Genetic study of Alport syndrome in Tunisia.

BACKGROUND: Alport syndrome is a genetic disorder affecting the kidneys, ears, and eyes, causing chronic kidney disease, sensorineural hearing loss, and ocular abnormalities. It results from pathogenic variants in the COL4A3, COL4A4, or COL4A5 genes, with different inheritance patterns: X-linked from COL4A5 variants, autosomal recessive from homozygous variants in COL4A3 or COL4A4, digenic from variants in both COL4A3 and COL4A4, and autosomal dominant from heterozygous variants in COL4A3 or COL4A4. METHODS: We analyzed 45 patients with Alport syndrome from 11 Tunisian families to determine their clinical and genetic characteristics. Clinical data were collected retrospectively, and whole-exome sequencing was conducted on one patient from each family. Sanger sequencing validated pathogenic variants, and cascade screening extended the analysis to 53 individuals. RESULTS: We identified nine likely pathogenic variants among 11 index cases: six novel and three known variations. Of these, five were in COL4A3, and four were in COL4A5, with variants including frameshift, nonsense, missense, and alternative splicing. Most variations affected the Gly-XY codon. Among the 45 clinically identified siblings, 30 tested positive for Alport syndrome. The cascade screening identified 3 additional affected individuals, 10 unaffected siblings, and 10 unaffected parents. The mode of inheritance was autosomal recessive in six families and X-linked in four families. CONCLUSIONS: This study is the first to screen the mutational spectrum of Alport syndrome in Tunisia. It reveals novel pathogenic variants and suggests that autosomal recessive inheritance may be more common in the Tunisian population than X-linked inheritance, contrary to existing literature.

Aniseikonia and visual functions with optical correction and after refractive surgery in axial anisometropia.

PURPOSE: To evaluate differences in the subjective aniseikonia and stereoacuity in patients with axial anisometropia after full correction of the refractive error with spectacles, contact lenses, and refractive surgery. METHODS: A prospective study was performed in Cairo University Hospitals on 20 patients with axial anisometropia caused by unilateral myopia > 5 D with > 4 D inter-ocular difference in spherical equivalent who were suitable candidates for excimer laser ablation (LASIK) or implantable collamer lens implantation (ICL). All patients had measurement of best-corrected visual acuity (BCVA), fusion, stereoacuity, and magnitude of aniseikonia with spectacles, contact lenses, and after surgery. RESULTS: The mean age at time of surgery was 25.7 ± 3.1 years. There were no statistically significant differences in the BCVA or stereoacuity with spectacles, contact lenses, or after refractive surgery. Microkonia < 5%) was perceived with spectacles in 8 patients (40%) and remained unchanged in 7 of these 8 patients with contact lenses. Following LASIK (n = 11), there was an induced macrokonia < 2% in 4 patients (36%), persistent microkonia of 3% in 1 patient (9%), and no change in image size in 6 (55%) patients. Following ICL implantation (n = 9), there was a perceived macrokonia of 2% in 4 patients (44%), disappearance of microkonia in 1 patient (11%) and no change in 4 patients (44%). CONCLUSIONS: Differences in BCVA, stereoacuity, and aniseikonia after correction of anisometropia by glasses, contact lens and surgery are both clinically and statistically insignificant. Retinal or neural adaptation might have a role in correction for differences in image size.

Vitamin D receptor gene polymorphism in patients with osteomalacic myopathy in Egypt.

INTRODUCTION: Vitamin D works by binding to vitamin D receptor (VDR). The muscle involvement in hypovitaminosis D was broadly named osteomalacic myopathy. METHODS: A case control study involved 20 female patients diagnosed with osteomalacic myopathy compared with 15 age-matched healthy female controls. We assessed both for VDR genotype single-nucleotide polymorphisms (SNP) at 3 sites (ApaI, BsmI, and FokI). RESULTS: ApaI and BsmI genotypes distribution in both groups showed non-significant difference unlike FokI genotypes in which we found significantly higher percentages of single allele mutation in patients vs. controls. CONCLUSION: The relation of VDR gene SNPs to muscle function was studied before but in healthy subjects. We tried to correlate if presence/absence of a certain mutation is responsible for the appearance of osteomalacic myopathy.

