Smart control of soil water and salt content for improving irrigation management of tomato crop field: Kairouan area

A good assessment of soil water and salt content is required for sustainable irrigation with brackish/saline water. The use of the Internet of Things (IoT) has been initiated for the tomato crop (Savera variety) as part of the PRIMA MEDITOMATO project. An experiment was carried out between February and June 2022 at a farmer's site. For continuous soil water and salt content assessment, TEROS (11/12) probes were implemented at depths of 0, 10, 20, 30, and 60 cm. The data logging process was performed by a ZL6 device and delivered by the ZENTRA Cloud web application (METER GROUPE Company). For the accuracy of the introduced sensors, calibration tests were first processed. Results of the calibration of the probes in the laboratory and in situ showed linear relationships between the humidity values measured by ZL6 (θZL6) and those determined by the gravimetric method, with high correlation coefficients (R2) of 0.86 and 0.96, respectively. There were also strong linear relationships between the ECbulk(ZL6) and the ECe measured on saturated paste extract with high correlation coefficients (R2) of 0.96 and 0.95. Corrected data, according to the determined linear regression equations, present the real-time assessment of soil water and salt content over the entire growth stage of tomatoes. The results of this monitoring showed that soil water content remained close to its status at field capacity (32%) at the beginning of the assessment and increased with the intensification of irrigation, reaching 46 and 54% at 20 and 30 cm, respectively, around mid-April. The salinity level was greater with depth. Indeed, it was low in topsoil with the increase in irrigation frequency and higher at 30 and 60 cm toward the end of the tomato cycle. According to this study, real-time data given by ZENTRA Cloud allows us to adjust irrigation management on time.

The nutritional composition of six plant species after irrigation with treated wastewater and possible hazards by heavy metal accumulation

A field experiment was conducted investigating the possibility of using treated wastewater (TWW) on sites affected by water scarcity in summer, waterlogging during the wet season, and salinity. A corresponding pot experiment was conducted comparable to the field experiment in Kalaât Landelous. The same plant species (Atriplex nummularia Lindl., Eucalyptus gomphocephala DC., Acacia cyanophylla Lindl., Casuarina glauca Sieber ex Spreng., Cupressus sempervirens L., and Pinus halepensis Mill.) were grown with the same treatments. While, in the field the plants, elemental composition cannot be linked to inputs by TWW, this was studied under controlled conditions. Additionally, a control was established lower in salinity receiving tap water. The effect of TWW irrigation on macro- and microelement uptake by the six plant species was studied. The treatments were high soil salinity under drained saline (DS) conditions, high salinity under waterlogged saline (WS), and a drained non-saline control (DNS: EC = 3.0 dS/m, pH = 8.4). TWW application under DS treatment increased Na, Cl, Ca, Mg, N, P, and K in most plant tissues compared to the control. TWW application in WS treatment resulted in an increase in heavy metals. Cu and Zn showed the highest bioaccumulation factor (BAF). The BAF in different plant tissues followed the order: Cu > Zn > Mn > Cd > Ni > Co > Pb. The plants accumulated significant amounts of metals in their roots.

Occurrence of Hypopituitarism in Tunisian Turner Syndrome patients: familial versus sporadic cases

OBJECTIVE

To explore unusual association between Turner Syndrome (TS) and Hypopituitarism in a Tunisian cohort.

METHODS

We reported 6 patients with TS associated to Hypopituitarism, including three familial cases except the fourth sister who showed only a TS phenotype. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed.

RESULTS

The average age of our patients was 17.2 years (11-31 years). They were all referred for short stature and pubertal delay, except for the fourth sister who presented spontaneous puberty with the integrity of the pituitary axis and the presence of an X ring chromosome. Karyotype analysis showed monosomy in 3 cases and a mosaic TS in the 3 remaining cases, including one patient with abnormal X chromosome structure. Somatotropic and corticotropic deficiencies were confirmed in 2 sporadic cases while the gonadotropic and thyrotropic axes were spared. In contrast; familial cases were consistently affected by the integrity of the corticotropic axis. MRI showed pituitary hypoplasia in all familial cases and pituitary stalk interruption syndrome in only one sporadic case. No correlation was found between the chromosome formula and the anterior pituitary involvement.

