Przetoka wieńcowa uchodząca do lewej komory z objawami dławicy piersiowej

Coronary arterial fi stula is a rare defect characterized by a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. Complications include ‘steal’ from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fi brillation, rupture, endocarditis/endarteritis and arrhythmias. Here we report the case of a 73-year-old female that was admitted for unstable angina. Coronary angiography revealed the presence of multiple large coronary-cameral fi stula. CT scan confi rmed the presence of ecstasis of the left main artery, associated with coronary-cameral fi stulae between left ventricle and ramus intermedius artery and the circumfl ex artery.Przetoka wieńcowa to rzadka wada naczyniowa polegającą na obecności połączenia między jedną lub większą liczbą tętnic wieńcowych a jamą serca lub dużym naczyniem krwionośnym. Powikłania obejmują podkradanie krwi z przyległego obszaru mięśnia sercowego, zakrzepicę i zatorowość, niewydolność serca, migotanie przedsionków, pęknięcie, zapalenie wsierdzia/zapalenie ściany tętnic i zaburzenia rytmu. W niniejszej pracy przedstawiono przypadek 73-letniej chorej przyjętej do szpitala z powodu niestabilnej dławicy piersiowej. Koronarografi a ujawniła poszerzenie pnia lewej tętnicy wieńcowej oraz obecność dużej mnogiej przetoki wieńcowo-komorowej między lewą komorą a gałęzią pośrednią i gałęzią okalającą

Cardiac metastasis from a renal cell carcinoma

Here we report a case of asymptomatic right ventricular tumor, for which surgical removal was done.  Pathology reveals that the mass is a metastasis of a renal carcinoma.Key words: Renal cell carcinoma, cardiac metastasis, myocardium, cardiac tumor

Ischemic cardiomyopathy revealed by central retinal artery occlusion (CRAO)

Here we report a case of central retinal artery occlusionrevealing an ischemic cardiomyopathy. A 54-year old smoker man presented at the hospital because of sudden visual loss in his left eye. There was cherry-red spot in the macula in his left eye. We performed a fluorescein angiogram and cervical color Doppler. Later   investigations revealed an ischemic cardiomyopathy undiagnosed until then.Key words: Central retinal artery occlusion, ischemic cardiomyopathy, cardiac thrombu

Interactive music learning implementation in Tunisian cultural context : pedagogical approach, success and restraints

L’éveil musical est une démarche d’enseignement de la musique relativement récente qui développe les activités auditives, rythmiques, corporelles et vocales. En Tunisie, l’enseignement de la musique dans les écoles maternelles se limite à l’apprentissage des chansons et des comptines, sans aborder la découverte de l’univers sonore et l’exploration de l’espace. Dans ce travail, on s’intéresse dans notre recherche au développement musical de l’enfant tunisien dans sa dimension culturelle, définissant une enculturation musicale. La recherche entreprise répond à deux questions problématiques : d’abord est ce que cette démarche d’éveil musical s’avère envisageable dans un contexte culturel tunisien, en tenant en considération des caractéristiques de la musique tunisienne ? Ensuite, quelles seraient les difficultés confrontées, émanant du cadre culturel prédéfini à la fois par les apprenants ou les enfants tunisiens âgés de 5 ans, de deux écoles maternelles de la ville de Sfax, et les éducateurs n’ayant eu aucune formation préalable dans le domaine de l’éveil ?Dans cette thèse, on se propose de présenter dans une première partie l’éveil musical et les méthodes actives. Dans la deuxième partie, sont traités des éléments liés à la pédagogie musicale tels que la psychologie de l’enfant, la musique tunisienne et l’importance de l’enculturation dans le développement musical de l’enfant tunisien.La troisième partie est consacrée à l’analyse des séances d’éveil musical réalisées dans les deux écoles maternelles de niveaux sociaux différents.Music interactive learning is a recent approach developing auditory, rhythmic, body and voice activities. In Tunisia, music education at nursery school is limited to song and nursery rhyme learning, without considering sonorous world discovery and space exploration. The present work deals with Tunisian children musical development, taking into account cultural magnitude, allowing musical enculturation. This research solves two main problems. The first one is related to this music approach in a Tunisian cultural context, where music is mostly Tunisian, characterized by its specifications. The second problem consider the difficulties while implementing the interactive music learning; these resulted from the predefined cultural frame, established by both the learners i.e. Tunisian children five-years old at two nursery schools in Sfax city, and the teachers who didn’t get any previous training nor knowledge about the interactive used method for teaching music.In the first part of this dissertation, interactive musical approach was presented among the active methods. In the second part, the parameters interacting with musical learning, such as child psychology, Tunisian music and the enculturation importance in musical development of Tunisian child were considered. Finally, in the third part, a case study was investigated where an interactive music course, held in both nursery schools having different social level was discussed

