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This paper presents a Machine Learning and IoT-based intelligent medical system for the detection and monitoring of patient stress. This system is made up of a medical kit measuring the oxygen saturation, the heart rate and the galvanic skin response thanks to sensors attached at the top of the patient’s hand which send the measured physiological values to the Firebase server. A voting classifier, combining five Machine Learning algorithms (Logistic Regression, K-Nearest Neighbors, Support Vector Machine, Decision Tree and Random Forest) using holdout and K-fold cross-validation, was implemented on a Raspberry board installed in the doctor’s office. The proposed system can make predictions with the Soft Voting classifier with an accuracy that reaches 78%.

Precision Medicine is being increasingly used in the developed world to improve health care. While several Precision Medicine (PM) initiatives have been launched worldwide, their implementations have proven to be more challenging particularly in low- and middle-income countries. To address this issue, the “Personalized Medicine in North Africa” initiative (PerMediNA) was launched in three North African countries namely Tunisia, Algeria and Morocco. PerMediNA is coordinated by Institut Pasteur de Tunis together with the French Ministry for Europe and Foreign Affairs, with the support of Institut Pasteur in France. The project is carried out along with Institut Pasteur d’Algérie and Institut Pasteur du Maroc in collaboration with national and international leading institutions in the field of PM including Institut Gustave Roussy in Paris. PerMediNA aims to assess the readiness level of PM implementation in North Africa, to strengthen PM infrastructure, to provide workforce training, to generate genomic data on North African populations, to implement cost effective, affordable and sustainable genetic testing for cancer patients and to inform policy makers on how to translate research knowledge into health products and services. Gender equity and involvement of young scientists in this implementation process are other key goals of the PerMediNA project.In this paper, we are describing PerMediNA as the first PM implementation initiative in North Africa. Such initiatives contribute significantly in shortening existing health disparities and inequities between developed and developing countries and accelerate access to innovative treatments for global health.

Gastrointestinal clear cell sarcoma (GICCS)/malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare form of cancer with aggressive clinical behavior. It has distinct pathological, immunohistochemical, ultrastructural, and molecular features. Herein, we present the case of a 20-year-old woman with no notable medical history who presented to the outpatient department with complaints of abdominal pain and vomiting. Symptoms had been evolving for 3 months. The physical examination revealed slight abdominal tenderness and melena. Biological investigations revealed iron-deficiency anemia. The upper and lower endoscopies showed no abnormalities. Magnetic resonance enterography revealed small bowel wall thickening of 15 mm × 2 mm. Exploratory laparotomy revealed an ileal mass with mesenteric lymphadenopathy. A wide resection of the mass was then performed. The final pathological report confirmed the diagnosis of small bowel GICCS/GNET. After 11 months of follow-up, the patient presented with mesenteric lymph node metastases.

Noonan syndrome is a genetic disorder frequently caused by PTPN11 mutations. Patients with Noonan syndrome are characterized by facial dysmorphism, short stature and congenital heart defects and they have a reported predisposition to malignancies such as leukemia, and solid and central nervous system tumors. Here, we report a case of a 14-year-old boy with Noonan syndrome treated for T-cell acute lymphoblastic leukemia who presented with 2 concomitant abnormalities: cerebral abscess and high grade glioblastoma. This exceptional association exhibits to a poorer prognosis and may sometimes delay the diagnosis and therefore the therapeutic intervention.

