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Date palm ( Phœnix dactylifera L.) like other crop species in the arid Mediterranean region is being threatened by genetic erosion and climate change. Therefore, the understanding and assessment of the diversity extent of this species is a primary requisite for preserving these crop resources. This study was designed to quantify the potential of Tunisian male date palms using a set of agro-morphological characteristics i.e. flowering traits, inflorescence morphology and pollen quality. The flowering time traits exhibited a trend of precocious phenotype at emergence spathe trait and the dominance of the full-season phenotype at the opening date. At inflorescence morphology, all observed traits expressed wide ranges which reflected the broad variability of the evaluated male genotypes. Significant difference was recorded for the majority of the examined traits with a high significant variation in the tree quantitative traits: Spathe Total Length, Spathe Maximum Width and Length to the brunched part. Pollen viability ranged from 51.10% to 98.75% while the germination rate was between 0.90% and 70.50%. Our phenotypic investigation has allowed the identification of males with desirable agronomic traits which have been genotyped using 18 nuclear SSR markers and a chloroplast minisatellite for preservation and effective utilization purposes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Phytoestrogens, with a wide range of beneficial effects, prevent bone loss caused by oestrogen deficiency.The purpose of this study was to evaluate the effect of Medicago sativa ethanol extract compared to 17β-oestradiol on osteoporosis in ovariectomized mice.The study was carried out on female mice, divided into five groups: control mice (GI), Medicago sativa treated mice (0.75 g/kg BW/day) (GII), ovariectomized mice (GIII) and ovariectomized mice treated either with Medicago sativa (GIV) or with 17β-oestradiol (50 µg/Kg BW/day) (GV).Our results showed that Medicago sativa or 17β-oestradiol treatments significantly attenuated perturbations of mineral levels, histological changes and oxidative stress in the femurs of ovariectomized mice. Medicago sativa prevented bone loss induced by oestrogen deficiency, which could be attributed to its richness in kaempferol, syringic acid, naringenin and myrictin. Its effects were more beneficial or similar compared to 17β-oestradiol.

Tunisia is characterized by the presence of specific seed-propagated apricot (Prunus armeniaca L.) material which is found in the oasis agroecosystems. In order to highlight the genetic diversity, population structure, and demographic history of this germplasm, 33 apricot accessions collected from six different oasis regions in southwestern Tunisia were genotyped using 24 microsatellite markers. A total number of 111 alleles was detected with an average of 4.62 alleles per locus. Bayesian model-based clustering analysis indicated four subdivisions within the collection sampled that corresponded mainly to the geographic origin of the material. The analysis of the 33 accessions using chloroplast markers allowed the identification of 32 haplotypes. Overall, the present study highlighted the high Tunisian apricot's diversity in the traditional oasis agroecosystems with low genetic differentiation. Understanding the structure of seed-propagated apricot collection is crucial for managing collections in regard to adaptive traits for Arid and Saharan climates as well as for identifying interesting genotypes that can be integrated into international coordinated actions of breeding programs., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The present study evaluated the antioxidant activity of Salvia officinalis (sage) and its protective effect on estrogen deficiency in ovariectomized rats. Female Wistar rats were treated during either 15 or 30 days as follows: group C: negative controls, group S: positive controls treated with sage leaves, ovariectomized rats (group OVX) and ovariectomized rats receiving either sage (OVX-S) or hormonal (Group OVX-E) treatments, respectively. After 15 and 30 days of treatments, OVX rats showed a gain in body weight and an increase of absolute and relative liver weights. Meanwhile, absolute and relative uterus weights were decreased. Moreover, ovariectomy altered plasma transaminases' activities, lipid profile, and disrupted the redox status of liver and uterine tissues. It affected also the reproductive tract by decreasing the uterus glycogen content and plasma LDH activity. Supplementation of sage via the diet reduced weight gain and oxidative stress resulting from estrogen deficiency. PRACTICAL APPLICATIONS: During menopause, sexual hormone deficiency, especially estrogen, causes several morphological and physiological disturbances in liver and uterus tissues. In fact, the body weight gain and disturbances of redox status in liver and uterus were the main health problems detected after menopause. Sage leaves, used as medicinal plant, exerted its beneficial effects in the management of menopause disorders. As an important source of antioxidants, sage leaves could prevent obesity and oxidative damage in the liver and uterus resulting from estrogen deficiency., (© 2020 Wiley Periodicals LLC.)

We investigated the effects of Medicago sativa supplementation on the lipid profiles and antioxidant capacities of ovariectomized mice.The study was performed on white Swiss female mice that were divided into five groups: control, treated with Medicago sativa (0.75 g/kg/day), ovariectomized, ovariectomized treated with β-estradiol (1 μg/day) or with Medicago sativa . The mice were sacrificed after 3 and 8 weeks of treatment.Ovariectomy induced a decrease in overall growth, uterine atrophy, and hyperlipidemia demonstrated by increased cholesterol, triglycerides, and decreased HDL. We have shown the involvement of oxidative stress in this hepatic lesion proven by increased levels of TBARS, GPX, and GSH, and decreased levels of SOD and catalase.Treatment with Medicago sativa restores lipid balance, the activity of antioxidant enzymes and improves lipid peroxidation. This is probably due to the richness of this plant in polyphenols and flavonoids considered as an antioxidant and phytoestrogenic elements.