CONCLUSION

Co-segregation of congenital Hypopituitarism with pituitary hypoplasia and X chromosome aberrations could imply a molecular anomaly of transcription factors responsible for the differentiation and development of pituitary cells such as PROP1, POUF1, Hesx1, Lhx3, Lhx4. The etiopathogenic link between X chromosome abnormalities and the occurrence of Hypopituitarism remains unclear; however, the progress of molecular biology may clarify the interrelation between transcription factors and sex chromosome segregation abnormalities.

Mapping heavy metal (Cu, Zn, and Pb) pollution and ecological risk assessment, in the surroundings of Gabes cement plant-Tunisia

The pollution and contamination assessment of three heavy metals (Cu, Pb, and Zn) in the topsoil, and common plants (Olea europaea, Prunus persica vulgaris, Ficus carica, Medicago sativa, Zygophyllum album, and Helianthemum kahiricum) were carried out at different distances from a cement plant. This evaluation was based on four evaluation methods: Bioconcentration factor, Contamination factor, Geoaccumulation Index and Potential ecological risk factor. The chlorophylls a and b contents were also analyzed. The highest levels of Cu, Zn, and Pb in the topsoil were found close to the cement factory (cluster D), and the lowest values were observed in a distant oasis (cluster H). The lowest chlorophylls values were observed in perennial plants (O. europaea and F. carica) near the cement plant. Zygophyllum album and H. kahiricum showed capability to remove Cu an Zn in contaminated locations, depending on the soil type. The spatialization of the results was essential to the understanding of the potential contribution of different sources of Cu, Zn, and Pb in the topsoil and to distinguishing different behaviors of the same plant species. Concerning H. kahiricum, further research should be undertaken since it has a high livestock acceptability index and is used in traditional medicine. Novelty statement The impact of three heavy metals (Cu, Zn, and Pb) on the topsoil and six species of plants common in Tunisia (arid climate) will be assessed, and the potential contribution of different sources to the contamination. Few studies have addressed the impact of cement dust in the topsoil and common plant species in arid rangelands, and, as far as we know, none of them have considered the spatialization of the data and results, considering the prevailing wind, plant species location, soil type, and use. Moreover, the ability of steppic vegetation to remove these three heavy metals (phytoextraction) was evaluated using the bioconcentration factor (BCF), soil pollution indices, and ecological risk. Chlorophylls a and b contents were also evaluated to establish the effect of the cement plant on the health of plants located nearby.

Salinity decreases cadmium accumulation in Vicia faba

The study investigates the effect of cadmium (Cd), salinity (NaCl), and combined stress on rhizosphere pH, growth parameters, membrane leakage, and genotoxicity in Vicia faba. Germinated seeds were exposed for 48 h to 0.01 mM Cd(NO₃)₂ (Cd), 50 mM NaCl (S50), 150 mM NaCl (S150), and Cd-NaCl (CdS50 and CdS150). An accumulation of Cd and Na was found essentially in Vicia roots under each single stress factor associated with variations in rhizosphere pH. Additional NaCl in metallic solution significantly dropped the rhizosphere pH and decreased Cd concentrations in roots by 2.3 and 3.8 times for CdS50 and CdS150, respectively. Growth parameters (root length and fresh and dry matters), mitotic activity, and micronucleus formation were not influenced by Cd and low concentration of NaCl when applied separately or together, while 150 mM of NaCl, alone or combined with Cd, affected negatively all the studied parameters, as well as chromosome and nucleus stability. V. faba seems to reduce the transport of Cd in saline conditions and therefore salinity (50 mM) may act as a protection against Cd accumulation.

