158 Prothetic abcess complicating Infective endocarditis

The cardiac abscess formation is appraised to 20–30% during the infectious endocarditis (IE). It is more frequent during prosthesis endocarditis and it can reach 60%. The prognosis is generally reserved. Objective To determine echocardiographic, bacteriological and evolutive features of prothetic IE complicated of abscess.Retrospective study including 51 patients having certain or probable IE according to Duke criterias between 2002 and 2005. At 9 patients (17,64%) the endocarditis was complicated of prothetic abscess. It was about 6 men and 3 women with a middle age of 39 ± years. IE was la ate IE in 5 cases. Clinical and biological infectious syndrome was constant. Isolated germs were staphylococcus aureus in 2 cases, GRAM négatif Bacillus in 2 cases. Culture negative endocarditis were noted in 5 cases. Brucellosis serology was positive at one patient. Prothetic abcess was diagnosed by transthoracic echocardiography (TTE) at 2 patients and by transesophagal echocardiography (TEE) at all patients.The abcess was localized on the aortic prosthesis at 5 patients, mitral prothesis at 3 patients and mitroaortic prothesis at one patient. TEE identified annular abcess at 2 patients and a myocardial abcess at 1 patient. Secondary septic localizations were noted at 6 patients: 4 cerebral abscesses, 2 splenic localization, a renal localization and an articular localization. High degree atrioventricular blocks were observed at 3 patients. The recourse to the surgery was frequent (7 patient/9 patient). It was an emergent sugery at 2 patients because of a heart failure. For the others, the indication for surgery was medical failure treatment at a mean delay of 19 days. The evolution was fatal at 5 patients. and the evolution was favorable at the others.Prothetic endocarditis complicated of abscess are serious requiring frequently a prothetic replacement, a very high risked surgery. TEE must be systematic at all patients carrier of prosthesis if they have infectious syndrome in order to carry the early diagnosis of IE and to avoid abcess formation

Integrated socio-hydrogeological approach to tackle nitrate contamination in groundwater resources. The case of Grombalia Basin (Tunisia)

Nitrate contamination still remains one of the main groundwater quality issues in several aquifers worldwide, despite the perduring efforts of the international scientific community to effectively tackle this problem. The classical hydrogeological and isotopic investigations are obviously of paramount importance for the characterization of contaminant sources, but are clearly not sufficient for the correct and long-term protection of groundwater resources. This paper aims at demonstrating the effectiveness of the socio-hydrogeological approach as the best tool to tackle groundwater quality issues, while contributing bridging the gap between science and society. An integrated survey, including land use, hydrochemical (physicochemical parameters and major ions) and isotopic (delta N-15(No3) and delta O-18(No3)) analyses, coupled to capacity building and participatory activities was carried out to correctly attribute the nitrate origin in groundwater from the Grombalia Basin (North Tunisia), a region where only synthetic fertilizers have been generally identified as the main source of such pollution. Results demonstrates that the basin is characterized by high nitrate concentrations, often exceeding the statutory limits for drinking water, in both the shallow and deep aquifers, whereas sources are associated to both agricultural and urban activities

L’endocardite à Bartonella en Tunisie: Particularités lésionnelles et évolutives

L'endocardite à Bartonalla est une infection ubiquitaire, son diagnostic est difficile vu qu'il s'agit souvent d'endocardite à hémoculture négative. Lebut de cette étude est d'analyser les particularités lésionnelles et  évolutives de cette entité dans un pays du nord d'Afrique, la Tunisie et dedémontrer la gravité de cette infection. Nous avons étudié  rétrospectivement les dossiers médicaux de 20 patients atteints  d'endocardite à Bartonella, confirmée selon les critères de Dukes modifiés. L'âge moyen de nos patients était 37 ans avec une prédominance  masculine (SR=3). Tous nos malades avaient un niveau socio-économique bas. Le motif essentiel de consultation était la dyspnée, 6 patients étaient admis dans un tableau d'insuffisance cardiaque congestive. Une  prédilection des lésions au niveau de la valve aortique a été notée (14 cas). Quatorze patients avaient des végétations endocarditiques avec une taille qui dépasse 10 mm chez 8 malades. La majorité des patients (18 patients) présentaient une régurgitation valvulaire massive en rapport principalement avec des mutilations importantes (6 cas de ruptures de cordages mitraux, 2 cas de déchirures des sigmoïdes aortiques, un cas de perforation valvulaire aortique, un cas de désinsertion de prothèse  mitrale). Quinze malades (3/4) avaient nécessité une chirurgie à la phase active de la maladie, l'indication majeure était l'insuffisance cardiaque. Une complication neurologique était notée chez 2 malades et une  complication rénale chez 3 malades. Treize patients étaient guéris, 5 malades étaient décédés et 2 malades opérés ont présenté une  réinfection à staphylococcus aureus et à candida albicans en  postopératoire. L'endocardite à Bartonella est une infection grave. Cette Bactérie possède un potentiel destructif important. Le recours à la chirurgie est quasi constant. La morbi-mortalité est élevée. La recherche de cette bactérie devrait être alors systématique chez nos malades suspects d'endocardite d'autant plus que la bartonellose est endémique sur nos terres

