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Driver drowsiness is the major cause of many traffic accidents. A study by the National Institute of Sleep and Vigilance showed that the majority of the accidents took place on fast tracks. 34% of these accidents are mainly due to lack of sleep. Indeed, the drowsiness of drivers appears mainly by a fall of vigilance with the appearance of various behaviors that represent clues for the decrease of reflexes like the presence of yawning, heaviness of the eyelids and the difficulty to keep the head in frontal position compared to the vision field. In this context, we are interested particularly in the proposal of new solutions allowing the automatic control of the driver drowsiness states. These solutions need to be non-invasive while being based only on the analysis of the visual indices. These indices are calculated starting from the spatiotemporal information of the contents of a video stream. The main goal of our work is to recognize driver abnormal behavior by analyzing the characteristics of the face. In fact, we have proposed a fusion system based on detection of yawn, detection of somnolence and the 3D head pose estimation. This fusion system is evaluated by the three databases and shows many success of our suggested approach.

Aim of the work: To assess the bone turnover markers and bone mineral density (BMD) in ankylosing spondylitis (AS) patients and to evaluate their association with clinical variables. Patients and methods: Forty-seven AS patients were compared with 47 matched control. Clinical features and inflammatory parameters were assessed. C-terminal telopeptide fragments of type I collagen (CTX), alkaline phosphatases (ALP), N-terminal propeptide of type I procollagen (PINP) serum levels, and BMD of the lumbar spine and femoral neck were evaluated. The Bath AS disease activity and functional indices (BASDAI and BASFI) were assessed. Results: Mean serum levels of C-reactive protein, ALP and CTX were higher in AS patients than control (p = 0.001, p = 0.001 and p = 0.027 respectively). Osteopenia and osteoporosis were significantly more frequent in AS patients (57.4%) than control (21.3%) (p

This research investigation proposes a new method for sustainable olive mill wastewater (OMW) treatment and handling. It is based on the combination of its impregnation onto raw cypress sawdust (RCS) followed by electrocoagulation. The retention of OMW compounds onto various RCS doses show an important decrease of its chemical oxygen demand (COD) and its main cation and anion content. The maximum retention efficiencies of COD, Na+, K+, Ca2+, Mg2+, Cl−, $$ {PO}_4^{3-} $$ , and $$ {SO}_4^{2-} $$ were about 51.0%, 75.3%, 28.7%, 77.9%, 84.7%, 41.1%, 98.3%, and 90.9%, respectively, for the highest RCS dose (200 g L−1). This organic matter- and nutrient-loaded biomass could be thermochemically converted through pyrolysis into biofuel and biochar for energetic and agronomic purposes, respectively. The treatment by electrocoagulation of the pre-treated OMW using mild steel electrodes could be considered an attractive treatment method since 75.6% of COD removal efficiency was achieved. Besides, this approach permits a significant energy consumption reduction by 46% as compared with the electrocoagulation process alone. It allows also a significant improvement of the treated effluent quality in terms of both organic and mineral contents that could be reused for the irrigation of olive trees in the context of circular economy.

Tailgut cysts, or retrorectal cystic hamartomas, are rare congenital developmental lesions. It is a benign lesion, but there is a risk of degeneration, so surgical resection is necessary.

Ephedra alata is a medicinal plant with a long history of traditional use for its bronchodilator, anti-asthmatic and cytotoxic effects. In this work, we develop a sensitive and validate LC-ESI/MS method to simultaneously identify and quantify 33 standard phenolic compounds in E. alata methanol (MeOH) crude extract and its derived fractions (Dichloromethane (DCM), Ethyl acetate (EAc), butanol (BuOH) and water). The antioxidant activities were tested using total antioxidant capacity (TAC), DPPH and FRAP assays. Results showed that the validated and reliable LC-ESI/MS method used unambiguously lead to identify and quantify 24 phenolic compounds most of them are present in all extracts. The major components detected were epicatechin, quinic acid, quercetin-3-o-rhamnoside, catechin, trans-cinnamic acid, naringin and trans-ferulic acid which their amounts vary according to the solvent used for the extraction. The DCM extract showed the highest activity when the TAC test was applied, the BuOH and EAc extracts displayed the highest activities with the DPPH test, whereas the DCM and EAc extracts exhibited the strongest activities with the FRAP method. This difference could be attributed to the nature and amounts of phenolic compounds of the extracts. These realized phytochemical and biological analyses could be helpful for the potential use of this plant in novel medicament products.

