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S Chiheb

Publications and source records attributed to S Chiheb.

12 recordsLinked to original sources
PubMed2005

Blood glucose changes and adjustments of diet and insulin doses in type 1 diabetic patients during scuba diving (for a change in French regulations).

OBJECTIVE: In France, diabetic subjects were not allowed to dive. The principal risk is hypoglycemia during immersion. However scuba diving is allowed in many countries. To follow blood glucose changes, food intake and insulin adjustments in type 1 diabetic patients when diving, and to propose specific guidelines for such patients willing to practice recreational scuba diving. METHODS: Fifteen well-controlled (mean HbA1c: 7.2%) type 1 diabetic patients without complications were volunteer to dive under strict medical monitoring. They dove 8 times in 4 days in autumn at a depth of 20 meters, in 12 degrees C to 16 degrees C water. A strict protocol based on blood glucose was implemented to prevent hypoglycaemia. RESULTS: No case of hypoglycemia was observed and no faintness was reported underwater. Mean blood glucose before diving was 200 mg/dl (11 mmol/l). There was a mean fall in blood glucose of 40 mg/dl (2.2 mmol/l) during dives, a mean decrease in daily insulin doses by 19.3% on the last day. Daily energy intake was 3,225 Kcal in average. A continuous glucose monitoring (CGMS) was performed in one patient and showed a rather stable glycemia during immersion but a decrease within the 8 hours after. CONCLUSION: When respecting a strict protocol to prevent hypoglycaemia, the risk of hypoglycaemia appears quite low. We recommend an ideal glycemic goal of 200-250 mg/dl (11-13.75 mmol/l) before immersion, a higher reduction of insulin doses (-30%) and taking carbohydrates on board in any case. The present data have recently led the French diving federation (FESSM) to allow type 1 diabetic patients to dive with some restrictive qualification requirements: dives within the "safety curve" (no decompression curve), in above 14 degrees C water, depth limited to the median space range (6 to 20 meters), plus mandatory guidance by a diving instructor.

Blood Glucose↗
PubMed2002

[Male breast cancer in Morocco].

INTRODUCTION: Male breast cancer is a rare disease, often of late presentation and poor prognosis. The aim of this work was to analyze the different clinical and therapeutic features for this disease in men. PATIENTS AND METHODS: This was retrospective study including 12 cases of male breast cancer seen in the Dermatology department of Casablanca between 1988 and 1999. RESULTS: The mean age of the patients was 60 years and the mean delay to consultation was 27 months. The skin was involved by tumor in 11 cases. Ulceration of the skin by tumor was seen in eight patients, and direct extension of the tumor into the nipple without ulceration was seen in three patients. Axillary lymph node involvement was seen in eight patients. Seven patients with invasive disease had metastases at distance. Treatment was usually surgical. Complementary treatment included radiotherapy, chemotherapy and/or hormonotherapy. DISCUSSION: Although breast cancer in men is far less common than breast cancer in women, it is associated with less favorable prognosis because diagnosis is usually made at an advanced stage. Concerted efforts must be made to educate both the public and health professionals, in order to make earlier diagnosis and thereby improve prognosis.

Aged↗
PubMed2001

[Allgrove's syndrome].

INTRODUCTION: Triple A syndrome is an autosomal recessive disease causing achalasia, alacrima and adrenal involvement with isolated glucocorticoid deficiency. Less than 70 cases have been reported worldwide. We report a case of familial adrenal insufficiency with hyperpigmentation diagnosed in a 14 month-old child. CASE REPORT: A 2 year-old boy, a product of consanguineous parents, was referred to our institution for evaluation of melanoderma. Since birth the boy had suffered from vomiting and diarrhea. Aged 6 months, mucosal erosive lesions had appeared associated with fever and further complicated at the age of one year by alacrima. At the age of 14 months, hyperpigmentation of all the skin had occurred. The family history is significant: two siblings (a girl and a boy) died of hypoglycemia with melanoderma and alacrima at the age of 5 and 3 respectively. Physical examination showed generalized hyperpigmentation particularly marked on the lips and genitalia. The genitalia of our patient were normal. Cortisol was 23.7 microns/l (normal: 193-772); ACTH was 11,722 pg/ml (normal: 10-60) and computed tomography of the abdomen confirmed adrenal gland hypoplasia. Treatment was initiated with hydrocortisone at the dose of 10 mg/day. At the age of 3, the boy developed plantar hyperkeratosis. When solid food was introduced, vomiting and regurgitation increased. An oesophagogram with fibroscopy revealed achalasia of the cardia. This was successfully corrected by surgery. Schimer's test confirmed alacrima. DISCUSSION: Our case report, characteristic of triple A syndrome, is unusual in view of the presence of plantar keratoderma and absence of any neurological abnormalities.

