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Congenital analbuminemia (CAA) is a very rare genetic disorder characterized by a significant reduced or even complete absence of human serum albumin. Our data describe the clinical features and laboratory results of a case confirmed by mutation analysis of the albumin gene in a 35-year-old man presenting recurrent acute coronary syndrome. To the best of our knowledge, only two cases of coronary artery disease have been reported worldwide without recurrence. Our findings contribute to shed light on the clinical characteristics and biochemical parameters of this disease and confirm that cardiovascular complications must be taken seriously in this pathology. Mutational screening disclosed two novel compound heterozygous nucleotide variations located in intron 12 and in 3'UTR. The prediction of the functional and structural impact of the reported variations using different bioinformatics tools demonstrates that these genetics variations affect RNA transcription and mRNA folding.

Coronary artery disease is an inflammatory disease. Systemic markers of inflammation such as Interleukin-6, Tumor Necrosis Factor alpha and C-reactive protein have previously been shown to be associated with increased risk of cardiovascular events. The aim of the present study is to assess the role of variants in the IL-6 (- 174 G/C), TNFα (- 308 A/G) and CRP (+ 1059G/C) genes as susceptibility markers for CAD in a Tunisian population. The investigation was conducted as a case-control study involving 204 patients and 400 age-gender matched controls. Genotyping was performed using polymerase chain reaction and restriction fragment length polymorphism analysis. There are significant differences between CAD patients and the control group with regard to BMI (p < 10 -3 ) and family history of CAD (p < 10 -3 ). The CAD patients are more likely to have a history of smoking (p < 10 -3 ), have a higher value of TC (p = 0.003), LDLc (p = 0.016), hs-CRP (p = 0.01), IL6 (p < 10 -3 ) and TNFα (p = 0.038). Our analysis showed significant differences between cases and controls in genotypic distribution of IL6-174CC (p = 0.003; OR = 7.71 CI (1.58-37.56)), TNFα - 308 AA (p = 0.004; OR = 2.95 (1.57-5.51)) and CRP + 1059 CC (p < 10 -3 ; OR = 5.40 (2.30-12.68)). However, we failed to find an association between the different genotypes and the inflammatory markers levels. Our results suggest that the presence of IL-6 (- 174 G/C), TNFα (-308 A/G) and CRP (+ 1059G/C) polymorphisms, may be considered to be a risk factor for CAD in Tunisian population.

Aims: To investigate the incidence, viral load and genetic diversity of bovine rotaviruses strains in Tunisia., Methods and Results: A total of 169 faecal specimens, collected from diarrhoeic calves from several farms located in the central eastern regions of Tunisia, between January 2006 and October 2010, were analysed by semi-nested multiplex RT-PCRs for P and G genotypes identification or were genotyped by DNA sequencing. Positive samples were tested by TaqMan real-time RT-PCR to quantify the viral load. Group A bovine rotaviruses were detected in 15·4% (26/169) of the total studied cases of diarrhoea. Overall, G10 was the predominant G type, detected in 12/26 samples (46·2%) and G6 accounted for 42·3% (11/26) while P[11] was the predominant P type, detected in 12/26 samples (46·2%). Two P[5] genotypes (7·7%) were found in the collection. Dual G or P combination and genotype G8 were not found. The most common VP7/VP4 combinations were G6P[11] (30·8%; n = 8) and G10P[11] (11·5%; n = 3). The combination G10P[14] was seen in one sample, and partial typing was assessed in 53·8% (n = 14) of the cases. The viral load determined by real-time RT-PCR showed an average of 1·68 × 10(9) genome copies/g of faeces., Conclusion: Knowledge of P and G types could help us understand the relatedness of animal rotaviruses to viruses causing disease in humans., Significance and Impact of the Study: This is the first time that the viral load and P types of bovine rotaviruses have been determined in Tunisia, and this study contributes to a better understanding of the epidemiology of such viruses circulating in Tunisia. Nevertheless, continuous surveillance is necessary to detect the emergence of new variants., (© 2014 The Society for Applied Microbiology.)

