Facial fractures in post-revolution Tunisia as violence indicator: About 476 cases.

INTRODUCTION: On January 2011, Tunisia had known a revolution. To move from dictatorship to democraty project, the country suddenly fell into political instability, which was accompanied by a wave of social violence. Traumatology, and, particularly, maxilla-facial traumatology, is usually a reliable indicator of the degree of violence. AIM: The aim of this study was to establish the epidemiological profile of facial fractures during the various phases of political transition through which Tunisia has passed since revolution (2012-2016). PATIENTS AND METHODS: A retrospective cross-sectional study was conducted among all patients with facial fractures admitted to the department of Oral and Maxillo facial Surgery of University Hospital of Sahloul during five years (2012-2016). Fractures diagnosed late at the sequelae stage were excluded. Data of patients were recorded according to medical files, including cause of injury, age and gender, injury mechanisms and type of facial fracture. RESULTS: During the period of the study, a total of 476 patients were identified, with a sex-ratio of 7.2 to 1, patients ranged in age from 1 year to 76-years-old with a mean age of 27 years. Assaults were the most common cause of injury (39.1%). Mandible was fractured in 257 cases (54.2%) followed by zygoma (116 cases, 24.4%), nasal bone (99 cases, 20.8%) and Orbital walls (98 cases, 20.6%). DISCUSSION: The epidemiological profile of facial fractures in Tunisia has been changed since 2011. Facial fractures occur mainly after assaults, which are an indicator of increased social violence accompanying political instability present in our country.

Long-term therapeutic outcomes of facial arteriovenous malformations: A retrospective bi-centric study of 30 cases.

INTRODUCTION: Among vascular malformations, arteriovenous malformations (AVM) are potentially the most invasive and destructive especially when located on the face. Their management is still subject to controversy and yet no consensus exists. Our aim was to report long-term therapeutic outcomes for patients with facial AVM managed either by embolization alone or by resection with/without preoperative embolization. MATERIAL AND METHODS: A bi-centric retrospective study was carried out covering the period from 2001 to 2018 including 30 patients with a facial AVM. Outcomes were categorized as follows: with 1=controlled disease, 2=improved disease (residual, no expansion), 3=persistent or stable disease (neither improved nor worsened), and 4=recurrent or worsened disease. RESULTS: The initial treatment modality was embolization (n=5, 16.7%), surgical resection (n=16, 53.3%), and surgical resection after embolization (n=9, 30%). The follow-up period ranged from 12 to 216 months with a median of 54.9 months. Taking all treatment modalities together, disease control was achieved in 60% of the cases. Disease control was achieved in 77.8% of the cases after embolization followed by surgery, in 68.7% after surgery alone and in none of the cases after embolization alone. CONCLUSIONS: According to our results, optimal treatment is based on a combination of embolization followed by a well-conducted surgical treatment.

[Eosinophilic granuloma or aggressive periodontitis?]. / Granulome éosinophile ou parodontite agressive ?

INTRODUCTION: Eosinophilic granuloma in the jawbones can be confused with aggressive periodontitis or more rarely with inflammatory lesions of dental origin. We had for objective to analyze the various elements of clinical, radiological, and pathological differential diagnosis for this rare lesion through a clinical observation. CASE REPORT: A 26-year-old male patient consulted for loose teeth and gingivitis. The initial diagnosis was aggressive periodontitis. The ineffective periodontal treatment suggested another diagnosis, eosinophilic granuloma, requiring tooth extraction and curettage. A histological analysis confirmed the diagnosis. Bone scintigraphy revealed a second focus on the left maxilla. Complementary chemotherapy was efficient on the mandibular site but failed to prevent worsening on the maxilla, which was treated surgically. Thirty months after, the patient's condition was stable. DISCUSSION: The diagnosis of eosinophilic granuloma is difficult and relies on histology and immunolabelling with protein S100 and antigen CD1a. Treatment is surgery and conservative in case of isolated lesions.

Effects of music therapy on occupational stress and burn-out risk of operating room staff.

The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is toassess the impact of music therapy on stress levels and burnout risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased significantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool.

Assessment of premature ventricular beats in athletes.

