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Abstract Unexplained deep vein thrombosis may justify screening for antineutrophil cytoplasmic antibody‐associated vasculitis as it can be an unusual presentation of this disease.

Objective: To identify the early predictors of severe envenomation in the southern region of Tunisia. Methods: It was a retrospective monocentric study including consecutive patients admitted to the emergency department for snakebite envenomation. Snakebite envenomation was defined by a history of snakebite. Predictors of severe envenomation were determined by univariate and multivariate analyses. Results: Our sample consisted of 109 patients aged 30 (20-44) years with a 1.1:1 sex-ratio (56 males and 53 females). During the 24-hour surveillance period, 25 patients developed severe envenomation (22.9%). The in-hospital mortality rate was 4.6% (n=5). The independent predictors of severe snakebite envenomation were leucocyte count over 11 550/mm3 (OR: 18.7, 95% CI: 3.3-107.8), creatine kinase over 155 IU/L (OR: 6.16, 95% CI: 1.1-35.6), and/or tourniquet before arrival to the ED (OR: 32.14, 95% CI: 3.5-295.9). Conclusions: This study emphasizes the importance of early evaluation of snakebite envenomation. Further studies are required to approve a severity scale proper to snakebite envenomation in Tunisia.

Abstract Proliferative glomerulonephritis with monoclonal immunoglobulin deposits is a new disorder with undefined treatment modalities. We propose cyclophosphamide‐bortezomib‐dexamethasone and autologous stem cell transplantation as a therapeutic protocol.

Summary: Clinicians, patients, policy makers, funders, programme managers, regulators, and science communities invest considerable amounts of time and energy in influencing or making decisions at various levels, using systematic reviews, health technology assessments, guideline recommendations, coverage decisions, selection of essential medicines and diagnostics, quality assurance and improvement schemes, and policy and evidence briefs. The criteria and methods that these actors use in their work differ (eg, the role economic analysis has in decision making), but these methods frequently overlap and exist together. Under the aegis of WHO, we have brought together representatives of different areas to reconcile how the evidence that influences decisions is used across multiple health system decision levels. We describe the overlap and differences in decision-making criteria between different actors in the health sector to provide bridging opportunities through a unifying broad framework that we call theory of everything. Although decision-making activities respond to system needs, processes are often poorly coordinated, both globally and on a country level. A decision made in isolation from other decisions on the same topic could cause misleading, unnecessary, or conflicted inputs to the health system and, therefore, confusion and resource waste.

Introduction: Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Several tools exist for the screening of frailty among these patients. However, no tool has been validated in Tunisia. This study aims to evaluate the usefulness of frailty screening in predicting the outcome of older adults presenting to the ED. Methods: This is a prospective, monocentric study. We evaluated the eligible patients at the ED and after their discharge. Follow-up phone calls were scheduled at 1, 2, 3, and 6 months after the ED visit. All patients aged 65 years or older; and visiting the ED during the inclusion period were involved. We used the ADL index and ISAR scale for assessing frailty. Results: We enrolled 184 patients; they were living alone in 25% of cases. Half of them had medical care insurance. The ADL index was maximum (6 = total dependency) in 20% of cases. The ISAR score was above 1 point in 38%. Unplanned hospitalizations have accounted for 34%. In univariate analysis, the ADL index and ISAR score were statistically higher in the group of “unplanned hospitalization”. In multivariate analysis, the ISAR score and ADL index have not been associated with unplanned hospitalization. Conclusion: Our results did not demonstrate the relevance of the ISAR or ADL scales in predicting the mortality or the need for unplanned hospitalization in multivariate analysis. This study did indicate an increased mortality in the “frail” patients in the univariate analysis. Further studies with larger samples and different tools are necessary.

Abstract Renal involvement in Niemann‐Pick disease type B is very rare. Kidney check‐up and renal biopsy should be performed in any patient presented with hypertension and kidney disease. Histology identifies the lesion, the prognosis, and guide treatment.

