The origin of the dorsal scapular artery: anatomic variations and surgical applications.

The dorsal scapular artery (DSA) can be either a direct branch of the subclavian artery (SCA), or a branch of the transverse cervical artery (TCA). In mandibular reconstruction, when a free flap is contraindicated a pedicled scapular flap has been described vascularized by the DSA. During the dissection of this flap, there is a risk of lesion of the TCA, which could be fatal to the flap if the DCA is a branch of the TCA. To evaluate the frequency of this anatomic situation, a dissection and radiologic study has been performed. 50 anatomic dissections on fresh cadavers and 93 arteriographies from 47 patients have been studied, to determine what was the DSA origin. In our dissections we found the origin of the DSA was a type I origin in 19 cases (38 %), a type II in 19 cases (38 %) and a type III in 12 cases (24 %). In our radiologic study, the DSA and the TCA had a common origin from the SCA (Type I) in 57/93 cases (61.3 %), the DSA was a direct branch of the SCA and the TCA (type II) in 22/93 cases (23.7 %), the DSA and the TCA had a common origin from the TCT (type III) in 14/93 cases (15 %). The DSA is coming from the TCA in 1/5 cases. A careful dissection of this flap in the subclavian area is necessary in all cases, a preoperative arteriography could be proposed to limit the risk of pedicle injury.

[Acute disseminated encephalomyelitis in Tunisia: Report of a pediatric cohort]. / Encéphalomyélite aiguë disséminée en Tunisie: étude d'une cohorte pédiatrique.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disorder of the central nervous system whose clinical features, management and outcome are incompletely understood in Tunisian population. OBJECTIVE: To describe clinical, neuroimaging and laboratory features; treatment and outcome in a cohort of Tunisian children with ADEM. METHODS: We conducted a retrospective review of the medical records of all children attending the Department of Child and Adolescent Neurology (Tunis) with ADEM between 2005 and 2015. Clinical, neuroimaging and laboratory features, therapeutic data and outcome were analyzed. RESULTS: There were 15 children (7 males and 8 females). The mean age at onset was 6.9 years. Thirteen (86.6%) patients had a prodromal event. The onset of neurological symptoms occurred within 17.6 days (4-30). Limb weakness was the most common presenting symptom (53.3%). Extrapyramidal syndrome was noticed in 6 patients (40%). Initial MRI showed a deep gray matter involvement in 7 cases (46.6%). Gadolinium enhancement at acute stage was observed in only 2 patients (13%). Cerebrospinal fluid findings did not show intrathecal oligoclonal bands. The use of high-dose IV methylprednisolone followed by oral steroid taper was associated with rapid recovery. Additional treatment with intravenous immunoglobulin was necessary in 2 patients. Complete recovery was obtained in 11 patients (73.3%). A monophasic course was noticed in 14 cases. Only one patient (5%) developed multiple sclerosis. CONCLUSION: The high frequency of prodromal events and extrapyramidal syndrome in addition to the low rate of gadolinium enhancement at acute stage seem to be the main features in our patients. Larger ADEM multicenter cohort studies in Tunisia and North Africa could provide more detailed information about this entity.

Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas (Observatoire dédié au Cancer Bretagne / Pays de la Loire).

BACKGROUND: In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer. METHODS/RESULTS: A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks. CONCLUSION: Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.

En 2006, bevacizumab-FOLFIRI représente la thérapie ciblée administrable dès la première ligne chez les patients porteurs d'un cancer colorectal métastatique non opérable. Une série homogène de 111 patients colligés en région Bretagne et Pays de la Loire ayant reçu du bevacizumab- FOLFIRI en première ligne en 2006 révèle les résultats suivants: 51 réponses, 29 stabilités, 21 progressions et 10 toxicités avant évaluation. La médiane de survie globale (OS) est de 25,1 mois et la médiane de survie sans progression (PFS) de 10,2 mois. Dans le cas d'une chirurgie secondaire, l'OS médian triple de 18,8 mois chez les patients non réséqués versus 59,2 mois ceux réséqués. En comparant les sujets âgés de plus et de moins de 70 ans, aucune différence n'a été mise en évidence en termes de bénéfice ou de risque. Bevacizumab-FOLFIRI pourrait être administré en pratique courante chez les personnes âgées sous couvert d'une évaluation gériatrique et d'une approche multidisciplinaire.

