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Forest species are characterized by their wealth of essential oils (EOs), which play key requested for alternative control methods against weeds, fungi and pests. This study reports the chemical composition and highlight the antioxidant, antifungal and phytotoxic properties of the EOs obtained from Eucalyptus populifolia Desf, Eucalyptus woollsiana and Eucalyptus exserta. The EOs were analyzed by gas chromatography coupled to mass spectrometry (GC/MS). Their antioxidant, antifungal and phytotoxic properties were investigated. All EOs displayed a specific richness in eucalyptol (75.94-7.01%), camphene (6.97-0.4%) globulol (5.20-5.83%) and α-pinene (0.71-12.82 %). EOs isolated from E. populifolia exhibited significant antioxidant activity. Furthermore, all investigated EOs displayed significant antifungal properties against four phytopathogenic fungi belonging to Fusarium genus. The phytotoxic activity against five weeds showed varying effectiveness on seed germination and seedling growth, which exhibited greater effectiveness compared to glyphosate. Eucalyptus EOs have the potential to be used in the formulation of biopesticides. [ABSTRACT FROM AUTHOR]

The JN.1 sub-variant is a new variant of the SARS-CoV-2 Omicron strain, derived from the BA.2.86 sub-variant. It was first detected in late 2023 and has quickly spread to many countries, becoming the most prevalent variant in some regions. JN.1 exhibits a unique mutation (L455S) in the spike protein compared to the BA.2.86 lineage, which may affect its transmissibility and immune evasion capabilities. JN.1 has been designated as a "variant of interest" by the World Health Organization due to its rapidly increasing spread and is being closely monitored for its impact on the COVID-19 pandemic. This study describes the emergence of SARS-CoV-2 JN.1 sub-variant in Tunisia, and reports its mutation profiles. Nasopharyngeal samples collected over a four-month period (October 2023 to January 2024) were subjected to RNA extraction and real-time RT-PCR confirmation of SARS-CoV-2 infection. The whole-genome sequencing was performed by an iSeq 100 sequencer and COVIDSeq kit reagents (Illumina, USA). Mutation analysis, using the NextClade platform and GISAID database, revealed the presence of JN.1 in 15 out of 80 positive cases (18.75%) during the study period. The emergence of JN.1 highlights the ongoing evolution of SARS-CoV-2 and the need for continued surveillance and research to better understand the characteristics and impact of emerging variants. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI). Methods: This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI. Results: A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI. Conclusion: Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients. [ABSTRACT FROM AUTHOR]

Background: Pediatric musculoskeletal disorders account for 10% of first-line consultations in Tunisia. Referral delay and deficiencies in musculoskeletal screening raise a challenge to the early diagnosis and management of rheumatic conditions in children. The pGALS (Pediatric Gait Arms Legs Spine) was developed and translated into many languages to overcome these deficiencies. Our study aimed to adapt and validate pGALS to the Tunisian dialect for school-age children. Methods: Using the Delphi method, we carried out a cross-cultural adaptation of the pGALS to the Tunisian dialect. This consensual version was validated in a cross-sectional study, in two pediatric centers. Results: Ninety-two patients were enrolled, 43 females (46.7%) and 49 males (53.3%), mean age was 9.4 ± 2.6 years. The mean test duration was 3.4 ± 2.3 min, and the acceptability and comprehension of the test were good. Six patients had a musculoskeletal complaint, 19 had positive pGALS, and 14 were diagnosed with musculoskeletal disease. The internal consistency score (Cronbach's α) was 0.852. The sensitivity of the test was 92.8%, the specificity was 92.3%, the positive likelihood ratio was 2.16, and the negative likelihood ratio was 0.01. Conclusion: The pGALS test adapted to the Tunisian dialect is a relevant, quick, and valid tool for screening musculoskeletal abnormalities in school-age children. [ABSTRACT FROM AUTHOR]

Introduction: Nephronophthisis (NPHP) is a tubulointerstitial kidney disorder with an autosomal recessive inheritance pattern. Its genetic heterogeneity contributes to phenotype variability. The most frequent etiology of juvenile nephronophthisis is a mutation in the nephronophthisis type 1 (NPHP1) gene. This study aimed to evaluate the genotype-phenotype correlation in NPHP1 gene mutation. Methods: A multicenter retrospective study was performed over 20 years from 1998 to 2018 to describe the clinical, biological, and radiological features associated with the large deletion NPHP1 gene in 32 patients. Results: The incidence of NPHP1 was 1.6/204041. Eighty-one percent of our patients were born out of consanguineous marriages. The mean age at diagnosis was 14 ± 7 years. The patients were divided into three groups: isolated nephronophthisis (72%), syndromic nephronophthisis (19%), and patients without recognizable syndrome (9%). Intrafamilial and geographical variability was observed in syndrome diagnoses and in age at the onset of CKD stage 5. Genotype frequency varied between 50% and 100% in genealogical data. Juvenile (47%), adolescent (37%), and adult (13%) clinical forms have been distinguished by the onset of CKD stage 5. The five-year survival rate of renal transplantation was 80%. Conclusion: Given the broad clinical spectrum of NPHP1 associated with the large deletion of the NPHP1 gene, no genotype-phenotype correlation could be established. [ABSTRACT FROM AUTHOR]

Extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae have emerged as important nosocomial pathogens. Community infections by these organisms have been also reported and were associated with previous intestinal colonization. We aimed to characterize cefotaxime‐resistant Enterobacteriaceae (CTX‐R‐En) isolated from hospitalized children in a Tunisian paediatric ward. Seventy CTX‐R‐En isolates were collected from 227 rectal swabs from hospitalized children in a paediatric ward. Antimicrobial susceptibility testing was determined according to the EUCAST guidelines. Isolates were characterized by polymerase chain reaction (PCR, genes encoding: ESBLs, pAmpC, carbapenemases, plasmid‐mediated quinolone resistance, virulence factors in Escherichia coli and Klebsiella pneumoniae isolates, occurrence of classes 1 and 2 integrons, phylogenetic groups of E. coli isolates, ERIC‐PCR and PCR‐based replicon typing) and conjugal transfer experiments. In total, 65 out of 227 (28·6%) hospitalized children were colonized with CTX‐M‐R‐En, and 70 isolates were identified. Isolates were 59 ESBL‐, 7 plasmidic‐AmpC (pAmpC)‐, 3 ESBL+pAmpC‐, and one ESBL+carbapenemase producers. The following bla genes were identified: blaCTX‐M‐15 (n = 54), blaCTX‐M‐1 (n = 5), blaCTX‐M‐9 (n = 2), blaCTX‐M‐13 (n = 1) and blaCTX‐M‐14 (n = 1), blaCMY‐2 (n = 5), blaCMY‐4 (n = 4), blaACC‐1 (n = 1) and blaOXA‐48 (n = 1). Our results showed that hospitalized children were colonized with various CTX‐R‐En‐producing several beta‐lactamase enzymes. [ABSTRACT FROM AUTHOR]