Seasonal Snowpack Classification Based on Physical Properties Using Near-Infrared Proximal Hyperspectral Data.

This paper proposes an innovative method for classifying the physical properties of the seasonal snowpack using near-infrared (NIR) hyperspectral imagery to discriminate the optical classes of snow at different degrees of metamorphosis. This imaging system leads to fast and non-invasive assessment of snow properties. Indeed, the spectral similarity of two samples indicates the similarity of their chemical composition and physical characteristics. This can be used to distinguish, without a priori recognition, between different classes of snow solely based on spectral information. A multivariate data analysis approach was used to validate this hypothesis. A principal component analysis (PCA) was first applied to the NIR spectral data to analyze field data distribution and to select the spectral range to be exploited in the classification. Next, an unsupervised classification was performed on the NIR spectral data to select the number of classes. Finally, a confusion matrix was calculated to evaluate the accuracy of the classification. The results allowed us to distinguish three snow classes of typical shape and size (weakly, moderately, and strongly metamorphosed snow). The evaluation of the proposed approach showed that it is possible to classify snow with a success rate of 85% and a kappa index of 0.75. This illustrates the potential of NIR hyperspectral imagery to distinguish between three snow classes with satisfactory success rates. This work will open new perspectives for the modelling of physical parameters of snow using spectral data.

Effect of audit and feedback on physicians' intraoperative temperature management and patient outcomes: a three-arm cluster randomized-controlled trial comparing benchmarked and ranked feedback.

PURPOSE: Audit and feedback can improve physicians' practice; however, the most effective type of feedback is unknown. Inadvertent perioperative hypothermia is associated with postoperative complications and remains common despite the use of effective and safe warming devices. This study aimed to measure the impact of targeted audit and feedback on anesthesiologists' intraoperative temperature management and subsequent patient outcomes. METHODS: This study was a three-arm cluster randomized-controlled trial. Anesthesiologists' intraoperative temperature management performance was analyzed in two phases. The first was a baseline phase with audit but no feedback for eight months, followed by an intervention phase over the next seven-month period after participants had received interventions according to their randomized group allocation of no feedback (control), benchmarked feedback, or ranked feedback. Anesthesiologists' percentage of hypothermic patients at the end of surgery (primary endpoint) and use of a warming device were compared among the groups. RESULTS: Forty-five attending anesthesiologists who took care of 7,846 patients over 15 months were included. The odds of hypothermia (temperature < 36°C at the end of surgery) increased significantly from pre- to post-intervention in the control and ranked groups (control odds ratio [OR], 1.27; 95% confidence interval [CI], 1.03 to 1.56; P = 0.02; ranked OR, 1.26; 95% CI, 1.01 to 1.56; P = 0.04) but not in the benchmarked group (OR, 1.05; 95% CI, 0.87 to 1.28; P = 0.58). Between-arm differences in pre- to post-intervention changes were not significant (benchmark vs control OR, 0.83; 95% CI, 0.62 to 1.10; P = 0.19; ranked vs control OR, 0.99; 95% CI, 0.73 to 1.33, P = 0.94). No significant overall effect on intraoperative warmer use change was detected. CONCLUSION: We found no evidence to suggest that audit and feedback, using benchmarked or ranked feedback, is more effective than no feedback at all to change anesthesiologists' intraoperative temperature management performance. Feedback may need to be included in a bundle to produce its effect. TRIALS REGISTRATION: www.clinicaltrials.gov (NCT02414191). Registered 19 March 2015.

Primary glomerulonephritis with predominant mesangial Immunoglobulin G deposits.