Uncontrolled proliferative signals and cell cycle dysregulation due to genomic or functional alterations are important drivers of the expansion of undifferentiated blast cells in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) cells. Therefore, they are largely studied as potential therapeutic targets in the field. We here present the most recent advancements in the evaluation of novel compounds targeting cell cycle proteins or oncogenic mechanisms, including those showing an antiproliferative effect in acute leukemia, independently of the identification of a specific target. Several new kinase inhibitors have been synthesized that showed effectiveness in a nanomolar to micromolar concentration range as inhibitors of FLT3 and its mutant forms, a highly attractive therapeutic target due to its driver role in a significant fraction of AML cases. Moreover, we introduce novel molecules functioning as microtubule-depolymerizing or P53-restoring agents, G-quadruplex-stabilizing molecules and CDK2, CHK1, PI3Kδ, STAT5, BRD4 and BRPF1 inhibitors. We here discuss their mechanisms of action, including the downstream intracellular changes induced by in vitro treatment, hematopoietic toxicity, in vivo bio-availability and efficacy in murine xenograft models. The promising activity profile demonstrated by some of these candidates deserves further development towards clinical investigation.

Bacteriophages could be a useful adjunct to antibiotics for the treatment of multidrug-resistant Pseudomonas aeruginosa infections. In this study, lytic P. aeruginosa myoviruses PsCh, PsIn, Ps25, and Ps12on-D were isolated from Tunisian sewage samples. Phage Ps12on-D displayed an adsorption time of ~10 min, a short latency period (~10 min), and a large burst size (~115 PFU per infected cell) under standard growth conditions. All phages were active at broad temperature (4 °C to 50 °C) and pH (3.0 to 11.0) ranges and were able to lyse a wide variety of P. aeruginosa strains isolated from clinical and environmental samples worldwide. Illumina sequencing revealed double-stranded DNA genomes ranging from 87,887 and 92,710 bp with high sequence identity to Pseudomonas phage PAK_P1. All four phages based on sequence analysis were assigned to the Pakpunavirus genus. The presented characterization and preclinical assessment are part of an effort to establish phage therapy treatment as an alternative strategy for the management of multidrug-resistant P. aeruginosa infections in Tunisia.

Light-chain deposition disease (LCDD) reoccurs almost invariably after renal transplantation, leading to early graft loss. We report a case of LCDD with monoclonal gammopathy of renal significance diagnosed in the post-transplant period in a 28-year-old male and we discuss the diagnostic and therapeutic challenges in the clinical course.

There is growing interest in the use of bio inoculants based on plant growth-promoting bacteria (PGPB) to promote plant growth under biotic and abiotic stresses. Here, we provided a detailed account of the effectiveness of a number of endophytic PGPB strains, isolated from the roots of the halophyte Salicornia brachiata in promoting durum wheat growth and enhancing its tolerance to salinity and fusarium head blight (FHB) disease. Bacillus spp. strains MA9, MA14, MA17, and MA19 were found to have PGPB characteristics as they produced indole-3-acetic acid, siderophores, and lytic enzymes, fixed free atmospheric nitrogen, and solubilized inorganic phosphate in vitro. Additionally, the in vivo study that involved in planta inoculation assays under control and stress conditions indicated that all PGPB strains significantly (p < 0.05) increased the total plant length, dry weight, root area, seed weight, and nitrogen, protein, and mineral contents. Particularly, the MA17 strain showed a superior performance since it was the most efficient in reducing disease incidence in wheat explants by 64.5%, in addition to having the strongest plant growth promotion activity under salt stress. Both in vitro and in vivo assays showed that MA9, MA14, MA17, and MA19 strains were able to play significant PGPB roles. However, biopriming with Bacillus subtilis MA17 offered the highest plant growth promotion and salinity tolerance, and bioprotection against FHB. Hence, it would be worth testing the MA17 strain under field conditions as a step towards its commercial production. Moreover, the strain could be further assessed for its plausible role in bioprotection and growth promotion in other crop plants. Thus, it was believed that the strain has the potential to significantly contribute to wheat production in arid and semi-arid regions, especially the salt-affected Middle Eastern Region, in addition to its potential role in improving wheat production under biotic and abiotic stresses in other parts of the world.