Background: Actually, no data on the prevalence of plasmid colistin resistance in Tunisia are available among clinical bacteria. Objectives: This study aimed to investigate the current epidemiology of colistin resistance and the spread of the mcr gene in clinical Gram-negative bacteria (GNB) isolated from six Tunisian university hospitals. Methods: A total of 836 GNB strains were inoculated on COL-R agar plates with selective screening agar for the isolation of GNB resistant to colistin. For the selected isolates, mcr genes, beta-lactamases associated-resistance genes and molecular characterisation were screened by PCRs and sequencing. Results: Colistin-resistance was detected in 5.02% (42/836) of the isolates and colistin-resistant isolates harboured an ESBL (blaCTX-M-15) and/or a carbapenemase (blaOXA-48, blaVIM) encoding gene in 45.2% of the cases. The mcr-1 gene was detected in four E. coli isolates (0.59%) causing urinary tract infections and all these isolates also contained the blaTEM-1 gene. The blaCTX-M-15 gene was detected in three isolates that also carried the IncY and IncFIB replicons. The genetic environment surrounding the mcr-carrying plasmid indicated the presence of pap-2 gene upstream mcr-1 resistance marker with unusual missing of ISApl1 insertion sequence. The Conclusions: This study reports the first description of the mcr-1 gene among clinical E. coli isolates in Tunisia and provides an incentive to conduct routine colistin susceptibility testing in GNB clinical isolates. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe clinical and imaging features of atlantoaxial subluxation (AAS) and the associated risk factors in patients with rheumatoid arthritis (RA). Methods: We conducted a retrospective and comparative study including 51 RA patients with AAS and 51 RA patients without AAS. Atlantoaxial subluxation was defined by the presence of an anterior C1C2 diastasis on the cervical spine radiograph in hyperflexion and/or an anterior, posterior, lateral or rotatory C1C2 dislocation on MRI with/without inflammatory signal. Results: In G1, clinical presentations revealing AAS were mainly neck pain (68.7%) and neck stiffness (29.8%). MRI revealed: diastasis C1C2 (92.5%), periodontoid pannus (92.5%), odontoid erosion (23.5%), vertical subluxation (9.8%) and spinal cord involvement (7.8%). A collar immobilisation and corticosteroid boluses were indicated in 86.3% and 47.1% of cases. C1‐C2arthrodesis was performed in 15.4% of cases. Atlantoaxial subluxation was significantly associated with: age at disease onset (p = 0.009), history of joint surgery (p = 0.012), disease duration (p = 0.001), rheumatoid factor (p = 0.01), anti‐cyclic citrullinated peptide (p = 0.02), erosive radiographic status (p < 0.005), coxitis (p < 0.001), osteoporosis (p = 0.012), extra‐articular manifestations (p < 0.001), and high disease activity (p = 0.001). Multivariate analysis identified RA duration (p < 0.001, OR = 1.022 CI[1.01–1.034]) and erosive radiographic status (p = 0.01, OR = 21.236 CI[2.05–219.44]) as predictive factors of AAS. Conclusion: Our study showed that longer disease duration and joint destruction are the major predictive factors of AAS. Early treatment initiation, tight‐control and regular monitoring of cervical spine involvement are required in these patients. [ABSTRACT FROM AUTHOR]

aimi,2 Nouha Trad,2 Yousra Hammi,1 Myriam Ayari,2 Shema Ayadi,2 Taha Sayari,1 Tahar Gargah11Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia; 2Department of Gastroenterology, Charles Nicolle Hospital, Tunis, TunisiaCorrespondence: Nouha Trad, Department of Gastroenterology, Charles Nicolle Hospital, Boulevard of April 9, 1938, Bab Saadoun, Tunis, 1007, Tunisia, Tel +216 50858104, Email [email protected] Background: Nephrotic syndrome (NS) is associated with a hypercoagulable state and may be complicated by thrombotic events. Venous thrombosis is well-acknowledged, while arterial thrombosis is rather unusual.Case Presentation: We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.Conclusion: Mesenteric arterial thrombosis, which is a rare but life-threatening NS complication, should always be considered, especially in the case of acute non-specific digestive symptoms. [ABSTRACT FROM AUTHOR]

Background: Since 2012, few reports on the molecular epidemiology of Pseudomonas aeruginosa were reported in Tunisia. Objectives: This study aimed to evaluate carbapenem-resistance determinants and molecular epidemiology and to compare the carbapenemase-phenotypic detection methods of multidrug-resistant P. aeruginosa isolates. Methods: During a period of four years (2014 to 2017), all imipenem-ceftazidime-resistant P. aeruginosa isolates were retrospectively selected at the microbial laboratory of Charles Nicolle hospital of Tunis. These isolates were examined by the modified Hodge test, modified carbapenem inactivation method (mCIM), and another mCIM, called CIMTris, and their performance was evaluated using PCR analysis as the gold standard. Results: A total of 35 isolates were recovered among patients hospitalized in different units. All strains were colistin-susceptible.All carbapenem-resistant isolates showed a high-level resistance to carbapenems. CIMTris and mCIM showed 96.15% and 46.15% sensitivity and 44.44% and 100% specificity, respectively, for detecting carbapenemase production.Conclusions: CIMTris is a promising approach for detecting carbapenemase activity in P. aeruginosa and merits further testing. Moreover, this study described the first detection of GES-5- and GES-9-producing P. aeruginosa in Tunisia as well as the co-occurrence of the blaGES-5 and blaVIM-11 carbapenemase genes in one isolate. These findings are of great concern because the rapid dissemination of MDR strains represents a major therapeutic and epidemiological threat. [ABSTRACT FROM AUTHOR]

As elevated levels of the soluble CXCL16 (sCXCL16) chemokine have been reported in severe coronavirus disease 2019 (COVID‐19) patients, this study examined whether sCXCL16 concentration on the first day of hospitalization predicted death in COVID‐19 patients. A total of 76 patients with COVID‐19 were admitted to the Military Hospital of Tunis, Tunisia, between October 2020 and April 2021, and later classified as survivors or nonsurvivors based on their outcomes. At admission, the groups were matched by age, gender, comorbidities, and the percentage of patients with moderate conditions. On the first day of admission, serum's sCXCL16 concentrations were measured using a magnetic‐bead assay. There was an eightfold increase in serum sCXCL16 levels in the nonsurvivors' group (3661.51 ± 2464.87 pg/mL vs. 454.3 ± 338.07 pg/mL, p < 0.0001). For the optimal cutoff value of sCXCL16 at 2095 pg/mL, we found a 94.6% sensitivity and a 97.4% specificity, with an area under curve of 0.981 (p = 5.03E−08; 95% confidence interval [95% CI]: 0.951–1.0114). Considering the risk of death at a concentration above the threshold, the unadjusted odds ratio was 36 (p < 0.0001). The adjusted odd ratio was estimated at 1.003 (p < 0.0001; 95% CI: 1.002–1.004). Finally, there was a significant difference between survival and nonsurvival groups in leukocyte numbers (p = 0.006), lymphocytes (p = 0.001), polymorphonuclear neutrophils (p = 0.001), and C‐reactive protein levels (p = 0.007), except for monocytes (p = 0.881). Based on these results, sCXCL16 level could be used for detecting nonsurvival COVID‐19 patients. Therefore, we recommend assessing this marker in hospitalized COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The SARS CoV-2 pandemic is a global health threat with high morbidity and mortality (1 to 4%) rates. COVID-19 is correlated with important immune disorders, including a "cytokine storm". A new therapeutic approach using the immunomodulatory drug, Anti-IL6 (tocilizimub), has been proposed to regulate it. We report here the first Tunisian experience using tocilizimub in two severe cases of COVID-19 pneumonia. The diagnosis was confirmed by chest scan tomography. Biological parameters showed a high level of Interleukin-6 (IL-6) that increased significantly during hospitalization. The patients developed hypoxia, so they received intravenously 8 mg/kg body weight tocilizumab. There was a resultant decrease in the level of IL6, with clinically good evolution. Blocking the cytokine IL-6 axis is a promising therapy for patients developing COVID-19 pathology. [ABSTRACT FROM AUTHOR]

Background: Multidrug-resistant Klebsiella pneumoniae spp. (kp) are emerging agents of severe infections of the respiratory, urinary tract and wounds that can progress to fatal septicemia. The use of bacteriophages is currently being considered as an effective alternative or adjuvant to antibiotic therapy. Results: In this study, we report capsule (K)-typing of 163 carbapenem-resistant Kp (CRKP) isolated 2014–2018 at the Military Hospital of Instruction of Tunis (MHT), Tunisia, by partial amplification and sequencing of the Kp wzi gene. The most prevalent K-type overall was K64 with 50.3% followed by K17 and K27 (22.7 and 11.0%, respectively). K64 Kp strains were most common and associated with increased case/fatality rates, especially at the intensive care unit (ICU). Using a K64 Kp strain we isolated and characterized a lytic Kp phage, vB_KpP_TUN1 (phage TUN1), from wastewater samples of the ICU at the MHT. TUN1 belongs to the Autographiviridae family and specifically digests K64 Kp capsules most probably via a depolymerase encoded by gp47. Furthermore, we successfully assembled phage TUN1 in a non-replicative host (E. coli) raising the possibility of in vitro assembly in the absence of live bacterial hosts. We propose that phage TUN1 is a promising candidate to be used as an adjuvant or an alternative to antibiotic therapy in CRKP infections, facilitating regulatory approval of phage therapy. Conclusions: K64, K17 and K27 are the most common wzi capsule types in this geographical location in Northern Africa. The lytic phage TUN1 efficiently lyses K64 Kp strains associated with increased case/fatality rates at body temperature. Together with its ability to be rescued in a non-replicative host these features enhance the utility of this phage as an antibacterial agent. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 epidemic began in Tunisia in March 2020; health-care workers (HCWs) were suddenly confronted with a particularly stressful situation. The aim of this study was to assess the psychological responses of HCWs during the epidemic, determine the stressors and identify ways to cope. Methods: This cross-sectional study used an online questionnaire that included 62 questions. ANOVAs and t -tests were used to compare the responses between professional groups, age groups, and genders. Results: Questionnaires were completed by 368 HCWs. HCWs believed they had a social and professional obligation to continue working long hours (95.3%). They were anxious regarding their safety (93.7%) and the safety of their families (97.8%). Youthful age (p = 0.044) and female gender (p s <0.046) were identified as stressors. The availability of personal protective equipment (PPE; 99.7%) and good communication between colleagues (98.1%) and managers (91.6%) were important protective factors. Family and friend support (95.9%), following strict protective measures (99.4%), knowing more about COVID-19 (94.8%), adopting a positive attitude (89.6%), and engaging in leisure activities (96.1%) helped in dealing with this epidemic. Conclusion: This study highlights the importance of providing HCWs with infection control guidelines and adequate PPE. Communication and support within the team and maintaining family support help in coping with this stressful situation. [ABSTRACT FROM AUTHOR]