Two genetically distinct bovine enteric caliciviruses are known: noroviruses of genogroup III (NoVsGIII), which are genetically related to human noroviruses, and neboviruses, which represent a new calicivirus genus. To investigate the presence of NoVsGIII and nebovirus strains in diarrheic calves in Tunisia, a total of 169 faecal specimens were collected from January 2006 to October 2010 from different cattle herds located in the central-east regions. RT-PCRs and sequencing were carried out using primers targeting the 3' end of the polymerase gene of NoVsGIII and neboviruses. This study revealed that NoVsGIII and nebovirus are endemic in diarrheic calves in Tunisia. NoVsGIII infections, all with genotype 2, had an apparent molecular prevalence of 16.6 % and were more frequent than nebovirus infections. NoVsGIII infections showed clear seasonality, with a peak in winter. Nebovirus infections, with a prevalence of 3.0 %, were all related to the reference strain Bo/Nebraska/80/US.

Ochratoxin A is a natural mycotoxin with nephrotoxic properties that can contaminate food products. It has been detected in high amount in human serum collected from nephropathy patients, especially those categorized as having a chronic interstitial nephropathy of unknown etiology. In the present study, ochratoxin A levels were measured in commonly consumed food items and in serum samples from nephropathy and healthy subjects in Tunisia. To assess ochratoxin A, a high performance liquid chromatography method was optimized. The ochratoxin A assay showed very different scales of ochratoxin A serum and food contamination from 0.12 to 1.5 ng/mL and 0.11 to 6.1 ng/g respectively, and in healthy subjects and 0.11 to 33.8 ng/g for food and 0.12 to 3.8 ng/mL for serum in nephropathy patients suffering from chronic interstitial nephropathy of unknown etiology. The disease seems related to ochratoxin A serum levels and food contaminations, since the healthy group was significantly different from the nephropathy group (P<0.001) for both food and serum ochratoxin A contamination. Those results combined with data published already, emphasize the likely endemic aspect of ochratoxin A-related nephropathy occurring in Tunisia., (Copyright © 2010 Elsevier GmbH. All rights reserved.)

Hyperhomocysteinaemia is considered as an important independent risk factor for atherosclerosis and thrombotic disease. This study determined the distribution of homocysteine (Hcy) levels in healthy Tunisian subjects and evaluated the relationship between Hcy levels and some cardiovascular risk factors. Randomly selected subjects (592 men and 114 women) were recruited from different regions of Tunisia. The overall mean Hcy level was 12.6 (SD 5.4) micromol/L. Hcy levels in subjects with hyperhomocysteinaemia varied according to geographical region. Subjects with hyperhomocysteinaemia had significantly elevated total cholesterol, LDL cholesterol, apolipoprotein A and apolipoprotein B and lower vitamin B12 levels compared with subjects with normohomocysteinaemia. Hcy levels correlated with total cholesterol (r = 0.09), apolipoprotein A (r = 0.012), and B (r= 0.013) levels and total/HDL cholesterol ratio (r = -0.085). Further epidemiological studies are needed to determine the precise role of Hcy in cardiovascular disease.

Introduction: Type 2 diabetes is a chronic disease associated to the presence of multiple risk factors. Among recently studied factors we cite PCR and micro-albumin., Objective: In the present study we intend to determine the correlation between urine albumin excretion rate, CRP levels and type of vascular complications in type 2 diabetes., Patients and Methods: We recruited 48 type 2 diabetic subjects subdivided into three groups according to the type of vascular complications (GI: type 2 diabetics without complications, GII: type 2 diabetics with microvascular complications and GIII: type 2 diabetics with macrovascular complications)., Results: We found a significant elevated levels of CRP and micro-albumin (P<0.05) when we compared diabetics with vascular complications to those without any complications. Diabetics with macrovascular complications have the highest levels of CRP and micro-albumin. Significant positive correlation was found between CRP and micro-albumin levels in a total group of diabetics (r=0.32; P<0.05)., Conclusion: The determination of CRP and microalbumin levels represents an interest in the screening of cardiovascular disease in type 2 diabetics., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

