RÉSUMÉ La présente étude transversale visait à évaluer les apports alimentaires journaliers chez les diabétiques de type 2 consultant au CHU Mohamed VI de Marrakech pendant le ramadan en 2010. Les données sociodémo graphiques et cliniques ont été collectées lors d'entretiens. L'appréciation des apports alimentaires qualitatifs et quantitatifs, basée sur les tables nutritionnelles françaises, a été effectuée par une diététicienne. Sur les 71 patients inclus, 55 % observaient le jeûne. La moyenne d'âge des participants était de 56,3 ans (ET 11,2). Il n'y avait pas de différences cliniques statistiquement significatives entre le groupe des jeûneurs et celui des nonjeûneurs, sauf pour le surpoids/l'obésité et la dépendance à l'insuline qui étaient plus fréquents chez les nonjeûneurs. L'apport calorique total journalier était significativement plus bas chez les jeûneurs que chez les nonjeûneurs (1447,5 [ET 756,3] Of the 71 patients recruited, 55% were fasting. The average age of participants was 56.3 (SD 11,2) years. There were no statistically significant clinical differences between the fasting and nonfasting groups except for overweight/obesity and insulin dependence, which were more prevalent in the nonfasting group. The mean total daily caloric intake was significantly lower in the fasting than nonfasting group [1447.5 (SD 756.3) versus 1919.0 (SD 823.4) Kcal/d], as was the carbohydrate, lipid and protein intake. Carbohydrate intake was 57% and 56% of total calories. Overall during Ramadan the diet of the fasting group was calorie deficient and inadequate while for nonfasters it was excessive, which put them at risk of complications. Nutritional education may be needed for diabetic patients for Ramadan.‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫التاسع‬ ‫املجلد‬ ‫الثالث‬ ‫العدد‬ 277

SummaryPrimary hyperparthyrodism (PHPT) is a common endocrine disease. It results from an inappropriate parathyroid hormone (PTH) secretion relative to serum ionized calcium level. Clinical manifestation of severe PHPT include bone disease called osteitis fibrosa cystica which reflects an increase osteoclastic resorption and osteoblastic activity. This high bone turnover is responsible of the occurrence of osteoclastomas, also named "brown tumors" (1). Rarely, PHPT may occur in inherited forms with association to fibrous jaw tumor that are unrelated to hyperparathyroidism. In this uncommon disease: hyperparathyroidism-jaw tumor (HPT-JT) syndrome, parathyroid tumor is frequently malignant and usually associated with nonendocrine malignancies (2). We report a case of a HPT-JT syndrome to focus on the differential diagnosis with brown tumors.KEY WORDS: hyperparathyroidism-jaw tumor syndrome; primary hyperparathyroidism; ossifying fibroma; brown tumor.

Insulin therapy is part of the treatment of type 1 or type 2 diabetes; Therapeutic education occupies a fundamental place in the management, whose main objective is to improve glycemic control and prevent complications of diabetes; including infections at the injection sites.

Insulinoma is an insulin-secreting pancreatic tumor responsible for hypoglycemia. It is a rare tumor that occurs in 1 to 4 persons / million in the population and represents 1 -2% of pancreatic tumors. The diagnosis is made by demonstrating, insulin secretion by measuring insulin levels and C-peptide in the presence of hypoglycemia and by demonstrating a pancreatic tumor by pancreatic CT and/or pancreatic MRI [5]. Surgical resection is the main modality for the treatment of insulinomas [1]. We report 2 observations of an insulinoma. A 47 year old patient, who consulted us for lipothymia associated with cold sweats and hunger, occurring preferably in the morning between 6 and 7 o’clock, The blood sugar level taken at the time of the malaise was 0.35 g/l. Assessment performed : Insulinemia ↑ : 701 pmol/l (18 -173), Peptide C↑: 2,35 pmol/ml ( 0,3- 1,4) in comparison with a hypoglycemia at 0,35 g/l. Abdominal MRI revealed a 16×16 mm nodule in the isthmus of the pancreas with poor vascularity compatible with an insulinoma. Observation 2: patient, 37 years, admitted for investigation and management of hypoglycemia ranging from 0.3 g/l occurring during physical activity. Workup performs: fasting test: peptide C↑: 3 ng/ml (1.1-1.47), insulinemia: 22.6 mUI/l (2.6- 24.9) vs. hypoglycemia 0.50 g/l, insulin/glycemia ratio=0.45 (normal <0.3), turner index:113 (normal <50). Normal abdominal CT scan completed by pancreatic MRI: pancreatic nodule in the isthmic region of 13*8 mm compatible with an insulinoma. Octreoscan: a hyperfixing focus on an isodense nodule of the head-neck junction of the pancreas measuring approximately 12*13 mm compatible with an insulinoma. Surgical management: enucleation. favorable evolution marked by the disappearance of hypoglycemia.

No abstract