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Background: Cutaneous fungal infections are very common, especially in poorer communities and with intercurrent HIV infection. Determining the fungal pathogen in skin‐related fungal neglected tropical diseases (NTDs) determines optimal therapy. We undertook a country survey across many African countries to determine the diagnostic capacity for skin fungal diseases. Methods: A detailed questionnaire was delivered to country contacts to collect data on availability, frequency, and location of testing for key diagnostic procedures and followed up with 2 rounds of validation by video call and by confirmation of individual country data confirmation by email. Results: Of 47 countries with data, seven (15%) and 21 (45%) do not offer skin biopsy in the public or private sector, respectively, but 22 (46%) countries do it regularly, mostly in university hospitals. Direct microscopy is often performed in 20 of 48 (42%) countries in the public sector and not done in 10 (21%). Fungal cultures are often performed in 21 of 48 (44%) countries in the public sector but not done in nine (20%) or 21 (44%) in either public or private facilities. Histopathological examination of tissue is frequently used in 19 of 48 (40%) countries but not in nine (20%) countries in the public sector. The cost of diagnostics to patients was a major limiting factor in usage. Conclusion: Major improvements in the availability and use of diagnostic tests for skin, hair, and nail fungal disease are urgently needed across Africa. [ABSTRACT FROM AUTHOR]

Abstract Introduction Telemedicine encompasses all medical practices that allow patients to be remotely cared for through new information and communication technologies. This study aims to assess the remote management of patients consulting emergency services and not requiring in-hospital care during both pre-pandemic and pandemic periods of COVID-19. Methods This was a prospective, randomized, controlled study. The telemedicine group received follow-up at home after emergency room discharge according to a predefined protocol, with telephone calls on days 2, 7, 15, and 30. The control group received standard care without regular telephone follow-up (only a call on day 30). The study was conducted with patients consulting the emergency department of FarhatHached Hospital in Sousse. Patient inclusion occurred between November 1, 2019, and April 30, 2020. The primary outcome measures were the re-consultation rate and treatment adherence. The secondary outcome measure was patient satisfaction.SPSS version 23.0 for Windows was used for data analysis. Descriptive statistics calculated frequencies, percentages, means, standard deviations, medians, and range. Analytical study involved Student’s t-test and Pearson chi-square test for mean and frequency comparisons, respectively. Significance threshold (p) for all tests was set at 0.05. Results A total of 400 patients were included. The average age of patients was 40 years. Both groups were comparable in terms of demographics and clinical characteristics. Diagnoses included mainly benign infectious diseases, trauma, mild decompensations of chronic conditions (asthma, COPD, heart failure), and suspected COVID cases. Patients in the telemedicine group tended to reconsult less in the month following their initial emergency room visit (14% versus 26.5%) (p = 0.004). There was a significant difference in treatment adherence between the telemedicine group and the control group (97.5% versus 92%; p = 0.014). The satisfaction with telemedicine was higher than satisfaction with regard to an in-person consultation at the emergency department (90% versus 37.5%). Conclusion It is necessary to implement telemedicine in Tunisia, especially in emergency services. It ensures better remote patient care by reducing re-consultation rates, increasing treatment adherence, and improving patient satisfaction.

Onopordum nervosum subsp. platylepis Murb. is an Asteraceae species found in Tunisia, Algeria, and Libya. It has been studied for its potential use as a vegetable rennet alternative to animal-derived rennet, making it important to understand its germination characteristics. This species often shows low germinability due to dormancy, which limits its large-scale cultivation. In preliminary experiments, many factors were analyzed to evaluate the seed germination of this thistle including physical stratification with abrasive paper and high-temperature water, chemical treatments with hydrogen peroxide (H2O2) or sulfuric acid (H2SO4), and the exogenous use of the growth regulator gibberellic acid (GA3). Based on the obtained results and subsequent analysis, GA3 and cold stratification durations were selected for the second experiment, which used a full factorial RSM design with three levels for each factor. Additionally, the total polyphenol content (TPC), total flavonoid content (TFC), condensed tannin content (CTC), and DPPH assay were analyzed during the optimization process and for ungerminated seeds. The findings revealed that 14 days of cold stratification followed by 750 ppm GA3 was the most efficient method for breaking the dormancy of these thistle seeds. The highest TPC was recorded in ungerminated seeds. However, germinated Onopordum nervosum ssp. platylepis seeds showed higher levels of TFC and CTC (14.83 mg QE/g DW and 6.49 mg EC/g DW, respectively) compared to the non-germinated ones and demonstrated the greatest potency in inhibiting free radicals (DPPH EC50 = 0.018 mg/mL) at the identified optimal germination conditions. Ungerminated seeds indicated significant phenolic content (TPC) and a limited ability to reduce oxidants, which could explain their low germination percentage. Our findings on the seed germination and dormancy characteristics of this endemic thistle will aid in the protection and development of its germplasm.

