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La lombalgie commune représente un problème de santé publique majeur en raison de son impact fonctionnel et de son coût économique élevé. Bien que controversée, la relation entre la lombalgie commune et le système podal a été rapportée par certains auteurs [1]. L'objectif de cette étude était d'analyser la fréquence et les caractéristiques cliniques des atteintes podales chez les patients souffrant de lombalgie commune, ainsi que la relation entre ces atteintes et l'incapacité fonctionnelle. Une étude transversale a été menée au service de rhumatologie de l'Hôpital Mongi Slim incluant 30 patients suivis pour une lombalgie commune. Les données sur la lombalgie, ses caractéristiques cliniques, et son étiologie ont été recueillies. Le retentissement fonctionnel a été évalué par l'Oswestry Disability Index (ODI) dont le score total s'étend de 0 % (aucune incapacité) à 100 % (incapacité totale) avec une incapacité sévère à partir de de 40 %. L'examen podal a inclus une évaluation clinique et un examen podoscopique des pieds. Le test du navicular drop a été utilisé pour rechercher une pronation excessive du pied. Une association entre les anomalies du système podal et le retentissement fonctionnel de la lombalgie a été recherchée. Un seuil de signification a été fixé pour un p < 0,05. L'étude a inclus 30 patients, avec une prédominance féminine (sexe ratio = 0,4). L'âge moyen était de de 55 ± 10 ans [30–85]. L'indice de masse corporelle (IMC) moyen était de 26 ± 3 kg/m2 [19–32]. Les comorbidités rapportées étaient : hypertension artérielle (16,6 %), diabète type 2 (10 %), dyslipidémie (10 %), asthme (6,6 %), bronchopneumopathie obstructive (3,3 %). Environ, 46 % étaient au chômage, 17 % occupaient un poste de bureau, 17 % un travail physique et 20 % étaient à la retraite. La durée d'évolution de la lombalgie était en moyenne de 5 ± 3,4 ans [1–14], avec un caractère récidivant retrouvé dans 90 % des cas. Les facteurs aggravants rapportés à l'interrogatoire étaient : le port de charges lourdes (43 %), la station debout prolongée (23 %), la position assise prolongée (10 %) et l'hyperextension du rachis (7 %). L'échelle visuelle analogique (EVA) moyenne était de 5 ± 1,7 [1–10]. Le score d'Owestry révélait un retentissement minime dans 56 % des cas, modérée dans 27 % des cas et sévère dans 17 % des cas. Un tiers des patients rapportaient une plainte au niveau des pieds à type de talagies (7 %), douleur du médio-pied (10 %) et de l'avant-pied (17 %). La déformation la plus retrouvée était l'hallux valgus (39 %), suivie des orteils en griffe (13 %). Des anomalies de l'arrière-pied (valgus ou varus) ont été présentes dans 80 % des cas. Les troubles statiques plantaires, à type de pied creux (57 %) ou plat (17 %), étaient observés chez 74 % des patients. Le navicular drop test moyen était de 5 mm ± 3 [1,3–12]. Une hyperpronation du pied a été détectée dans 17 % des cas. Une association significative a été trouvée entre un score élevé à l'ODI et le syndrome d'hyperpronation (p = 0,05). Aucune association statistiquement significative n'a été notée entre l'ODI et les autres anomalies podales. Notre étude a confirmé la fréquence élevée des anomalies podales chez les patients souffrant de lombalgie commune. L'hyperpronation du pied semble être associée à une aggravation de l'incapacité fonctionnelle, suggérant qu'une prise en charge adaptée des anomalies podales pourrait contribuer à réduire l'impact de la lombalgie. [ABSTRACT FROM AUTHOR]

