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Background: Oncology nurses constantly provide emotional support to patients and are confronted with their suffering, which represents chronic stress leading to the development of burnout syndrome., Aim: This study aimed to evaluate the prevalence of burnout and identify associated factors in a sample of oncology nurses., Methods: We conducted a descriptive cross-sectional study with 70 oncology nurses at the Salah Azaiez Institute of Oncology in Tunisia. Burnout was assessed using the Maslach Burnout Inventory Human Service Survey. This study follows the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Guidelines., Results: Burnout affected 60 nurses (85.7%), with a high level in 20% of cases. High scores of emotional exhaustion, depersonalisation, and low personal accomplishment were recorded in 65.7%, 50% and 25.7% respectively. Emotional exhaustion was associated with higher age, marital status, having 2 or 3 or more dependent children, number of patients under care exceeding 15, professional experience and history of psychiatric problems. Depersonalisation was correlated with age, marital status, professional grade and history of psychiatric problems. Low levels of personal accomplishment increased with the number of patients under care, history of psychiatric problems and the regret of professional choice., Conclusion: Burn-out is a reality in oncology hospital with an alarming rate. Interventions including rationalisation of workload, support groups, training in emotion and stress management would improve the mental health of these nurses and increase their performance. The screening for burnout should be included as a regular practice in health promotion programmes for oncology health professionals, particularly for a vulnerable subgroup that possesses the risk mentioned above factors., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

The current study was conducted within the context of the Holocene era in Sebkha El-Guettiate, located in southeastern Tunisia. The aim was to determine the factors influencing the geochemical and mineralogical composition of sediments and to elucidate the sedimentary characteristics of the Holocene within the Sebkha core. We examined a sediment core extending 100 cm from this Sebkha, subjecting it to comprehensive analysis to uncover its sedimentological, mineralogical, and geochemical properties. Several techniques were employed to strengthen and validate the connections between geochemical and mineralogical analyses, including X-ray diffraction (XRD), X-ray fluorescence (XRF), scanning electron microscopy (SEM), and infrared (IR) spectroscopy, among others. Furthermore, statistical analyses utilizing principal component analysis (PCA) were applied to the results of the geochemical and mineralogical studies, aiding in the identification of patterns and relationships. A comprehensive mineralogical assessment of the core's sediments revealed the presence and interpretation of carbonate minerals, evaporite minerals, and detrital minerals. Through the application of infrared (IR) spectrometer techniques to all sediment samples, we gained insight into the mineralogical components and the distribution of key elements such as quartz, kaolinite, calcite, feldspar, and organic carbon. The geochemical composition demonstrated a clear dominance of silica (SiO2), accompanied by fluctuations in carbonate percentages (CaCO3). The prominent major elements, primarily magnesium (Mg) and calcium (Ca) originating from dolomitization, sodium (Na) and chlorine (Cl) from halite, and calcium (Ca) from gypsum, exhibited varying levels. Results from Rock-Eval 6 pyrolysis indicated that the organic matter within the sediments is generally a mixture of terrestrial and aquatic origins. This study provides practical information that underscores the diverse origins contributing to Sebkha sediment formation, often influenced by saline systems., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The impact of rainwater harvesting systems on biodiversity in hyperarid North African areas has not been assessed to date despite its demonstrated usefulness. The present study investigated this impact by considering the richness of wintering birds (RWB) in the Tataouine region (pre-Saharan Tunisia). We used data from three sets of variables-rainwater harvesting system type, microhabitat conditions, and topography-to determine the best predictors causing variation in the RWB by means of generalized linear mixed models. Our results show that the jessour system is the most attractive for the wintering bird species, followed by the tabia system, and lastly by the control areas. In the jessour system, RWB is influenced positively by slope and shrub cover and quadratically by tree cover, whereas this richness is affected positively by the extent of the herbaceous layer in the tabia system. In the control areas, RWB is negatively affected by elevation and quadratically affected by tree cover. Variation partitioning (VP) analysis reveals that (i) space is the most robust factor explaining the RWB in control areas (adj. R 2  = 0.15, p = 0.001), (ii) microhabitat is central in the tabia system (adj. R 2  = 0.10, p = 0.001), and (iii) the shared fraction between microhabitat and space is relevant in the jessour systems (adj. R 2  = 0.20). Specific management actions, especially preserving, maintaining, and promoting these traditional systems, are suggested to improve the attraction of wintering bird species to the Tataouine region. The implementation of a scientific watch system is recommended to understand how changes take place in such an arid environment., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Phlebotomine sand flies (Diptera: Phlebotominae) belonging to the genus Phlebotomus are vectors of pathogens such as arboviruses, bacteria, and parasites (Leishmania). Species of the genus Sergentomyia (Se.) transmit Sauroleishmania (Reptile Leishmania) and feed on cold-blooded vertebrates; recently, they have been incriminated in mammalian Leishmania transmission. In addition, they have been reported to feed on warm-blooded vertebrates. This study aimed to (i) screen wild-caught Sergentomyia species for the detection of mammalian Leishmania and (ii) identify the blood meal origin of engorged females. The sand flies were collected using centers for disease control and prevention (CDC) traps, mounted and identified morphologically. Only females of the genus Sergentomyia were screened for Leishmania infection using PCR targeting the 18S ribosomal DNA locus. For positive specimens, Leishmania parasites were typed using nested PCR targeting ribosomal internal transcribed spacer 1 followed by digestion with HaeIII. The PCR-RFLP results were confirmed through sequencing. Blood meal identification was performed through PCR amplification of the vertebrate cytochrome b gene using degenerate primers followed by sequencing. In total, 6026 sand fly specimens were collected between 2009 and 2018. Among these, 511 belonged to five species of Sergentomyia genus: Se. minuta (58.51%), Se. fallax (18.01%), Se. clydei (14.68%), Se. dreyfussi (6.26%), and Se. antennata (2.54%). A total of 256 female Sergentomyia sp. specimens were screened for Leishmania infection. Seventeen (17) were positive (6.64%). Two Leishmania species were identified. Leishmania major DNA was detected in five specimens; this included three Se. fallax, one Se. minuta, and one Se. dreyfussi collected from Tunisia. Leishmania infantum/L. donovani complex was detected in four Se. minuta and three Se. dreyfussi specimens collected from Tunisia. In addition, we identified the blood meal origin of five engorged Se. minuta specimens collected from Tunisia. Sequencing results revealed two blood sources: humans (n = 4) and reptiles (n = 1) indicating possible role of Sergentomyia species in the transmission of human Leishmania. In addition, these species could be involved in the life cycle of L. infantum/L. donovani complex and L. major. The results of the blood meal origin showed that Sergentomyia fed on both cold- and warm-blooded vertebrates. These findings enable a better understanding of the behavior of this sand fly genus. Further studies should focus on the role of Sergentomyia in human Leishmania transmission and possible control of this disease., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Coastal ecosystems are the most vulnerable to natural and anthropogenic pressures which should be assessed using various chemical and ecological indicators. Our study aims to provide practical monitoring of anthropogenic pressures related to metal discharges in coastal waters for identifying potential ecological deterioration. The spatial variability of various chemical elements concentrations and their main sources were determined in the surficial sediments of a Mediterranean coastal area submitted to high anthropogenic pressure, the semi-enclosed Boughrara Lagoon located in southeastern Tunisia, by conducting several geochemical and multi-elemental analyses. The grain size and the geochemical analyses both suggested a marine influence of the sediment inputs in the north of the area (near Ajim channel), whereas continental and aeolian features dominated the sedimentary inputs in the southwestern lagoon. This last area was also characterized by the highest concentrations of metals, in particular Pb (4.45-173.33 ppm), Mn (68.45-1469.27 ppm), Cu (7.64-134.26 ppm), Zn (28.74-244.79 ppm), Cd (0.11-2.23 ppm), Fe (0.5-4.9%), and Al (0.7-3.2%). By referring to background crustal values and the contamination factor calculations (CF), the lagoon is considered as highly polluted for Cd, Pb, and Fe (3 < CF < 6). Three possible sources of pollution were identified: phosphogypsum effluents (P, Al, Cu, and Cd), the ex-Pb mine (Pb and Zn), and the cliff weathering and streams input from the red clay quarry (Fe). Furthermore, pyrite precipitation was identified for the first time in the Boughrara lagoon, suggesting the occurrence of anoxic conditions in this lagoon., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The aim of this study was to measure the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among workers at the Institut Pasteur de Tunis (IPT), a public health laboratory involved in the management of the COVID-19 pandemic in Tunisia, and to identify risk factors for infection in this occupational setting. A cross-sectional survey was conducted on IPT workers not vaccinated against coronavirus disease 2019 (COVID-19). Participants completed a questionnaire that included a history of reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection. Immunoglobulin G antibodies against the receptor-binding domain of the spike antigen (anti-S-RBD IgG) and the nucleocapsid protein (anti-N IgG) of the SARS-CoV-2 virus were detected by enzyme-linked immunoassay (ELISA). A multivariate analysis was used to identify factors significantly associated with SARS-CoV-2 infection. A total of 428 workers were enrolled in the study. The prevalence of anti-S-RBD and/or anti-N IgG antibodies was 32.9% [28.7-37.4]. The cumulative incidence of SARS-CoV-2 infection (positive serology and/or previous positive RT-PCR test) was 40.0% [35.5-44.9], while the proportion with asymptomatic infection was 32.9%. One-third of the participants with RT-PCR-confirmed infection tested seronegative more than 90 days postinfection. Participants aged over 40 and laborers were more susceptible to infection (adjusted OR [AOR] = 1.65 [1.08-2.51] and AOR = 2.67 [1.45-4.89], respectively), while tobacco smokers had a lower risk of infection (AOR = 0.54 [0.29-0.97]). The SARS-CoV-2 infection rate among IPT workers was not significantly different from that detected concurrently in the general population. Hence, the professional activities conducted in this public health laboratory did not generate additional risk to that incurred outside the institute in day-to-day activities., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Research Problem: ST Elevation Myocardial Infarction (STEMI+) is an absolute emergency. The young age of patients and the difficulty of access to care remain the main characteristics of STEMI+ management in Tunisia. In the governorate of Béja, located in the Northwestern region of Tunisia, given the lack of a cardiology interventional room in the hospital and in the private establishments of the region and the distance from the specialized centers of at least 127 km, the patient is beyond 90 min of the transfer. This delay in care generates a heavy burden of morbidity and mortality. The main objective of this study will be to audit the delays of management of patients presenting STEMI+ at the regional hospital of Béja (Tunisia) in accordance with the recommendations of learned societies. Secondarily, we will identify factors associated with delayed presentation after the onset of clinical symptoms. Investigation process : it will be a descriptive, exhaustive and prospective study, including patients admitted to the emergency and/or the cardiology department of the regional hospital of Béja for STEMI+ during the study period. For each patient admitted for STEMI, the following data will be collected : sociodemographic characteristics; medical history; cardiovascular risk factors; diagnostic and therapeutic management modalities; intra-hospital evolution; survival at 01 months in relation to the current coronary episode and the estimation of the different management delays., Research Plan: ethical considerations will be respected, as well as the confidentiality and anonymity of the data. The study will last one year from the 1st september 2022 to 31 august 2023. The results will allow us to describe the delays of management of patients with STEMI+ in the region of Béja (Tunisia). At least 2 publications in international scientific journals are planned.

