Autosomal recessive congenital hereditary corneal dystrophy associated with a novel SLC4A11 mutation in two consanguineous Tunisian families

BACKGROUND

Autosomal recessive congenital hereditary corneal dystrophy (CHED) is a rare isolated developmental anomaly of the eye characterised by diffuse bilateral corneal clouding that may lead to visual impairment requiring corneal transplantation. CHED is known to be caused by mutations in the solute carrier family 4 member 11 (SLC4A11) gene which encodes a membrane transporter protein (sodium bicarbonate transporter-like solute carrier family 4 member 11).

METHODS

To identify SLC4A11 gene mutations associated with CHED (OMIM: #217700), genomic DNA was extracted from whole blood and sequenced for all exons and intron-exon boundaries in two large Tunisian families.

RESULTS

A novel deletion SLC4A11 mutation (p. Leu479del; c.1434_1436del) is responsible for CHED in both analysed families. This non-frameshift mutation was found in a homozygous state in affected members and heterozygous in non-affected members. In silico analysis largely support the pathogenicity of this alteration that may leads to stromal oedema by disrupting the osmolarity balance. Being localised to a region of alpha-helical secondary structure, Leu479 deletion may induce protein-compromising structural rearrangements.

CONCLUSION

To the best of our knowledge, this is the first clinical and genetic study exploring CHED in Tunisia. The present work also expands the list of pathogenic genotypes in SLC4A11 gene and its associated clinical diagnosis giving more insights into genotype-phenotype correlations.

Early Onset and Severe Progression of Neuro-ophthalmological Manifestations in a Case with Parry–Romberg Syndrome

Parry–Romberg syndrome is a rare disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, and muscles, and sometimes extending to the osteocartilaginous structures. Ophthalmological and neurological involvements are relatively rare. We present a case of an early onset of left hemifacial atrophy, a progressive severe left ocular impairment, and the presence of a neurological disorder in the left hemisphere of the brain. The neuro-ophthalmological manifestations on the left side include enophthalmos, mild pseudoptosis, moderate asymmetry of the eyebrows, diffuse chorioretinal atrophy, reduced visual acuity, reduced central retinal thickness (162 µm) with the interruption of the ellipsoid zone, and the alteration of the outer nuclear layer, with associated reduced responses in photopic and scotopic amplitudes. The patient reported high intensity left brain white matter and a brief clinical focal seizure. This case report adds to the repertoire spectrum of this rare syndrome. The presentation calls for a multidisciplinary care for patients like our case.

Disseminated lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy

Dysfunction of the third cranial nerve can be provoked by a number of different conditions. An isolated cranial neuropathy as a first clinical sign of a non-Hodgkin lymphoma is very infrequent. We represent here an atypical case of lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. The patient was managed by alternating cycles of cyclophosphamide, vincristine, and prednisone. She made a full recovery with a complete resolution of the symptomatology.

Novel BEST1 gene mutations associated with two different forms of macular dystrophy in Tunisian families

BACKGROUND

Epidemiological studies of hereditary eye diseases allowed us to identify two Tunisian families suffering from macular dystrophies: Best vitelliform macular dystrophy (BVMD) and autosomal recessive bestrophinopathy (ARB). The purpose of the current study was to investigate the clinical characteristics and the underlying genetics of these two forms of macular dystrophy.

METHODS

Complete ophthalmic examination was performed including optical coherence tomography, electroretinography, electrooculography and autofluoresence imaging in all patients. Genomic DNA was extracted from peripheral blood collected from patients and family members.

RESULTS

Sanger sequencing of all exons of the BEST1 gene in both families identified two new mutations: a missense mutation c.C91A [p.L31 M] at the N-terminal transmembrane domain within the ARB family and a nonsense mutation C1550G (p.S517X) in the C-terminal domain segregating in the BVMD family.

CONCLUSIONS

Several mutations of the BEST1 gene have been reported which are responsible for numerous ocular pathologies. To the best of our knowledge, it is the first time we report mutations in this gene in Tunisian families presenting different forms of macular dystrophy. Our report also expands the list of pathogenic BEST1 genotypes and the associated clinical diagnosis.