The characterization of the largest worldwide representative data set of apricot ( Prunus armeniaca L.) germplasm was performed using molecular markers. Genetic diversity and structure of the cultivated apricot genetic resources were analyzed to decipher the history of diffusion of this species around the world. A common set of 25 microsatellite markers was used for genotyping a total of 890 apricot accessions in different collections from the center of origin to the more recent regions of apricot culture. Using a Bayesian model-based clustering approach, the apricot genotypes can be structured into five different genetic clusters (F ST = 0.174), correlated with the geographical regions of origin of the accessions. Accessions from China and Central Asia were clustered together and exhibited the highest levels of diversity, confirming an origin in this region. A loss of genetic diversity was observed from the center of origin to both western and eastern zones of recent apricot culture. Altogether, our results revealed that apricot spread from China and Central Asia, defined as the center of origin, following three major diffusion routes with a decreasing gradient of genetic variation in each geographical group. The identification of specific alleles outside the center of origin confirmed the existence of different secondary apricot diversification centers. The present work provides more understanding of the worldwide history of apricot species diffusion as well as the field of conservation of the available genetic resources. Data have been used to define an apricot core collection based on molecular marker diversity which will be useful for further identification of genomic regions associated with commercially important horticultural traits through genome-wide association studies to sustain apricot breeding programs., (Copyright © 2020 Bourguiba, Scotti, Sauvage, Zhebentyayeva, Ledbetter, Krška, Remay, D’Onofrio, Iketani, Christen, Krichen, Trifi-Farah, Liu, Roch and Audergon.)

The present study was undertaken to evaluate the effects of Salvia officinalis essential oil (SEO) and simvastatin in hyperlipidemic mice. Animals were randomly divided into four groups. The control group received a standard diet. The high-fat diet (HFD) group received HFD. The third and fourth groups received HFD associated either with simvastatin (2.5 mg/kg bw) or with SEO (4 mg/kg bw). All animals were sacrificed after 8 weeks of treatment. SEO and simvastatin reduced in HFD mice body weight gain, hyperlipidemia, disruption of liver and renal functions and reactive oxygen species production. In fact, total cholesterol, triglycerides, total lipids, and low-density lipoprotein cholesterol levels, as well as aspartate transaminase, alanine transaminase, gamma-glutamyltranspeptidase and lactate dehydrogenase activities were reduced, while fecal lipids increased compared to those of HFD mice. The lipid-lowering effect of SEO was more effective than that of simvastatin. PRACTICAL APPLICATIONS: High-fat diet provokes hyperlipidemia, atherosclerosis, and abnormal lipid metabolism leading to the development of hepatic and renal dysfunctions as well as perturbations of the antioxidant status in liver and kidney. The results of this research highlight the beneficial effects of SEO in the management of these disorders without inducing side effects; in fact, the plant essential oil decreased lipids and improved the antioxidant status more than did a synthetic drug., (© 2020 Wiley Periodicals, Inc.)

The hyperlipidemia is a serious health problem that increases the risk of many complications including cardiovascular disease. This study aims to evaluate the possible antihyperlipidemic effects of the feather protein hydrolysate (FPH) in a mice fed with a high-fat diet (HFD)-fed mice during 5 weeks. The FPH administration improved dose-dependent lipid profile, as well as the liver and renal dysfunction indices in hyperlipidemic mice. The FPH also restored the antioxidant status in liver, kidney, and heart by lowering the lipid peroxidation and enhancing the antioxidant enzymes (catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase [SOD]). Moreover, the histological studies proved that FPH administration prevents hepatic steatosis, glomerular hyperfiltration risk, and cardiac muscle hypertrophy. Accordingly, the FPH is a promising novel medicinal ingredient for possible use in the hyperlipidemic treatment and related complications., Competing Interests: The authors have declared no conflict of interest., (© 2018 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim.)

Context: Presbycusis, an age-related hearing impairment (ARHI), represents the most common sensory disability in adults. Today, the molecular mechanisms underlying presbycusis remain unclear. This is in particular due to the fact that ARHI is a multifactorial complex disorder resulting from several genomic factors interacting with lifelong cumulative effects of: disease, diet, and environment., Objective: Identification of novel biomarkers for presbycusis., Materials and Methods: We selectively ascertained 18 elderly unrelated women lacking environmental and metabolic risk factors. Subsequently, we screened for methylation map changes in blood samples of women with presbycusis as compared to controls, using reduced representation bisulfite sequencing. We focused on hypermethylated cytosine bases located in gene promoters and the first two exons. To elucidate the related gene expression changes, we performed transcriptomic study using gene expression microarray., Results: Twenty-seven genes, known to be expressed in adult human cochlea, were found in the blood cells to be differentially hypermethylated with significant (p < 0.01) methylation differences (>30%) and down-expressed with fold change >1.2 (FDR <0.05). Functional annotation and qRT-PCR further identified P2RX2, KCNQ5, ERBB3 and SOCS3 to be associated with the progression of ARHI., Discussion and Conclusion: Down-expressed genes associated with DNA hypermethylation could be used as biomarkers for understanding complex pathogenic mechanisms underlying presbycusis.

Background: To investigate beneficial effects of Pomegranate seeds oil (PSO), leaves (PL), juice (PJ) and (PP) on brain cholinesterase activity, brain oxidative stress and lipid profile in high-fat-high fructose diet (HFD) induced-obese rat., Methods: In vitro and in vivo cholinesterase activity, brain oxidative status, body and brain weight and plasma lipid profile were measured in control rats, HFD-fed rats and HFD-fed rats treated by PSO, PL, PJ and PP., Results: In vitro study showed that PSO, PL, PP, PJ inhibited cholinesterase activity in dose dependant manner. PL extract displayed the highest inhibitory activity by IC50 of 151.85 mg/ml. For in vivo study, HFD regime induced a significant increase of cholinesterase activity in brain by 17.4% as compared to normal rats. However, the administration of PSO, PL, PJ and PP to HDF-rats decreased cholinesterase activity in brain respectively by 15.48%, 6.4%, 20% and 18.7% as compared to untreated HFD-rats. Moreover, HFD regime caused significant increase in brain stress, brain and body weight, and lipid profile disorders in blood. Furthermore, PSO, PL, PJ and PP modulated lipid profile in blood and prevented accumulation of lipid in brain and body evidenced by the decrease of their weights as compared to untreated HFD-rats. In addition administration of these extract protected brain from stress oxidant, evidenced by the decrease of malondialdehyde (MDA) and Protein carbonylation (PC) levels and the increase in superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels., Conclusion: These findings highlight the neuroprotective effects of pomegranate extracts and one of mechanisms is the inhibition of cholinesterase and the stimulation of antioxidant capacity.

