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Introduction Strangulation of the penis is a rare situation that requires urgent treatment for penile decompression. The complications could range from simple edema to severe ones such as urethrocutaneous fistula, complete urethral transection, penile gangrene and penile amputation. This work has been reported in line with the SCARE criteria. Case presentation A 9-year-old patient was presented to the emergency service.During examination of the genitals, the glans was hanging to the penis by a very slim pedicle, its coloration was normal and the urethra was almost cut at the sulcus coronarius. The cause of strangulation was multiple hair coils.We performed single stage reparation which consists of refreshing the edges of the urethra and glans, followed by anastomosing the two cut urethral ends, reinforcement by interposing a well vascularized dartos layer was also performed. At the six months follow-up, the penis had a good cosmetic outcome and the glans sensation was present. Discussion The penile tourniquet syndrome is one of the major causes of pediatric penile trauma. Ritual circumcision is basically the main cause of the series followed by penile strangulation. Surgical reparation can be performed in one or two stages. It should be performed by a surgeons experienced in hypospadias repair by following the same principles of dissection and applying a second layer coverage for the urethroplasty. Conclusion Hair-coil penile strangulation is an uncommon condition. The repair can be realized in one or two stages but it must be performed by a surgeon experienced in hypospadias surgery. Early surgical repair is required to achieve successful results., Highlights • Penile tourniquet syndrome is one of the most important causes of pediatric penile trauma. • The complications range from simple edema to severe ones. • We performed single stage reparation. • After 6 months of following up, we noticed that penile cosmesis was good, the glans sensation was present.

The goal - to analyze the features of treatment and medical expenses in childrenhospitalized for acute bronchitis.Material and methods. The study analyzed medical records and examined 30 childrenaged 3 to 11 years hospitalized for acute bronchitis. Peculiarities of clinical symptoms,structure of the treatment measures and their cost were studiedThe results. The length of hospital stay was 7.4 ± 0.53 days with subsequent therapyand rehabilitation in an outpatient setting. Antibiotics, antipyretics, antihistamines,mucolytics and corticosteroid hormones were used in the treatment. The total cost ofone case treatment was on average 674.2 ± 80.9 hryvnias. The most expensive werethe costs of infusion therapy and antibiotics, which were prescribed to about a third ofpatients, and the cheapest - antipyretics. Taking into account the age of the children, theacute nature of the process, antibiotics’ use from the reserve group was irrational andsignificantly increased the cost of the treatment.Conclusions. The introduction of a new model of medicine has a positive effect onthe optimization of acute bronchitis treatment tactics from shifting the emphasis fromintensive antibacterial therapy to the restoration of mucociliary clearance. The choiceof antibacterial drugs was still an irrational, from a clinical and economic point ofview.

Healthcare-associated infections (HAIs) are with high rates of mortality and an additional cost, in onco-hematology patients.To assess the prevalence trends of HAIs in the onco-hematology ward of the Tunisian National Bone Marrow Transplant Center (NBMTC), and to determine the principal associated risk factors.Six repeated point prevalence surveys were conducted, from May 2018 to March 2019, using a two months interval. All patients hospitalized in the day of the survey were included. Risk factors of HAIs were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). They were assessed using a logistic regression model.Nineteen patients out of a total of 74 patients have been diagnosed with 19 HAIs, representing a prevalence of 25.7%. No significant downward or upward trend of prevalence was revealed over time (p=0.3). The most common HAI was respiratory tract infection (57.9%) with a prevalence of 14.9%. Multiple logistic regression analysis revealed that HAI was significantly associated with neutropenia (Adjusted OR: 14; 95% CI: 1.5-127; p=0.01) and duration of central venous catheter (Adjusted OR: 1.1; 95% CI: 1-1.2; p=0.005).High prevalence of HAIs in our center with a high rate of mortality, requiring identifying potential problems in infection control practices.