Background: Severe valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine predictors of maternal cardiac, obstetric and neonatal complications in pregnant women with severe valve disease., Methods: This is an observational retrospective cohort study of all pregnant women with severe heart valvulopathy who gave birth between 2010 and 2017., Results: We included 60 pregnancies in 54 women. Cardiac complications occurred during 37 pregnancies (61%). In multivariate analysis, parity (aOR =2.41, 95% CI[1.12-5.16]), revelation of valvulopathy during pregnancy (aOR = 6.34; 95% CI[1.26-31.77]), severe mitral stenosis (aOR = 6.98, 95% CI[1.14-41.05],) and systolic pulmonary arterial pressure (aOR =1.08, 95% CI[1.01-1.14]) were associated with cardiac complications. Obstetrical complications were noted during 19 pregnancies (31.8%). These complications were associated with nulliparity (aOR = 5.22; 95% CI[1.15-23.6]), multiple valve disease (aOR = 5.26, 95% CI[1.19-23.2]), systolic pulmonary arterial pressure (aOR =1.04, 95% CI[1.002-1.09]), and treatment with vitamin K antagonists (aOR = 8.71, 95% CI[1.98-38.2]). Neonatal complications were noted in 39.3% of newborns (n = 61) and these were associated with occurrence of obstetric complications (aOR = 16.47, 95% CI[3.2-84.3]) and revelation of valvulopathy during pregnancy (aOR = 7.33, 95% CI[1.4-36.1])., Conclusions: Revelation of valvular heart disease during pregnancy is a predictor of not only cardiac but also neonatal complications. Valvular heart disease screening during pre-conceptional counseling is thus crucial., (© 2021. The Author(s).)

