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Introduction Tunisian emigrants may consume psychoactive substances in other countries. This community is exposed to sociocultural and legal contexts different from those in Tunisia and the degree of acculturation would tend to increase over time. However, data on the use of psychoactive substances, particularly cannabis, in this particular population are scarce. Objectives This study aims to determine the profile of Tunisian young adults residing abroad who use cannabis. Methods We conducted a cross-sectional, descriptive and analytic study. It was carried out in the form of an online survey. We focused on young Tunisians people who have completed their secondary studies at the pilot high school of Sfax and currently residing abroad. Data collection was through Google Forms administred questionnaire. Results Thirty-five participants were included in our study. Cannabis use behavior affected 48.6% of them (N=17)) and it was done with friends in a festive setting in 88% of cases (N=15). Cannabis use was more common among people who were single (p=0.001), living alone (p=0.047), had a psychiatric history (p=0.032) and hanging out with friends who also smoked cannabis (p=0.032).Cannabis use was also more common among cigarette smokers (p=0.000) and alcohol consumers (p=0.000). It was significantly more common among people who shared erroneous beliefs about cannabis, that it is a mild drug (p= 0.024) and that it does not cause dependence (p= p=0.042). Conclusions Cannabis use among Tunisian young adults residing abroad seems to be a form of poly-consumption, more common among singles, living alone and having a psychiatric vulnerability. These findings underscore the need for targeted interventions and educational initiatives to address cannabis use within this specific population. Disclosure of Interest None Declared

Introduction Understanding adolescents perceptions of their weight status and the factors influencing these perceptions is pivotal for developing targeted interventions and policies to counteract the rising obesity trends. Objectives This cross-sectional study aimed to determine the accuracy of weight status perceptions among Tunisian adolescents compared to objective metrics and to identify sociodemographic characteristics and life habits associated with the underestimation of weight status. Methods A cross-sectional, school-based study was conducted among a randomized sample of adolescents attending secondary schools in Sousse, Tunisia. A total of 1399 students participated, with anthropometric measurements taken, and a pre-tested Arabic questionnaire administered to gather sociodemographic data and perceived weight status, assessed using the Figure Rating Scale (FRS). The accuracy of perceived weight status was determined by comparing the measured weight status with participants; self-reported perceptions. We evaluated the association between body weight distortion and life habits which included regular physical activity, screen time (time spent on internet per day), number of fruits and vegetables consumed per day, and fast-food consumption. Results The study achieved an 86.68% response rate, with over half of the participants being female (60.5%), and the average age being 17 years. The majority of adolescents (41%) perceived themselves as having normal body weight, while 34.5% perceived themselves as underweight, 16.6% as overweight, and 7.9% as obese. However, based on BMI categories, 72.6% had a normal measured weight, 20.4% were overweight, and 6.9% were obese. A substantial proportion of participants (45.6%) underestimated their weight status, with a significant proportion being objectively overweight or obese (26%). Furthermore, we found a significant association between the perception of weight accuracy with four correlates: gender, mother educational level, regular physical activity, and the number of fruits and vegetables consumed per day. Conclusions The findings revealed a disparity between perceived and actual weight status among Tunisian adolescents, with a significant underestimation of weight status, particularly among those who are overweight or obese. The results highlighted the crucial need for interventions that address weight perception inaccuracies and promote healthy weight awareness and management among adolescents in Tunisia. The study underscored the importance of further research to understand the development and progression of body weight underestimation throughout adolescence and the roles of lifestyle behaviors in shaping weight perceptions. Disclosure of Interest None Declared

Introduction Psychological vulnerability and problematic psychotropic drug use among medical residents are critical and intricate areas of study in the field of healthcare and mental well-being. This topic looks into the potential links between the psychological vulnerabilities experienced by medical residents, which are frequently associated with the demanding nature of their profession, and their use of psychotropic drugs in a way that poses problems or risks. Exploring this relationship is critical for understanding the mental health challenges that medical residents face and developing effective strategies to support their psychological well-being. Objectives to identify the psychological factors linked to problematic psychotropic drug use in medical residents. Methods We conducted a cross-sectional descriptive and analytical study among Tunisian medical residents between August and September 2022. We used a self-administered questionnaire with a data collection form, the DAST-10 (Drug Abuse Screening Test) scale, and the DASS-21 (Depression, Anxiety, and Stress Scale) in an online survey. Data was analyzed using the 20th version of the SPSS software. Results The sample consisted of 80 medical residents. Among them, 23.8% (n=19) had reported a previous use of psychotropic drugs, and 15% (n=12) a misuse (without a prescription and/or without following the prescription). The DAST-10 revealed that 6 residents (31.6%) had problematic use of psychotropic drugs. A high level of stress on the DASS-21 scale was associated with a problematic use (p=0.01) and a misuse (p=0.01) of psychotropic drugs. Furthermore, residents with high stress levels were more likely to demonstrate problematic use of psychotropic drugs (p=0.004). Such problematic use was correlated with personal history of anxiety disorders (p=0.01). Furthermore, residents with problematic psychotropic drug use had higher anxiety and depression scores on the DASS-21 scale (p>0.05). Conclusions Our findings revealed a concerning prevalence of psychotropic drug use among medical residents and an association with high stress levels. This result emphasizes the need for targeted interventions to support young doctors’ mental health. Disclosure of Interest None Declared

Introduction Chromatin modifications and epigenetics are important pathogenesis mechanisms leading to various neurologic and psychiatric disorders including epilepsy, drug addictions, depression, autistic spectrum, learning disabilities and schizophrenia. Recently, the disruption of the chromatin remodeling BAF complex has been linked to several neurodevelopmental syndromes, commonly referred to as PBAFopathies. Objectives Here, we review the implication of PBAF complex genes in schizophrenia and we outline syndromes caused by mutations in these chromatin-modifying enzymes labelled as PBAFopathies to discuss the functional consequences of reported mutations in the literature. Methods We comprehensively review the scientific literature using Pubmed database and other search platforms such as Google scholar to state the role of PBAF complex genes in schizophrenia and to reveal the most frequent genes mutations reported in literature. Results Our review revealed that the human analogs of the subfamily of ATP-dependent chromatin remodeling complexes, which are known in eukaryotes as the mammalian SWI/SNF complex (counting a group of proteins that associate and possess a DNA-stimulated ATPase activity that can destabilize histone-DNA interactions in reconstituted nucleosomes providing crucial nucleosome rearrangement and allowing the activation/repression of genes) are crucial for the regulation of genes expression and cells differentiation. They involve two well-known complexes which are SWI/SNF-A (known as BAF complex) and SWI/SNF-B (known as Polybromo-associated BAF or PBAF complex). SWI/SNF is a multisubunit chromatin-remodeling complex that performs fundamental roles in gene regulation, cell lineage specification, and organismal development and mutations that inactivate SWI/SNF subunits are found in nearly 20% of human cancers and in various developmental disorders, forming a continuum or spectrum of diseases. Since the first description of BRG1/BRM mutations in schizophrenia, other mutations of the SWI/SNF subunits have been reported: SMARCA1, SMARCA2, SMARCA4/BRG1, etc. Single nucleotide polymorphisms (SNPs) in these and other genes of PBAF have been also associated with schizophrenia. Conclusions This review focuses on the PBAF SWI/SNF subunits to find out if schizophrenia may be considered as a member of the spectrum of PBAFopathies. Disclosure of Interest None Declared

Introduction Turner syndrome characterized by total/partial and/or homogeneous/mosaic X chromosome monosomy is associated with various physical health concerns, including facial dysmorphism, short stature, infertility, and other organ defects such as heart, kidney, bone, skin, … as well as variable degrees of cognitive impairments. Besides, social skills, communication and relationships are usually disordered. Objectives The aim of this study was to report social challenges of Turner syndrome particularly related to discrimination regarding physical and cognitive impairments. Methods A retrospective analysis of clinic data and karyotypes were carried out for the patients diagnosed with Turner syndrome among patients who consulted at our genetic counselling at the medical University of Sfax, during the last two decades. Cytogenetic analysis were carried out using conventional methods and RHG banding with analysis of at least 20 metaphases and 3 karyotypes for each patient. Social challenges were recorded for each patient during pre-cytogenetic consultation and oriented questioning. Results We identified 23 cases referred with a cytogenetic diagnosis of monsomy X. The karyotyping was indicated for dysmorphism, primary or secondary amenorrhea, female infertility and recurrent pregnancy losses. Homogeneous X chromosome monosomy was recorded in 13% of cases, whereas mosaic forms with and without structural X/Y abnormalities were more frequent (82%). The mean age of patients in the study was twenty years. When the 45,X population was the predominant one (56,5%), dysmorphism and primary amenorrhea were constant. In the mosaic forms, clinical traits of Turner syndrome were insignificant. Discrimination based on physical appearance, intellectual disability, and failure to conceive were the three types of social challenges revealed by patients of our study. Parents of Turner patients were also concerned at the psychological level. They in fact revealed their emotional distress face to stressful experiences of their children with Turner syndrome regarding the social discrimination they encountered particularly in schools. Conclusions Social challenges related to discrimination based on physical appearance, intellectual disability, and failure to conceive in Turner syndrome lead to depression, low self-esteem and anxiety. Disclosure of Interest None Declared