The present investigation focuses on population genetic structure analysis of the endangered giant clam species Tridacna maxima across part of the Red Sea, with the main aim of assessing the influence of postulated potential barriers to gene flow (i.e., particular oceanographic features and marked environmental heterogeneity) on genetic connectivity among populations of this poorly dispersive bivalve species. For this purpose, a total of 44 specimens of T. maxima were collected from five sampling locations along the Saudi Arabian coast and examined for genetic variability at the considerably variable mitochondrial gene cytochrome c oxidase I (COI). Our results revealed lack of population subdivision and phylogeographic structure across the surveyed geographic spectrum, suggesting that neither the short pelagic larval dispersal nor the various postulated barriers to gene flow in the Red Sea can trigger the onset of marked genetic differentiation in T. maxima. Furthermore, the discerned shallow COI haplotype genealogy (exhibiting high haplotype diversity and low nucleotide diversity), associated with recent demographic and spatial expansion events, can be considered as residual effect of a recent evolutionary history of the species in the Red Sea.

An array of Egyptian and Tunisian lifeworlds in 2016.

The goal – to evaluate the features and diagnostic value of the capillary bedbiomicroscopy results in various pathological conditions.Material and methods. The paper presents data on microcirculation study in patientsof various ages (adults and children) with different somatic pathologies (with diabetesmellitus, arterial hypertension, chronic gastroduodenitis, acute bronchitis) comparedwith healthy persons. The state of microcirculation was recorded using a digital USBmicroscope and evaluated by qualitative and semi quantitative assessment.Results. In patients with diabetes, the most changes in the form of capillariesand venules microaneurism, reduction of the functioning vessels number, slowingblood flow, decrease of arteriolo-venular coefficient were registered. In arterialhypertension, the signs of an increase in peripheral resistance were dominated, andin inflammatory diseases of the gastroduodenal zone and during bronchitis there wasa slowing of blood flow in arterioles and capillaries, an increase in the vascularity ofarterioles and the erythrocytes adhesion inside vessels.Conclusions. Biomicroscopy is simple and informative method for studyingmicrocirculation both chronic and acute diseases, the volume and nature of violationspredominantly depends on the type of pathology, its severity and duration.

The study aimed to utilize the peripheral blood immunological parameters and resulting individual and combined inflammatory indices [neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR) and C-reactive protein/lymphocyte ratio (CLR)] in predicting the prognosis and mortality in COVID-19 patients.The measurements of individual and combined inflammatory indices (NLR, LMR and CLR) were performed at hospital admission and at last day of hospitalization for COVID-19 patients.Prominent elevation of NLR and CLR among patients with refractory disease admitted to Intensive Care Unit (ICU) and deceased patients was found when compared with moderate ill patients and healthy controls. Interestingly, NLR and CLR typically returned to near normal value as patients recover from severe infection. By contrast, deceased patients had persistent increased NLR and CLR until last day of hospitalization in ICU. ROC obtained for the above parameters showed that NLR and CLR were the most associated immunological parameters with the severity of COVID-19 disease. Using multivariate logistic regression analysis, CLR 69.46 is an independent prognostic factors in identifying critically ill COVID-19 cases. Study of the combined markers NLR and CLR showed that most of patients admitted in ICU were characterized with high NLR combined with high CLR, while most of healthy subjects and non-ICU group have low NLR combined with low CLR.The combination of NLR and CLR could improve the predictive efficacy compared to individual markers to segregate patients who will develop a severe disease from those with a mild pathology.

The Ceratonia siliqua fruits contain several substances known to have high adaptability to environmental conditions. The aim of this paper is to evaluate the changes in physicochemical properties of different Tunisian provenances of carob pulps harvested at three ripening stages. Furthermore, six provenances were investigated during the ripening process in terms of their moisture, ash, minerals, bioactive compounds, antiradical activity and sugar profile. The results demonstrated that all examined parameters are highly influenced by geographic origin. Concerning ripening impact, our data showed that water and ash content significantly decreased during the development of six provenances, as well as the bioactive and mineral contents. Thus, the total polyphenols (TP), total flavonoids (TF) and condensed tannins (CT) contents exhibited the highest levels in the unripe fruits. The antiradical activity trend was positively correlated to the behavior of the bioactive compounds content. Moreover, the sucrose, glucose and fructose were the main sugar qualified and quantified in carob pods at different ripening stages. At the maturity stage, the monosaccharide contents (glucose and fructose) were slightly reduced, while, the sucrose was rapidly accumulated. In conclusion, the ripening process diversely affected the nutritional composition and generally extended the exploitation of carob fruits. The study could provide valuable information about the suitability of carob pods at different maturity stages as potential biomaterials for nutraceutical applications.