The biocorrosion mechanism of 304 L stainless steel (SS), in contact with untreated wastewater (UTWW) and treated wastewater (TWW) in terms of biofilm growth were monitored and evaluated using electrochemical experiments, scanning electron microscopy (SEM) examinations and microbiological analyses. Within UTWW, open circuit potential (Eoc) and charge transfer resistance (Rct) showed a significant increase after 5 days of immersion. SEM and microbiological analyses revealed that a mature biofilm was formed after 5 days of immersion and could offer a protection to the surface. However, considering the high level of chloride in TWW, according to SEM analysis, the bacterial biofilm was more porous and gelatinous. Furthermore, the significant changes in the electrochemical impedance spectroscopy (EIS) parameters were shown after 7 days of immersion. The synergy between the metal surface, aggressive compounds and bacterial cells could have great impact on corrosion process. In fact, the correlation between different experimental studies used in this investigation showed that the corrosion mechanisms are different when untreated wastewater (UTWW) was compared to treated wastewater (TWW) according to immersion time. Mechanism could be divided into two stages with the UTWW and three stages with the TWW. Furthermore, corresponding corrosion mechanisms were presented according to different immersion times.

Aim of the work: To study microbiological, clinical and therapeutic aspects of spondylodiscitis (SD) and predisposing risk factors in Tunisian patients. Patients and methods: Patients with SD admitted to Rheumatology Departments, Southern Tunisia, were retrospectively studied. Medical records were reviewed over the last 20-years and investigations included bacterial cultures, magnetic resonance imaging (MRI) or computed-tomography percutaneous disc biopsy (CT-PDB). Results: There were 67 SD cases (incidence of 0.17/100,000 inhabitants/year); 38 men and 29 women and mean age was 55 ± 16 years. Advanced age, tuberculosis and brucellar contagion were the predominant risk factors. The duration from onset to diagnosis was 133.6 ± 115 days. Low back pain (LBP) was the most common symptom. Lumbar spine was the most frequent location. Neurologic symptoms (radicular pain, spinal chord compression, neurologic loss) were observed in 31 patients. C-reactive protein was elevated in 54 (52.17 ± 43.97 mg/L). MRI showed abnormalities in 60 patients and CT-PDB was performed in 39. Pathogens were isolated in 43 cases. Mycobacterium tuberculosis (MT) was the most common (55.8%) followed by staphylococcus aureus (18.6%), brucella (16.3%), Escherichia coli (EC) (4.7%) and streptococcus-β in 1 patient; 1 patient had both MT and EC. Medical treatment was prescribed in 91% and surgery performed in 6. 88% of patients improved after 24 months follow-up. Conclusion: Spondylodiscitis should be considered for all patients presenting with chronic LBP with systemic symptoms and evidence inflammation. MRI is required to establish a diagnosis and evaluate the spread of infection. CT-PDB is useful to identify the causative micro-organism before antibiotic administration. These findings could to pave the way for constructing national guidelines. Keywords: Infectious spondylodiscitis, Low back pain, Epidemiology, Outcome, Tunisia

Organosilica nanoparticles hold great promise for nanomedicine applications. These nanoparticles are synthesized from polytrialkoxysilylated precursors without any silica source. In this work we present two kinds of organosilica nanoparticles with either amine or ammonium walls constituting their structure. Both types of nanoparticles are very efficient for gemcitabine monophosphate delivery, a small hydrophilic anticancer drug whose encapsulation is still a challenge. The nanoparticles are endocytosed by MCF-7 breast cancer cells as monitored by confocal microscopy. They are efficient and lead to 60% cancer cell death.