BACKGROUND: Glomerular deposits are a major pathologic feature of a wide range of human glomerulonephritis and may be located in the mesangial, subepithelial, and subendothelial regions. Rare cases of primary glomerulonephritis definied by exclusive or predominant mesangial IgG deposits were reported. We reviewed the pathologic findings for the 848 renal biopsies examined in our department between 2007 and 2016, one case of primary mesangial IgG glomerulonephritis (MIG) in the absence of any evidence of systemic lupus erythematous (SLE), of other systemic diseases or of Infections. REPOTED CASE: Male patient aged 55 years consults for nephrotic syndrome (proteinuria=7g/1.73m2/day; Albuminemia=14g/L) with hematuria.. The serum creatinine concentration was 88 µmol/l, and the creatinine clearance was on MDRD at 82 ml/min/1.73m2. He had a renal biopsy showing the absence of proliferative lesions and the presence of exclusive mesangial IgG deposit. CH50, C3 and C4 levels were normal and antinuclear antibody and anti-DNA antibody assays remained negative during the follow-up period. A full dose corticosteroid was initiated (1mg/Kg/day). The interval from onset of steroid therapy to remission was 2 months. During follow-up; the patient had developed 2 relapsing nephrotic syndrome episods. Then he was switched to Mycophenolate mofetil with remission after 2 months. CONCLUSION: MIG is a very rare but distinct type of primary glomerulonephritis that is characterized by exclusive or predominant mesangial IgG deposits. Its renal prognosis may be less favorable than previously reported because of the possibility of steroids resistance of the nephrotic syndrome and the recurrence after renal transplantation.

Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework.

PURPOSE: Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period. METHODS: After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour. RESULTS: Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management. CONCLUSION: This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.

Value of Microperimetry in Detecting Early Retinal Toxicity of Hydroxychloroquine in Children with Juvenile Systemic Lupus Erythematosus.

PURPOSE: To evaluate retinal sensitivity in children who are on hydroxychloroquine (HCQ) for systemic lupus erythematosus using microperimetry and compare the results with those of the Humphrey visual field (HVF) 10-2 and spectral-domain optical coherence tomography (SD-OCT). PROCEDURE: A case-control cross-sectional study including 19 patients (less than 18 years old) on HCQ for at least 5 years. Controls were 21 normal children. Participants underwent a complete ophthalmic examination, then were investigated using HVF 10-2, SD-OCT, and microperimetry. RESULTS: Ocular examination revealed no abnormalities. The overall mean microperimetry sensitivity of the patients (15.75 dB) was not significantly different from that of the controls (16.35 dB). The HVF 10-2 showed a significant difference in the mean deviation of the patients. Conclusions and Message: Microperimetry was not more revealing than HVF 10-2 and SD-OCT. Larger studies are required to compare the diagnostic accuracy of screening modalities of retinal toxicity in children on HCQ.

Acute tubular necrosis following transurethral resection of the Prostate using Glycine as irrigating fluid.

Transurethral resection of the prostate is currently the gold standard for the surgical treatment of the benign prostatic hyperplasia. This surgery may lead transurethral resection of the prostate (TURP) syndrome and in some cases, acute tubular necrosis can develop. We report a patient who developed hyponatremia, hemolysis and oliguric acute renal failure as a major complication following TURP using glycine as irrigating fluid.A 64-year-old man was admitted for a prostate resection procedure. Physical examination revealed a healthy elderly man. Preoperative laboratory data showed serum sodium 140 mEq/L, blood urea nitrogen (BUN) 0.6 g/L, creatinine 0.7 mg/dL and hemoglobin 12.9 g/dL. Few hours after, the patient becomes incoherent and developed oliguria, nausea and vomiting. The laboratory data revealed rapidly elevating BUN and creatinine levels (BUN 2.4 g/L; creatinine 6.1 mg/dL), the serum sodium concentration decreased by 14 meq/L. A decreased hemoglobin level (7.4 g/dL) with an elevated lactate dehydrogenase level (665 U/L) was observed. Renal ultrasonography was normal. The diagnosis of acute tubular necrosis complicating TURP syndrome was retained. The hyponatremia was slowly corrected to 132 mmol/L by diuresis and fluid restriction. The renal function recovered after four hemodialysis sessions. Using glycine as an irrigant for TURP may cause hyponatremia, hemolysis and also acute renal failure, especially in patients with longer resection time. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.

