Severity assessment of non-cystic fibrosis bronchiectasis by the FACED score

Objectives: Bronchiectasis (BE) is a major health problem associated with a high morbidity and mortality. This study aimed to determine the relation of the FACED score (a multidimensional score contributing to stratify patients into risk categories) with the severity of non-cystic fibrosis bronchiectasis (NCFB) among our population.Materials and Methods: This is a retrospective single center study of 105 consecutive patients with NCFB hospitalized for acute exacerbations (AE) at the Department of Respiratory Medicine of Fattouma Bourguiba Teaching Hospital in Monastir (Tunisia) between January 2005 and December 2017. Patients were divided into two groups (G): G1: FACED Score ≤ 2 and G2: FACED score ≥3. We compared different severity parameters of BE between the two groups.Results: The study included 105 patients with NCFB. Patients of G2 had more comorbidities (P = 0.028), an altered respiratory function with a lower forced vital capacity (G1:2.73, G2:1.33 L; P < 0.001), a decreased PaO2 (88 vs. 68 mmHg; P < 0.001), a high CO2 level (P < 0.001), and a higher number of AE/year (0.96, 2.12 AE/year; P < 0.001). Hospitalizations for AE of G2 were characterized by a lower PaO2, a higher PaCO2 (P < 0.001), a longer course of antibiotic (P < 0.001) with an extended hospitalization (P = 0.007). An ultimate evolution toward chronic respiratory failure was more common in G2 (P < 0.001).Conclusion: A high FACED score is associated with more symptoms, an altered respiratory function, a higher number and more severe AE, more health-care utilization with worse outcomes. Further studies are necessary to evaluate the impact of such scales in clinical practice

Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien

La cétose est une complication aiguë du diabète qui consiste en une accumulation de corps cétoniques sanguins. Malgré la haute prévalence du diabète cétosique décrite, il existe très peu d’informations concernant l’épidémiologie de cette complication inaugurale du diabète en Tunisie. L’objectif était de déterminer les caractéristiques épidémiologiques et clinico-biologiques des cétoses inaugurales dans un hôpital du Centre-Est tunisien. Il s’agit d’une étude rétrospective, transversale et exhaustive, à propos de patients admis pour une cétose inaugurale sur une période allant de janvier 2010 à août 2016. La population d’étude a été divisée en 2 groupes selon la présence ou pas d’une auto-immunité anti pancréatique: groupe DAI (diabète de type 1 auto-immun) regroupe tous les patients avec une auto-immunité, et le groupe DNAI (diabète cétosique non auto-immuns) sans auto-immunité. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’âge moyen de 34±14,33 ans. La prédominance masculine était nette: 68% dans la population générale. L’âge de la cétose était significativement plus précoce dans le groupe DAI. Un facteur précipitant la cétose était retrouvé chez 77,7% de la population globale d’étude, significativement plus fréquent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouvé était les infections virales. Les Anticorps anti thyroïdiens étaient significativement importants dans le groupe DAI. La cétose est un facteur de décompensation inaugurale fréquent du diabète en Tunisie. La population la plus importante a été décrite chez l’adulte jeune masculin, avec l’absence d’une auto-immunité, et un profil clinique du diabète de type 2

