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.

Unusual case of otomycosis caused by Saksenaea vasiformis.

Saksenaea vasiformis is a species of the order Mucorales rarely reported as a cause of human mucormycosis. We report an unusual case of S. vasiformis otitis occurring in a diabetic woman after penetration of an insect in the right ear. Direct microscopic examination of the clinical sample showed hyaline and non septate hyphae belonging to the order Mucorales. Fungal identification was performed by sequencing the ITS region of the rDNA. To our knowledge, this is the first report of S. vasiformis infection in Tunisia.

Investigations of the charge transfer phenomenon at the hybrid dye/BiVO4 interface under visible radiation.

Photocatalytic hybrid systems were realized by associating bismuth vanadate (BiVO4) nanostructured thin films with anchored organic and metal-organic complex molecules. The chosen dyes are based on indoline and azo-based moieties. Optical and photoinduced charge transfer features were investigated experimentally and analysed theoretically through the electron band alignment on the organic/inorganic interface. Quantum calculations were carried out for the studied hybrid systems by using DFT and semi-empirical approaches. The calculations were performed by implementing a cluster model applied for the nanostructures and hybrid systems. The electronic density peculiarities point out efficient charge transfer for D149 based hybrids compared to azo-based systems. The electron distribution in hybrid systems inferred from the computational analysis and their experimental probing using Kelvin Force Microscopy (KFM) maps the way to understanding the photoinduced charge transfer occurring at the interfaces between organic dyes and an inorganic photocatalyst. The presented approach helps to predict suitable photoactive hybrid materials leading to efficient photocatalytic devices.

Isolation and molecular identification of Acanthamoeba spp from oasis water in Tunisia.

In the southern Tunisia Oasis, we conducted 211 water with drawals from various water traffic sites. This water is used for agriculture, swimming or various other human activities. Acanthamoeba genus was detected in 82% of collected samples. Sequencing of the amplification products with primers P892C/P892 has allowed us to detect genotypic variation with predominance of T4 genotype (51%) and presence of the genotypes T14, T5, T3, T16, T15, T10, T11, T9 and T7. They T4, T3, T5, T15, T11 and T10 genotypes have a high potential for pathogenicity and a very high degree of virulence due to their production of serine proteases and extracellular cysteine enzymes involved in tissue degradation of the host. T4 genotype was the most abundant in the environment as well as in infections caused by Acanthamoeba spp. T5 genotype was ranked second and T3 genotype was less abundant in the environment and its pathogenicity is discussed. Acanthamoeba strains with the genotypes T16, T9 and T7 were considered non pathogenic. In fact, they have been isolated only from the environment. However, for these strains, their role as a reservoir can be a real risk to human health.

Rhodotorula fungemia: Report of two cases in Sfax (Tunisia).

Rhodotorula is emerging as an important cause of nosocomial and opportunistic infections. We present two cases of Rhodotorula mucilaginosa fungemia diagnosed at our hospital during the last decade. The first case was of a term neonate who presented congenital heart disease (interventricular communication) and body dysmorphic disorder. He was admitted for respiratory failure and sepsis. The second case involved in a 33-year-old woman that had Hodgkinien lymphoma associated to tuberculosis. Identification was performed using commercial systems and confirmed by PCR sequencing of internal transcribed spacer, ITS1 and ITS2 regions of rDNA. Antifungal susceptibility tested by sensititre yeast revealed susceptibility to amphotericin B and resistance to fluconazole for the two strains. These cases emphasize the emerging importance of Rhodotorula sp. as a pathogen and it must be considered a potential pathogen in patients with immunosupression and with central venous catheters. Correct identification is mandatory for appropriate management, as Rhodotorula spp. are resistant to antifungal agents, such as fluconazole.

Morphological and molecular identification of free living amoeba isolated from hospital water in Tunisia.