Copyright of Sultan Qaboos University Medical Journal is the property of Sultan Qaboos University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this study, the characterization of the Fahs aquifer system (northeastern Tunisia) was achieved using data from 13 water boreholes, 70 vertical electrical soundings (VES) and a Landsat TM image. Available lithological columns and their corresponding well logs were compared to define precisely the Quaternary water reservoirs. Qualitative and quantitative interpretations of VES data were carried out to reconstitute the geometry of these reservoirs. They were supported by satellite imagery processing, which allowed identification of superficial lineaments affecting the Fahs plain. The restitution of lithological columns using well logs revealed that the Quaternary series contains three lithological units: two clayey units separated by a gravel and sand unit encompassing some clayey intercalations that increase northward (toward the oued El Kebir downstream). Moreover, it was recognized that, in the southern part of the plain at 22–128 m depth, the substratum of the Quaternary series consists of Cretaceous marls and limestones. This zone, which exhibits high apparent resistivities (45–100 Ω m) for different AB spacings, appears to be rich in reservoirs. The correlation between the restored lithological columns and the interpreted VES, in the form of geo-electrical cross sections, revealed variations in depth (8–50 m), thickness (14 to > 80 m) and resistivity (12–35 Ω m) of the coarse unit corresponding to the Fahs aquifer. Seven discontinuities were discerned from these sections, whereas 16 superficial lineaments were determined from the Landsat image. Their joint superposition showed that five of them coincided perfectly; they may correspond to normal faults generating an aquifer system compartmentalized in raised and sunken blocks. [ABSTRACT FROM AUTHOR]

Background: Several studies have suggested that polymorphisms within genes encoding T‐lymphocyte immune regulating molecules: CD28, CTLA‐4, and ICOS, may alter the signaling process and subsequently could be involved in susceptibility to a broad spectrum of autoimmune diseases. Methods: This study aimed to replicate associations between common polymorphisms in the 2q33.2 cluster and susceptibility to pemphigus foliaceus (PF) in the Tunisian population. We investigated seven polymorphisms: rs3116496 and rs1879877 (CD28), rs231775, rs3087243, and (AT)n repeat (CTLA4); rs11889031 and rs10932029 (ICOS) in a case–control study which enrolled 106 Tunisian PF patients and 205 matched healthy controls. Results: We confirmed the associations with CTLA4((AT)13, p = 0.00137, OR = 3.96 and (AT)20, p = 0.008, OR = 5.22; respectively) and ICOS genes (rs10932029>CT, p = 0.034, OR = 2.12 and rs10932029>TT, p = 0.04 and OR = 0.41). Conclusion: Our results indicate that susceptibility to PF is located in the proximal and the distal 3′ flanking region of the CTLA4/ICOS promoter. These findings may open avenues to the treatment of patients with biological drugs targeting CTLA4/ICOS molecules, in a personalized manner to achieve more effective treatment. [ABSTRACT FROM AUTHOR]

This study presents a range of approaches to achieve enhanced characterization of the Zaghouan aquifer system (northeastern Tunisia). Existing water borehole data were analyzed to identify the different reservoir formations, while satellite imagery is analyzed to determinate the superficial lineaments affecting these formations. To define the deep structures determining the geometry of the Zaghouan aquifer system, lithostratigraphic correlations were constructed and analyzed supported by both quantitative and qualitative assessment of gravity measurements. The available lithological columns and their corresponding well logs reveal different carbonate and detritic reservoirs. The carbonate reservoirs consist of Jurassic, Cretaceous and Eocene limestones, whereas the detritic ones are composed of Oligo–Miocene sandstones and Plio-Quaternary to Quaternary sands and gravels. The structural map obtained from processing the satellite imagery confirms several lineaments drawn on the geological map, such as the Zaghouan fault, but also reveals new ones hitherto unrecognized. The intersections of the detected lineaments explain the occurrence of many springs in the area offering potentially favorable opportunities for accessing water resources in fractured aquifers. Analysis of lithostratigraphic correlations shows notable variations in the thickness, depth and composition of reservoir formations. Gravity data interpretation gives more precision by highlighting buried structures and discontinuities with different directions and depths. The delineated tectonic features demonstrate an aquifer system compartmentalized in raised and subsided blocks. The raised compartments may constitute continental divide areas and preferential aquifer recharge zones, while the sunken ones contain a multilayer aquifer composed of Quaternary and Pliocene reservoirs overlying multiple permeable layers, Tertiary and/or Mesozoic in age. [ABSTRACT FROM AUTHOR]

Anticipatory approaches are increasingly used to guide decision-making on environmental issues. A number of these approaches, particularly in the field of anticipatory governance, promote the participation of users in anticipatory thinking. Various tools are already used for this purpose. Nevertheless, most of these tools focus on the present and the future, rarely on the past. This article introduces a tool for the participatory modeling of past, current and future governance of groundwater in a territory. This tool was coupled with the Futures Triangle to foster dialog among the actors of Aousja Ghar El Melh territory in Tunisia. The tool allowed opening up dialog on what stakeholders in Aousja Ghar El Melh wanted to keep or change in past and current governance, and what future they envisioned for their territory. This article highlights the need for further methodological developments in order to be more dynamic and better integrate the three governance temporalities. Several avenues are discussed, including a dynamic presentation of the model and the use of role-playing games. This experiment also highlights the need not only to identify the different approaches to anticipatory governance at hand, but also to think ahead about how to articulate them, especially in an inter-disciplinary and multi-actor process. • Past, present and future governance are strongly interconnected and need to be analyzed and reflected upon jointly. • Modeling can open up stakeholders' dialog for reflecting jointly on past, present and future groundwater governance. • Further methodological developments include a dynamic presentation of the model and the use of role-playing games. • Approaches to anticipatory governance need to be thoughtfully articulated in inter-disciplinary and multi-actor processes. [ABSTRACT FROM AUTHOR]

Since the response of plant species to air pollutants is variable, the classification of plants into sensitive and tolerant groups is vital because the former can serve as biological indicators and the latter as sinks for the air pollutants. The morphological, biochemical, and physiological effects of fluoride stress were investigated in mulberry plants (Morus alba L.) grown at different distances from a phosphate fertilizer factory in Tunisia. Gas exchange (photosynthetic rate, stomatal conductance, and transpiration rate), photosynthetic pigments (chlorophyll and carotenoids) and water status (leaf relative water content) were decreased in the mulberry leaves grown near the polluted sites. However, lipid peroxidation (malondialdehyde content) and osmotic regulator (proline and soluble sugars content) levels were increased as compared to the control site. The obtained results suggest that Morus alba leaves could be considered as an air pollution bioindicator. [ABSTRACT FROM AUTHOR]