Saline soil reclamation by agroforestry species under Kalaât Landelous conditions and irrigation with treated wastewater in Tunisia

Irrigation with treated waste water (TWW) in combination with plantation of agroforest species was tested in the Kalaât Landelous region for the reclamation of salt affected soils. Five species (Atriplex nummularia, Eucalyptus gomphocephala, Acacia cyanophylla, Casuarina glauca, Pinus halepensis) were cultivated in saline soils that are affected by shallow, saline groundwater and were irrigated with TWW during the summer season. The results after 4 years of experimentation show a distinct decrease in soil pH and salinity accompanied by a decrease in Cl and Na concentrations. Irrigation decreased the heavy metal concentrations in the topsoil but an increase in deeper layers indicate to leaching due to TWW irrigation. The investigated plant species were differently affected in growth performance by salinity and TWW irrigation. Atriplex nummularia appeared to be the most resistant species and Pinus halepensis the most sensitive one to hydro-pedological conditions of the Kalaât Landelous plot. In conclusion, salt-tolerant plant species seem to be good candidates for the reclamation of salt-affected, waterlogged sites in combination with TWW irrigation, as the adaptations of such species seem to operate under different abiotic stress conditions.

[Virus and Atypical Pathogens Detected in Community-Acquired Lower Respiratory Tract Infection in Infants and Children of Sfax Region, Tunisia]

Little is known about viral and atypical bacteria pathogen spectra of community-acquired lower respiratory tract infection in children in Tunisia. Thus, a prospective study was carried out between January 2009 and March 2010 in Sfax. Nasopharyngeal aspirates collected from 368 patients (78 with pneumonia and 290 with acute bronchiolitis) were analyzed by indirect immunofluorescence assay and PCR to detect influenza viruses, parainfluenza viruses, respiratory syncytial virus (RSV), human metapneumovirus, human rhinovirus, human enterovirus, adenovirus, coronavirus, Mycoplasma pneumonia (Mpn) and Chlamydia pneumonia (Cpn). One or more etiology was documented in 319 cases (86.7%). The most detected viruses were RSV (42.7%), rhinovirus (32.9%) and adenovirus (28.5%). Co-detection of two or three pathogens was found in 40% of positive samples. This study highlights the importance of respiratory viruses in lower respiratory tract infection in children of Sfax region as well as the high rate of co-detection of multiple viruses, resulting in challenges in clinical interpretation.

Fulminant mulch pneumonitis in a previously healthy child

Chronic granulomatous disease (CGD) is associated with multiple and recurrent infections. In patients with CGD, invasive pulmonary infection with aspergillus species remains the greatest cause of mortality. Acute fulminant presentations of fungal pneumonia are catastrophic. It is a medical emergency, and currently the treatment is based on association of corticosteroids and antifungal therapy. We describe the case of an 11-year-old boy, with late initial presentation of CGD, which was revealed by fulminant aspergillus pneumonia. He was successfully treated with an association of high doses of steroids and voriconazole.

Chromosomal and Nuclear Alterations in the Root Tip Cells of Vicia faba Induced by Sodium Chloride

  Despite the well-known toxic effect of chloride sodium (NaCl), only few studies analyze its genotoxic effect on crops. Micronucleus assay is an efficient tool for the measure of chromosomal DNA damages. Based on this test, the effects of salt on micronucleus induction, and on chromosome and nucleus changes, were investigated in Vicia faba root tips treated with NaCl (electrical conductivity = 25 dS/m) during 24 hours. V. faba meristematic cells showed a significant increase in the number of micronuclei compared with the control. Micronucleus size varied from small to large and appeared at different stages of mitosis. Moreover, different chromosomal aberrations like breaks, bridges, rings, vagrant, and lagging chromosomes, were observed in the metaphase, the anaphase, and the telophase. In addition, nuclear alterations in the interphase were characterized by the presence of binucleated cells, strap nuclei with lesions, hyperchromasia, buds, and nuclei with irregular shapes and lesions.

[Management of patients with major beta thalassemia in a paediatric department in the south of Tunisia: About 26 cases]

AIM

Our objectives were to assess the management of patients with major thalassemia and identify the various complications and monitoring means.

PATIENTS AND METHODS

A retrospective study was conducted on 26 β-thalassemic patients in the department of paediatrics, Hédi Chaker hospital, Sfax, Tunisia during a period of 25 years (from 1 January 1990 to 31 December 2014).

