Search

Résumé: Introduction: La technique de Koyanagi a suscité depuis quelques années un intérêt croissant, de par ses résultats satisfaisants ou encore le risque moindre de complications postopératoires pour le patient, dans l’hypospadias postérieur. Objectifs: Evaluer les indications et les résultats de la technique de Koyanagi. Patients et méthodes: C’est une étude rétrospective descriptive portant sur les patients hospitalisés au service de chirurgie pédiatrique de l’EPS de Monastir pour hypospadias postérieur et opérés selon la technique de Koyanagi avec un suivi ultérieur en ambulatoire et un recul d’au moins 02 ans. Résultats: Au total 35 patients ont été colligés. L’âge moyen lors de la première consultation en chirurgie pédiatrique était de 12,2 mois avec une moyenne d’âge au moment de l’intervention de 28,8 mois. La durée moyenne de l’intervention chirurgicale était de 166,1 min. La durée totale moyenne de séjour était de 7,9 jours. Uniquement 4 patients soit 11,4% de l’échantillon ont présenté des complications immédiates. La reprise chirurgicale a été indiquée pour 23 cas et les indications étaient par ordre de fréquence décroissant: le recul du méat (34,3%), fistule isolée ou associée à un recul du méat (11,4%) et le recul du méat avec transposition péno-scrotale (2,9%). L’évaluation finale de l’acte chirurgical a permis de retrouver que le siège du méat était distal dans la majorité des cas (85,7%), deux patients ont gardé une courbure résiduelle estimée par l’opérateur comme étant minime et ne nécessitant pas une reprise chirurgicale et aucun de nos patients n’a gardé d’anomalies du jet urinaire. Conclusion: L’urétroplastie selon Koyanagi, est une technique intéressante pour la correction d’hypospadias postérieur surtout en cas de courbure ventrale mais avec un taux de complications assez élevé. Abstract: Introduction: The koyanagi technique because of its satisfying results and less risk of postoperative complications for the patient has generated an increasing interest during recent years. Objective: To report the indications and the results of the koyanagi technique. Patients an methods: This is a descriptive retrospective study of patients admitted in the pediatric surgery's department of the EPS Monastir, Tunisia for proximal hypospadias and operated on according to Koyanagi's technique during the period from 02 january 2006 to 30 june 2013, with subsequent follow-up of at least 02 years. Results: The data of total 35 patients were collected. The average age at the first consultation in pediatric surgery was 12.2 months and the age at surgery was 28.8 months with extremes ranging from 12-55 months. The mean operative time was 166.1 min. The average stay at hospital was 7.9 days. Only 4 patients (11.4%) presented immediate complications. Reoperation was indicated for 23 cases and indications were by decreasing order of frequency: dehiscence (34.3%), fistula (11.4%) and dehiscence with persistent penile-scrotal transposition (2.9%). The final clinical evaluation of the surgery found that meatus was distal in the majority of cases (85.7%), two patients kept a residual curvature estimated as being minimal and not requiring any further surgery and none of our patients presented abnormalities of the urinary stream. Conclusions: Koyanagi's technique in repairaing proximal hypospadias seems to be an excellent option especially in cases of severe curvature but with a high rate of complications. Mots clés: Hypospadias postérieur, Chirurgie, Koyanagi, Enfant, Keywords: Posterior hypospadias, Surgery, Koyanagi, Children