This study investigated the protective and the curative effects of Bacillus subtilis SPB1 crude lipopeptide biosurfactant in alleviating induced obesity complications in rats fed on high-fat-high-fructose diet (HFFD). Male Wistar rats were divided into five groups with the following treatment schedule: normal diet-fed rats (CD), HFFD-fed rats, HFFD-fed rats supplemented with SPB1 biosurfactant from the first day of the experiment (HFFD + Bios1), rats fed on HFFD receiving standard drug (HFFD + Torva), or SPB1 biosurfactant (HFFD + Bios2) during the last 4 weeks of the study. HFFD induced hyperglycemia, manifested by a significant (p < 0.001) increase (20%) in the levels of glucose and α-amylase activity in the plasma, when compared with CD. The administration of SPB1 biosurfactant to rats fed on HFFD reverted back normal blood glucose and α-amylase activity levels. Also, the findings clearly showed that acute oral administration of SPB1 biosurfactant reduced significantly (34%) the peak of blood glucose concentration 60 min after glucose administration, as compared with untreated rats fed on HFFD. Furthermore, renal dysfunction indices such as creatinine and urea as well as the level of angiotensin I-converting enzyme (ACE) exhibited remarkable increases in serum of rats fed on HFFD by 28.35%, 46%, and 92%,. Interestingly, SPB1 lipopeptides treatments decreased the creatinine and urea levels significantly (p < 0.001) near normal values, as compared with that of the HFFD group, and also showed an improvement of the kidney cortex architecture. Moreover, SPB1 biosurfactant displayed a potent inhibition of ACE activity in vitro (CI 50  value=   1.37 mg/mL) as well as in vivo in obese rats by 42% and 27.25% with HFFD + Bios1 and HFFD + Bios2 treatments, respectively, and comparatively with the HFFD group. Besides, SPB1 lipopeptides treatments improved some of serum electrolytes such as Na + , K + , Ca 2+  , and Mg 2+ . The results showed that SPB1 lipopeptide biosurfactant presented useful hypoglycemic and antihypertensive properties, and was able to alleviate renal lipid deposition in rats fed on a hypercaloric diet.

This study was aimed to assess the plausible anti-obesity effects of Bacillus subtilis SPB1 crude lipopeptide biosurfactant on high fat high fructose diet-fed rats (HFFD). Male Wistar rats were divided into five groups with the following treatment schedule: normal diet (CD), HFFD, HFFD supplemented with SPB1 biosurfactant from the first day of the experiment (HFFD+Bios1, 10mg/kg/day), HFFD receiving standard drug (HFFD+Torva, 10mg/kg/day) or SPB1 biosurfactant (HFFD+Bios2, 10mg/kg/day) during the last 4 weeks of the study. The results showed an increase in body weight of HFFD by ∼19% as compared to controls (CD). Moreover, serum lipase activity underwent a threefold increase which led to an increase in the levels of total cholesterol (T-Ch), triglycerides (TG) and LDL-cholesterol (LDL-Ch) in serum of untreated HFFD, as well as a rise in the calculated atherogenic index (AI). Furthermore, liver dysfunction indices such as AST, ALT, CPK, LDH, GGT, ALP and T-Bilirubins exhibited remarkable increases in serum of HFFD as compared to controls (CD). Whereas, the administration of Bacillus subtilis SPB1 biosurfactant to HFFD improved the body weight gain and serum lipids profile and reverted back near normal the activities of lipase and liver toxicity indicators. In addition, notable protective and curative effects were reported in liver tissues. Overall, these results suggest that the lipopeptides biosynthesized by Bacillus subtilis SPB1 achieved an anti-obesity effect through the inhibition of lipid digestive and liver dysfunction enzymes., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Purpose: Usher syndrome accounts for about 50% of all hereditary deaf-blindness cases. The most severe form of this syndrome, Usher syndrome type I (USH1), is characterized by profound congenital sensorineural deafness, vestibular dysfunction, and retinitis pigmentosa. Six USH1 genes have been identified, MYO7A, CDH23, PCDH15, USH1C, SANS, and CIB2, encoding myosin VIIA, cadherin-23, protocadherin-15, harmonin, scaffold protein containing ankyrin repeats and a sterile alpha motif (SAM) domain, and calcium- and integrin-binding member 2, respectively., Methods: In the present study, we recruited four Tunisian families with a diagnosis of USH1, together with healthy unrelated controls. Affected members underwent detailed audiologic and ocular examinations. We used the North African Deafness (NADf) chip to search for known North African mutations associated with USH. Then, we selected microsatellite markers covering USH1 known loci to genotype the DNA samples. Finally, we performed DNA sequencing of three known USH1 genes: MYO7A, PCDH15, and USH1C., Results: Four biallelic mutations, all single base changes, were found in the MYO7A, USH1C, and PCDH15 genes. These mutations consist of a previously reported splicing defect c.470+1G>A in MYO7A, three novel variants, including two nonsense (p.Arg3X and p.Arg134X) in USH1C and PCDH15, respectively, and one frameshift (p.Lys615Asnfs*6) in MYO7A., Conclusions: We found a remarkable genetic heterogeneity in the studied families with USH1 with a variety of mutations, among which three were novel. These novel mutations will be included in the NADf mutation screening chip that will allow a higher diagnosis efficiency of this extremely genetically heterogeneous disease. Ultimately, efficient molecular diagnosis of USH in a patient's early childhood is of utmost importance, allowing better educational and therapeutic management.