RESULTS

The mean age of the beginning of transfusion was 11.5 months. That was with phenotyped red blood cells but not leukodepleted blood. Twenty-three patients received chelation. Before 2001, all patients received deferoxamine, poor adherence to this treatment was observed in 66% of cases. It was replaced by deferiprone since 2006 and deferasirox since 2009. A combination of 2 or 3 chelators was indicated for four patients. A total splenectomy was performed in 10 cases patients; it was due to hypersplenism. The bone marrow transplant was performed for one patient at the age of 9 year but it was rejected. Many complications were detected: endocrine complications (19 cases), immune complications (9 cases), gallbladder stones (5 cases), cardiac complications (4 cases), osteoporosis (3 cases), infectious complications (3 cases) and thromboembolic complications (2 cases). We noted some side effects related to chelation therapy in twelve cases. Four patients were dead.

CONCLUSION

Improving the medical care of homozygous β-thalassemic children requires adherence to transfusion regimen and chelation therapy. Bone marrow transplantation remains the only possible curative therapy, which must be promoted in our country.

Management of cholestatic pruritus in children with Alagille syndrome: Case report and literature review

Alagille syndrome causes intractable pruritus and disfiguring xanthomas because of retained bile acids and cholesterol. Drug therapy in addition to surgical intervention may be effective in many patients in reducing serum bile acids, cholesterol levels, pruritus, and skin xanthomas. In this report, we describe a child with Alagille syndrome who presented with severe pruritus and xanthomas as a consequence of severe hypercholesterolemia and discuss the treatment modalities.

Transient neonatal diabetes mellitus and activating mutation in the KCNJ11 gene in two siblings

Transient neonatal diabetes mellitus is a rare disease usually associated with chromosome 6 abnormalities. Mutations of the genes encoding the potassium channel are rarely associated with these transitional forms. Herein, we report the clinical features of two siblings with a heterozygous mutation C679 G>A in the KCNJ11 gene.

Familial haemophagocytosis lymphohisticytosis type 3: A case report

Familial hemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive disorder of immune regulation. Here, we report on a fatal case of type 3 FHL (FHL3) in a 45-day-old boy. Clinically, the infant presented with fever and hepatosplenomegaly. Biology showed pancytopenia, elevated ferritin, and decreased fibrinogen. Images of hemophagocytosis were found at the bone morrow examination. The diagnosis of FHL type 3 was made by the identification of homozygous mutation in the Munc13-4 gene (UNC13D) located in exon 20: 1822 del 12bp (V608fs). This mutation was previously observed in a Tunisian and in Moroccan families.

CREM variant rs17583959 conferred susceptibility to T1D risk in the Tunisian families

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the destruction of insulin-producing pancreatic β-cells by autoreactive T cells. Studies in animal models, such as the non-obese diabetic (NOD) mouse reveal that this disease is under the control of several genes that encode molecules implicated in regulation of transcription factors and in T cell activation. In order to underline the role of the genes involved in this regulation pathways, we investigated, using the Sequenom MassARRAY platform, 13 single-nucleotide polymorphisms (SNPs) belonging to CREM, IRF5, STAT4, and STAT5a/b genes in 59 T1D Tunisian families. In the current study, we identified an association with rs17583959 (allele G; Z score=2.27; p=0.02; Genotype GG: score=1.96; p=0.04) of CREM gene. In LD analysis a strong LD between the 3 CREM variants (Block 1) was detected; rs2384352 was in complete LD with rs1148247. When haplotypes were constructed between CREM polymorphisms (rs1148247, rs17583959, rs2384352), AGA haplotype (H2) was significantly over-transmitted from parents to affected offspring (Z score=2.988; P=0.002) and may confer a risk for T1D disease. Whereas, AAG haplotype (H5) (Z score=-2.000; p=0.045) was less transmitted than expected to affected children suggesting its protective effect against T1D pathology. No significant association in IRF5, STAT4, and STAT5a/b genes were observed. In conclusion, this study shows an eventually involvement of CREM gene in the development of T1D pathology in Tunisian families. These facts are consistent with a major role for transcription factor genes involved in the immune pathways in the control of autoimmunity. Further researches of association and functional analysis across populations are needed to confirm these findings.