Isolated optic nerve infiltration as a site of relapse of acute lymphoblastic leukemia

Optic nerve infiltration is relatively rare in acute lymphoblastic leukemia. We present a case of a -53 year-old-man who was diagnosed with T- acute lymphoblastic leukemia (ALL). The patient was treated with ALL national protocol and the central nervous system (CNS) prophylactic management. On treatment, the patient presented with sudden severe vision deterioration of both eyes. Fundoscopic examination of the eye and magnetic resonance imaging of the orbits were in favor of an infiltration of the optical nerve. An isolated extramedullary relapse of the optical nerve was retained. The patient was treated with salvage chemotherapy systematic and intrathecal. Waiting forthe beginning of radiotherapy, the patient presented a bone marrow relapse. He died of a severe hemorrhagic syndrome. Conclusion: Optic nerve leukemic infiltration has a severe prognosis. Ophthalmic assessment is essential in patients with ALL in order to diagnose an early ocular involvement and the patient's vision can be preserved if treatment is initiated promptly.

[Not Available]

Chemical corneal burns are a common pathology. Those with strong bases penetrate deeply into the anterior segment and are particularly severe. We report the case of a patient suffering from corneal perforation secondary to an accidental projection of soda, and we propose to discuss the clinical and therapeutic particularities.

A Framework for Knowledge Models Transformation: A Step Towards Knowledge Integration and Warehousing

An intelligent decision support system should based on a knowledge warehouse (KW). A KW gathers knowledge initially expressed in different formalisms and therefore heterogeneous. Consequently, the KW building process requires knowledge homogenisation. This paper deals with this main issue; it introduces a three-layer architecture for a KW; more precisely, it focuses on the first layer architecture called Knowledge Acquisition and Transformation. This layer aims to transform heterogeneous knowledge models into the MOT (Modeling with Object Types) semi-formal language [Paquette, G (2002). Knowledge and Skills Modeling: A Graphical Language for Designing and Learning. Sainte-Foy: University of Quebec Press (in French).] that we have selected as a pivot knowledge model. For this transformation step, first, we design four meta-models; one for MOT and one for each of the three explicit knowledge models, namely, decision tree, association rules and clustering. Secondly, we define 15 transformation rules that we formalise in ATL (Atlas Transformation Language). Finally, we exemplify the knowledge transformation in order to show its usefulness for the KW building process.

Presumed Tuberculous uveitis: clinical features and management

AIM

To illustrate the various clinical features and management of presumed tuberculous uveitis in an endemic area in Tunisia.

METHODS

This is a retrospective study including 14 patients (26 eyes) diagnosed with presumed tuberculous uveitis at the Department of Ophthalmology Habib Bourguiba University Hospital of Sfax-Tunisia.

RESULTS

Mean age at onset was 31.7 years. Uveitis was bilateral in 86 % of cases (12 eyes). Panuveitis was the most common manifestation and represented 50% of cases (13 eyes). Ocular findings include mutton-fat keratic precipitates in 35% of cases (9 eyes), posterior synechiae in 31% of cases (8 eyes), vitritis in 81% of cases (21eyes), multifocal choroiditis in 23% of cases (6 eyes), periphlebitis in 27% of cases (7 eyes), and macular edema in 42% of cases (11eyes). Anti-tubercular treatment was prescribed in all patients and was associated with systemic corticosteroids in 71% of cases (10 patients). After a mean follow-up of 16.27 months (range, 6-36), inflammation was controlled with improvement in visual acuity. Recurrence developed in 7 % of cases (1 patient).

CONCLUSION

In the present study, posterior synechiae, vitritis, multifocal choroiditis, and retinal vasculitis are the most common manifestations of tuberculous uveitis in tuberculosis endemic area in Tunisia. These manifestations are suggestive of a tubercular cause of uveitis and merit specific treatment.

Prevalence of free living amoeba in the domestic waters reservoirs in Sfax, Tunisia

Free living amoebas (FLA) are opportunistic pathogen found in different water sources in the environment. The aim of this study was to investigate the prevalence of free living amoeba in different samples of domestic water reserves (DWR) in Sfax region from Tunisia. It was a prospective study dealing with 486 water samples collected from different DWR. After filtration through a cellulose acetate membrane samples were cultured on non-nutrient agar and the FLA were detected and strained with Giesma, Trichrome and red nuclear stain for morphological and morphotypic studies. FLA were found in 62% of samples. The Acanthopodial morphotype was detected in 43%, Polytactic (38%), Monotactic (28%), Fan-shaped (17%), Rugose (11%), Dactilopodial (10%) and Eruptive (9%). These results demonstrate that domestic water reserves are a significant source of the FLA and maintenance of DWR is recommended.

[Ocular tuberculosis : A case series]

OBJECTIVES

Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis.