The present study aimed to scrutinize the potential of Bacillus subtilis SPB1biosurfactant, orally administered, for preventing diabetic complications in rats. The findings revealed that, Bacillus subtilis biosurfactant was an effective reducer of α-amylase activity in the plasma. Moreover, this supplement helped protect the β-cells from death and damage. Both the inhibitory action of SPB1 biosurfactant on α-amylase and the protection of the pancreas' β-cells lead to a decrease of the blood glucose levels, consequently antihyperglycemic effect. Interestingly, this lipopeptide biosurfactant modulated key enzyme related to hyperlipidemia as lipase; which leads to the regulation of the lipid profile in serum by the delay in the absorption of LDL-cholesterol and triglycerides, and a significant increase in HDL-cholesterol. Histological analyses also showed that it exerted a protective action on the pancreases and efficiently preserved the liver-kidney functions of diabetic rats, evidenced by significant decreases in aspartate transaminase, alanine transaminase, gamma-glytamyl transpeptidase and lactate deshydrogenase activities in the plasma, as well as in the creatinine and urea contents. Overall, the present study demonstrated that the hypoglycemic and antilipidemic activities exhibited by Bacillus subtilis biosurfactant were effective enough to alleviate induced diabetes in experimental rats. Therefore, SPB1biosurfactant could be considered as a potential strong candidate for the treatment and prevention of diabetes., (© 2015 Wiley Periodicals, Inc.)

This study aims to evaluate the impact of androgen therapy on metabolic and inflammatoy profiles in male hypogonadic patients. Forty cases with isolated hypogonadism and 80 controls were enrolled. Clinical data were collected (age, weight, height, waist circonference and androgenothearapy). Blood tests were performed to evaluate testosterone, homeostasis index modal assessment (HOMA-IR), lipids and C reactive protein (CRP). Among hypogonadic patients, 14 of them were treated for 4 +/- 3.4 years. Amongst them testosterone levels were significantly elevated comparatively to non-treated patients and significantly lower than controls. Significant differences were noted on waist circumference between non treated patients and controls. Body mass index and HOMA-IR were significantly higher in non-treated patients. Triglycerides and HDLc were significantly decreased respectively in treated and non-treated patients. However, CRP levels were significantly decreased in controls. In conclusion, androgen therapy appeared to protect against obesity, insulin resistance, and hyperlipidemia. Effects on systemic inflammation seemed to be more discrete. Testosterone substitution should be strongly indicated in daily practice with careful prostate monitoring.

We conducted a survey of the National Centre for Biotechnology Information (NCBI) PubMed database to identify methods most commonly used for the evaluation of the effect of plant food supplements on the cardiovascular system and their relevance to the regulatory status of these products. Particularly, our search strategy was aimed at the selection of studies concerning the clinical evaluation of the beneficial effects of the most commonly studied plant food supplements acting on the cardiovascular system. Following the screening of 3839 papers for inclusion criteria, 48 published reports were retained for this review. Most studies included in this review used a double blind controlled design, and evaluated the effect of plant food supplements on individuals affected by a disease of the cardiovascular system. The majority of the studies were found to be of low methodological quality on the Jadad scale, mainly because of inadequate reporting of adverse events and of patient withdrawals. In comparison, measures used for the evaluation of benefits included mostly cardiovascular risk factors as recommended in international guidelines and in accordance with principles laid down for the evaluation of health claims in food. The risk factors most frequently evaluated belonged to the category of "lipid function and levels", "heart function" and "blood pressure". For the absolute majority of the studies, the study period did not exceed one month. This review highlights critical factors to be considered in the design of studies evaluating the health effects of plant food supplements on the cardiovascular system. Between others, the inclusion of healthy individuals, better reporting and description of the characteristics of the product used could improve the quality and relevance of these studies.

Background: Domestication generally implies a loss of diversity in crop species relative to their wild ancestors because of genetic drift through bottleneck effects. Compared to native Mediterranean fruit species like olive and grape, the loss of genetic diversity is expected to be more substantial for fruit species introduced into Mediterranean areas such as apricot (Prunus armeniaca L.), which was probably primarily domesticated in China. By comparing genetic diversity among regional apricot gene pools in several Mediterranean areas, we investigated the loss of genetic diversity associated with apricot selection and diffusion into the Mediterranean Basin., Results: According to the geographic origin of apricots and using Bayesian clustering of genotypes, Mediterranean apricot (207 genotypes) was structured into three main gene pools: 'Irano-Caucasian', 'North Mediterranean Basin' and 'South Mediterranean Basin'. Among the 25 microsatellite markers used, only one displayed deviations from the frequencies expected under neutrality. Similar genetic diversity parameters were obtained within each of the three main clusters using both all SSR loci and only 24 SSR loci based on the assumption of neutrality. A significant loss of genetic diversity, as assessed by the allelic richness and private allelic richness, was revealed from the 'Irano-Caucasian' gene pool, considered as a secondary centre of diversification, to the northern and southwestern Mediterranean Basin. A substantial proportion of shared alleles was specifically detected when comparing gene pools from the 'North Mediterranean Basin' and 'South Mediterranean Basin' to the secondary centre of diversification., Conclusions: A marked domestication bottleneck was detected with microsatellite markers in the Mediterranean apricot material, depicting a global image of two diffusion routes from the 'Irano-Caucasian' gene pool: North Mediterranean and Southwest Mediterranean. This study generated genetic insight that will be useful for management of Mediterranean apricot germplasm as well as genetic selection programs related to adaptive traits.

Objective: To study the evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle) (ECUD-M) associated with ileocystoplasty., Patients and Methods: Over 18 years from 1992 to 2009, ECUD-M with ileocystoplasty was performed in 120 patients with mean age of 25.5 years. Renal impairment was evident in 43 patients (17 children and 26 adults)., Results: Ninety percent of patients demonstrated a neurologic bladder and mild to moderate renal failure. Initially, all patients underwent continuous bladder drainage for a mean of 3 weeks. Renal function improved in 35 patients, although with persistent mild renal insufficiency. The other patients demonstrated moderate persistent residual renal insufficiency. During a mean follow-up of 10 years (range, 1-18 years), renal function returned to normal in 13 patients, stabilized at lower values in 15, and remained moderate in 5. After a mean follow-up of 8 years (range, 6-12 years), renal failure gradually worsened, increasing to higher values in 6 patients and leading to hemodialysis in 4. One patient underwent living-donor kidney transplantation, with good evolution., Conclusion: ECUD-M with ileocystoplasty can lead to normalization unless stabilizationof impaired residual renal function by eliminating the obstructive factor provides self-adequate management of the diversion. The procedure delays for the need forhemodialysis therapy, and enables patients to prepare for kidney transplantation into a previously reconstructed lower urinary tract., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: To determine predictive factors of mortality among children after isolated traumatic brain injury., Materials and Methods: In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay., Results: There were 276 patients with 196 boys (71%) and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%). Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS) was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS) was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM) was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4%) died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98), neurovegetative disorder (OR: 7.1), meningeal hemorrhage (OR: 2.74), and lesion type VI according to Marshall tomographic grading (OR: 13.26)., Conclusion: In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.

