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Ben Nessib D, Ferjani HL, Majdoub F, Ben Aissa R, Gzam Y, Kaffel D, Maatallah K, Hamdi W. Anterior Chest Wall Non-traumatic Arthropathies: A Crucial but Often Overlooked Site. Curr Rheumatol Rev 2024; 20:88-96. [PMID: 37670695 DOI: 10.2174/1573397119666230905122525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the distribution of Anterior Chest Wall (ACW) arthropathies in a tertiary care center and identify clinical, biological and imaging findings to differentiate osteoarthritis (OA) from non-osteoarthritis (N-OA) etiologies. METHODS Search from medical records from January 2009 to April 2022, including patients with manubriosternal and/or sternoclavicular and/or sternocostal joint changes confirmed by ultrasonography, computed tomography or magnetic resonance imaging. The final study group was divided into OA and N-OA subgroups. RESULTS A total of 108 patients (34 males and 74 females, mean age: 47.3 ± 13 years) were included. Twenty patients had findings of OA, while 88 were diagnosed with N-OA pathologies. SpA was the most common etiology in the N-OA group (n = 75). The other N-OA etiologies were less common: rheumatoid arthritis (n = 4), Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome (n = 3), infectious arthritis (n = 3) and microcrystalline arthropathies (n = 3). Regarding the distinctive features, ACW pain was the inaugural manifestation in 50% of patients in OA group and 18.2% of patients in N-OA group (p = 0.003); high inflammatory biomarkers were more common in N-OA group (p = 0.033). Imaging findings significantly associated with OA included subchondral bone cysts (p < 0.001) and intra-articular vacuum phenomenon (p < 0.001), while the presence of erosions was significantly associated with N-OA arthropathies (p = 0.019). OA was independently predicted by the presence of subchondral bone cysts (p = 0.026). CONCLUSION ACW pain is a common but often underestimated complaint. Knowledge of the different non-traumatic pathologies and differentiation between OA and N-OA etiologies is fundamental for appropriate therapeutic management.
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Affiliation(s)
- Dorra Ben Nessib
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Hanene Lassoued Ferjani
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Fatma Majdoub
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Rania Ben Aissa
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Yosra Gzam
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Kaouther Maatallah
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
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Boussaid S, Ben Aissa R, Rekik S, Rahmouni S, Jammali S, Zouaoui K, Sahli H, Elleuch M. Ultrasonography Enthesitis and Synovitis Screening in Psoriatic Patients: A Case Control Study. Mediterr J Rheumatol 2023; 34:495-505. [PMID: 38282930 PMCID: PMC10815525 DOI: 10.31138/mjr.180923.ues] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 01/30/2024] Open
Abstract
Background The clinical screening of enthesitis and synovitis in patients with psoriasis lacks specificity and sensitivity during the preclinical phase. Aims to assess US subclinical synovitis and enthesitis in psoriatic patients compared with healthy controls. Methods A cross-sectional study on 40 psoriatic patients and 40 healthy sex- and age-matched controls. US examination of 18 joints was performed along with 22 entheseal sites on the upper and lower limbs. US subscores were established according to the US abnormalities: inflammatory score (tendon thickening, hypoechogenicity, bursitis, Doppler signal), damage score (calcification, enthesophytes, bone erosion) and total score (the sum of inflammatory and damage scores). Results US synovitis were more frequent in psoriatic patients (0.68%) than in controls (0.29%), but the difference was not significant. Patients with psoriasis had more US enthesitis (92,5%) compared to controls (40%)(p<0.001). The total number of enthesitis was higher in the psoriatic group (20.90%) compared to controls (4,78%)(p<0.001). There were more US abnormalities in the psoriatic group compared to controls for calcaneal tendon enthesis(p<0.001), distal patellar tendon enthesis(p<0.001) and deep flexor tendons of the finger enthesis(p<0.001). Compared to controls, psoriatic patients had a significantly higher inflammatory score (Mean±SD) (2.85±3.34 versus 0.58±1.17), damage score (3±2.57 versus 0.60±1.41), and total score (5.85±5.20 versus 1.18±2.07) (p < 0.001 each). Patients with scalp psoriasis had more US enthesitis (p=0.020). Conclusion Our results indicate that US enthesitis and synovitis are more frequent in patients with psoriasis. Prospective studies with larger sample size are needed to define the contribution of US in predicting the clinical onset of PsA.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Rania Ben Aissa
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Safa Rahmouni
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Khaoula Zouaoui