Free-living amoebae (FLA) are opportunistic and ubiquitous protozoa that are widely found in various environmental sources. They are known to cause serious human infections. The aim of our study was to detect FLA and Acanthamoeba spp. in hospital water circuits. Eighty-four water samples were collected over a period of 4 months (September-December 2011) from different wards of the Sfax University Hospital (surgical services, intensive care unit, operating theater, and water storage tanks). FLA were detected in 53.5 % of samples as follows: surgical services (80 %), operating theater and surgical intensive care unit (13.3 %), medical intensive care unit (0 %), water storage tanks (6.6 %). The predominant morphotype was the acanthopodial (89 %). The others morphotypes were as follows: monopodial (40 %), dactylopodial (22 %), rugosa (62 %), eruptive (24 %), fan shaped (18 %), and polypodial (18 %). Acanthamoeba was found in 40 samples (47.6 %). 64.2 % of isolates were identified as Acanthamoeba spp. by PCR, using primers to amplify a region of 18S rDNA which showed variation in the product length. Sequence analysis of five PCR products identified Acanthamoeba sp. These isolates belong to T4, T10, and T11 genotypes, and to our knowledge this is the first report of the T10 and T11 genotype in Tunisia.The occurrence of potentially pathogenic FLA in the hospital environment may represent a health risk for patients, since these organisms can cause severe opportunistic illness and also can harbor pathogenic agents. Thus, increased awareness regarding these parasites and recognition of their importance, particularly in immunocompromised patients is crucial.

[Malignant peripheral sheath nerve tumor: An exceptional mass of the anterior and middle mediastinum]. / Tumeur maligne des gaines des nerfs périphériques : masse exceptionnelle du médiastin antérieur et moyen.

Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.

Geotrichum capitatum septicemia: case report and review of the literature.

Geotrichum capitatum is an uncommon cause of invasive infections in immunocompromised patients, particularly those with hematological malignancies and severe neutropenia. The aim of this study was to report the cases of invasive geotrichosis in our hospital. It is a retrospective study of invasive geotrichosis diagnosed in the Laboratory of Parasitology-Mycology of the UH Habib Bourguiba, Sfax, from January 2005 to August 2013. Six cases of invasive Geotrichum infections were diagnosed. There were three men and three women. The mean age was 35 years. Five patients have acute myeloid leukemia with a profound neutropenia, and one patient was hospitalized in the intensive care unit for polytraumatism. Clinically, the prolonged fever associated with pulmonary symptoms was the predominant symptom (n = 5). Geotrichum capitatum was isolated in one or more blood culture. Two patients had urinary tract infections documented by multiple urine cultures positive for G. capitatum. Five patients received conventional amphotericin B alone or associated with voriconazole. The outcome was fatal in four cases. Invasive geotrichosis is rare, but particularly fatal in immunocompromised patients. Approximately, 186 cases have been reported in the literature. The prognostic is poor with mortality over 50 %. So, early diagnosis and appropriate management are necessary to improve prognosis.

Juvenile hyaline fibromatosis: a case report.

Juvenile hyaline fibromatosis is a rare, hereditary disease with distinct clinical and histopathological features. Clinically, it presents with gingival hypertrophy, pappulonodular skin lesions and joint contractures. Bone involvement is usually an uncommon finding. We report a case of a 2-year-old patient, daughter of consanguineous parents, who presented since the age of 2 months with impairment of mental development, multiple joint contractures, motion limitation and nodules on the scalp. The calvarian lesions were surgically removed, and histopathological examination concluded to juvenile hyaline fibromatosis.

Epicardial cavernous hemangioma: a two-case report.

AIMS: We report two-cases of cavernous hemangiomas arising from the epicardium in two women aged respectively 24 and 79 years old. The first patient was symptomatic and presented with palpitations. The second patient was referred after a random discovery at echocardiography. Chest CT and MRI were performed in the two cases and showed a mass located in the pericardial cavity. Coronary CT was necessary in the first case to ascertain the degree of coronary artery involvement. Both of our patients underwent surgical resection under cardiopulmonary bypass with an uneventful postoperative course for the first case. The second one, died postoperatively from pneumonia. CONCLUSION: Cardiac cavernous hemangiomas, although rare and well tolerated require prompt management and surgery at discovery to avoid further complications which may put at risk the patient's life prognosis.