Background: Visceral Leishmaniasis (VL) is the most severe and fatal disease if left untreated. In people living with HIV/AIDS (PLHA), VL is considered an emerging opportunistic infection. The aim of this manuscript was to report a first case in Tunisia of a concomitant presentation of visceral and oral leishmaniasis in a patient LHA. A systematic review of the literature was performed according to PRISMA guidelines, as well., Case Presentation: The patient, a 43-year-old heterosexual man, treated for HIV/AIDS was referred for macrocheilitis of the upper and lower lips. A noticeable nodular and painless swelling extending to the cheeks' mucosa was noted. The patient's poor oral hygiene was evident due to the presence of multiple dental caries. Histological analysis of the biopsied lower lip sample revealed the presence of numerous Leishmania amastigotes. The diagnosis of VL was clinically confirmed by the presence of a mild splenomegaly and pancytopenia and biologically by the identification of the parasite using PCR Lei and the species L. infantum involved using RFLP-PCR and culture. The treatment consisted of an intravenous administration of liposomal Amphotericin B (Ambisome®, 40 mg/kg/weight) for a period of 6 weeks. A favorable outcome was noted after one year with the resolution of clinical symptoms and a negative Leishmania blood PCR test. After 2 years, the patient remained asymptomatic but showed a positive Leishmania blood PCR test. Dolutegravir® was introduced in the patient's ART regimen., Conclusions: To the best of our knowledge, this is the first case report in Tunisia of atypical VL diagnosed through an uncommon oral location in an HIV/AIDS co-infected patient . Since VL is a severe and potentially fatal disease, it is essential for dentists to perform a thorough clinical examination and adopt a multidisciplinary approach in order to ensure an early diagnosis and an effective treatment outcome., (© 2024. The Author(s).)

Background: Vaccination constitutes the best strategy against COVID-19. In Tunisia, seven vaccines standing for the three main platforms, namely RNA, viral vector, and inactivated vaccines, have been used to vaccinate the population at a large scale. This study aimed to assess, in our setting, the kinetics of vaccine-induced anti-RBD IgG and IgA antibody responses., Methods: Using in-house developed and validated ELISA assays, we measured anti-RBD IgG and IgA serum antibodies in 186 vaccinated workers at the Institut Pasteur de Tunis over 12 months., Results: We showed that RNA vaccines were the most immunogenic vaccines, as compared to alum-adjuvanted inactivated and viral-vector vaccines, either in SARS-CoV-2-naïve or in SARS-CoV-2-experienced individuals. In addition to the IgG antibodies, the vaccination elicited RBD-specific IgAs. Vaccinated individuals with prior SARS-CoV-2 infection exhibited more robust IgG and IgA antibody responses, as compared to SARS-CoV-2-naïve individuals., Conclusions: After following up for 12 months post-immunization, we concluded that the hierarchy between the platforms for anti-RBD antibody-titer dynamics was RNA vaccines, followed by viral-vector and alum-adjuvanted inactivated vaccines.

In this study, we investigated for the first time the anti-inflammatory and immunomodulatory properties of crude polysaccharide (PSHT) extracted from green marine algae Halimeda tuna . PSHT exhibited anti-oxidant activity in vitro through scavenging 1, 1-diphenyl-2-picryl hydroxyl free radical, reducing Fe 3+ /ferricyanide complex, and inhibiting nitric oxide. PSHT maintained the erythrocyte membrane integrity and prevented hemolysis. Our results also showed that PSHT exerted a significant anti-edematic effect in vivo by decreasing advanced oxidation protein products and malondialdehyde levels and increasing the superoxide dismutase and glutathione peroxidase activities in rat's paw model and erythrocytes. Interestingly, PSHT increased the viability of murine RAW264.7 macrophages and exerted an anti-inflammatory effect on lipopolysaccharide-stimulated cells by decreasing pro-inflammatory molecule levels, including nitric oxide, granulocyte-macrophage colony-stimulating factor (GM-CSF) and tumor necrosis factor-alpha (TNF-α). Our findings indicate that PSHT could be used as a potential immunomodulatory, anti-inflammatory, anti-hemolytic, and anti-oxidant agent. These results could be explained by the computational findings showing that polysaccharide building blocks bound both cyclooxygenase-2 (COX-2) and TNF-α with acceptable affinities.

Importance: Cervical tuberculous lymphadenitis (CTL), the most frequent extrapulmonary form of tuberculosis, is currently a major health problem in Tunisia and in several regions around the world. CTL diagnosis is challenging mainly due to the paucibacillary nature of the disease and the potential misdiagnosis as cervical non-tuberculous lymphadenitis. This study demonstrates the added value of the heparin-binding hemagglutinin-interferon-gamma release assay as an immunoassay in the context of CTL., Competing Interests: The authors declare no conflict of interest.

