Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children’s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia.Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014.Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%).Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician.Keywords: Flexible bronchoscopy, child, bronchoalveolar lavage, foreign body aspiration, pulmonary alveolar proteinosi

Cystic fibrosis in Tunisian children: a review of 32 children

Background: Cystic fibrosis is rare in Tunisia.Its diagnosis requires experienced specialists. Its prognosis is poor in developing countries.Objectives: To study the epidemiologic, clinical, genetic features and the therapeutic challenges of cystic fibrosis in Tunisian children.Methods: Covering a period of 21 years, this retrospective study included all patients with a definite diagnosis of cystic fibrosis from the Pediatrics Department B of The Children’s Hospital of Tunis.Results: Data from 32 children (14 boys and 18 girls) were collected. The diagnosis was made during the first year of life in 28 cases. Meconium ileus was found in 5 cases, respiratory manifestations in 22 cases, chronic diarrhea in 19 cases, faltering growth in 17 cases and a pseudo Barter syndrome in 2 cases. The sweat chloride test was positive in all cases. The most frequent mutation was F508del (56% of cases). Respiratory complications marked the outcome. Among our 32 patients, 15 patients (50%) died at an average age of 5 years and 3 months, mainly due to respiratory failure. The mean age of the surviving patients was 5 years.Conclusion: Cystic fibrosis prognosis is poor in our series compared to developed countries due to the longer diagnostic delay and the limited therapeutic options.Keywords: Cystic fibrosis, children, Tunisia

Mineral and heavy metals content in tilapia fish (Oreochromis niloticus) collected from the River Nile in Damietta governorate, Egypt and evaluation of health risk from tilapia consumption

This study was conducted to determine heavy metals and trace elements content in tilapia fish collected from three sources in Damietta governorate, Egypt and to evaluate the human health risk due to tilapia consumption. Tilapia samples were collected from two locations in the River Nile stream, tow fish farms and two sluiceways. Health risk assessment was evaluated based on the consumption habits of adult human. The results revealed that all samples vary in elements concentrations. The calculation of human health risk revealed that the consumption of tilapia in the three tested area does not pose any health risk except for Selenium. It could be concluded that consumption of such fish may be a risk for consumers who eat fish more than one time per week. Consequently, precautions should be taken and warning against eating tilapia fish caught from these regions should be announced.This study was conducted to determine heavy metals and trace elements content in tilapia fish collected from three sources in Damietta governorate, Egypt and to evaluate the human health risk due to tilapia consumption. Tilapia samples were collected from two locations in the River Nile stream, tow fish farms and two sluiceways. Health risk assessment was evaluated based on the consumption habits of adult human. The results revealed that all samples vary in elements concentrations. The calculation of human health risk revealed that the consumption of tilapia in the three tested area does not pose any health risk except for Selenium. It could be concluded that consumption of such fish may be a risk for consumers who eat fish more than one time per week. Consequently, precautions should be taken and warning against eating tilapia fish caught from these regions should be announced

Acute Pesticide Poisoning in Children: A Review of 50 Cases

Background: Pesticide poisoning is very common in Tunisia. Various factors are involved in the analysis of the clinical presentations and the severity of this condition. Major factors are the chemical nature of the pesticides and the quantity entered the body. Methods: This is a retrospective study, reporting the pediatric cases that presented to us with signs and symptoms of pesticide poisoning. Fifty cases pesticide poisoning were admitted to the hospital between January 2013 and October 2016. Results: A total of 50 pediatric cases were included in this study with the mean age of 3 years and 4months. The poisoning was accidental in 49 cases and self-inflicted in one, with the mode being oral (N=45), respiratory (N=2) and cutaneous (N=3). The average duration of hospital care for these patients was 2 hours and 30 minutes (range: 30 min-24 hr). The clinical manifestations of poisoning noted were due to muscarinic and nicotinic receptors inhibition. Upon clinical examination, 29 patients had no pesticide in the gastric lavage fluid and urine and demonstrated no abnormal cholinesterase activity. The therapeutic management was mainly symptomatic with antidote medications prescribed (atropine and oxime). All patients had favorable outcomes and no death occurred. Conclusion: This study demonstrated the frequency of pesticide poisoning in a pediatric setting and the importance of early management. Optimal therapeutic approaches were evaluated, demonstrating that prevention still remains the best solution in such cases

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children\u2019s respiratory diseases: the experience of a unique pediatric unit in Tunisia.

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children\u2019s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Keywords

Long-term outcome of Tunisian children with primary ciliary dyskinesia confirmed by transmission electron microscopy.

