Checklist of The Monogenea (Platyhelminthes) Parasitic in Tunisian Aquatic Vertebrates.

153 species of monogeneans have been recorded in Tunisian aquatic vertebrates (89 hosts). A list of these species with hosts is presented. A comparison of the Monogenea diversity off the coast of Tunisia with other regions of the Mediterranean Sea and the world is provided. The number of parasites depends on the number of hosts examined and their diversity in the region. This list shows that Monopisthocotylea is the richest group. In addition, new records have been reported during a survey of the diversity of monogeneans fish in the southern coast of Tunisia (Gulf of Gabes) including: Benedenia monticellii (Parona and Perugia, 1895) Johnston, 1929, Lamellodiscus bidens Euzet, 1984, Lamellodiscus confusus Amine, Euzet & Kechemir-Issad, 2007, Lamellodiscus ergensi Euzet & Oliver, 1966, Lamellodiscus hilii Euzet, 1984, Lamellodiscus impervius Euzet, 1984, Lamellodiscus knoepffleri Oliver, 1969, Lamellodiscus theroni Amine, Euzet & Kechemir-Issad, 2007, Ligophorus acuminatus Euzet & Suriano, 1977, Ligophorus angustus Euzet & Suriano, 1977, Ligophorus heteronchus Euzet & Suriano, 1977, Ligophorus macrocolpos Euzet & Suriano, 1977, Ligophorus minimus Euzet & Suriano, 1977, Capsala maccallumi Price, 1939 and Pseudanthocotyloides heterocotyle (Van Beneden, 1871) Euzet & Prost, 1969.

Helminth parasites of the chub mackerel Scomber colias off the Tunisian coast and their use in stock discrimination.

Nine helminth parasites were used as biological tags to discriminate diverse areas of Scomber colias Gmelin, 1789. During three seasons, a total of 369 fish were examined in four zones off the Tunisian coast, including Bizerte in the north, Kelibia and Mahdia in the centre and Zarzis in the south. Discriminant analyses were used to identify distinct areas of S. colias. Fish from Bizerte were grouped as one area and were correlated negatively with the monogenean Grubea cochlear and the digenean Lecithocladium excisum. Specimens from Kelibia and Mahdia were grouped together and were characterized by the ectoparasite Pseudokuhnia minor and by endoparasites Prodistomum orientalis, Monascus filiformis and anisakid larvae. Fish from Zarzis were grouped as one area and were positively correlated with the monogenean G. cochlear and the digenean L. excisum. These results were corroborated by comparing the prevalence and mean abundance of parasites among zones. Results of other discriminant analyses used for the classification of S. colias between localities after pooling specimens from the central areas of Kelibia and Mahdia also allowed the identification of three distinct areas: one in the north, correlated negatively with G. cochlear and L. excisum; one in the centre, characterized by P. minor, P. orientalis, M. filiformis and anisakid larvae; and one in the south, from Zarzis, characterized by G. cochlear and L. excisum. Results of comparisons of infection parameters between seasons and those of seasonal discrminant analyses showed a seasonal stability of communities from the northern and the southern areas. Specimens from the central regions showed variability between seasons, suggesting migratory movements.

Morphometrics and levels of infections of digeneans in belonid fish species off the coast of Tunisia.

Three species of belonid fish, Belone belone gracilis Lowe, 1839, Belone svetovidovi Collette & Parin, 1970 and Tylosurus acus imperialis (Rafinesque, 1810), caught off the eastern Tunisian coast were infected with eight species of Digenea. Among these, four species were commonly found in B. b. gracilis and are new host records for B. svetovidovi. They are: Lecithostaphylus retroflexus (Molin, 1859), Tergestia acanthocephala (Stossich, 1887) Stossich, 1899 and Aponurus laguncula Looss, 1907 in the intestine, and the metacercaria Condylocotyla pilodora Pearson and Prévot, 1985 in the pericardial sac. Four other digenean species were recorded from T. a. imperialis: Lecithostaphylus tylosuri Châari et al., 2013 and Tetrochetus coryphaenae Yamaguti, 1934 in the intestine, Oesophagotrema mediterranea Châari et al., 2011 in the oesophagus and vomer teeth, and Sclerodistomoides pacificus Kamegai, 1971 in the gall bladder. Tetrochetus coryphaenae and S. pacificus represent new host and geographical records. The spatial variation of digenean parasites within belonid host species is discussed.