Tuberculosis (TB), a chronic bacterial disease caused by Mycobacterium tuberculosis, commonly affects the lung but can also affect other parts of the body (extrapulmonary tuberculosis, EPT). A rapid diagnosis is essential to initiate a specific and effective treatment. Although mycobacterial culture remains the gold standard for EPT diagnosis, molecular tools are attracting increasing interest. GeneXpert MTB/RIF, a rapid automated diagnostic test, allows the detection of Mycobacterium tuberculosis as well as mutations in the hot-spot region of the rpoB gene associated with Rifampicin resistance. The present study was performed to evaluate the performance of the GeneXpert MTB/RIF test for the diagnosis of EPT compared to the standard method. This prospective study was conducted on 304 clinical samples collected from 192 patients attending the Laboratory of Mycobacteria and Tuberculosis of Pasteur Institute of Morocco, between 2016 and 2017. Out of the 304 samples, 113 were pleural f luids decontaminated using the Petroff method and 191 were biopsies (78 lymph nodes and 113 pleural biopsies) decontaminated using the Löwenstein method. Mycobacterium tuberculosis detection and identification were performed on all samples using smear microscopy, Löwenstein–Jensen medium culture and the GeneXpert MTB/RIF test. Our results showed that 54.5 (103/189) were men and 45.5% (86/189) were women. The age of patients ranged from 2–78 years and the majority of patients was in the age group 25–45 years. Extrapulmonary samples were derived from lymph nodes, pleural f luids and pleural tissues, with a percentage of 25.66, 37.17 and 37.17%, respectively. Interestingly, the sensitivity of the GeneXpert was 51.4 for all samples and 83.3% for lymph nodes. In conclusion, the present study revealed that the performance of the GeneXpert test depends highly on the type of sample, with a high sensitivity observed for lymph nodes. Additionally, we clearly showed that the GeneXpert MTB/RIF test presents limitations in the diagnosis of pleural TB. Thus, we recommend the coupled use of the GeneXpert MTB/RIF and the conventional techniques for EPT diagnosis.

The clinical management of metastatic melanoma requires predictors of the response to checkpoint blockade. Here, the authors use immunological assays to identify potential prognostic/predictive biomarkers in circulating blood cells and in tumor-infiltrating lymphocytes from patients with resected stage III melanoma.

Purpose: The concept of interposing double dorsal preputial flaps to cover the urethroplasty was introduced in 2005 to reduce the risk of urethrocutaneous fistula (UCF). Our study aims to compare the postoperative outcomes of urethroplasty for distal hypospadias between two groups: one receiving single preputial flap coverage and another receiving double flap coverage., Materials and Methods: We conducted a retrospective analysis study of boys with primary distal hypospadias who underwent surgery by the same experienced surgeon, at our department between 2010 and 2021. The study population was divided into two groups: Group A, which underwent urethroplasty coverage with single dorsal preputial flap, and Group B, which underwent coverage with double flap. Postoperative complications were compared between the two groups., Results: We collected 105 cases, comprising 51 in Group A and 54 cases in Group B. The mean age at surgery was 29 months in Group A and 24 months in Group B. Post-operative follow-up period ranged from 6 months to 8 years. Functional and cosmetic outcomes were judged excellent in 88.7%. Only 10 boys experienced complications requiring reoperation. UCF occurred in 5 patients from Group A, while no cases were reported in Group B (p = 0.024). Meatal stenosis was identified in three patients in Group A and in two patients in Group B (p = 1). No other complications, such as glans dehiscence or penile torsion, were noted., Conclusion: Double dorsal dartos flap is an effective method for covering the new urethra and can be recommended in the treatment of patients with virgin distal hypospadias., (© 2024 The Author(s). International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)

Background: we aim to discuss the origin and the differences of the phenotypic features and the management care of rare form of disorder of sex development due to Mosaic monosomy X and Y chromosome materiel., Methods: We report our experience with patients harboring mosaic monosomy X and Y chromosome material diagnosed by blood cells karyotypes and cared for in our department from 2005 to 2022., Results: We have included five infants in our study. The current average age was 8 years. In four cases, the diagnosis was still after born and it was at the age of 15 years in one case. Physical examination revealed a variable degree of virilization, ranging from a normal male phallus with unilateral ectopic gonad to ambiguous with a genital tubercle and bilateral not palpable gonads in four cases and normal female external genitalia in patient 5. Karyotype found 45, X/46, XY mosaicism in patient 1 and 2 and 45, X/46, X, der (Y) mosaicism in patient 3, 4 and 5. Three cases were assigned to male gender and two cases were assigned to female. After radiologic and histologic exploration, four patients had been explored by laparoscopy to perform gonadectomy in two cases and Mullerian derivative resection in the other. Urethroplasty was done in two cases of posterior hypospadias. Gender identity was concordant with the sex of assignment at birth in only 3 cases., Conclusion: Because of the phenotypic heterogeneity of this sexual disorders and the variability of its management care, then the decision should rely on a multidisciplinary team approach., (© 2024. The Author(s).)