Abstract Introduction Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound was found to be useful for the diagnosis of heart failure (HF) in ED patients with acute dyspnea. Its value in identifying HF in acute exacerbation of chronic obstructive pulmonary disease exacerbation (AECOPD) was not specifically demonstrated. Objective To determine the value of ΔIVC in the diagnosis of HF patients with AECOPD. Methods This is a prospective study conducted in the ED of three Tunisian university hospitals including patients with AECOPD. During this period, 401 patients met the inclusion criteria. The final diagnosis of HF is based on the opinion of two emergency experts after consulting the data from clinical examination, cardiac echocardiography, and BNP level. The ΔIVC was calculated by two experienced emergency physicians who were blinded from the patient’s clinical and laboratory data. A cut off of 15% was used to define the presence (

Molecular hydrogen (H2 gas) dissolved in water to produce Hydrogen-Rich Water. Hydrogen-Rich Water (HRW) is considered as ergogenic aid in different exercise modes. However, acute pre-exercise HRW ingestion effect is unclear regarding athlete performance. This study aimed at investigating acute effect of HRW ingestion on aerobic and anaerobic exercise performance. Twenty-two male amateur middle-distance runners volunteered to participate in this study. In a randomized, double-blind study design, all players ingested 500 mL of HRW or placebo (PLA) supplement 30 min before the start of the tests. Over 4 days, maximal aerobic speed of Vameval test (MAS), time to exhaustion at MAS (Tlim), squat jump (SJ), counter-movement jump (CMJ) and five jump test (5JT) were evaluated. Also, rate of perceived exertion (RPE) and peak heart rate (HRpeak) were measured during the aerobic tests. For Vameval test, HRW ingestion improved MAS, HRpeak and RPE compared with the placebo condition. For Tlim test, HRW ingestion demonstrated improvements in time to exhaustion, RPE and HRpeak. However, no significant change was observed between HW and placebo conditions in SJ, CMJ, 5JT. 500 mL of HRW can significantly improve HRpeak, time to exhaustion, RPE, with no significant effect on MAS, jumping performance in amateur endurance athletes.

The purpose of this paper is to examine whether managers of bankrupt firms are more or less conditionally conservative in their financial reporting relative to non-bankrupt firms. The study further examines the cross-sectional differences in conditional conservatism among bankrupt and non-bankrupt firms. The study employs a sample of US firms to investigate conditional conservatism in firms that experience financial distress and go bankrupt relative to non-stressed non-bankrupt firms. The study also uses switching regression models to identify the drivers of the cross-sectional difference in conditional conservatism among bankrupt and non-bankrupt firms. Empirical results show that bankrupt firms are timelier in recognizing bad news than good news when compared to non-bankrupt firms. The higher level of conditional conservatism in bankrupt firms is mainly driven by their higher levels of leverage and tax-reduction incentives. The cross-sectional analyses show that these results largely hold for more leveraged firms and firms with higher tax costs. Taken together, these results suggest that the conservative tendency of managers of bankrupt firms can stem from the agency problem between lenders and managers and from tax-decreasing motivations. The novelty of the authors’ research stands in studying the drivers of the cross-sectional differences in conditional conservatism between bankrupt and non-bankrupt firms and specifically, the demonstration that taxation also induces conditional conservatism in the setting of ex post bankrupt firms.