Oxidative stress in blood and testicle of rat following intraperitoneal administration of aluminum and indium.

Aluminum (Al) and indium (In) have embryotoxic, neurotoxic and genotoxic effects, oxidative stress being one of the possible mechanisms involved in their cytotoxicity. We have recently demonstrated that indium intraperitoneal (ip) administration induced histological disorganization of testicular tissue. In the present research we aimed at investigating the effect of Al and In ip administration on systemic and testicular oxidative stress status. Studies were performed on Wistar rats ip injected with Al, In or physiological solution for two weeks. Our results showed that In significantly decreased the absolute weight of testicles. Measurements of lactate dehydrogenase (LDH) and paraoxonase (PON) activities showed that In induced a significant augmentation in the first parameter but no changes were observed in the second. Both Al and In caused oxidative stress in testicles by increasing malondialdehyde (MDA) and protein carbonyls (PC) production. Concomitantly, thiol group (-SH) and glutathione (GSH) level were enhanced in the testicles. In the blood, while concentrations of MDA was not changed, those of GSH was significantly decreased in the Al and In groups. Our results indicated that Al and In cause oxidative stress both in blood and testicles but In has cytotoxic effect as well as negative impact on testicle weights. These findings could explain the testicular histological alterations previously described after In ip administration.

Invasive fungal infections in renal transplant recipients: about 11 cases.

UNLABELLED: Invasive fungal infections are a major complication and an important cause of morbidity and mortality among solid organ transplant recipients. Their diagnosis is difficult and their prognosis is often pejorative. OBJECTIVE: The aim of this study was to report the cases of invasive fungal infections in renal transplant recipients in Habib Bourguiba Sfax university hospital and to identify the main fungal agents. MATERIALS AND METHODS: It is a retrospective study of invasive fungal infections in renal transplant recipient reported in our hospital from January 1995 to February 2013. RESULTS: Invasive fungal infections were diagnosed in 11 cases (3.4%) among 321 renal transplant recipients. These infections included four cases of pneumocystosis, two cases of candidiasis, two cases of aspergillosis, two cases of cryptococcosis and one case of mucormycosis. There were six men and five women. The mean age was 37 years. The infection was late in 63% of cases (>3 months after transplantation). The prolonged corticosteroid and immunosuppressive therapy were the main risk factors (100%) followed by renal failure (45%), graft rejection (45%), broad spectrum antibiotics (45%), CMV infection (36%), neutropenia (36%) and dialysis (18%). The evolution under treatment was favourable only in two cases (18%). CONCLUSION: Invasive fungal infections are not common among kidney transplant recipients. However, they remain an important cause of morbidity and mortality in this group of patients. Prevention, early diagnosis and appropriate management are necessary to improve prognosis and reduce mortality rate.

[Fusariosis diagnosed in the laboratory of an UH in Tunisia: epidemiological, clinical and mycological study]. / Fusarioses diagnostiquées au laboratoire d'un CHU en Tunisie : étude épidémiologique, clinique et mycologique.