Rhinoviruses (RV) are a major cause of Severe Acute Respiratory Infection (SARI) in children, with high genotypic diversity in different regions. However, RV type diversity remains unknown in several regions of the world. In this study, the genetic variability of the frequently circulating RV types in Northern Tunisia was investigated, using phylogenetic and phylogeographic analyses with a specific focus on the most frequent RV types: RV-A101 and RV-C45. This study concerned 13 RV types frequently circulating in Northern Tunisia. They were obtained from respiratory samples collected in 271 pediatric SARI cases, between September 2015 and November 2017. A total of 37 RV VP4-VP2 sequences, selected among a total of 49 generated sequences, was compared to 359 sequences from different regions of the world. Evolutionary analysis of RV-A101 and RV-C45 showed high genetic relationship between different Tunisian strains and Malaysian strains. RV-A101 and C45 progenitor viruses' dates were estimated in 1981 and 1995, respectively. Since the early 2000s, the two types had a wide spread throughout the world. Phylogenetic analyses of other frequently circulating strains showed significant homology of Tunisian strains from the same epidemic period, in contrast with earlier strains. The genetic relatedness of RV-A101 and RV-C45 might result from an introduction of viruses from different clades followed by local dissemination rather than a local persistence of an endemic clades along seasons. International traffic may play a key role in the spread of RV-A101, RV-C45, and other RVs., Competing Interests: The authors have declared that no competing interests exist.

Introduction: In order to implement a centralized cytotoxic reconstitution unit (CCRU), a study was conducted to compare the implementation costs of a CCRU equipped with a cytotoxic safety cabinet (CSC) and one equipped with an isolator with negative pressure., Materials and Methods: This study compares items such as infrastructure, air treatment and CCRU qualification costs, equipment's purchase and qualifications costs, as well as staff dressing costs. Two plans were elaborated according to the international recommendations in a way that they respond to the necessary requirements in both cases. Requests for quotes for the compared items were sent to different suppliers., Results: The implementations' cost of a CCRU equipped with a CSC is cheaper than the one equipped with an isolator. The price of an isolator is much higher than a CSC; its qualification is also more expensive. However, the requirements and the costs for the air treatment and the dressing of the staff are less in the case of an isolator. The overall cost of the CCRU's implementation is approximately 1.3 times higher in the case of an isolator. However, by excluding the equipment purchase cost, the overall cost of a CSC's implementation becomes higher., Conclusion: For Tunisia, it seems that the CSC is the most adapted. However, this work should be completed by the comparison of the CCRU's operating costs in order to optimize the resources and figure out the cheapest system.

Background: Contemporary registries on atrial fibrillation (AF) are scare in North African countries., Hypothesis: In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal., Methods: NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described., Results: A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA 2 DS 2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died., Conclusions: NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal., (© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Introduction: Hearing impairment (HI) is characterized by complex genetic heterogeneity. The evolution of next generation sequencing, including targeted enrichment panels, has revolutionized HI diagnosis., Objectives: In this study, we investigated genetic causes in 22 individuals with non- GJB2 HI., Methods: We customized a Haloplex HS kit to include 30 genes known to be associated with autosomal recessive nonsyndromic HI (ARNSHI) and Usher syndrome in North Africa., Results: In accordance with the ACMG/AMP guidelines, we report 11 pathogenic variants; as follows; five novel variants including three missense ( ESRRB- Tyr295Cys, MYO15A -Phe2089Leu and MYO7A -Tyr560Cys) and two nonsense (USH1C- Gln122Ter and CIB2- Arg104Ter) mutations; two previously reported mutations (OTOF- Glu57Ter and PNPT1 -Glu475Gly), but first time identified among Tunisian families; and four other identified mutations namely WHRN- Gly808AspfsX11, SLC22A4 -Cys113Tyr and two MYO7A compound heterozygous splice site variants that were previously described in Tunisia. Pathogenic variants in WHRN and CIB2 genes, in patients with convincing phenotype ruling out retinitis pigmentosa, provide strong evidence supporting their association with ARNSHI. Moreover, we shed lights on the pathogenic implication of mutations in PNPT1 gene in auditory function providing new evidence for its association with ARNSHI. Lack of segregation of a previously identified causal mutation OTOA -Val603Phe further supports its classification as variant of unknown significance. Our study reports absence of otoacoustic emission in subjects using bilateral hearing aids for several years indicating the importance of screening genetic alteration in OTOF gene for proper management of those patients., Conclusion: In conclusion, our findings do not only expand the spectrum of HI mutations in Tunisian patients, but also improve our knowledge about clinical relevance of HI causing genes and variants., Competing Interests: The authors declared that there is no conflict of interest., (© 2021 The Authors. Published by Elsevier B.V. on behalf of Cairo University.)

Background: The outcome ofhepatitis B (HBV) infection is influenced by immune responses and host genetics. Interleukin-18 (IL-18) is a determinant factor in controlling the balance of Th1/Th2 during antiviral response.Weexamine therole of two functional polymorphisms -607A/C and-137A/C inIL-18 gene with risk of chronic HBV infection., Methods and Results: Genomic DNA isolates were obtained from 200 seropositive cases stratified according to their HBV DNA loads, and 200 blood donorsas a control population. Genotypes of the two polymorphisms were identified by ARMS-PCR method. The -607A allele, the-607AA and -607AC genotypes were associated with increased risk to develop chronic HBV infection (1.98, 5.11 and 3.5-fold risks, respectively). By contrast, the -137C minor allele and CG genotype had protected effects against chronic HBV infection. We found that -607A allele, -607AA and -607AC genotypes were significantly more frequent in patient's group with high HBV DNA levels compared to patient group with low HBV DNA level. Additionally, they were associated with increased 1.72, 6.04 and 3.28-fold risk of high HBV DNA replication. Patients carrying "-607A/-137 C" or "-607A/-137 G" haplotypes presented a high risk to develop chronic HBV infection (OR = 3.27; OR = 4.32, respectively)., Conclusions: Taken together, our data suggest that theIL-18 -607A/C functional polymorphism was associated with susceptibility to enhanced replicative form of HBV DNA in chronic infection., (Copyright © 2020. Published by Elsevier B.V.)

Background: Olive production is the main agricultural activity in Tunisia. The diversity of fungi was explored in two different olive groves located in two distant geographical zones in Sfax (Tunisia) with different management practices., Results: Fungal isolation was made from soil and the major olive tree pests, namely the Olive fly, Bactrocera oleae Gmelin (Diptera: Tephritidae), and the Olive psyllid, Euphyllura olivina Costa (Homoptera: Psyllidae). A total of 34 fungal isolates were identified according to their phenotypic, genotypic, biochemical and biological activities. Twenty fungal species were identified belonging to six different genera (Alternaria, Aspergillus, Cladosporium, Fusarium, Lecanicillium and Penicillium) by the analysis of their ITS1-5.8S-ITS2 ribosomal DNA region. Different bioassays performed in this work revealed that 25/34 (73.5%) of the identified fungal isolates showed an entomopathogenic and/or antagonistic activity, 9/34 (26.5%) of them displayed phytopathogenic features., Conclusions: Fungal species that showed entomopathogenic and/or antagonistic potentialities and that are non-phytopathogenic, (17/34; 50%) of our fungal isolates, could be explored for olive protection against fungal diseases and pests, and might have a future application as biocontrol agents.

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children., Competing Interests: The authors declare no competing interests., (Copyright: Ahmed Trabelsi et al.)