Objectives: Corrosive substance ingestion in children represents a significant public health issue due to its long-term health sequelae. Esophageal stricture, main complication of this dangerous condition, is treated by pneumatic dilation and eventually by esophageal replacement. We aimed, through this study, to report the outcomes of esophageal pneumatic dilation complicating corrosive substance ingestion in children in a developing country., Methods: This cross-sectional study was performed on the population of pediatric patients with caustic esophageal stenosis between January 2005 and December 2020. All patients underwent pneumatic balloon dilation. A logistic regression model was built to predict the probability of the occurrence of the event (success/failure) of the dilation. The ROC curve is used to evaluate the performance of the logistic regression model to discriminate between positive and negative values of the dependent variable., Results: The success rate of pneumatic balloon dilation was 80.4%. The median duration of overall management was 11 months. The severity of caustic stricture observed during endoscopy was significantly linked to worse outcomes (p = 0.001). Multivariate analysis indicated that the severity of stenosis and the number of dilation sessions were independent risk factors for failure of dilation. ROC curve analysis showed that the area under the curve was 71.7%. A Cut-Off point value of 7 provided the best sensitivity and specificity., Conclusion: Pneumatic balloon dilation has been proven to be efficacious in infants with caustic esophageal stricture. Pediatric surgeons should take into account factors to promptly switch to replacement surgery and avoid unnecessary and time-consuming serial dilations., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The ubiquitous environmental fungus Aspergillus flavus is also a life-threatening avian pathogen., Objectives: This study aimed to assess the genetic diversity and population structure of A. flavus isolated from turkey lung biopsy or environmental samples collected in a poultry farm., Methods: A. flavus isolates were identified using both morphological and ITS sequence features. Multilocus microsatellite genotyping was performed by using a panel of six microsatellite markers. Population genetic indices were computed using FSTAT and STRUCTURE. A minimum-spanning tree (MST) and UPGMA dendrogram were drawn using BioNumerics and NTSYS-PC, respectively., Results: The 63 environmental (air, surfaces, eggshells and food) A. flavus isolates clustered in 36 genotypes (genotypic diversity = 0.57), and the 19 turkey lung biopsies isolates clustered in 17 genotypes (genotypic diversity = 0.89). The genetic structure of environmental and avian A. flavus populations were clearly differentiated, according to both F-statistics and Bayesian model-based analysis' results. The Bayesian approach indicated gene flow between both A. flavus populations. The MST illustrated the genetic structure of this A. flavus population split in nine clusters, including six singletons., Conclusions: Our results highlight the distinct genetic structure of environmental and avian A. flavus populations, indicative of a genome-based adaptation of isolates involved in avian aspergillosis., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Objective: The aim of our study was to assess prevalence of geriatric assessment (GA) in patients over 75years with nonmetastatic invasive bladder cancer (MIBC)., Material and Methods: We performed a retrospective study between 2000 and 2015. We assessed comobidity by Charlson score and ASA score, geriatric assessement (GA) and treatments., Results: One hundred and twenty one patients were inclued. Median age was 81 (73-95) at diagnosis. Thirty nine patients (32%) were evaluated by GA, G8 screening tool was performed in 16% of patients. Patients without GA were older (82 vs. 81years) and had less comorbidities (Charlson≥2 à 61% vs. 69%). Seventy-four percent of patients received a curarive therapy: 60% were treated by RC, 9% by chemoradiotherapy, 26% received palliative therapy and 15% were only in observation., Conclusion: Patients with MIBC over 75years were less evaluated and less treated. Patients in pallative care received mostly observation. Although practices have improved, GA was underused. Care of these patients needs standardization in order to adapt therapeutic to their comorbidities and to treat them with curative intent., Level of Proof: 4., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Trichobezoar is an uncommon clinical entity in which ingested hair mass accumulates within the digestive tract. It is generally observed in children and young females with psychological disorders. It can either be found as an isolated mass in the stomach or may extend into the intestine. Untreated cases may lead to grave complications., Material and Methods: We retrospectively analyzed the clinical data of six patients treated for trichobezoar in Monastir pediatric surgery department during 16-year-period between 2004 and 2019. Imaging (abdominal computed tomography and upper gastroduodenal opacification) and gastroduodenal endoscopy were tools of diagnosis., Results: Our study involved 6 girls aged 4 to 12. Symptoms were epigastric pain associated with vomiting of recently ingested food in 3 cases and weight loss in one case. Physical examination found a hard epigastric mass in all cases. The trichobezoar was confined to the stomach in 4 cases. An extension into the jejunum was observed in 2 cases. Surgery was indicated in all patients. In two cases, the attempt of endoscopic extraction failed and patients were then operated on. All patients had gastrotomy to extract the whole bezoar even those with jejunal extension. Psychiatric follow-up was indicated in all cases. The six girls have evolved well and did not present any recurrence., Conclusion: open surgery still plays a crucial role in Trichobezoard management . After successful treatment, psychiatric consultation is imperative to prevent reccurrence and improve long term prognosis., Competing Interests: None