METHODS

We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay.

RESULTS

The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae.

CONCLUSION

Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.

Swept-Source Optical Coherence Tomography Angiography in West Nile Virus Chorioretinitis and Associated Occlusive Retinal Vasculitis

A 65-year-old man with diabetes and a history of fever of unknown origin 2 weeks earlier complained of sudden decreased vision in the left eye. The patient was diagnosed with bilateral West Nile virus (WNV) chorioretinitis associated with occlusive retinal vasculitis in the left eye. Swept-source optical coherence tomography angiography (SS-OCTA) of the left eye showed extensive, well-delineated, hypointense non-perfusion areas and perifoveal capillary arcade disruption in the superficial capillary plexus, as well as larger non-perfusion areas, capillary rarefaction, and diffuse capillary network attenuation and disorganization in the deep capillary plexus. OCTA may be a valuable tool for noninvasively assessing occlusive retinal vasculitis associated with WNV infection. It allows an accurate detection and precise delineation of areas of retinal capillary nonperfusion in both the superficial and deep capillary plexuses. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:672-675.].

[Primary neuroendocrine tumors of the breast: a retrospective study of 21 cases and literature review]

PURPOSE

The aim of the present study was to discuss the epidemiology, clinical and pathologic features, treatment, and prognosis of primary neuroendocrine carcinomas of the breast.

PATIENTS AND METHODS

We report 21 cases diagnosed over a period of 12 years (1995-2011) at the university hospital of Sfax. A review of the clinical data with pathology and immunohistochemistry study was carried out for all the cases.

RESULTS

The average age was 62 years (34-86 years). At the time of the diagnosis, tumours were classified T1 and T2 (16 cases), N1 (11 cases) and M1 in two cases. The histological examination has shown 13 cases of solid neuroendocrine carcinoma, six cases of large cell type and two cases of atypical carcinoid. Grade I and II SBR were found in 18 cases. Eighty-one percent of the tumours were reactive for synaptophysin; all tumours were positive for chromogranin. Thirteen (61.9%) tumours were estrogen receptor-positive and 12 (57.5%) progesterone receptor-positive. Nineteen (90.5%) tumours were negative for HER2/neu. Overall five-year survival was 72.7%. All patients had surgical treatment with modified radical mastectomy in 13 cases. Adjuvant treatment was indicated according to histopronostic elements.

CONCLUSION

For primary neuroendocrine carcinoma of the breast, multivariate analysis identified three predictive factors for mortality: disease stage, histological grade and lymph node involvement.

An MDA Approach for the Evolution of Data Warehouses

Modeling and data warehousing have been considered, for more than one decade, as a new challenging research topic for which different approaches have been proposed. Nevertheless these proposals have focused on static aspects only. In practice, the evolution of the operational information system can lead to changes in its dependent multidimensional data warehouse (i.e. that this system feeds with data), and therefore may require the evolution of the data warehouse model. In this evolving context, the authors propose a model-driven based approach in order to automate the propagation of the evolutions occurred in the source database towards the multidimensional data warehouse. This approach is based on two evolution models, along with a set of transformation rules formalized in Query/View/Transformation. This paper describes this evolution approach for which we are developing a software prototype called DWE© (Data Warehouse Evolution).

Subdural hematoma during therapy of gastro-intestinal stromal tumor (GIST) with Imatinib mesylate

Imatinib mesylate is a widely used tyrosine-kinase inhibitor (TKI) in chronic myeloid leukemia (CML) treatment. Imatinib has contributed to complete and prolong cytogenetic responses so that it is now the standard treatment of CML. Recently, Imatinib mesylate has shown a significantly prolonged progression-free survival and overall survival in metastatic and locally advanced c-Kit positive gastro-intestinal stromal tumors (GISTs) and more recently a prolonged disease-free survival in operated high risk GIST. Imatinib is a welltolerated treatment with few side effects mainly gastro-intestinal symptoms (nausea, vomiting and diarrhea), headaches, rash and periorbital edema. Hemorrhage incidents are rare in patients treated with Imatinib. They are more frequently seen in CML patients. Hemorrhage incidents in CML include in many cases upper gastro-intestinal (GI) tract bleeding and central nervous system bleeding in rare ones. In GIST patients treated with Imatinib, hemorrhage incidents are exclusively made of upper GI tract bleeding consecutive to tumor perforation or necrosis. In our observation, we present the case of a subdural hematoma occurring in a patient treated with adjuvant Imatinib for a high risk localized gastric GIST. No other case of subdural hematoma in GIST treated with Imatinib has been reported in literature.

