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Inflammatory fibroid polyps (IFPs) are rare submucosal lesions that usually arise in the stomach. It represents 0.1% of all gastric polypoid lesions and are frequently asymptomatic. It’s usually revealed by an abdominal pain. Gastrointestinal bleeding can occur when the polyp is ulcerated. We report a case of a 72-year-old female with an IFP of the prepyloric region. The head of the polyp was thirty-five millimeters in diameter. It was revealed by an upper gastrointestinal bleeding and epigastric pain. An endoscopic resection was performed.

Background Melanoma, an aggressive malignant skin cancer, has the ability to spread both locoregionally and to distant sites. The risk of metastasis is correlated to invasion depth and the presence of ulceration. Although gastrointestinal (GI) metastases are uncommon, gastric involvement is particularly rare. Case presentation We report a case of a 62-year-old male who presented with abdominal pain, dyspepsia, anorexia, and weight loss. On physical examination abdominal masses and hepatomegaly were detected. Radiological imaging showed widespread masses in the abdominal and thoracic regions. Upper GI endoscopy identified an umbilicated protruded lesion with central dark pigmentation at the antro-fundic junction. Histopathological examination and immunohistochemical staining were consistent with melanoma. A subsequent rigorous skin examination uncovered a primary malignant skin melanoma. Due to worsening general condition, the patient received palliative hospice care. Conclusion This report highlights the critical need for vigilant skin examination when encountering gastric lesions with dark pigmentation, which led to the identification of initially undetected cutaneous melanoma.

The compost effects on soil organic matter (SOM) stability were evaluated. Manure at 10 % ratio and compost at 10 %, 20 % and 40 % ratios (v/v) were added to the soil and their effects were compared to unamended control soil after 90-days of greenhouse-experiment. Humic acids (HA) and fulvic acids (FA) were extracted from two different soil-sample layers at 0–15 and 15–30 cm depth. The CHA/CFA ratio and the humification parameters were determined, and the soil-HA were characterized by spectroscopic methods (E4/E6 and FTIR). The humification parameters progress with time were affected by the amendment concentration. After 90 days, the treated soils HA’ FTIR spectra showed an increase in aromatic carbon polycondensation and O-containing groups reflecting the high degrees of molecular associations and humification of soil HA. Compared to 10 % manure application and 40 % compost ratio use, the applications of 10 % and 20 % compost ratios induced higher humification level and highly oxidized HA structure. Moreover, changes in the HA compositional and functional groups were noticed at the upper layer which exhibited higher reactivity compared to the lower layer which displayed more humified SOM. Through the humification process, the HA fraction was improved to reach more stable and complex macromolecules, where aromatic structures were bio-converted into highly functionalized compounds.

Abstract When someone violates a social norm, others may think that some sanction would be appropriate. We examine how the experience of emotions like anger and disgust relate to the judged appropriateness of sanctions, in a pre-registered analysis of data from a large-scale study in 56 societies. Across the world, we find that individuals who experience anger and disgust over a norm violation are more likely to endorse confrontation, ostracism and, to a smaller extent, gossip. Moreover, we find that the experience of anger is consistently the strongest predictor of judgments of confrontation, compared to other emotions. Although the link between state-based emotions and judgments may seem universal, its strength varies across countries. Aligned with theoretical predictions, this link is stronger in societies, and among individuals, that place higher value on individual autonomy. Thus, autonomy values may increase the role that emotions play in guiding judgments of social sanctions.

Abstract The emergence of COVID-19 dramatically changed social behavior across societies and contexts. Here we study whether social norms also changed. Specifically, we study this question for cultural tightness (the degree to which societies generally have strong norms), specific social norms (e.g. stealing, hand washing), and norms about enforcement, using survey data from 30,431 respondents in 43 countries recorded before and in the early stages following the emergence of COVID-19. Using variation in disease intensity, we shed light on the mechanisms predicting changes in social norm measures. We find evidence that, after the emergence of the COVID-19 pandemic, hand washing norms increased while tightness and punishing frequency slightly decreased but observe no evidence for a robust change in most other norms. Thus, at least in the short term, our findings suggest that cultures are largely stable to pandemic threats except in those norms, hand washing in this case, that are perceived to be directly relevant to dealing with the collective threat.