Macrophagic activation syndrome related to an infection by Rickettsia conorii in a child

Since the Arab Spring, a resurgence of zoonotic diseases such as rickettsiosis, endemic in the Mediterranean basin, has been observed. It preferentially infects microvascular endothelial cells of mammalian hosts inducing vasculitis with endothelial injury. Rickettsioses are considered benign infectious diseases. Severe systemic manifestations have been reported and are often explained by a delay in diagnosis. We present a case of hemophagocytic syndrome occurring in a 4-year-old Libyan girl as a complication of Mediterranean spotted fever. Rickettsial infection was confirmed by serology and the patient was treated with clarithromycin, with a favorable outcome.

A Miniaturized Column Chromatography Method for Measuring Receptor-Mediated Inositol Phosphate Accumulation

Inositol phosphates (IPs), such as 1,4,5-inositol-trisphosphate (IP3), comprise a ubiquitous intracellular signaling cascade initiated in response to G protein-coupled receptor-mediated activation of phospholipase C. Classical methods for measuring intracellular accumulation of these molecules include time-consuming high-performance liquid chromatography (HPLC) separation or large-volume, gravity-fed anion-exchange column chromatography. More recent approaches, such as radio-receptor and AlphaScreen™ assays, offer higher throughput. However, these techniques rely on measurement of IP3itself, rather than its accumulation with other downstream IPs, and often suffer from poor signal-to-noise ratios due to the transient nature of IP3. The authors have developed a miniaturized, anion-exchange chromatography method for measuring inositol phosphate accumulation in cells that takes advantage of signal amplification achieved through measuring IP3and downstream IPs. This assay uses centrifugation of 96-well-formatted anion-exchange mini-columns for the isolation of radiolabeled inositol phosphates from cell extracts, followed by low-background dry-scintillation counting. This improved assay method measures receptor-mediated IP accumulation with signal-to-noise and pharmacological values comparable to the classical large-volume, column-based methods. Assay validation data for recombinant muscarinic receptor 1, galanin receptor 2, and rat astrocyte metabotropic glutamate receptor 5 are presented. This miniaturized protocol reduces reagent usage and assay time as compared to large-column methods and is compatible with standard 96-well scintillation counters.

[Unilateral to bilateral pleurisy: Pleural tuberculosis?]

Pleural tuberculosis is the first or second most common form of extrapulmonary tuberculosis as well as the main cause of pleural effusion in many countries. It is rare in young infants and is more common in children over 10 years of age. We report the case of a 19-month-old girl admitted for prolonged fever with unilateral pleural effusion. The mother reported a history of lymph node tuberculosis 6 years previously. Intravenous antibiotics with cefotaxime and vancomycin were started. Thoracocentesis yielded a serosanguinous exudate fluid with a lymphocyte predominance. The tuberculin skin test and PCR GeneXpert(©) on pleural fluid were negative. The initial outcome was favorable, but the chest X-rays 10 days after discharge showed bilateral pleural effusion. Pleural biopsy was proposed but the culture of pleural fluid was positive for Mycobacterium tuberculosis. The child was put under standard treatment for tuberculosis. The outcome was favorable.

Occipital dermoid cyst associated with dermal sinus complicated with meningitis: A case report

BACKGROUND

Occipital dermal sinus, usually associated with dermoid cyst, is a rare entity; it results from the persistence of an abnormal embryonal communication between the skin and the intradural space. Its main complication is intracranial infection.

CASE DESCRIPTION

This 2-year-old girl was hospitalized for meningitis. Neuroradiological studies revealed a cystic mass of the posterior fossa communicating with the skin and hydrocephalus. The diagnosis of dermoid cyst associated with dermal sinus was established at surgery. The patient was treated with radical excision of both the occipital cyst and the dermal sinus associated with systemic antibiotic therapy. She had a good outcome.