Apricot was introduced into the Mediterranean Basin from China and Asian mountains through the Middle-East and the Central Europe. Traditionally present in Tunisia, we were interested in accessing the origin of apricot species in the country, and in particular in the number and the location of its introductions. A set of 82 representative apricot accessions including 49 grafted cultivars and 33 seed propagated 'Bargougs' were genotyped using 24 microsatellite loci revealing a total of 135 alleles. The model-based Bayesian clustering analysis using both Structure and InStruct programs as well as the multivariate method revealed five distinct genetic clusters. The genetic differentiation among clusters showed that cluster 1, with only four cultivars, was the most differentiated from the four remaining genetic clusters, which constituted the largest part of the studied germplasm. According to their geographic origin, the five identified groups (north, centre, south, Gafsa oasis and other oases groups) enclosed a similar variation within group, with a low level of differentiation. Overall results highlighted the distinction of two apricot gene pools in Tunisia related to the different mode of propagation of the cultivars: grafted and seed propagated apricot, which enclosed a narrow genetic basis. Our findings support the assumption that grafting and seed propagated apricots shared the same origin.

Introduction: Small cell osteosarcoma (SCO) is a rare bone tumour representing 1.3% of all osteosarcomas. This rare variety of osteosarcoma tends to arise in the metaphysis of long bones and may extend secondary to epiphysis. By histopathology, the tumour is composed of small round cells with a variable degree of osteoid production. We report a new case of SCO in the distal femur with epiphyseal involvement. We also present the clinical, radiologic and therapeutic features of SCO with particular emphasis on the pathologic features that allow differentiation of this neoplasm from other small round cell tumours., Observation: A 14-year-old girl presented with a 6-month history of a painful tumefaction of the left knee with motor deficit. Imaging analysis of the knee demonstrated a lytic lesion of the metaphysis in addition to epiphysis of the distal femur with cortical destruction and invasion of soft tissues. Histological examination of a biopsy specimen showed sheets of neoplastic small round cells simulating Ewing's sarcoma. Osteoid was focally present. A diagnosis of SCO was made. The patient received 2 cycles of adjuvant chemotherapy with ifosfamide, adriamycin and cisplatin. MRI showed no change in tumour size. An en bloc, wide-margin resection of the lesion was performed. Histological examination showed a viable tumour with few necrotic foci. The patient received adjuvant chemotherapy with Holoxan and VP16. The clinical response was favourable., Conclusion: SCO is a rare clinical entity with a high grade of malignancy that must be distinguished from other round cell tumours, particularly Ewing's sarcoma, in order to optimise treatment protocols.

Aim: To determine epidemiological, causes, clinical and Para clinical manifestations and outcome in children with traumatic head injury in south Tunisia., Methods: A retrospective study over a 8 year period (1997-2004) of 454 children's with head injury admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during the ICU stay., Results: Mean age (+/- SD) was of 7.2 +/-3.8 years. The main cause of trauma was traffic accidents (69.4%). There were a predominance of male patient's with a sex-ratio of 2.21. The Score of coma of Glasgow adapted to the child, was on average from 8 +/- 3 points. Extra-cranial pathology was present were observed in 38.9%. The cerebral CT-Scan performed on admission for all patients was pathological in 86.3% of the cases. The most observed lesions were meningeal Haemorrhage (35.2%) and the cerebral contusion (34.5%). According to the "Traumatic Coma Dated Bank classification" we noted a high proportion of type 2 group (46%). Secondary systemic insults were observed in 377 children (83%). Evolution was marked by the death of 82 children (18%). Among survivors, a good recovery was observed in 229 children (50.4%)., Conclusion: In Tunisia, head injury is a frequent cause of hospitalization. It is essentially involved in traffic accidents. The short term prognosis is poor with a high (18%) mortality. Prevention is highly advised.

Unlabelled: Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores., Material and Methods: This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales., Results: The study population consisted of 38 women and 21 men (mean age: 61 years; range 46-75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4-12). The VAS score for pain at rest dropped from 68.3+/-31 to 28.3+/-12 (p<10(-3)) over the follow-up period. The score for pain during effort fell from 82.5+/-36 to 40.3+/-15. In all cases, active joint mobility was better at the final assessment (p<0.001). The Constant score rose from 28.8+/-14.2 to 51.6+/-21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r=0.62) and during effort (r=0.59) and with the increased Constant score., Conclusion: Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.

Cancers and hepatoprotective prevention using traditional medicines have attracted increasing interest. The aim of our study was to characterize the putative protective effects of ethanol and chloroform extracts of Peganum harmala on thiourea-induced diseases in adult male rat. We seek to determine the effects of these plant extracts on body weight, thyroid and endocrine cancer parameters. In addition the putative hepatoprotective effect was checked by the determination of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and the bilirubin level in the blood. Our data show that ethanol and chloroform extracts of Peganum harmala protected the animal against the carcinogenic effects induced by thiourea since neuron-specific enolase (NSE) and thyroglobulin (TG) levels were back to the normal range. In addition, the observed-hepatocytotoxicity after thiourea treatment was greatly reduced (AST and ALT activities were respectively 270 IU/l and 60 IU/l and in the same order of magnitude as in the untreated rats) as well as the bilirubin levels (6 micromol/l) especially for animals receiving the choroform preparation. Therefore we may suggest that extracts of Peganum harmala are efficient to reduce the toxicity induced by thiourea in male rat as far as the above parameters are concerned.