Highlights • The extra-intestinal pathovar of E. coli was found to be highly prevalent. • The emergence of the pandemic clone ST131 non-ESBL producer was observed. • qnrS1 resistance gene was found in the intestinal microbiota of Tunisian healthy children. • Intestinal microbiota are important as reservoirs of virulent as well as resistant strains. • Reinforcing hand hygiene and antibiotic rational use are imperative to avoid diffusion of these pathogens in the community. Abstract This study was performed to investigate the distribution of antimicrobial resistance genes and extra-intestinal virulence determinants in a collection of 98 Escherichia coli strains isolated from rectal swabs of healthy children. Forty-six isolated strains were resistant to at least one of the tested antibiotics (usually active against enterobacteria). They were mainly resistant to ampicillin and ticarcillin (42.97%), tetracyclin (26.5%), and trimethoprim/sulfamethoxazole (18.4%). No resistance to the third generation of cephalosporins, carbapenems, aminoglycosides and colistin was found. Resistance to penicillins was encoded by bla TEM-1 (n =34) and bla SHV-1 genes (n =4). Tetracyclin resistance was encoded by tetB (n =12), tetA (n = 5), and tetC (n =1) genes. Amongst resistant quinolones isolated (n =5), chromosomal mutations in gyrA and parC genes were detected in four isolates and qnrS1 gene in two strains. Nine plasmid replicon types were detected; IncFIB (n =36) and IncI1 (n =7) were the most frequent ones. Isolates frequently belonged to phylogenetic groups A (51.1%) and D (27.5%). Extra-intestinal pathovar (n =38) occurred mainly in B2 phylogroup (P =0.0002). Amongst them, two isolates (non-extended-spectrum-β-lactamase (ESBL)-producers) belonged to the pandemic clone ST131. A significant distribution of virulence determinants and pathogenicity island marker was observed within strains belonging to B2 and D phylogroups. Interestingly, our results showed that ExPEC strains, including ST131 pandemic clone, are present within fecal isolates in healthy children. These findings highlight the importance of intestinal microbiota as a reservoir for virulent and resistant strains. Thus, reinforcing hand hygiene and antibiotic rational use is imperative to avoid the diffusion of these pathogens in the community. [ABSTRACT FROM AUTHOR]

A continuous research is attempted to fulfil the highest industrial demands of natural amylases presenting special properties. New α-amylases extracted from stems and leaves of Pergularia tomentosa, which is widespread and growing spontaneously in Tunisia, were studied by the means of their activities optimization and purification. Some similarities were recorded for the two identified enzymes: (i) the highest amylase activity showed a promoted thermal stability at 50°C; (ii) the starch substrate at 1% enhanced the enzyme activity; (iii) the two α-amylases seem to be calcium-independent; (iv) Zn2+, Cu2+, and Ag2+ were considered as important inhibitors of the enzyme activity. Following the increased gradient of elution on Mono Q-Sepharose column, an increase in the specific activity of 11.82-fold and 10.92-fold was recorded, respectively, for leaves and stems with the presence of different peaks on the purification profiles. Pergularia amylases activities were stable and compatible with the tested commercial detergents. The combination of plant amylase and detergent allowed us to enhance the wash performance with an increase of 35.24 and 42.56%, respectively, for stems and leaves amylases. Characterized amylases were reported to have a promoted potential for their implication notably in detergent industry as well as biotechnological sector. [ABSTRACT FROM AUTHOR]

Crude extracts from a medicinal Tunisian plant, Pergularia tomentosa L., were the investigated natural material. Butanolic extract of roots analyzed with IR spectra revealed the presence of hydroxyl, alcoholic, and carboxylic groups and sugars units. Analysis of some secondary metabolites, total phenolic, flavonoids, flavonols, and procyanidins, was performed using different solvents following the increased gradient of polarity. Fruits and leaves contained the highest amounts of all these compounds. Antioxidant properties were evaluated by the determination of free radical scavenging activity and the reducing power of methanolic extracts. Fruits and leaf extracts were the most powerful antioxidants for the two-assay in vitro system. Stems and fruits extracts exhibit an antifungal activity against Fusarium oxysporum f. sp. lycopersici which could become an alternative to synthetic fungicide to control Solanum species fungal diseases. [ABSTRACT FROM AUTHOR]

Background Juvenile idiopathic arthritis (JIA) is characterized by a widely variable clinical course and outcome. If uncontrolled, joint damage may occur. In this context, coxitis is a feared complication. The aim of our study was to determine the prevalence and patterns of hip involvement in Tunisian JIA patients. Methods A retrospective study including children with JIA according to the International League of Associations for Rheumatology (ILAR)) was conducted between 2012and 2021. Sociodemographic data as well as disease characteristics were collected. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Hip involvement was assessed clinical exam and imaging (standard radiograph, ultrasound or magnetic resonance imaging (MRI)). We compared these parameters between the two groups: G1: presence of coxitis and G2: absence of coxitis. Results The study included 40 patients with a male predominance: sex ratio was 1.6. The mean age was 11.1 years-old [3–16]. The mean age at onset of the disease was 18.1 years old [8–30]. The distribution of the different subsets was as follows: polyarticular with rheumatoid factor (n  = 1), polyarticular without rheumatoid factor (n  = 2), enthesitis-related arthritis (n  = 29), oligoarthritis (n  = 7), psoriatic arthritis (n  = 1). Extra-articular manifestations were found in 21.2% of cases: ocular (n  = 4), pulmonary (n  = 2) and cardiovascular (n  = 1). The mean ESR and CRP was 30.9 mm/h [2–90] and 15.8 mg/l [1–70] respectively. A high ESR or CRP were found in 67% of cases. Hip involvement concerned 70% of the patients and was bilateral in 67.9% of them. Hip radiographs were normal in 50% of cases. Ultrasound was performed in 9 patients and revealed a positive Doppler synovitis (n  = 2), a negative Doppler synovitis (n  = 7) and joint effusion (n  = 2). MRI was performed in 20% of cases and revealed synovitis (67%) and joint effusion (33%). Overall, 79.3% of patients had medical treatment combining NSAIDs and rehabilitation, 39% of the patients had had local infiltration with Hexatrione and only two patients had hip replacement. Hip involvement was not correlated with age at onset (P  = 0.2), subtype (P  = 0.8), sex (P  = 0.7), extraarticular manifestations (P  = 0.4). Similarly, there was no correlation between the presence of coxitis and ESR (P  = 0.07) as well as CRP (P  = 0.5). Conclusion Our study showed that hip involvement is frequent among Tunisian patients with JIA. Although not correlated with disease characteristics, hip involvement should be assessed frequently and carefully. [ABSTRACT FROM AUTHOR]

Avian ESBL-producing Escherichia coli isolates have been increasingly reported worldwide. Animal to human dissemination, via food chain or direct contact, of these resistant bacteria has been reported. In Tunisia, little is known about avian ESBL- producing E. coli and further studies are needed. Seventeen ESBL-producing Escherichia coli isolates from poultry feces from two farms (Farm 1 and farm 2) in the North of Tunisia have been used in this study. Eleven of these isolates (from farm 1) have the same resistance profile to nalidixic acid, sulfonamides, streptomycin, tetracycline, and norfloxacine (intermediately resistant). Out of the six isolates recovered from farm 2, only one was co-resistant to tetracycline. All isolates, except one, harbored blaCTX-M-1 gene, and one strain co-harbored the blaTEM-1 gene. The genes tetA and tetB were carried, respectively, by 11 and 1 amongst the 12 tetracyclineresistant isolates. Sulfonamides resistance was encoded by sul1, sul2, and sul3 genes in 3, 17, and 5 isolates, respectively. The qnrB1 was detected in nine strains, one of which co-harbored qnrS1 gene. The search for the class 1 and 2 integrons by PCR showed that in farm 1, class 1 and 2 integrons were found in one and ten isolates, respectively. In farm 2, class 1 integron was found in only one isolate, class 2 was not detected. Only one gene cassette arrangement was demonstrated in the variable regions (VR) of the 10 int2-positive isolates: dfrA1- sat2-aadA1. The size of the VR of the class 1 integron was approximately 250 bp in one int1-positive isolate, whereas in the second isolate, no amplification was observed. All isolates of farm 1 belong to the phylogroup A (sub-group A0). However, different types of phylogroups in farm 2 were detected. Each of the phylogroups A1, B22, B23 was detected in one strain, while the D2 phylogroup was found in 3 isolates. The virulence genes iutA, fimH, and traT were detected in 3, 7, and 3 isolates, respectively. Two types of gene combination were detected: iutA+fimH+traT in 3 isolates and iutA+fimH in one isolate. The isolates recovered in farm 1 showed the same profile of PFGE macro-restriction, while isolates of farm 2 presented unrelated PFGE patterns. We conclude that these avian ESBL-producing E. coli isolates show homo- and heterogenic genetic background and that plasmids harboring ESBL genes could be involved in the dissemination of this resistance phenotype. [ABSTRACT FROM AUTHOR]