Interactive music learning implementation in Tunisian cultural context : pedagogical approach, success and restraints

L’éveil musical est une démarche d’enseignement de la musique relativement récente qui développe les activités auditives, rythmiques, corporelles et vocales. En Tunisie, l’enseignement de la musique dans les écoles maternelles se limite à l’apprentissage des chansons et des comptines, sans aborder la découverte de l’univers sonore et l’exploration de l’espace. Dans ce travail, on s’intéresse dans notre recherche au développement musical de l’enfant tunisien dans sa dimension culturelle, définissant une enculturation musicale. La recherche entreprise répond à deux questions problématiques : d’abord est ce que cette démarche d’éveil musical s’avère envisageable dans un contexte culturel tunisien, en tenant en considération des caractéristiques de la musique tunisienne ? Ensuite, quelles seraient les difficultés confrontées, émanant du cadre culturel prédéfini à la fois par les apprenants ou les enfants tunisiens âgés de 5 ans, de deux écoles maternelles de la ville de Sfax, et les éducateurs n’ayant eu aucune formation préalable dans le domaine de l’éveil ?Dans cette thèse, on se propose de présenter dans une première partie l’éveil musical et les méthodes actives. Dans la deuxième partie, sont traités des éléments liés à la pédagogie musicale tels que la psychologie de l’enfant, la musique tunisienne et l’importance de l’enculturation dans le développement musical de l’enfant tunisien.La troisième partie est consacrée à l’analyse des séances d’éveil musical réalisées dans les deux écoles maternelles de niveaux sociaux différents.Music interactive learning is a recent approach developing auditory, rhythmic, body and voice activities. In Tunisia, music education at nursery school is limited to song and nursery rhyme learning, without considering sonorous world discovery and space exploration. The present work deals with Tunisian children musical development, taking into account cultural magnitude, allowing musical enculturation. This research solves two main problems. The first one is related to this music approach in a Tunisian cultural context, where music is mostly Tunisian, characterized by its specifications. The second problem consider the difficulties while implementing the interactive music learning; these resulted from the predefined cultural frame, established by both the learners i.e. Tunisian children five-years old at two nursery schools in Sfax city, and the teachers who didn’t get any previous training nor knowledge about the interactive used method for teaching music.In the first part of this dissertation, interactive musical approach was presented among the active methods. In the second part, the parameters interacting with musical learning, such as child psychology, Tunisian music and the enculturation importance in musical development of Tunisian child were considered. Finally, in the third part, a case study was investigated where an interactive music course, held in both nursery schools having different social level was discussed

A large cardiac hydatid cyst in the interventricular septum: A case report

Isolated cardiac location is an uncommon presentation of echinococcosis (0.5-2%), and involvement of the interventricular septum is even rarer. It may lead to various complications because of rupture and embolization. We report the case of a 26 - year- old man who was diagnosed to have a large inter-ventricular hydatid cyst complicated by both cerebral and coronary embolism. Presentation, management and follow-up of the patient is discussed. This case is of particular interest because of the rarity of septal localization of a hydatid cyst, and the conflict between the severity of the complications that occurred and the absence of correlated symptoms. Keywords: Large hydatid cyst, Interventricular septum, Acute coronary syndrome, Cerebral 19 embolization, Echocardiography, MRI, Surger

Evaluation of GeneXpert MTB/RIF for the detection of Mycobacterium tuberculosis and resistance to rifampin in extra-pulmonary specimens

Aims and objectives: This study evaluated the performance of GeneXpert (GX) for direct detection of MTB in extra-pulmonary specimens and assessed the ability of the assay to detect resistance to RIF. Methods: 104 clinical samples from a tertiary hospital in Sfax, Tunisia were analyzed. Specimens were processed using GX, Ziehl Neelsen and auramine smear, conventional culture on LJ and MGIT >60 media, and drug phenotypic susceptibility testing on LJ and MGIT 960. The diagnosis was made based on clinical, radiological, microbiological, pathological and therapeutic criteria. Results: In total, 51 patients were considered tuberculous. The PCR result obtained in less than two hours was positive for 46 samples and rifampicin was sensitive to all these cases. The sensitivity, specificity, positive predictive value and negative predictive value of GX were 90%, 60.6%, 19.6% and 98.3% compared with direct examination, 84.8%, 74.6%, 60.9% and 91.4% compared with culture and 84.3%, 94.3%, 93.4%, 86.2% compared with final diagnosis. The sensitivity of the GXt was 86% in biopsies and 75% in pus, collections and in biological fluids. Conclusion: The GX is a simple, rapid technique for real-time PCR and has increased the sensitivity of detection of Mycobacterium tuberculosis complex. It must be part of the diagnostic arsenal of tuberculosis without replacing conventional microbiological tools and allow early diagnosis and appropriate treatment