A Hard Look at NGC 5347: Revealing a Nearby Compton-thick AGN

Current measurements show that the observed fraction of Compton-thick (CT) active galactic nuclei (AGN) is smaller than the expected values needed to explain the cosmic X-ray background. Prior fits to the X-ray spectrum of the nearby Seyfert-2 galaxy NGC 5347 (z = 0.00792, D = 35.5 Mpc ) have alternately suggested a CT and Compton-thin source. Combining archival data from Suzaku, Chandra, and—most importantly—new data from NuSTAR, ... See full text for complete abstrac

An Improved Hazard Rate Twisting Approach for the Statistic of the Sum of Subexponential Variates

In this letter, we present an improved hazard rate twisting technique for the estimation of the probability that a sum of independent but not necessarily identically distributed subexponential Random Variables (RVs) exceeds a given threshold. Instead of twisting all the components in the summation, we propose to twist only the RVs which have the biggest impact on the right-tail of the sum distribution and keep the other RVs unchanged. A minmax approach is performed to determine the optimal twisting parameter which leads to an asymptotic optimality criterion. Moreover, we show through some selected simulation results that our proposed approach results in a variance reduction compared to the technique where all the components are twisted

Unified Importance Sampling Schemes for Efficient Simulation of Outage Capacity Over Generalized Fading Channels

The outage capacity (OC) is among the most important performance metrics of communication systems operating over fading channels. Of interest in the present paper is the evaluation of the OC at the output of the Equal Gain Combining (EGC) and the Maximum Ratio Combining (MRC) receivers. In this case, it can be seen that this problem turns out to be that of computing the Cumulative Distribution Function (CDF) for the sum of independent random variables. Since finding a closed-form expression for the CDF of the sum distribution is out of reach for a wide class of commonly used distributions, methods based on Monte Carlo (MC) simulations take pride of price. In order to allow for the estimation of the operating range of small outage probabilities, it is of paramount importance to develop fast and efficient estimation methods as naive MC simulations would require high computational complexity. In this line, we propose in this work two unified, yet efficient, hazard rate twisting Importance Sampling (IS) based approaches that efficiently estimate the OC of MRC or EGC diversity techniques over generalized independent fading channels. The first estimator is shown to possess the asymptotic optimality criterion and applies for arbitrary fading models, whereas the second one achieves the well-desired bounded relative error property for the majority of the well-known fading variates. Moreover, the second estimator is shown to achieve the asymptotic optimality property under the particular Log-normal environment. Some selected simulation results are finally provided in order to illustrate the substantial computational gain achieved by the proposed IS schemes over naive MC simulations

An Accurate Sample Rejection Estimator of the Outage Probability With Equal Gain Combining

We evaluate the outage probability (OP) for L-branch equal gain combining (EGC) receivers operating over fading channels, i.e., equivalently the cumulative distribution function (CDF) of the sum of the L channel envelopes. In general, closed form expressions of OP values are out of reach. The use of Monte Carlo (MC) simulations is not a good alternative as it requires a large number of samples for small values of OP. In this paper, we use the concept of importance sampling (IS), being known to yield accurate estimates using fewer simulation runs. Our proposed IS scheme is based on sample rejection where the IS density is the truncation of the underlying density over the L dimensional sphere. It assumes the knowledge of the CDF of the sum of the L channel gains in closed-form. Such an assumption is not restrictive since it holds for various challenging fading models. We apply our approach to the case of independent Rayleigh, correlated Rayleigh, and independent and identically distributed Rice fading models. Next, we extend our approach to the interesting scenario of generalised selection combining receivers combined with EGC under the independent Rayleigh environment. For each case, we prove the desired bounded relative error property. Finally, we validate these theoretical results through some selected experiments