Introduction: Gastrointestinal angiodysplasia (GIAD) is the most common vascular anomaly in the gastrointestinal (GI) tract, yet little is known about the factors favoring their bleeding. Our study aim was to determine the characteristics of patients with GIAD lesions in a Tunisian population and identify the risk factors of bleeding. Patients and methods: A retrospective study was carried out from January 2010 to February 2020 at a tertiary care medical center in Tunisia. Clinical and endoscopic data were collected from each patient’s medical reports. We divided the patients into two groups: group A, patients with symptomatic GIAD; and group B, patients with incidental lesions. Group A was subsequently divided into two subgroups, according to the presence or absence of recurrent bleeding. The groups were compared by clinical, laboratory, and endoscopic features. Results: GIAD was diagnosed in 114 patients, with a mean age of 70 ± 13.3 years. GIAD lesions were mainly located in the colon (n = 72, 63%). Fifty-four patients (47%) presented with GIAD-related bleeding. The bleeding diagnosis was made during endoscopic procedures by visualizing active bleeding and the stigmata of recent hemorrhage in 10 (18.5%) and 12 (22.2%) cases, respectively. Most of the patients were treated by argon plasma coagulation (93%). Predictive factors of bleeding were age > 75 years, number of lesions >10, chronic kidney disease, diabetes mellitus, and coronary artery disease (p: 0.008; 0.002; 0.016; 0.048; and 0.039, respectively). Conclusion: Knowledge of the predictive factors of bleeding aids endoscopists in the decision-making process in cases of angiodysplasia. Resumen: Introducción: La angiodisplasia gastrointestinal (ADGI) es la anomalía vascular más común en el tracto gastrointestinal (GI), sin embargo, poco se sabe de los factores que favorecen su sangrado. El objetivo de nuestro estudio fue determinar las características de los pacientes con lesiones de ADGI en una población tunecina e identificar los factores de riesgo de sangrado. Pacientes y métodos: Se realizó un estudio retrospectivo de enero del 2010 a febrero del 2020 en un centro médico de tercer nivel de Túnez. Los datos clínicos y endoscópicos fueron obtenidos de los reportes médicos de cada uno de los pacientes. Dividimos a los pacientes en dos grupos: el grupo A fue conformado con pacientes con ADGI sintomática y el grupo B con pacientes con lesiones incidentales. El grupo A fue dividido a su vez en dos subgrupos, según la presencia o ausencia de sangrado recurrente. Los grupos fueron comparados por características clínicas, de laboratorio y endoscópicas. Resultados: Se diagnosticó ADGI en 114 pacientes, con una edad promedio de 70 ± 13.3 años. Las lesiones de ADGI se localizaron principalmente en el colon (n = 72, 63%). Cincuenta y cuatro pacientes (47%) presentaron sangrado asociado a ADGI. El diagnóstico de sangrado se realizó durante los procedimientos endoscópicos al visualizar sangrado activo y estigmas de hemorragia reciente en 10 (18.5%) y 12 (22%.2%) casos, respectivamente. La mayoría de los pacientes fueron tratados con coagulación con plasma de argón (93%). Los factores predictores de sangrado fueron la edad > 75 años, el número de lesiones > 10, enfermedad renal crónica, diabetes mellitus y enfermedad de las arterias coronarias (p: 0.008; 0.002; 0.016; 0.048; y 0.039, respectivamente). Conclusión: Conocer los factores de riesgo de sangrado ayuda a los endoscopistas en el proceso de toma de decisiones en casos de angiodisplasia.