Molecular detection and MST genotyping of Coxiella burnetii in ruminants and stray dogs and cats in Northern Algeria.

Aiming at identifying the reservoir and contamination sources of Coxiella burnetii in Northern Algeria, we investigated the molecular presence of the bacterium in 599 samples (blood, placenta, liver, spleen, and uterus) collected from cattle, sheep, dogs and cats. Our qPCR results showed that 15/344 (4.36%) blood samples and six/255 (2.35%) organ specimens were positive for C. burnetii. In cattle, three (4%) blood and liver samples were positive. In sheep, one blood (1.19%) and 3 (8.57%) placenta samples were positive. At the Algiers dog pound, 8 (10%) and 3 (5%) blood samples were qPCR positivein dogs and cats, respectively. In addition, MST genotyping showed that MST 33 was present in cattle and sheep, MST 20 in cattle,andMST 21 in dogs and cats.

[Reasons for using emergency departments of major hospitals in Greater Tunis]. / Motifs du recours aux services d'urgence des principaux hôpitaux du Grand Tunis.

Tunisia, similar to many countries, has a problem of overcrowding of the emergency departments (ED). This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged 18 years, with stratification according to time of day of presentation to ED (morning, afternoon and evening). Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients (52.5%) were male and the mean age was 46.0 (SD 18.1) years. The main reasons for choosing the ED were: speed (54.0%) and ease of access (47.7%) of ER and occurrence of an acute episode (26.4%). Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED.

[Exclusive breastfeeding and mixed feeding: knowledge, attitudes and practices of primiparous mothers]. / Allaitement maternel exclusif et allaitement mixte: connaissances, attitudes et pratiques des mères primipares.

We assessed the knowledge attitudes and practices of primiparous women with regard to exclusive breastfeeding and the use of formula milk. A total of 260 women were interviewed and the results showed that 41.5% of the women breastfed exclusively while 58.5% bottle-fed only or did so together with breastfeeding. Of those who breastfed, 43.0% did not do so soon after giving birth and did not know about colostrum. Overall, the knowledge, attitudes and practices of the mothers were unsatisfactory concerning the golden rules for successful breastfeeding, the ideal duration of exclusive breastfeeding and the food to include when introducing complementary feeding. This might be due to a low level of schooling and information, hence the need for improving strategies for maternal care during the antenatal and postnatal periods.

[Cost effectiveness analysis of screening strategies for cervical cancer in Tunisia]. / Analyse coût-efficacité des stratégies de dépistage du cancer du col utérin en Tunisie.

We aimed to identify the most appropriate screening strategy for cervical cancer (periodicity of 3, 5 or 10 years) for Tunisia, taking into consideration the incidence of the disease, costs of screening and economic implications. We simulated follow-up of a fictitious cohort of 1 million women 35-39 years over 30 years. Computation of yearly medical care costs was based on data from medical files of patients diagnosed with cervical cancer in 2004 at the National Institute of Cancer, Tunis. For a 60% coverage level of screening, cervical cancer reduction would be 49.2% for a 3-year periodicity. The reduction would be 40.3% and 33.1% for 5 and 10 years periodicity respectively. Considering cost-effectiveness, 10-year screening gave the lowest annual cost to avoid 1 cervical cancer case.

First detection of CTX-M-28 in a Tunisian hospital from a cefotaxime-resistant Klebsiella pneumoniae strain.

A cefotaxime-resistant Klebsiella pneumoniae ML4313 was obtained from a patient from intensive care unit of Military hospital in Tunisia. This strain was resistant to beta-lactams, aminoglycosides, quinolones and phenicols, and tetracyclines. It was identified as producer of extended-spectrum beta-lactamases (ESBL) by double-disk synergy test between amoxicillin-clavulanate and cefotaxime, ceftriaxone, ceftazidime and aztreonam. The ESBL was identified as CTX-M-28 by sequencing of PCR products and by isoelectric focusing. The ESBL resistance was transferred by a 50kb plasmid. CTX-M-28 is closely related to CTX-M-15. This is the first description of this enzyme in Tunisia.

Identification of plasmid-encoded extended spectrum beta-lactamases produced by a clinical strain of Proteus mirabilis.