Objectives Extended-spectrum β-lactamases are widespread in hospital settings worldwide. The prevalence of ESBL producing Klebsiella pneumoniae (ESBL-KP) strains isolated from patients has recently increased in Tunisia. We conducted this study to determine the prevalence and the genetic characterization of ESBL-KP in a Tunisian Hospital. Patients and methods We performed antibiotic susceptibility testing, multiplex PCR, and DNA sequencing analysis on 118 non repetitive K. pneumonia strains isolated during three years, to determine the prevalence and genotypes of ESBL among K. pneumoniae clinical isolates. Results Most ESBL-producing K. pneumonia strains were isolated from hospitalized patients, especially in neonatal and pediatric wards. The resistance to other antibiotics was high. Most of the pathogens were isolated from the urinary tract (86.44%). Carbapenems were the most effective antimicrobial agents followed by amikacin and fosfomycin. The rate of blaSHV , blaTEM , and blaCTX-M genes among the isolates was 89, 56.78, and 81.35%, respectively. Sequencing revealed the amplicons encoding TEM-1, TEM-53, TEM-158, SHV-1, SHV-11, SHV-28, CTX-M-15, CTX-M-15-like. The blaCTX-M-15 was the dominant gene among Tunisian isolates, but this was the first report of blaTEM-53 and blaTEM-158 genes in the country. Conclusions Our results confirm the predominance of CTX-M-15 in Tunisia. To our knowledge, this is the first report of TEM-158 and TEM-53 in Tunisia. [ABSTRACT FROM AUTHOR]

Pneumococcal conjugate vaccines have not yet been introduced into the national program for childhood vaccination in Tunisia. The aim of this 7-year study was to obtain local data about serotype distribution and antimicrobial resistance of Streptococcus pneumoniae. A total of 203 isolates of culture confirmed that S. pneumoniae was evaluated. Invasive ( n=108) and noninvasive ( n=95) pneumococcal isolates were obtained from patients aged from 1 month to 85 years old. Considering all age groups, vaccine coverage was 40%, 62%, and 68% for PCV7, PCV10, and PCV13 serotypes, respectively. Overall, 31% of these isolates were penicillin G nonsusceptible. The most prevalent serotypes identified were those found in currently available pneumococcal conjugate vaccines, emphasizing the importance of implementing the vaccine in the routine immunization schedule at the national level. [ABSTRACT FROM AUTHOR]

Abstract: The prevalence of plasmid-mediated quinolone resistance (PMQR) determinants was investigated in a Tunisian collection of 300 uropathogenic Escherichia coli. PMQR genes were detected in 68 isolates (22.7%) as follows: aac(6′)-Ib-cr (n=66), qnrB1 (n=3), qnrA6 (n=1), and qnrS1 (n=1). Three isolates carried the 2 determinants aac(6′)-Ib-cr and qnrB1. aac(6′)-Ib-cr was usually carried on IncF-type plasmids (n=47/60) and frequently associated with bla CTX-M-15 (n=60). Substitutions in gyrA and parC genes were detected in 57.5% of strains. A major cluster including 29 isolates was individualized, 28 of them belonged to the virulent ST131 clone. In our hospital, the high prevalence of PMQR in E. coli isolates was due to horizontal transfer but also to the spread of ST131 clone. [Copyright &y& Elsevier]

In Tunisia, Kalâat El Andalous irrigated district is one of the most affected areas by salinization. The objective of this study was to predict the root zone salinity (over 10 years) in this area using the SaltMod simulation model for subsurface drainage system. SaltMod is based on water balance, salt balance model, and seasonal agronomic aspects. In the pilot area, irrigated vegetables crops such as tomato (Lycopersicum esculentum), melon (Cucumis mela) and squash (Cucurbuta maxima) occupy the field during summer and rainfed wheat during winter. The model predicted more or less similar values of electrical conductivity in the root zone. Highest value of electrical conductivity reached during the irrigation season was 7.7 dS m-1. Following the fall rains, there was a decrease of the soil salinity when the average minimum value of electrical conductivity was 3.1 dS m-1. The simulation also showed that decreasing the depth of the drain did not change significantly the root zone salinity. The depth of the drain could be reduced to 1.6 m without any damage to crops. There was a slight reduction in drainage flow when the depth of the drain changed from 1.8 m to 1.2 m. Decrease of the drain depth decreased water table level. There was no variation in root zone salinities due to change in drain spacing. The predicted drainage flows were related to the occurrence of irrigation and rainfall. In this study, calibration of SaltMod for water-salt balance parameters proved the validity of the model for the local conditions. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the prevalence and the emergence of plasmid-mediated quinolone resistance among broad-spectrum beta-lactam-resistant Proteus mirabilis and Morganella morganii clinical isolates recovered in the Military Hospital in Tunisia. Methods: Of 200 strains examined, 50 exhibited resistance to quinolones. Quinolone resistance determinants ( qnr and aac(6′)-Ib-cr) were characterized by multiplex PCR and sequencing. Chromosomal quinolone resistance mutations in the quinolone resistance-determining region (QRDR) and class 1 integron characterization were analysed by PCR and sequencing. The clonal relationship between the isolates was studied by pulsed-field gel electrophoresis (PFGE). Results: Fourteen isolates harboured qnrA6 and among them 8 (57%) were extended-spectrum beta-lactamase (ESBL) producers, whilst 12 (85%) isolates harboured blaDHA-1. Mutations in the QRDR were detected in gyrA (Ser83Ile, Glu87Lys), gyrB (Ser464Phe), and parC (Ser80Ile). qnrA6 and blaDHA-1 genes were found embedded in complex sul1-type class 1 integrons. A gene cassette carrying aac(6′)-Ib-cr was found located in the class 1 integron upstream of the qacEΔ1 gene. According to the PFGE analysis, the isolates were clonally unrelated. Conclusions: This is the first description in North Africa of class 1 integrons carrying blaDHA-1, qnrA6 gene, and aac(6′)-Ib-cr determinants in clinical strains of Proteus mirabilis and Morganella morganii. [ABSTRACT FROM AUTHOR]

The aim of this study is to test a pooling approach for the RT-PCR test to detect low viral loads of SARS-CoV-2. We found that a single positive specimen can still be detected in pools of up to 10. Each laboratory should conduct its own evaluation and validation of pooling protocols according to its specific context. • Pooling samples of SARS-COV-2 is a cost-saving method with the ability to detect the virus in specimens with low viral load. • We found that a single positive specimen can still be detected in pools of up to 10. • Additional amplification cycles, or inclusion of a re-test for negative group samples, could reduce false-negative rates. [ABSTRACT FROM AUTHOR]

Background: Zoonotic cutaneous leishmaniasis (ZCL) due to Leishmania major is highly prevalent in Tunisia and is transmitted by a hematophagous vector Phlebotomus papatasi (P. papatasi). While probing for a blood meal, the sand fly injects saliva into the host's skin, which contains a variety of compounds that are highly immunogenic. We recently showed that the presence of anti-saliva antibodies was associated with an enhanced risk for leishmaniasis and identified the immunodominant salivary protein of Phlebotomus papatasi as a protein of approximately 30 kDa. Methodology/Principal Findings: We cloned and expressed in mammalian cells two salivary proteins PpSP30 and PpSP32 with predicted molecular weights close to 30 kDa from the Tunisian strain of P. papatasi. The two recombinant salivary proteins were purified by two-step HPLC (High-Performance Liquid Chromatography) and tested if these proteins correspond to the immunodominant antigen of 30 kDa previously shown to be recognized by human sera from endemic areas for ZCL and exposed naturally to P. papatasi bites. While recombinant PpSP30 (rPpSP30) was poorly recognized by human sera from endemic areas for ZCL, rPpSP32 was strongly recognized by the tested sera. The binding of human IgG antibodies to native PpSP32 was inhibited by the addition of rPpSP32. Consistently, experiments in mice showed that PpSP32 induced the highest levels of antibodies compared to other P. papatasi salivary molecules while PpSP30 did not induce any detectable levels of antibodies. Conclusions: Our findings demonstrate that PpSP32 is the immunodominant target of the antibody response to P. papatasi saliva. They also indicate that the recombinant form of PpSP32 is similar to the native one and represents a good candidate for large scale testing of human exposure to P. papatasi bites and perhaps for assessing the risk of contracting the disease. Author Summary: Leishmania is transmitted by female sand flies and deposited during a blood meal together with saliva. Saliva contains a vast repertoire of pharmacologically active molecules that facilitate the acquisition of the blood meal and contribute to the establishment of the infection. These molecules can induce the production of anti-saliva antibodies, which can be used as markers of exposure to the vector bite. Epidemiological studies using sand fly salivary gland extract as antigens are hampered by the difficulty in obtaining large amounts of salivary glands. In the present study, we have investigated the use of recombinant salivary proteins from the Tunisian strain of Phlebotomus papatasi, the main vector of zoonotic cutaneous leishmaniasis (ZCL) in Tunisia, as an alternative method for screening of exposure to the sand fly bites. We primarily identified PpSP32 as the immunodominant protein and described the low level of polymorphisms in the amino acid sequence of the target protein. Further, we tested the suitability of using the recombinant form of this protein to estimate positive anti-saliva antibodies in serum samples of individuals from an endemic area for ZCL. Our findings indicate that this protein represents a promising epidemiological tool that can aid in implementing control measures against leishmaniasis. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates the correlation and agreement between central venous saturation (ScvO2) and mixed venous saturation (SvO2) during cardiopulmonary bypass (CPB) in coronary artery surgery patients. Findings suggest that, although mean biases between the measurements were low, limits of agreement were too large for a clinically acceptable assessment of (SvO2) by (ScvO2) in the given conditions.