Resumen: Introducción: La angiodisplasia gastrointestinal (ADGI) es la anomalía vascular más común en el tracto gastrointestinal, sin embargo, poco se sabe de los factores que favorecen su sangrado. El objetivo de nuestro estudio fue determinar las características de los pacientes con lesiones de ADGI en una población tunecina e identificar los factores de riesgo de sangrado. Pacientes y métodos: Se realizó un estudio retrospectivo de enero del 2010 a febrero del 2020 en un centro médico de tercer nivel de Túnez. Los datos clínicos y endoscópicos fueron obtenidos de los reportes médicos de cada uno de los pacientes. Dividimos a los pacientes en 2 grupos: el grupo A fue conformado con pacientes con ADGI sintomática y el grupo B con pacientes con lesiones incidentales. El grupo A fue dividido a su vez en 2 subgrupos, según la presencia o ausencia de sangrado recurrente. Los grupos fueron comparados por características clínicas, de laboratorio y endoscópicas. Resultados: Se diagnosticó ADGI en 114 pacientes, con una edad promedio de 70 ± 13.3 años. Las lesiones de ADGI se localizaron principalmente en el colon (n = 72, 63%). Presentaron sangrado asociado a ADGI 54 pacientes (47%). El diagnóstico de sangrado se realizó durante los procedimientos endoscópicos al visualizar sangrado activo y estigmas de hemorragia reciente en 10 (18.5%) y 12 (22%.2%) casos, respectivamente. La mayoría de los pacientes fueron tratados con coagulación con plasma de argón (93%). Los factores predictores de sangrado fueron la edad > 75 años, el número de lesiones > 10, enfermedad renal crónica, diabetes mellitus y enfermedad de las arterias coronarias (p: 0.008, 0.002, 0.016, 0.048 y 0.039, respectivamente). Conclusión: Conocer los factores de riesgo de sangrado ayuda a los endoscopistas en el proceso de toma de decisiones en casos de angiodisplasia. Abstract: Introduction: Gastrointestinal angiodysplasia (GIAD) is the most common vascular anomaly in the gastrointestinal tract, yet little is known about the factors favoring their bleeding. Our study aim was to determine the characteristics of patients with GIAD lesions in a Tunisian population and identify the risk factors of bleeding. Patients and methods: A retrospective study was carried out from January 2010 to February 2020 at a tertiary care medical center in Tunisia. Clinical and endoscopic data were collected from each patient's medical reports. We divided the patients into 2 groups: group A, patients with symptomatic GIAD; and group B, patients with incidental lesions. Group A was subsequently divided into 2 subgroups, according to the presence or absence of recurrent bleeding. The groups were compared by clinical, laboratory, and endoscopic features. Results: GIAD was diagnosed in 114 patients, with a mean age of 70 ± 13.3 years. GIAD lesions were mainly located in the colon (n = 72, 63%). Fifty-four patients (47%) presented with GIAD-related bleeding. The bleeding diagnosis was made during endoscopic procedures by visualizing active bleeding and the stigmata of recent hemorrhage in 10 (18.5%) and 12 (22.2%) cases, respectively. Most of the patients were treated by argon plasma coagulation (93%). Predictive factors of bleeding were age > 75 years, number of lesions > 10, chronic kidney disease, diabetes mellitus, and coronary artery disease (P: 0.008, 0.002, 0.016, 0.048; and 0.039, respectively). Conclusion: Knowledge of the predictive factors of bleeding aids endoscopists in the decision-making process in cases of angiodysplasia.

One of the most important components of sepsis management is hemodynamic restoration. If the target mean arterial pressure (MAP) is not obtained, the first recommendation is for volume expansion, and the second is for norepinephrine (NE). We describe the methodology of a randomized multicenter trial aiming to assess the hypothesis that low-dose NE given early in adult patients with sepsis will provide better control of shock within 6 hours from therapy starting compared to standard care. This trial includes ICU septic patients in whom MAP decrease below 65 mmHg to be randomized into 2 groups: early NE-group versus standard care-group. The patient's attending clinician will determine how much volume expansion is necessary to meet the target of a MAP > 65 mm Hg. If this target not achieved, after at least 30 ml/kg and guided by the available indices of fluid responsiveness, NE will be used in a usual way. The latter must follow a consensual schedule elaborated by the investigating centers. Parameters to be taken at inclusion and at H6 are: lactates, cardiac ultrasound parameters (stroke volume (SV), cardiac output (CO), E/E' ratio), and P/F ratio. MAP and diuresis are recorded hourly. Our primary outcome is the shock control defined as a composite criterion (MAP > 65 mm Hg for 2 consecutive measurements and urinary output > 0.5 ml/kg/h for 2 consecutive hours) within 6 hours. Secondary outcomes: Decrease in serum lactate> 10% from baseline within 6 hours, the received fluid volume within 6 hours, variation of CO and E/E', and 28 days-Mortality. The study is ongoing and aims to include at least 100 patients per arm. This study is likely to contribute to support the indication of early initiation of NE with the aim to restrict fluid intake in septic patients. (ClinicalTrials.gov ID: NCT05836272).

