rhamnopyranosyl-(1 → 2)-β-D-xylopyranosyloleanolic acid, 3-O-β-D-glucopyranosyl-(1 → 2)-[β-D-xylopyranosyl-(1 → 4)]-β-D-xylopyranosyl-(1 → 4)-β-D-xylopyranosyl-(1 → 3)-α-L-rhamnopyranosyl-(1 → 2)-α-L-arabinopyranosyloleanolic acid 28-O-β-D-glucopyranosyl-(1 → 6)-β-D-glucopyranosyl ester, and 3-O-β-D-glucopyranosyl-(1 → 2)-α-L-arabinopyranosylhederagenin 28-O-β-D-xylopyranosyl-(1 → 6)-[α-L-rhamnopyranosyl-(1 → 2)]-β-D-glucopyranosyl ester. The majority of the isolated compounds were evaluated for their cytotoxicity against two tumor cell lines (SW480 and EMT-6), and for their anti-inflammatory activity. The compounds 3-O-β-D-glucopyranosyl-(1 → 2)-[β-D-xylopyranosyl-(1 → 4)]-β-D-xylopyranosyl-(1 → 4)-β-D-xylopyranosyl-(1 → 3)-α-L-rhamnopyranosyl-(1 → 2)-α-L-arabinopyranosyloleanolic acid and 3-O-β-D-glucopyranosyl-(1 → 2)-[β-D-xylopyranosyl-(1 → 4)]-β-D-xylopyranosyl-(1 → 4)-β-D-xylopyranosyl-(1 → 3)-α-L-rhamnopyranosyl-(1 → 2)-β-D-xylopyranosyloleanolic acid exhibited the strongest cytotoxicity on both cancer cell lines. They revealed a 50% significant inhibitory effect of the IL-1β production by PBMCs stimulated with LPS at a concentration inducing a very low toxicity of 23% and 28%, respectively.