Drug susceptibility testing of Mycobacterium tuberculosis by a nitrate reductase assay applied directly on microscopy-positive sputum samples

Aims and objectives: Current methods for drug susceptibility testing (DST) of Mycobacterium tuberculosis (MTB) are either costly or slow. As the prevalence of multidrug-resistant (MDR) strains increases, the need for fast, reliable, and inexpensive methods is obvious. This study evaluated a rapid colorimetric nitrate reductase assay (NRA) for direct DST of MTB directly from clinical sputum samples. Methods: A total of 111 sputa with positive microscopy results for acid-fast bacilli (AFB) with more than 10 AFB per high-power field were used in the study. The samples were decontaminated using the modified Petroff method. The NRA results were compared with the reference indirect proportion method. Results: The sensitivity and the specificity of the direct NRA were 90% and 97.3%, 92.6% and 98.2%, 52.9% and 100%, and 28.6% and 100% for rifampin, isoniazid, streptomycin, and ethambutol, respectively. The results were in most cases available in 28 days (84.3%). Conclusions: The direct NRA could be used as a rapid, inexpensive, and accurate method to determine rifampin and isoniazid susceptibility directly from sputum. The technique might become a valid alternative to traditional methods, especially in low-income countries

Screening and Detecting Salmonella in Different Food Matrices in Southern Tunisia Using a Combined Enrichment/Real-Time PCR Method: Correlation with Conventional Culture Method

A combined enrichment/ newly developed invA TaqMan® real-time PCR (qPCR) method as a screening assay to detect Salmonella spp. in 500 naturally food matrices is evaluated. DNA template for qPCR was extracted from an overnight pre-enriched sample in buffered peptone water using lysis–guanidine isothiocyanate method. Heterologous internal amplification control (IAC) was incorporated during qPCR assays and co-amplified with the invA gene of the target pathogen. InvA qPCR exhibited 100% specificity when testing 94 Salmonella strains (inclusivity) and 32 non-Salmonella strains (exclusivity). The qPCR showed a consistent detection of two copies of the invA gene/PCR reaction, a good intra- and inter-run reproducibility with a good PCR efficiency (89.6%). QPCR was sensitive and showed Salmonella detection at 8.5 × 100 CFU mL-1 of artificially spiked poultry meat -BWP solution in less than 40 cycles. When analyzing 500 different food matrices and comparing the results with the ISO 6579:2002 conventional culture method, the sensitivity and specificity were 100 and 76.6%, respectively. QPCR showed Salmonella spp. DNA in raw poultry meat 27/45 (60%), milk 31/93 (33.3%), raw red meat 5/13 (38.5%), and fish 11/46 (23.9%) samples. The prevalence of Salmonella spp. in cakes, dairy, cooked meals, charcuterie products using qPCR was 11/14 (26.8%), 5/22 (22.7%), 32/150 (21.3%), and 5/20 (25%), respectively, compared to 0% as demonstrated by culture. S. Anatum was the most common serovar found associated with red meat compared to S. kentucky isolated from fish and poultry meat. In conclusion, our study is the first to use a combined enrichment/invA qPCR method as a screening assay to detect Salmonella DNA in different types of commercialized food in Southern Tunisia. QPCR results indicate that Salmonella contamination is common in milk and in other types of food samples

Endocarditis Due to Kytococcus schroeteri: Case Report and Review of the Literature

We report the third case of endocarditis caused by the newly described micrococcal species Kytococcus schroeteri. A 49-year-old woman was admitted to the hospital with suspected prosthetic valve endocarditis. Five blood cultures and prosthetic valve cultures grew the same type of organism, initially identified as Micrococcus sp. Assignment to the genus Kytococcus was suggested by the arginine dihydrolase activity and resistance to oxacillin. After sequencing of the 16S rRNA genes, the isolate was recognized as K. schroeteri. The patient was treated first with vancomycin combined with gentamicin and later with pristinamycin and rifampin. Three cases of K. schroeteri endocarditis described within a short period of time might indicate a specific pathogenicity of this new species. The isolation of kytococci from normally sterile sites should not be overlooked