D 3 -MapReduce: Towards MapReduce for Distributed and Dynamic Data Sets

International audienceSince its introduction in 2004 by Google, MapRe-duce has become the programming model of choice for processing large data sets. Although MapReduce was originally developed for use by web enterprises in large data-centers, this technique has gained a lot of attention from the scientific community for its applicability in large parallel data analysis (including geographic, high energy physics, genomics, etc.). So far MapReduce has been mostly designed for batch processing of bulk data. The ambition of D 3-MapReduce is to extend the MapReduce programming model and propose efficient implementation of this model to: i) cope with distributed data sets, i.e. that span over multiple distributed infrastructures or stored on network of loosely connected devices; ii) cope with dynamic data sets, i.e. which dynamically change over time or can be either incomplete or partially available. In this paper, we draw the path towards this ambitious goal. Our approach leverages Data Life Cycle as a key concept to provide MapReduce for distributed and dynamic data sets on heterogeneous and distributed infrastructures. We first report on our attempts at implementing the MapReduce programming model for Hybrid Distributed Computing Infrastructures (Hybrid DCIs). We present the architecture of the prototype based on BitDew, a middleware for large scale data management, and Active Data, a programming model for data life cycle management. Second, we outline the challenges in term of methodology and present our approaches based on simulation and emulation on the Grid'5000 experimental testbed. We conduct performance evaluations and compare our prototype with Hadoop, the industry reference MapReduce implementation. We present our work in progress on dynamic data sets that has lead us to implement an incremental MapReduce framework. Finally, we discuss our achievements and outline the challenges that remain to be addressed before obtaining a complete D 3-MapReduce environment

Variability in Responses to Phoma medicaginis Infection in a Tunisian Collection of Three Annual Medicago Species

Spring black stem and leaf spot, caused by Phoma medicaginis, is an issue in annual Medicago species. Therefore, in this study, we analyzed the response to P. medicaginis infection in a collection of 46 lines of three annual Medicago species (M. truncatula, M. ciliaris, and M. polymorpha) showing different geographic distribution in Tunisia. The reaction in the host to the disease is explained by the effects based on plant species, lines nested within species, treatment, the interaction of species × treatment, and the interaction of lines nested within species × treatment. Medicago ciliaris was the least affected for aerial growth under infection. Furthermore, the largest variation within species was found for M. truncatula under both conditions. Principal component analysis and hierarchical classification showed that M. ciliaris lines formed a separate group under control treatment and P. medicaginis infection and they are the most vigorous in growth. These results indicate that M. ciliaris is the least susceptible in response to P. medicaginis infection among the three Medicago species investigated here, which can be used as a good candidate in crop rotation to reduce disease pressure in the field and as a source of P. medicaginis resistance for the improvement of forage legumes

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Morpho-phenological diversity among natural populations of Medicago polymorpha of different Tunisian ecological areas

Medicago polymorpha is a herbaceous legume that can be a useful pasture plant, in particular, in regions with a Mediterranean climate. The genetic variation in 120 lines of M. polymorpha sampled from five regions in Tunisia was characterized on the basis of 16 morpho-phenological characters. Results from analysis of variance (ANOVA) showed that differences among populations and lines existed for all traits, with population explaining the greatest variation for measured traits. The populations of Enfidha and Soliman were the earliest flowering, while those of El Kef, Bulla Regia and Mateur were the latest. El Kef and Mateur exhibited the highest aerial dry weight while the lowest value was found for Soliman. Moderate to lower levels of heritability (H²) were registered for investigated traits. There was no significant association between pairwise population differentiation (QST) and geographical distances. Studied lines were clustered into three groups with 59 for the first group, 34 for the second group, and 27 lines for the third group. The lines of the first two groups showed the largest length of stems while those of the second group had the highest number of leaves. The variation of quantitative traits among populations was influenced by the altitude, temperature and relative humidity. Overall, the high levels of within population variation and the lack of correlation between population differentiation and geographical distances suggest a potentially important rate of long-distance seed dispersal and confirm the role played by natural selection in the population structure of Tunisian populations of M. polymorpha.Keywords: Medicago polymorpha, populations, quantitative traits, population differentiation, environmental parameter

A Rare Case of Haemoptysis Revealing Aortic Coarctation in an Adult

Haemoptysis is a frequently occurring but sometimes life-threatening condition. Congenital cardiovascular abnormalities are rare causes of haemoptysis. We report a case of a 33-year-old man without any past medical history complaining of haemoptysis with no other associated clinical manifestations. A contrast-enhanced chest computed tomography scan revealed aortic coarctation with dilation of the internal mammary, intercostal and bronchial arteries. He underwent stent placement after balloon angioplasty with favourable outcomes