Purpose: Androgen deprivation therapy (ADT) may cause vasomotor symptoms (VMS) including hot flushes and sweats, which affect quality of life (QoL). Serelys Homme is a nonhormonal and a natural origin product that could affect VMS in men undergoing ADT. We evaluated effectiveness and tolerance of Serelys Homme administration on VMS and QoL of patients undergoing combined ADT and radiation therapy for prostate cancer. Methods and Materials: Between April 2017 and July 2019, 103 patients were screened, and 53 patients refused to participate in the study. Serelys Homme therapy consisted of a daily administration of 2 tablets for 6 months. Patients were evaluated with 4 questionnaires including the adapted Modified Rankin Scale (adapted-MRS), European Quality of Life 5 Dimensions 3 Level Version (EQ 5D3L), Functional Assessment of Cancer Therapy–Prostate (FACT-P), and Hot Flash Related Daily Interference Scale (HFRDIS) at day 0, day 90 (D90), and day 180 (D180). Statistical evaluation was performed using the Wilcoxon rank sign test. A 2-sided P < .05 was considered statistically significant. Results: Among the 50 patients, 4 withdrew after inclusion. All patients (n = 46) received either postoperative or definitive radiation therapy combined with a short (n = 15) or long course (n = 31) of ADT. Serelys Homme administration significantly decreased the rate of patients who had ≥7 VMS and 3 to 6 VMS per day. The number of patients presenting with moderate or severe VMS was decreased at D90 (P = .005) and at D180 (P = .005). In addition, VMS duration was reduced at D90 (P = .002) and D180 (P < .001). Finally, at D90 and D180, 11.1% and 16.0% of patients, respectively, with initial severe or moderate VMS had a complete response without further symptoms. Among QoL parameters, fatigue decreased significantly. Effectiveness evaluated by doctors was rated as moderate or good to excellent VMS control in 20% and 60% of the patients, respectively. No side effects were recorded in the whole population. Conclusions: This study demonstrated effectiveness and excellent tolerance of Serelys Homme. We observed a significant reduction of the frequency, duration, and intensity of hot flushes and sweats induced by ADT. Serelys Homme increased QoL scores. These encouraging results open the prospect to further studies and Serelys Homme use in patients undergoing ADT for prostate cancer.

Involvement of posterior elements of the spine in spinal tuberculosis is rare. We report a case of a 56-year-old woman who presented with asymptomatic tuberculosis of the tenth and eleventh costotransverse joints. The latter was discovered with a CT scan made to look for a pulmonary embolism. Magnetic Resonance Imaging (MRI) showed liquid in the costotransverse joints with a paravertebral abscess. The patient was managed conservatively. Although rare, posterior tuberculosis of the spine should be known by spine surgeons. MRI is the key to the diagnosis. Conservative treatment is the standard treatment, and surgery is reserved for patients with neurological deficit.

Byline: Hadhri. Khaled, Bellil. Mehdi, Kooli. Mondher Sir, Computed tomography (CT) scan of the lumbar spine of a 62-year-old male with history of decompressive surgery of lumbar spinal stenosis and [...]

Abstract Background Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastasis. Urinary bladder metastasis from breast cancer is rarely reported in the literature. Case presentation We report a case of a 77-year-old female with history of left breast cancer, who presented a thickening of the bladder wall at pelvic ultrasound. Biopsy confirmed that the origin was lobular carcinoma of breast origin. The patient received chemotherapy, but the clinical course of the patient was very aggressive and she died one year later. Conclusion Bladder metastasis from breast cancer is rare, but the literature reveals an increase in such occurrence over the last few years. Pathologic diagnosis relies on immunohistochemical studies. Chemotherapy and hormonal treatment represent the standard therapy, with radiotherapy being used only to control bladder bleeding. The prognosis is usually poor.

This paper presents a Machine Learning and IoT-based intelligent medical system for the detection and monitoring of patient stress. This system is made up of a medical kit measuring the oxygen saturation, the heart rate and the galvanic skin response thanks to sensors attached at the top of the patient's hand which send the measured physiological values to the Firebase server. A voting classifier, combining five Machine Learning algorithms (Logistic Regression, K-Nearest Neighbors, Support Vector Machine, Decision Tree and Random Forest) using holdout and K-fold cross-validation, was implemented on a Raspberry board installed in the doctor's office. The proposed system can make predictions with the Soft Voting classifier with an accuracy that reaches 78%. [ABSTRACT FROM AUTHOR]

Abstract Mycetoma, commonly known as Madura foot, is a chronic granulomatous infection caused either by fungi (eumycetoma) known as actinomycete. This disease occurs preferentially in young adults, and it affects the foot in particular. We report a Tunisian case of mycetoma occurring in an old patient, particular by its cystic presentation.

Abstract Osteonecrosis in antiphospholipid syndrome is a diagnostic challenge for clinicians. Early diagnosis and intervention are important for better prognosis.

