Vein of Galen Aneurysmal Malformation revealed by a severe heart failure and pulmonary hypertension in an infant

Neonatal and pediatric heart failure is commonly caused by congenital heart diseases, especially by large left-to-right shunting. It is rarely related to a Vein of Galen Aneurysmal Malformation (VGAM). Diagnosis and management of these cerebrovascular malformations in infancy are still difficult and remain a medical challenge. We report the case of a 2-month-old infant hospitalized for heart failure. In addition to symptoms relating to heart failure, the child presented in an agitated state with opisthotonic posture. Echocardiography showed dilated right heart cavities with pulmonary hypertension and no heart defect. Brain magnetic resonance imaging scanning confirmed the diagnosis of VGAM, showing multiple cerebral parenchyma damages. The baby was treated with diuretics and an angiotensin-converting-enzyme inhibitor leading to stabilization of her heart failure. Given the gravity of the neurological sequelae, no embolization procedure was planned for this child. She died 5 years later of acute heart failure

A bio-economic model to improve irrigated durum wheat performance and regional profit in Mediterranean conditions

International audienceIn Tunisia, Durum wheat (DW) holds the most important place among irrigated cereals in terms of production and cultivated area. It is grown on an average annual area of 48 700 ha, which represents two-thirds of the irrigated cereal area. This area allows producing an average of 180 000tons representing around 20% of national durum wheat production. However, the achieved yield of the durum wheat, reached 360kg/ha against an expected yield of 700 kg/ha (El Faleh and Gharbi, 2014). This result showed also very low water productivity and economic performance. Focusing on the irrigation practices, researches have shown that poor management in terms of applied dose and irrigation timing are major factors limiting the agronomic performance of the DW. Other researches have focused on the cropping system and have pointed out the negative impacts of pricing policy on the economic performance of DW and profit at regional level. In order to improve the durum wheat production and the economic performance, there is an urgent need for approaches that integrate both economic and agronomic criteria. As pointed out by many studies that bio economic modelling approach is the most widely recommended approach for studying the effect of different management practices on farm performance (Blanco and Flichman, 2002). Several bio-economic models have been developed for production at the field level and farm level (Reckling et al., 2016). However, they fail to identify impacts at higher levels (e.g., region, country) that may be useful to policy makers. Hybrid models address this issue by aggregating results from the farm level to higher levels (Britz et al., 2012). These models usually consider the diversity of farm types (e.g., crop, livestock) and technologies, but none of them focuses on cereal production.This work aims to highlight the main levers for improving the agronomic and economic performance of DW crop and the regional profit. In order to do this issue, we develop the economic model MORBIT coupled to the biophysical model CROPSYST

Success of anti-CD20 monoclonal antibody treatment for severe autoimmune hemolytic anemia caused by warm-reactive immunoglobulin A, immunoglobulin G, and immunoglobulin M autoantibodies in a child: a case report

Abstract Background Autoimmune hemolytic anemia is rare in children. First-line therapies for this disease consist of corticosteroids and intravenously administered immunoglobulin that are effective in most patients. However, a small proportion of cases (5 to 10%) is refractory to these therapies and may represent a medical emergency, especially when hemolysis is due to warm immunoglobulin M. Recently, reports of the use of rituximab in adult autoimmune diseases have shown promising results. In children, there are few studies on the use of rituximab in the treatment for autoimmune hemolytic anemia, especially on its long-term efficacy and adverse effects. Case presentation Here, we report the case of a 10-year-old Tunisian girl with refractory acute autoimmune hemolytic anemia caused by warm-reactive immunoglobulin A, immunoglobulin G, immunoglobulin M, and C3d autoantibodies. First-line treatments using corticosteroids and intravenously administered immunoglobulin were ineffective in controlling her severe disease. On the other hand, she was successfully treated with rituximab. In fact, her hemolytic anemia improved rapidly and no adverse effects were observed. Conclusions The case that we report in this paper shows that rituximab could be an alternative therapeutic option in severe acute autoimmune hemolytic anemia with profound hemolysis refractory to conventional treatment. Moreover, it may preclude the use of plasmapheresis in such an urgent situation with a sustained remission

Large-scale participation in policy design: citizen proposals for rural development in Tunisia

International audienceMore and more literature and practice recommend involving the public at the early stages of the policy cycle, i.e. issue identification, definition of the policy objectives and policy design. Policy design involves, among others, identifying solutions, ideas or alternatives which may address the policy objectives. Three main arguments are often put forward to advocate for the involvement of stakeholders, or the public, in policy design: a "user-centered " argument (i.e. for the policy to better meet people's priorities), an innovation argument (i.e. to conceive new solutions) and a collective argument (i.e. to identify collective actions and better tackle environmental problems). However, in both research and practice these arguments have been challenged. Research has insufficiently generated evidence of the influence of large-scale participation in policy design on resulting proposed actions. The objective of this paper is to analyze whether a large-scale participatory process leads to action proposals that fit people's priorities and that are innovative and collective. It draws from a land management and rural development policy design experiment conducted in six vulnerable areas of Tunisia. 4,300 direct participants were involved and 11,583 action proposals were collected. Our results highlight the influence of the local circumstances on innovation and the interest towards collective actions. Our results also show that whether policy design is made individually or in group influences the outcomes. The results also suggest that appropriate facilitation can help fostering more collective and innovative actions. We conclude the paper by opening up the idea of hybridizing policy design methods with methods from political and agricultural sciences in order to better understand the drivers and rationalities behind participants' action proposals