Phylogenetically diverse rhizobial strains endemic to Tunisia were isolated from symbiotic nodules of Lotus creticus, growing in different arid extremophile geographical regions of Tunisia, and speciated using multiloci-phylogenetic analysis as Neorhizobium huautlense (LCK33, LCK35, LCO42 and LCO49), Ensifer numidicus (LCD22, LCD25, LCK22 and LCK25), Ensifer meliloti (LCK8, LCK9 and LCK12) and Mesorhizobium camelthorni (LCD11, LCD13, LCD31 and LCD33). In addition, phylogenetic analyses revealed eight additional strains with previously undescribed chromosomal lineages within the genera Ensifer (LCF5, LCF6 and LCF8),Rhizobium (LCF11, LCF12 and LCF14) and Mesorhizobium (LCF16 and LCF19). Analysis using the nodC gene identified five symbiovar groups, four of which were already known. The remaining group composed of two strains (LCD11 and LCD33) represented a new symbiovar of Mesorhizobium camelthorni, which we propose designating as sv. hedysari. Interestingly, we report that soil properties drive and structure the symbiosis of L. creticus and its rhizobia., (© FEMS 2020.)

Galeazzi fracture is defined as the association of radius fracture and inferior radioulnar joint dislocation. Its diagnosis is often unrecognized initially. The purpose of our study is to determine the epidemioclinical features of Galeazzi fracture-dislocations in adults and to assess the functional and radiological outcomes of our case series. We conducted a retrospective descriptive study of 45 patients with Galeazzi fractures treated surgically whose data were collected in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia, over a period ranging from 2009 to 2018. We used Mestdagh score for the clinical evaluation of the results. The mean time between fracture and treatment initiation was 5.35 days. Fixation of the radius was performed using screwed plate in 39 cases and fixation of the radio-ulnar joint using a plug in 13 cases. The average time for union was 10.5 weeks. Outcomes were excellent in 35 patients, good in 3 patients, medium in 6 patients and adverse in a patient. We had 3 cases of sepsis at the level of the plug and two cases of malunions. Galeazzi fracture-dislocation is an under diagnosed disorder in some cases. Dynamic intraoperative examination after solid fixation of the radius can allow for good functional results., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (© Nizar Sahnoun et al.)

Background: Glaucoma is an optic neuropathy induced by many factors. Vascular dysfunction is involved in the mechanism underlying glaucoma., Aim: To determine the involvement of nitric oxide (NO), which is implicated in the regulation of ocular blood flow, in primary open angle glaucoma (POAG). Furthermore, lactate and uric acid (UA) levels were investigated., Methods: Concentrations of NO, UA and lactate in plasma and aqueous humor (AH) were measured in 214 Tunisian patients (100 patients with POAG and 114 subjects with cataract as control group). NO metabolites, nitrate and nitrite (NOx) production were determined using the Griess reaction. UA and lactate concentrations were measured using enzymatic- colorimetric methods., Results: NOx concentrations in patients with POAG were significantly lower compared to cataract group in plasma (5.23±1.55 µmol/L vs 18.35±6.87 µmol/L, p=0.01) and AH (20.54±7.41 µmol/L vs 45.25±10.92 µmol/L, p=0.02). Plasma and AH levels of lactate and UA were significantly higher in glaucoma patients than in control subjects., Conclusions: In the present study, decreased NO and increased UA and lactate levels were found in the AH and plasma of POAG patients compared to control subjects. These data suggest a possible involvement of these factors in glaucoma.

Introduction: The loss of correct relationships between the sesamoid and the first metatarsal is one of the architectural consequences of the hallux valgus (HV). The reduction of this dislocation by lateral soft tissue release (LSTR) is one of the objectives of surgery., Aim: To study the relationship between postoperative position of sesamoid and clinical outcome at one-year postoperative follow-up., Methods: It's a retrospective study including patients operated for evolved HV performed in la Rabta orthopedic department in Tunis. These patients had a Scarf osteotomy associated with at least one Weil osteotomy. The functional evaluation was based on the AOFAS score (American-orthopedic-foot-and-ankle-society). We classified the sesamoid position according to 3 scores: Hardy & Clapham , RCAOFAS and the Agrawal. We compared each score of the sesamoid position to the clinical outcome., Results: We collected 46 cases of HV in 45 patients. The mean AOFAS score increased from 60,9 to 85,5/100 postoperatively. Our patients were divided into 2 groups: group A whose result was excellent and group B whose result was good, fair and poor. The analytical study of this work concluded that there was no relationship between the postoperative sesamoid position and the clinical outcome, regardless of the radiological classification used (p=0,361, p=0,222, p=0,260)., Conclusion: Sesamoids that remain in postoperative dislocation are not necessarily predictive of a poor clinical outcome at one year of the surgical cure.

There is a major need for the identification of biomarkers, which are able to guide personalized therapy for bladder cancer, in particular after resection of the primary tumor. Specifically, miR-9 upregulation has been preliminarily associated with a more aggressive phenotype of bladder cancer, namely muscle-invasive bladder cancer (MIBC) or high-grade non-muscle-invasive bladder cancer (HG NMIBC). In order to explore the potential utility of miR-9 as a biomarker in bladder cancer, we have investigated its expression pattern in a sample of Tunisian patients who have undergone primary resection. This is a retrospective study performed on BCa samples from 90 patients (44 specimens of HG NMIBC, 23 specimens of LG NMIBC, and 23 specimens of MIBC). Ten samples from the non-tumoral zone of cystectomy specimens were used as controls. For each specimen, we measured miR-9 expression and correlated it with the clinical characteristics of the patients. Overall, miR-9 was overexpressed in MIBC compared to NMIBC specimens (median fold change [FC]: - 8.89 vs 1.41, p = 0.001). Similarly, miR-9 expression was significantly different in LG NMIBC, HG NMIBC and MIBC subgroups (median FC: 0.68, 2.14 and 8.89, respectively; p = 0.001). ROC analysis showed that miR-9 expression pattern could be used as potential biomarker for distinguishing NMIBC subgroups: indeed miR-9 expression is relatively low in LG NMIBC and high in HG NMIBC. The thresholds are estimated at 0.063 and 21.597, respectively. Moreover, miR-9 was associated with a higher risk of progression. This study suggests the clinical value of miR-9 as a prognostic factor in bladder cancer after tumor resection. Should the prognostic ability of miR-9 be confirmed in larger studies, also on different ethnic groups, it would be useful to investigate whether urine sampling-which is easier to perform, less invasive and less costly-can provide the same results as analysis on surgical specimens.