Organic polymer coatings have been extensively used for painting in industrial applications to prevent the deleterious effects on the metallic components. In this study, electrostatic polyester coatings with two amounts of graphite (5 and 10 wt% Gr) were deposited on structural steel substrate. The effect of Gr addition on the microstructure, mechanical, adhesion and tribological behavior were characterized using SEM, EDS, XRD, nano-indentation and scratch test. The coatings’ resistance to corrosion was investigated using electrochemical measurements in 3.5 wt% NaCl solution. According to the results, the Gr particles were homogeneously distributed throughout the polyester coatings. The hardness and elastic modulus of the polyester coatings increased from ~0.23 and ~6.7 to ~0.68 and 10.9 GPa upon increasing the Gr contents from 0 to 10 wt% Gr, respectively. Moreover, the friction coefficient decreased from ~0.5 to ~0.2. The results also showed an attenuation of the severe wear mechanism and a reduction of the plastic deformation. Consequently, the wear resistance improved by three times due to the lubricating role of Gr. All the coatings showed a high adhesion level to the steel substrate with a cohesive critical load higher than Lc1 = ~7 N and an adhesion strength greater than σc = ~215 MPa. The incorporation of Gr allows high protection of the steel against corrosion due to their barrier role.

This study aimed to formulate sodium lauryl sulfate cross-linked chitosan beads and sodium alginate-chitosan films for designing a dressing that would shorten the healing time of skin wounds. Teucrium polium extract-loaded chitosan-sodium lauryl sulfate beads (CH-SLS) and chitosan-alginate (CH-ALG) films were prepared and characterized by using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD) analysis, and scanning electron microscopy (SEM). The swelling properties of the CH-SLS beads were also analyzed in a water solution. The obtained Teucrium polium extract-loaded CH-SLS beads and CH-ALG films (TBF) were further incorporated into the commercial adhesive dressing. This TBF wound dressing was then investigated for evaluation of its wound healing potential in the mice using the excision wound model. Healing was assessed by the macroscopic appearance and the rate of wound contraction during 8 days. On day 4, the TBF-treated wounds exhibited 98% reduction in the wound area when they were compared with healing ointment, elastic adhesive dressing, and untreated wounds which were exhibited 63%, 43%, and 32%, respectively. Furthermore, the application of TBF dressing reduced skin wound rank scores and increased the percentage of wounds contraction. These results demonstrate that TBF dressing improves considerably the healing rate and the macroscopic wound appearance at a short delay and this application may have therapeutic benefits in wound healing.

Both music and endpoint knowledge of exercise have been shown to independently influence exercise performance. However, whether these factors work as synergists or counteract one another during exercise is unknown. The purpose of this study was to determine the single and combined effect of listening to preferred music and types of endpoint knowledge on repeated countermovement jump (CMJ) test performance. Twenty-four (n = 24) current or previously competitive basketball players underwent CMJ testing under the following endpoint knowledge conditions: (1) unknown/no knowledge, (2) knowledge of the number of jumps, and (3) knowledge of exercise duration. For each of these, participants listened to either their preferred music or no music during the duration of testing. For the exercise portion, participants completed repeated CMJs where participants were encouraged to jump as high as possible with jump height, contact time, and flight time as outcomes. Rate of perceived exertion (RPE) and feeling scale were measured before and after exercise. The results showed that, regardless of knowledge type, preferred music resulted in a significant decrease in both contact time and flight time (F ≥ 10.4, p ≤ 0.004, and ηp2 ≥ 0.35), and a significant improvement of jump height (F = 11.36, p = 0.001, and ηp2 = 0.09) and feeling scale ratings (F = 36.9, p < 0.001, and ηp2 = 0.66) compared to no-music condition, while RPE was not significantly affected. Regardless of the presence of music, knowledge of the number of jumps and duration resulted in lower contact time (p < 0.001, 0.9 < d < 1.56) versus unknown condition during CMJs. Moreover, a significant decrease in RPE values was found during prior endpoint knowledge of number (p = 0.005; d = 0.72) and duration (p = 0.045; d = 0.63) compared to unknown condition. However, feeling scale ratings were not significantly affected. Moreover, no interactions with significance findings were found for any parameters. Overall, data suggest that listening to music and endpoint knowledge alter exercise responses in basketball players, but they do not interact with one another.

Abstract Unexplained deep vein thrombosis may justify screening for antineutrophil cytoplasmic antibody‐associated vasculitis as it can be an unusual presentation of this disease.

