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Grapevine rupestris stem pitting-associated virus (GRSPaV) is one of the most widespread grapevine viruses transmitted mainly by graft. GRSPaV presence was tested in 487 samples representative of the Tunisian grapevine germplasm (including autochthonous, table, wine, wild grape and rootstock genotypes) from different Tunisian regions. GRSPaV infection was detected in 51.3% of samples from different Tunisian regions, among them the table grapevine cultivars were the most commonly infected (68.7%). Genetic variability of GRSPaV isolates from wild and cultivated grapevines was assessed by sequencing the partial coat protein (CP) gene of nineteen Tunisian isolates and one Italian GRSPaV isolate from Sicily, and the partial RNA-dependent RNA polymerase (RdRp) gene of thirteen Tunisian GRSPaV isolates. According to phylogenetic analysis of CP nucleotide sequences obtained in this study and sequences retrieved from the GenBank, Tunisian isolates fell into four phylogenetic groups already described (Group I, II, III and IV) and two new phylogenetic groups (VI and VIII). Phylogenetic analysis of the partial RdRp reveals that Tunisian isolates of GRSPaV are distributed into four phylogroups. This study highlights the importance of regular monitoring of GRSPaV infections in Tunisia, with special regard to those grapevine accessions employed in conservation and selection programs. In particular, the presence of new GRSPaV genetic variants and infection of wild grapevines must be taken into account for choosing a correct control strategy.

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Resume Introduction Le diabete est une maladie metabolique chronique qui peut avoir un impact important sur l’aptitude au travail. Notre objectif vise a etudier l’impact du diabete sur le travail chez des patients tunisiens. Materiel et methodes Etude retrospective portant sur tous les patients diabetiques consultant au service de pathologies professionnelles du CHU Farhat Hached de Sousse durant la periode allant du 1er janvier 2009 jusqu’au 31 decembre 2013. Resultats Durant l’etude, nous avons examine 101 patients diabetiques. La prevalence du diabete parmi tous les consultants du service de pathologies professionnelles du CHU Farhat de Sousse a ete de 5,1 %. La plupart etait des ouvriers (29,7 %), des chauffeurs (14,9 %) et des infirmiers (10,9 %), travaillant notamment dans les secteurs d’industrie (30,7 %) et de la sante (26,7 %). Le diabete etait de type 2 dans 86,1 % des cas, complique chez 72,2 % des patients. Des episodes d’hypoglycemie ont ete rapportes par 8,9 % des patients. L’absenteisme pour cause de diabete a ete observe chez 55,4 % des cas. L’absenteisme a ete significativement correle au diabete desequilibre et complique. Conclusion Le diabete est une maladie grave qui touche le patient, son employeur mais aussi la societe non seulement, en reduisant les chances de travail mais egalement, en contribuant a la perte du travail et en limitant les aptitudes physiques de ceux qui continuent a travailler. Afin de limiter les accidents du travail et l’absenteisme chez les travailleurs diabetiques, un suivi regulier et une surveillance accrue pour prevenir les complications du diabete sont necessaires.

Cushing syndrome (CS) is a rare feature of McCune-Albright syndrome. Treatments consist of bilateral adrenalectomy followed by lifelong glucocorticoid and mineralocorticoid treatment. However, cases of spontaneous remission of CS have been reported in the literature. We report a case of McCune-Albright syndrome with CS treated with metyrapone for 30 months with prolonged remission after a 12-year follow-up. Adrenalectomy may be avoided in some cases of CS caused by McCune-Albright syndrome. Metyrapone could be a good alternative to surgical treatment.

Vineyards in western and center regions of Algeria were surveyed for the Grapevine leafroll-associated virus 2 (GLRaV-2). Analyses by DAS-ELISA and Reverse Transcription Polymerase Chain Reaction (RT-PCR) reveal 15, 8% prevalence. The genetic diversity of the GLRaV-2 population was studied by phylogenetic analyses of the HSP70h gene region of seven samples sequenced in this study and other sequences downloaded from GenBank. Results reveal segregation of the GLRav-2 population into six distinct groups. An estimation of the ratio of non-synonymous substitutions per non-synonymous site to synonymous substitutions per synonymous site indicated that HSP70h gene evolve under positive selection. Similarity plot constructed with representative sequence from each group confirmed previous results. All Algerian isolates belong to group PN. As far as we know, this is the first characterization of GLRaV-2 isolates from Algeria.