INTRAVITREAL INFLIXIMAB IN REFRACTORY UVEITIS IN BEHCET'S DISEASE: A Safety and Efficacy Clinical Study.

PURPOSE: To assess the safety and efficacy of intravitreal infliximab (1 mg/0.05 mL) in patients with refractory posterior uveitis in Behcet's disease. METHODS: Twenty patients were included in this study. Best corrected visual acuity (BCVA), vitreous haze (graded 0-4), vasculitis, retinitis, and papillopathy (presence or absence) were assessed at baseline, Day 1 and Week 2, 4, 6, 8, 12, and 18. Optical coherence tomography (OCT) central foveal thickness, fluorescein angiography, and flash electroretinogram were done at baseline and 4, 12, and 18 weeks. RESULTS: Mean baseline logMAR BCVA was 0.94 (20/160), had improved significantly by Week 2 to 0.6 (20/80) (P < 0.0001), and reached 0.36 (20/40) by Weeks 18 with three injections (P < 0.0001). Mean central foveal thickness OCT decreased significantly from baseline 361 µm to 180 µm at the end of follow-up (P < 0.0001). Profound decrease in mean vitreous haze gradings from two to 0.2 by the end follow-up (P < 0.05). There was a significant reduction in the number of patients with vasculitis (15 at baseline to 1 weeks at 18 weeks), retinitis (nine at baseline to none at 4 weeks), and papillitis (two at baseline to none at 4 weeks) (P < 0.05). No significant electrophysiological changes or ocular adverse inflammatory reactions were observed during the study period. CONCLUSION: Intravitreal infliximab appeared to be safe and effective in treating uveitis in Behcet's disease and should be considered as an alternative to systemic therapies.

Exploring Damage Patterns in CFRP Reinforcements: Insights from Simulation and Experimentation.

Carbon Fiber Reinforced Polymers (CFRP) have become increasingly significant in real-world applications due to their superior strength-to-weight ratio, corrosion resistance, and high stiffness. These properties make CFRP an ideal material for reinforcing concrete structures, particularly in scenarios where weight reduction is crucial, such as in bridges and high-rise buildings. The transformative potential of CFRP lies in its ability to enhance the durability and load-bearing capacity of concrete structures while minimizing maintenance costs and extending the lifespan of the infrastructure. This research explores the impact of reinforcing structural elements with advanced composite materials on the strength and durability of concrete and reinforced concrete structures. By integrating Carbon Fiber Reinforced Polymer (CFRP) reinforcements, we subjected both rectangular and T-section concrete beams to comprehensive three-point bending tests, revealing a substantial increase in flexural strength by 45% and crack resistance due to CFRP reinforcement. The study revealed that CFRP reinforcement increased the flexural strength of concrete beams by 45% and improved crack resistance significantly. Additionally, the load-bearing capacity of the beams was enhanced by 40% compared to unreinforced specimens. These improvements were validated through finite element simulations, which showed a close alignment with the experimental data. Furthermore, an innovative simulation study was conducted using a finely tuned finite element numerical model within the Abaqus calculation code. This model accurately replicated the laboratory specimens in terms of shape, dimensions, and loading conditions. The simulation results not only validated the experimental observations but also provided deeper insights into the stress distribution and failure mechanisms of the reinforced beams. Novel aspects of this study include the identification of specific failure patterns unique to CFRP-reinforced beams and the introduction of an enhanced interaction model that more accurately reflects the composite behavior under load. In CFRP-reinforced beams, specific failure patterns were identified, including flexural cracks in the tension zone and debonding of the CFRP sheets. These patterns indicate the points of maximum stress concentration and potential weaknesses in the reinforcement strategy. The study revealed that while CFRP significantly improves the overall strength and stiffness, careful attention must be given to the bonding process and the quality of the adhesive used to ensure optimal performance. These findings contribute significantly to the understanding of material interactions and structural performance, offering new pathways for the design and optimization of composite-reinforced concrete structures. This research underscores the transformative potential of composite materials in elevating the structural integrity and longevity of concrete infrastructures.