Pine seeds are known for their richness in lipid compounds and other healthy substances. However, the reference procedures that are commonly applied for their analysis are quite laborious, time-consuming, and expensive. Therefore, it is important to develop rapid, accurate, multi-parametric, cost-effective and, essentially, environmentally friendly analytical techniques that are easily implemented at an industrial scale. The viability of using near-infrared (NIR) spectroscopy to analyse the seed lipid content and profile of three different pine species (Pinus halepensis, Pinus brutia and Pinus pinaster) was investigated. Moreover, species discrimination using NIR was also attempted. Different chemometric models, namely partial least squares (PLS) regression, for lipid analysis, and partial least square—discriminant analysis (PLS-DA), for pine species discrimination, were applied. In relation to the discrimination of pine seed species, a total of 90.5% of correct classification rates were obtained. Regarding the quantification models, most of the compounds assessed yielded determination coefficients (R2P) higher than 0.80. The best PLS models were obtained for total fat, vitamin E, saturated and monounsaturated fatty acids, C20:2, C20:1n9, C20, C18:2n6c, C18:1n9c, C18 and C16:1. Globally, the obtained results demonstrated that NIR spectroscopy is a suitable analytical technique for lipid analysis and species discrimination of pine seeds.

Inflammatory demyelinating disorders of the central nervous system are debilitating conditions of the young adult, here we focus on multiple sclerosis (MS) and neuro-Behçet disease (NBD). MS is an autoimmune disorder of the central nervous system. NBD, a neurological manifestation of an idiopathic chronic relapsing multisystem inflammatory disease, the behçet disease. The diagnosis of MS and NBD relies on clinical symptoms, magnetic resonance imaging and laboratory tests. At first onset, clinical and imaging similarities between the two disorders may occur, making differential diagnosis challenging and delaying appropriate management. Aiming to identify additional discriminating biomarker patterns, we measured and compared gene expression of a broad panel of selected genes in blood and cerebrospinal fluid (CSF) cells of patients suffering from NBD, MS and non inflammatory neurological disorders (NIND). To reach this aim, bivariate and multivariate analysis were applied. The Principal Analysis Component (PCA) highlighted distinct profiles between NBD, MS, and controls. Transcription factors foxp3 in the blood along with IL-4, IL-10, and IL-17 expressions were the parameters that are the main contributor to the segregation between MS and NBD clustering. Moreover, parameters related to cellular activation and inflammatory cytokines within the CSF clearly differentiate between the two inflammatory diseases and the controls. We proceeded to ROC analysis in order to identify the most distinctive parameters between both inflammatory neurological disorders. The latter analysis suggested that IL-17, CD73 in the blood as well as IL-1β and IL-10 in the CSF were the most discriminating parameters between MS and NBD. We conclude that combined multi-dimensional analysis in blood and CSF suggests distinct mechanisms governing the pathophysiology of these two neuro-inflammatory disorders.

Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.

In this study, soil samples are extracted from a polluted site at different depths. Soils texture and pollutant presence are different with depth. Preliminary analyzes showed pollution by heavy metals. To simulate soil leaching operation in static condition, a series of leaching tests are conducted in laboratory column under conditions of upflow unsaturated soil. Electrical conductivity and pH measurements on the recovered leachate are performed. Different flow rates are tested. Comparison of different profiles shows that the dissolved pollutants are concentrated in the upper soil levels and disperse weakly in the lower parts which confirm the nature of anthropogenic pollution of heavy metals. Water mobilizes a high amount of dissolved ionic substances up to 80% of the initial concentration. The increase in flow rate requires more pore volume injected to achieve the maximum clearance rate. The down flow condition extracts a small amount of dissolved substances.

Organic pollutants are one of the most pollutants in soils. To evaluate pollutant propagation and to apply a remediation technology, it is necessary to know transfer parameters between pollutant and soil components. Evaporation of the Non Aqueous Phase Liquid “NAPL” is one of the most phenomenon, studied mainly when the Soil Vapor Extraction is used. NAPL/gas mass transfer coefficient is the parameter describing this evaporation phenomenon. Many relations are defined to determine this coefficient with neglecting the dispersion coefficient. In this paper, empirical models for determination of NAPL/gas lumped mass transfer coefficient “l” from literature are tested. Results are compared to analytic solution of the convection dispersion equation results. The influence of the longitudinal dispersivity aLonl determination was evaluated. It has been shown that dispersion coefficient can be neglected in the model of l determination for pore’s velocity more than 0.1 cm.s-1. The correction is need for low pore’s velocity.