Background:A high prevalence of osteopenia and osteoporosis is observed in patients with Inflammatory Bowel Disease (IBD).Objective:The aim of our study was to investigate the prevalence of bone loss, bone remodeling and risk factors in Tunisian patient with IBD.Patients and Methods:The study included 40 patients with IBD and 32 age- and sex-matched healthy controls subjects. All participants underwent bone densitometry by dual energy X-ray absorptiometry at the femoral neck and lumbar spine. Serum levels of 25-hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), osteocalcin(OC), and urinary degradation products of C-terminal telopeptide of type I collagen (CTXI) were measured in all participants to assess the bone metabolism status.Results:Twelve (30%) patients were normal, 32.5% were osteopenic and 37.5% were osteoporotic. Osteoporosis was more frequent in IBD patients than controls (p=0.0001). Age and inflammation were associated with low bone mineral density (BMD). Mean calcium, phosphorus and alkaline phosphatase levels were similar in both groups. Median 25(OH) D levels were significantly lower in IBD patients compared with controls (p=0.0001). Median urinary CTXI levels were significantly higher in IBD patients compared with healthy controls (p=0.007). No significant differences between IBD patients and controls concerning the median serum OC and PTH levels were found.Conclusion:In our study, there is a high prevalence of low BMD in IBD patients and an increase in bone resorption without a change of bone formation. Low BMI and hypovitaminoses D were identified as risk factors for low BMD.

Resume Introduction L’occlusion colique est le mode de revelation de 8 a 29 % des cancers du colon. L’objectif de notre travail est de comparer la mise en place du stent versus colostomie de decharge dans la prise en charge du cancer du colon gauche en occlusion. Materiel et methodes Nous avons realise une recherche systematique de la litterature a partir de l’interrogation de la base de donnees MEDLINE, EMBASE et Cochrane Library, pour identifier les articles relatifs a la comparaison du stent vs colostomie publies entre 2000 et 2016. Resultats La recherche electronique nous a permis d’identifier 6 etudes. Une seule etude etait prospective comparative. Trois etudes etaient dans un but curatif. Le nombre total etait 7205 malades. Dans le groupe « stent », il y avait une diminution de la duree moyenne de sejour par rapport au groupe « stomie » et une diminution du cout avec une relation statistiquement significative. Par ailleurs, il n’y avait pas de difference entre les deux groupes en termes de mortalite hospitaliere et de morbidite precoce. Conclusion Devant une occlusion neoplasique du colon gauche, le choix entre colostomie ou stent colique depend de la strategie therapeutique. En effet, en cas d’une strategie curative ou d’administration d’anti-angiogeniques il est recommande de pratiquer une colostomie. Cependant en cas de traitement palliatif, la prothese colique est le traitement de choix.

Background: Contact dermatitis is common disease and represents a significant problem in healthcare sector, mainly among nurses. Many studies reported the prevalence of contact dermatitis from different parts of the world. Nevertheless, data about its frequency in Tunisia especially in public hospital seems to be insufficient. This study aims to assess the prevalence of contact dermatitis among nurses working in public hospital and identify risk factors. Patient and Methods: A cross sectional study was conducted among a representative sample of 1278 health professionals working in a public hospital matched by professional status and department. The survey was based on a questionnaire, a specialized examination and patch tests. Results: The prevalence of occupational contact dermatitis was 22% (17.5 - 27.2). The worker profile at risk of contact dermatitis was a female nurse aged 37 years working in a surgical department during 12.7 ± 9.36 years. Hands were damaged in 92.4% of cases and rhythmicity with occupational exposure was reported by 86% of affected individuals. Patch tests using European Standard Battery were performed among 33 workers and revealed a sensitization to an allergen among 26 workers. Patch test using rubber battery (if suspicion of allergic contact dermatitis to gloves) was performed among 29 agents and positive among 12. The analytical study revealed that history of atopy, job tenure, the mean daily number of hand washing, the mean daily number of worn gloves and mean duration of glove wearing were significantly higher in the affected population. Conclusion: Contact dermatitis affects particularly nurses in public hospitals. Its prevention requires a diagnostic approach based on a detailed professional investigation and patch tests.