Emergence and dissemination of multiresistant strain of Proteus mirabilis have made infections treatment more difficult that this bacterium is responsible. The aim of this study is to determine the implication of the enzymatic mechanism and to describe the properties of ESBLs (extended spectrum beta-lactamases). A clinical strain of Proteus mirabilis SM514 isolated in the intensive care unit at the Military hospital in Tunisia during the period 2004 was found to be highly resistant to cephalosporins and penicilins. Cells sonicate of the isolate hydrolysed cefotaxime more efficiently than ceftriaxone and ceftazidime and had three beta-lactamases bands of approximate of isoelectric points (pI) of 5.4; 5.6 and superior to 7.6. The specific activities (AS) vary from 5.26 to 7.77U/mg of protein respectively for cefotaxime and the benzylpenicillin. These activities are inhibited by the clavulanic acid and the sulbactam. The values of the IC(50) are respectively 3.7 and 11.7muM. Only the beta-lactamases of pI 5.4 and superior to 7.6 hydrolyze the cefotaxime. Transformant produces the ESBLs of pI 5.4; 7.45 and greater than 7.6. The genes coding for this enzymes are carried by a transferable plasmids.

Health and behaviours of Tunisian school youth in an era of rapid epidemiological transition.

To assess youth health behaviours and related quality of life in urban Tunisia, we conducted a cross-sectional survey of a representative sample of 699 secondary-school students. The overweight rate was 20.7%. Most of the sample had an insufficient level of physical activity and were unfamiliar with the recommended frequency of moderate physical activity. Norm-based scores of psychological state were about average, slightly better for boys than girls. Girls perceived themselves to be more stressed than boys. Of all students, 35% declared having smoked a cigarette and 14% having drunk alcohol at least once in their lives. The main sources of health education were mass media (59%) and medical staff (36%).

[Breast cancer in Tunisia: epidemiologic characteristics and trends in incidence]. / Cancer du sein en Tunisie: caracteristiques epidemiologiques et tendance evolutive de l'incidence.

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry (NTCR) and from the Salah AZAIZ Institute (SAI) Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases/100,000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years (11%) could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia.

Corrigendum to 'Coxiella burnetii infection with women's febrile spontaneous abortion reported in Algiers'.

[This corrects the article DOI: 10.1016/j.nmni.2018.08.003.].

Coxiella burnetii infection with women's febrile spontaneous abortion reported in Algiers.

We investigated Q fever infection in Febrile Spontaneous Abortions in women by using a serologic method (Immuno-Fluorescence Assay, IFA) and a molecular method (real-time quantitative PCR, qPCR) in Obstetric-Gynaecology (OB-GYN) services in two hospitals in Algiers. We included in the case group 380 women who experienced Febrile Spontaneous Abortion; the control group comprised 345 women who gave birth without any other infections or complications. Among the 725 women included, antibodies against Coxiella burnetii were detected by IFA in three (03) cases patients; all control group samples were IFA negative. In other hand, only four (04) placental samples among the case group came back with q PCR positive for IS1111 and IS30a too. A relationship between C. burnetii infection and febrile spontaneous abortion exists in OB-GYN services in Algiers.

WITHDRAWN: [Clinical strain of Proteus mirabilis able to produce a plasmid mediated ceftazidimase.] / Identification d'une ceftazidimase plasmidique produite par une souche clinique de Proteus mirabilis.

Resistance to third generation cephalosporins due to the acquisition and expression of extended spectrum beta-lactamases (ESBLs) enzymes among Gram negative bacteria continue to pose a challenge to infection management worldwide. The aim of this study was to determine the implication of the enzymatic mechanism and to describe the properties of ESBLs from a clinical strain of Proteus mirabilis NC4150 isolated in the intensive care unit at the Military Hospital in Tunisia during the period 2004. The isolate was identified, tested for antimicrobial susceptibility and analysed for presence of ESBL genes. Two beta - lactamases which confers a multirésistance on antibiotics including the oxyimino beta-lactams were identified. Isoelectric points of these two beta-lactamases are 5.4 and 5.7. The specific activities (AS) vary from 0.2 to 36.27 U/mg of protein respectively for ampicilline and the ceftazidime. These activities are inhibited by the clavulanic acid and the sulbactam. The values of the IC 50 are respectively 16 muM and 2.4 mu M. Only the beta - lactamase of pI 5.7 hydrolyze the ceftazidime. Transformant and transconjugant produces only the ESBL (extended spectrum beta-lactamases) of pI 5.7. The gene coding for this enzyme is carried by a transferable plasmid named pNC4150.