Aim: To establish predictive values for the six minutes walk test (6MWT) specific to subjects old more than 40 years from Tunisian population and to compare them with the other pre-established reference equations., Methods: 155 voluntary Tunisian subjects, including 75 women, from 40 to 80 years old, sedentaries, no smokers, and without acute or chronic pathologies carried 2 TM6m in a hospital corridor on a way of 30 meters length according to the American Thoracic Society recommendations. Covered distance, heart rate and level of dyspnea were given during each 6MWT., Results: The covered distance was better at the second 6MWT and was significantly different from the predicted values from pre-established equations. Age, sex, weight and size contributed in a multiple linear regression model to explain 60% of the variance of the covered distance and to establish the following regression equation: calculated distance (m) = 299.8 - (4.34 * ageyears) + (342.6 * heightm) - (1.46 * weightkg) + (62.5 * sex) with sex=1 for men and 0 for women and the lower Limit of the normal = calculated distance--124.5 m, Conclusion: The use of the regression equation established in this study would be adapted to the subjects between 40 and 80 years old and pertaining to the Tunisian population, and its use must be limited to these criteria.

The development of a lung cancer in young patients with emphysematous bullae is a classical, albeit rare, event. These patients can however be operated upon for the resection of a giant bulla causing respiratory distress. We report the case of a 41 year old male patient who was submitted to the resection of a giant right apical emphysematous bulla. The histopathological examination of the fragment revealed an undifferentiated lung carcinoma the diameter of which was less than one centimeter. This observation underlines the need for a systematic examination of the resected material and for a careful radiological follow-up of such patients.

Background: It's generally agreed that calcified liver cystic Echinococcosis (CE) is associated with negative serology; the influence of other cystic features on serologic result remains unclear. The aim of this study is to determine predictive factors of negative indirect passive hemagglutination (IHA) in liver CE., Methods: 119 patients operated on for liver CE, had preoperative IHA. Correlation was studied between serological result and sex, age of patient and number (single vs multiple), size, ultrasonic type (unilocular, multivesicular, degenerative) and intrabiliary rupture of cyst., Results: IHA sensitivity was 74.8%. Univaried analysis showed that false negative serology was correlated with age <10 or >20 years (p < 0.01), single cyst (p < 0.006), cystic size <9 cm (p < 0.03) and unilocular or degenerative cyst in comparison with multivesicular type (p < 0.01 and p < 0.03 respectively)., In Conclusion: in liver CE, cystic predictive factors of false negative IHA are single cyst, unilocular or degenerative type and size inferior to 9 cm.

Amplified fragment length polymorphism (AFLP) has been proposed as a valuable tool for finding molecular markers linked to QTL controlling architectural trait. Segregation of polymorphic AFLP fragments was followed in F2 offsprings Hedysarum coronarium derived from two native wild accesions crossing: Jebel Zit x El Haouaria, which had previously characterised by morphological and AFLP markers. A comparison of profiles from the morphologically contrasted parental individuals and F2 offspring has been assessed using five AFLP primer combinations. These generated 178 bands revealed by silver-stained denaturing polyacrylamide gels, of which 150 were polymorphic. Several AFLP markers appeared to be implied in the orthotropic form that can assist the selection and improve Hedysarum forage crop.

Objectives: To analyze the clinico-biological manifestations, identify the causes and evaluate the outcome of patients with severe thrombotic microangiopathies admitted in a Tunisian intensive care unit., Methods: Retrospective study over a period of 10 years (1995-2004) in an intensive care unit., Results: Were included in this study 9 cases with a mean age of 29.2+/-9 years (range 15-44 years). Fever was observed in 5 patients, neurological impairment in 5 and digestive manifestations in 6. Haemolytic anaemia, thrombocytopenia and acute renal failure were observed in 100% of the cases. In our study, the aetiologies of thrombotic microangiopathies were: complicated pregnancy in 6 cases, systemic lupus erythematosus in 1 case. In contrast, no aetiology was found in 2 patients. Plasma exchange was performed in 5 patients, while 4 patients received only plasma infusion. After an average stay of 18+/-12.5 days, evolution was marked by the death 3 patients., Conclusion: The incidence of severe thrombotic microangiopathies is rare in Tunisian ICU. The clinical manifestations are not specific. Despite the improvement in the outcome by exogenous plasma supply, thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with a high mortality rate.

Aim: A restrospective study was carried in order to evaluate the efficacy and safety of retrobulbar anaesthesia during keratoplasty., Methods: Of 250 consecutive keratoplasty, 30 (12%) were performed under retrobulbar anaesthesia. Patients received a mean volume of 12 ml, composed of etidocaine (2/3), bupicaine (1/3) and hyaluronidase. Ocular compression duration was at least 20 minutes., Results: Surgery was found painless by 90% of patients. Akinesia was complete in 80% of cases., Conclusion: Theses results demonstrate that retrobulbar anaesthesia may be recommended to this type of surgery.

Introduction: Complete androgen insensitivity syndrome or testicular feminization syndrome (TF) is the most common form of male pseudohermaphrodism, caused by a failure of androgen receptor binding. Patient with male genotype 46 XY, has a female morphotype with well developed external sexual organs., Exegesis: - We report the case of a 29 year-old girl with a TF syndrome discovered during the exploration of a primary amenorrhoea. Bilateral orchidectomy was performed. The testis were immature; they showed bilateral leiomyoma of the tunica albuginea and multiple hamartomas on the right side., Conclusion: Benign tumors are developped in 80% of cases of TF and they are generally hamartomatous nodules of testis. Association of paratesticular leiomyoma to synchronous hamartoma has never been described, its histogenesis is discussed.