IntroductionImplementation of health technology assessment (HTA) is still in an early stage with some heterogeneity in the Middle East and North Africa (MENA). Our objective was to assess the current and future status of HTA implementation in the MENA region by focusing on regional commonalities.MethodsPreparatory discussions for the first ISPOR conference in the MENA region indicated some potentially generalizable trends of HTA roadmaps. To widen the perspective, a policy survey was conducted among conference participants by applying an HTA implementation scorecard. Discussion group members helped to validate key conclusions during and after the conference.ResultsHealth policy experts in MENA countries would like to facilitate HTA implementation and expect significant changes with some generalizable directions in 10 years compared to the current status according. HTA capacity building has to be strengthened by more graduate and postgraduate programs. Increased public budget and enhanced institutionalization are necessary success factors of HTA implementation. The scope of HTA has to be extended from pharmaceuticals to non-pharmaceutical technologies and to revision of previous policy decisions. Although cost-effectiveness with explicit threshold remains the most preferred HTA criterion, several other criteria have to be considered, maybe even by applying an explicit MCDA framework. The role of local evidence and data has to be strengthened in MENA countries, which translates to the extended use of local patient registries and payers' databases. Duplication of efforts can be reduced if international collaboration is integrated into national HTA implementation.DiscussionOur results should be viewed as an initial step in a multi-stakeholder dialogue on HTA implementation. Each MENA country should develop its context-specific HTA roadmap, as such roadmaps are not transferable without taking into account country size, economic status, public health priorities and adopted systems of health care financing.

An activated carbon was prepared by phosphoric activation of olive pomace and further oxidation by nitric acid. Another carbon was obtained from β-cyclodextrin dehydration in concentrated sulfuric acid. A composite of the oxidized activated carbon and the carbon from β-cyclodextrin was prepared. The four materials were characterized by N2 adsorption–desorption measurements, X-ray diffraction, infrared and Raman spectroscopies, elemental analysis, “Boehm” titration and measurements of pH of the point zero charge. The obtained adsorbents were tested for boron adsorption in aqueous solution. Despite their lowest specific surface areas, the composite carbon and the amorphous carbon from cyclodextrin dehydration showed the highest boron adsorption uptake (1.41 and 1.68 mg·g−1) compared to the raw (1.05 mg·g−1) and oxidized (0.95 mg·g−1) activated carbons. The surface chemistry particularly rich in phenolic groups was responsible for the high boron adsorption uptake of the carbon composite and the amorphous carbon, both prepared through cyclodextrin dehydration.

An efficient and credible approach to road traffic management and prediction is a crucial aspect in the Intelligent Transportation Systems (ITS). It can strongly influence the development of road structures and projects. It is also essential for route planning and traffic regulations. In this paper, we propose a hybrid model that combines extreme learning machine (ELM) and ensemble-based techniques to predict the future hourly traffic of a road section in Tangier, a city in the north of Morocco. The model was applied to a real-world historical data set extracted from fixed sensors over a 5-years period. Our approach is based on a type of Single hidden Layer Feed-forward Neural Network (SLFN) known for being a high-speed machine learning algorithm. The model was, then, compared to other well-known algorithms in the prediction literature. Experimental results demonstrated that, according to the most commonly used criteria of error measurements (RMSE, MAE, and MAPE), our model is performing better in terms of prediction accuracy. The use of Akaike’s Information Criterion technique (AIC) has also shown that the proposed model has a higher performance.