Seborrheic Keratosis: Report of a Rare Presentation and Reminder of the Current Knowledge of the Problem.

A 75-year-old man presented with an abdominal enlarging painless tumor of the skin evolving over the last 30 years. His past medical history was unremarkable. Physical examination revealed a brownish pedunculated cutaneous mass which had an irregular keratotic warty surface with no discharge or ulceration. The mass was clinically presumed to be a melanocytic tumor, or a verrucous carcinoma. A monoblock excision of the mass was performed with a good outcome. The specimen was then sent to our pathology department to rule out malignancy. Macroscopic examination revealed a brownish tumor of 7.5 × 7 × 1.5 cm which had fissures and cauliflower-like appearance. Final histological report concluded to a giant seborrheic keratosis.

The Tunnelled Atrial Catheter: A Promising Solution for Vascular Capital Depletion in Dialysis despite Associated Thrombi.

Introduction: Longer survival in dialysis led to a higher incidence of vascular access complications and failure. With the limited access to kidney transplantation programs and peritoneal dialysis, exhaustion of vascular access for hemodialysis is an increasingly common situation. Among the available options, atrial tunneled dialysis catheter (ATDC) has been reported as an effective vascular access in this population. Methodology. We report the experiences of two nephrology centers in Tunis with ATDC as an ultimate vascular access for dialysis. Case Reports. Two patients with exhausted vasculature underwent ATDC insertion in 2020 and 2022, respectively, as a vascular access of last resort. Both patients underwent CRBI, which resolved with favorable outcomes. One case was complicated by post-operative thrombosis and was successfully treated with thrombolysis. Both patients are currently on dialysis via their ATDC with a catheter patency of 29 months. Conclusion: ATDC is a life-saving and safe vascular access in cases of depleted vasculature. Little more than 50 cases have been reported in the literature during the last 30 years. As the frequency of vasculature exhaustion is expected to increase, preservation of veinous access in patients at risk of chronic kidney disease have never been more crucial.

Two decades of data on the neurotoxic Gymnodinium catenatum dynamics and paralytic shellfish toxins contamination of molluscs in the southwestern Mediterranean: What have we learned?

Harmful algal blooms have been documented in the Moroccan Western Mediterranean region since 1993, primarily associated with the presence of paralytic shellfish toxins (PSTs) produced by the dinoflagellate Gymnodinium catenatum. The proliferation of this neurotoxic species has led to recurring bans on the harvesting of molluscs, resulting in significant socio-economic repercussions and threats to human health. In the present study, we examine the dynamics of G. catenatum and mollusc PST contamination patterns over a 20-year period (2002-2021) in two distinct marine ecosystems: M'diq Bay and the Oued Laou Estuary. For the PST contamination, we considered two commercially important shellfish species: the smooth clam, Callista Chione, and the cockle, Acanthocardia tuberculata. The highest G. catenatum abundances were consistently observed from November to February in both sites. Our data revealed inter-annual variations in G. catenatum abundance, peaking at 91,840 cells.L-1 in November 2011. PST contamination levels in A. tuberculata were significantly higher than those observed in C. chione. Furthermore, we identified a significant correlation (Pearson, P-value <0.05) between PST contamination of smooth clams and the abundance of G. catenatum. The contamination of A. tuberculata by PSTs reached very high levels, with up to 13,500 µg STX di-HCl eq. kg-1 of shellfish meat, exceeding the established safety thresholds by 16-fold. Additionally, there has been an increase in the prevalence and incidence of PSTs over the years. Notably, we observed a substantial increase in G. catenatum blooms and PST events in the Western Mediterranean during the last decade (2010-2021). The examined data suggest that rainfall could play a pivotal role in G. catenatum bloom dynamics by enriching marine waters with nutrients. The statistical model selection approaches indicated that nutrient concentrations (i.e., nitrate and phosphorus) were the most significant parameters for G. catenatum blooms in the studied area.