Objectives: To summarize the difficulties involved in translating tests in Arabic and to describe the translation methods and to apply those to functional indexes., Method: Four functional indexes were translated and then subjected to the following test validation methods: back translation, pre-test, and review by an expert committee., Results: Translation problems were underlined. These include in particular the different types of equivalence between the source language and the target language (semantics, idioms, conceptual... equivalences). Problems related to comprehensive literal words were the most observed., Conclusion: The current method combining translation with back translation is not sufficient and must be used with, a pre-test and a review committee.

Objective: To translate into Arabic and validate the Oswestry index for low back pain in an Arab population., Background: No functional disability index to assess low back pain written in the Arabic language and validated in an Arab population is available., Design: Arabic translation of the Oswestry index was obtained by the "forward translation/backward translation" method. Adaptations were made after a pilot study involving ten patients aged 18 to 65 years old. Impairment outcome measures (pain as measured on a visual analog scale [VAS], Schober-McRae, index, duration of morning stiffness and number of night awakenings), disability (Quebec index, Waddell index), handicap (as measured on a VAS) and Beck depression scale scores were recorded. Inter-rater reliability was assessed by use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of the Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis was performed. Internal consistency was assessed by use of the Cronbach alpha coefficient., Results: Eighty Tunisian patients with low back pain were included in the validation study. Two items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 58.19% of the cumulative variance: the first factor represented discomfort in dynamic activities, the second discomfort in static activities. The Cronbach alpha coefficient was 0.76 for factor 1 and 0.70 for factor 2., Conclusion: We translated into and adapted the Oswestry index for the Arabic language in a population of Tunisian women? with low back pain. The 8-item version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further study is needed to confirm such a hypothesis.

Objective: To search influence of measurement technique of thoracic gas volume(Vgt) and airway resistance(Raw) by plethysmography on results., Materials and Methods: 20 healthy subjects, aged 22.75 + 0.40 years were studied. Vgt and Raw were measured by series of gentle panting manoeuvres (GPM) or calm respiration (CR) before and after closure of a shutter valve. So, four methods were compared : method 1 (M1) CR before ahd after, method 2 (M2): CR before and GPM after, method 3 (M3) GPM before and CR after, and method 4 (M4): GPM before and after the closure of the shutter valve. Five tests were maked with each method., Results: There is no significant inter-tests variability with each method. Raw(cm H2O/L/s) measured by M1 and M2 were so elevated if compared to M3 and M4 (M1 : 2.65 + 0.102; M2: 2.47 + 0.171; M3: 1.21 + 0.080; M4: 1.30 + 0.102 ; p < 0.05). There is also a significant variability intermethods in Vgt I): (M1: 3.53 + 0.188; M2 : 3.60 + 0.203; M3 : 3.91 + 0.262; M4: 3.84 + 0.247; p < 0.05)., Conclusion: The plethysmography measurement method must be considered in the interpretation of Vgt and Raw values.

Objective: To translate in Arabic and validate the Lequesne index for use in Tunisian., Background: No instrument wording in Arabic language and validated in an Arab population to measure lower limb functional disability caused by OA., Design: Arab translation was obtained using the "forward translation/backward translation" method. Adaptations were made after a pilot study. Patients with symptomatic knee osteoarthritis fulfilling the revised criteria of the American College of Rheumatology were included. Impairment outcome measures (VAS pain; knee mobility; Kellgren's radiological score); disability (the maximum distance walked; WOMAC index) and Beck depression scale were recorded. Inter rater reliability was assessed using the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using the Spearman rank correlation coefficient (convergent and divergent validities) and a factor analysis was performed. Internal consistency of each factor was assessed by Crohnbach alpha coefficient., Results: One hundred and three patients were included. All questions were acceptable and retained. Inter rater reliability was excellent with ICC = 0.91. The Bland and Altman method showed distribution of differences homogenous and no systematic trend. Expected divergent validity and convergent validity were observed, suggested good construct validity. Two main factors were extracted by factor analysis of the Lequesne, and explained more than 55% of the cumulative variance, the first factor represents disability and the second represents pain and stiffness. Crohnbach alpha coefficient was, respectively, 0.68 for factor 1 and 0.54 for factor 2. In conclusion, we translated and adapted the Lequesne index into Arabic to suit Tunisian people. Translated questionnaire is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it can suit other Arab populations especially North Africans. Further studies are needed to confirm such hypothesis.

A case of intra-biliary rupture of pancreatic hydatid cyst is presented. The site of the cyst in the pancreatic head, cholangitis, the advanced age of patient, previous history of cholecystectomy, liver hydatidosis and gastrectomy for ulcer disease, led to diagnostic and therapeutic difficulties. As in some cases of intra-biliary rupture of the liver hydatid cyst, surgical treatment of this pancreatic hydatid cyst included evacuation of cystic contents through choledocotomy and biliary-enteric anastomosis with uneventful postoperative course.

The survey was performed during the month of March 1998 and concerned 9 ICUs located in teaching hospitals. To be included each ICU had to MV for more than 12 hours were included in the study and had a 28 day follow-up in the ICU or until hospital discharge. Collected parameters were indications of MV, modalities of MV and of weaning, complication and outcome at hospital discharge. Assist-control ventilation was the most used ventilation modality (69.8%). Weaning of MV was performed in 63% of the study patients and was based on a once-a-day attempt of spontaneous breathing through a T-piece (59.5%) and a combination of intermittent mandatory ventilation with pressure support (IMV-PS: 27%) or pressure support alone (11.2%). Mean length of hospital stay was 19.7 +/- 15.9 days of which 11.6 days were spent in the ICU. Fifty nine patients (54%) were alive at discharge form the ICU of whom 4 ultimately died during their hospital stay. MV practice as well as ICU facilities are not homogenous in Tunisia. Recommendations and guidelines should be built in order to standardize MV practice in Tunisia.