CONCLUSION

Posterior fossa dermoid cyst should be considered in all children with chronic occipital skin lesion, especially a dermal sinus. We emphasize the importance of early neurosurgical treatment of dermoid cysts to prevent the development of severe complications.

Competitive sorption and desorption of trace elements by Tunisian Aridisols Calcorthids

The sorption and retention processes play an important role in determining the bioavaibility and fate of trace elements in soils. Sorption and desorption of Pb(2+), Zn(2+), Ni(2+), Cu(2+), and Co(2+) in three Tunisian Aridisols Calcorthids (AR1, AR2, and AR3) were studied using batch experiments. Sorption and retention capacities were determined by means of K r parameter and they were related to soil properties. The results showed that in all studied soils, K r values for Pb(2+) and Cu(2+) were higher than those of Zn(2+), Ni(2+), and Co(2+) indicating that soils have higher affinity for the first ones. The high sorption and retention capacity of the three studied soils is ascribed to their alkaline pH and their high carbonates contents favoring the precipitation of these elements. Moreover, bivariate correlation analysis showed that sorption and retention of the studied cations was also strongly correlated with clay fraction and Fe oxides contents. All soils show high sorption irreversibility of Pb(2+), Zn(2+), Ni(2+), Cu(2+), and Co(2+). The soils with highest sorption capacity show also the highest irreversibility.

Comorbidity in the Tunisian population

Genetic diseases in the Tunisian population represent a real problem of public health as their spectrum encompasses more than 400 disorders. Their frequency and distribution in the country have been influenced by demographic, economic and social features especially consanguinity. In this article, we report on genetic disease association referred to as comorbidity and discuss factors influencing their expressivity. Seventy-five disease associations have been reported among Tunisian families. This comorbidity could be individual or familial. In 39 comorbid associations, consanguinity was noted. Twenty-one founder and 11 private mutations are the cause of 34 primary diseases and 13 of associated diseases. As the information dealing with this phenomenon is fragmented, we proposed to centralize it in this report in order to draw both clinicians' and researcher's attention on the occurrence of such disease associations in inbred populations as it makes genetic counseling and prenatal diagnosis challenging even when mutations are known.

Association of TCR/CD3, PTPN22, CD28 and ZAP70 gene polymorphisms with type 1 diabetes risk in Tunisian population: family based association study

Type 1 diabetes (T1D) is caused by an immune-mediated destruction of the insulin-producing β-cells. Several studies support the involvement of T cell activation molecules in the pathogenesis of T1D. In order to underline the role of the genes involved in this activation pathway, we investigated, using the Sequenom MassARRAY platform, 45 single-nucleotide polymorphisms (SNPs) belonging to TCR/CD3, CD28, ZAP70, and PTPN22 genes in 59 T1D Tunisian families. In the current study, we identified an association with rs706 (Z score=2.782; p=0.005) of TCRβ gene. We also demonstrated that rs10918706 in the intron of the CD3z gene was associated with increased risk of T1D (Z score 2.137; p=0.032). In the same region, rs2949655 (Z score=2.101; p=0.035) and rs1214611 (Z score=4.036; p=0.00005) showed a genotype association with the risk of T1D. When haplotypes were constructed, GAA haplotype displayed significant association with T1D (Z score=2.135; p=0.032), while GGA haplotype (Z score=-1.988; p=0.046) was negatively associated with the disease. We also identified an association with rs3181096 (Z score=2.177; p=0.029), rs17695937 (Z score =2.111; p=0.034) and rs2488457 (Z score=2.219; p=0.026), respectively of CD28, ZAP70 and PTPN22 genes. In addition, our results suggest a significant effect on T1D susceptibility for AC (Z score=2.30; p=0.02) and CTGGC (Z score=2.309, p=0.02) haplotypes of ZAP70 and PTPN22 genes, respectively. While, the GTCT (Z score=-2.114, p=0.034) and CTAGG (Z score=-2.121, p=0.033) haplotypes of CD28 and PTPN22 genes, may confer protection against T1D. These findings confirm the role of PTPN22 and CD28 involved in the T cell activation pathway in the development of T1D in Tunisian families. Interestingly, ZAP70 and TCRβ/CD3z seem to contribute to the susceptibility to the disease in our population. However, this finding has to be confirmed in further studies.