The study of the tumor microenvironment (TME) has become an important part of colorectal cancer (CRC) research. Indeed, it is now accepted that the invasive character of a primary CRC is determined not only by the genotype of the tumor cells, but also by their interactions with the extracellular environment, which thereby orchestrates the development of the tumor. In fact, the TME cells are a double-edged sword as they play both pro- and anti-tumor roles. The interaction of the tumor-infiltrating cells (TIC) with the cancer cells induces the polarization of the TIC, exhibiting an antagonist phenotype. This polarization is controlled by a plethora of interconnected pro- and anti-oncogenic signaling pathways. The complexity of this interaction and the dual function of these different actors contribute to the failure of CRC control. Thus, a better understanding of such mechanisms is of great interest and provides new opportunities for the development of personalized and efficient therapies for CRC. In this review, we summarize the signaling pathways linked to CRC and their implication in the development or inhibition of the tumor initiation and progression. In the second part, we enlist the major components of the TME and discuss the complexity of their cells functions.

Asthma is associated with increased deposition and altered phenotype of airway smooth muscle (ASM) cells. However, little is known about the processes responsible for these changes. It has been suggested that alterations of the extracellular matrix (ECM) contribute to the remodeling of ASM cells in asthma. Three-dimensional matrices allow the in vitro study of complex cellular responses to different stimuli in a close-to-natural environment. Thus, we investigated the ultrastructural and genic variations of ASM cells cultured on acellular asthmatic and control bronchial matrices. We studied horses, as they spontaneously develop a human asthma-like condition (heaves) with similarities to chronic pulmonary changes observed in human asthma. Primary bronchial ASM cells from asthmatic ( n = 3) and control ( n = 3) horses were cultured on decellularized bronchi from control ( n = 3) and asthmatic ( n = 3) horses. Each cell lineage was used to recellularize six different bronchi for 41 days. Histomorphometry on HEPS-stained-recellularized matrices revealed an increased ASM cell number in the control cell/control matrix ( p = 0.02) and asthmatic cell/control matrix group ( p = 0.04) compared with the asthmatic cell/asthmatic matrix group. Scan electron microscopy revealed a cell invasion of the ECM. While ASM cells showed high adhesion and proliferation processes on the control ECM, the presence of senescent cells and cellular debris in the asthmatic ECM with control or asthmatic ASM cells suggested cell death. When comparing asthmatic with control cell/matrix combinations by targeted next generation sequencing, only AGC1 ( p = 0.04), MYO10 ( p = 0.009), JAM3 ( p = 0.02), and TAGLN ( p = 0.001) were differentially expressed out of a 70-gene pool previously associated with smooth muscle remodeling. To our knowledge, this is the first attempt to evaluate the effects of asthmatic ECM on an ASM cell phenotype using a biological bronchial matrix. Our results indicate that bronchial ECM health status contributes to ASM cell gene expression and, possibly, its survival., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ben Hamouda, Miglino, de Sá Schiavo Matias, Beauchamp and Lavoie.)

Severe asthma is associated with an increased airway smooth muscle (ASM) mass and altered composition of the extracellular matrix (ECM). Studies have indicated that ECM-ASM cell interactions contribute to this remodeling and its limited reversibility with current therapy. Three-dimensional matrices allow the study of complex cellular responses to different stimuli in an almost natural environment. Our goal was to obtain acellular bronchial matrices and then develop a recellularization protocol with ASM cells. We studied equine bronchi as horses spontaneously develop a human asthma-like disease. The bronchi were decellularized using Triton/Sodium Deoxycholate. The obtained scaffolds retained their anatomical and histological properties. Using immunohistochemistry and a semi-quantitative score to compare native bronchi to scaffolds revealed no significant variation for matrixial proteins. DNA quantification and electrophoresis revealed that most DNA was 29.6 ng/mg of tissue ± 5.6, with remaining fragments of less than 100 bp. Primary ASM cells were seeded on the scaffolds. Histological analysis of the recellularizations showed that ASM cells migrated and proliferated primarily in the decellularized smooth muscle matrix, suggesting a chemotactic effect of the scaffolds. This is the first report of primary ASM cells preferentially repopulating the smooth muscle matrix layer in bronchial matrices. This protocol is now being used to study the molecular interactions occurring between the asthmatic ECMs and ASM to identify effectors of asthmatic bronchial remodeling., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: To investigate the efficacy of misoprostol used alone, and the time of fetal expulsion for medical termination of pregnancy in the second trimester., Patients and Methods: 50 patients were enrolled in a prospective study over two years and in whom termination of pregnancy was indicated between 14 and 28 weeks of amenorrhea. Misoprostol was reported in a well-defined protocol: group 1: 2 tablets every 3 hours as intra vaginal, group 2: half dose for women bull 4th or more or carrying a scarred uterus for terms greater than or equal to 22 weeks of amenorrhea., Results: 48 patients expelled misoprostol alone and we have used an aspiration in two cases. The period of expulsion for 24 hours was 97% for the first group and 90% for the second., Conclusion: using misoprostol within this protocol is effective and reduce the time required for the fetal expulsion of the second trimester pregnancy.