Spinal dysraphism describes a group of congenital abnormalities characterised by an incomplete midline closure of bony, neural and soft tissue elements. The condition represents one of the more com...

Donohue syndrome (DS) is a rare and lethal autosomal recessive disease caused by mutations in the insulin receptor (INSR) gene, manifesting marked insulin resistance, severe growth retardation, hypertrichosis, and characteristic dysmorphic features. We describe a new case of Donohue syndrome born at 37 weeks' gestation of unrelated parents and presented with intra-uterine growth retardation, nipple hypertrophy, macropenis, distended abdomen, hirsutism and dysmorphic features. The clinical course showed failure to thrive, and episodes of alternating hypoglycemia and hyperglycemia. Laboratory tests revealed direct hyperbilirubinemia. The diagnosis of Donohue syndrome was established based on the above clinical characteristics and determination of the INSR mutation. He was found to have homozygous nonsense mutation c. 2270 C>T (Arg924X) at exon 14 of the INSR gene. He later developed enterocolitis and died at 3 months old. Prenatal diagnosis was performed for the family via chorionic villous biopsy. We try to explain gastrointestinal dysfunction seen in our patient.

Background/aims Transanal endoscopic microsurgery is a minimally invasive technique that allows the excision of benign and selected malignant tumours. We present a study for evaluating surgical morbidity, mortality and local recurrence rate of patients with rectal adenomas treated with transanal endoscopic microsurgery in six different Italian centres following the same protocol. Methods A total of 882 patients with rectal lesions (adenomas and early stage of carcinomas) underwent transanal endoscopic microsurgery in six different Surgical Departments from January 1993 to October 2004. Five hundred and ninety patients had preoperative diagnosis of adenomas but 588 patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate. Results The study involved 588 patients, with a median age of 66 years (25th percentile–75th percentile = 58–71 years). No postoperative mortality was reported. Intraoperative complications were observed in three patients (0.5%). Minor complications occurred in 48 patients (8.2%) whereas major complications were found only in 7 patients (1.2%). Definitive histology confirmed adenomas in 530 cases (90.1%). Two patients (0.3%) were lost to follow-up so were not included in the paper. At median follow-up of 44 months (25th percentile–75th percentile = 15–74 months), 23 (4.3%) adenomas recurred and were successfully retreated by transanal endoscopic microsurgery [20 cases (87%)] and by conventional surgery [3 patients (13%)]. No further recurrences were observed at subsequent follow-up. Thirty-one (5.3%) patients died during follow-up for old age, cardiac disease, etc. Conclusions Transanal endoscopic microsurgery is, in our experience, an effective method for local resection of benign rectal tumours with morbidity of 11.4%, no postoperative mortality and with a percentage of local recurrence of 4.3%.

Objectifs Etudier les caracteristiques cliniques et therapeutiques de l’achalasie de l’enfant Patients et Methodes Etude retrospective d’enfants presentant un megaoesophage suivis entre 2005 et 2013. Resultats 6 enfants ont ete etudies (5 filles et 1 garcon). Il s’agissait dans 3 cas d’un syndrome des 3A (Achalasie, Alacrymie, Addison), dans 1 cas d’un syndrome des 2A (Achalasie, Alacrymie), dans 1 cas d’un syndrome des 4A (Achalasie, Alacrymie, Addisson, Dysautonomie) et dans 1cas d’une achalasie isolee. L’âge moyen au diagnostic etait de 6 ans (18 mois-12 ans). Le diagnostic etait evoque devant une dysphagie (N=6), un amaigrissement (N=4), des regurgitations (N=1) et des bronchopneumopathies(N=1). Tous les patients ont eu un transit oesogastroduodenal montrant une dilatation de l’oesophage avec un aspect effile du cardia et une manometrie oesophagienne pour confirmer le diaagnostic. Initialement, 2 enfants ont ete traites par Nifedipine et 4 ont eu une dilatation pneumatique avec amelioration transitoire des symptomes. Les 6 enfants ont eu secondairement une myotomie extra muqueuse de Heller. Conclusion Les formes associees d’achalasie sont plus frequentes chez l’enfant. Leur evolution semble plus pejorative temoignant d’un mecanisme histopathologique different.