Background Psychiatric disorders, such as depression and anxiety, are commonly associated with epilepsy in the general population, but the relationship between psychiatric disorders and epilepsy among adults with intellectual disabilities is unclear. Aims To conduct a systematic review and meta-analysis to assess whether epilepsy is associated with an increased rate of psychiatric disorders in adults with intellectual disabilities. Method We included literature published between 1985 and 2020 from four databases, and hand-searched six relevant journals. We assessed risk of bias by using SIGN 50 and the Cochrane risk of bias tool. Several meta-analyses were carried out. Results We included 29 papers involving data on 9594 adults with intellectual disabilities, 3180 of whom had epilepsy and 6414 did not. Of the 11 controlled studies that compared the overall rate of psychiatric disorders between the epilepsy and non-epilepsy groups, seven did not show any significant inter-group difference. Meta-analysis was possible on pooled data from seven controlled studies, which did not show any significant inter-group difference in the overall rate of psychiatric disorders. The rates of psychotic disorders, depressive disorders and anxiety disorders were significantly higher in the non-epilepsy control groups compared with the epilepsy group, with effect sizes of 0.29, 0.47 and 0.58, respectively. Epilepsy-related factors did not show any definite association with psychiatric disorders. Conclusions It is difficult to pool data from such heterogeneous studies and draw any definitive conclusion because most studies lacked an appropriately matched control group, which will be required for future studies.

Hemorrhoidal disease is a common reason for consultation in proctology. It can be treated in several ways (medical, endoscopic, and surgical). Laser treatment has been described since 1960 and has developed in recent years. The purpose of this literature review was to study the results of laser treatment of hemorrhoids and to compare them with those of surgical methods. We performed a systematic search of the literature by querying the Medline, Google Scholar, and Cochrane Library databases. Retrospective studies and case reports were excluded. We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure). The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies. The age of the patients varies between 18 and 74 years old. HeLP laser treatment was significantly superior to surgical treatment in terms of postoperative pain (p

Skeletal fluorosis is a rare toxic osteopathy reported as an endemic disease and caused especially by prolonged ingestion of high fluoride concentration. Spinal cord compression primarly by the ossification of the posterior longitudinal ligament and ligamentum flavum, may rarely reveal the disease. Surgical decompression is the treatment of choice.

International audience; Aquivion membrane displays improved properties as compared to Nafion membrane, partly due to shorter side chains. However, some improvements are still necessary for proton exchange membrane fuel cell to operate at low relative humidity. To overcome this drawback, the addition of clay nanoparticle into the Aquivion matrix can be considered. In this study, different composite membranes have been prepared mixing short-side-chain PFSA (perfluorosulfonic acid) Aquivion and selectively modified halloysite nanotubes for PEMFC low relative humidity operation. Halloysites were grafted with fluorinated groups, sulfonated groups, or perfluoro-sulfonated groups on inner or outer surface of the tubes. The obtained composite membranes showed improved properties, especially higher water uptake associated with reduced swelling and better mechanical strength compared to pristine Aquivion membrane and commercially available Nafion HP used as reference. The best performance in this study was obtained with Aquivion loaded with 5 wt% of pretreated perfluoro-sulfonated halloysite. The composite membrane, referred to as Aq/pHNT-SF5, displayed the largest water uptake and proton conductivity among the panel of membranes tested. The chemical stability was not affected by the presence of halloysite in the Aquivion matrix.