The synthesis and metal-ion complexation properties of two new derivatives of 1,3-di(carboxymethyl)-p-tert-butylcalix[4]arene, bis(2-thienylmethylamide) 3 and bis(furanylmethylamide) 4, have been studied using UV/Vis spectrophotometry and, in some cases, 1H-NMR spectroscopy. The cations examined are alkali metals (Li+, Na+, K+, Rb+ and Cs+), alkaline earth metals (Mg2+, Ca2+, Sr2+ and Ba2+), heavy metals (Ag+, Cd2+, Hg2+ and Pb2+), and lanthanides (La3+, Nd3+, Eu3+, Gd3+ and Yb3+).

Dams represent large semi-closed reservoirs of pesticides and various organic and inorganic pollutants from agricultural and human activities, and their monitoring should receive special attention. This study evaluated the environmental health status of Bir Mcherga dam using zooplankton species. The dam has a capacity of 130 Mm3 and its waters are used for irrigation, water drinking supply, and fishery. Copepods and cladocerans (crustaceans) were collected in situ monthly between October and August 2012. Oxidative stress (CAT, MDA), neurotoxicity (AChE), and genotoxicity (micronucleus test) biomarkers were analyzed in two zooplankton species: Acanthocyclops robustus and Diaphanosoma mongolianum. High values of cells with a micronucleus were observed during summer. AChE activities were inhibited during early winter and summer. The high seasonal variability of CAT and MDA levels indicates that zooplankton is continuously exposed to different oxidative stresses. These results suggest that there is an obvious and continuous multi-faceted stress in Bir Mcherga reservoir and, consequently, an urgent monitoring of freshwater environments in Tunisia is needed, particularly those intended for human consumption and irrigation.

This article is devoted to the modeling, performance evaluation and robust control of the railway transport network in Sahel Tunisia. The regular increase in the number of passengers makes the management of transportation systems more and more complex. Railway transport requires specific needs. Indeed, many decision and optimization problems occur from the planning phase to the implementation phase. Railway transport networks can be considered as discrete event systems with time constraints. The time factor is a critical parameter, since it includes schedules to be respected in order to avoid overlaps, delays and collisions between trains. The uncertainties affect the service and the availability of transportation resources and, consequently, the transport scheduling plan. Petri nets have been recognized as powerful modeling and analysis tools for discrete event systems with time constraints. Consequently, they are suitable for railway transport systems. In this article, stochastic P-time Petri nets are used for the railway transport networks in Sahel Tunisia. A global model is first detailed. Then, this model is used to analyze the network traffic and evaluate the performance of the system. Robustness again disturbances is introduced and a control strategy is developed to reduce the consequences of the disturbances in order to maintain the expected schedule.

Highlights • Metastases to gallbladder from renal cell carcinoma are very rare. • Most of the cases are diagnosed incidentally, and both clinical presentation and physical examination are unspecific. • Imaging although its specificity can’t make the difference between primary gallbladder carcinoma and metastasis from RCC. • Only pathological examination of the specimen after cholecytectomy with immunochemistery can assess the diagnosis., Introduction Metastatic tumors to the gallbladder are uncommon. Metastases from renal cell carcinoma (RCC) to the gallbladder are exceptional. Frequencies of less than 0.6% reported in large autopsy reviews and few cases have been reported in the literature. Presentation of case Herein we present a case of a 50-year-old man that developed four years after radical nephrectomy for RCC, a gallbladder metastasis, discovered incidentally on Computed Tomography (CT) scan. It was described as an intraluminal gallbladder polyp. Radiological features were very suggestive of primary gallbladder carcinoma, thus the patient had a laparoscopic cholecystectomy. The pathological examination of the surgical specimen concluded to a RCC metastasis. Immunochemistry with vimentin and pancytokeratin were supportive of this diagnosis. The clinical course was uneventful after 18 months period of follow up. Discussion At the time of presentation, almost one-third of the patients with RCC are metastatic. Metastases to the gallbladder are extremely rare. Clinical presentation and physical examination are unspecific. Radiological findings can raise information and orient the diagnosis although the difference between both diagnoses remains difficult. Usually, it is a pedunculated and not associated with gallstones with enhancement on CT scan. The treatment remains surgical with R0 cholecystectomy, and prognosis is mainly related to disease free interval and single site metastasis. Conclusion We highlight here the challenge to make the difference between a primary gallbladder carcinoma and metastasis from RCC. Diagnosis is made on pathological examination and immunochemistry.