INTRODUCTION: Premature ventricular complexes (PVC) are generally considered as a benign electrocardiographic abnormality in the athletic population. However it may be indicative of underlying heart disease which may increase the risk of sudden death. This implies the need for cardiological evaluation before indicating the ability to practice competitive sports. AIM: The aim of this study was to evaluate an athlete population with PVC and establish underlying etiologies in order to take a decision regarding practicing sports. METHODS: This is a prospective study which included athletes examined in the Tunisian National Centre of Sports Medicine and Sports Science (TNCSM) from January 2013 to June 2015 who presented PVC on an electrocardiogram. RESULTS: Five thousand seven hundred and ninety eight athletes were referred to the TNCSM. We identified 42 athletes having PVC with a prevalence of 1.8%. The average age of the study population was 21.6±5.99 years. 83% were men. 88% were asymptomatic. The electrocardiogram was considered normal in 62% of the athletes according to the Seattle criteria. At the Holter monitoring, the average number of PVC was 920 PVC/24hours. Thirteen athletes had doublets and 11 had triplets. One patient had polymorphic PVC and an R/T phenomenon. The transthoracic echocardiography (TTE) was normal in 71% of cases. Three athletes had hypertrophic cardiomyopathy (HCM). All patients underwent a stress test. The PVC disappeared in 12% of athletes MRI was performed in 10 athletes confirming the three cases of HCM and revealing a case of arrhythmogenic right ventricular dysplasia and a case of compression of the right ventricle by pectus exacavatum. CONCLUSION: After this assessment, five athletes were not allowed to practice sport. This study shows the necessity of a thorough cardiological assessment of athletes with ventricular arrhythmia in order to detect underlying heart disease and prevent sudden death in this young apparently healthy population.

11beta-Hydroxysteroid dehydrogenase type 1-driven cortisone reactivation regulates plasminogen activator inhibitor type 1 in adipose tissue of obese women.

BACKGROUND: Plasminogen activator inhibitor type 1 (PAI-1) is the main inhibitor of the fibrinolytic system and contributes to an increased risk of atherothrombosis in insulin-resistant obese patients. In adipose tissue, we have shown that PAI-1 is synthesized mainly in the visceral stromal compartment and is positively regulated by glucocorticoids. We have demonstrated that adipose tissue expression of 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD-1), an enzyme that catalyzes the conversion of inactive cortisone to active cortisol, is exaggerated in obese patients. OBJECTIVES: We hypothesized that increased action of 11beta-HSD-1 in adipose tissue of obese subjects may contribute to PAI-1 overproduction. PATIENTS AND METHODS: Using in situ hybridization, we studied the expression of the mRNAs coding for PAI-1 and 11beta-HSD-1 in the stromal compartment of visceral adipose tissue obtained from obese women. The regulation of PAI-1 secretion from in vitro incubated tissue explants was also investigated. RESULTS: Regression analysis showed a significant positive linear relationship between PAI-1 and 11beta-HSD-1 mRNAs expression. In vitro incubation of adipose tissue explants demonstrated that cortisone stimulated PAI-1 gene expression and secretion, and that these effects were inhibited by co-incubation with the 11beta-HSD inhibitor, glycyrrhetinic acid. CONCLUSIONS: Our data demonstrate that 11beta-HSD-1-driven cortisone reactivation regulates adipose PAI-1 synthesis and secretion. They suggest that the increased PAI-1 synthesis and secretion observed in obese patients can be also related, at least in part, to an increased local conversion of cortisone to cortisol. Therefore, local cortisol metabolism in adipose tissue may be involved in increasing the risk of cardiovascular disease in obese subjects.

Contraction induced by glicentin on smooth muscle cells from the human colon is abolished by exendin (9-39).

UNLABELLED: Glicentin and glucagon-like peptide-1 (7-36) amide (GLP-1) are gut hormones released during digestion. Glicentin and GLP-1 slow down gastric emptying and glicentin can switch off the duodenojejunal fed motor pattern. The effect of glicentin on the motor activity of colon has never been reported in humans. Our aim was to determine if circular smooth muscle cells (SMC) from the human colon are target cells for glicentin or GLP-1, and if their motility is dependent upon these digestive hormones. METHODS: Twenty-two resections were performed on patients operated for colon adenocarcinoma. The SMC were isolated from colonic circular muscle layer and cell contraction was assessed. RESULTS: Glicentin caused a dose-related contraction of SMC, when GLP-1 determined a contraction of weak amplitude. Exendin-(9-39), described as a GLP-1 receptor antagonist, inhibited contraction due to glicentin or GLP-1. In contrast, on antral SMC from rabbit, GLP-1 exerts neither relaxation nor contraction; however, exendin-(9-39) dose dependently reduced the contractile activity of glicentin [glicentin EC(50) = 5 pM, exendin-(9-39) pA(2) = -9.36]. CONCLUSIONS: The circular muscle from the human colon is a target tissue for glicentin and GLP-1. Whereas glicentin is a long-life digestive hormone which would contribute to segmental contraction, the biological activity of GLP-1 remains unknown on this tissue. On the digestive smooth muscle, exendin-(9-39) behaved as an antagonist for two members of the glucagon-receptor family, GLP-1 and glicentin.