Unusual intraatrial thrombus in a neonate with coarctation of the aorta

Left atrial thrombus in neonates is uncommon. We describe a newborn with coarctation of the aorta, in whom a thrombus confined to the left appendage was discovered on the first day of life and was thought to be a myxoma.

[Hereditary hemorrhagic telangiectasia. Report of a pediatric case]

Hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber syndrome, is an autosomal dominant multiorgan disorder. This multisystemic vascular dysplasia is determined by a mutation of one of two main genes, endoglin (ENG) or HHT1, or ACVRL1 or HHT2. These mutations induce vascular disorders that cause recurrent epistaxis and eventually multiple telangiectasia and arteriovenous visceral malformations. We report the case of a 7-year-old girl who developed severe hypoxemia due to multiple pulmonary arteriovenous malformations.

[An uncommon cause of hematemesis in children: factor XI deficiency]

Congenital factor XI deficiency, also called hemophilia C, is a rare coagulation disorder that is particularly common in Ashkenazi Jews. Individuals with factor XI deficiency may or may not have a mild bleeding tendency, which is typically provoked by surgery or trauma. We report the case of a 5.5-year-old girl who presented with abdominal pain, vomiting, and hematemesis. Biological tests showed a prolonged activated partial thromboplastin time (aPTT) of 113 s (control=29 s) caused by a constitutional factor Xl deficiency (2.7%). The progression was spontaneously favorable.

[Neonatal renal candidiasis: a case report]

Neonatal renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies.

CASE REPORT

a female infant was born by cesarian section at 30 weeks' gestation to a mother whose pregnancy had been complicated by rupture of membranes for 5 days. The infant was admitted at birth, maternofetal bacterial infection was suspected, and intravenous antibiotics were prescribed. The patient developed sepsis caused by Klebsiella pneumoniae at the age of 13 days. She was referred to our hospital at the age of 50 days because of renal abscess. At admission, the baby presented with hypothermia and abdominal distention. Renal ultrasonography findings were compatible with fungal disease. Blood, urine, and cerebrospinal fluid cultures were negative for fungi; however, galactomannan antigen blood levels were increased. Amphotericin B was administered for 6 weeks. End-organ evaluation of the heart, brain, and eyes did not demonstrate disseminated infection. The patient was discharged with a prescription for oral fluconazole and remained well at follow-up.

[Pediatric Crohn's disease in Tunisia]

Crohn's disease occur mainly in adults. However, pediatric onset forms are not rare and have many characteristics.

AIM

to study clinical, diagnostic, therapeutic and evolutive characteristics of crohn's disease in tunisian children.

METHODS

Retrospective multicenter study conducted in 10 pediatric departments on a period of 10 years (2000-2008) RESULTS : 43 children were included. The sex-ratio was 1.68. The mean age at the onset of the symptoms was 11+/-2.3 years (5-16 years). The age of onset was inferior to 10 years in 25 % of the children. The delay before management was superior to 1 year in 25% of cases. The initial symptoms were dominated by diarrhea (95%). Perineal manifestations were present at diagnosis in 30% of children and extra-digestive manifestations in 53%. Ileocolonic localization was the most frequent (46%). The initial disease flare was moderate in 83% of cases. The treatment was medical in 77 % of cases, nutritional and medical in 18.5%. Maintenance therapy was instituted in 86% of cases and consisted essentially in azathioprin (62%). The mean follow-up was 3 years and 4 months. 60% of the children had at least one acute flare. During evolution, 7% of children had anoperineal surgery and 11% an intestinal resection.

CONCLUSION

Crohn's disease seems rare in Tunisia. The time of diagnosis is often delayed. The management is based on immunosuppressive therapy and nutritional support.

