Optineurin in patients with Amyotrophic Lateral Sclerosis associated to atypical Parkinsonism in Tunisian population

Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous disorder and the phenotypic variability goes far beyond the used clinical stratification parameter. Evidence has emerged that ALS may coexist with distinct neurodegenerative diseases in single cases. We aim to study the clinical features of two familial cases of ALS carriers of two distinct variants harbored in the Optineurin (OPTN) gene. We included definite familial ALS followed up in the Department of Neurology of Razi University Hospital, Tunisia, and selected according to Byrne criteria. Preliminary screening for the four main ALS genes (SOD1, C9ORF72, TARDBP, FUS) was conducted. Given the negative results, we proceeded to NGS target-re-sequencing with a custom panel including genes associated with ALS-FTD, Alzheimer's, and Parkinson's diseases. Both families are carriers of two different OPTN variants and they present very different ALS clinical features. The first family comprises two siblings diagnosed with ALS and Corticobasal syndrome (ALS-CBS) at an early age of onset and carriers of OPTN p.E135X in the homozygous state. The proband for the second family was diagnosed with ALS at an early age of onset presenting as progressive muscular atrophy with rapid progression. Genetic analysis revealed the presence of the homozygous variant p.R520H. Our findings highlight the peculiarity of genetic Tunisian drift. Indeed, genes with a recessive mode of inheritance may explain part of ALS diversity in clinical features. Therefore, the screening of the OPTN gene is highly recommended among inbreeding populations such as the Tunisian one.

[Production of innervated bronchial epithelium from a blood sample]

Asthma is a frequent respiratory disease, with severe asthma occurring in 3 to 5% of cases. Chronic inflammation of the bronchial epithelium is essential to its pathophysiology. When activated by the bronchial environment, the peripheral sensory nervous system contributes to inflammation of the airways. However, due to a lack of reliable models, the mechanisms of action remain largely unknown. Using induced pluripotent stem cells reprogrammed from blood cells, we have set up a model of bronchial epithelium innervated by sensory neurons. This model will ensure better understanding of the mechanisms of action underlying neurogenic inflammation.

Application of histochemical and immunohistochemical techniques for detection of lung tissue in cooked sausage

Background

Using unauthorized tissues in sausage is a common food adulteration in some parts of the world.

Aims

This study was designed to compare the accuracy of histochemical and immunohistochemical techniques for the detection of lung tissue in cooked sausage samples.

Methods

Samples with different levels of sheep lung tissues (1, 2.5, and 5%) and a control group were prepared and stained histochemically using H&E, Masson trichrome, and Periodic Acid-Schiff (PAS) stainings, and immunohistochemically using two different commercially-available antibodies of TTF1 Pan-cytokeratin.

Results

The highest positive results of lung tissue detection were achieved in sausage samples stained with anti-TTF1 immunohistochemical staining method. Both anti-TTF1 and anti-pan-cytokeratin immunohistochemical techniques detected all contaminated sausage samples treated with 50 g/kg lung tissues. Anti-TTF1 staining method had the highest odds ratio (7.4), followed by anti-pan-cytokeratin method (6.0). Reversely, PAS staining method had the lowest odds ratio (0.21), followed by Masson trichrome method (1.7). Additionally, anti-TTF1 method had the highest (1.8-31.0) confidence intervale (95%), while PAS had the lowest (0.02-2.1). Totally, the odds ratio of lung tissue detected by immunohistochemical methods were higher than those detected by histochemical staining.

Conclusion

This is the first report on the comparison of histochemical and immunohistochemical techniques for lung tissue detection in cooked sausage. Anti-TTF1 immunohistochemical staining proved to be the most useful technique for the detection of unauthorized lung tissue in cooked sausages.

Clinical predictors of disease progression in a cohort of Tunisian progressive Multiple Sclerosis

BACKGROUND

Knowledge about progressive Multiple Sclerosis (MS) is mainly based on Caucasian studies. In our North-African context, MS exhibits particular characteristics that are mainly related to a more severe phenotype. Given the limited data available, there is an imminent need to characterize progressive MS in our latitudes.

OBJECTIVE

To describe the specificities of progressive MS and identify the inherent clinical predictors of disability accrual with a Tunisian cohort.

METHODS

A retrospective, hospital-based study was conducted in the department of neurology of Razi hospital. Patients, who had been diagnosed with MS, were divided into relapsing MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS). Epidemiological, clinical and paraclinical data were compared among the three groups.

RESULTS

Of the 504 patients, a progressive MS was described among 115 patients. This percentage of (22.8%) is divided into 13.9% SPMS and 8.9% PPMS. During the first clinical attack, motor symptoms have revealed to be predominant during PPMS (91.1%). For SPMS onset, the median time was 10 years, and was significantly delayed for patients with visual onset or full recovery from the first relapse. Patients with progressive MS exhibited a more rapid disability accumulation.

