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BACKGROUND Since the Cleopatra trial, the therapeutic standard for HER-metastatic breast cancer (BC) is combination of Pertuzumab, Trastuzumab and Docetaxel. Given the lack of availability of Pertuzumab in Tunisia, treating these diseases according to international recommendations remains a challenge. We report the case of a patient in which this protocol could be administered with favorable outcomes. CASE REPORT This observation is reporting the case of a luminal B-HER2 overexpressed BC in a 36 year-old woman. At presentation, radiological investigations revealed bone, hepatic, pulmonary, cerebral and meningeal metastasis. She was first treated with combination of Trastuzumab-Paclitaxel (8 courses)-Zoledronic Acid followed by whole brain radiotherapy (RT). A subsequent CT scan showed cerebral and hepatic complete response with pulmonary partial response. Thus, the patient was put on Tamoxifen with Trastuzumab as a maintenance treatment. 8 months later, the CA 15-3 level was rising without radiological progression. She had achieved surgical castration and the anatomopathological examination revealed ovarian metastasis. We rechallenged Paclitaxel with Trastuzumab and only 6 courses of Pertuzumab. Normalization of the CA 15-3 rate has been achieved. A relay by Anastrozole with Trastuzumab (Total of 27 injections) was done. The last workup concluded with a complete hepatic, pulmonary and cerebral response and a condensation of bone lesions. She is alive in excellent general condition 3 years after diagnosis. CONCLUSION Efforts by our health authorities are underway to offer anti HER therapies to comply with international standards. Meanwhile, this case has shown that thanks to continuous anti HER pressure with trastuzumab combined with only 6 injections of Pertuzumab, we have achieved prolonged survival in this patient. [ABSTRACT FROM AUTHOR]

An extensive spatial survey was conducted on trace metal content in stream sediments from Oued El Maadene basin, northern Tunisia. Our objectives were to evaluate the level of trace metal pollution and associated ecological risk and identify the major sources of metal pollution. A total of 116 stream sediment samples were collected and analysed for total As, Cd, Cr, Cu, Ni, Pb, V, Zn, and Zr concentrations. The results showed that concentrations of Cr, Ni, V, and Zr were close to natural levels. In contrast, As, Cd, Cu, Pb, and Zn had elevated concentrations and enrichment factors compared to other contaminated regions in northern Tunisia. Ecological risk to aquatic ecosystems was highlighted in most areas. Principal component analysis showed that Cr, Ni, V, and Zr mainly derived from local soil and bedrock weathering, whilst As, Cd, Pb, and Zn originated from mining wastes. Trace metals could be dispersed downstream of tailings, possibly due to surface runoff during the short rainy season. Surprisingly, Cu, and to a lesser extent As, originated from agricultural activities, related to application of Cu-based fungicides in former vineyards and orchards. This study showed that, despite the complete cessation of mining activities several decades ago, metal pollution still impacts the local environment. This large pollution, however, did not mask other additional sources, such as local agricultural applications of fungicides. [ABSTRACT FROM AUTHOR]

The aim of this study is to determine the general state of the Korba aquifer (northwestern Tunisia) with respect to seawater intrusion and to assess the suitability of groundwater for drinking and irrigation purposes. A total of 60 groundwater samples were collected and analysed for physicochemical parameters (pH, EC, TDS, Na + , K + , Ca 2+ , Mg 2+ , HCO3 - , Cl - , NO 3 - , SO 4 2- and Br - ). Major ionic ratios highlighted the dominance of the reverse ion exchange process triggered by the marine intrusion. Br - /Cl - ratio suggested that the irrigation with saline water and wastewater were potential additional sources of salinization. Hydrochemical Facies Evolution Diagram coupled with a GIS-based framework revealed that most of samples are located beneath the mixing line, showing dominant marine intrusion process. Based on the water quality index, most of groundwater samples were unsuitable for drinking. In addition, according to high sodium adsorption ratio, the groundwater quality was limited for irrigation purposes., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