The genus Fusarium, initially known for its important agro-economic impact, is more and more often implicated in human pathology. In fact, multiples allergic, toxic and infectious manifestations are more reported in immunocompetent and immunocompromised hosts. The objective of our study was to analyse the epidemiological, mycological and clinical features of fusariosis reported in our CHU. Eighty-seven cases of Fusarium infections were collected: 34 cases of onychomycosis (39%), 26 cases of intertrigos (30%), 25 cases of keratomycosis (29%), one case of atypical invasive fusariosis due to Fusarium oxysporum species complex (FOSC) and one case of localized gingivolabial fusariosis due to Fusarium solani species complex (FSSC) in a patient with leukemia in phase of deep bone marrow aplasia, whose outcome was favorable after exiting of aplasia period and a treatment by amphotericine B. The case of pseudotumoral cutaneous fusariosis to F. oxysporum complicated with osteolysis and septic arthritis occurred in a pregnant woman without any immune deficit. The evolution was fatal in spite of prescription of multiple systemic antifungals. Concerning keratomycosis, Fusarium was the first agent responsible for these infections (43%). The corneal traumatism was found in 37.5% of cases and FSSC was the most isolated (72%). For superficial dermatomycosis, Fusarium was the third agent of onychomycosis in molds (25%). The most isolated species were FSSC (68%) and FOSC (20%). The intertrigo frequency was 0.07% and they were mostly caused by FSSC (84%) and FOSC (16%). Fusarium is an important cause of mold infections in our region. So, the species identification is useful because some species are resistant to the most common systemic antifungal agents.

[Sternal tuberculosis causing spontaneous fracture of the sternum]. / Tuberculose sternale avec fracture spontanée du sternum.

Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.

Home matters: work and household predictors of smoking and cessation among blue-collar workers.

OBJECTIVE: This study examined the joint influence of work- and household-related variables on smoking behavior among a population representative sample of blue-collar workers with live-in partners. METHODS: The study used data on 1389 blue-collar workers from the Tobacco Use Supplement to the United States Current Population Survey 2002 to 2003 longitudinal overlap sample. Unadjusted and adjusted logistical regression analyses, which employed sampling and replicate weights to account for sampling design, were run to estimate independent and joint effects of the predictors. RESULTS: In adjusted analyses, partner smoking (OR=4.97, 95%CI=3.02-8.18) and complete and partial home smoking policy (OR=0.16, 95%CI=0.09-0.29 and OR=0.39, 95%CI=0.23-0.68, respectively) were significant predictors of smoking status, but worksite smoking policies and presence of a young child under 5 in the household were not (p>0.05). Baseline complete home smoking ban was a significant predictor of subsequent cessation (OR=3.49, 95%CI=1.19-10.23), while partner smoking status, workplace smoking policy, and the presence of a young child in the home did not predict cessation (p>0.05). CONCLUSION: Household-related variables were significant predictors of smoking status and cessation among blue-collar workers. Current efforts to decrease smoking in this group, which are mostly focused on work-related risk factors, should consider how to incorporate household risk factors.

[Solitary fibrous tumour of the pleura: about five cases]. / La tumeur fibreuse solitaire pleurale : à propos de cinq observations.

BACKGROUND: Pleural solitary fibrous tumour (PSFT) is a rare, usually benign tumour, with unpredictable behaviour. PATIENTS AND METHODS: Five cases of PSFT were diagnosed in our department over a 12-year period from January 1999 to December 2010. Clinical, radiological, histological, therapeutic and follow-up information were provided in all cases. RESULTS: Our series comprised four men and one woman. The mean age of the patients at presentation was 55 years. All patients were symptomatic. Radiologic investigations showed a pleural lesion with a mean size of 10.6cm ranging from 3 to 17cm. Histologic diagnosis was made from resected parietal pleura in three cases and visceral pleura in two cases. The histologic features were suggestive of malignancy in two cases and benign in three cases. Immunohistochemical study showed that the tumour cells expressed vimentin, CD34, CD99 and Bcl2. Complete resection was obtained in all patients. The evolution was marked in the two patients with malignant PSFT by the recurrence of the tumour after 6 and 21 months respectively. Both died from the condition. The three patients with a benign form are disease-free after 3, 11 and 2 and half years of follow-up. CONCLUSIONS: PSFT is rare tumour, the diagnosis of which is based on histologic investigations. These tumours require long-term monitoring due to the possibility of local recurrence and malignant transformation.