A 27-yr-old man was referred for fever, weight loss, fatigue, and occasional mild epimesogastric pain without diarrhea or vomiting. Laboratory tests were suggestive of an active inflammatory disease but serological, bacteriological, viral searches, markers of autoimmunity, and neoplasia were all negative. The following were also negative: ultrasonography; conventional x-rays; CT scans; esophagogastroduodenoscopy, pancolonoscopy with ileoscopy; cytohistology including duodenum and ileocolon. Empiric antibiotic regimens failed to control the temperature. Small bowel enema disclosed multiple proximal jejunal strictures. Jejunoscopy revealed erythema, friability, linear ulcerations, stenosis, and dilation in the proximal jejunum. Multiple directed biopsies showed inflammatory changes devoid of any specific features. The patient received steroid treatment and his temperature normalized. Six months later, he was readmitted on account of intestinal subocclusion that was managed conservatively. A few days later urgent laparotomy was performed with peritoneal lavage, repair of double perforated proximal jejunal ulcers, and stricturoplasty. Surgical jejunal biopsy confirmed the results of enteroscopic biopsies. The patient is presently without fever, in the absence of steroid treatment. There have been no reports of cryptogenic fever due to isolated jejunal Crohn's disease in the recent literature. Our patient's clinical picture resembled disease as seen in older children and adolescents, in whom it is a difficult diagnosis owing to the absence of diarrhea. In adults with Crohn's disease isolated jejunal involvement represents approximately 1% of cases. A thorough small bowel investigation is warranted in young adults with cryptogenic fever and low serum protein levels, even in the absence of major gastrointestinal complaints.

The internal anal sphincterotomy operation represents the best therapy for the treatment of those anal lesions, above all anal fissures, which cause hypertrophy and spasms of the internal anal sphincter. The Authors report their experience of 253 operations of internal subcutaneous sphincterotomy carried out between 1989 and 1995 under local anaesthesia in the outpatient clinic. The excellent results achieved prove that the procedure can easily be carried out under local anaesthesia in an outpatient clinic and, therefore, it is preferable to the surgical technique of isolation of the internal sphincter, not only for its practicality but also for the improved results.

Objectif Le deficit en vitamine D maternel est une etiologie de l’hypocalcemie neonatale, cause devenue frequente sous nos cieux. A travers cette observation nous rappelons que le rachitisme neonatal par carence maternelle en vitamine D est a rechercher de principe. Observation Nourrisson âge de 45 jours sous allaitement maternel exclusif hospitalise a l’âge de 1 mois pour convulsions. Pas de prise de vit D. L’examen clinique etait normal. A la biologie hypocalcemie a 1,68 mmol/l, glycemie normale, dosage des phosphatases alcalines 1413 UI/l, dosage parathormone normal, dosage de 25-hydroxyvitamine D bas a 13,1 μg/l (30-100 μg/l). Le bilan maternel montre une hypocalcemie a 2,03 mmol/l et dosage 25 hydroxyvitamine D bas a 9,3 μg/l. Le diagnostic de rachitisme carentiel neonatal par hypovitaminose D maternelle a ete retenu. L’evolution a ete favorable sous vitamine D et calcium. Discussion Le deficit en vitamine D maternel durant la grossesse et l’allaitement peut etre a l’origine de rachitisme infantile. Cette entite est a evoquer devant une hypocalcemie neonatale survenant sous nos cieux vu les habitudes alimentaires et les coutumes vestimentaires. La prevention passe par un apport de vitamine D pendant la grossesse et l’allaitement.