Étude lésionnelle et bactériologique des infections du sac vitellin (omphalites) chez les poussins chair, Nord-Est de la Tunisie

The present study was carried out for three objectives: firstly, to investigate the prevalence of the yolk sac infections in broilers in the northeast of Tunisia. The second goal was to know the main germs responsible for this problem. Finally, we aimed to study the sensitivity of isolated bacteria to the main antibiotics used in the field. A total of 170 chicks (3 to 8 days) were necropsied. Suspected yolk sacs were collected using sterile swabs and sent to the laboratory for bacteriological analysis and antibiogram. Overall prevalence of 55.3% (94 chicks) was assessed. Statistically significant difference was noted among the different age groups, with highly prevalence observed in 5 days old animals (76%). Bacteriological analysis revealed that 71.3% (67 chicks) showed single bacterial infection. E. coli was the most important isolated bacteria (74.5%), followed by Klebsiella spp. (31.9%), Salmonella spp. (10.6%), Proteus spp. (9.6%) and Staphylococcus aureus (2.1%). A high correlation was noted between the chick mortality and infection by E. coli, Klebsiella and Proteus. Tested bacteria isolates (109 isolates) to twelve antibiotic agents showed high sensitivity to streptomycin, colistin, amoxicillin and amoxicillin-clavulanic-acid. A higher resistance was noted to enrofloxacin. Multidrug resistant isolates were detected in 38 (34.9%) bacteria isolates. Keywords: Yolk sac infection, Bacteriology, Multidrug resistance, Broiler, TunisiaLa présente étude a un triple objectif: d’abord pour estimer la prévalence de l’infection du sac vitellin chez le poulet de chair dans les élevages du Nord-Est de la Tunisie. Le second objectif est d’identifier les principales bactéries responsables de ce problème. Enfin, nous visons l’étude de la sensibilité des souches isolées vis-à-vis des principales molécules d’antibiotiques utilisées sur le terrain.  Un total de 170 poussins (3-8 jours d’âge) est autopsié. Les sacs vitellins suspects sont prélevés moyennant des écouvillons stériles envoyés au laboratoire en vue des analyses bactériologiques et des antibiogrammes. La prévalence globale des omphalites est de 55,3% (94 poussins). Une différence statistiquement significative est notée selon les tranches d’âge, avec une plus grande prévalence observée chez les oiseaux âgés de 5 jours (76%). Les analyses bactériologiques ont révélé que 71,3% (67 poussins) des animaux montraient une infection bactérienne unique. E. coli est la bactérie la plus isolées (74,5%), suivie de Klebsiella spp. (31,9%), Salmonella spp. (10,6%), Proteus spp. (9,6%) et Staphylococcus aureus (2,1%). Une corrélation élevée est notée entre la mortalité des poussins et l’infection par E. coli, Klebsiella et Proteus. Les isolats testés (109 isolats) vis-à-vis de 12 antibiotiques montrent une sensibilité importante à la streptomycine, la colistine, l’amoxicilline et l’amoxicilline-acide clavulanique. Une résistance élevée est notée vis-à-vis de l’enrofloxacine. Une multi-résistance est détectée chez 38 souches (34,9%) isolées. Mots clefs: Infection du sac vitellin, Bactériologie, Multi-résistance aux antibiotiques, poulet de chair, Tunisi

CUTANEOUS MANIFESTATIONS OF PRIMARY IMMUNODEFICIENCY DISEASES IN TUNISIAN CHILDREN

Abstract. Skin manifestations are frequent among patients with primary immunodeficiency diseases (PIDs). Their prevalence varies according to the type of immunodeficiency. This review provides the reader with an up-to-date summary of the common dermatologic manifestations of PIDs among Tunisian children. We conducted a prospective study on two hundred and ninety children with immune deficiency. Demographic details (including age, sex, and consanguinity) with personal and family history were recorded. Special attention was paid to cutaneous manifestations. Dermatological involvements were grouped according to the etiology of their most prominent sign. Cutaneous manifestations were found in 164 patients (56.5%). They revealed the diagnosis of PIDs in 71 patients (24.5 %). The mean age at presentation was 21 months. Overall the most prominent cutaneous alterations were infectious. They accounted for 106 cases (36.55%). The most prevalent causes of cutaneous infections were bacterial: 93 cases (32.06%). Immuno-allergic skin diseases were among the common findings in our study. These include eczematous dermatitis found in 62 cases (21.38%). Malignancy related PIDs was seen in a boy with Wiskott Aldrich syndrome. He developed Kaposi’s sarcoma at the age of 14 months. Cutaneous changes are common among children with PIDs. In pediatric patients with failure to thrive, chronic refractory systemic manifestations often present in other family members, recurrent cutaneous infections unresponsive to adequate therapy, atypical forms of eczematous dermatitis or unusual features should arouse the suspicion of PIDs and prompt specialized immunologic consultation should be made