This study investigated the prevalence of sapovirus infections in children with acute gastroenteritis in Monastir region, Tunisia, from January 2003 to April 2007. Sapovirus was characterized by sequence and phylogenetic analyses of the partial polymerase gene. From 788 fecal specimens tested, 6 (0.8%) were positive for sapovirus, of these, 4 (66.7%) were monoinfections. All sapovirus positive samples were detected in outpatient, contrary to norovirus which was significantly more frequent in hospitalized children than in outpatients (14.5 vs. 9.5%, P = 0.03). The mean age of children with sapovirus infections was 11 ± 5.56 months (range 6-19 months). Sapovirus isolates were detected in March and between September and December 2003. Fever, vomiting, abdominal pain, and dehydration were not observed in patients with sapovirus infections. Analysis of nucleotide and amino acid sequences revealed that all 6 Tunisian sapovirus strains clustered in the GGI/1 genotype and strains were identical in the region sequenced, sharing 90.2% nucleotide identity with the reference strain Sapporo/82/JP (U65427). This represents the first finding of sapovirus infections in North Africa and especially in Tunisia. The data indicate that, contrary to norovirus which can cause severe diarrhea and is an important etiologic agent in hospitalized cases, sapovirus causes mild gastroenteritis in Tunisian children.

Recently, homocysteine and new inflamatory biomarkers are demonstrated to be involved in cardiovascular diseases. These risk factors are not well studied in acute coronary syndrome. We investigated the distribution of homocysteine and inflammatory markers in patients with acute coronary syndrome and evaluated the association between these parameters and severity of the disease. One hundred and twenty-two patients with acute coronary syndrome were recruited in the cardiac intensive unit care of military hospital of Tunis. Classic risk factors, lipid parameters, total homocysteine, HsCRP, IL-6 and TNFα were determined for all participants. We investigated the distribution of these parameters according to the number of diseased vessels in patients with acute coronary syndrome. Patients with three affected vessels showed significant elevated homocysteine, HsCRP, IL-6, TNF-α, total cholesterol, LDL-cholesterol and Lp (a) compared to those with one and those with two affected vessels. Homocysteine (OR = 1.14; 95%IC: 1.04-1.25; P = 0.006), TNF-α (OR = 1.27; 95%IC: 1.13-1.44; P = 10(-3)), HsCRP (OR = 1.09; 95%IC:1.03-1.16; P = 0.005) and IL-6 (OR = 1.15; 95%IC: 1.06-1.25; P = 0.001) were significant predictors of severity of the disease. We conclude that homocysteine and inflammatory biomarkers appear to enhance the degree of affected arteries and so the severity of coronary artery disease.

Aims: A prospective study was performed to characterize the main human enteric viruses able to persist in sewage samples and in shellfish tissues, and to establish the correlation between environmental strains and viral infantile diarrhoea observed in the same area during the same period., Methods and Results: A total of 250 sewage (raw and treated) and 60 shellfish samples were collected between January 2003 and April 2007 in Monastir region, Tunisia. Group A rotavirus (RVA) was detected in 80 (32%) sewage samples, norovirus (NoV) in 11 (4·4%) and enteric adenovirus (AdV) in 1 (0·4%). Among 60 shellfish samples collected near sewage effluents, one was contaminated by NoV (1·6%)., Conclusion: Our data represent the first documentation in Tunisia, combining gastroenteritis viruses circulating in the environment and in clinical isolates. We observed a correlation between environmental strains and those found in children suffering from gastroenteritis during the same period study. This suggests the existence of a relationship between water contamination and paediatric diarrhoea., Significance and Impact of the Study: Our results address the potential health risks associated with transmission of human enteric viruses through water-related environmental routes. The research findings will aid in elucidating the molecular epidemiology and circulation of enteric viruses in Tunisia and in Africa, where data are rare., (© 2010 The Authors. Journal compilation © 2010 The Society for Applied Microbiology.)

The aims of our investigations were (1) to look for Aichi virus in environmental samples and (2) to compare the Aichi virus strains in both clinical and environmental samples in order to evaluate the role of environmental contamination as a possible vehicle for viral transmission. Aichi virus was detected in 15 (6%) sewage samples and in 4 (6.6%) shellfish samples. Aichi virus was identified for the first time in water samples. Phylogenetic analysis revealed several clusters that occurred sequentially in time, suggesting some parallelism in the evolution of environmental and human strains. Aichi virus present in sewage reflects the viruses circulating in the community.