The multidimensional social problems that everyone seeks to remedy them are very complex and no actor can confront them on their own. So the different parties have to work together by creating relations of partnerships. The State has long been the main actor in the control and regulation of social relations. However, in recent years there has been a rapid decline in their role given the enormous charge and lack of resources. Hence the need for the intervention of other parties. Some review of literature explores the conceptualization of social partnership in order to meet the needs of the organization or solve organizational problems. More and more large companies and multinationals get started on a voluntary approach to social responsibility and have begun to move closer to certain social enterprises by concluding partnership agreements. The purpose of this study was to study the social transformation that follows the creation of a relation of a social partnership between a social enterprise and a company that has involved a strategy of social responsibility. Then, we will present the environment to finally study the impact of social partnership on the environment; on economic, cultural and political dimensions.

Previous studies considered entrepreneurial orientation as a determinant of firms’ growth and performance. In this research, we are interested in spin-offs. Indeed, we aim to study the relationship between their entrepreneurial orientation and their performance. Therefore, we carried out a cross-cultural study in three different countries; Tunisia, Canada, and Morocco. We opted for a personal survey. We addressed our questionnaire to 180 managers of spin-offs and we analyzed the research variables using SPSS 20.00 (Statistical Packages for Social Sciences) and Smart PLS 3 (Partial Least Squares). Our findings highlight a positive correlation between entrepreneurial orientation and performance of spin-offs within the three samples.

Many business leaders defines a time of crisis as a moment which completely hinders society activity which ultimately leads to bankruptcy they prefer the choice of resentment downturn and do not consider it a key moment for the renewal ideas, ways of thinking, of policies and strategies adopted that mobilize around new ambitions, new development projects, new sales models, new businesses, new markets and do a crisis a moment of creation and innovation and collective revitalization. The purpose of this article is to study the various steps of the management of crisis and best management practices in times of crisis to be applied properly by the manager. Therefore, we would have to ask the following question: How can we ride a situation of crisis and provide benchmarks based on best management practices?

The transmission of an enterprise faces different forms which are the recovery, indeed whether it's about a sale or a succession the transmission often puts in danger the existence of an enterprise. An enterprise can be taken over by another enterprise as part of its external growth strategy or by an individual who can be an heir, a former employee of the enterprise, a commercial or financial partner or a foreign buyer for the firm, but whatever his prior knowledge of the target enterprise the individual buyer holds the position of a new manager and fits into a functioning structure and leads a staff that he did not recruit.. As part of our article, we have been interested in the study of the recovery of enterprises and its various aspects, in the first part the general case we discussed the resumption namely the transfer of businesses and through the brakes related to the transmission and the process of transmission. The second part is dedicated to the recovery and its integration in the fields of entrepreneurship, as well as the different forms that can take the recovery of a company namely: the external growth and the recovery of enterprises by individuals.

Forest ecosystems are an important anthropogenic pillar to human wellbeing, providing a multitude of ecosystem services. In Mediterranean countries, where climate change effects are exponentially increasing, the value of the forest ecosystem services is even higher and their preservation is more crucial. However, the biophysical and economic value of such services is usually not observable due to their non-marketable characteristics, leading to their underestimation by decision-makers. This paper aims to guide decision-making through a set of new management scenarios based on ecosystem services’ values and their spatial distribution. It is a cumulative multidisciplinary study based on biophysical models results, economically valued and implemented using the geographic information system (GIS) to analyze spatial data. The investigation was based on a biophysical and economic valuation of cork, grazing, carbon sequestration and sediment retention as a selection of ecosystem services provided by cork oak forest (Ain Snoussi, Tunisia). The valuation was made for the actual situation and two management scenarios (density decrease and afforestation of the shrub land), with emphasis on their spatial distribution as a basis to new management. The total economic value (TEV) of the investigated services provided by Ain Snoussi forest (3787 ha) was €0.55 million/year corresponding to €194/ha/year. The assessment of two different scenarios based on the land cover changes showed that the afforestation scenario provided the highest TEV with €0.68 million/year and an average of €217/ha, while the density decrease scenario provided €0.54 million/year and an average of €191/ha. Such results may orient decision-makers about the impact new management may have, however they should be applied with caution and wariness due to the importance of the spatial dimension in this study.