Introduction The prevalence of alterations of liver function tests in patients with schizophrenia and bipolar disorders is not well known. These alterations are often considered as side effects of medication Objectives Our study aimed to evaluate and compare liver function before and after treatment in patients with schizophrenia (SCZ), schizo-affective disorder (SCA) and bipolar disorder (BD). Methods This was a prospective study among patients with SCZ, SCA and BD according to DSM-5 criteria. Patients, from the “C” psychiatry department of Hedi Chaker University Hospital in Sfax, were assessed during both acute and remission phases in their illness. The acute phase (T0) assessment was made in drug-free patients from june 2016 to july 2018. As for the remission phase (T1), it was made between november 2019 and march 2020. Blood tests were performed in the Laboratory of Biochemistry at Habib Bourguiba University Hospital in Sfax. Clinical and biological parameters of patients were compared with those of healthy controls. Biological assessment consisted mainly in Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Albumine. Results Thirty patients were included in our study. Their mean age was 35.83 ± 12.24 years and they were all males. They suffered from SCZ in 33.33% of cases, from SCA in 26.66% of cases and from BD in 40% of cases. Psychoactive substance use was common among 80% of patients. In the remission phase, 90% were polymedicated with use of antipsychotics in 83% of cases and mood stabilisers in 53% of cases. Table 1 shows the evolution of the studied liver function markers in our patients.Table 1: evolution of some liver function markers in patients Markers T0 T1 p AST (UI/L) Patients 33,22 ± 23,18 19,34 ± 4,97 0,05 a: significant difference between patients with SCZ (T1) and controls; b: significant difference between patients with BD (T1) and controls; e: significant difference between patients (T1) and controls Conclusions Our results showed an improvement of liver function in patients with SCZ and BD after treatment. This suggests that liver function alterations are due to these diseases rather than the medication. Disclosure of Interest None Declared

Introduction Maintaining sexuality is important to the well-being of women, particularly after menopause and benefits of sexual satisfaction in terms of emotional well-being and quality of life have been well demonstrated. Objectives This study aims to assess the sexual health behaviors in Tunisian women during and after menopause and the awareness of Tunisian partners about the role of the quality of their sexuality regarding their physical and psychological wellbeing. Methods We comprehensively review the scientific literature using Pubmed database to state Tunisian literature regarding sexual behaviors and function in women during and after menopause. Interviews with twenty Tunisian women after menopause about sexual health have been conducted. Results Our bibliographic research revealed a poor literature with only two papers responding to our inquiry but among a specific female population investigated after experiencing breast cancer “Female sexuality in premenopausal patients with breast cancer on endocrine therapy and sexuality after breast cancer: cultural specificities of Tunisian population”. Interrogated women reported a poor sexual satisfaction as well as sexual difficulties in the partner or with him. In fact, there is an important wrong understanding of the female anatomy and physiology by both partners, for the female sexual satisfaction. There is also many wrong cultural ideas about menopause and sexuality. Conclusions Currently, sexuality in Tunisian women during and after menopause is influenced by ageing, by previous sexual function and experiences, the male domination in partner’s sexual practices and the sexual functioning in the partner. In general, there is an unfavorable body image and disturbed sexual health. Disclosure No significant relationships.

Introduction The low prevalence of some genetic neuro-developmental syndromes associated to psychiatric disorders requests to be integrated in human genome-phenome databases from which pleiotropy can be compiled from by systematic integration of phenotypes associated with genetic loci using phenomic inference tools. Williams-Beuren syndrome (WBS) is a neurodevelopmental disorder related to elastin gene at 7q11.23. Anxiety, depression and attention problems are the main behavioral problems found in WBS with no gender differences. Significant differences between cohorts are reported in particular regarding somatic complaints and aggressive behavior. Objectives Here, we report a Tunisian cohort of WBS patients for whom clinical behavioral phenotypes as well as genetic features are detailed. Methods Sixteen patients from Sfax, Tunisia were referred for genetic assessment due to a suspected WBS syndrome. Results Genetic evaluation using fluorescent in situ hybridization confirmed 7q11.23 microdeletion in only eight patients. Comparison of detailed behavioral phenotypes revealed differences between age groups, gender groups and genetic groups. Anxiety and depression were recorded in the two older male patients and aggressive behavior was recorded in only two boys. The severity of behavioral features were dependent to familial environment and to parental socio-economic and educational levels. Conclusions A more complete understanding of phenomic space is critical for elucidating genome-phenome relationships mediating neurodevelopmental disorder associated to psychiatric diseases for assessing and managing psychiatric and behavioral risks in young syndromic children. Disclosure No significant relationships.

Introduction Age at onset of pediatric bipolar spectrum disorder (BSD) is an important marker of a more severe form and a highly heritable mood/mental disorder. Objectives Here, we report a familial Tunisian BSD follow-up study showing a very early onset of the BSD at the neonatal period. Methods A 28-year-old female and her 30-year old sister were referred for genetic and psychological assessments due to recurrent depressive episodes. Results Psychological assessment revealed a BSD type II with episodes of hypomania for both patients. The 30-year old sister presented a mixed form of BSD coupled with autistic traits, hyposomnia and obsessive-compulsive behaviors. Intellectual and cognitive abilities were without concerns. Familial history revealed BDS among paternal relatives including the brothers’ and sisters’ father as well as all their uncles offspring’s, and their grandparents, who were consanguineous. The depressive mood was a common sign in the three generations. Personal history revealed significant signs of a very early onset of the disorder since the neonatal period for the two sisters as well as for their four paternal cousins who also presented BSD features. Familial risk of BSD in this family correlates with a variably higher personal risk of other psychiatric disorders such as anxiety, drug abuse, personality disorders, and autism spectrum disorder. Conclusions Environmental conditions, familial care and educational level have a strong correlation with the severity and the efficiency of cognitive management of BSD and its psychiatric comorbidities. BSD is highly heterogeneous and polygenic and personalized management has considerable clinical repercussions benefits. Disclosure No significant relationships.

Introduction Rarely, thyroid cancer can lead to hyperthyroidism. The link between dysthyroidism and psychiatric symptoms is well established, but cases of psychosis associated with hyperthyroidism are rarely reported in the literature. Objectives Identifying psychosis secondary to hyperthyroidism caused by a secreting tumor through a case and literature review. Methods We report the case of a patient with thyroid suspect tumor and chronic psychosis. We performed a literature review based on a PubMed search with the following keywords: “dysthyroidism psychosis”. Results Mr. S,32, with a personal psychiatric history of chronic psychosis evolving since 4 years, without notable pathological history, was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggressiveness, subtotal insomnia and refusal of treatment. The psychiatric examination revealed the presence of a chronic delusional syndrome with a theme of persecution, mysticism,and an interpretive, intuitive and hallucinatory mechanism, without dissociative syndrome. The somatic examination objectified a cachectic patient with a bilateral symmetrical non-impulsive exophthalmos, a goiter with a thrill on palpation, dysphonia and sinus tachycardia.A laboratory workup revealed inflammatory syndrome, collapsed TSH (

Introduction The COVID-19 pandemic represents a stressful event for humanity. The spread of this disease mainly affects health professionals and interests them closely. Objectives Identify the impact of the COVID-19 pandemic on the mental health of healthcare personnels and associated factors exposing them to increased psychological fragility. Methods The current article is a narrative review of the existing literature. A search on electronic database like PubMed was undertaken using the search terms “coronavirus mental health healthcare workers”. 20 articles were included in this review. Results Studies revealed that health care workers have prensented considerable psychiatric symptoms such as anxiety, depression, PTSD, stress, insomnia, somatization, mental and physical exhaustion, addiction and obssessive compulsive symptoms. The prevalence of these symptoms varies from study to another with almost a more notable prevalence of anxiety and depressive symptoms. The following factors that predispose to developing mental distress were noted: being a frontline health worker, having direct contact with infected patients, working in a city with a high infection rate, female sex, isolation, being a suspected case, stigmatization, change of organization, lack of materials, lack of information, lack of communication, lack of support, fear of contamination or of contaminating loved ones, having an organic pathology. Conclusions This notable impact of the pandemic on the mental health of healthcare workers alerts us as colleagues and civil society to the ultimate need for an urgent adequate and up-to-date intervention to alleviate this distress.