[Prognostic factors in metastatic colorectal cancer in Tunisia: A retrospective study of 130 patients]

BACKGROUND

The survival of patients with a metastatic colon cancer has improved with palliative chemotherapy, targeted therapies and surgery. Several prognostic factors influencing the survival of these patients were identified in the literature represented mainly by clinical factors: general condition, number and site of metastases, rate of white blood cells, initial carcinoembryonic antigen (CEA) rate, hemoglobin level, and therapeutic factors mainly represented by resection of metastases.

AIM

To evaluate within a Tunisian retrospective study the significant prognostic factors on survival of metastatic colorectal cancer (MCRC).

METHODS

We collected retrospectively 130 patients with MCRC treated in Sfax from january 2000 to December 2007. Uni and multivariate analysis were performed according to cox model for the following factors : Age or > 40 years, gender, synchronous vs metachronous metastases, disease-free survival (DFI) 1 > 1year, tumor site(colon vs rectum), performance status or PS ( 0-1or 2-3), white blood cells count (< or > 103/ml3 , haemoglobin rate (Hb) or > 11g/dl, seric carcinoembryonic antigen rate (CEA) < vs > 10 ng/ml, number of metastatic sites (single vs multiple), site of metastatic site (liver vs extrahepatic) and resection or not of the metastatic localizations.

RESULTS

Statistical analysis showed for univariate analysis the positive impact of : PS 1, (Hb) rate > 11 g/dl, CEA) < 10 ng/ml and resection of metastases, while in in multivariate analysis, they were : a good PS and Hb > 11 g/dl.

CONCLUSION

Our retrospective study confirmed the known prognostic impact of simple clinical tools like a good performance Status and Hb > 11 g/dl, a (CEA) rate lower than 10 ng/ml and resection of metastases which were identified by several other series such as predictive factors of a better survival in patients with metastatic colorectal cancer.

Metamodel Matching Techniques

During the last decade, Model Driven Engineering (MDE) has been proposed for supporting the development, maintenance and evolution of software systems. Model Driven Architecture (MDA), Software Factories and Eclipse Modeling Framework (EMF) are among the most representatives MDE approaches. Nowadays, it is well recognized that model transformation is at the heart of MDE approaches and, consequently represents one of the most important operations in MDE. However, despite the multitude of model transformation language proposals emerging from academic world and industry, these transformations are often manually specified; which is a tedious and error-prone task, and therefore an expensive process. Matching operation between metamodels is the keystone toward a (semi-)automatic transformation process. In this paper, the authors review metamodel matching techniques of the literature and then analyze their pros and cons in order to show how they can be useful for a semi-automatic transformation process. The result is a comparison of metamodel matching techniques, highlighting their similarities and differences in terms of information used for matching, demonstrating significant similarities between these techniques. Next, the authors compare four well-known metamodel matching techniques namely Similarity flooding, SAMT4MDE+ (extended Semi-Automatic Matching Tool for Model Driven Engineering), ModelCVS and AML (AtlanMod Matching Language) on ten couples of metamodels. For this comparison, the authors define a set of six criteria inspired from the database schema matching. One among these criteria is relevant to the quality of matching and for which we define a quality measure metrics. Furthermore, the authors develop a plug-in under Eclipse to support our comparison using ten couples of metamodels.

[Rectal stromal tumor: about a case]

Gastro-intestinal stromal tumors are uncommon mesenchymal tumors. There are localized preferentially in the stomach. The rectal localization is exceedingly rare. Through a new case of rectal stromal tumour as well as a review of the literature, we propose to focus on clinical, radiological and therapeutic particularities of this rare entity.

[Long-term use of silicone oil: indications and tolerance]

PURPOSE

The aim of this study was to analyze the indications and the effect of permanently maintaining silicone oil in the treatment of certain cases of vitreoretinal pathology.

PATIENTS AND METHODS

Twenty-seven cases seen from January 2002 to December 2008 were retrospectively studied. Silicone oil was kept in the eyes for more than 2years. The surgical file was analyzed in all cases. The evaluation criteria were ocular pressure, emulsification, cataract, corneal dystrophy, and the functional response of the retina and optic nerve. Ultrasound echography (12 MHz), magnetic resonance imaging, and electrophysiological explorations (visual evoked potential and electroretinography) were performed.