Spatial variability of helminth parasites and evidence for stock discrimination in the round sardinella, Sardinella aurita (Valenciennes, 1847), off the coast of Tunisia.

Three digeneans - Parahemiurus merus (Linton, 1910), Aphanurus stossichii (Monticelli, 1891) and Lecithochirium sp. - and one tetraphyllidean cestode larva were used as biological tags to discriminate the stock of Sardinella aurita (Valenciennes, 1847). In total, 579 fish were examined in five zones off the Tunisian coast, including Bizerte and Kelibia in the north, Mahdia in the east, Gabes and Zarzis in the south. Discriminant analyses used for the separation of S. aurita allowed for the identification of two discrete stocks. Sardinella aurita from Bizerte, Kelibia and Zarzis clumped together as a single stock. Parahemiurus merus and A. stossichii were the most important species in determining the location of sampled fish from these regions. Specimens from Mahdia and Gabes were grouped as one stock characterized by the presence of Lecithochirium sp. and larvae of the Tetraphyllidea. These results were corroborated by comparing the parameters of prevalence and mean abundance of parasites among zones. The separation of S. aurita between localities after pooling specimens from Bizerte, Kelibia and Zarzis and separately pooling those from Mahdia and Gabes also allowed the identification of two discrete stocks, one in offshore waters from Bizerte, Kelibia and Zarzis characterized by the digeneans P. merus and A. stossichii and one in inshore waters from Mahdia and Gabes characterized by Lechithochirium sp. and tetraphyllidean larvae.

Digenean species diversity in teleost fishes from the Gulf of Gabes, Tunisia (Western Mediterranean).

This study is the first attempt to survey the diversity of fish digeneans in the Gulf of Gabes (southern coast of Tunisia). A total of 779 fishes belonging to 32 species were sampled. 53 species of Digenea belonging to 15 families were recorded. Among these species, 24 are reported for the first time from the coast of Tunisia. We report one new host record, Lecithochirium sp. from Sardinella aurita. The Hemiuridae is the dominant family. A host-parasite list is presented with the information on the prevalence, abundance and mean intensity of each species collected. The diversity of Digenea is compared with other localities in the Mediterranean Sea and the northern east of Tunisia. The Gulf of Gabes shows the lowest diversity linked to the anthropogenic activities and impact of exotic species. The use of Digenea as indicators of the state of the ecosystem is discussed.

[Effect of conservative treatment in the management of low-degree urogenital prolapse]. / Apport du traitement conservateur dans la prise en charge du prolapsus urogénital de bas grade. Le devenir après deux ans.

OBJECTIVE: The objective of our study was to determine the respective effects of conservative treatment (pelvic muscle exercises plus advice on healthy living) and the absence of treatment in the management of urogenital prolapse. MATERIALS AND METHODS: Forty-seven women (mean+/-S.D. age: 53.42+/-11.01 years) consulting for genital prolapse (grade I or II cystocele) were randomized into two groups: a conservative treatment group (CTG) and a nontreated group (NTG). The patients' outcomes were rated according to several parameters; a clinical examination, the "Measurement of Urinary Handicap" (MUH) scale, urodynamic tests, the Ditrovie quality of life scale and patient satisfaction on a visual analogue scale (VAS). RESULTS: The immediate post-treatment results showed that pelvic heaviness persisted in only five patients (18.51%) in the CTG compared with fourteen (70%) in the NTG (p<0.001). Furthermore, a significant improvement in the MUH scale score was noted in the CTG compared with the NTG. The Ditrovie score also improved. The maximum urethral closure pressure (MUCP) ranged from 54.4+/-13.23 to 57.81+/-12.8 cm H(2)O in the CTG versus 54.05+/-12.18 to 52.95+/-12.18 cm H(2)O in the NTG. Uroflowmetry revealed a significant improvement in the maximum flow rate. These benefits were maintained two years after cessation of the conservative treatment in 20 of the CTG patients. CONCLUSION: Conservative treatment can be effective in the treatment of low-degree urogenital prolapse and enables the improvement of clinical symptoms and urodynamic parameters. The benefits were maintained two years after treatment cessation.