Abstract Acute localized exanthematous pustulosis (ALEP) is a rare localized variant of acute generalized exanthematous pustulosis (AGEP). We report a case of ALEP localised on the trunk and induced by a mosquito bite in a breast cancer treated female patient.

Abstract Since its outbreak in December 2019, a consistent number of case reports have been published describing a complex spectrum of skin manifestations associated with COVID‐19. We report a first observation of demodicosis of the scalp after a severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2) infection.

Abstract Primary mucinous adenocarcinoma is an exceptionally rare neoplasm with a propensity for local recurrence and metastasis. We report the second case in the world literature of a primary mucinous adenocarcinoma of the orbit in a 66‐year‐old man suffering from pain, progressive protrusion of left eye, and a deep drop in vision on the left for several weeks. His first external examination revealed significant proptosis with downward displacement of the left globe with no signs of lagophthalmos. A limitation of abduction was also noted. A CT of the orbit with and without contrast showed intra‐ and extra‐conical solid expansive process. MRI of the orbit with contrast and without contrast has shown a process of the supero‐internal angle of the left orbit. The patient was operated via a combined approach, and complete enucleation was done. The final pathologic diagnosis was mucinous adenocarcinoma of the orbit. The postoperative neuroimaging showed a complete resection of the tumor. The patient is referred for adjuvant radiotherapy. A CT of the orbit was made 3 months postoperatively and did not show any local recurrence.

IntroductionBreast cancer is a major public health problem worldwide. It is the leading cause of cancer deaths in females. In developing countries like Tunisia, the frequency of this cancer is still growing. The aim of this study was to determine the crude and standardized incidence rates, trends and predictions until 2030 of breast cancer incidence rates in a Tunisian governorate.MethodsThis is a descriptive study including all female patients diagnosed with breast cancer in Monastir between 2002 and 2013. The data were collected from the cancer register of the center. Tumors were coded according to the 10th version of international classification of disease (ICD-10). Trends and predictions until 2030 were calculated using Poisson linear regression.ResultsA total of 1028 cases of female breast cancer were recorded. The median age of patients was 49 years (IQR: 41-59 years) with a minimum of 16 years and a maximum of 93 years. The age-standardized incidence rate (ASR) was of 39.12 per 100000 inhabitants. It increased significantly between 2002 and 2013 with APC of 8.4% (95% CI: 4.9; 11.9). Prediction until 2030 showed that ASR would reach 108.77 (95% CI: 57.13-209.10) per 100000 inhabitants.ConclusionThe incidence and the chronological trends of breast cancer highlighted that this disease is of a serious concern in Tunisia. Strengthening preventive measures is a primary step to restrain its burden.

The surface modification of textile fabrics and therefore, the development of advanced textile materials featuring specific implemented and new properties, such as improved durability and resistance, is increasingly in demand from modern society and end-users. In this regard, the sol–gel technique has shown to be an innovative and convenient synthetic route for developing functional sol–gel coatings useful for the protection of textile materials. Compared with the conventional textile finishing process, this technique is characterized by several advantages, such as the environmentally friendly approaches based on one-step applications and low concentration of non-hazardous chemicals. The sol–gel method, starting from inorganic metal alkoxides or metal salts, leads to inorganic sols containing particles that enable a chemical or physical modification of fiber surfaces, giving rise to final multifunctional properties of treated textile fabrics. This review considered the recent developments in the synthesis of inorganic nanoparticles and nanosols by sol–gel approach for improving wear and UV resistance, as well as antibacterial or antimicrobial effects for textile applications.

Based on Chinese and Arabic literature, this paper summarizes the spread of Laozi’s text and thought in the Arab world. The specific course of dissemination can be divided into two stages: from 1966 to 2000, the Dao De Jing was disseminated on the basis of indirect translations; from 2000 to today, the spread of the Dao De Jing in the Arab world reached a climax when the first direct translation was published. Laozi’s text and thought have gained acceptance and popularity largely because of their soothing function and similarity to the Sufi spirit found in Arab culture. The spread of Laozi’s text and thought in the Arab world presents three features: a long and friendly history of cultural exchange has served as a foundation; languages such as English and French have functioned as intermediaries; and similarities between Sufism and Daoism have provided points of connection.