A collection of 20 multidrug-resistant Providencia stuartii isolates recovered from 2005 to 2009 at the Military Hospital of Tunis, Tunisia, was analysed. They all expressed the extended-spectrum β-lactamase (ESBL) VEB-1a. The bla gene was plasmid-located and it was associated with complex genetic structures, including Re elements. Pulsed-field gel electrophoresis (PFGE) revealed a clonal relationship between all of these isolates. This study identified a nosocomial dissemination of an ESBL-producing P. stuartii clone in a Tunisian hospital over a long period of time. [ABSTRACT FROM AUTHOR]

Abstract: Seasonal hydrographic conductivity–temperature–depth surveys and moored current meter measurements have been analysed using an inverse approach in order to highlight the main features of the circulation in the western Sicily Strait during 2003. The variational inverse section model combines different types of constraints to seek for a continuous flow field satisfying data and physical assumptions within prescribed prior error bars. It is based on a finite element discretization that allows an appropriate resolution of very irregular topography. The corresponding results, consistent with data and dynamics, are providing new insight into the circulation of the surface and intermediate layers in conjunction with transport and formal error estimates during five hydrographic cruises. In the upper layer, these insights include the southward Atlantic Tunisian Current (ATC) off the Cap Bon Coasts, its high variability at short time-scales and its recirculation during October. For the Levantine Intermediate Water (LIW) regime, a detailed view of the circulation in the western Sicily Strait is given evidencing its recirculation at the western sill during the same period. Transports for both ATC and LIW are computed and found to be maximum in spring and decrease in summer and fall. [Copyright &y& Elsevier]

Background: In Tunisia, country of intermediate endemicity for Hepatitis B virus (HBV) infection, most molecular studies on the virus have been carried out in the North of the country and little is known about other regions. The aim of this study was to determine HBV genotype and subgenotypes in Central-East Tunisia. A total of 217 HBs antigen positive patients were enrolled and determination of genotype was investigated in 130 patients with detectable HBV DNA. HBV genotyping methods were: PCR-RFLP on the pre-S region, a PCR using type-specific primers in the S region (TSP-PCR) and partial sequencing in the pre-S region. Results: Three genotypes (D, B and A) were detected by the PCR-RFLP method and two (D and A) with the TSP-PCR method, the concordance between the two methods was 93%. Sequencing and phylogenetic analysis of 32 strains, retrieved the same genotype (D and A) for samples with concordant results and genotype D for samples with discordant results. The sequences of discordant genotypes had a restriction site in the pre-S gene which led to erroneous result by the PCR-RFLP method. Thus, prevalence of genotype D and A was 96% and 4%, respectively. Phylogenetic analysis showed the predominance of two subgenotypes D1 (55%) and D7 (41%). Only one strain clustered with D3 subgenotype (3%). Conclusions: Predominance of subgenotype D7 appears to occur in northern regions of Africa with transition to subgenotype D1 in the East of the continent. HBV genetic variability may lead to wrong results in rapid genotyping methods and sequence analysis is needed to clarify atypical results. [ABSTRACT FROM AUTHOR]

Background Juvenile Idiopathic Arthritis (JIA) is a chronic disease characterized by prolonged synovial inflammation that may cause structural joint damage. However, little is known about cervical spine involvement in JIA. The main objective of this study is to describe radiological findings of the cervical spine in patients with JIA. Methods We conduct a retrospective monocentric study. All JIA patients were included (ILAR criteria). Sociodemographic, JIA subtype, and clinical characteristics were collected. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis-related enthesitis form. Cervical spine radiographs including anteroposterior and lateral with flexion views were analyzed. A p -value < 0.05 was considered significant. Results We included 25 patients (16 girls and 9 boys) diagnosed with JIA with a mean age at disease onset of 9.9 ± 3.9 [3–16]. The median disease duration was 36 months (IQR 25–75%; 30–84). The JIA subtypes were in decreasing order of frequency: Enthesitis-related Arthritis (n  = 9), Oligoarticular (n  = 6), Polyarticular RF- (n  = 4), Polyarticular RF + (n  = 2), Systemic (n  = 2), Psoriatic Arthritis (n  = 1), and Undifferentiated (n  = 1). Median ESR and CRP were 17 mm/h [2–98] and 15.4 mg/l [0–56] respectively. The Median BASDAI score was 2.8 [1–6.3]. Median JADAS10 score was 5.3 [0–20]. Four patients (16%) were on long-term corticosteroid therapy. Five patients (20 %) have a cervical spine involvement with the following subtypes: Polyarticular (n  = 2), enthesitisenthesitis-related arthritis (n  = 2), and systemic (n  = 1). Clinical manifestations were neck pain (n  = 3) and limited range of motion (n  = 4). Neurological examination noted brisk deep tendon reflexes (n  = 6), positive Babinski reflex (n  = 1) and positive Hoffmann reflex (n  = 2). No patient had a neurological deficit. The conventional radiographs of the cervical spine showed: loss of cervical lordosis (n  = 2), diastasis C1-C2 (n  = 3), erosion of the odontoid process (n  = 1), and anterior ankylosis (n  = 3). Subsequent cervical spine MRI confirmed these findings and showed pannus at the craniocervical junction in one case and block vertebra of C6-C7 in another case. Atlanto-axial subluxation was anteroposterior in 3 patients and rotatory in one. Conclusion Cervical spine involvement is frequent and underestimated in JIA, and its radiological features are various. Hence, regular radiographic monitoring of the cervical spine is required to prevent the development of this complication. [ABSTRACT FROM AUTHOR]

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in the pediatric population. Methotrexate (MTX) has been considered as the cornerstone of treatment of poly and oligoarticular subtypes of JIA. However, this treatment is supposed to be for long term, which may involve an obstacle for adherence. The aims of the study were to evaluate adherence of Tunisian JIA patients to MTX and to identify factors associated with high adherence to MTX. Methods A cross-sectional study including patients with confirmed JIA diagnosis, according to the International League of Associations for Rheumatology (ILAR) criteria, was performed. Demographic data as well as disease characteristics were obtained from medical records. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. Adherence was measured, for patients under MTX for >3 months, using the 5-item Compliance Questionnaire Rheumatology (CQR5) (1). Patients were divided into two groups: group 1: High adherence (HA) for patients having a CQR5 ≥ 80% and group 2: low adherence (LA) for patients having CQR5 < 80%. A p inferior to 0.05 was considered statistically significant. Results The study included 29 patients (10 males and 19 females) with a mean age at disease onset of 9.1 ± 3.4 years. The mean disease duration was 61 ± 79 months [7–336]. JIA subtypes were in decreasing order of frequency as follows: enthesitis-related arthritis (n  = 13), oligoarticular (n  = 8), Polyarticular without rheumatoid factor (n  = 4), Polyarticular with rheumatoid factor (n  = 2), systemic (n  = 1) and, psoriatic arthritis (n  = 1). A biologic inflammatory syndrome was found in 48.3% (n  = 14) of cases. The mean ESR and CRP were 20 mm/h ± 11.3 [3–98] and 5 ± 17.8 mg/l [0–56] respectively. Nineteen (65.5%) patients had coxitis. Overall, 55.17% of patients (n  = 16) were treated with MTX with a mean weekly dose of 9.2 ± 3.2 mg [5–15]. MTX was orally administrated in all patients. NSAIDs and prednisone were prescribed in 51.7% (n  = 15) and 17.2% (n  = 5) of cases respectively. The MTX was associated with biological DMARDs in five patients (17.2%). It was about Etanercept in 4 patients and Tocilizumab in 1 patient. Mean CQR5 score was 70.8% ± 18 [25–100]. Only seven patients (43.8%) showed high adherence to MTX. The statistical study revealed no difference between HA and LA in term of gender (P  = 0.84), age at disease onset (P  = 0.39), disease duration (P  = 0.9), prednisone use (P  = 0.22), the occurrence of coxitis (P  = 0.2), ESR (P  = 0.83) and CRP (P  = 0.033) rates. Conclusion In this study, less than one half of JIA patients were highly adherent to MTX according to CQR5. Low adherence should be considered before declaring MTX treatment failure. [ABSTRACT FROM AUTHOR]