[Megalencephaly with dystonia revealing Canavan disease]

Canavan disease, or N-acetyl aspartic aciduria, is an autosomal recessive leukodystrophy characterized by spongy degeneration of the brain. The disease results from the accumulation of N-acetyl aspartic acid in the brain, due to aspartoacylase deficiency. We report the case of a 6-month-old girl who presented with megalencephaly, peripheral hypertonia, and a developmental delay noticeable after 4 months of age. Magnetic resonance imaging of the brain with spectroscopy was suggestive of Canavan disease, which was confirmed by chromatography of urinary organic acids.

[Primary distal renal tubular acidosis in children in the South of Tunisia: study of 15 cases]

BACKGROUND

primary distal renal tubular acidosis in children (RTA) is characterized by metabolic acidosis due to defect in urinary excretion of hydrogen (H+) in the distal tubular.

AIM

To report the epidemiological, clinical, therapeutic and evolutionary of distal RTA in our patients.

PATIENTS AND METHODS

We conducted a retrospective study of all cases of distal RTA collected in the department of pediatrics of Hedi Chaker University hospital in the south of Tunisia, during a period of 23 years (1988-2010). We studied the epidemiological, clinical, biological, evolutionary and therapeutic data.

RESULTS

During the study period 15 cases of distal RTA were collected. The average age was 6 months (1 month -2 years). Most common presenting symptoms were vomiting (8cases), failure to thrive (4cases), lack of appetite, polyuria-polydipsia syndrome (1case) and urinary infection (2cases). The clinical examination showed staturoponderal delay (9 cases), dehydration (6 cases), signs of rickets (3 cases) and polyuria (10 cases). Biological data showed high urine pH in the presence of metabolic acidosis in 11 cases, hypokalaemia in 10 cases and hypercalciuria in all cases. Urine acidification test with ammonium chloride was performed in 4 cases, the urinary pH was always higher than 5.5 in all cases. Ammoniuria performed in 9 cases was less than 40mmol/l. Radiological investigation objectified a nephrocalcinosis in fourteen patients and signs of rickets in three cases. Deafness was found in three patients. Genetic study performed in two cases showed mutation of ATP6V1B1 gene. The medical treatment involved an alkali load. Long-term outcome was favorable in 7 cases.

CONCLUSION

The distal renal tubular acidosis is a rare pathology in our country but probably under diagnosed. The clinical gravity of this disease and the risk of evolution towards the terminal renal insufficiency justify an antenatal diagnosis to establish a neonatal management or propose a therapeutic interruption of the pregnancy if the distal RTA is associated with a severe pathology.

[Epidemiology of rotavirus gastroenteritis among children under 5 years of age in Tunisia - results of sentinel hospital surveillance 2009 to 2011]

BACKGROUND

Rotavirus is the major cause of severe acute gastroenteritis among young children. The objectives of this study were to assess the epidemiology, clinical and virological features of community-acquired rotavirus acute gastroenteritis, in children under 5 years of age, hospitalized in Tunisia.

METHODS

A multicenter prospective observational study was conducted from April 2009 to March 2011, in 11 sentinel pediatric departments. Clinical data and stool samples were collected for all children under 5 years, admitted for acute gastroenteritis. Rotavirus was detected by Elisa immunoassay test and genotyped for G and P by semi-nested multiplex RT-PCR.

RESULT

A total of 621 children were enrolled in this study. Rotavirus was detected in 30.3% of cases (95% CI [26.7-33.9]). The estimated incidence rate of rotavirus acute gastroenteritis was 11 cases/100,000 child-years (95% CI [9.43-12.57]). This infection affected predominantly children aged under 24 months, and occurred mainly in winter (55.3%). Vomiting, fever and dehydration were observed in 79.6%, 69.5% and 57% respectively. Genotype analysis identified four G types (G1, G2, G3 and G4) and 4 P types (P[4], P[6], P[8] and P[9]). The most common G/P combination was G3P[8] (24.4%), followed by G4P[8] (13.3%) and G1P[8] (6.5%).

CONCLUSION

These results highlight the frequency and potential severity of rotavirus acute gastroenteritis in pediatric hospital settings. The present study could provide a sufficient database to make a decision related to the introduction of rotavirus vaccine in Tunisian national immunization program.