A new vegetative disorder was observed in Tunisian carrot (Daucus carota subsp. sativus) fields consisting of leaf curling, a yellowish purply-bronze discolouration of the leaves, as well as a stun...

Bacteremia become fearsome in hematopoietic stem cell transplant (HSCT) recipients with the emergence of multidrug-resistant (MDR) strains.Our purpose was to investigate the prevalence of MDR bacteremia in HSCT recipients at the Tunisian National Bone Marrow Transplant Center, associated factors and attributable mortality rate.Our retrospective study (January 2010-December 2017) included all MDR bacteremia in the Hematology department. MDR rods were: extended spectrum beta-lactamase producing Enterobacterales (ESBL-E), P. aeruginosa and A. baumannii resistant to at least three families of antibiotics, methicillin-resistant S. aureus (MRSA) and vancomycin resistant E. faecium (VRE).The prevalence of MDR bacteremia among HSCT recipients was 5.9% (48/816) with a stable trend over time (rs=0.18). Neutropenia, prior hospitalization, prior antibiotherapy and prior colonization with MDR pathogens were observed in 59%, 58%, 48% and 31% of cases, respectively. Imipenem was the most prescribed first-line antibiotic (50%). The attributable mortality rate was 13%. MDR bacteria (n=48) belonged to ESBL-E (60%), P. aeruginosa (19%), A. baumannii (13%), MRSA (4%) and VRE (4%). For ESBL-E and P. aeruginosa, the rates of antibiotic resistance were respectively, 17% and 44% to imipenem, 31% and 56% to amikacin and 15% and 0% to colistin. Strains of A. baumannii were susceptible only to colistin. The MRSA (n=2) were resistant to ciprofloxacin and gentamicin and susceptible to glycopeptides. The VRE (n=2) were susceptible to linezolid and tigecycline.Low prevalence of MDR bacteremia in HSCT recipients but high attributable mortality rate, requiring reinforcement of hygiene measures.

The purpose of our study was to investigate the epidemiology of coagulase negative staphylococci (CoNS) responsible for bacteremia in hematopoietic stem cell transplant (HSCT) recipients and to determine the prevalence and the genetic background of methicillin resistance. The prevalence of CoNS bacteremia was 7.4% (54/728), higher in allograft (10.7%) than in autograft (4.7%) recipients. A sepsis or a septic shock were observed in 9% of cases. No deaths were attributable to CoNS bacteremia. The methicillin resistance rate was 81%. All MR-CoNS, harbored mecA gene and 90% were typeable with SCCmec typing using PCR amplification. The SCCmec type IV was the most frequent (44%). Clonal dissemination of MR- Staphylococcus epidermidis strains was limited. Our study showed a low prevalence and favorable outcome of CoNS bacteremia in HSCT recipients with limited clonal diffusion. However, they were associated with a significant rate of severe infections and a high rate of methicillin resistance, mediated by SCCmec IV element in most cases.