Background: Femoral hernias are an uncommon groin pathology among pediatric patients. Therefore, they are frequently misdiagnosed. In the present study, we review our experience with this rare surgical entity during the past 25 years., Methods: The medical records of 19 patients who underwent 22 femoral hernia repairs between January 1994 and December 2019 were retrospectively analysed., Results: Patients' age ranged from 2 to 12 years (mean age was 5. 5 years) with an approximately equal sex ratio (10 girls/9 boys). There were three bilateral cases identified separately. They were discovered and managed at different times. All the children were referred with a groin lump, but the correct pre-operative diagnosis was made in only 13 cases (59%). In the remaining cases, four were identified intraoperatively following negative exploration for a supposed inguinal hernia. The other five were found to have a femoral hernia 1 month to 12 months after ipsilateral inguinal hernia repair. All patients underwent elective surgery. The femoral canal was closed using either Lytle or McVay procedure. Recurrence occurred in only one patient 2 months after initial repair., Conclusion: Femoral hernias are often misdiagnosed. Pre-operative diagnosis can be obtained through careful clinical assessment. In equivocal cases, ultrasonography and laparoscopy could be useful. A correct pre-operative diagnosis will lead to suitable treatment, thus avoiding unnecessary reoperations and their related complications., Competing Interests: None

Microsporidiosis is an emerging opportunistic infection causing severe digestive disorders in immunocompromised patients. The aim of this study was to investigate the prevalence of intestinal microsporidia carriage among immunocompromised patients hospitalized at a major hospital complex in the Tunis capital area, Tunisia (North Africa), and perform molecular epidemiology and population structure analyses of Enterocytozoon bieneusi , which is an emerging fungal pathogen. We screened 250 stool samples for the presence of intestinal microsporidia from 171 patients, including 81 organ transplant recipients, 73 Human Immunodeficiency Virus (HIV)-positive patients, and 17 patients with unspecified immunodeficiency. Using a nested PCR-based diagnostic approach for the detection of E. bieneusi and Encephalitozoon spp., we identified 18 microsporidia-positive patients out of 171 (10.5%), among which 17 were infected with E. bieneusi . Microsporidia-positive cases displayed chronic diarrhea (17 out of 18), which was associated more with HIV rather than with immunosuppression other than HIV (12 out of 73 versus 6 out of 98, respectively, p = 0.02) and correlated with extended hospital stays compared to microsporidia-negative cases (60 versus 19 days on average, respectively; p = 0.001). Strikingly, internal transcribed spacer (ITS)-based genotyping of E. bieneusi strains revealed high-frequency occurrence of ITS sequences that were identical ( n = 10) or similar (with one single polymorphic site, n = 3) to rare genotype WL12. Minimum-spanning tree analyses segregated the 17 E. bieneusi infection cases into four distinct genotypic clusters and confirmed the high prevalence of genotype WL12 in our patient population. Phylogenetic analyses allowed the mapping of all 17 E. bieneusi strains to zoonotic group 1 (subgroups 1a and 1b/1c), indicating loose host specificity and raising public health concern. Our study suggests a probable common source of E. bieneusi genotype WL12 transmission and prompts the implementation of a wider epidemiological investigation.