Introduction Women around the world are still victims of violence and discrimination in many areas. In Tunisia, discrimination against women remains a reality, and they are often more vulnerable to violence, especially sexual violence, compared to men. Objectives To describe the epidemiological characteristics of victims of sexual assault in the Mahdia region in Tunisia Methods This is a descriptive and retrospective study of 110 sexual assault cases examined at the legal medecin department of Mahdia University Hospital between January 2016 and August 2018. Results The majority of victims were female (80 %). All genders, 77% were under the age of 25 years old. The median age of the men was 11.5 years. The median age of women was 18. The urban origin was more common (55.5%). Only 8.1% were married compared to 87.4% single. Only 2.7% said they were divorced and only one woman was a widow. 41.8% of the sample said they were still in school and almost 29,1% of the cases were out of work. 3.6% reported a history of sexual assault. The sexual act was the same in all situations. The perpetrator was unique in 73.6% of cases, male (100%), known to his victim (57%) or even a member of the family circle (14%). Sexual assault by penetration was mostly reported (51%), and it was almost exclusively penile(98.2%). Conclusions Sexual violence remains under-reported. The statistical data do not allow to know the phenomenon of its whole, because the majority of acts remain unknown, due to the absence of complaints or medical consultations.

Introduction Several studies have mentioned the link between psychotrauma and psychosis. A direct causal link remains to be discussed. Objectives Evaluate the link between sexual abuse and psychosis. Methods We report the case of a male patient who developed schizophrenia following sodomy rape. We performed a literature review based on a PubMed search with the following keywords: “rape sodomy psychosis”. Results Mr. M., 26 years old, with a personal psychiatric history of chronic psychosis evolving for 10 years, consulted us for follow-up of his schizophrenia. When he was 16, the patient was raped by sodomy by a 40-year-old man under stabbing threat. After this incident, the patient did not verbalize this trauma, he isolated himself, became irritable and aggressive and has had olfactory hallucinations. The symptomatology worsened until the age of 24 when the patient presented a delusional syndrome with a theme of persecution, mysticism, bewitchment by a mechanism of interpretation and visual hallucinations. Then,he was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggression. He had been diagnosed with schizophrenia evolving over 9 years. Treatment with an antipsychotic: risperidone and valproic acid was started. The evolution was quickly favorable but the patient currently presents blunted affect, a sexual disinterest and a strong desire for revenge from his rapist. Treatment adjustment and psychotherapy would be considered. Conclusions The onset of subsequent rape psychosis and the persistence of symptoms related to the trauma are arguments in favor of a direct causal link between sexual abuse and schizophrenia. Disclosure No significant relationships.

Introduction Clozapine is the drug of choice for patients with an unsatisfactory response to classic antipsychotic treatment. Little is known about the involvement of clozapine in the development of parotid disease. Objectives Identify the clinical characteristics of Clozapine-induced parotitis through a case and literature review. Methods We report the case of a patient with a refractory schizoaffective disorder, bipolar type and who developed recurrent parotitis while taking clozapine. We conducted a literature review based on a PubMed search of articles published on this subject with the following keywords: ‘parotitis clozapine’. Results Miss W., 34 years old, suffers from a severe schizoaffective disorder that has been diagnosed for several years. She has received various psychotropic medications. She suffered from frequent relapses that required recurrent hospital admissions. One year ago, a diagnosis of treatment-resistant schizoaffective disorder was made. The decision to introduce clozapine, associated with mood stabilizer treatment, was made on the basis of her treatment refractory symptoms. She experienced considerable sialorrhea after beginning clozapine treatment. Miss W. developed bilateral recurrent swelling over both temporal-mandibular areas after 6 months of treatment. It often appears after eating and lasts from 4 to 6 hours. There was no change in white blood cell count and she was afebrile. An otolaryngologist was consulted and a diagnosis of clozapine-induced parotitis was suggested. A spasmolytic and an anticholinergic treatment were prescribed and clozapine was continued. Conclusions This iatrogenic effect of clozapine must be recognized by clinicians in order to be better prevented.

Introduction Lorazepam is a benzodiazepine derivative that is globally used for the therapy of anxiety and insomnia. Objectives The objective of our work was to show that Lorazepam can be a cause of unexpected liver injury even though it is a rare entity. Methods We reported the case of a patient who had a Drug-Induced Liver Injury (DILI) under Lorazepam. We performed a literature review based on a PubMed search with the following keywords: “Lorazepam,DILI”. Results A 20 year-old-Tunisian woman was hospitalized in the psychiatry department of the hospital of Nabeul in Tunisia for a brief psychotic episode.She had a DILI under Olanzapine, Chlorpromazine and Lorazepam, which conducted us to interrupt her treatments except for the Lorazepam(5mg/day). The hepatic tests went back to normal even under Lorazepam. Few days later, the liver enzymes increased again to reach very high levels. Extensive workup was negative for other causes of liver injury, including viral hepatitis A, B, C and E.; capillary electrophoresis of serum proteins was normal; Exhaustive immunological tests were performed searching for auto immune hepatitis(anti-smooth muscle antibodies, anti-LKM1, anti-LC1, anti-SLA/LP) primary biliary cholangitis(anti-mitochondrial antibodies, anti-GP210, anti-sp100) and other antibodies like antinuclear antibodies were negative. Liver biopsy showed polymorphic inflammatory infiltrate including some eosinophilic polynuclear cells and rare vaguely epitheloid macrophages, with necrotico-inflammatory foci in the lobules, all of which were consistent with DILI. Lorazepam was discontinued and within 10 days her liver enzymes decreased and completely normalized. Conclusions Lorazepam, with an unknown action mechanism, can be a cause of DILI. Disclosure No significant relationships.

The seismic hazard map of the larger Europe-Africa-Middle East region has been generated as part of the global GSHAP hazard map. The hazard, expressing Peak Ground Acceleration (PGA) expected at 10% probability of exceedance in 50 years, is obtained by combining the results of 16 independent regional and national projects; among these is the hazard assessment for Libya and for the wide sub-Saharan Western African region, specifically produced for this regional compilation and here discussed to some length. Features of enhanced seismic hazard are observed along the African rift zone and in the Alpine-Himalayan belt, where there is a general eastward increase in hazard with peak levels in Greece, Turkey, Caucasus and Iran.

Local earthquake data collected by seven national and regional seismic networks have been compiled into a travel time catalog of 32341 earthquakes for the period 1980 to 1995 in South-Central Europe. As a prerequisite, a complete and corrected station list (master station list) has been prepared according to updated information provided by every network. By simultaneous inversion of some 600 well-locatable events we obtained one-dimensional (1D) velocity propagation models for each network. Consequently, these velocity models with appropriate station corrections have been used to obtain high-quality hypocenter locations for events inside and among the station networks. For better control, merging of phase data from several networks was performed as an iterative process where at each iteration two data sets of neighbouring networks or groups of networks were merged. Particular care was taken to detect and correctly identify phase data from events common to data sets from two different networks. In case of reports of the same phase data from more than one network, the phase data from the network owning and servicing the station were used according to the master station list. The merging yielded a data set of 278007 P and 191074 S-wave travel time observations from 32341 events in the greater Alpine region. Restrictive selection (number of P-wave observations >7; gap