Streptomyces is the most frequently described genus of Actinomycetes, a producer of biologically active secondary metabolites. Indeed, the Streptomyces species produces about 70% of antibiotics and 60% of antifungal molecules used in agriculture. Our study was carried out with the goal of isolating and identifying antimicrobial secondary metabolites from Streptomyces misionensis V16R3Y1 isolated from the date palm rhizosphere (southern Tunisia). This strain presented a broad range of antifungal activity against Fusarium oxysporum, Aspergillus flavus, Penicillium expansum, Aspergillus niger, Candida albicans, Candida metapsilosis, and Candida parapsilosis and antibacterial activity against human pathogenic bacteria, including Escherichia fergusonii, Staphylococcus aureus, Salmonella enterica, Enterococcus faecalis, Bacillus cereus and Pseudomonas aeruginosa. The purification procedure entailed ethyl acetate extract, silica gel column, and thin layer chromatography. Based on 1H NMR metabolomic procedure application, also supported by the GC-MS analysis, cyclic dipeptide (l-Leucyl-l-Proline) was identified as the major compound in the bioactive fraction. In order to confirm the identity of the active compound and to have a large quantity thereof, a chemical synthesis of the cyclic dipeptide was performed. The synthetic compound was obtained with a very good yield (50%) and presented almost the same effect compared to the extracted fraction. This study indicates for the first time that Streptomyces misionensis V16R3Y1 exhibits a broad spectrum of antimicrobial activities, produced cyclic dipeptide (l-Leucyl-l-Proline) and might have potential use as a natural agent for pharmaceutical and agri-food applications. [ABSTRACT FROM AUTHOR]

Highlights • High prevalence of imported/acquired carbapenem-resistant A. baumannii (CRAB) faecal carriage among ICU patients. • OXA-23 was the most frequent carbapenemase among identified CRAB, followed by NDM-1. • Co-occurrence of carbapenem and aminoglycoside resistance genes among multidrug-resistant A. baumannii. • Circulation of clonally related CRAB strains. ABSTRACT Gastrointestinal colonisation by carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical step before nosocomial infection. This study evaluated CRAB intestinal carriage in patients admitted to a Tunisian ICU and determined the antimicrobial resistance mechanisms involved. From December 2014 to February 2015, all 63 patients admitted to the ICU were screened for rectal CRAB colonisation upon admission and once weekly thereafter. ICU patients who acquired a CRAB nosocomial infection were also included. β-Lactamases and associated resistance genes were screened by PCR sequencing, and molecular typing was performed by PFGE and MLST. The CRAB faecal carriage rate at admission was 4.8% (3/63). The CRAB acquisition rate during ICU stay was analysed in 39 of the remaining 60 patients and the rate of acquired CRAB faecal carriage was 15.4% (6/39); 4 patients also showed an ICU-acquired CRAB infection (one patient was a faecal carrier and suffered infection). Overall, 13 CRAB isolates were collected from 12 patients, of which 11 isolates showed resistance to all antibiotics tested except colistin. bla OXA-23 and bla NDM-1 were detected in 11 and 2 isolates, respectively. All OXA-23-producing strains carried armA, tetB, sul1 and catB , and some of them carried aph(3′)-VIa, bla TEM-1 , aph(3′)-Ia and ant(2′′)-Ia. The bla NDM-1 -positive isolates harboured aph(3′)-VIa and catB. Three PFGE patterns and two STs were identified [ST195 (n = 11), ST1089 (n = 2, NDM-1-positive)]. Whether imported or acquired during ICU stay, CRAB colonisation is a major risk factor for the occurrence of serious nosocomial infection. Systematic screening of faecal carriage is mandatory to prevent their spread. [ABSTRACT FROM AUTHOR]

Introduction: Salmonella Livingstone is one of the most common serotypes responsible for nosocomial outbreaks in Tunisia. In this study, 42 isolates of Salmonella Livingstone were analyzed. Most of these were isolated from humans (31 strains from Tunisia and 9 strains from Belgium) and 2 isolates came from food products (beef and pork). Methodology: All strains were characterized by antibiogram, multilocus sequence typing (MLST), and virulotyping. This last technique was carried out by simple PCR of five chromosomal genes (agfA, hin/H2, iroB,phoP/Q, and slyA) and two plasmid genes (spvA and spvC). Results: All Tunisian strains were resistant to amoxicillin, amoxicillin-clavulanic acid, ticarcillin, cefalotin, gentamicin, and kanamycin. They were also resistant to third-generation cephalosporin antibiotics (cefotaxim and ceftazidim). Belgian isolates were susceptible to all antibiotics tested. Further to MLST analyses, Tunisian strains belonged to the same sequence type, ST543. For Belgian isolates, eight strains had a ST543 profile, two strains had a ST638 profile, and one strain had a ST457 profile. Analyses of the virulence gene contents showed that strains isolated in different years and from different origins had the same virulence profile. These carried all five chromosomal genes and lacked plasmid-located virulence genes spvA and spvC. Conclusions: A combination of different typing methods showed that the majority of Belgian strains and all Tunisian strains were closely related; they belonged to the same sequence type (ST543) and had the same virulence profile, but different antibiotic resistance profiles depended on the country of origin. [ABSTRACT FROM AUTHOR]

On March 13, 2021, Tunisia started a widespread immunization program against SARS-CoV-2 utilizing different vaccinations that had been given emergency approval. Herein, we followed prospectively a cohort of participant who received COVID-19 vaccine (Pfizer BioNTech and Sputnik-Gameleya V). The goal of this follow-up was to define the humoral and cellular immunological profile after immunization by assessing neutralizing antibodies and IFN- γ release. 26 vaccinated health care workers by Pfizer BioNTech (n =12) and Sputnik-Gameleya V (n =14) were enrolled from June to December 2021 in Military hospital of Tunis. All consenting participants were sampled for peripheral blood after three weeks of vaccination. The humoral response was investigated by the titer of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies to S1 protein. The CD4 and CD8 T cell responses were evaluated by the QuantiFERON® SARS-CoV-2 (Qiagen® Basel, Switzerland). Regardless the type of vaccine, the assessment of humoral and cellular response following vaccination showed a strong involvement of the later with expression of IFN-γ as compared to antibodies secretion. Moreover, we showed that people with past SARS-CoV-2 infection developed high levels of antibodies than those who are not previously infected. However, no significant difference was detected concerning interferon gamma (IFN-γ) expression by CD4 and CD8 T cells in health care worker (HCW) previously infection or not with COVID-19 infection. Analysis of immune response according to the type of vaccine, we found that Pfizer BioNTech induced high level of humoral response (91.66%) followed by Sputnik-Gameleya V (64.28%). However, adenovirus vaccine gave a better cellular response (57.14%) than mRNA vaccine (41.66%). Regarding the immune response following vaccine doses, we revealed a significant increase of neutralizing antibodies and IFN-γ release by T cells in patients fully vaccinated as compared to those who have received just one vaccine. Collectively, our data revealed a similar immune response between Pfizer BioNTech and Sputnik-Gameleya V vaccine with a slight increase of humoral response by mRNA vaccine and cellular response by adenovirus vaccine. It's evident that past SARS-CoV-2 infection was a factor that contributed to the vaccination's increased immunogenicity. However, the administration of full doses of vaccines (Pfizer BioNTech or Sputnik-Gameleya V) induces better humoral and cellular responses detectable even more than three months following vaccination. [ABSTRACT FROM AUTHOR]