Introduction: Medication adherence is the cornerstone of the successful drug management of a chronic disease., Aim: To develop a systematic review and meta-analysis of the prevalence and the factors associated with non-adherence in patients with type 2 diabetes in North African countries., Methods: A literature search was conducted on Medline via Pubmed with a complementary search on Google Scholar. The meta-analysis was conducted using the Metaprop function of R software. The Cochrane Q test and Higgins I² statistic were used to estimate the heterogeneity., Results: In total, 16 studies measuring the prevalence of medication adherence in North African countries were selected in this systematic review. The combined prevalence of non-adherence was 38% (95% CI 30%-47%) with a random-effects model. The meta-analysis revealed a significant heterogeneity between studies (I² = 96%, p <0.01). Factors associated with non-adherence in type 2 diabetics were education level, social security coverage, therapeutic education, cost of medication, socioeconomic level, the duration of diabetes, unbalanced diabetic diet, polypharmacy, female gender, family support and age., Conclusion: The combined prevalence of non-adherence among type 2 diabetics in North Africa was high and multifactorial, requiring global and integrated management by patients, physicians and pharmacists.

This study investigates the performance of the combination of biological pre-treatment with Kefir grains (KGs) and photocatalytic process using Ag-doped TiO 2 nanoparticles (NPs) for the simultaneous removal of toxic pollutants from landfill leachate (LFL). After 5 days of 1% (w/v) KGs pre-treatment at 37 °C, TOC, COD, NH 4 + -N, and PO 4 3- removal rates were 93, 83.33, 70 and 88.25%, respectively. The removal efficiencies were found to be 100, 94, 62.5, 53.16 and 47.52 % for Cd, Ni, Zn, Mn and Cu, respectively. The optimal conditions of Ag-doped TiO 2 photocatalytic process were optimized using Box-Behnken design and response surface methodology (BBD-RSM) to enhance the quality of pre-treated LFL. Interestingly, Ag-doped TiO 2 photocatalytic process increases the overall removal efficiencies to 98, 96, 85 and 93% of TOC, COD, NH 4 + -N, and PO 4 3- , respectively. Furthermore, the removal efficiency of toxic heavy metals was gradually improved. In addition, KGs and Ag-doped TiO 2 exhibited excellent recyclability showing the potential of combined biological/photocatalytic process to treat hazardous LFL., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In recent years, the photocatalytic process by using TiO 2 nanoparticles (NPs) has produced a great interest in wastewater treatment due to its interesting features such as low-cost, environmental compatibility, and especially capacity to eliminate persistent organic compounds as well as microorganisms in water. In the present work, the photocatalytic activity of Gd-doped TiO 2 nanopowders, with different doping amount 0.1, 1, and 5 mol% synthesized by the sol-gel method, was studied under UV/Visible irradiation for water treatment application. The Gd-doped TiO 2 nanoparticles were investigated for their photocatalytic degradation of methylene blue (MB) dye and antibacterial activities against two bacterial strains namely Stenotrophomonas maltophilia (S. maltophilia) and Micrococcus luteus (M. luteus). MB dye was used as a pollutant model to estimate reactive oxygen species (ROS) generation and to correlate killing action of nanoparticles with the generation of ROS. Scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), and Raman spectroscopy were used to characterize the as-synthesized nanomaterials. Photocatalytic, as well as antibacterial tests, showed that doping with an appropriate amount of Gd could reduce the radiative recombination process of photogenerated electron-hole pairs in TiO 2 and induce a significant enhancement in photocatalytic and consequently antibacterial activity. The experimental sequence of bactericidal activity and photocatalytic degradation efficiency exhibited by the different gadolinium-doped nanoparticles was the following: 0.1 mol% Gd-doped TiO 2  > 1 mol% Gd-doped TiO 2  > 5 mol% Gd-doped TiO 2  > pure titania.