Adrenal Insufficiency↗
PubMed2000

[Vogt-Koyanagi-Harada's disease: 3 cases].

BACKGROUND: Vogt-Koyanagi-Harada's disease is a bilateral chronic panuveitis sometimes associated with signs of meningo-encephalic, auditory and skin and nail involvement. We report 3 cases. CASE REPORTS: The first case was a 30-year-old woman who consulted for a red eye, low visual acuity, poliosis, and diffuse alopecia which had developed over 9 months. The ophthalmology examination disclosed anterior uveitis with retinal detachment. The second patient was a 9-year-old child who developed poliosis, canities, and achromic lesions over a 2 month period. The ophthalmology examination disclosed low visual acuity, irido-corneal synechiae and pigmented deposits on the anterior lens. The third patient was a 20-year-old man who consulted for alopecia, diffuse canities, and white body hair. The ophthalmology examination disclosed low visual acuity, anterior uveitis, and a serous chorio-retinal detachment. All three patients were given general corticosteroid therapy (1 mg/kg/d). The clinical course was favorable in all cases with however one case of recurrent ocular involvement and one case of pigmentation disorders. DISCUSSION: The diagnosis of Vogt-Koyanagi-Harada's disease was established in these three cases on the basis of the ocular and skin and nail signs. This rare disease usually occurs in young, often female, patients. The pathogenesis remains unknown. Among the three signs observed, ocular involvement is the most serious. Skin and nail signs are seen in two-thirds of cases. For rapid diagnosis and early treatment, this disease requires a multidisiplinary management associating the dermatologist and the ophthalmologist.

Adult↗
PubMed1999

[Leishmania tropica cutaneous leishmaniasis in an emerging focus in North Morocco: new clinical forms].

INTRODUCTION: Leishmania tropica cutaneous leishmaniasis is usually described as dry, small and self-healing lesions, mainly located on the face and occurring in stable endemic foci. In 1989, similar aspects were observed in a rural hypoendemic focus in center Morocco where about 60 cases were diagnosed. In contrast, an epidemic urban focus in Taza-North Morocco--was identified in 1995 with peculiar clinical aspects. Our objectives is to describe these clinical characteristics. PATIENTS AND METHODS: From October 1995 to November 1996, 132 cases were diagnosed from this new focus during a monthly active survey. Age, sex, duration of lesions, clinical aspects and therapeutic regimen were detailed for each patient. RESULTS: Among the patients, 56.8 p. 100 were women. Mean age was 24.6 +/- 21.5 years (range: 8 months to 85 years). The mean duration of lesions was 6.9 +/- 6.5 months and 91.4 p. 100 evoluted for less than one year. Impetiginized, ulcerocrusted and noduloulcerative forms were predominant (61 p. 100). Furthermore, severe, vegetant inflammatory and multiple lesions were observed in infants and elderly patients. Limbs were involved in 30 p. 100 of cases. Eighty-six patients were treated with intralesional glucantime regimen and cured in 72 p. 100 of cases. Intramuscular treatment by glucantime was required in case of multiple lesions and failure of local therapy. DISCUSSION: In this study, the high frequency of severe lesions in infants and elderly patients suggests that the introduction of the parasite occurred recently in this area. The brief duration of lesions confirms the acute character for cutaneous leishmaniasis related to L. tropica in this epidemic focus. The host immune status associated with parasite intrinsic factors probably plays a role in these perculiar clinical manifestations.

Adolescent↗
PubMedDate not supplied

Cutaneous leishmaniasis: an emerging epidemic focus of Leishmania tropica in north Morocco.

Cutaneous leishmaniasis in Morocco occurs mainly in the south and is caused by Leishmania major and L. tropica. In 1995, for the first time, 4 autochthonous cases were confirmed by smear and/or culture from the province of Taza in north Morocco. An active survey revealed 128 more cases. The number had increased gradually since 1994. Most of the cases (86%) came from the suburbs of the city of Taza. All cultured and typed parasites were characterized as L. tropica MON-102. A leishmanin skin test survey among a random sample of the exposed population showed an overall positivity rate of 19.9%, with no correlation with age or gender. The spatial distribution of the cases and skin test positivity, their occurrence in all age groups, the highly variable clinical picture, the severity and large size of lesions in older patients, the slow recovery of some treated patients, and the isoenzymic monomorphism of the parasite, all suggested that cutaneous leishmaniasis caused by L. tropica is an emerging disease in Taza.

Adolescent↗
PubMedDate not supplied

[Behçet's disease].

Explore the source record for details and available documents.

Adolescent↗