Background: Primary ciliary dyskinesia (PCD) is rare. Its diagnosis requires experienced specialists and expensive infrastructure. Its prognosis is variable. Objective: To study the long-term outcome of PCD in Tunisian children with ciliary ultra-structure defects detected by electron microscope. Methods: Covering a period of 20 years (1996-2015), this retrospective study included all patients with definite PCD (outer dynein arms (DA) defects and/or situs inversus) and presumed PCD (other ciliary ultra-structure defects). The clinical data and the investigations made were registered at diagnosis and during the follow-up. Results: Patients with a definite PCD (G1, n=7) were diagnosed earlier compared to those with a presumed PCD (G2, n=13) (2.5 vs. 9.3 years on average). At diagnosis, bronchiectasis was more frequent in G1 (3/7 vs. 4/13). The inner DA loss was constant in G1 and predominant in G2. The treatment adhesion was more often irregular in G2 (2/7 vs. 8/13). During a mean follow-up of 11 years, G1 showed less severe outcome (clubbing (0 vs. 3), bronchiectasis (3 vs. 11; more expanded in G2), proximal and distal airway obstruction (0/3 vs. 5/7), lobectomy (0 vs. 2), and death (0 vs. 2)). Conclusion: Precocious diagnosis and regular treatment may enhance the PCD prognosis

Cystic fibrosis in Tunisian children: a review of 32 children

Background: Cystic fibrosis is rare in Tunisia.Its diagnosis requires experienced specialists. Its prognosis is poor in developing countries. Objectives: To study the epidemiologic, clinical, genetic features and the therapeutic challenges of cystic fibrosis in Tunisian children. Methods: Covering a period of 21 years, this retrospective study included all patients with a definite diagnosis of cystic fibrosis from the Pediatrics Department B of The Children\u2019s Hospital of Tunis. Results: Data from 32 children (14 boys and 18 girls) were collected. The diagnosis was made during the first year of life in 28 cases. Meconium ileus was found in 5 cases, respiratory manifestations in 22 cases, chronic diarrhea in 19 cases, faltering growth in 17 cases and a pseudo Barter syndrome in 2 cases. The sweat chloride test was positive in all cases. The most frequent mutation was F508del (56% of cases). Respiratory complications marked the outcome. Among our 32 patients, 15 patients (50%) died at an average age of 5 years and 3 months, mainly due to respiratory failure. The mean age of the surviving patients was 5 years. Conclusion: Cystic fibrosis prognosis is poor in our series compared to developed countries due to the longer diagnostic delay and the limited therapeutic options

Gold octahedra nanoparticles (Au_0.03 and Au_0.045): Synthesis and impact on marine clams Ruditapes decussatus

The increased use of gold nanoparticles (AuNPs) in several applications has led to a rise in concerns about their potential toxicity to aquatic organisms. In addition, toxicity of nanoparticles to aquatic organisms is related to their physical and chemical properties. In the present study, we synthesize two forms of gold octahedra nanoparticles (Au_0.03 and Au_0.045) in 1.3-propandiol with polyvinyl-pyrrolidone K30 (PVPK30) as capping agent using polyol process. Shape, size and optical properties of the particles could be tuned by changing the molar ratio of PVP K30 to metal salts. The anisotropy in nanoparticles shape shows strong localized surface plasmon resonance (SPR) in the near infrared region of the electromagnetic spectrum. Environmental impact of Oct-AuNPs was determined in the marine bivalve, Ruditapes decussatus exposed to different concentrations of Au_0.03 and Au_0.045. The dynamic light scattering showed the stability and resistance of Au_0.03 and Au_0.045 in the natural seawater. No significant modification in vg-like proteins, MDA level and enzymatic activities were observed in treated clams with Au_0.03 even at high concentration. In contrast, Au_0.045 induced superoxide dismutase (SOD), catalase (CAT), glutathione transferase (GST) activities, in a concentration dependent manner indicating defense against oxidative stress. Enhanced lipid peroxidation represented by malondialdehyde content confirmed oxidative stress of Au_0.045 at high concentration. These results highlight the importance of the physical form of nanomaterials on their interactions with marine organisms and provide a useful guideline for future use of Oct-AuNPs. In addition, Vitellogenin is shown not to be an appropriate biomarker for Oct-AuNPs contamination even at high concentration. We further show that Oct-AuNPs exhibit an important antioxidant response without inducing estrogenic disruption

Trend in Energy Intensity and Carbon Performance in North Africa

Decoupling economic growth from environmental degradation and climate change, increasing resource efficiency, and promoting both sustainable production and sustainable lifestyles is a challenge in North Africa, a region where even a relative decoupling of income growth and carbon (CO2) emissions has not been achieved. This chapter aims to examine recent trends in emissions and the main drivers of improvement in the region's carbon intensity (carbon emissions per unit of GDP), energy intensity (energy use per unit of GDP), and per capita emissions. It also analyzes the effect of policies such as energy taxes and energy standards on the energy efficiency of SMEs in North Africa and suggests actions and policies to encourage structural transformation and ensure better energy efficiency