Background: Hyperhomocysteinaemia has been identified as a strong risk factor for ischemic stroke (IS). A point mutation in methylene tetrahydrofolate reductase (MTHFR C677T) has been associated with increased plasma homocysteine (Hcy) levels., Aim: This preliminary study aimed to investigate whether hyperhomocysteinaemia and/or MTHFR C677T mutation are associated with ischemic stroke., Methods: A case-control study including 50 consecutive patients with confirmed IS and 97 controls was performed. Fasting plasma homocysteine levels, MTHFR C677T genotypes were assessed. Other factors such as hypertension, obesity, dyslipidemia, diabetes mellitus, recurrent stroke tobacco and alcohol were investigated., Results: Mean plasma homocysteine levels were significantly higher in IS patients than in controls (15.83+/-10.60) μmol/L vs 13.78+/-6.29 μmol/L, p=0.04), while no association of MTHFR C677T variant was observed even with homocysteine. The risk to develop ischemic stroke in hyperhomocysteinemic subjects was 2.4 times more than in subjects with normal Hcy levels (OR= 2.4; 95% CI: 1.13-5.06; p<0.05)., Conclusion: Our findings suggest that high levels of homocysteine but not MTHFR C677T polymorphism represent risk factors for arterial ischemic stroke in Tunisian subjects.

Aichi virus has been described as a novel causative agent of gastroenteritis in humans. In this study, we report the seroprevalence distribution of Aichi virus in Tunisia. A panel of 1,000 sera was screened by applying an enzyme-linked immunosorbent assay for immunoglobulin G specific for Aichi virus. A considerable prevalence (92%) of antibody to Aichi virus was found across all age groups. The specific anti-Aichi virus antibodies increased with age, from a high rate (68.8%) in children under 10 years old to about 100% in persons more than 60 years old. We found a statistically significant increase in levels of antibody to Aichi virus according to the age of patients. Immunoglobulin M antibodies were detected among five children. A high frequency of Aichi virus monoinfections in hospitalized children with severe gastroenteritis was previously observed in Tunisia. Aichi virus causes diarrhea with dehydration, fever, and vomiting. This work is the first to establish a correlation between the high seroprevalence of specific Aichi virus antibodies, clinical presentation, and a high frequency of isolation of Aichi virus by genomic characterization in stools of children suffering from gastroenteritis. Our data show the importance and emerging character of Aichi virus in the viral etiology of pediatric gastroenteritis.

Background: An elevated level of homocysteine (Hcy) has been shown to be a cardiovascular risk factor in the majority of research studies. Recently, it was found to be associated with new risk factors such as inflammatory markers., Objectives: To investigate the distribution of plasma total Hcy (tHcy) and the levels of inflammatory markers in patients with acute coronary syndrome (ACS), and to evaluate the association between these parameters and the severity of the disease., Methods: A total of 122 patients with ACS and 80 control subjects were recruited from the cardiac intensive care unit of the Military Hospital of Tunis, Tunisia. Lipid profile and the levels of tHcy, high-sensitivity C-reactive protein (HsCRP), interleukin (IL)-6, IL-8, IL-1beta and tumour necrosis factor-alpha (TNFalpha) were determined for all participants. The distribution of these parameters were compared between groups and according to the number of diseased vessels in patients with ACS., Results: ACS patients had significantly elevated levels of tHcy (P<0.01), HsCRP (P<0.001), IL-6 (P<0.001), TNFalpha (P<0.001), folates (P<0.05) and vitamin B(12) (P<0.001), but lower high-density lipoprotein cholesterol (P<0.05) levels. The analysis of the association between these parameters and the number of diseased vessels showed significant differences in tHcy, HsCRP, IL-6 and TNFalpha, with positive correlations. Significantly negative correlations were found between the number of diseased vessels and folate (r=-0.34; P<0.01), and vitamin B(12) (r=-0.22; P<0.01)., Conclusion: Elevated levels of tHcy, IL-6, TNFalpha and HsCRP appear to be associated with a greater number of diseased arteries and, consequently, the severity of coronary artery disease.