Introduction: The delineation of organs-at-risk and lymph node areas is a crucial step in radiotherapy, but it is time-consuming and associated with substantial user-dependent variability in contouring. Artificial intelligence (AI) appears to be the solution to facilitate and standardize this work. The objective of this study is to compare eight available AI software programs in terms of technical aspects and accuracy for contouring organs-at-risk and lymph node areas with current international contouring recommendations., Material and Methods: From January-July 2023, we performed a blinded study of the contour scoring of the organs-at-risk and lymph node areas by eight self-contouring AI programs by 20 radiation oncologists. It was a single-center study conducted in radiation department at the Lorraine Cancer Institute. A qualitative analysis of technical characteristics of the different AI programs was also performed. Three adults (two women and one man) and three children (one girl and two boys) provided six whole-body anonymized CT scans, along with two other adult brain MRI scans. Using a scoring scale from 1 to 3 (best score), radiation oncologists blindly assessed the quality of contouring of organs-at-risk and lymph node areas of all scans and MRI data by the eight AI programs. We have chosen to define the threshold of an average score equal to or greater than 2 to characterize a high-performing AI software, meaning an AI with minimal to moderate corrections but usable in clinical routine., Results: For adults CT scans: There were two AI programs for which the overall average quality score (that is, all areas tested for OARs and lymph nodes) was higher than 2.0: Limbus (overall average score = 2.03 (0.16)) and MVision (overall average score = 2.13 (0.19)). If we only consider OARs for adults, only Limbus, Therapanacea, MVision and Radformation have an average score above 2. For children CT scan, MVision was the only program to have a average score higher than 2 with overall average score = 2.07 (0.19). If we only consider OARs for children, only Limbus and MVision have an average score above 2. For brain MRIs: TheraPanacea was the only program with an average score over 2, for both brain delineation (2.75 (0.35)) and OARs (2.09 (0.19)). The comparative analysis of the technical aspects highlights the similarities and differences between the software. There is no difference in between senior radiation oncologist and residents for OARs contouring., Conclusion: For adult CT-scan, two AI programs on the market, MVision and Limbus, delineate most OARs and lymph nodes areas that are useful in clinical routine. For children CT-scan, only one IA, MVision, program is efficient. For adult brain MRI, Therapancea,only one AI program is efficient., Trial Registration: CNIL-MR0004 Number HDH434., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by ethics and conducted in accordance with the ethical standards of the Declaration of Helsinki (as revised in 2013). This study was approved by Ethics committee named the French National Commission of Informatics and Liberty (CNIL) (CNIL-MR0004 Number HDH434). The present study has been approved by the French Health Data Institute (Health DataHub) as the number HDH301. All methods were carried out in accordance with relevant guidelines and regulations. All participants have signed informed consent to the use of their data for research purposes. Consent for publication: Not applicable. Competing interests: The authors have declared no conflicts of interest. The Lorraine Cancer Institute used MVision AI software until January 1, 2023., (© 2024. The Author(s).)

The interplay between human microbiota and various physiological systems has garnered significant attention in recent years. The gut microbiota plays a critical role in maintaining physiological homeostasis and influences various aspects of human health, particularly via the gut brain axis. Since 2017, the challenging concept of the gut-retina axis has emerged thanks to a network analysis emphasizing the potential role of the gut microbiota disruption in the development of the age-related macular degeneration and further retinal damages. Many other ocular disorders have been linked to the dysbiosis of the gut microbiota, including uveitis and glaucoma. It has been shown that age related macular degeneration can be prevented or reversed using a diet that induces changes in the gut microbiota. The potential link between the gut microbiota as well as others types of microbiota such as the ocular surface microbiota and the development/progression of age related as well as inherited retinal degenerations and other degenerative eye diseases, has recently been broadened. Therefore, the pathogenesis of several eye diseases has recently been associated with a larger perception called the gut eye axis. This mini-review examines the potential mechanisms underlying the gut eye axis and suggests implications for the management of eye diseases. By understanding the modulation of the gut microbiota and its impact on eye disease, this mini-review provides insight into potential therapeutic interventions and avenues for future research., 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 © 2024 Kammoun, Rekik, Dlensi, Aloulou, Smaoui, Sellami, Trigui, Gargouri, Chaari, Sellami, Elatoui, Khemakhem, Hadrich, Neji, Abdelmoula and Bouayed Abdelmoula.)

Lead (Pb) is one of the most common heavy metals with toxicological effects on many tissues in humans as well as animals. In order to counteract the toxic effects of this metal, the administration of synthetic or natural antioxidants is thus required. The aim of this study was to examine the beneficial effect of the aqueous extract of Ononis natrix (AEON) against lead acetate-induced damage from a behavioral, biochemical, and histological point of view. Forty-eight male mice were divided into four equal groups: Ctr (control); Pb (lead acetate 1g/l); Pb + On 100 mg/kg (lead acetate 1 g/l + AEON 100 mg/kg); Pb + On 500 mg/kg (lead acetate 1 g/l + AEON 500 mg/kg). AEON was administered orally from day 21 after the start of lead exposure up to the end of the experiment. The results revealed that lead induced behavioral disorders, increased serum levels of liver markers (AST, ALT, and bilirubin), as well as kidney markers (urea and creatinine). At the same time, levels of thiobarbituric acid reactive substances (TBARS) and glutathione peroxidase (GPx) increased significantly. Moreover, Pb caused structural changes in the liver and kidneys of Pb-exposed mice. However, AEON administration significantly improved all lead-induced brain, liver, and kidney dysfunctions. Our results suggest that AEON could be a source of molecules with therapeutic potential against brain, liver, and kidney abnormalities caused by lead exposure., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aberrant mechanotransduction and compromised epithelial barrier function are associated with numerous human pathologies including inflammatory skin disorders. However, the cytoskeletal mechanisms regulating inflammatory responses in the epidermis are not well understood. Here we addressed this question by inducing a psoriatic phenotype in human keratinocytes and reconstructed human epidermis using a cytokine stimulation model. We show that the inflammation upregulates the Rho-myosin II pathway and destabilizes adherens junctions (AJs) promoting YAP nuclear entry. The integrity of cell-cell adhesion but not the myosin II contractility per se is the determinative factor for the YAP regulation in epidermal keratinocytes. The inflammation-induced disruption of AJs, increased paracellular permeability, and YAP nuclear translocation are regulated by ROCK2, independently from myosin II activation. Using a specific inhibitor KD025, we show that ROCK2 executes its effects via cytoskeletal and transcription-dependent mechanisms to shape the inflammatory response in the epidermis., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

Introduction: Both exercise and pre-meal metformin could lower postprandial glucose and lipid profiles., Aims: To explore whether pre-meal metformin administration is superior to metformin administration with the meal in reducing postprandial lipid and glucose metabolism, and whether its combination with exercise confer superior benefits in metabolic syndrome patients., Materials and Methods: In a randomized crossover design, 15 metabolic syndrome patients were assigned to 6 sequences including 3 experimental conditions: metformin administration with a test meal (met-meal), metformin administration 30 min prior to a test meal (pre-meal-met) with or without an exercise bout designed to expend 700 Kcal at 60% VO 2 peak performed the evening just before pre-meal-met condition. Only 13 participants (3 males, 10 females; age: 46 ± 9.86, HbA1c: 6.23 ± 0.36) were included in the final analysis., Results: Postprandial triglyceridemia was unaffected by any condition (all P > .05). However, both pre-meal-met (-7.1%, P = .009) and pre-meal-metx (-8.2%, P = .013) significantly reduced total cholesterol AUC with no significant differences between the two latter condition ( P = .616). Similarly, LDL-cholesterol levels were significantly lower during both pre-meal-met (-10.1%, P = .013) and pre-meal-metx (-10.7%, P = .021) compared to met-meal with no difference between latter conditions ( P = .822). Plasma glucose AUC was significantly reduced by pre-meal-metx compared to both pre-meal-met (-7.5%, P = .045) and met-meal (-8%, P = .03). Insulin AUC was significantly lower during pre-meal-metx compared to met-meal (-36.4%, P = .044)., Conclusions: Metformin administration 30 minutes prior to meal seems to exert favorable effects on postprandial TC and LDL-Cholesterol levels compared to its administration with meal. Addition of one exercise bout only improved postprandial glycemia and insulinemia., Trial Registry: Pan African clinical trial registry, Identifier PACTR202203690920424.