Purpose: The management of older patients in radiation therapy (RT) departments has been challenging in the context of the Coronavirus Disease 2019 (COVID-19) outbreak. We report our experience of RT adapted schedules or strategy changes in older patients during the COVID-19 pandemic. Methods and Materials: Patients aged ≥75 years were recruited during weekly chart rounds. All were potentially eligible for a specific intervention to reduce the frequency of patients’ visits to the hospital. The effect of deferring radiation and hypofractionation of RT schedules was assessed in terms of the number of courses initially planned and replanned during the lockdown. Results: Twenty patients were identified during the official lockdown in France (March 17 to May 11). Median age was 78 years (75-95 years). Most patients were male (n = 12, 60%) being treated in the postoperative setting (n = 17, 85%). RT was delayed in 11 cases (55%) with hormonal therapy prescribed in 10 cases (50%). Altered RT fractionation was proposed for 5 cases (25%); combinations of altered fractionation and deferral of radiation were applied in 3 cases (15%). The number of radiation courses initially planned and replanned according to the pandemic context: 563 and 197, respectively (−62%; P < .001). None presented recurrence when RT was initiated, and no patient developed symptomatic COVID-19 infection. Conclusions: In the context of the COVID-19 outbreak, individual risk-based radiation therapy seems to be safe. Systematic screening of patients for COVID-19 before starting radiation therapy is mandatory. In our department the oncogeriatrics expertise availability for daily practice was of great use during the pandemic. Other prospective studies are needed to validate such strategies in case of resurgence of similar outbreaks.

Acute generalized exanthematous pustulosis (AGEP) is a rare yet well-known cutaneous reaction pattern, mostly caused by drugs. Acute localized exanthematous pustulosis (ALEP) is a localized variant of AGEP. A 42-year-old female presented with multiple erythematous pustules on the face, which appeared three days after the intramuscular injection of piroxicam. Histopathology revealed subcorneal pustules, epidermal spongiosis, and mixed inflammatory cell infiltration in the dermis. The pustules resolved within several days once the patient had discontinued the drug. Herein, we report the first case, as far as we know, of a female with a cutaneous drug reaction consistent with ALEP caused by piroxicam.

La dysplasie cémento-osseuse est une lésion fibro-osseuse non néoplasique qui touche l´os alvéolaire. Elle peut se présenter sous l´une des trois formes :périapicale, focale ou floride. Elle est souvent asymptomatique de découverte fortuite lors d´un examen radiologique de routine. Cependant, elle peut devenir symptomatique suite à une surinfection, une fois exposée à la flore bactérienne buccale. Nous rapportons un cas de dysplasie cémento-osseuse floride associée à une actinomycose osseuse chez une femme tunisienne de 53ans. Cette surinfection est rarement évoquée dans la littérature ; une recherche sur pubmed utilisant la formule booléenne « cemento-osseous dysplasia AND actinomyces » a révélé un seul article (Smith et al, 2011). Le traitement de l´infection actinomycosique nécessite souvent une antibiothérapie de longue durée parfois associée à une chirurgie de débridement comme dans ce cas où la piézochirurgie a été utilisée dans l´élimination de la dysplasie et de l´os nécrotique.

Byline: Khaled. Hadhri, Mohamed. BenSalah, Mondher. Kooli Dear Sir, A 72-year-old male presented with a complaint of 6-month gait disturbance and claudication caused by thoracic spine Paget disease involving T7 [...]

Byline: Hadhri. Khaled, Ben. Mohamed, Bellil. Mehdi Sir, A 54-year-old female with no pathological history presented with a 1-year right buttock pain irradiating to the homolateral lower limb. It was [...]