Background: This study was initiated to evaluate, for the first time, the performance and quality of the influenza-like illness (ILI) surveillance system in Tunisia., Methods: The evaluation covered the period of 2012-2015 and used different data sources to measure indicators related to data quality and completeness, representativeness, timeliness, simplicity, acceptability, flexibility, stability and utility., Results: During the evaluation period, 485.221 ILI cases were reported among 6.386.621 outpatients at 268 ILI sentinel sites. To conserve resources, cases were only enrolled and tested for influenza during times when the number of patients meeting the ILI case definition exceeded 7% (10% after 2014) of the total number of outpatients for the week. When this benchmark was met, five to 10 patients were enrolled and sampled by nasopharyngeal swabs the following week. In total, The National Influenza Center (NIC) received 2476 samples, of which 683 (27.6%) were positive for influenza. The greatest strength of the system was its representativeness and flexibility. The timeliness of the data and the acceptability of the surveillance system performed moderately well; however, the utility of the data and the stability and simplicity of the surveillance system need improvement. Overall, the performance of the Tunisian influenza surveillance system was evaluated as performing moderately well for situational awareness in the country and for collecting representative influenza virologic samples., Conclusions: The influenza surveillance system in Tunisia provided pertinent evidence for public health interventions related to influenza situational awareness. To better monitor influenza, we propose that ILI surveillance should be limited to sites that are currently performing well and the quality of data collected should be closely monitored and improved.

Aquatic wildlife is exposed through trophic transfer of hazardous substances to several threats inducing physiological impairments. We aimed at assessing the impact of contamination in one of the hot spots of pollution along Mediterranean coasts, the gulf of Gabes in Tunisia, on Common tern Sterna hirundo, a piscivorous top predator bird. Firstly, we compared the reproductive effort of breeding adults through clutch size distribution in three sites with different levels of pollution. Then, a battery of genotoxicity and oxidative stress biomarkers was carried out to assess physiological impairments in chicks. While defense mechanisms showed a depletion, lipid peroxidation and genotoxicity increased significantly according to pollution level. The multi-biomarker approach used here, discriminated chicks according to contamination degree of their nesting sites. Increases in genotoxicity and oxidative stress were correlated to a decrease in chick body mass known to lead to long-term impacts on juvenile survival and recruitment in birds., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Dromedary camels are natural host of the Middle East respiratory syndrome coronavirus (MERS-CoV). However, there are limited studies of MERS-CoV infection of other domestic mammals exposed to infected dromedaries. We expanded our surveillance among camels in Egypt, Tunisia, and Senegal to include other domestic mammalian species in contact with infected camels. A total of 820 sera and 823 nasal swabs from cattle, sheep, goats, donkeys, buffaloes, mules, and horses were collected. Swabs were tested using RT-PCR and virus RNA-positive samples were genetically sequenced and phylogenetically analysed. Sera were screened using virus microneutralization tests and positive sera (where available) were confirmed using plaque reduction neutralization tests (PRNT). We detected 90% PRNT confirmed MERS-CoV antibody in 35 (55.6%) of 63 sera from sheep collected from Senegal, two sheep (1.8%) of 114 in Tunisia and a goat (0.9%) of 107 in Egypt, with titres ranging from 1:80 to ≥1:320. We detected MERS-CoV RNA in swabs from three sheep (1.2%) of 254 and five goats (4.1%) of 121 from Egypt and Senegal, as well as one cow (1.9%) of 53 and three donkeys (7.1%) of 42 from Egypt. Partial sequences of the RT-PCR amplicons confirmed specificity of the results. This study showed that domestic livestock in contact with MERS-CoV infected camels may be at risk of infection. We recommend expanding current MERS-CoV surveillance in animals to include other livestock in close contact with dromedary camels. The segregation of camels from other livestock in farms and live animal markets may need to be considered.

Purpose : In this study, we investigated the association of two polymorphisms (rs869109213 and rs2070744) in the eNOS gene and one polymorphism Bgl II in the α 2 β 1 integrin gene ( ITGA2 ) with the risk of diabetic retinopathy (DR) in a Tunisian population. Methods : The study investigated of 110 type 2 diabetes mellitus (T2DM) and 127 DR patients. The genotypes of the eNOS 4b/4a (rs869109213) and -786T/C (rs2070744) polymorphisms and of the Bgl II polymorphism of ITGA2 were studied using the PCR or PCR-RFLP method. Results : The genotype distributions of the two polymorphisms in eNOS 4b4a and eNOS (-786T/C) were significantly different between T2DM and DR patients ( p < .004 and p = .033, respectively). These polymorphisms were associated with the risk of DR (OR = 2.65, 95%CI [1.45-4.84], p = .002) for the eNOS 4b4a genotype and (OR = 2.43, 95%CI [1.06 - 5.56], p = .036) for the CC genotype of the eNOS gene (-786T/C). Similarly, the genotype distribution of the Bgl II polymorphism was significantly different between the two groups studied ( p = .037). This polymorphism was associated with an increased risk of DR (OR = 4.03, 95% CI [1.17 - 7.85], p = .022) for Bgl II(+/+). Conclusion : The present study suggests that the polymorphisms 4b4a and -786T/C in the eNOS gene might be associated with DR. In addition, the Bgl II polymorphism in the ITGA2 gene was a risk factor for DR.

Penile cancer is a rare pathology in Tunisia where circumcision is a common practice. Squamous cell carcinoma accounts for 95% of cases. Treatment is essentially based on surgery. We conducted a retrospective study in order to highlight the epidemiological, clinical, therapeutic features as well as the evolutionary characteristics of 11 cases with primary penile cancer., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Introduction: Sanctioning evaluation in cardiology is carried out using multiple choice questions, short-answer questions, clinical cases and editorial questions. However, these methods do not assess clinical reasoning in a context of uncertainty in contrast with script concordance tests (SCT)., Aim: To compare the scores obtained by the students in the 3rd year of medicine with the SCT versus the sanctioning test of cardiology and to study the correlation between these two evaluation methods., Methods: This is a prospective study including 31 3rd year students who completed their cardiology clerckship in the Cardiology Department of the HabibThameur Hospital during the first half of 2016. We compared the scores obtained in the 13 SCT test (39 items) with those of the cardiology normative test., Results: Students 'mean score at SCT was significantly lower than that of experts (66.6 ± 10.2 vs 86 ± 6.7%, p <0.0001). The mean score obtained by students at the SCT was significantly higher than that of the cardiology sanctioning test (p <0.001). Cronbach alpha coefficient was 0.71. There was no correlation between the two tests (r = 0.329; p= 0.07)., Conclusion: The evaluation of our students by the SCT showed mean score statistically higher than the questions of a classic test, without correlation between them. This should encourage us to incorporate SCT into our assessment methods to promote clinical reasoning.