In order to appreciate the repercussion of diabetes on the respiratory function, we measured the pulmonary volumes, the ventilatory flows, the airways resistances (Raw) and the diffusing capacity for the carbon monoxide (DLCO) of 49 diabetes distributed into 27 IDDM and 22 NIDDM aged from 15 to 56 years, compared to 31 control subjects. We found a significant decrease in the total pulmonary capacity (TCL), the vital capacity (VC), the inspiratory capacity (IC), the ventilatory flows and the DLCO. The decrease of the VC and the FEV1 will be more marked in the IDDM. The decrease of the DLCO will be more pronounced within masculine sex, it seems to be correlated with the duration of diabetes and more impaired if a diabetic nephropathy is associated especially in IDDM. Our results suggest that in the diabetes evolution, the lung is among the target organs in the degenerative complications. The respiratory tests reflect the pulmonary reach in the diabetes and provides important perspectives in the following.

Spinal spondylosis is rarely implicated in syringomyelia. We report the case of a 70-year-old patient with a 10-year history of gait disturbance; constrictive pain of lower limbs and urinary incontinance. Physical examination disclosed spastic tetraparesis. In the upper limbs, deep tendon reflexes were abolished, with hyposthesia and hands amyotrophy. Brain and cervical MRI showed syringomyelobulbia with cervical spondylotic myelopathy. Extensive cervical laminectomy induced a mild clinical improvement. A second MRI performed 6 months after surgery depicted a complete disappearance of the bulbo-medullar cavitation with secondary atrophy. Extradural spondylotic compression of the spinal cord should be firmly considered as an etiology of syringomyelia. A purely extradural decompression could be sufficient to induce regression of the medullary cavitation.

We report a case of otomycosis due to Scopulariopsis brevicaulis in a patient with left cholesteatomatous chronic otitis media who presented with otorrhea associated with left otalgia. Scopulariopsis brevicaulis is a fungus which is rarely described as causing otomycosis although it is a saprophyte and widespread in the environment. In this case the contamination could be due to intensive gardening with poor hygiene. Its mycologic diagnosis is relatively easy and nystatin remains the most effective treatment in this region.

Purpose: Ocular cicatricial pemphigoid (OCP) is a chronic progressive disease characterised by exacerbations of immunologically driven conjunctival inflammation. In the advanced stages of the disease, severe xerosis with mechanical factors may contribute to the development of blinding keratopathy. The authors report two cases of penetrating keratoplasty (PK) in patients with OCP and discuss the modalities of the surgical procedure for this particular disease., Methods: Two patients with stage III OCP according to Foster's classification, underwent PK. Initial and final visual acuity, indications of PK, surgical procedure, postoperative therapy, and complications were recorded., Results: For the first patient, after 3 months of follow-up, the graft is still clear, with a remarkable improvement in vision (3/10). For the second patient, however, graft rejection developed 15 days after the operation, complicated later by endophthalmitis, which was controlled with an antibiotic., Discussion: The progression of ocular pemphigoid involves the filling of the conjunctival fornices, formation of symblepharon with lagophthalmos, and dry eye, from which blinding keratopathy can originate. A corticosteroid-based or immunosuppressant treatment blocks the progression of the fibrosis but does not get rid of palpebrale or corneal anomalies, making surgery necessary. This surgery generally gives disappointing results and should be planned when the disease is perfectly under control, during a lull in the disease so as to avoid reactivation of the fibrosis process. Reconstruction of the conjunctival fornices should also precede any corneal transplantation., Conclusion: These results indicate that PK may be performed to restore of sight in patients with advanced OCP after controlling the primary immunological process and aggressive treatment of the mechanical factors damaging the ocular surface.

Introduction: Pterygium is a fibrovascular overgrowth of bulbar cunjonctiva over the cornea and may produce visual impairment. Many surgical techniques and adjunctive therapies have been proposed but recurrence remains frequent., Materials and Methods: We report a prospective study of 52 eyes treated by limbal conjunctival autograft for primary and recurrent pterygium. We compare our results with the technique of simple excision performed in 111 cases of pterygium (3 being a recurrent pterygium)., Results: The mean age of the patients was 45 years. 30 cases of pterygium were primary (57.7%) and 22 were recurrent (42.3%). After an average follow-up of 14 months, the incidence of recurrence was 10%. Only 2 of these recurrent cases of pterygium were primary., Discussion: Conjunctival autograft is a simple, safe, and highly effective procedure for the treatment of pterygium. It reduces the rate of recurrence more than simple excision (55.9% after a follow-up of 1 year)., Conclusion: The introduction of limbal conjunctival autograft for the treatment of pterygium meets three main goals: safety, good optical outcome and a lower rate of recurrence. This procedure could be accepted as a successful technique for cases with recurrent pterygium specially in younger patients and when the environment al factors lower the development of recurrent pterygium.

Mucormycosis is a rare opportunistic infection but a fulminant disease. We report the 4 first cases of rhinocerebral mucormycosis diagnosed in Sfax region (Tunisia). They occurred in insulin dependent diabetes and developed varying clinical manifestations from facial cellulites to ocular and cerebral extension. The diagnosis of mucormycosis was not initially evoked, but confirmed tardively by anatomopathologic and mycologic examinations. The evolution was favourable in 2 cases by administration of amphotericine B associated with extensive surgical debridement and correction of the diabetes. Two patients had a fatal outcome. This infection has a severe prognosis and necessitates early diagnosis.

Background: Tuberculoma of the brain is rare, and its location in the cavernous sinus is exceptional. Many factors make the diagnosis difficult, necessitating a surgical procedure., Case Description: A 44-year-old woman complained of persistent headaches and diplopia. The examination revealed a right cavernous sinus syndrome. Radiologic investigation showed a growing process in the right cavernous sinus, overlapping the sella turcica. The diagnoses of metastasis, tuberculoma, and sarcoidosis were considered, but none of them could be confirmed. A biopsy of the lesion via a subtemporal approach revealed a tuberculoma. Antituberculous treatment led to complete resolution of her symptoms., Conclusion: The diagnosis of a cavernous sinus tuberculoma is difficult; it is confirmed by biopsy. However, a trial of medical treatment, if the results are favorable, may obviate the need for a surgical procedure.