New bridged oligofuran for optoelectronic applications.

Based on density functional theory (DFT) calculations, we have investigated the structural and optoelectronic properties of oligofuran (OFu)-bridged systems via useful electron donating groups (>S, >CH2, >SiH2 and >NH) and electron accepting ones (>CC(CN)2, >CO, >CS and >CCH2). The results were then discussed and compared with those obtained with the correspondingunbridged form. It was found that the optical band gap of OFu decreases significantly when it is bridged by >NH group arranged through an alternating way with >CS or >CC(CN)2 group, which gives bridged polyfuran (PFu) with desirable opto-electronic properties. Further, an intra-molecular charge transfer for the systems was undertaken in support of time-dependent DFT (TD-DFT) and semi-empirical ZINDO calculations. In this frame, we have shown that >CC(CN)2 and >S bridging groups leads to a new oligomer possessing favorable optoelectronic parameter for its use as an active layer in organic photovoltaic cells.

Evolution of adrenal-regeneration hypertension in blinded rats.

The influence of blinding upon the blood pressure and adrenal regeneration of monoephrectomized but otherwise normal and mononephrectomized adrenal-enucleate rats on a high Na intake was evaluated. Blinding had no effect on control blood pressure, or upon the incidence, course and severity of adrenal-regeneration hypertension. Similarly there was no discernible effect on the regeneration of enucleate adrenal glands. The adrenal glandsands of otherwise normal blinded rats showed some enlargement in proportion to body weight, a finding which is probably attributable to loss of body weight in several animals.

Increased dietary calcium lowers blood pressure in the spontaneously hypertensive rat.

The effect of increased dietary calcium on the development of hypertension in spontaneously hypertensive (SH) rats was investigated by feeding lab chow fortified with calcium carbonate (2.5% calcium, hCa) beginning at 4 wk of age. A control SH group was fed regular lab chow (1.2% calcium, rCa). Two groups of age-matched Wistar-Kyoto (WKY) rats were treated in parallel. Systolic blood pressure (BP) was measured weekly until the age of 18 wk using a tail cuff method. The hCa diet significantly attenuated the time course of hypertension in SH rats even though both SH groups eventually developed hypertension. The hCa also lowered BP in WKYs, but to a lesser extent. Urine output (24-hr volumes) was not affected by hCa, but in both SH and WKY groups fed the hCa diet, the excretion of Na+, K+ and Ca++ was markedly elevated at 11, 15, and 19 wk of age. Urine osmolality was also elevated. Plasma Na+, Ca++ and osmolality were not significantly altered by the diet in either SH or WKY rats; plasma potassium was significantly lower in the SH group fed the hCa diet than in the group given rCa. The hCa diet did not significantly affect the body or heart, kidney, adrenal, or thymus weights. The results suggest that hCa diet may attenuate genetic hypertension by inducing an osmotic diuresis.

[Epidemiological profile of salivary-glands tumors in a Tunisian teaching hospital]. / Profil épidémiologique des tumeurs des glandes salivaires dans un CHU tunisien.

INTRODUCTION: Salivary-glands tumors come in various presentations and the epidemiological data are variable. The aim of this retrospective study was to establish an epidemiological profile of salivary-glands tumors in a Tunisian teaching hospital and to compare it to published data. PATIENTS AND METHODS: The study was made on 76 men and 80 women with a mean age of 43 years (five months to 85 years). Sixty percent of the tumors were parotid lesions, 16% were submandibular and 24% located on minor salivary glands. Eighty-four percent of parotid tumors were benign. Malignant-parotid tumors often affected men over 60 years of age. Most minor salivary-glands tumors were located on the palate. DISCUSSION: Benign salivary-glands tumors, often have a parotid localization affect, more women in the Tunisian population. Contrary to the literature, in our series, malignant tumors were predominant in women.