Hydatid pulmonary embolism rarely occurs. It arises from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst into the venous circulation. We report a case with pulmonary hydatidosis resulting in a massive bilateral pulmonary embolism in a 56-year-old woman with history of hepatic echinococcosis. A brief overview of clinical features and radiologic findings is presented.

Innovation remains a complex concept that can’t be analysed and researched by ignoring the definition and influences of all aspects and interactions which were identified in the innovation cycle. Consequently the paper initiate the development of a modern methodological framework to be applied for analysing business social innovations in its continuity to be used by companies to adapt their activities to the current market demands. These innovations are intended for running innovative company, with employees ready for new ideas. The research development has taken into analyse several approaches: the concept of social innovation, the manner of which social innovation can be analysed, focusing on methodological aspects and the third part presents the conclusions. Given the present economic crises effects, its societal and social consequences in a reduced interest for applied social innovation, people tend to choose not making changes in their life and work despite new and innovative ideas; this can be taken as an approach for to avoiding risks and activity disruptions. As results our expectations merge within the idea that a complex society requires complex answers at all problems and personalised applications of any new theory or idea. Therefore the purpose of the paper is to propose concrete ideas of social innovation that can be easily put into practice.

Considering typical spectra of a broad range of carbonaceous materials from gas-shale to nanotubes, various ways by which defects show up in Raman spectra are exampled and discussed. The position, resonance behavior, and linewidth of both the D and G bands are compared, even if in some cases obtaining accurate information on the materials from the fitting parameters is a difficult task. As a matter of fact, even if a full picture is unreachable, defining parameter trends is one acceptable option. Two ways to determine the linewidth, either graphically and or by fitting are proposed in order to be able to compare literature data. The relationship between the crystallite size obtained from the linewidth and from X-ray diffraction, which is complementary to the Tuinstra and Koenig law, is examined. We show that a single approach is not possible unless modeling is performed and therefore that analysis of Raman spectra should be adapted to the specificities of each sample series, i.e., a minimum of knowledge about the materials is always required.

Background. The Sjögren Syndrome (SS) can include various manifestations of central nervous system impairment. Extrapyramidal signs are known to be very rare and unusually discovered on early onset in this pathology. Observation. A 46-year-old woman with a history of progressive Parkinsonism for 6 years and a normal brain magnetic resonance imaging was partially improved with levodopa therapy. The later discovery of a sicca syndrome led to performing of further investigations, which revealed the presence of anti-SSA antibodies and a sialoadenitis of grade 4 according to Chisholm’s classification on labial salivary gland biopsy. The diagnosis of primary SS was established and the adjunction of corticotherapy has remarkably improved Parkinson’s signs without use of other immunosuppressive agents. Conclusion. Based on these findings, we discuss the hypothesis of either a causal link between SS and Parkinsonism or a fortuitous association of two distinct pathologies with or without a shared immunopathogenesis.

Abstract Hepatoid adenocarcinoma is a rare variant of extrahepatic adenocarcinoma which behaves like hepatocellular carcinoma in morphology and functionality. We present a rare case of hepatoid adenocarcinoma of the gallbladder which invades deeply the liver bed, in a 59-year-old woman. Histologically, most of the mass in the gallbladder was composed of cells with eosinophilic cytoplasm arranged in a trabecular pattern, which resembled hepatocellular carcinoma. The main differential diagnosis was hepatocellular carcinoma with invasion into the gallbladder. The gallbladder origin of the hepatoid adenocarcinoma was verified by the presence of foci of conventional adenocarcinoma, the recognition of high-grade dysplasia in the adjacent epithelium and the absence of cirrhosis.