[Breast cancer prognosis in Salah Azaiez Institute of Cancer, Tunis]. / Pronostic du cancer du sein à l'Institut de Carcinologie Salah Azaïez de Tunis.

We estimated survival rate at 9 years of all (470) women with breast cancer diagnosed at Salah Azaïez Institute of Cancer in Tunis to identify the main prognosis factors. Data were collected on residence, socioeconomic level, circumstances of discovery of the tumour, histological type, tumour size, presence of metastases, extension of the tumour, treatment and survival. Comparison of survival curves was done with Log Rank test. Cox model was used for multivariate adjustments and calculation of the hazard ratio (HR) (relative risk of death). There was a survival rate of 61% at 5 years and of 51% at 9 years. Tumour size >5 cm was significantly associated with lower survival as was capsular rupture. After stratification for tumour size and age, only surgery and radiotherapy were significantly associated with improved survival.

Pyridoxine-dependent epilepsy: A novel mutation in a Tunisian child.

Pyridoxine-dependent epilepsy (PDE) is a rare autosomal recessive metabolic disease characterized by seizures in neonates or infants, which is unresponsive to antiepileptic drugs but controlled by pyridoxine. Without prompt treatment, continued seizures and severe encephalopathy result. Mutations in the ALDH7A1 gene encoding α-amino-adipic semialdehyde (α-AASA) dehydrogenase (antiquitin) have been identified as the cause of PDE. We report on a novel ALDH7A1 mutation in a Tunisian child with PDE.

[Magnetic resonance imaging features of desmoplastic cerebral ganglioglioma of infancy: report of 1 case]. / Imagerie par résonance magnétique du gangliogliome desmoplastique infantile cérébral: à propos d'un cas.

Desmoplastic infantile ganglioglioma is a rare intracranial tumor of infancy, characterized by solid and cystic component, voluminous size and supratentorial location. These tumors are diagnosed usually below the age of 2 years. We report 1 case of desmoplastic ganglioglioma in 13-year-old male. Computed tomography and magnetic resonance imaging diagnosed supratentorial mixed cystic and solid tumor, which presented as a large cystic component with intense contrast enhancement of a mural nodule. The tumor was surgically removed, and histology revealed desmoplastic ganglioglioma. The patient had a good follow up. This observation emphasizes the possibility of desmoplastic ganglioglioma in older infants. It mustn't be considered as a specific entity of very young age infant and must be recognized in older infant because it may be misdiagnosed as malignant glioma. Despite the pseudo malignant appearance, these tumors have a good prognosis after surgery and when excision is complete they don't led to recurrences.

[Atypic radiologic aspect of a renal cell carcinoma in children]. / Présentation radiologique atypique d'un carcinome à cellules claires du rein chez l'enfant.

Renal cell carcinoma is rare in children and is usually found in late childhood. The authors report on an exceptional case of renal cell carcinoma in a 10-year-old girl. The radiological aspect is misleading and has not been previously reported in the literature. Renal cortex was thin because of congenital megalo-ureter, so the tumor developed entirely into excretory cavities (to the proximal ureter), while a primitive urothelial disease (tumoral or inflammatory) was first evoked. The atrophied cortex was the tumoral starting point which prolapsed into excretory cavities, upraising the urothelial epithelium.

[Discoid menisci in children: ultrasonographic features]. / Le ménisque discoïde chez l'enfant: aspects échographiques.

OBJECTIVE: Discoid meniscus is a rare congenital pathology affecting mainly the lateral meniscus. Radiological diagnosis, initially based on arthrographic findings, is now established on well defined MRI criteria. In this study, ultrasonography (US) was the modality proposed for diagnosing discoid meniscus and compared to the normal sonographic meniscal pattern. Subjects and methods. 8 children aged from 6 to 11 years, with a symptomatology highly suggestive of meniscal pathology, were investigated by US of both knees, followed by MRI in 3 and arthroscopy in all cases. RESULTS: In all 8 cases, a meniscus was diagnosed as discoid when it no longer had its normal triangular shape, was abnormally elongated and thick and demonstrated a heterogeneous central pattern. Associated lesions (fracture, cystic degeneration) were well demonstrated on US. The lateral meniscus was involved in all 8 cases, the pathology was bilateral in 5 cases and MRI/US correlation was good in 3 cases. Arthroscopy confirmed US findings in all cases. CONCLUSION: US, a more widely available imaging modality, is a reliable technique for the diagnosis of discoid meniscus in children.