Hydatic cyst of the Fallopian tube is an exceptional localization, the diagnosis of which is frequently confirmed preoperatively. A 44-year-old woman was addressed for pelvic mass with fortuitous discovery. The diagnosis preoperatively confirmed by the extemporaneous histological study was hydatic cyst of the Fallopian tube. Salpingectomy was required. The pelvic hydatic cyst, particularly in the Fallopian tube, is a rare complaint. Clinics and biology were very important for diagnosis but only anatomopathology can confirm diagnosis of hydatic cyst. The treatment of Fallopian tube hydatic cyst is surgival and often radical (salpingectomy)., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: Uterine synechias may pose real problems for fertility prognosis. It depends mainly on its etiology., Aim: To study the epidemiological profile of patients, describe the circumstances of discovery of uterine synechias, specify the diagnostic procedures for pelvic ultrasound, hysterography and hysteroscopy and estimate the benefits on fertility., Methods: A retrospective study over a period of 10 years from 1 January 2000 to December 31, 2009 in the department of obstetrics gynecology B Charles Nicolle's Hospital in Tunis., Results: We collected 86 patients. The age average was 35.42 years, gestit average of 1.36 with 37.2% of nulligeste and an average parity of 0.67. The uterine revision was the main etiology (55.8%). The main circumstance of discovery was the exploration of infertility (60%). Hysterosalpingography showed a luminal filling defect in 79% of patients mostly fundic location (37.3%). Faced with data from the hysteroscopy sensitivity of HSG was 78% and positive predictive value was 100%. For the seat of the synechia its sensitivity is only 40%. The surgical procedure took place in one time in 74 cases. Our complication rate is 8.14%: 2 uterine perforations, 2 falseroads and 3 cases of hemorrhage stopping surgery., Conclusion: The main etiology is a history of uterus revision. The main circumstance of discovery is the exploration of infertility. Anatomic results were generally good as testified hysteroscopy control.

Objectives: Positive and differential diagnoses of mesenchymal tumors of the uterus may be sometimes problematic. The purpose of this study was to evaluate the utility of a panel of antibodies in this diagnosis., Materials and Methods: The expression of AML, desmin, h-caldesmon and CD10 was studied in nine endometrial stromal sarcomas (SSE), two leiomyosarcomas (LMS) and 10 highly-cellular leiomyoma (HCL)., Results: AML positivity was found in five SSE, in all HCL and in only one LMS. Desmin expression was found in two SSE, in all HCL and LMS. H-caldesmon was negative in all SSE, positive in all HCL and in one case of LMS. CD10 was expressed in two-third of SSE. However, neither HCL nor LMS was marqued., Conclusion: CD10 is the most specific antibody of SSE. It seems to have the best value in the diagnosis of mesenchymal tumors in association with desmin and h-caldesmon, specific markers of smooth-muscle differentiation.

Background: The ovarian tumors' diagnosis is based on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis., Aim: The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis., Methods: We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors., Results: The average age of our patients was 51,3 years with an average size of 8,4cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and S-100 protein., Conclusion: The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors.