Clinicopathological and therapeutic features of metaplastic carcinoma of the breast: a study of 15 cases

Background: Metaplastic carcinoma of the breast is a rare entity containing a mixture of malignant epithelial and mesenchymal elements. The World Health Organization only recognized it as a distinct pathological entity since 2000. The aim of this study is to better characterize this rare disease.Methods: We reviewed retrospectively 15 cases of metaplastic carcinoma of the breast treated in our institute between 1994 and 2015. We analyzed clinical, histological, therapeutic and evolutive data.Results: All patients were females ranging from 29 to 75 years old (median, 50). Tumor size ranged from 20 to 150 mm (median, 72 mm). The Treatment consisted of radical mastectomy in 14 cases, often combined with post-operative radiation and/or chemotherapy. There were 8 cases of carcinosarcoma, 4 cases of spindle cell carcinoma and 3 cases of squamous cell carcinoma. Follow-up data were available on 12 patients. The median follow-up was 47 months (range, 10 to 146 months). Definitive nodal metastases were identified in 6 cases. One patient developed a local recurrence. Extranodal metastases occurred in 3 patients. Three patients died at median interval of 20 months (range, 13-30). Eight patients were alive with no evidence of recurrent or metastatic disease (median, 47 months) and one patient was alive with metastatic disease.Conclusions: Based on this series, metaplastic breast carcinoma is characterized by a large tumor size at presentation, a low frequency of nodal metastases and a high proportion of triple negativity. Our series is consistent with the literature

Extreme Idiopathic gigantomastia

Gigantomastia is a rare mastopathy of unknown cause. Due to mechanical and psychological complications related to excessive breast weights and volume, effective surgical treatment is required. Most cases of gigantomastia in the literature are associated with pregnancy or puberty and very rare cases of spontaneous gigantomastia have been reported We report a 38 years old woman with an idiopathic gigantomastia treated successfully with Thorek technique

Germline bi-allelic <i>SH2B3/LNK</i> alteration predisposes to a neonatal juvenile myelomonocytic leukemia-like disorder

Juvenile myelomonocytic leukemia (JMML) is a rare, generally aggressive myeloproliferative neoplasm affecting young children. It is characterized by granulomonocytic expansion, with monocytosis infiltrating peripheral tissues. JMML is initiated by mutations upregulating RAS signaling. Approximately 10% of cases remain without an identified driver event. Exome sequencing of 2 unrelated cases of familial JMML of unknown genetics and analysis of the French JMML cohort identified 11 patients with variants in SH2B3, encoding LNK, a negative regulator of the JAK-STAT pathway. All variants were absent from healthy population databases, and mutation spectrum was consistent with a loss of function of the LNK protein. A stoploss variant was shown to affect both protein synthesis and stability. The other variants were either truncating or missense, the latter affecting the SH2 domain that interacts with activated JAK. Of the 11 patients, 8 from 5 families inherited pathogenic bi-allelic SH2B3 germline variants from their unaffected heterozygous parents. These children represent half of the cases with no identified causal mutation in the French cohort. They displayed typical clinical and hematological JMML features with neonatal onset and marked thrombocytopenia. They were characterized by absence of additional genetic alterations and a hypomethylated DNA profile with fetal characteristics. All patients showed partial or complete spontaneous clinical resolution. However, progression to thrombocythemia and immunity-related pathologies may be of concern later in life. Bi-allelic SH2B3 germline mutations thus define a new condition predisposing to a JMML-like disorder, suggesting that the JAK pathway deregulation is capable of initiating JMML, and opening new therapeutic options

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Myocardial and liver iron overload, assessed using T2* magnetic resonance imaging with an excel spreadsheet for post processing in Tunisian thalassemia major patients

C24H33CINO5P , M r = 481.95, orthorhombic, P2~2121, a=8.026(2), b= 16.103 (6), c = 19.169 (5) A, V= 2478 (2) A 3, z = 4, O x = 1.29gem -3, CuKa radiation, 2= 1.54184A, g= 22.73 cm -~, F(000) = 1024, R = 0.037, wR = 0.037 for 3596 observed reflections and 391 variables. The structure was solved by automatic application of the vector-search orientation function and the DIRDIF structure expansion procedure. The structure contains phosphorinane anions and ephedrine cations which are linked in a three-dimensional network by N-H...O and O-H...O hydrogen bonds. The phosphorinane ring is in the chair conformation. The ephedrine is in the usual extended form. The structure of a diastereoisomer is reported by Kok, Wynberg, Garcia-Granda, Beurskens & Smit [Acta Cryst. (1988), C44, 2235-2237]