Introduction A diagnosis of ductal infective endocarditis (DIE) usually relies on the clinical histories of infectious syndrome, results of blood cultures and echocardiography. It remains a therapeutic challenge. The prognosis is still poor. Is the prevention of infective endarteritis a valid reason to always close the isolated silent PDA in childhood? The question is not yet eluded [1] , [2] , [3] , [4] . We present the case of six years old girl with DIE developed after dental procedure. The patient was managed by combined medical and early surgery with favorable evolution. Case report A six year old girl was admitted to our service with tachypnea, fatigue and fever lasting for seven days. The patient had dental procedures few days earlier. The physical examination revealed a temperature at 40 °C and a left subclavian murmur. The acute phase marker levels were significantly elevated and β-hemolytic group A streptococcus was grown in his blood culture. Echocardiography revealed vegetations with the diameter of 10 mm on the left side of the PDA ( Fig. 1 ) with turbulent flow in the left pulmonary artery. Treatment with ceftriaxone 200 mg/kg/day and gentamycin 5 mg/kg/day was started then readapted according to antibiogram. The operation was performed on day 15 of antibiotherapy ( Fig. 2 a and b), whom was continued for 4 weeks. The fever did not return and the clinical course of the patient was stable; the final echocardiogram revealed the absence of left ventricular dilatation with a correct systolic function, normal pulmonary pressure. She was discharged four weeks after the surgical cardiac procedure. Conclusions Infective endarteritis (IE) complicating PDA is very rare nowadays and the risk is very low especially in the industrialized world. Indeed, standardized management by a skilled multidisciplinary team with expertise in imaging, surgery and intensive care has proven to decrease mortality [3] , [4] , [5] , [6] , [7] . Primary prevention is vital. Even though it was not clear if the closure of a small PDA was beneficial, routine closure of any PDA in children and young adults appeared reasonable. The reasons for this recommendation included the risk of infective endocarditis and low-or-zero morbidity from closure, especially when using a transcatheter device [8] , [9] .

Introduction Interrupted aortic arch (IAA) is a rare congenital ductal-dependent heart disease. It commonly presents in infancy following spontaneous closure of the patent ductus arteriosus (PDA) [1] , [2] . Few cases have been reported in pediatric age [3] . We present the case of 13 years old boy with IAA and a large ventricular septal defect (VSD), a restrictive PDA and an Eisenmenger syndrome. Case report A thirteen years old Tunisian boy presented to our consultation with malaise, headache and weakness of his legs. He reported reduced exercise tolerance since two years. There was no family history of congenital heart disease or sudden unexpected death ( Fig. 1 , Fig. 2 ). Physical examinations noted a generalized cyanosis. Radial pulses were normal but his femoral pulses were weak. The systolic pressure difference between the upper and lower limbs was 40 mmHg. Transthoracic echocardiography noted a conal VSD with a posterior malalignment of the conal septum with right to left shunt. The short axis examination showed a large pulmonary tract and a restrictive PDA with an increased velocity of 3.3 m/s and right to left shunt. The high left parasternal examination with a slightly rightward angulation of the transducer demonstrated a complete interruption of aortic arch. Computed tomography revealed an IAA between the left common carotid artery and the left subclavian artery (type B) and a PDA (3.3 mm) between the left pulmonary artery (LPA) and the descending aorta. Pulmonary arterial hypertension was confirmed in cathlab with mean pulmonary arterial pressure (mPAP) at 100 mmHg. Following multidisciplinary team discussion, on regard of patient health state, Eisenmenger syndrome, the restrictive PDA and the contraindication to performing surgery, we discuss the percutaneous stenting of the PDA. Conclusion Interrupted aortic arch is a rare congenital abnormality that presents in infancy. We presented the case of 13 years old boy with IAA, Eisenmenger syndrome and a restrictive PDA. Following multidisciplinary team discussion, giving the restrictive pattern of the PDA and the Eisenmenger syndrome, we discuss a percutaneous of the PDA.

Peliosis hepatis constitutes a rare hepatic benign lesion. Its diagnosis may be challenging especially with carcinomatous lesions. Herein, we reported a case of peliosis hepatis misdiagnosed as colorectal metastases.

Manufacturing job-shops can have uncertainties related to different operations. A time interval is associated with each operation compose of two limits: the minimum time required to perform the operation and a maximum time not to exceed in order to ensure the quality of the manufactured products. The fuzzy sets can be applied to many fields in which uncertainty plays a key role [1]. The uncertain knowledge associated with these discrete event system with time constrains requires specific reasoning and modeling methods. Fuzzy logic provides a framework for the exploitation of fuzzy knowledge, which from a qualitative point of view gives finer results than classical logic. The paper proposes a new approach for monitoring and maintenance of manufacturing systems with time constraints that integrates fuzzy logic and P-time Petri nets (P-TPN) tool. So, in this context, we propose a new fuzzy Petri net able to analyze monitoring and recovery tasks of a discrete event system with time constraints, using a temporal fuzzy approach. The monitoring module is consists of P-time PNs and fault tree. The first is used as modeling tool of normal behavior of the system. The second model corresponds to monitoring model. Finally, to illustrate the effectiveness and accuracy of proposed monitoring approach an application to a winding unit is outlined.