Context: Chondroitin 6 sulphate (C6S) is a glycosaminoglycan (GAG) whose accumulation is notable in mucopolysaccharidosis type IVA and VII. Flaxseed, Linum usitatissimum L. (Linaceae) (FS), is reported to have comparable properties to those of soybean, a source of genistein, a potential new treatment for MPSs., Objective: We assess the effect of total ethanol flaxseed extract (EFSE) in an animal model of C6S accumulation., Materials and Methods: The study was performed in adult male Wistar rats ( n  = 24) for 15 successive days. The animals were divided into four groups: (1) control injected with physiological saline buffer, (2) intoxicated rats injected intraperitoneally with C6S, (3) intoxicated with C6S and treated with EFSE, and (4) treated with EFSE. All groups were subjected to histopathological and biochemical studies. The antioxidant and phytochemical properties of EFSE were examined., Results: Dry EFSE contains total phenols (6.28 mg EAG/g), condensed tannins (2.98 mg ECAT/g) and flavonoids (0.44 mg ECAT/g) with high antioxidant potential [RPE (IC 50 = 8.37 ± 0.176), DPPH (IC 50 = 12.79 ± 0.273)]. The LD 50 is higher than 5000 mg/kg. The histopathological examination showed an accumulation of C6S in the C6S intoxicated group, which disappeared in the C6S-EFSE treated group. GAGs assays showed an increased excretion in the C6S intoxicated group and increased excretion of 14% in the C6S-EFSE group compared to the C6S group., Discussion and Conclusions: EFSE showed significant potential for chelation. Its use for the treatment of GAG accumulation could be suggested and generalized to a larger study population.

Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients' hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points ( p < 0.001), forced expiratory volume in one second by 110 ± 180 ml ( p = 0.04), 6-min walk distance by 35 ± 42 m ( p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg ( p = 0.048), resting heart-rate by 7 ± 9 bpm ( p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg ( p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work., 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. The reviewer IL declared to the handling editor a shared affiliation with all authors besides AA at the time of review., (Copyright © 2022 Toulgui, Benzarti, Rahmani, Aissa, Ghannouchi, Knaz, Sayhi, Sellami, Mahmoudi, Jemni, Gargouri, Hayouni, Ouanes, Ammar and Ben saad.)

Background: Pregnancy affects a woman's susceptibility to and severity of certain infectious diseases. Central neuraxial block for analgesia during labor is superior to nonneuraxial methods in efficacy, safety, and maternal satisfaction. Although Coronavirus disease (COVID-19) can be vertically transmitted from mother to fetus, little is known about the effects of COVID-19 on pregnant women or about anesthesia management and the risk of adverse effects related to neuraxial techniques in women with untreated COVID-19 during gestation., Aim: This investigation assesses the effects of neuraxial analgesia during labor of COVID-19-positive parturients on their hemodynamic stability., Results: The study was conducted on 64 patients and involved 32 parturients positive for SARS-CoV-2 by polymerase chain reaction (PCR) and a similar number of control "negative" patients. The affected group had an uneventful course during gestation. Seven were positive for ground-glass opacities on chest X-rays, and none underwent computed tomography (CT) scans. Two neonates were PCR-positive for SARS-CoV-2, and all 32 neonates were released from the hospital. No clinical differences were observed between the neonates in the COVID-19 and control groups. Although parturients in both groups were hemodynamically stable, hemodynamic stability was subnormal in the COVID-19 group regarding blood pressure, oxygen saturation, heart rate, and body temperature. None of the women in either group required a vasopressor or oxygen supplementation during delivery. No other clinical differences were observed between the COVID-19 and control groups., Conclusion: This is the first case-controlled study testing the anesthetic implications of neuraxial labor analgesia in pregnant, COVID-19-positive women. Although management of neuraxial labor analgesia did not differ in pregnant women positive and negative for COVID-19, their hemodynamic characteristics differed significantly. Therefore, care is required to prevent adverse outcomes in pregnant women positive for COVID-19., (© 2022 Abdalla, Nahid, Valappil, Gudavalli, Sellami, Korichi, Ahmad, Cespedes, Gopalakrishnan, licensee HBKU Press.)

Heavy metal pollution is a challenging concern that threatens the soil environment and human health worldwide. The purpose of this work is to assess the heavy metals (Cr, Cu, Zn, and Pb) pollution in the urban and peri-urban soils in and around Setif city, eastern Algeria. The work combines chemical analysis of thirty-six soil samples, statistical valuation and interpretation of chemical data and pollution indices (geoaccumulation index, pollution index, and integrated pollution index) with thematic mapping. The average concentrations (in mg/kg) of Cd, Cr, Cu, Pb, and Zn were found < 0.02, 43.35, 43.75, 331.20, and 78.26 mg/kg, respectively. Compared with the French regulatory limits (AFNOR U44-041), Cd, Cr, and Cu still non-hazardous at Setif city scale; however, Zn and Pb concentrations are two to three times higher than the background values referred to the Chinese [Formula: see text] standard (GB15618-1995). The pollution indices indicate that Pb and Zn represent the highest threats among the studied pollutants and polluted wide areas of anthropogenic activities located respectively in the oldest district of the city, near the industrial zone and near uncontrolled landfill of domestic and industrial waste. Cu, Pb, and Zn originate seemly from vehicle emission, particles of brakes and tires, and industrial emissions. However, Cr distribution is uncorrelatable with anthropogenic sources. The Cr with an average concentration less than the background value derives seemly from animal feces and organic fertilizers. The integrated pollution index shows that the accumulation of heavy metals in the soils of Setif city from anthropogenic sources reached alarming levels that can disperse into the environment and threaten the human health. The urbanization and industrial development of Setif city are expected to grow and a subsequent heavy metal pollution will be rising prior issue. Corrective measures should be endeavored by the local authorities to mitigate the current environmental situation and a sustainable development plan for the city should be anticipated to guarantee optimal future environmental conditions., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Radiotherapy (RT) for head and neck cancer is now guided by cone-beam computed tomography (CBCT). We aim to identify a CBCT radiomic signature predictive of progression to RT., Material and Methods: A cohort of 93 patients was split into training ( n  = 60) and testing ( n  = 33) sets. A total of 88 features were extracted from the gross tumor volume (GTV) on each CBCT. Receiver operating characteristic (ROC) curves were used to determine the power of each feature at each week of treatment to predict progression to radio(chemo)therapy. Only features with AUC > 0.65 at each week were pre-selected. Absolute differences were calculated between features from each weekly CBCT and baseline CBCT1 images. The smallest detectable change ( C  = 1.96 × SD, SD being the standard deviation of differences between feature values calculated on CBCT1 and CBCTn) with its confidence interval (95% confidence interval [CI]) was determined for each feature. The features for which the change was larger than C for at least 5% of patients were then selected. A radiomics-based model was built at the time-point that showed the highest AUC and compared with models relying on clinical variables., Results: Seven features had an AUC > 0.65 at each week, and six exhibited a change larger than the predefined CI 95%. After exclusion of inter-correlated features, only one parameter remains, Coarseness. Among clinical variable, only hemoglobin value was significant. AUC for predicting the treatment response were 0.78 ( p  = .006), 0.85 ( p  < .001), and 0.99 ( p  < .001) for clinical, CBCT4-radiomics (Coarseness) and clinical + radiomics based models respectively. The mean AUC of this last model on a 5-fold cross-validation was 0.80 (±0.09). On the testing cohort, the best prediction was given by the combined model (balanced accuracy [BAcc] 0.67 , p  < .001)., Conclusions: We described a feature selection methodology for delta-radiomics that is able to select reproducible features which are informative due to their change during treatment. A selected delta radiomics feature may improve clinical-based prediction models.

Hepatic encephalopathy (HE) is a neurophysiological syndrome secondary to acute or chronic liver failure. Studies showed that HE patients exhibit a deficit in motor coordination, which may result from cerebellar functional impairment. The aim of this study is to assess the time-dependent alteration of locomotor behavior and the glial and neuronal alteration in rat with acute HE induced chemically. The study was carried out in male Sprague-Dawley rats with thioacetamide (TAA) induced acute liver failure at different stages 12 h, 24 h and 36 h. Hepatic and renal functions were assessed via various biochemical and histopathological examinations, while the cerebellum and the midbrain were examined using histology and immunohistochemistry for tyrosine hydroxylase (TH), cyclooxygenase-2 (COX-2) and glial fibrillary acidic protein (GFAP). We used as well, the open field test and the Rotarod test for assessing the locomotor activity and coordination. Our data showed a progressive loss of liver function and a progressive alteration in locomotor behavior and motor coordination in acute HE rats. In the cerebellum, we noted an increase in the degeneration of cerebellar Purkinje neurons parallel to increased COX-2 immunoreactivity together with astrocytic morphology and density changes. Likewise, in substantia nigra pars compacta, TH levels were reduced. We showed through the current study, a progressive deterioration in locomotor behavior in acute HE rats, as a result of Purkinje neurons death and a deficient dopaminergic neurotransmission, together with the morpho-functional astroglial modifications involving the oxidative stress and neuroinflammation., (Copyright © 2021. Published by Elsevier B.V.)