Novel chocolate spreads were enriched by soluble and insoluble dietary fibers from Tunisian Deglet Nour date seeds at 1, 2, 3, 4, and 5% levels in the conventional chocolate spread. Defatted Deglet Nour date seeds, date seed soluble fiber concentrate (DSSFC) and date seed insoluble fiber concentrate (DSIFC) were characterized by high levels of dietary fibers (80-90%). Chocolate spread enriched with 5% of DSSFC presented the highest oil binding capacity (304.62%) compared to the control (102%). Whatever the DSIFC and DSSFC incorporation levels, no significant difference was recorded between the firmness, chewiness, and adhesiveness of prepared chocolate spreads compared to the control (p < .05). Sensory evaluation revealed that all prepared chocolate spreads enriched by DSIFC and DSSFC were accepted by panelists. These results indicated the value of date seeds as new source of dietary fibers to develop chocolate spread and could also improve health benefits and functional properties., Paractical Application: Tunisia is considered to be one of the dates-producing countries. The mean annual yield of date fruits is about 200,000 tons. From this, around 20,000 tons of date seeds could be collected. This by-product of date processing industries could be regarded as an excellent source of dietary fiber with interesting technological functionality and many beneficial effects on human health. Then, date seeds could present a value addition by extraction and use of date seed fiber concentrate in chocolate spread formulation., (© 2016 Wiley Periodicals, Inc.)

Background: Violence against women in the marriage is now recognized as a violation of human rights and as a major problem of public health., Aim: The objectives of this study were to estimate the prevalence, specify the typology and to determine associated factors with violence against women in the marriage., Methods: It was a cross-sectional study carried on 197 married women recruited in family planning center of Monastir, by means of a questionnaire containing some sociodemographic characteristics of the consultant and her spouse and the Woman Abuse Screening Tool to estimate the violence in the marriage Results : The lifetime prevalence of violence against women in the marriage was 56.9%. The most common form of violence was psychological (56.9%), followed by economic violence (41.1%), physical violence (32%) and sexual violence (10.6%). The combination of at least two forms of violence was reported by 84% of victims. The precarious professional status of consultant and her spouse, spouse's alcoholism, the number of children upper for three were the main factors associated with violence in marriage., Conclusion: These results justify the implement of screening and support programs for women victims of violence in marriage.

Background: The spread of smoking among women in Tunisia has reached alarming proportions because of increasing smoker rate, the younger age of smoking initiation and therefore its duration., Aim: Identify predictors of success or failure of smoking cessation, Methods: we conducted a retrospective study (January 2008-June 2011), including 101 female smokers (19.8%) among 510 smokers of both sexes undergoing smoking cessation interventions. Univariate and multivariate analysis between groups of smokers who succeeded and who failed smoking cessation was performed., Results: Average age of our patients was 44 years. The overall success rate at 6 months and 1 year were respectively 24.7 and 18.8%. In univariate analysis, a statistically significant difference in terms of successful weaning was observed in smokers who had a late age of smoking onset (after 20 years) (p=0.03), respiratory or cardiovascular comorbidities associated (p=0.03) and good adhesion to the consultation (p=0.02). In multivariate analysis only the presence of a tobacco-related disease (OR: 4.43, 95% CI [1.29- 15.17], p=0.01) and adherence to the consultation (OR 5.02 95% CI [1.29 -19.39], p=0.01) were significantly associated with a good prognosis for successful weaning at 6 months and one year. A possible but not significantly associated with age of smoking initiation was observed (OR=0.3 95% CI [0.08-1.07], p=0.06)., Conclusion: Beyond validated smoking cessation and prolonged follow-up, a differential approach, taking into account women specificities, would increase the chances of quitting smoking.

Background: The prevalence related to alcohol use disorders in adults is 1.7%. It varies around the world. In Tunisia, as in most Arab and Muslim countries, alcohol consumption is still a taboo and little studied., Aims: To estimate the prevalence of alcohol abuse and dependence Band to assess associated socio-demographic factors in primary care patients in Sousse governorate., Method: It's a descriptive study carried out between June and November 2006. The sample included 30 primary care units in Sousse governorate, chosen by a stratified random method. We used the Composite International Diagnostic Interview (CIDI 2.1) translated and validated in Tunisian dialect., Results: Our sample included 2577 participants. The lifetime prevalence of alcohol abuse and during the last 12 months were 2.8% and 1%. Those of alcohol dependence were respectively 0.7% and 0.3%. Only one case of alcohol abuse was found among women and no cases of dependence have been noticed. For men's, the prevalence of alcohol abuse at the lifetime and during the last 12 months were 12.8 % and 4.5 %. For men's alcohol dependence, prevalence rates were 3% and 1.6 %. Associated factors with abuse or alcohol dependence were studied in men's sample (n=560). Alcohol abuse was more common after multivariate logistic regression in the age group betwen18 and 34 years and in those with a diploma. Alcohol dependence was associated with only high level of education., Conclusion: Our study provides further evidence that alcohol abuse and dependence in primary care remain low compared to other international studies and highlights the role of primary care physicians in the screening of these health problems especially among men.

In 2013 in Tunisia, 3 persons in 1 family were infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The index case-patient's respiratory tract samples were negative for MERS-CoV by reverse transcription PCR, but diagnosis was retrospectively confirmed by PCR of serum. Sequences clustered with those from Saudi Arabia and United Arab Emirates.

Glycosylation on the globular head of the hemagglutinin (HA) protein of influenza virus acts as an important target for recognition and destruction of virus by innate immune proteins of the collectin family. In the current study, we have characterized the dynamic amino acid changes at N-linked glycosylation sites of full length sequences of HA genes of 5 A/H3N2 Tunisian strains isolates from mild, severe, and fatal cases. Compared to the reference strain, A/Perth/16/2009 substitutions in potential N-glycosylation sites were observed in 5 HA genes at five different positions (45, 124, 128, 144, and 145) generating the losses and gains of N-linked glycosylation sites. Also the mutation N145S was presented in the receptor-binding site of all segments analyzed. Point mutations in several positions in the gene encoding the H3 of Tunisian strains were shown to ablate a glycan attachment site and also loss of a potential glycosylation site. The relation between these mutations and virulence of influenza A/H3N2 virus needed to be verified in the further experiments.

Aims: To establish FeNO norms for healthy Tunisian adults aged 18-60 years and to prospectively assess their reliability., Methods: This was a cross-sectional analytical study. A convenience sample of healthy Tunisian adults was recruited. Subjects responded to a medical questionnaire, and then FeNO levels were measured by an online method (Medisoft, Sorinnes (Dinant), Belgium). Clinical, anthropometric, and plethysmographic data were collected. All analyses were performed on natural logarithm values of FeNO., Results: 257 adults (145 males) were retained. The proposed reference equation to predict FeNO value is lnFeNO (ppb) = 3.47-0.56× height (m). After the predicted FeNO value for a given adult was computed, the upper limit of normal could be obtained by adding 0.60 ppb. The mean ± SD (minimum-maximum) of FeNO (ppb) for the total sample was 13.54 ± 4.87 (5.00-26.00). For Tunisian and Arab adults of any age and height, any FeNO value greater than 26.00 ppb may be considered abnormal. Finally, in an additional group of adults prospectively assessed, we found no adult with a FeNO higher than 26.00 ppb., Conclusion: The present FeNO norms enrich the global repository of FeNO norms that the clinician can use to choose the most appropriate norms.