The isokinetic assessment of peripheral muscle function in patients with coronary artery disease: correlations with cardiorespiratory capacity.

OBJECTIVE: We aimed to determine whether diminished cardiorespiratory capacity in patients with coronary artery disease (CAD) is accompanied by impaired skeletal muscle function as measured by isokinetic dynamometry. We also evaluated the correlation between isokinetic strength and aerobic capacity in these patients. MATERIALS AND METHODS: Fifteen CAD patients and 15 age-matched healthy subjects (mean age 60+/-6 vs. 57+/-3.5 years) underwent maximal laboratory exercise testing, a 6-min walking test and an assessment of peripheral skeletal muscle function by use of an isokinetic apparatus. Quadricep and hamstring function was tested at two angular velocities, 150 and 180 degrees s(-1) with simultaneous electrocardiography monitoring. The cardiorespiratory and mechanical parameters (VO(2), ventilatory threshold [VT], heart rate [HR], and power) were measured at VT and at maximal effort. RESULTS: Quadricep and hamstring peak torque was impaired in CAD patients, with quadriceps peak torque at 180 degrees being 71.13 +/- 14 vs. 91.13 +/- 23 Nm (P<0.01) and hamstring peak torque 46.50+/-10 vs. 59.86+/-12 Nm (P<0.01). CAD subjects presented a deficient aerobic capacity as compared with the healthy subjects at maximal effort. At VT, the VO(2), ventilation, and HR were significantly lower in CAD patients, at 13.77+/-2.33 vs. 17.08+/-3.59 ml min(-1) kg(-1) (P<0.05), 29.64 +/- 664 vs. 37.76 +/- 7.2 ml min(-1) (P<0.05), and 86+/-14 vs. 111+/-15 beats min(-1) (P=0.001), respectively. The 6-min walking distance was significantly shorter for CAD patients than healthy subjects (425.93+/-52.77 vs. 551.46 +/- 57.94 m; P<0.01). In CAD patients quadriceps and hamstring strength was not correlated with VO(2) at maximal effort and at VT. Total distance walked during the 6-min walk and VO(2)max were correlated (r=0.869; P<0.001) but not at VT. CONCLUSION: CAD patients showed impaired cardiorespiratory capacity accompanied by increased muscle fatigability as compared with healthy subjects. An isokinetic muscle assessment in these patients must be achieved systematically and seems to have value in cardiovascular rehabilitation.

[Acquired hemophilia A in prepartum: case report and literature review]. / Hémophilie A acquise découverte au cours de la grossesse : à propos d'un cas et revue de la littérature.

INTRODUCTION: Acquired hemophilia A (AH) is a rare hemorrhagic disorder, secondary to the occurrence of factor VIII inhibitor. In young patients, this disorder is commonly observed during the post-partum period, and has been rarely documented in the prepartum. We report a new case of a prepartum AH and review literature data. CASE REPORT: An isolated prolongation of the activated partial thromboplastin time (APTT) was fortuitously discovered in a 31-year-old pregnant women, with spontaneous ecchymosis of her lower limbs few days prior to delivery. Coagulation tests revealed decreased factor VIII activity (18%) and the presence of factor VIII inhibitor (1,4 Bethesda unit). In order to eradicate the autoantibody, the patient was first treated with prednisone and then with rituximab. CONCLUSION: Prepartum factor VIII inhibitors need to be precociously recognized to allow prophylactic management of the delivery bleeding.

Hydatid cyst open in biliary tract: therapeutic approaches. Report of 22 cases.