Background: cervical pregnancy is one of the rarest ectopic locations. It can be responsible of spontaneous haemorrhage enquiring hysterectomy. Ultrasonography technical improvements allow early diagnosis and conservative treatment., Aim: This study aims to report a new case of cervical pregnancy treated conservatively., Case Report: patient with cervical pregnancy diagnosed on ultrasonography and treated by one dose systemic methotrexate requiring a second injection because of no decreasing of serum beta human chorionic gonadotrophin level leading to expulsion of the pregnancy one month later., Conclusion: methotrexate is the standard treatment of early diagnosed cervical pregnancy. When haemorrhage occurs, many therapeutic methods allow conservative treatment in order to preserve fertility.

Background: Twin pregnancy is associated to high neonatal morbidity particularly for the second twin., Aim: To assess twin delivery practice in our department and prognosis of second twin., Methods: Retrospective study of medical files of parturition women with twin pregnancy between January 2003 and December 2006. Were excluded women delivered before 28 weeks gestation, twin pregnancies with death or malformation of one of twins. Descriptive and comparative analyses were realised., Results: One hundred forty six twin pregnancies were counted. Vaginal delivery was attempted with 90 parturition women with 85.5% of success. Caesarean section delivery rate was 47.2%. Overall there's no difference between twins considering neonatal complication. In case of vaginal delivery, the second twin's 5 minutes Apgar score was statistically under the one of the 1st twin if compared to the caesarean section delivery. This difference was no more significant if regarding the Apgar score under 7 at 5 minutes. Apgar score of the second twin was also under the one of the first twin in non cephalic presentation., Conclusion: Vaginal delivery of twin pregnancy was noot associated to high risk for twins. Obstetrical manoeuvres should be well controlled to reduce obstetrical trauma.

Objectives: Severe maternal morbidity remains a public health issue in developing countries. We report in this retrospective study, patients' characteristics and frequency of pathologies responsible of severe maternal morbidity., Materials and Methods: Between January 1999 and December 2003, 119 cases of severe maternal pathologies of pregnancy and delivery occurred among 19,736 live births., Results: Severe maternal morbidity was 602.95 per 100,000 live births and obstetrical haemorrhages were the most frequent cause (39%) followed by hypertensive disease (25%). Maternal mortality rate was 30.4 per 100,000 live births, and hypertensive disease represents the first cause of mortality in our study, contrary to all Tunisian data where haemorrhage remains the first one., Conclusion: Improvement of prognostic of high risk pregnancies has allowed diminution of maternal mortality. Instead of this diminution, efforts must be done in the management of severe obstetrical pathologies responsible of high maternal morbidity notably complications of hypertensive disease.

Background: adenomyosis is a frequent gynecologic pathology which affects women particularly in the fifth decade. It is responsible of abnormal uterine bleeding and pelvic pain. The diagnosis can be difficult especially when it's associated to other gynaecologic pathologies. Contribution of transvaginal sonography and magnetic resonance imaging made preoperative diagnosis possible. THE AIM of this study is to report frequency, epidemiologic profile, clinical signs and diagnostic and therapeutic methods of adenomyosis., Methods: this is a retrospective study about 52 cases of adenomyosis diagnosed upon 336 hysterectomies for benign pathologies. Descriptive analysis of epidemiologic, clinical, diagnosis and therapeutic data was performed., Results: prevalence of adenomyosis was 15% and multiparity observed for 90% of women was the main risk factor., Conclusion: women desirous of pregnancy and affected by adenomyosis can benefit from conservative treatment, but hysterectomy remains the reference treatment.

Spontaneous subperiosteal hematoma of the orbit is uncommon and only five cases have been reported in literature. The aim is to report a new case of this exceptional complication of labour and delivery. A 28-year-old woman developed immediately after delivery exophthalmia, chemosis and diplopia. CT scan showed a subperiosteal hematoma of the orbit. Spontaneous evolution was good. For her second pregnancy, caesarean section was decided because of the risk of recurrence. Since no etiology is found, venous hyperpression occurring during labor could be the lone origin.

Reactive arthritis are definied as steriles arthropathies using classic bacteriological techniques. They are due to extra articular infection and are often associated with HLA B27. The outcome of these arthritis is characterised by the recurrence of flares with sometimes appearition of ankylosing spondylitis. The pathogenesis of reactive arthritis is modified when bacterial antigens or alive micro-organisms are discovered in involved joints. Several current works have underlined the interest of antibiotic therapy in the chlamydial reactive arthritis. Chronic forms can justify the use of anti-rheumatic drugs such as salazopyrine.