Cribriform-morular thyroid carcinoma: A case report with review of the literature.

Cribriform-morular thyroid carcinoma (CM-TC) is a rare entity that usually occurs in association with familial adenomatous polyposis (FAP) but may be sporadic. Herein, we present a new case of cribriform-morular thyroid carcinoma occurring in a 28-year-old woman with no history of FAP.

Multiple hydatid cyst disease revealed by an expansive intracranial process: A case report.

Hydatid disease is a real public health problem in developing countries. Cerebral localization is rare; it does not exceed 2%. It is more frequent in children and adolescents. It is often primary in children. In adults, it is less frequent and generally associated with other localizations. We report the case of a 60-year-old Tunisian patient with pulmonary, hepatic and cerebral hydatid cyst, revealed by neurological symptoms with an expansive intracranial process on brain imaging.

Lack of SARS-CoV-2 in environmental samples collected from September 2020-February 2021 in a university that followed CDC reopening guidance.

This study aimed to provide environmental surveillance data for evaluating the risk of acquiring SARS-CoV-2 in public areas with high foot traffic in a university. Air and surface samples were collected at a university that had the second highest number of COVID-19 cases among public higher education institutions in the U.S. during Fall 2020. A total of 60 samples were collected in 16 sampling events performed during Fall 2020 and Spring 2021. Nearly 9800 students traversed the sites during the study period. SARS-CoV-2 was not detected in any air or surface samples. The university followed CDC guidance, including COVID-19 testing, case investigations, and contact tracing. Students, faculty, and staff were asked to maintain physical distancing and wear face coverings. Although COVID-19 cases were relatively high at the university, the possibility of acquiring SARS-CoV-2 infections at the sites tested was low.

Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial.

BACKGROUND: This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year. PATIENTS AND METHODS: This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles. RESULTS: The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2­week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1­year follow-up in group I and 1 (2.9%) case in group II (p = 0.024). CONCLUSION: Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.

Focal Segmental Glomerulosclerosis and Hyalinosis in a Patient with Spondyloarthritis: A Rare Renal Involvement Case Report.

Background: During its course, spondyloarthritis (SpA) may be associated with extra-articular manifestations affecting several organs. Renal involvement is one of the most common extra-articular manifestations and is dominated by secondary amyloidosis (AA), immunoglobulin A (IgA) nephropathy, and urolithiasis. Other nephropathies such as Focal segmental glomerulosclerosis and hyalinosis (FSGS) are less common and are limited to few case reports. Case: We report the case of a patient followed for axial SpA, who consulted, after being lost to follow-up for 3 years, for elevated blood pressure and edema of both lower limbs associated with an hydrocele and bilateral pleural effusion. Biological examinations showed hypoproteinemia, hypoalbuminemia, and proteinuria. In this context of nephrotic syndrome, the diagnosis of FSGS was confirmed by renal biopsy. Furthermore, the etiological investigation ruled out the causes of secondary FSGS. Conclusion: Renal involvement is a sign of severity in SpA. Its detection and management should be part of the overall management of SpA.

Cholesterol Granuloma of the Breast Mimicking Cancer: A Case Report and Review of the Literature.

Cholesterol granuloma of the breast is an infrequent benign lesion with clinical and radiological findings suggestive of cancer. Herein, we present the case of a 52-year-old woman with no significant past medical history, who presented to the outpatient department for her routine breast screening. Physical examination revealed a painless palpable nodule in the upper external quadrant of the left breast, measuring 0.7 cm. On imaging, the mass met the criteria for Breast Imaging Reporting and Data System (BI-RADS) category 4B. Subsequently, a core needle biopsy of the mass was performed. Despite the alarming radiologic features, microscopic findings were consistent with breast cholesterol granuloma.