High-quality and accurate environmental investigations are essential for the evaluation of contamination and subsequent decision-making processes. A combination of environmental geochemical indices, multivariate analyses and geographic information system approach was successfully used to assess contamination status and source apportionment of trace elements (Ag, As, Cd, Cr, Cu, Hg, Ni, Pb, Sb, V and Zn) in surface stream sediments from the Oued Rarai basin in north-western Tunisia, containing various metal and metalloid ores. The contamination level reported in this study indicates a non-negligible potential ecological risk, mainly related to sediment transport along the river. Antimony (concentrations ranged from 0.02 to 297 mg kg -1 and Igeo > 5), arsenic (from 0.5 to 1490 mg kg -1 and Igeo > 5), lead (from 2.9 to 5150 mg kg -1 and Igeo > 5) mercury (from 0.05 to 54.4 mg kg -1 and Igeo > 5) and silver (from 0.05 to 9.4 mg kg -1 and Igeo > 5) showed the most crucial contamination. Besides, potential ecological risk index values were maximum for arsenic with a median of 302, indicating a very high to serious ecological risk (> 160). Results from correlation analysis and principal component analysis revealed three main geochemical associations related to lithologic, tectonic and anthropogenic sources. V, Cr and Cu mainly originated from natural bedrock and soil. Ag and Cd were more controlled by both natural and mining enrichments. Mercury and Pb were mostly influenced by the ancient ore-related activities at the Oued Rarai site and north-east-south-west trending faults. Finally, Sb, As, Ni and Zn were largely controlled by the siliciclastic continental Neogene sequences. Finally, the physical and chemical dynamics of the watershed system, lithological properties, mineralisation, tectonic settings and mobilisation of subsurface sediments largely controlled both concentrations and spatial patterns of trace elements in the study basin. These results need to be considered in the strategies of suitable environmental management at former and current mining sites in north-western Tunisia., (© 2021. The Author(s).)

Introduction: Taxanes are widely used in medical oncology. The aim of our study was to report and analyze the toxicity features of these drugs in Tunisian patients and to determine their impact on treatment response., Methods: Our retrospective study concerned 90 patients treated by taxanes in a medical oncology unit, from January 2014 to January 2017. We collected their epidemiologic and anatomo-clinical data and we detailed toxicity features including types grades and impact on tumor response., Results: Median age was 46 years. 80% of patients had breast cancer. Tumors were metastatic in 23.3% of cases. Nail toxicity was observed in 100% of patients. Grade I-II digestive toxicity was observed in 54.4% of cases. Hematological toxicity was noted in 42.2% of patients and it reached grade III-IV in five patients. Neurological toxicity occurred in 31% of patients and was grade III-IV in 6 cases. Alopecia was observed in 60% of patients. Fatigue was noted in 57.8% of patients. Myalgia was observed in 42.2% of patients. Toxicity did not affect the response to treatment., Conclusion: The taxanes' toxicity profile in Tunisian patients is characterized by more frequent digestive and nail toxicities and less frequent hematological toxicities, dose reduction and treatment delays than other populations., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

The most important limits of oxaliplatin treatment is its peripheral neurotoxicity. The aim of our study was to evaluate the oxaliplatin-induced peripheral neuropathy, its impact on treatment and its management. One hundred chemo-naive patients treated with oxaliplatin-based regimen in the medical oncology department of the military hospital of Tunis between 2012 and 2017 were recruited retrospectively. Evaluation of neuropathy was done according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE V4). Fifty-six patients were aged more than 60 years. The sex-ratio was 1.56. Twenty-seven patients were overweight, 17 were obese and 56 had a BMI inferior to 25 kg/m 2 . Two patients were consuming alcohol. Twenty-three patients had diabetes. Sixty-four patients developed chronic peripheral neuropathy because of oxaliplatin (grade 1-2 in 58 cases and grade 3 in 6 cases). Sex, BMI, diabetes and alcohol consumption were not associated with the development of peripheral neuropathy. No association was found between grades of neuropathy and sex, alcohol consumption and diabetes. The median cumulative dose of oxaliplatin that induced neuropathy was 432.4 mg/m 2 . The most prescribed treatment was gabapentin (81%) and carbamazepine (16.8%). The treatment was not sufficient to stop neuropathy in 82.6% of cases. Dose reduction was done in 64.2% of cases, treatment delay in 10.7% of cases and treatment interruption in 10.7% of cases. We didn't find any association between known risk factors and peripheral neuropathy. The cumulative dose is interesting to define or to predict the timing of neurotoxicity., Competing Interests: The authors declare no competing interests., (© Aref Zribi et al.)