Purpose: To develop a radiomic model predicting nonresponse to induction chemotherapy in laryngeal cancers, from multicenter pretherapeutic contrast-enhanced computed tomography (CE-CT) and evaluate the benefit of feature harmonization in such a context., Methods: Patients (n = 104) eligible for laryngeal preservation chemotherapy were included in five centers. Primary tumor was manually delineated on the CE-CT images. The following radiomic features were extracted with an in-house software (MIRAS v1.1, LaTIM UMR 1101): intensity, shape, and textural features derived from Gray-Level Co-occurrence Matrix (GLCM), Neighborhood Gray Tone Difference Matrix (NGTDM), Gray-Level Run Length Matrix (GLRLM), and Gray-Level Size Zone Matrix (GLSZM). Harmonization was performed using ComBat after unsupervised hierarchical clustering, used to determine labels automatically, given the high heterogeneity of imaging characteristics across and within centers. Patients with similar feature distributions were grouped with unsupervised clustering into an optimal number of clusters (2) determined with "silhouette scoring." Statistical harmonization was then carried out with ComBat on these 2 identified clusters. The cohort was split into training/validation (n = 66) and testing (n = 32) sets. Area under the receiver operating characteristics curves (AUC) were used to evaluate the ability of radiomic features (before and after harmonization) to predict nonresponse to chemotherapy, and specificity (Sp) and sensitivity (Se) were used to quantify their performance in the testing set., Results: Without harmonization, none of the features identified as predictive in the training set remained significant in the testing set. After ComBat, one textural feature identified in the training set keeps a predictive trend in the testing set-Zone Percentage, derived from the GLSZM, was predictive of nonresponse in the training set (AUC = 0.62, Se = 70%, Sp = 64%, P = 0.04) and obtained a satisfactory performance in the testing set (Se = 80%, Sp = 67%, P = 0.03), although significance was limited by the size of the testing set. These results are consistent with previously published findings in head and neck cancers., Conclusions: Radiomic features from CE-CT could help in the selection of patients for induction chemotherapy in laryngeal cancers, with relatively good sensitivity and specificity in predicting lack of response. Statistical harmonization with ComBat and unsupervised clustering seems to improve the predictive value of features extracted in such a heterogeneous multicenter setting., (© 2021 American Association of Physicists in Medicine.)

Objective: To report outcome and predictive factors in patients with N3 (> 6 cm) non-metastatic locally advanced head and neck squamous cell carcinoma (LAHNSCC) treated with a conservative approach or with initial surgery., Methods: 104 patients were included: 69 treated with radiotherapy (RT) ± chemotherapy (CT) and 35 with nodal surgery with or without primary tumour resection, which was completed in 30 patients by adjuvant RT ± CT. Positron-emission tomography-computed tomography (PET-CT) guided surveillance after RT ± CT was standard., Results: Two-year overall survival (OS) and locoregional control (LRC) were 39.4% and 37.5%, respectively. In univariate analysis, body mass index (BMI), performance status (PS), p16 status and haemoglobin value influenced OS and disease-free survival (DFS). In multivariate analysis, p16 positive status and BMI ≥ 25 remained independent prognostic factors for better OS (p = 0.023) and DFS (p = 0.002). Only under/normal weight remained an independent and adverse significant prognostic factor in multivariate analysis for regional control (RC). Patients treated with primary RT ± CT had slightly better 2-year OS (43.5% versus 33.3%, p = 0.31)., Conclusions: Patients with N3 LAHNSCC have poor prognosis, but long term LRC is achievable, especially in overweight patients and those with a good PS., (Copyright © 2021 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Background: Adolescents with type1 diabetes appear to be at greater risk for developing eating disorders (ED) which are often associated with impaired metabolic control of diabetes., Aim: To estimate the prevalence of ED in a population of adolescents with type 1 diabetes (T1D) and to identify risk factors associated with this disorder in order to propose preventive measures., Methods: A cross-sectional, population-based study involved 102 adolescents with type 1 diabetes, aged 11-18 years, recruited from the National Institute of Nutrition in Tunis, Tunisia over a period of one-year January 2017-January 2018., Results: The prevalence of ED was 33.3%. It was significantly higher among girls (46.2% vs 20%, p = 0.005). Unspecified ED were predominant with a prevalence of 29.4%. Independent factors associated with ED were female sex, abdominal obesity and quality of life. The risk of developing ED was multiplied by 3.5 for women (adjusted OR = 3.5 and CI95% [1.4-8.6]) and by 5.6 for patients with abdominal obesity (Adjusted OR = 5.6 and CI95% [1.5-20.4]). Impaired quality of life and specifically anxiety about diabetes increased significantly the risk of developing ED in our patients. However, we didn't find significant association between ED and age, family characteristics, duration of diabetes, metabolic balance, treatment and complications of diabetes., Conclusion: We concluded that ED should be always suspected in adolescents with T1D especially in girls. Unspecified ED are more common in this group of patients. Treatment of diabetes requires a multidisciplinary care approach including diabetologist, dietician and psychiatrist in order to promote healthy eating and to improve quality of life of adolescents with T1D.

Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: Research concerning factors of death after neonatal surgery is scarce. Insight into mortality might improve perioperative care. This study aimed to identify predictive factors of mortality after neonatal surgery in a low income country (LIC)., Methods: Charts of all newborn patients who underwent surgical procedures under general anesthesia during the neonatal period in our department of pediatric surgery between January 2010 and December 2017 were reviewed. We used univariate and multivariate analysis to evaluate perioperative variables potentially predictive of early postoperative mortality., Results: One hundred eighty-two cases were included in the study: 41 newborns (28.6%) were premature (<37 weeks of gestation) and 52 (22.5%) weighed less than 2.5 kg. The most commonly diagnosed conditions were esophageal atresia (24%) and bowel obstruction (19%). Forty-four patients (24%) died during hospitalization. The highest rate of mortality was observed for congenital diaphragmatic hernia. Univariate analysis showed that perinatal predictive variables of mortality were prematurity, low birth weight, the necessity of preoperative intubation, and duration of surgery more than 2 h. Logistic regression showed three independent risk factors, which are the duration of surgery, low birth weight and the necessity of preoperative intubation., Conclusion: The overall mortality in infants undergoing neonatal surgery is still high in LICs. Knowledge of independent risk factors of early mortality may help clinicians to more adequately manage the high-risk population., Type of the Study: Clinical research paper., Level of Evidence: III., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Fungi and bacteria associated to phytoparasitic nematodes Globodera rostochiensis and Meloidogyne spp. in Algeria were identified and characterized. Trichoderma spp. showed the highest prevalence in the cysts of G. rostochiensis . A number of isolates were identified through PCR amplification and the sequencing of the internal transcribed spacer (ITS)1-2 and Rpb2 gene regions. The most represented species were T. harzianum and T. afroharzianum . The latter and T. hirsutum were reported for the first time in Algeria. Fusarium spp., including F. oxysporum and F. solani , comprised a second group of fungi found in cysts. Taxa associated to females of Meloidogyne spp. included T. harzianum , Fusarium spp. and other hyphomycetes. To assess the efficacy of Trichoderma spp., two assays were carried out in vitro with the culture filtrates of two T. afroharzianum and T . harzianum isolates, to check their toxicity versus the second stage juveniles of M. incognita . After 24-48 h exposure, a mortality significantly higher than the control was observed for both filtrates at 1% dilutions. The TRI genes involved in the production of trichothecenes were also amplified with the PCR from some Trichoderma spp. isolates and sequenced, supporting a putative role in nematode toxicity. Bacteria isolated from the cysts of G. rostochiensis included Brucella, Rhizobium, Stenotrophomonas and Bacillus spp., identified through 16S rRNA gene sequencing. The potential of the microbial isolates identified and their mechanisms of action are discussed, as part of a sustainable nematode management strategy.