Objectives: To describe clinical and molecular characteristics of an outbreak due to metallo-β-lactamases (MBLs) producing Klebsiella pneumoniae collected at Charles Nicolle Hospital of Tunis and to analyze the impact of outer membrane porin (OMP) loss on carbapenem resistance levels. Methods: Between 2010 and 2015, 178 carbapenem-resistant Enterobacteriaceae were isolated. Screening for MBL production was performed using combined disk diffusion method, with imipenem and ethylene diamine tetraacetic acid (EDTA) as inhibitors. Resistance genes and virulence factors were identified by polymerase chain reaction (PCR) and sequencing. Genotyping was performed by pulsed-field gel electrophoresis and multilocus sequence typing. Genetic environment of carbapenemase genes was determined by PCR mapping. Conjugation assays were performed, and plasmids were assigned to incompatibility groups by PCR-based replicon typing. OMPs were profiled by sodium dodecyl sulfate-polyacrilamide gel electrophoresis, and porin genes were sequenced. Results: Nineteen K. pneumoniae (10.6%) showing MBL activity were isolated from patients hospitalized on four different wards. NDM-1 was the only MBL identified, in association with blaOXA-48. All strains lacked at least one OMP, and carbapenem resistance levels were remarkably elevated in strains lacking OmpK35 and OmpK36. blaNDM-1 was located in IncFIA-type conjugative plasmid, with the same genetic context in all strains. The epidemiological diffusion of blaNDM-1 was due to two clones, one major clone belonging to sequence type (ST) 147 (n = 16) and the other clone belonging to ST307 (n = 3). Conclusions: This study describes an outbreak of NDM-1-producing K. pneumoniae strains, isolated from a Tunisian hospital, caused by two clones belonging to ST147 and ST307; and highlights the role of OMPs loss, in combination with β-lactamase expression, in conferring high carbapenem resistance. [ABSTRACT FROM AUTHOR]

Our study aimed to investigate colistin resistance and the mechanisms involved in a collection of 35 extended-spectrum beta-lactamase (ESBL) and 13 CMY-2-producing E . coli strains which were previously recovered from chicken gut microbiota in Tunisia, as well as to determine the genetic location of mcr genes. Forty-eight ESBL and CMY-2-producing E . coli strains were obtained from 137 fecal samples of healthy chickens during 2013. These strains were tested for colistin resistance by the broth microdilution method, and screened for mcr-1 and mcr-2 genes by PCR. Two of these strains were colistin-resistant (MIC = 8 mg/L). Both harbored the mcr-1 gene, were CMY-2 producers, and were additionally resistant to tetracycline, ciprofloxacin, chloramphenicol, gentamicin, tobramycin and trimethoprim-sulfamethoxazole. They shared phylogroup A, the same pulsed-field gel electrophoresis (PFGE)-pattern, and were typed as ST2197. In both strains, IS Apl1 and pap2 were detected upstream and downstream of mcr-1 gene, respectively. The analysis of the two mcr-1 -positive strains and their transconjugants by PCR-based replicon typing and S1-PFGE, demonstrated that mcr-1 gene is linked to an IncP plasmid (~242 kb), and bla CMY-2 to an IncI1 plasmid (97 kb). The occurrence of E . coli harboring mcr-1 gene among intestinal microbiota in poultry and its location on a conjugative plasmid could represent a risk for public health. The evolution of this type of resistant microorganisms should be evaluated in the future. [ABSTRACT FROM AUTHOR]

This study was conducted to detect extended spectrum beta-lactamases (ESBLs) and plasmidic AmpC beta-lactamase (pAmpC-BL)-producing Escherichia coli isolates in industrial poultry samples were collected from healthy chickens of the three farms. Samples were inoculated onto desoxycholate-lactose-agar plates supplemented with cefotaxime (2 mg/L). E. coli was identified by biochemical and molecular methods and antibiotic susceptibility testing by the disk diffusion method. Genes encoding ESBLs and pAmpC-BL were detected by PCR and sequencing. Phylogenetic groups were determined by triplex PCR. The molecular typing of strains was done by pulsed field gel electrophoresis (PFGE) and Multilocus Sequence Typing (MLST) in those isolates showing different PFGE patterns. Cefotaxime-resistant E. coli isolates were recovered in 48 of 137 fecal samples (35%), and one isolate/sample was further studied. The following beta-lactamase genes were detected: bla CTX-M-1 (29 isolates, isolated in all three farms), bla CTX-M-15 (5 isolates, confined in farm II), bla CTX-M-14 and bla CMY-2 (one isolate and 13 isolates, respectively, in farm III). The 48 cefotaxime-resistant isolates were distributed into phylogroups: B1 (n = 21), A (n = 15) and D (n = 12). PFGE analysis revealed 19 unrelated patterns: 15 different profiles among ESBL-positive strains and 4 among the CMY-2-positive isolates. The following sequence types-associated phylogroups were detected: a) CTX-M-1-positive strains: lineages ST542-B1, ST212-B1, ST58-B1, ST155-B1 and ST349-D; b) CTX-M-15-positive strain: lineage ST405-D; c) CTX-M-14-positive strain: lineage ST1056-B1; d) CMY-2-positive strains: lineages ST117-D, ST2197-A, and ST155-B1. Healthy chickens constitute an important reservoir of ESBL- and pAmpC-BL-producing E. coli isolates that potentially could be transmitted to humans via the food chain or by direct contact. [ABSTRACT FROM AUTHOR]

Abstract: Crude extracts from the fruit of Lycium shawii, a plant collected from the south of Tunisia, were screened for their in vitro antioxidant, antimicrobial and antifungal activities. The dried fruits were extracted with EtOH and an aqueous suspension of the obtained EtOH extract was partitioned successively with CHCl3, CH2Cl2, EtOAc and n-BuOH, leaving residual water extract. Total phenolic content of extracts from these fruits were also determined. β-Carotene bleaching assay and Folin–Ciocalteu reagent were used to determine total antioxidant activity and total phenols of fruit extracts. Total phenolic and flavonoid contents varied from 100 to 377mg GAE/g DW and 3.3–110.6mgquercetin/gDW, respectively. Several extracts showed high antioxidant capacity and an antimicrobial activity against different strains. This is, to our knowledge, the first report on the detail chemical composition, antioxidant and antimicrobial activities of L. shawii extracts. The results provided evidence that the studied fruit might indeed be potential sources of natural antioxidant and antimicrobial agents. [Copyright &y& Elsevier]

The shortage of water resources of good quality is becoming an issue in arid and semi arid regions. Per consequent, the use of water resources of marginal quality is becoming an important consideration, particularly in arid regions in Tunisia, where large quantities of saline water are used for irrigation. Nevertheless, the use of these waters in irrigated lands requires the control of soil salinity and a comprehensive analysis even beyond the area where water is applied. The aim of this study was to investigate the effects of saline water irrigation on soil salinity distribution and some physiological traits of field-grown adult olive trees (Olea europaea L. cv. Chemlali) under contrasting environmental conditions of the arid region in the south of Tunisia. The plants were subjected, over two growing seasons, to two drip irrigated treatments: fresh water (ECe=1.2dSm−1, FW) and saline water (ECe=7.5dSm−1, SW). Saline water irrigation (SW) has led to a significant increase in soil salinity. Furthermore, these results showed that soil salinity and soil moisture variations are not only dependent on water salinity level but are also controlled by a multitude of factors particularly the soil texture, the distance from the irrigation source and climatic conditions (rainfall pattern, temperature average, …). On the other hand, salt treatment reduced leaf midday water potential (LMWP), relative water content and photosynthetic activity and increased the leaf proline content, and this increase was season-dependent. Indeed, LMWP in SW plants decreased to −3.71MPa. Furthermore, the highest level of proline in SW plants was registered during summer period (2.19μmol/mg Fw). The proline accumulation recorded in stressed plants has allowed them to preserve appropriate leaf water status and photosynthetic activity. More to the point, this olive cultivar seems to be more sensible to soil salinity during the intense growth phase. Such tendencies would help to better manage water resources for irrigation, particularly under actual climatic conditions of water scarcity. For example, in the case of the availability of different water qualities, it would be better to preserve those of high quality for olive irrigation during the intense vegetative growth phase, in coincidence with high salt sensitive period, and those of low quality for irrigation during partial growth and plant rest phases. What’s more, the urgent use of saline water for irrigation should not be applied without taking into consideration the different surroundings conditions where it is used, particularly the water salinity level, the soil type, the adopted irrigation system, the degree of the crop salt tolerance, the plant growth phase and the climatic conditions of the experimental site. [Copyright &y& Elsevier]