Electroencephalography (EEG) signal recorded during motor imagery (MI) has been frequently used in noninvasive Brain-Computer Interface (BCI) is a new type of device that allows direct communication between user's brain and machine. This paper proposes a novel solution for extraction and classification of left/right hand, both feet, and tongue movement by exploiting two approaches of deep learning such as artificial neural network ANN and convolutional neural network CNN. A wide range of spatial and frequency domain features are extracted from the EEG signals and to train an ANN and CNN networks to perform the classification tasks. The EEG signals of mental tasks are extracted and classified by these architectures. In addition, the proposed methods are validated by the EEG dataset of the BCI competition IV-2a and we compared them with each other. The results show that the CNN model surpasses the ANN model by an accuracy value of 60.55%.

Objective. This study aimed to examine the association of the different dimensions and forms of work–family conflict with the occurrence of neck and lower back pain (LBP) in Tunisian nurses. Method...

Background Previous systematic reviews showed no significant association between epilepsy and challenging behaviours in adults with intellectual disabilities. Aims To identify whether there is an association between epilepsy and challenging behaviour in adults with intellectual disabilities by carrying out a systematic review of published data. PROSPERO registration number: CRD42020178092. Method We searched five databases and hand-searched six journals. Two authors independently screened titles, abstracts and full articles using a standardised eligibility checklist. Several meta-analyses were carried out. Results The narrative analysis of data from 34 included articles (14 168 adults with intellectual disabilities, 4781 of whom also had epilepsy) showed no significant association between epilepsy and challenging behaviour. Meta-analysis was possible on data from 16 controlled studies. This showed no significant intergroup difference but after sensitivity analysis meta-analysis of 10 studies showed a significantly higher rate of overall challenging behaviour in the epilepsy group (effect size: 0.16) compared with the non-epilepsy group. Aggression and self-injurious behaviour both showed a statistically significant higher rate in the epilepsy group, with very small effect sizes (0.16 and 0.28 respectively). No significant intergroup difference was observed in the rate of stereotypy. Conclusions The findings are contradictory and must be interpreted with caution because of the difficulty in pooling data from varied studies, which is likely to introduce confounding. Where significant differences were found, effect sizes are small and may not be clinically significant, and there are major methodological flaws in the included studies, which should be addressed in future large-scale properly controlled studies.

Febrile neutropenia (FN) is the main reason for antibiotic prescription in hematology wards where, on the other hand, antibiotic stewardship (AS) is poorly explored. The objectives of the present study were to evaluate (1) the impact of an AS intervention on antibiotic consumption and (2) the applicability and acceptance rate of the intervention and its clinical impact. A persuasive AS intervention based on European Conference on Infection in Leukaemia (ECIL) guidelines for FN was implemented in a high-risk hematology ward in a tertiary referral public university hospital. This included the creation and diffusion of flow charts on de-escalation and discontinuation of antibiotics for FN, and the introduction in the team of a doctor dedicated to the implementation of flow charts and to antibiotic prescription revision. All consecutive patients receiving antibiotics during hospitalization were included. A segmented linear regression model was performed for the evaluation of antibiotic consumption, taking into account 1-year pre-intervention period and 6-month intervention period. Overall, 137 consecutive antibiotic prescriptions were re-evaluated, 100 prescriptions were for FN. A significant reduction of the level of carbapenem consumption was observed during the intervention period (level change (estimate coefficient ± standard error) = - 135.28 ± 59.49; p = 0.04). Applicability and acceptability of flow charts were high. No differences in terms of intensive care unit transfers, bacteremia incidence, and mortality were found. A persuasive AS intervention in hematology significantly reduced carbapenem consumption without affecting outcome and was well accepted. This should encourage further applications of ECIL guidelines for FN.