Background: The data contribute to a better understanding of the circulation of influenza viruses especially in North-Africa., Objective: The objective of this surveillance was to detect severe influenza cases, identify their epidemiological and virological characteristics and assess their impact on the healthcare system., Method: We describe in this report the findings of laboratory-based surveillance of human cases of influenza virus and other respiratory viruses' infection during three seasons in Tunisia., Results: The 2008-09 winter influenza season is underway in Tunisia, with co-circulation of influenza A/H3N2 (56.25%), influenza A(H1N1) (32.5%), and a few sporadic influenza B viruses (11.25%). In 2010-11 season the circulating strains are predominantly the 2009 pandemic influenza A(H1N1)pdm09 (70%) and influenza B viruses (22%). And sporadic viruses were sub-typed as A/H3N2 and unsubtyped influenza A, 5% and 3%, respectively. Unlike other countries, highest prevalence of influenza B virus Yamagata-like lineage has been reported in Tunisia (76%) localised into the clade B/Bangladesh/3333/2007. In the pandemic year, influenza A(H1N1)pdm09 predominated over other influenza viruses (95%). Amino acid changes D222G and D222E were detected in the HA gene of A(H1N1)pdm09 virus in two severe cases, one fatal case and one mild case out of 50 influenza A(H1N1)pdm09 viruses studied. The most frequently reported respiratory virus other than influenza in three seasons was RSV (45.29%)., Conclusion: This article summarises the surveillance and epidemiology of influenza viruses and other respiratory viruses, showing how rapid improvements in influenza surveillance were feasible by connecting the existing structure in the health care system for patient records to electronic surveillance system for reporting ILI cases.

We present major results concerning isolation and determination of the nucleotide sequence of hemagglutinin (HA1) of the pandemic (H1N1)pdm09 influenza viruses found in Tunisia. Amino acid analysis revealed minor amino acid changes in the antigenic or receptor-binding domains. We found mutations that were also present in 1918 pandemic virus, which includes S183P in 4 and S185T mutation in 19 of 27 viruses analyzed from 2011, while none of the 2009 viruses carried these mutations. Also two specific amino acid differences into N-glycosylation sites (N288T and N276H) were detected. The phylogenetic analysis revealed that the majority of the Tunisian isolates clustered with clade A/St. Petersburg/27/2011 viruses characterized by D97N and S185T mutations. However it also reveals a trend of 2010 strains to accumulate amino acid variation and form new phylogenetic clade with three specific amino acid substitutions: V47I, E172K and K308E.

Hearing loss is a common congenital anomaly with an incidence of 1 in 1000 live births. It has been described together with several other clinical features as fortuitous association or commune genetic syndrome. In this study, we investigated a consanguineous Tunisian family with moderate to profound congenital hearing loss, mental retardation and autistic behaviors. We performed a genome wide microarray analysis study using approximately 300,000 SNPs in a common set of 7 invidious of this family. We identified regions of suggestive linkage with hearing loss on chromosomes 6p12 and 7q34. In addition, we identified a deletion on chromosome 8p in the two autistic individuals. This report presents an illustration of how consanguinity could increase familial clustering of multiple hereditary diseases within the same family. The application of next generation sequencing for this family seems to be a good strategy for further analysis leading to the identification of candidate genes., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Recently, the D222G substitution was observed in the HA of pandemic (H1N1) 2009 viruses isolated from fatal cases in several countries. We made a similar observation in one fatal case in Tunisia showing a D222G substitution in a virus isolate. The man was 47 years old and had no other subjacent pathologies or any known risk factors. He died after three days, suffering from severe respiratory symptoms of flu. The causal link of the D222G substitution in Tunisia with virulence must be verified. Further study is warranted to elucidate the intriguing relationship between the D222G substitution and severe disease. Constant molecular surveillance is important to monitor the pathogenicity of circulating strains and evaluate vaccine efficacy.

The chemical composition of the essential oils of five populations of Hypericum triquetrifolium Turra from Tunisia and their intraspecific variability were analyzed in detail by GC/MS. One hundred seventy-four compounds were identified, representing averages of 87.9 to 98.7% of the oil composition. The components are represented here by homologous series of monoterpene hydrocarbons, oxygenated monoterpenes, sesquiterpenes hydrocarbons, oxygenated sesquiterpenes, non-terpenic hydrocarbons, and others. Sesquiterpene hydrocarbons were the most abundant chemical compounds. Multivariate chemometric techniques, such as cluster analysis (CA) and principal-component analysis (PCA), were used to characterize the samples according to the geographical origin. By statistical analysis, the analyzed populations were classified into four chemotype groups., (Copyright © 2012 Verlag Helvetica Chimica Acta AG, Zürich.)

Background: Increasing consumer demand for healthier food products has led to the development of governmental policies regarding health claims in many developed countries. In this context, contamination of poultry by food-borne pathogens is considered one of the major problems facing the progress of the poultry industry in Tunisia., Result: Zeolite (Clinoptilolites) was added to chicken feed at concentrations 0,5% or 1% and was evaluated for its effectiveness to reduce total flora in chickens and its effects on performance of the production. The broilers were given free and continuous access to a nutritionally non-limiting diet (in meal form)that was either a basal diet or a' zeolite diet' (the basal diet supplemented with clinoptilolite at a level of 0,5% or 1%). It was found that adding zeolite in the broiler diet significantly (p < 0,05) reduced total flora levels, as compared to the control, on the chicken body. In addition, it was found that zeolite treatment had a positive effect on performance production and organoleptic parameters that were measured and mainly on the increase level of Omega 3 fatty acid., Conclusion: This study showed the significance of using zeolite, as a feed additive for broilers, as part of a comprehensive program to control total flora at the broiler farm and to increase level of Omega 3 fatty acid on the chicken body.

A study was undertaken between November 2008 and March 2010, in the focus of cutaneous leishmaniasis of Central Tunisia, to evaluate the role of Psammomys obesus (n=472) and Meriones shawi (n=167) as reservoir hosts for Leishmania major infection. Prevalence of L. major infection was 7% versus 5% for culture (p=not signifiant [NS]), 19% versus 16% for direct examination of smears (p=NS), and 20% versus 33% (p=NS) for Indirect Fluorescent Antibody Test among P. obesus and M. shawi, respectively. The peak of this infection was in winter and autumn and increased steadily with age for the both species of rodents. The clinical examination showed that depilation, hyper-pigmentation, ignition, and severe edema of the higher edge of the ears were the most frequent signs observed in the study sample (all signs combined: 47% for P. obesus versus 43% for M. shawi; p=NS). However, the lesions were bilateral and seem to be more destructive among M. shawi compared with P. obesus. Asymptomatic infection was ~40% for both rodents. This study demonstrated that M. shawi plays an important role in the transmission and the emergence of Leishmania major cutaneous leishmaniasis in Tunisia.