The Arabo-Islamic world of the later medieval period (thirteenth–sixteenth centuries) witnessed substantial transformations in the writing and reading of Arabic literary texts. For a long time, the study of these texts and of their diversity and changes was determined by the model of a “post-classical” literary field in fossilizing decline. In the twenty-first century, however, new trends in literary and historical scholarship have been disengaging from these old, but still widespread, negative paradigms. They have managed to replace a condescending insistence on what Arabic literary texts no longer represented, or could no longer do, for more critical appreciations of what they really were, did, and meant for contemporaries. This special journal issue brings together five articles that were written in the context of a collaborative research project that aims to remedy this challenging situation in current understandings of late medieval Arabic history writing. This project, funded by the European Research Council and entitled “The Mamlukisation of the Mamluk Sultanate-II (MMS-II): Historiography, Political Order, and State Formation in Fifteenth-Century Egypt and Syria,” runs for five years (2017–21) at Ghent University (Belgium). MMS-II is aiming to tackle this challenge by arguing with and beyond, instead of against or irrespective of, this historiographical production’s vexed interests and related subjectivities. The MMS-II project studies more specifically how not just fifteenth-century historians’ truth but also the political order of their courtly surroundings were constructed in textual practice. This introduction seeks to explain in more theoretical, programmatic, and empirical detail why and how MMS-II considers this textual relationship between history writing and dynamics of power to be a valid and valuable—yes, even a necessary—research perspective in the study of fifteenth-century Arabic historiography. It furthermore aims to explain how MMS-II research is unfolding in practice, and how this journal issue’s five articles tie in with this approach as well as with their wider context of fifteenth-century history writing. This introduction pursues these goals by first explaining how MMS-II considers the construction of political order, within the wider framework of a revaluation of the concept and reality of state formation in fifteenth-century Syro-Egypt. It then presents the texts of history with which MMS-II engages, focusing especially on sketching the current state of scholarship on these texts. Third, this introduction explains in more detail how MMS-II research takes up a particular position within that scholarship and aims to connect the study of history writing with that of state formation. Finally, the fourth part summarizes not just how the five articles in this issue of MSR fit into this research program, but also what they contribute to it, both individually and collectively.

The life trajectory of Ibn Taghrībirdī and his career has stirred considerable curiosity and interest among medieval historians and modern researchers. Through their biographical depictions and pointed analysis, they all endeavor to construct a comprehensive rendering of his various historiographical undertakings. Only a few decades after his death in 874/1470, a number of medieval historians began to trace his life-story and career, including al-Sakhāwī (830–902/1427–97) and al-Ṣayrafī (819–900/1416–95), who shed a critical light on his works. The subsequent generation of sixteenth-century historians, showed a more positive assessment of his achievement in the field. Under the pen of Ibn al-ʿImād al-Ḥanbalī, Ibn Taghrībirdī appears as one of the greatest historians of his time. Later, the 1792 publication of a first edition of his Mawrid al-Laṭāfah sparked renewed interest in him and his other works came to the attention of European scholarship through annotated editions and translations. To better ascertain the value of his historiographical works, several attempts to contextualize his writings were made in the twentieth century. Despite decades of extensive research on Ibn Taghrībirdī, few studies have evolved beyond treating his historiographical works as mere “containers of facts” or contextualizing the man and his oeuvre against a complex socio-political background. We are left with a wide-open lane for inquiry to bring a new impetus to his life-story and achievements in historical writing. To help plot a new way forward, the current article will question “dominant narratives” related to Ibn Taghrībirdī’s life and historiographical contributions. What we mean by “dominant narratives” in this context is the bulk of medieval, stereotyped representations and the modern assumptions that engage with his individual trajectory and career, and in which he was regarded as a member of the awlād al-nās or else as a semi-official court historian.