In this study, we investigated the potential exploitation of the brown mussel Perna perna (Linnaeus, 1758) in an aquaculture farm (Monastir Bay, Mediterranean Sea, Tunisia). The quality of seawater as well as performance indicators such as Condition Index, length, weight, growth and frequency distribution of the mussel were determined over an annual cycle; from July 2017 to August 2018. Interestingly, P. perna has an extended sexual cycle during the year with two main spawning periods, the first in spring and the second in autumn, when suspended matter and Chlorophyll a were at their maximum concentrations in seawater. Spat mussels and young mussels showed significant growth rates from 1 July 2017 to 31 October 2017. Adult mussels exhibited negative allometric growth and a modal size of 41 to 50 mm. Results showed that several potentially toxic microalgae species developed at low densities in this marine zone. By using Solid Phase Adsorption Toxins Tracker (SPATT); lipophilic toxins including Okadaic acid and yessotoxins were detected at low levels in seawater and may be involved in the positive LSTs (lipophilic shellfish toxins) mouse bioassays in P. perna during the autumn. No other toxins such as paralytic shellfish toxins or amnesic shellfish toxins nor pathogenic bacteria or viruses were detected in P. perna. Altogether, our results suggest that finfish farms in Monastir Bay could be suitable sites for farming P. perna.

Aim: Ruptures of the intra-abdominal vein causing a spontaneous hemoperitoneum in cirrhotic patients is a rare condition. However, diagnosis must be considered early in cirrhotic patients with hematic ascites as a delayed diagnosis with hemodynamic instability is associated with a poor prognosis. Case report: We present the case of a 54-year-old cirrhotic patient who presented a spontaneous hemoperitoneum due to the rupture of the intra-abdominal vein that was diagnosed during exploratory laparoscopy. Conclusion: Early diagnosis and management of spontaneous hemoperitoneum due to the rupture of intra-abdominal vein helps improve its prognosis.

Unlike liver and lung, the stomach is rarely a metastatic location for cancers. We report a case of a 62-year-old man known to have lung adenocarcinoma poorly differentiated presented with melena 1 month after diagnosis. Upper endoscopy revealed an ulcerated tumor in the prepyloric antrum. The diagnosis of gastric metastasis from pulmonary cancer was confirmed by the immunohistochemical staining for the thyroid transcriptional factor-1 and the pattern cytokeratine CK7+/CK20-. In conclusion, gastric metastasis from primary lung cancer is a rare phenomenon that every clinician must keep in mind.

Synchronous multiple primary cancers of the stomach and kidney are very rare, only 45 cases of synchronous multiple primary cancers of the stomach and kidney had been reported in the literature up until 2020. Thus far, no particular risk factors have been identified. We present a case of synchronous multiple primary cancers of the stomach and kidney in a 67-year-old female presenting with a 3-month history of vomiting and abdominal pain. The diagnosis of gastric adenocarcinoma with signet ring cells was confirmed through upper endoscopy with biopsies, while CT-guided biopsies of the renal tumor confirmed the diagnosis of primary kidney neoplasm.

Usually, fatty hepatic infiltration is diffuse and homogeneous. However, in some cases, it can be localized simulating benign or malignant tumors. We present a case of a 61-year-old female patient with family history of malignancy: sister with lung cancer, an other sister with colon cancer and a mother with breast cancer; who presented with multiple hepatic nodules at the ultrasonography images. CT scan and MRI were not sufficient to pose a certain diagnosis which was later confirmed by liver biopsy.