The removal of Acid Orange 51 (AO 51) dye in aqueous solution by microscale zero-valent iron (m-ZVI) was investigated. The m-ZVI powder was characterized granulometrically by laser particle sizer and morphologically by transmission electron microscopy (TEM). The effects of pH, m-ZVI concentration, H 2 O 2 addition, and dye concentration on the decolorization of AO 51 were experimentally investigated. Results indicate that the removal efficiency is independent from pH values, increases with increasing ZVI dosage, and decreases with dye concentration. With 1 g/L of m-ZVI, AO 51 was effectively removed without and with addition of 25 mM H 2 O 2 , yielding a decolorization efficiency of around 70% and 98%, respectively, at pH 3 within 60 min of reaction time. The involvement of ˙OH in oxidizing AO 51 was examined by measuring the removal rates based on ˙OH scavenging molecule. Finally, the disappearance of AO 51 was estimated by monitoring the UV-Vis spectral evolution after 120 min of treatment while the Fourier-Transform Infrared spectroscopy (FT-IR) was performed to verify the occurrence of organic sorption on m-ZVI surface. The scanning electron microscope (SEM) images before and after the reaction illustrated morphological changes on m-ZVI surface. The detoxification of the treated solution was demonstrated using phytotoxicity test.

Objective: Few studies have investigated methods to monitor the moisture distribution and filling percentage of dressings during wound management. In this study, a new system allowing moisture monitoring across the wound dressing to be measured is examined., Method: The system is composed of a wound bed model with a fluid injection system to mimic exudate flow, a flexible sensor array and data acquisition software. The sensor is composed of 14 flexible electrode arrays, screen-printed on a flexible support and placed on the top of a wound dressing. The system is used to evaluate the performance of a foam-based dressing model., Results: During constant injection of fluid, the wound dressing absorbed moisture at the wound interface throughout the experiment, and expanded as the fluid spread from the wound bed to the edging areas of the foam. The in-time monitoring by the use of the screen-printed electrodes allowed a mapping of the dressing wet surface and estimation of the foam saturation (filling percentage) based on a simple acquisition method without the need to remove the dressing from the wound bed., Conclusion: The findings of this study propose a non-invasive method to monitor the filling of the wound dressing and consequently, a potential solution for determining the optimal dressing change during wound management without causing irritation or further damage to the periwound skin.

This study was undertaken to evaluate the performance of four wastewater treatment plants/processes over a 4 year period. The wastewater flow evolution, energy consumption, and quality indicator parameters (BOD 5 , COD and TSS) at the inlet and outlet sites of the plants were determined. In comparing three domestic WWTPs with different wastewater treatment processes, the multivariate analyses (RDA and ANOVA) showed that although the Agareb plant received the highest pollution load, it displayed a high level of removal efficiency especially for COD, BOD, TSS, TKN and NH 4 + . It also revealed that the fluctuations in the wastewater composition and its contamination by varied industrial discharge could lead to the decrease in performance of the WWTP with activated sludge process as observed for the Southern Sfax plant. However, the electrolysis of the outlet water of Southern Sfax plant showed a significant improvement in COD removal., (Copyright © 2016 Elsevier Ltd. All rights reserved.)