Background Septic arthritis is an infectious disease that commonly affects weight-bearing or proximal joints such as the knee and the hip. The sternoclavicular joint is an unusual site of this entity. It usually occurs in patients with diabetes mellitus, intravenous drug abusers, or those with rheumatoid arthritis. Analysis of the previous literature showed few articles and these described essentially cases of unilateral presentation. Case presentation We report a rare case of a bilateral septic arthritis of the sternoclavicular joint sustained by a 71-year-old Tunisian woman whose medical history was significant for methicillin-resistant Staphylococcus aureus infective endocarditis 6 months ago. Imaging investigations revealed destruction of the medial extremities of her two clavicles and bilateral collections in the soft tissues around her sternoclavicular joints. She was treated successfully by needle aspiration drainage combined with a 12-week antibiotherapy. Conclusions Bilateral septic arthritis of the sternoclavicular joint is an extremely rare entity, with a paucity of literature. Only early diagnosis, which is obtained from the culture of the joint fluid using needle aspiration, allows satisfactory functional outcome and a good prognosis. Osteoarticular infections should be considered in patients with recent infective endocarditis in cases of fever recurrence.

The aim was to describe the profile of workers with occupational multi-site musculoskeletal disorders (MSMSD) and study the relationship between these lesions and socio-professional factors. This is a cross-sectional study involving 254 subjects with occupational musculoskeletal disorders (MSD), identified in the Department of Occupational Medicine at the University Hospital of Mahdia, in Tunisia, over a period of 10 years from 2005 to 2014. The study population was subdivided into two groups; mono-site MSD and multi-site (≥2 sites) groups. Data collection was based on a questionnaire prepared beforehand and covered the description of sociodemographic and professional characteristics. To study psychosocial constraints at work, we have used the Karasek questionnaire. MS-MSD was correlated to the number of dependent children (p=0.02), job/place of work (p=0.00), qualification (p=0.02), taking a rest period (p=0.03), decision latitude (p=0.00), mental demands (p=0.002), social support (p=0.00) and job stress (p=0.04). After binary logistic regression, MS-MSD depended significantly on the number of dependent children (p=0.013; OR=0,33; IC=0,17-0,83), working spouse (p=0.05; OR=0.35; IC=0.12-0.99), job/place of work (p=0.00; OR=4.16; IC=1.95-8.88), qualification (p=0.008; OR=0.28; IC=0.11-0.72), taking a break during work (p=0.04; OR=3.10; IC=1.04-9.22) and social support (p=0.00; OR=7,1; IC=1,9-25,3). When individual risk factors are fixed, the prevention of MS-MSD must target modifiable levers, related to the professional environment of the employees.

Background The genetic diversity of M. bovis in Tunisia is still underestimated despite the implementation of an eradication program. The lack of data about spatial distribution of the M. bovis population hinders the control of bovine tuberculosis (bTB) progress. This study represents the largest molecular analysis of M. bovis isolates in Tunisia. It is aimed to upgrade the understanding of bTB epidemiology and the geographical distribution of the infection. Tuberculosis research was performed in cattle (n = 149) with TB-compatible lesions collected over 5 months from a slaughterhouse located in Sfax, Tunisia. Results Ninety-four animals were found to be infected by M. bovis and two others by M. caprae. Spoligotyping revealed twenty-five patterns, SB0120, SB0134, and SB0121 being the most prevalent profiles (36.4%, 11.4%, and 7.2%, respectively). Three new spoligotypes were detected: SB2345, SB2344 and SB2343. MIRU-VNTR analysis classified the isolates in seventy-three profiles and showed a large genotypic variety observed within the main spoligotype which was split into several MIRU-VNTR types: 29 in SB0120 (h = 0.983), 10 in SB0134 (h = 0.981) and 7 in SB0121 (h = 1). Genotyping revealed a common pattern in different geographic regions. It also showed that Sfax, located in southern-Tunisia, represents a high-risk area with an elevated genetic diversity. Conclusions Spatial analysis may provide insights into disease transmission, which affects the effectiveness of eradication campaigns in cattle. Electronic supplementary material The online version of this article (10.1186/s12917-017-1314-y) contains supplementary material, which is available to authorized users.