Le Fœtus in Fœtu (FIF) est une anomalie congénitale extrêmement rare définie comme une masse contenant un axe vertébral associé souvent à d'autres organes ou à des membres autour de cet axe. Nous rapportons l'observation d'un fœtus de sexe féminin âgé de 4 mois qui se présentait pour une masse rétropéritonéale mesurant 7x6x4cm évoquant un tératome à la tomodensitométrie. La masse était réséquée. L'examen macroscopique montrait une masse d'aspect fétiforme recouverte par un tissu cutané et se prolongeant par des ébauches de membres supérieurs et inférieurs (A). A la coupe, elle était centrée par plusieurs fragments ostéocartilagineux disposés d'une façon linéaire rappelant un axe vertébral (B). L'examen histologique objectivait la présence du tissu glial autour d'un ventricule cérébral en plus des tissus cutané, musculaire et osseux. Le diagnostic d'un FIF était retenu. Le FIF a été rapporté essentiellement au niveau du rétropéritoine suivi par les localisations sacro-coccygienne, intra-abdominale, crânienne, buccale, médiastinale, pulmonaire, rénale et scrotale. Le diagnostic est établi en anténatal dans 15% des cas. L'étiopathogénie du FIF inclut la théorie de grossesse monochoriale biamniotique monozygote par laquelle un aberrant jumeau asymétrique s'intériorise dans l'autre jumeau et la théorie d'implantation défectueuse d'un embryon dans le mésenchyme de son jumeau au lieu de la paroi utérine. Le diagnostic différentiel se pose avec le tératome, le pseudokyste méconial et la grossesse ectopique.

Erdheim-Chester disease (ECD) is a very rare and aggressive form of non-Langerhans histiocytosis with unclear pathogenesis. Because of the heterogeneity of clinical presentation, diagnosis is often challenging and delayed. Currently, Interferon alpha is the first line treatment that is associated with a better survival. The prognosis is relatively poor, especially in case of neurological and cardiovascular involvement. Herein, we report the case of a 64-year-old Tunisian female patient presenting an aggressive form of ECD revealed by diabetes insipidus and cerebellar ataxia with a diagnosis delay of 4 years. The assessment of disease extent had also shown associated asymptomatic cardiac and bone involvement. Pegylated Interferon alpha was started at high dose allowing disease stabilization. This case illustrates that physicians should be aware of the heterogeneous manifestations of ECD in order to insure an early diagnosis and treatment. Long-term and regular follow-up is crucial because of the risk of disease progression.

The present paper aims at placing the Mediterranean within the cultural perceptions and literary productions of the Arab World, particularly the Maghreb. How do collective consciousness and cultural representations in the South see the Mediterranean as a heritage ofcivilization? Does the Mediterranean exist at all for Arabs? Is it completely absent, or does it holds at least a marginal place in the Arab cultural and scientific productions? If the latter hypothesis were true, what are the underlying reasons for this relative marginality of the Mediterranean? These are some of the questions we will try to answer, the goal being to make some clarifications on the outlook of Southern Mediterranean countries towards the Mediterranean cultural heritage.

Solitary osteochondromas rarely occur in the axial skeleton. Those tumors mostly arise on the posterior elements of the cervical column causing various symptoms especially when developing within the spinal canal. Exophytic lumbar variety is uncommon presenting with palpable mass or spinal deformity. We report a 20-year-old man presenting with a solid painless mass at the lower lumbar region. Radiological examinations revealed an exophytic lesion arising in the third lumbar spinous process appearing to be a solitary osteochondroma. The lesion was treated by en-bloc resection; histopathological examination confirmed the diagnosis of osteochondroma with no evidence of recurrence at the end of 2-year follow up. Keywords: Osteochondroma, Lumbar spine, Spinous process, Tumor, Diagnostic imaging, Surgery

A 2-year-old boy with prenatal diagnosis of a malformation uropathy was referred to paediatric surgery department. On systemic examination, there were no palpable masses. An ultrasonography of abdomen with color Doppler, a renal artery angiographic and scintigraphy revealed a preostial aneurysm at the left renal artery. The patient had a left nephrectomy. Grossly, the specimen measured 75 mm × mm 50 × 20 mm with renal artery aneurysm measuring 30 mm × 35 mm. On cut section, the renal parenchyma contained a whitish tumor that measured 35 mm × 10 mm. Histopathologically, this tumor was diagnosed as metanephric stromal tumor.

Byline: Yosra. Soua, Kamar. Belhareth, Maha. Lahouel, Rim. Hadhri, Hayet. Akkari, Hichem. Belhadjali, Monia. Youssef, Jameleddine. Zili Sir, Pyoderma gangrenosum is an uncommon neutrophilic dermatosis, classically presenting as inflammatory and [...]