GOAL: Discuss the different therapeutic options based on results of a series of patients undergoing operation for hydatid cyst ruptured into the biliary tract. PATIENTS AND METHODS: This was a retrospective study of 22 patients operated on between 2001 and 2007 for hydatid cyst ruptured into the biliary tract. RESULTS: The mean age of patients was 37 years old. There were 14 men and eight women. Cholangitis was present in 59% of patients and isolated pain in the right upper quadrant was found in 20% of patients. Procedures performed included internal fistula drainage through the sphincter of Oddi (37.3%), cystobiliary disconnection by percutaneous transhepatic cystocholedochostomy (27.3%), bipolar drainage (27.3%), direct suture closure of the fistula (9.1%). The postoperative course was uneventful in 15 patients. Specific morbidity concerned four patients. An external biliary fistula and suppuration of the residual cavity was observed in two patients each. One patient died. Median survival was 24 months. No recurrence or late complications were seen in this series. CONCLUSION: The management of hydatid cyst ruptured into the biliary tract is not consensual. Radical treatment is best because it provides definitive treatment of both the fistula and the cyst at the same time. However, conservative treatment is the preferred treatment in endemic countries. The choice of the technique depends of the experience of the surgeon, as well as local and topographic conditions. The best treatment remains preventive by eradication of echinococcosis.

[Does combination of intrathecal magnesium sulfate and morphine improve postcaesarean section analgesia?]. / L'adjonction de sulfate de magnésium à la morphine en intrathécal améliore-t-elle l'analgésie après césarienne ?

BACKGROUND: Intrathecal morphine (IT) is commonly used for postoperative analgesia after caesarean section. The addition of intrathecal (IT) magnesium to spinal bupivacaine-fentanyl anaesthesia increases the duration of spinal analgesia for labour without additional side effects. In this prospective, randomized, double blind, controlled study, we evaluated whether adding intrathecal magnesium could prolong spinal morphine analgesia after caesarean section. PARTURIENT AND METHODS: After ethics committee approval and obtaining written consent, one hundred and five (ASA I or II) adult patients undergoing caesarean section were recruited. They were randomly allocated to one of three groups: (1) group Morphine (M): 10 mg of isobaric bupivacaine 0.5% (2 ml)+100 microg morphine (1 ml)+10 microg fentanyl (0.1 ml)+1 ml of isotonic saline solution, (2) group Magnesium (Mg): 10mg of isobaric bupivacaine 0.5% (2 ml)+100mg of magnesium sulphate 10% (1 ml)+10 microg fentanyl (0.1 ml)+1 ml of isotonic saline solution, (3) group Morphine+Magnesium (MMg): 10mg of isobaric bupivacaine 0.5% (2 ml)+100mg of magnesium sulphate 10% (1 ml)+100 microg morphine (1 ml)+10 microg fentanyl (0.1 ml). We recorded the following: time to the first analgesic request, pain scores with the visual analogic scale at rest and in movement at h0, h1, h2, h4 and then every 4h for the first 36 postoperative hours, the occurrence of adverse events and patients' satisfaction. RESULTS: Time of the first analgesic request was 28+/-8h in group MMg versus 19+/-6h in group M and 7+/-6h in group Mg (p<0.01). Pain scores were statistically lower in group MMg (9+/-7 and 17+/-9 mm respectively) compared to group M (16+/-9 and 28+/-11 mm respectively) and Mg (21+/-9 and 37+/-13 mm respectively) (p<0.01). There was no difference in adverse events among the three groups. Patients satisfaction was better in group MMg (p<0.01). CONCLUSION: In patients undergoing caesarean section under spinal anaesthesia, the addition of IT magnesium sulphate (100mg) to morphine 100 microg improved the quality and the duration of postoperative analgesia without increasing the incidence of adverse effects.

[Functional and quality of life outcome of non-operated rotator cuff tears]. / Le devenir fonctionnel et la qualité de vie des ruptures de la coiffe des rotateurs non opérées.

UNLABELLED: Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores. MATERIAL AND METHODS: This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales. RESULTS: The study population consisted of 38 women and 21 men (mean age: 61 years; range 46-75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4-12). The VAS score for pain at rest dropped from 68.3+/-31 to 28.3+/-12 (p<10(-3)) over the follow-up period. The score for pain during effort fell from 82.5+/-36 to 40.3+/-15. In all cases, active joint mobility was better at the final assessment (p<0.001). The Constant score rose from 28.8+/-14.2 to 51.6+/-21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r=0.62) and during effort (r=0.59) and with the increased Constant score. CONCLUSION: Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.