CONCLUSION

Compared to Caucasians, Tunisians exhibited a faster rate of conversion to SPMS. According to our natural progressive MS history, early clinical features are predictors of MS disability accrual.

Changes in the hearing threshold of workers in a steel industry: 5-year follow-up

Introduction: noise is one of the most important harmful factors in the workplace. The physiological effects of noise on humans are gradual in the long run. Despite industrial advances, exposure to excessive noise is one of the health problems of workers in the world's steel industry. This study aimed to investigate the effect of noise on hearing loss in steel industry workers. Materials and Methods: This descriptive cross-sectional study was designed and conducted. The study population was 121 workers in a steel rolling industry whose 5-year audiometry was studied from 1391 to 1395. An audiometer performed the audiometric test of these workers in 5 years. Their audiometric results were extracted from their medical records and examined under ethical principles. Data were analyzed using SPSS software version 21, and T-Test and Wilcoxon Signed Ranks Test was used for statistical analysis. Results: The mean age of participants was 38.88 ± 4.92 years and the mean work experience was 10.94 ± 3.57 years. In this study, a gradual increase in the average hearing threshold at different frequencies in both ears was seen from 2012 to 2016. Conclusion: noise as a detrimental factor in the steel industry causes a gradual increase in exposed workers' hearing threshold.

Retrospective study of the reproductive performance of Barb and Thoroughbred stallions in Algeria

Background and Aim

The Barb horse occupies a prominent place in the history, culture, and equestrian traditions of the Maghreb (Algeria, Morocco, and Tunisia). Although many studies on the breed standard and morphometry have been published, there are no studies on its fertility and reproductive potential. Thus, this work aimed to study the fertility of Barb, Arabian Purebred, and Thoroughbred horses in Algeria.

Materials and Methods

A total of 168 stallions and 1202 mares at the Chaouchaoua Stud farm in Tiaret, Algeria, were included in the study. The reproductive performance during 1592 cycles over 10 consecutive mating seasons (2003-2012) was evaluated. Multivariate analysis with logistic regression was used to analyze the reproductive parameters such as the number of cycles operated, number of pregnant mares, pregnancy rate per cycle, seasonal pregnancy rate, and embryonic mortality rate, and to determine the influence of breed, stallion's age, and year of the study on reproduction.

Results

Statistical analysis showed that stallion breed was a significant influencing factor for the number of pregnant barren mares (Odds ratio [OR]=1.72; p=0.03; 95% confidence interval [CI]=1.05, 2.84) seasonal pregnancy rate (OR=1.40; p<0.001; 95% CI=1.29, 1.53). Additionally, the reproductive performance of the Barb stallion was superior to that of the Thoroughbred stallion. With regard to the significant influence of stallion's age of >5 years on the number of pregnant foaling mares and seasonal pregnancy rate, significant interactions were observed between the stallion's breed and age, and the pregnancy rate per cycle: in the Barb breed, the pregnancy rate per cycle increased with the age of the stallion, while in the Thoroughbred, it decreased with age. Moreover, a significant effect of the year of the study on the pregnancy rate per cycle and number of pregnant foaling mares was observed. In contrast, the number of cycles and embryonic mortality rate were not influenced by the breed and age of the stallion, or the year of the study.

Conclusion

The Algerian Barb horse attained a similar level of fertility compared with that of the Arabian Purebred and Thoroughbred stallions depending on its age and reproductive performance.

In vivo percutaneous microwave ablation in kidneys: Correlation with ex vivo data and ablation work

PURPOSE

To compare diameters of in vivo microwave ablation (MWA) performed in swine kidneys with ex vivo diameters, and to correlate with ablation work (AW), a new metric reflecting total energy delivered.

MATERIAL AND METHODS

Eighteen in vivo MWA were performed in 6 swine kidneys successively using one or two antennas (MicroThermX^®). Ablation consisted in delivering power (45-120W) for 5-15minutes. Ex vivo diameters were provided by the vendors and obtained on bovine liver tissue. AW was defined as the sum of (power)*(time)*(number of antennas) for all phases of an ablation (in kJoules). Kidneys were removed laparoscopically immediately after ablation. After sacrifice, ablations zones were evaluated macroscopically, and maximum diameters of the zones were recorded. Wilcoxon sum rank test and Pearson's correlation were used for comparisons.

RESULTS

For a single antenna (n=12), the in vivo diameters ranged from 12 to 35mm, and 15-49mm for 2 antennas (n=6). The in vivo diameters remained shorter than ex vivo diameters by 8.6%±30.1 on 1 antenna and 11.7%±26.5 on 2 antennas (P=0.31 and 0.44, respectively). AW ranged from 13.5 to 108kJ. Diameters increased linearly with AW both with 1 and 2 antennas, but only moderate correlations were observed (r=0.43 [95% confidence interval: -0.19; 0.81], P=0.16; and 0.57 [-0.44; 0.95], P=0.24, respectively).