It is of interest to assess the clinical and pathological aspects of Gallbladder and biliary tract carcinomas confirmed by histological data. It is also of further interest to evaluate the link between Helicobacter pylori and biliary tract cancers. Eighty-nine (89) cases (mean age 60±12 years) of Gallbladder and biliary tract cancer confirmed by histological data were enrolled for the study at the Department of Pathology in Mohammed VI University Hospital, in Morocco. The data such as age, sex, clinical and histo pathological features were collected. Bile duct specimens were investigated for H. pylori using Giemsa and immuno histo chemistry staining. Results show that bile duct stones were found in 53.9% of cases. It is known using histological data that adeno carcinoma is common accounting for 70 % of all bile duct tumors. Moreover, Helicobacter pylori was detected in 54% of cases linking with the presence of bile duct stones characterized by the histological subtype, the macroscopic classification and lymph node's presence (p<0.001). Thus, data collected suggest the potential association of Helicobacter pylori with gallbladder cancer possibly through the formation of bile duct stones., Competing Interests: The authors have no conflict of interest to disclose., (© 2019 Biomedical Informatics.)

Medicinal plants play an important role in the management of diabetes mellitus especially in developing countries where resources are lacking. Herbal of natural origin, unlike the synthetic compounds, are more effective, safer and have less side effects. For continuing research on biological properties of Moroccan medicinal plants, the present work was undertaken to evaluate the potential and mechanism of the antidiabetic activity of the Caralluma europaea methanolic extract in alloxan-induced diabetic mice. A high-performance liquid chromatography technique (HPLC) was used to identify and quantify the major phenolic compounds in the methanolic extract. The in vitro antioxidant property was evaluated using 2,2-diphenyl-1-picrylhydrazyl radical (DPPH) scavenging method, reducing power and ß -carotene-linoleic acid assays. The acute toxicity of the extract was evaluated by giving it orally to mice at single doses of 200, 500, 1000, 2000 mg/kg body weight. The antidiabetic effect was conducted on Swiss albino mice. Diabetes was induced with single intraperitonial injection of alloxan monohydrate (200 mg/kg body weight) and animals were treated with methanol extract at a dose of 250 mg/kg and 500 mg/kg body weight. The blood glucose levels were measured and histopathological analysis of pancreas was performed to evaluate alloxan-induced tissue injuries. The main phenols identified and quantified in the extract were ferulic acid, quercetine, 3,4 dihydroxybenzoic acid, rutin, epigallocatechin, and catechin. Ferulic acid was found to be the main phenolic compound ant its proportion was up to 52% of total phenolic compounds, followed by quercetin (36%). The result showed that methanol extract exhibited an antioxidant effect. Acute toxicity studies revealed that C. europaea extract was safe up 2000 mg/kg body weight and approximate LD 50 is more than 2000 mg/kg. Moreover, the methanol extract prevented the diabetogenic effect of alloxan and decreased significantly the blood glucose level ( P  < 0.001) in treated mice. Morphometric study of pancreas revealed that C. europaea extract protected significantly the islets of Langerhans against alloxan-induced tissue alterations.

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome resulting from acute or chronic hepatic impairments. The clinical features of HE include attention as well as a mild cognitive deficits associated with impaired attentional and executive networks in patients as well as in animal models of HE. The underlining pathomechanism of memory impairment in HE patients is still not fully understood; however, it may involve a possible gliopathy as well as neuropathy. The aim of the present investigation is to assess progression of short working memory deterioration in acute HE and to delineate the glial and the neuronal alteration which may underlie such cognitive impairment. The study was carried out in male Sprague-Dawley rats with acute liver failure induced by thioacetamide (TAA). The study was performed on different stages of acute HE; 12 h, 24 h and 36 h following administration of TAA. The liver functions were assessed via different biochemical markers (ALT, AST, bilirubin, urea and creatinine) and an histopathological examination of the liver tissue. While for the behavioral study, we used T-Maze test to assess short working memory using the percentage of alternation behavior, together with an immunohistochemical analysis of the Glial Fibrillary Acidic Protein (GFAP) as the key marker of astrocytes in the hippocampus, as well as serotonin (5-HT) for 5-HTergic neurons within the dorsal Raphe nucleus (DRN). Our data revealed a progressive loss of liver tissue integrity with inflammation and hepatocytes degeneration which was associated to obvious loss of the liver function. In parallel, we observed a gradual alteration of the alternation behavior, as a sign of altered short working memory in the acute HE rats. At the central level, the immunohistochemical study showed a time dependent region-specific changes of GFAP-immunoreactive astrocytes within the hippocampus. While within the DRN, serotonin levels declined progressively in a time-dependant manner. Our data revealed for the first time, a gradual loss of short memory function in acute HE, resulting from liver dysfunction. Such cognitive deterioration may involve a possible gliopathy as well as a 5-HTergic dysfunction which could be considered as a new key element for understanding the basis of memory and attention loss in HE patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The regulation of sugar metabolism and partitioning plays an essential role for a plant's acclimation to its environment, with specific responses in autotrophic and heterotrophic organs. In this work, we analyzed the effects of high salinity on sugar partitioning and vascular anatomy within the floral stem. Stem sucrose and fructose content increased, while starch reduced, in contrast to the response observed in rosette leaves of the same plants. In the stem, the effects were associated with changes in the expression of SWEET and TMT2 genes encoding sugar transporters, SUSY1 encoding a sucrose synthase and several FRK encoding fructokinases. By contrast, the expression of SUC2 , SWEET11 and SWEET12 , encoding sugar transporters for phloem loading, remained unchanged in the stem. Both the anatomy of vascular tissues and the composition of xylem secondary cell walls were altered, suggesting that high salinity triggered major readjustments of sugar partitioning in this heterotrophic organ. There were changes in the composition of xylem cell walls, associated with the collapse and deformation of xylem vessels. The data are discussed regarding sugar partitioning and homeostasis of sugars in the vascular tissues of the stem.

The aim of this study is to investigate management and outcome in esophageal atresia (EA) and to identify early predictive factors of morbidity and mortality in a developing country. Charts of neonates with repaired EA from 2007 to 2016 were reviewed. Patients' characteristics, operative details, and postoperative outcomes were collected. Statistical analyses were performed to identify predictors of complicated evolution. Forty-two cases were collected. There were 14 girls and 28 boys. Only one patient had antenatal diagnosis (2.3%). The mean gestational age was 38 weeks. Nine patients (21.4%) weighed less than 2.5 kg. Seventeen (40.4%) patients had associated malformations most commonly cardiac (9/17). Thirteen patients had delayed diagnosis (30.9%). Thirty-nine (92.8%) patients underwent primary esophageal anastomosis. Overall survival was 76.2%. Nineteen patients (57% of survivals) had complicated evolution before the age of one year and 15 patients (46.8% of survivals) developed complications after the age of one year. Perinatal variables associated with mortality were prematurity (p = 0.004, OR = 5.4, IC95% = [1.13-25.80]), low birth weight (p = 0.023, OR = 7, IC95% = [1.38-35.47]), cardiac malformations (p = 0.006, OR = 10.5, IC95% = [2.03-54.27]) and delayed diagnosis (p = 0.005, OR = 10.11, IC95% = [2.005-50.980]). Variables associated with short-term and middle-term complications were duration of intubation (p = 0.019, OR = 0.118, IC95% = [0.019-0.713]) and the presence of short-term complications (p = 0.016, OR = 7.33, IC95% = [1.467-36.664]) respectively. These factors may be used to identify patients who will benefit from more intensive follow-up program., (© The Author(s) 2019. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.)

Plant responses to abiotic stresses entail adaptive processes that integrate both physiological and developmental cues. However, the adaptive traits that are involved in the responses to a high soil salinity during reproductive growth are still poorly studied. To identify new clues, we studied the halophyte, Thellungiella salsuginea , and three Arabidopsis accessions, known as tolerant or salt-sensitive. We focused on the quantitative traits associated with the stem growth, sugar content, and anatomy of the plants subjected to the salt treatment, with and without a three-day acclimation, applied during the reproductive stage. The stem growth of Thellungiella salsuginea was not affected by the salt stress. By contrast, salt affected all of the Arabidopsis accessions, with a natural variation in the effect of the salt on growth, sugar content, and stem anatomy. In response to the high salinity, irregular xylem vessels were observed, independently of the accession's tolerance to salt treatment, while the diameter of the largest xylem vessels was reduced in the tolerant accessions. The stem height, growth rate, hexoses-to-sucrose ratio, and phloem-to-xylem ratio also varied, in association with both the genotype and its tolerance to salt stress. Our findings indicate that several quantitative traits for salt tolerance are associated with the control of inflorescence growth and the adjustment of the phloem-to-xylem ratio.