RESULTS

Twenty-seven eyes of 27 patients were included in this study. The main reasons for maintaining long-term silicone oil are recurrent vitreous hemorrhage, retinal detachment with severe proliferative vitreoretinopathy, and penetrating injury. The patients were distributed into two groups: group 1 included patients with both functional and anatomic failure, group 2 patients had achieved ambulatory vision. Follow-up ranged from 27 to 72months. Cataract incidence was approximately 91% in group 2. Emulsification was noted without high pressure in 50% of the cases in group 1. High pressure averaged 31.8% in group 2. Keratopathy was observed in 9% of the cases in group 2. Intraorbital migration of silicone oil was found in one case. The visual field was improved in 77% of the cases in group 2.

CONCLUSION

This study provided interesting insights into certain clinical situations in which silicone oil has to be maintained permanently. The complications stem not only from the presence of silicone oil, but also from the preoperative status of the eye and the vitreoretinal surgery.

Optic neuropathy as a presenting feature of systemic lupus erythematosus: two case reports and literature review

Systemic lupus erythematosus (SLE) may affect the eyes and/or visual system in up to a third of patients; however, optic nerve involvement has been rarely reported. SLE presenting as optic neuropathy is exceptional. We report two new cases of optic neuropathy as a presenting feature of SLE. The first patient presented with an ischemic optic neuropathy and antiphospholipid antibodies, and the second presented with optic neuritis. A literature review for previous cases of SLE presenting as optic neuropathy was performed. Early diagnosis of SLE-associated optic neuropathy is warranted and leads to a better prognosis.

Designing Data Marts from XML and Relational Data Sources

Due to the international economic competition, enterprises are ever looking for efficient methods to build data marts/warehouses to analyze the large data volume in their decision making process. On the other hand, even though the relational data model is the most commonly used model, any data mart/ warehouse construction method must now deal with other data types and in particular XML documents which represent the dominant type of data exchanged between partners and retrieved from the Web. This chapter presents a data mart design method that starts from both a relational database source and XML documents compliant to a given DTD. Besides considering these two types of data structures, the originality of our method lies in its being decision maker centered, its automatic extraction of loadable data mart schemas and its genericity.

Reinforcement of a minor alternative splicing event in MYO7A due to a missense mutation results in a mild form of retinopathy and deafness

PURPOSE

Recessive mutations of the myosin VIIA (MYO7A) gene are reported to be responsible for both a deaf-blindness syndrome (Usher type 1B [USH1B] and atypical Usher syndrome) and nonsyndromic hearing loss (HL; Deafness, Neurosensory, Autosomal Recessive 2 [DFNB2]). The existence of DFNB2 is controversial, and often there is no relationship between the type and location of the MYO7A mutations corresponding to the USH1B and DFNB2 phenotype. We investigated the molecular determinant of a mild form of retinopathy in association with a subtle splicing modulation of MYO7A mRNA.

METHODS

Affected members underwent detailed audiologic and ocular characterization. DNA samples from family members were genotyped with polymorphic microsatellite markers. Sequencing of MYO7A was performed. Endogenous lymphoid RNA analysis and a splicing minigene assay were used to study the effect of the c.1935G>A mutation.

RESULTS

Funduscopy showed mild retinitis pigmentosa in adults with HL. Microsatellite analysis showed linkage to markers in the region on chromosome 11q13.5. Sequencing of MYO7A revealed a mutation in the last nucleotide of exon 16 (c.1935G>A), which corresponds to a substitution of a methionine to an isoleucine residue at amino acid 645 of the myosin VIIA. However, structural prediction of the molecular model of myosin VIIA shows that this amino acid replacement induces only minor structural changes in the immediate environment of the mutation and thus does not alter the overall native structure. We found that, although predominantly included in mature mRNA, exon 16 is in fact alternatively spliced in control cells and that the mutation at the very last position is associated with a switch toward a predominant exclusion of that exon. This observation was further supported using a splicing minigene transfection assay; the c.1935G>A mutation was found to trigger a partial impairment of the adjacent donor splice site, suggesting that the unique change at the last position of the exon is responsible for the enhanced exon exclusion in this family.

CONCLUSIONS

This study shows how an exonic mutation that weakens the 5' splice site enhances a minor alternative splicing without abolishing a complete exclusion of the exon and therefore causes a less severe retinitis pigmentosa than the USH1B-associated alleles. It would be interesting to examine a possible correlation between intrafamilial phenotypic variability and the subtle variation in exon 16 inclusion, probably related to genetic background specificities.