Aim: Evaluate the effect of lipopenic and hypotensive treatment on homocysteine levels., Methods: We recruited 145 type 2 diabetics and 130 control subjects. Thirty-seven diabetics had no complications, 54 had microvascular complications and 54 had macrovascular complications. We determined the parameters homocysteine of lipid, vitamin B12, triglycerides, and folates for all subjects. Associated treatments used one or more of the following drugs, statin, fibrate, angiotensin-converting enzyme inhibitor and beta-blockers., Results: Hyperhomocysteinemia was present in 35.6% of patients. Diabetics had elevated serum levels of triglycerides (P < 0.001), homocysteine (P < 0.01), folates (P < 0.01) and vitamin B12 (P < 0.001). A strong association was found between type 2 diabetes and hyperhomocysteinemia (P < 0.001). Diabetics with associated treatment had elevated homocysteine, vitamin B12 and folate levels when compared to diabetes-free controls. For diabetics with macrovascular complications, we found significant differences in homocysteine (P = 0.010) and folate (P = 0.014) between those taking associated drugs and those who did not. For diabetics with microvascular complications, a significant difference was found in folate only (P = 0.012)., Conclusion: Drugs used for hypertension and hyperlipidemia may have an effect on homocysteine levels, for this reason the interaction between drug action and homocysteine levels should be taken into consideration.

Background: Wastewater frequently has been contaminated by enteric viruses, which can cause gastroenteritis, hepatitis, and other viral diseases. Since current water treatments do not ensure their complete removal and they become contaminants of the water environment., Aim: In order to monitor and assess the prevalence and the seasonal incidence of enteric viruses contaminating wastewater, a total of 93 samples were collected from the stations of Sayada-Lamta-Bouhjar and El Frina., Methods: The purpose of this study is to establish a rapid, sensitive and specific RT-PCR method using highly conserved primers to detect enteric viruses (caliciviruses, enteroviruses and hepatitis A viruses) circulating in the area of Monastir, during the period from October 2005 to July 2006., Results: Our study shows that the caliciviruses were detected in 67.56% of the wastewater samples and present an essentially winter distribution with a specific peak in spring. The enteroviruses were detected in 35.13% of the samples tested and present a regular circulation during the year with a predominance in the summer and early fall. Finally, the presence of hepatitis A viruses was noted especially in winter in 10.81% of the wastewater samples., Conclusion: We notice that current wastewater treatment methods are sometimes not efficient to eliminate enteric viruses.

Ochratoxin A is a fungal toxin produced by Aspergillus and Penicillinium. These Fungi oftenly contaminate plant-derived products, and can generate deleterious toxic effects in man. In this study, ochratoxin A was determined in human serum samples collected in Tunisia, using high performance liquid chromatography (HPLC) and fluorescence detection. The samples were collected from healthy subjects (n = 105) as well as from patients with various kidney disorders. Five different kinds of kidney disorders were represented: transplanted subjects (27), patients with Chronic Interstitial Nephropathy (22) of known etiology, Chronic Vascular Nephropathy (26), Chronic Glomerular Nephropathy (26) or Chronic Interstitial Nephropathy (30) of unknown etiology. Mean concentrations of ochratoxin A in the healthy group was 0.49+/-0.79 ng/mL. The highest mean concentration of ochratoxin A was found in group of Chronic Interstitial Nephropathy of unknown etiology 1.25+/-1.22 ng/mL. Significant differences were also observed according to the geographic origin of healthy subjects and nephropthic patients within Tunisia.

Background: Cardiopulmonary bypass induces a nonspecific inflammatory response. Procalcitonin has been advocated as a specific biomarker for infection. The authors studied the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery and compared it with those of C-reactive protein, white blood cell count, and interleukins 6 and 8., Methods: The authors prospectively included 100 patients scheduled to undergo elective cardiac procedures with cardiopulmonary bypass. Blood samples were taken before surgery and each day over the 7-day postoperative period, and measurement of procalcitonin, C-reactive protein, white blood cell count, and interleukins 6 and 8 were performed. Diagnosis of infection was performed by a blinded expert panel. Data are expressed as value [95% confidence interval]., Results: Infection was diagnosed in 16 patients. Procalcitonin was significantly higher in infected patients, with a peak reached on the third postoperative day. Only the areas under the receiver operating curve of procalcitonin (0.88 [0.71-0.95]) and C-reactive protein (0.72 [0.58-0.82]) were significantly different from the no-discrimination curve, and that of procalcitonin was significantly different from those of C-reactive protein, white blood cell count, and interleukins 6 and 8. A procalcitonin value greater than 1.5 ng/ml beyond the second day diagnosed postoperative infection with a sensitivity of 0.93 [0.70-0.99] and a specificity of 0.80 [0.70-0.87]. Procalcitonin was significantly higher in patients who died (27.5 [1.65-40.5] vs. 1.2 [0.7-1.5] ng/ml; P < 0.001)., Conclusion: Procalcitonin is a valuable marker of bacterial infections after cardiac surgery.