Competing Interests: There are no conflicts of interest.

Bacillus thuringiensis Vip3A protein has been widely used for crop protection and for delay resistance to existing insecticidal Cry toxins. During current study, a fusion between vip3Aa16 and the toxic core sequence of cry1Ac was constructed in pHT Blue plasmid. Vip3Aa16-Cry1Ac protein was expressed in the supernatant of B. thuringiensis with a size of about 150 kDa. Bioassays tested on Ephestia kuehniella showed that the use of the chimera toxin as biopesticide improved the toxicity to reach 90% ± 2 with an enhancement of 20% compared to the single Vip3Aa16 protein. The findings indicated that the fusion protein design opens new ways to enhance Vip3A toxicity against lepidopteran species and could avoiding insect tolerance of B. thuringiensis delta-endotoxins. Through computational study, we have predicted for the first time the whole 3D structure of a Vip3A toxin. We showed that Vip3Aa16 structure is composed by three domains like Cry toxins: an N-terminal domain containing hemolysin like fold as well as two others Carbohydrate Binding Module (CBM)-like domains. Molecular docking analysis of the chimera toxin and the single Vip3Aa16 protein against specific insect receptors revealed that residues of CBM like domains are clearly involved in the binding of the toxin to receptors., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The synthesis and characterization of di-aqua-bis-[2-(2-hy-droxy-eth-yl)pyridine-κ 2 N , O )nickel(II) dinitrate, [Ni(C 7 H 9 NO) 2 (H 2 O) 2 ](NO 3 ) 2 , under ambient conditions is reported and compared with catena -poly[[bis-[2-(2-hy-droxy-eth-yl)pyridine-κ 2 N , O ]copper(II)]-μ-sulfato-κ 2 O : O '], [Cu(C 7 H 9 NO) 2 (SO 4 )] n [Zegh-ouan et al. (2016 ▸). Private communication (refcode 1481676). CCDC, Cambridge, England]. In the two complexes, the 2-(2-hy-droxy-eth-yl)pyridine ligands coordinate the metal ions through the N atom of the pyridine ring and the O atom of the hy-droxy group, creating a chelate ring. The Ni II or Cu II ion lies on an inversion centre and exhibits a slightly distorted M O 4 N 2 octa-hedral coordination geometry, build up by O and N atoms from two 2-(2-hy-droxy-eth-yl)pyridine ligands and two water mol-ecules or two O atoms belonging to sulfate anions. The sulfate anion bridges the Cu II ions, forming a polymeric chain. The photoluminescence properties of these complexes have been studied on as-synthesized samples and reveal that both compounds display a strong blue-light emission with maxima around 497 nm. From DFT/TDDFT studies, the blue emission appears to be derived from the ligand-to-metal charge-transfer (LMCT) excited state. In addition, the IR spectroscopic properties and thermogravimetric behaviours of both complexes have been investigated.

Enterobacterial components in the joints of patients are believed to contribute to a perpetuating inflammation leading to a reactive arthritis (ReA), a condition in which microbial agents cannot be recovered from the joint. At present, it is unclear whether nucleic acids from Shigella spp. are playing a pathogenic role in causing not only ReA but also other forms of arthritis. Quantitative real-time polymerase chain reaction assay (qPCR) is the method of choice for the identification of bacteria within the synovium. The aim of our study was to detect the presence of Shigella spp. nucleic acids in the synovial tissue (ST) of Tunisian arthritis patients. We investigated 57 ST samples from rheumatoid arthritis (RA) n = 38, undifferentiated oligoarthritis (UOA) n = 12, and spondyloarthritis (SpA) n = 7 patients; 5 ST samples from healthy individuals were used as controls. Shigella spp. DNA and mRNA transcripts encoding the virulence gene A (VirA) were examined using an optimized qPCR with newly designed primers and probes. Using qPCR, Shigella spp. DNA was found in 37/57 (65%) ST samples (24/38, i.e., 63.2% of RA, 8/12, i.e., 67% of UOA, and 5/7, i.e., 71.4% of SpA patients). Paired DNA and mRNA were extracted from 39 ST samples, whose VirA cDNA was found in 29/39 (74.4%) patients. qPCR did not yield any nucleic acids in the five healthy control ST samples. The qPCR assay was sensitive and showed a good intra- and inter-run reproducibility. These preliminary findings generated by an optimized, highly sensitive PCR assay underline a potential role of past gastrointestinal infections. In Tunisian patients, a bacterial etiology involving Shigella spp. in the manifestation of arthritic disorders including RA might be more common than expected.

The entomopathogenic Photorhabdus luminescens TT01 is a promoting bacterium that controls effectively many insect pests. Indeed, it exhibited a mortality rate of 32.36% against the first instar larvae of the turnip moth Agrotis segetum, when it was used at a concentration of 5 × 10 7  cells/ml but no toxicity against the second instar larvae in the same condition. P. luminescens TT01 oral toxicity is associated to septicaemia since cells fraction exhibited the highest mortality rate of 34%. In order to enhance P. luminescens TT01 insecticidal potential, combination with Bacillus thuringiensis Vip3Aa16 toxin was tested. An improvement of insecticidal activity was shown. Indeed, 100% mortality of A. segetum first instar larvae was obtained after 2 days of treatment, when using TT01 cells and Vip3Aa16 toxin at a concentration of 5 × 10 7  cells/ml and 9.025 ng/cm 2 , respectively. Moreover, growth inhibition rate of 45% of the second instar larvae was observed, when using the same combination. A. segetum mortality could be the result of several alterations in the midgut epithelium caused by Vip3Aa16 toxin, allowing a rapid invasion of the hemocoel by TT01 cells as demonstrated by histopathological study. Clear symptoms of intoxication were observed for all combinations tested, including swelling, vesicle formation, cytoplasm vacuolization and brush border membrane lysis. Taken together, these results promote the use of P. luminescens TT01 as a potent bioinsecticide to control effectively A. segetum by oral treatment in a mixture with Vip3Aa16 toxin., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The aim of this study was to examine the relationship between bone mass and bone turnover markers with lean mass (LM) in pubescent soccer players. Two groups participated in this study, which included 65 elite young soccer players who trained for 6-8 hours per week and 60 controls. Bone mineral density; bone mineral content in the whole body, lower limbs, lumbar spine, and femoral neck; biochemical markers of osteocalcin; bone-specific alkaline phosphatase; C-telopeptide type I collagen; and total LM were assessed. Young soccer players showed higher bone mineral density and bone mineral content in the whole body and weight-bearing sites (P < .001). Indeed, the total LM correlated with whole-body bone mineral density and bone mineral content (P < .001). There were significant differences within the bone formation markers and osteocalcin (formation)/C-telopeptide type I collagen (resorption) ratio between young soccer players compared with the control group, but no significant difference in C-telopeptide type I collagen was observed between the 2 groups. This study showed a significant positive correlation among bone-specific alkaline phosphatase, osteocalcin, and total LM (r = .29; r = .31; P < .05) only for the young soccer players. Findings of this study highlight the importance of soccer practice for bone mineral parameters and bone turnover markers during the puberty stage.

Objectives: The dynamic nature of the skeleton is achieved by a remodeling process. Receptor activator of nuclear factor kappa B (RANK) ligand (RANKL) stimulates bone resorption by activating RANK signaling. Therefore it is considered as a candidate gene regulating susceptibility to osteoporosis. In the current study, we have investigated the association between the RANKL gene -693G > C and -643 C > T polymorphisms and bone mineral density (BMD) in a population of postmenopausal Tunisian women., Methods: Polymorphic sites in RANKL gene (rs9533155 -693G > C and rs9533156 -643 C > T polymorphisms) were determined using PCR-RFLP analysis in 566 postmenopausal Tunisian women. All statistical analysis were examined by SPSS software., Results: We have detected a significant difference in lumbar spine and hip BMD for -643C > T genotypes. For -693G > C genotypes, a significant difference was detected only in hip BMD. The distribution of -643C > T genotypes and alleles between three groups (osteoporotic, osteopenic and normal women) revealed a significant association of the TT genotype with development of osteoporosis (p = 0.01; odds ratio 2.15), although for the -693G > C polymorphism, no significant results were found., Conclusion: We have demonstrated the association of the -643C > T polymorphism with BMD variation and osteoporosis risk in postmenopausal Tunisian women.