Newly discovered Erwinia amylovora phages PEar1, PEar2, PEar4 and PEar6 were isolated from three different orchards in North Tunisia to study their potential as biocontrol agents. Illumina sequencing revealed that the PEar viruses carry a single-strand DNA genome between 6608 and 6801 nucleotides and belong to the Inoviridae, making them the first described filamentous phages of E. amylovora. Interestingly, phage-infected cells show a decreased swimming and swarming motility and a cocktail of the four phages can significantly reduce infection of E. amylovora in a pear bioassay, potentially making them suitable candidates for phage biocontrol.

This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. A 50-year-old female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Endodontic and periodontal treatments were realized with 36 months radiological and clinical follow-up with the collaboration of her internist doctor.

Acute intoxication with nicotine is possible to cause nonspecific clinical signs and may be serious and lead to the death. We report a rare and severe form of acute nicotine poisoning secondary to dermal absorption of tobacco.

To the Editor: Pharmacist prescribing rights in Australia have recently sparked debate between medical practitioners and pharmacists.[1] While discussion on the potential role of pharmacists to prescribe is important, the debate has focused on the initiation of medications. The pharmacists' expanded deprescribing role can be achievable with a team-based approach in which there is a clear delineation of roles and responsibilities, separating the prescribing from the dispensing pharmacist, as in New Zealand.[[5]] In Australia, many health practitioners can prescribe medications. [Extracted from the article]

Background: Observational studies using real-world data (RWD) can address gaps in knowledge on deprescribing medications but are subject to methodological issues. Limited data exist on the methods employed to use RWD to measure the effects of deprescribing., Objective: To describe methodological approaches used in observational studies of deprescribing medications in older adults., Method: We conducted a systematic review in Medline for observational studies published in English (01/01/2000-09/14/2023) that examined the health effects of medication deprescribing in older adults. We described study characteristics and methods, focusing on the operationalization of deprescribing as an exposure and potential time-related biases., Results: Forty-five studies were included, representing a variety of drug classes (e.g., statins, aspirin, bisphosphonates) and diseases. Most studies adequately addressed potential time-related biases. The definition of deprescribing was not clearly defined in 12 studies. There was heterogeneity regarding the minimum duration of time that qualified as deprescribing, even within a drug class; fewer than one-third of studies provided a justification for these definitions., Conclusion: Observational studies are common to examine the effects of deprescribing; however, there were inconsistencies in measuring deprescribing and a lack of transparency in reporting. There is a need for minimum sufficient reporting criteria for observational studies on deprescribing., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Introduction: Infective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality., Patients and Methods: A prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology., Results: Thirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2-44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13-90])., Conclusions: Cardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The present study aimed to investigate and compare the enzymatic production of endophytic bacteria isolated from healthy and brittle leaf disease affected date palm leaves (pectinase, cellulase, lipase, and amylase). The findings revealed that the enzymatic products from the bacterial isolates of healthy date palm leaves were primarily 33% amylolytic enzyme, 33 % cellulase, 25 % pectinase, and 25 % lipase. The isolates from brittle leaf disease date palm leaves, on the other hand, were noted to produce 16 % amylolytic enzyme, 20 % cellulose, 50 % pectinase, and 50 % lipase. The effects of temperature and pH on amylase, pectinase, and cellulose activities were investigated. The Bacillus subtilis JN934392 strain isolated from healthy date palm leaves produced higher levels of amylase activity at pH 7. A Box Behnken Design (BBD) was employed to optimize amylase extraction. Maximal activity was observed at pH and temperature ranges of pH 6-6.5 and 37-39 °C, respectively. Under those conditions, amylase activity was noted to be attained 9.37 U/ml. The results showed that the enzyme was able to maintain more than 50 % of its activity over a temperature range of 50-80 °C, with an optimum at 70 °C. This bacterial amylase showed high activity compared to other bacteria, which provides support for its promising candidacy for future industrial application.