CONCLUSION

Although diameters after in vivo renal MWA increased linearly with AW, the moderate correlation and wide standard deviations observed may justify a careful imaging monitoring during treatment delivery and settings adaptation, if needed, for optimal ablation.

Value of troponin levels in the diagnosis of cardiac dysfunction in moderate scorpion envenomation

Context:

Cardiac dysfunction is one of the most serious consequences of scorpion envenomation. The best tool to evaluate cardiac function is echocardiography, but it is not available at all emergency departments. Many studies aimed to describe biological predictive factors of cardiac dysfunction in scorpion envenomation. Troponin is one of these biomarkers but its correlation with myocarditis is not well established. The aim of this study was to evaluate correlation between troponin levels and cardiac dysfunction in moderate scorpion envenomation.

Methods:

A retrospective monocentric study including patients admitted in the emergency department for moderate scorpion envenomation with troponin measurement during their early management. On arrival, an electrocardiogram and a chest X-ray were realized for all patients.

Results:

We enrolled 132 patients with a mean age at 31.3 ± 24.4 years and a 1.35 sex-ratio. All patients had moderate systemic manifestations. There were 28 patients with clinical manifestations of cardiac dysfunction without life-threatening troubles (21.2%). Troponin was undetectable in 69 patients (56%). The mean value of troponin level (pg/ml) was higher in patients with clinical manifestations of left ventricular dysfunction (1.80 ± 3.8 vs. 0.11 ± 0.5; p = 0.02). Troponin levels were significantly higher in patients with positive T wave on electrocardiogram.

Conclusion:

In patients with moderate scorpion envenomation with positive T wave, high values of troponin suggest the presence of cardiac dysfunction.

[Post-herpes simplex encephalitis chorea: Viral replication or immunological mechanism?]

INTRODUCTION

Herpes simplex encephalitis is a severe neurological condition, whose outcome is improved if treated early with acyclovir. Post-herpes simplex encephalitis with acute chorea has rarely been reported.

CASE REPORT

We report on two observations of children presenting with post-herpes simplex encephalitis with acute chorea, related to two different pathophysiological mechanisms. The first one is an 11-month-old girl developing relapsing herpes simplex encephalitis with chorea due to resumption of viral replication. The second one is a 2-year-old boy with relapsing post-herpes simplex encephalitis acute chorea caused by an immunoinflammatory mechanism. We discuss the different neurological presentations of herpetic relapses, notably those presenting with movement disorders, as well as their clinical, paraclinical, physiopathological, and therapeutic aspects.

CONCLUSION

Post-herpes simplex encephalitis with acute chorea may involve two mechanisms: resumption of viral replication or an immunoinflammatory mechanism. Treatment of post-herpes simplex encephalitis with acute chorea depends on the underlying mechanism, while prevention is based on antiviral treatment of herpes simplex encephalitis with acyclovir at the dose of 20mg/kg/8h for 21 days.

Pulmonary computed tomography scan findings in chronic granulomatous disease

BACKGROUND

Chronic granulomatous disease is a phagocyte defect, characterised by recurrent infections in different organs due to a defect in NADPH oxidase complex. This study was performed to investigate pulmonary problems of CGD in a group of patients who underwent computed tomography (CT) scan.

METHODS

Computed tomography scan was performed in 24 patients with CGD. The findings of the CT scan were documented in all of these patients.

RESULTS

Areas of consolidation and scan formation were the most common findings, which were detected in 79% of the patients. Other abnormalities in order of frequencies were as follows: small pulmonary nodules (58%); mediastinal lymphadenopathy (38%); pleural thickening (25%); unilateral hilar lymphadenopathy (25%); axillary lymphadenopathy (21%); bronchiectasis (17%); abscess formation (17%); pulmonary large nodules or masses (8%); and free pleural effusion (8%).

CONCLUSION

The pulmonary CT scans of the patients with CGD demonstrated a variety of respiratory abnormalities in the majority of the patients. While recurrent respiratory infections and abscesses are considered as prominent features of CGD, early diagnosis and precise check-up of the respiratory systems are needed to prevent further pulmonary complications.

[Iliofemoral cutaneous mucormycosis with endopelvic extension in an immunocompetent child]

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.

[Distribution of ABO groups in patients undergoing heart surgery]

The authors examined retrospectively the AB0 blood groups of 3982 patients who underwent cardiac surgery. There were 3392 cases of acquired heart disease, 590 congenital heart disease. They found significant difference in the total patients blood groups distribution in contrast to the control group. Further significant differences were found in the following cases: 1. total male patients, 2. acquired heart disease (both males and females), 3. isolated aortic valve disease (both males and females), 4. ischaemic heart disease (only males). In regard to the total patients group, their findings suggest significant difference between the males and females blood group distribution. This observation was peculiar to the acquired heart diseases only. They conclude that there is a positive correlation between AB0 blood groups and certain cardiac diseases, most notably, ischaemic heart disease in male patients.