The use of reliable and specific diagnosis tools in patients of intensive care unit constitutes the best way to follow up these patients and to take charge of severe infections. It is in the context that the measuring of procalcitonin should be considered in order to prove its role in invasive candidosis. This prospective study included 52 patients from an intensive care unit. Blood samples for serum procalcitonin were drawn on days 1, 3, 5. Our results showed that on the one hand, procalcitonin levels have significantly increased in cases of confirmed and probable candidosis. On the other hand, this parameter has a certain prognosis value. In conclusion, an increase in procalcitonin level does not only imply a bacterial infection but it should also evoke a case of invasive candidosis especially in intensive care units.

Unlabelled: The aim of this study was to assess the role of thyroglobulin in monitoring patients with differentiated thyroid carcinoma., Methods: We retrospectively sudied thirty patients who had total thyroidectomy and had been followed beteween 1999 and 2004 in nuclear medicine department. They have had iodine 131 whole body scans, repeated determination of thyroglobulin, thyreostimulin and thyroglobulin antibodies., Results: One hundred twelve samples of thyroglobulin were done. In post surgical period thyroglobulin was ranging from 0.3 to 600 ng/ml. In 38 months follow up 4 patients (11.4%) had shown reccurent disease. Thyroglobulin sensitivity was 75%. One patient had diffuse lung metastases with high thyroglobulin level 600 ng/ml wich decreased after iodine 131 therapy., Conclusion: Serum thyroglobulin is the differentiated thyroid carcinoma marker of choice nevertheless one should establish the level of thyroid stimulation and seek for the antithyroglobulin antibodies.

Point mutations in methylenetetrahydrofolate reductase (MTHFR) and hyperhomocysteinemia were implicated in the pathogenesis of diabetic nephropathy (DN) in many ethnic groups. This study addressed the association of C677T and A1298C single nucleotide polymorphisms (SNPs) of MTHFR gene with DN in Tunisian type 2 diabetes (T2DM) patients. Study subjects comprised 93 DN patients, 267 patients with normoalbuminuria, and 400 control subjects. C677T and A1298C genotypes were determined by PCR-RFLP analysis, and homocysteine levels were measured by ELISA. A1298C and C677T were highly prevalent among T2DM patients, with allele frequencies of 0.26 and 0.36, respectively. Higher mutant 677T allele and 677C/T and 677T/T genotypes of C677T SNP, but not A1298C SNP, together with 677C/1298A, 677C/1298C, and 677T/1298A haplotypes were seen in DN patients compared to normoalbuminuric patients, (p<0.001). Plasma homocysteine was positively associated with MTHFR 677T/T genotype among the three groups, and was significantly elevated in double heterozygous DN patients but not in normoalbuminuric patients or controls. Logistic regression analysis with DN as dependent variable showed that homocysteine (OR, 1.153) and MTHFR 677T/T (OR, 9.799) were the only variables associated with DN, after adjusting for possible confounding variables. C677T, but not A1298C, SNP, is a risk factor for DN, presumably acting by elevating homocysteine levels.

Insulin is a hormone which has an essential role in lipids metabolism by modulating the activity of many key enzymes and by its intervention on the production and the catabolism of lipoproteins. The aim of this study was to determine the influence of insulin resistance on lipid profile in a diabetic group. The study group consists of 118 diabetic patients. We assayed for each patient total cholesterol, high density lipoprotein cholesterol, triglycerides and insulin. Insulin resistance was determined by HOMA index. Insulin was found correlated to body mass index, triglycerides, waist circumference, and glycated haemoglobin. Triglycerides and glycated haemoglobin were significantly more elevated in insulin resistant group than in insulin sensitive group. Insulin resistance may be the initial anomaly in type 2 diabetes and incite us to search on molecular anomalies in the insulin action.