On the Efficient Simulation of Outage Probability in a Log-Normal Fading Environment

The outage probability (OP) of the signal-to interference-plus-noise ratio (SINR) is an important metric that is used to evaluate the performance of wireless systems. One difficulty toward assessing the OP is that, in realistic scenarios, closed-form expressions cannot be derived. This is, for instance, the case of the Log-normal environment, in which evaluating the OP of the SINR amounts to computing the probability that a sum of correlated Log-normal variates exceeds a given threshold. Since such a probability does not admit a closed form expression, it has thus far been evaluated by several approximation techniques, the accuracies of which are not guaranteed in the region of small OPs. For these regions, simulation techniques based on variance reduction algorithms are a good alternative, being quick and highly accurate for estimating rare event probabilities. This constitutes the major motivation behind this paper. More specifically, we propose a generalized hybrid importance sampling scheme, based on a combination of a mean shifting and a covariance matrix scaling, to evaluate the OP of the SINR in a Log-normal environment. We further our analysis by providing a detailed study of two particular cases. Finally, the performance of these techniques is performed both theoretically and through various simulation results

Tormund's return: Hints of quasi-periodic eruption features from a recent optical tidal disruption event

Quasi-periodic eruptions (QPEs) are repeating thermal X-ray bursts associated with accreting massive black holes, the precise underlying physical mechanisms of which are still unclear. We present a new candidate QPE source, AT 2019vcb (nicknamed Tormund by the ZTF collaboration), which was found during an archival search for QPEs in the XMM-Newton archive. It was first discovered in 2019 as an optical tidal disruption event (TDE) at $z=0.088$, and its X-ray follow-up exhibited QPE-like properties. Our goals are to verify its robustness as QPE candidate and to investigate its properties to improve our understanding of QPEs. We performed a detailed study of the X-ray spectral behaviour of this source over the course of the XMM-Newton archival observation. We also report on recent Swift and NICER follow-up observations to constrain the source's current activity and overall lifetime, as well as an optical spectral follow-up. The first two Swift detections and the first half of the 30 ks XMM-Newton exposure of Tormund displayed a decaying thermal emission typical of an X-ray TDE. However, the second half of the exposure showed a dramatic rise in temperature (from 53 to 114 eV) and 0.2-2 keV luminosity (from $3.2\times10^{42}$ to $1.2\times10^{44}$ erg s$^{-1}$). The late-time NICER follow-up indicates that the source is still X-ray bright more than three years after the initial optical TDE. Although only a rise phase was observed, Tormund's strong similarities with a known QPE source (eRO-QPE1) and the impossibility to simultaneously account for all observational features with alternative interpretations allow us to classify Tormund as a candidate QPE. If confirmed as a QPE, it would further strengthen the observational link between TDEs and QPEs. It is also the first QPE candidate for which an associated optical TDE was directly observed, constraining the formation time of QPEs.Comment: Accepted for publication in A&A, 20 pages, 17 figure

On the generalization of the hazard rate twisting-based simulation approach

Estimating the probability that a sum of random variables (RVs) exceeds a given threshold is a well-known challenging problem. A naive Monte Carlo simulation is the standard technique for the estimation of this type of probability. However, this approach is computationally expensive, especially when dealing with rare events. An alternative approach is represented by the use of variance reduction techniques, known for their efficiency in requiring less computations for achieving the same accuracy requirement. Most of these methods have thus far been proposed to deal with specific settings under which the RVs belong to particular classes of distributions. In this paper, we propose a generalization of the well-known hazard rate twisting Importance Sampling-based approach that presents the advantage of being logarithmic efficient for arbitrary sums of RVs. The wide scope of applicability of the proposed method is mainly due to our particular way of selecting the twisting parameter. It is worth observing that this interesting feature is rarely satisfied by variance reduction algorithms whose performances were only proven under some restrictive assumptions. It comes along with a good efficiency, illustrated by some selected simulation results comparing the performance of the proposed method with some existing techniques