Investigating the prevalence of anti-influenza A viruses (AIV) antibodies in wild birds can provide important information for the understanding of bird exposure to AIV, as well as for prevention purposes. We investigated AIV exposure in nature by measuring the prevalence of anti-AIV antibodies in the nests and adults of an abundant and anthropophilic waterbird species common around the Mediterranean sea, the yellow-legged gull (Larus michahellis). Sampling took place in two colonies located in the gulf of Gabès in southern Tunisia: Sfax and Djerba. Antibodies were detected in the two sites, with higher prevalence in adults, eggs, and nests at Sfax than Djerba. Across both colonies, clutches that were laid later in the season, and, thus, more likely by younger parents, showed lower prevalence. Using patch occupancy modeling applied to egg clutches, we found that it is unnecessary to sample all the eggs in a given nest; nest status (antibody positive or negative) can be reliably estimated from a single egg. Differences in the density of birds, notably Larids, between the two sites may explain the observed differences in prevalence. The higher concentration of Larids in the Sfax colony could favor the transmission of AIV to yellow-legged gulls. This study highlights the importance of further developing ecological-based approaches to the factors determining the circulation of infectious agents in species such as the yellow-legged gull, which exist at the interface between diverse biological communities and human activities.

Leukemia is a type of cancer of the blood or bone marrow that is characterized by an abnormal increase of white blood cells. Leukemia is clinically and pathologically subdivided into a variety of large groups. The risk of developing leukemia may be influenced by polymorphisms of xenobiotic metabolizing enzymes. In this work, we conduct a case-control study to assess the impact of polymorphisms in GSTM1, GSTT1 and NAT2 genes on the risk of developing leukemia. Our data have shown that GSTM1*0 and GSTT1*0 were respectively associated with 2.05 and 4.36 increased risk for acute lymphoblastic leukemia (ALL). We have also shown that GSTM1*0 and GSTT1*0 act additively to increase the risk for ALL. Indeed, patients harbouring the "GSTM1*0/GSTT1*0" genotype were at 11.81-fold increased risk for developing ALL (P = 2 10(-5)). The risk for developing acute myeloid leukemia (AML) increases on patients with "rapid or intermediate NAT2 genotypes". Finally, the comparison of leukemia subgroups according to GSTM1, GSTT1 and NAT2 genotypes, suggests that leukemogenesis of different leukemia subgroups is very distinct. In conclusion, our findings suggest that leukemogenesis is associated with carcinogen metabolism and consequently related to environmental exposures.

Zoonotic cutaneous leishmaniasis, caused by Leishmania major (L. major), is endemic in Tunisia. Several rodents have been identified as reservoir hosts of parasites. This study reports, for the first time, the natural infection with L. major zymodeme MON-25 in a specimen of least weasel: Mustela nivalis Linnaeus, 1776 (M. nivalis) collected in Sidi Bouzid. This finding justifies further research on larger samples of this animal to verify its role as a potential reservoir host for cutaneous leishmaniasis in Tunisia.

Otosclerosis is a condition characterized by an abnormal bone metabolism in the otic capsule, resulting in conductive and/or sensorineural hearing loss. Otosclerosis is a common disorder in which genes play an important role. Case-control association studies have implicated several genes in the abnormal bone metabolism associated with otosclerosis: COL1A1, TGFB1, BMP2, and BMP4. To investigate the association of these genes with otosclerosis in the Tunisian population, we examined nine single nucleotide polymorphisms (SNPs) in 159 unrelated otosclerosis patients and 155 unrelated controls. We found an association of rs11327935 in COL1A1 with otosclerosis that was shown to be sex specific. The coding polymorphism T263I in TGFB1 was also associated with otosclerosis in the Tunisian population. The effect sizes of both the associations were consistent with previous studies, as the same effect was found in all cases. The association of BMP2 and BMP4 was not significant. However, a trend towards association was found for the BMP4 gene that was consistent with earlier reports. In conclusion, this study replicates and strengthens the evidence for association between polymorphisms of COL1A1 and TGFB1 in the genetic aetiology of otosclerosis., (© 2011 The Authors Annals of Human Genetics © 2011 Blackwell Publishing Ltd/University College London.)

Background: Amyloid deposition in the brain is an early event in Alzheimer's disease (AD), but a dysfunction of the blood-brain barrier or a disturbance in the metabolism of folate and homocysteine (Hcy) may affect the development of dementia. We investigated if the concentrations of folate and Hcy would be modified in cerebrospinal fluid (CSF) of clinically diagnosed AD patients., Methods: We included 70 AD patients, 33 patients with another type of dementia (nAD) and 30 age-matched control subjects. Plasma Hcy was assayed as well as Hcy, folate, Aβ1-42 and T-tau in CSF. We used ANOVAs for comparison between groups, and then pairwise comparisons by Wilcoxon tests with Bonferroni-corrected p values. Correlations were tested with the Spearman's rank test., Results: Levels of Aβ1-42, T-tau and folates in CSF were significantly different between groups, but not Hcy. In addition, the average folate in CSF was lower in AD patients compared with controls (18.7 ± 2.4 vs. 20.3 ± 1.7 nmol/l, Bonferroni-corrected p value < 0.02). There was no correlation between Aβ1-42 or T-tau and folate or Hcy in CSF, regardless of the group. In the AD group, there was a significant inverse correlation between Hcy and folate in CSF (ρ = -0.63, p < 0.0001), whereas in the nAD group, a significant correlation was found for Hcy between plasma and CSF (ρ = 0.59, p < 0.0005)., Conclusion: The concentration of folate in CSF was found to be decreased in AD patients. These findings support the hypothesis of a possible role of folate in the onset or worsening of AD., (Copyright © 2011 S. Karger AG, Basel.)

Recent evidences indicate that polymorphisms within the promoter region of the vascular endothelial growth factor (VEGF) gene may elevate the risk for Alzheimer's disease (AD). To further investigate, we have analyzed association between promoter polymorphisms of the VEGF gene in 93 AD patients and age and sex matched 113 controls from Tunisian population. The distribution of genotype and allele frequencies of the VEGF (-2578C/A) and (-1154G/A) polymorphisms did not differ significantly between AD and control groups (p>0.05). In the subgroup of ApoE varepsilon4 carriers, the -2578A was observed to be significantly higher in the AD patients than in the control individuals. After adjusting the data by gender, age and the ApoE varepsilon4 status using logistic regression, the -2578A allele was found to increase the risk for sporadic AD by 1.7-fold. The present study provides the evidence that the -2578A allele may be associated with the development of AD in the individuals with ApoE varepsilon4 allele. In addition, AD patients carrying the -2578A allele had lower Abeta42 (p=0.029) levels than those without this allele, particularly in subjects with ApoE varepsilon4 allele., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)