Background: The chemical composition and biological activities of Eucalyptus essential oils (EOs) have been documented in numerous studies against multiple infectious diseases. The antibacterial activity of individual Eucalyptus EOs against strains that cause ear infections was investigated in our previous study. The study's antibacterial activity was promising, which prompted us to explore this activity further with EO blends., Methods: We tested 15 combinations (9 binary combinations and 6 combinations of binary combinations) of Eucalyptus EOs extracted by hydrodistillation from eight Tunisian Eucalyptus species dried leaves against six bacterial strains responsible for ear infections: three bacterial isolates (Haemophilus influenzae, Haemophilus parainfluenzae, and Klebsiella pneumoniae) and three reference bacteria strains (Pseudomonas aeruginosa, ATTC 9027; Staphylococcus aureus, ATCC 6538; and Escherichia coli, ATCC 8739). The EOs were analyzed using GC/FID and GC/MS. The major compounds, as well as all values obtained from the bacterial growth inhibition assay, were utilized for statistical analysis., Results: The antibacterial activity of the EO blends exhibited significant variation within Eucalyptus species, bacterial strains, and the applied methods. Principal component analysis (PCA) and hierarchical cluster analysis (HCA), based on the diameters of the inhibition zone, facilitated the identification of two major groups and ten subgroups based on the level of antibacterial activity. The highest antibacterial activity was observed for the mixture of EOs extracted from E. panctata, E. accedens, and E. cladoclayx (paac) as well as E. panctata, E. wandoo, E. accedens, and E. cladoclayx (pwac) using the disc diffusion method. Additionally, significant activity was noted with EOs extracted from E. panctata, E. wandoo (pw) and E. panctata, E. accedens (pa) using the broth microdilution method., Conclusion: Our findings suggest that certain EO combinations (paac, pwac, pw, and pa) could be considered as potential alternative treatment for ear infections due to their demonstrated highly promising antibacterial activities., (© 2024. The Author(s).)

Background: The chemical composition and biological activity of Eucalyptus essential oils have been studied extensively (EOs). A few of them were tested for antibacterial effectiveness against otitis strains. The chemical composition and antibacterial activity of the EOs of eight Tunisian Eucalyptus species were assessed in the present study., Methods: Hydrodistillation was used to extract EOs from the dried leaves of eight Eucalyptus species: Eucalyptus accedens, Eucalyptus punctata, Eucalyptus robusta, Eucalyptus bosistoana, Eucalyptus cladocalyx, Eucalyptus lesouefii, Eucalyptus melliodora and Eucalyptus wandoo. They are assessed by GC/MS and GC/FID and evaluated for antibacterial activity using agar diffusion and broth microdilution techniques against three bacterial isolates (Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae) and three reference bacteria strains (Pseudomonas aeruginosa, ATTC 9027; Staphylococcus aureus, ATCC 6538; and Escherichia coli, ATCC 8739). Furthermore, the selected twenty-one major compounds and all values of the inhibition zone diameters were subjected to further statistical analysis using PCA and HCA., Results: The EO yields of the studied Eucalyptus species range from 1.4 ± 0.4% to 5.2 ± 0.3%. Among all the species studied, E. lesouefii had the greatest mean percentage of EOs. The identification of 128 components by GC (RI) and GC/MS allowed for 93.6% - 97.7% of the total oil to be identified. 1,8-cineole was the most abundant component found, followed by α-pinene, p-cymene, and globulol. The chemical components of the eight EOs, extracted from the leaves of Eucalyptus species, were clustered into seven groups using PCA and HCA analyses, with each group forming a chemotype. The PCA and HCA analyses of antibacterial activity, on the other hand, identified five groups., Conclusion: The oils of E. melliodora, E. bosistoana, and E. robusta show promise as antibiotic alternatives in the treatment of otitis media., (© 2021. The Author(s).)

Background: Rapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians., Hypothesis: Cardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea., Materials and Methods: A prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve., Results: This study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non-HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636-0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11-0.29); p < .001]., Conclusions: Our study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea., (© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Hepatoid adenocarcinoma is a rare variant of extrahepatic adenocarcinoma which behaves like hepatocellular carcinoma in morphology and functionality. We present a rare case of hepatoid adenocarcinoma of the gallbladder which invades deeply the liver bed, in a 59-year-old woman. Histologically, most of the mass in the gallbladder was composed of cells with eosinophilic cytoplasm arranged in a trabecular pattern, which resembled hepatocellular carcinoma. The main differential diagnosis was hepatocellular carcinoma with invasion into the gallbladder. The gallbladder origin of the hepatoid adenocarcinoma was verified by the presence of foci of conventional adenocarcinoma, the recognition of high-grade dysplasia in the adjacent epithelium and the absence of cirrhosis.