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
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Ben Nessib D, Armi S, Ferjani H, Garsi M, Ben Sassi S, Kerkeni S, Ben Aissa R, Berraies G, Kaffel D, Mathlouthi N, Maatallah K, Belghith C, Slimani O, Hamdi W. Low back pain in pregnant women: A necessary or an avoidable evil? Musculoskeletal Care 2023; 21:865-870. [PMID: 37010863 DOI: 10.1002/msc.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence, the main features and the potential risk factors of LBP in pregnant women. METHODS This cross-sectional study included 173 pregnant women in the third trimester. Non-inclusion criteria were severe mental disability and known previous history of musculoskeletal diseases. The participants were categorised into two groups: women with pregnancy-related LBP and pain-free women. Demographic, socio-professional, clinical and obstetrical data were compared between the two groups using the appropriate statistical tests. RESULTS The mean age was 32.2 ± 5.4 years [17-45]. Among them, 108 (62.4%) reported one or more episodes of LBP during at least 7 days, mostly in the third semester (n = 71). The presence of LBP was significantly associated with history of LBP in previous pregnancies and jobs requiring prolonged standing. Active jobs and the presence of gestational complications were significantly more common in pain-free women. In the multivariate analysis, LBP was independently predicted by the history of LBP in previous pregnancies and the absence of gestational complications. CONCLUSIONS The association of LBP with gestational complications as a protective factor has not yet been reported in previous studies. These complications are a common cause of hospitalisation, which represents a period of relative rest during pregnancy. Our results revealed that history of LBP in previous pregnancies, sedentary lifestyle prior to pregnancy and prolonged standing are the main risk factors of LBP. In contrast, rest and avoidance of physical overstrain during pregnancy may be protective factors.
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Affiliation(s)
- Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Sawssem Armi
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hanène Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Mariem Garsi
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Senda Ben Sassi
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sarra Kerkeni
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rania Ben Aissa
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ghada Berraies
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Nabil Mathlouthi
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Cyrine Belghith
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Olfa Slimani
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Gynecology-Obstetrics Department A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
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Triki W, Rabhi E, Ferjani H, Ben Aissa R, Ben Nessib D, Maatallah K, Kaffel D, Hamdi W. 10 Impact of the month of birth on the development of juvenile idiopathic arthritis among Tunisian children. Rheumatology (Oxford) 2022; 61:keac496.006. [PMCID: PMC9539198 DOI: 10.1093/rheumatology/keac496.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is the most common inflammatory disease influenced by genetic as well as environmental factors. Prior studies from Israel and USA suggested that JIA had a seasonality of birth, with birth peaking in winter and especially in January. Objectives The aim of the study was to evaluate the impact of month of birth and season, and the onset of JIA in Tunisian children. Methods We conducted a case-control study including 27 children with JIA compared with a homogeneous control group of 27 children hospitalized in a pediatric orthopedic unit for traumatic reasons and healthy for any chronic inflammatory rheumatism. Statistical differences between groups were also analyzed by non-parametrical tests. Results Fifty-four patients (25 females and 29 males) were enrolled. The mean age was 11.04 ± 5.58 years and the mean duration of the diseases was 5.29 ± 3,18 years. The frequency of each JIA subset was at follows: polyarticular rheumatoid factor positive (n = 2), polyarticular rheumatoid factor negative (n = 5), psoriatic arthritis (n = 1), enthesitis-related arthritis (n = 11) and oligoarthritis (n = 8). Although the majority of children with JIA were born in November (22.2%) and December (18.5%), there was no significant difference in month of birth distribution between the cases and the controls. Likewise, there was no significant correlation between season of birth and the onset of the disease (p = 0,6). Conclusion This study didn’t show any correlation between season and month birth, and the onset of JIA. Our result may be explained by the weather in Tunisia which is relatively warm with little variation in temperature between seasons compared with the country where they found a significant correlation. It also may be due to the limited number of our cases.
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Affiliation(s)
- Wafa Triki
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Emna Rabhi
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Hanene Ferjani
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Rania Ben Aissa
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Dorra Ben Nessib
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Kaouther Maatallah
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Dhia Kaffel
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
| | - Wafa Hamdi
- University Tunis el Manar, Tunisia, Faculty of Medicine of Tunis, Beb Saadoun, Tunisia,Kassab Orthopedics Institute, Rheumatology Department, Ksar Said, Tunisia
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Al-Gallas N, Khadraoui N, Hotzel H, Tomaso H, El-Adawy H, Neubauer H, Belghouthi K, Ghedira K, Gautam HK, Kumar B, Laouini D, Zarrouk S, Abbassi MS, Aissa RB. Quinolone resistance among Salmonella Kentucky and Typhimurium isolates in Tunisia: first report of Salmonella Typhimurium ST34 in Africa and qnrB19 in Tunisia. J Appl Microbiol 2020; 130:807-818. [PMID: 32780929 DOI: 10.1111/jam.14822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
AIMS Characterization of quinolone-resistant Salmonella Kentucky and Typhimurium isolates in Tunisia from various sources, detection of some plasmid-mediated quinolone resistance genes and the genetic relatedness. METHODS A total of 1404 isolates of S. Kentucky (n = 1059)/S. Typhimurium (n = 345) from various sources from all over Tunisia were tested for quinolone resistance by disk diffusion method. Minimum inhibitory concentrations of nalidixic acid, ciprofloxacin and ofloxacin were determined. Quinolone-resistant isolates were screened for plasmid-mediated quinolone-resistance genes (qnrA,qnrB,qnrS, aac(6')-Ib-cr and qepA) by polymerase chain reaction (PCR). Mutations in the quinolone-resistance-determining regions of the gyrA and parC genes were detected by PCR and DNA sequencing. Pulsed-field gel electrophoresis and multilocus sequence typing were accomplished for isolates harbouring plasmid-mediated quinolone-resistance genes. RESULTS According to our selection criteria (NAL = resistance phenotype; CIP = resistant with diameter 0, or intermediate), only 63 S. Kentucky/41 S. Typhimurium isolates were investigated: 49% (5/104) were multidrug resistant. Two S. Typhimurium isolates harboured qnrB19 with different PFGE profiles. A mutation was detected in the gyrA gene for each of these two isolates. MLST revealed the presence of ST313 and ST34, an endemic sequence type. CONCLUSION Our study highlights the presence of quinolone multidrug-resistant Salmonella in humans and animals in Tunisia. This is the first report of S. Typhimurium ST34 in Africa and qnrB19 in Tunisia. SIGNIFICANCE AND IMPACT OF THE STUDY This is the first report that describes not only the current epidemiological situation of the quinolone resistance in S. Kentucky and Typhimurium isolated from various sources and regions in Tunisia, but also, the genetic resistance determinants associated with phenotypic antibiotic resistance and the molecular mechanisms of their quinolone-resistance. Also, we provide the first report of S. Typhimurium ST34 in Africa, and the first report of qnrB19 in Salmonella in Tunisia.
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Affiliation(s)
- N Al-Gallas
- Water and Food Control Lab, National Center of Salmonella, Shigella, Vibrio-Enteropathogens - Institut Pasteur de Tunis (IPT) Tunis-Belvédère, Tunis, Tunisia.,Department of Biology, College of Sciences, University of Hafar Al-Batin (UHB), City Hafr Al Batin, Saudi Arabia
| | - N Khadraoui
- Water and Food Control Lab, National Center of Salmonella, Shigella, Vibrio-Enteropathogens - Institut Pasteur de Tunis (IPT) Tunis-Belvédère, Tunis, Tunisia.,Laboratory of Bioactive Substances, Biotechnology Center of Borj Cedria, Hammam-Lif, Tunisia
| | - H Hotzel
- Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - H Tomaso
- Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - H El-Adawy
- Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), Institute of Bacterial Infections and Zoonoses, Jena, Germany.,Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - H Neubauer
- Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - K Belghouthi
- Water and Food Control Lab, National Center of Salmonella, Shigella, Vibrio-Enteropathogens - Institut Pasteur de Tunis (IPT) Tunis-Belvédère, Tunis, Tunisia.,Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - K Ghedira
- Group of Bioinformatics and Mathematical Modeling, Laboratory of Medical Parasitology, Biotechnologies and Biomolecules, Institut Pasteur de Tunis, Université de Tunis El-Manar, Tunis, Tunisia
| | - H K Gautam
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, CSIR-HRDC Campus, Ghaziabad, UP, India
| | - B Kumar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, CSIR-HRDC Campus, Ghaziabad, UP, India
| | - D Laouini
- Laboratory of Transmission, Control and Immunobiology of Infections, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia
| | - S Zarrouk
- Genomics Platform, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia
| | - M S Abbassi
- University of Tunis El Manar, Insitute of Veterinary Research of Tunisia, Tunis, Tunisia
| | - R B Aissa
- Water and Food Control Lab, National Center of Salmonella, Shigella, Vibrio-Enteropathogens - Institut Pasteur de Tunis (IPT) Tunis-Belvédère, Tunis, Tunisia
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