Impact of illness on mothers of children with cystic fibrosis in Tunisia: A qualitative interview study: Impact of cystic fibrosis on Tunisian mothers.

BACKGROUND: Caring for a child with cystic fibrosis (CF) is challenging and stressful and even more so in a country with limited resources. Our aim was to study the impact of CF on the daily life of mothers with children who have CF in Tunisia, emphasizing the difficulties encountered. METHODS: Overall, 20 participants were interviewed about their experiences of being caregivers and mothers of children with CF, including their knowledge about the condition, their attitude toward it, the impact of CF on their daily lives, the main difficulties they had faced, and their concerns and wishes about CF management. RESULTS: The median age of the interviewees was 39 years. None of the mothers had known about CF before; 14 of them had difficulty accepting it at first, with suicidal thoughts in one case. Six hid the illness from the close family for fear of negative prejudices. Three mothers decided to stop having children despite availability of prenatal screening. CF also influenced the mothers' social activities (n = 13) and interfered with their jobs (n = 5). It was responsible for additional expenses in all cases. Chest physiotherapy represented a daily source of coping for all participants. Hospitalization related to Pseudomonas aeruginosa infection was considered stressful and constraining by 12 mothers. The mothers' main concern was the child's life expectancy (n = 7). Their main wish was to administer a curative treatment (n = 17). CONCLUSION: CF was found to have deeply affected the mothers' psychosocial life stressing the need for the involvement of qualified psychologists and social workers together with the medical staff.

Quality enhancement of frozen Nile tilapia fillets using rosemary and thyme oil / [Melhoria da qualidade de filetes de tilápia do Nilo congelados com óleo de alecrim e tomilho]

The food industry and the frozen fish sector in particular have benefitted greatly from advancements in food processing technologies. This study investigated the effect of adding natural antioxidants such as rosemary and thyme oil to frozen fillets of Nile tilapia (Oreochromis niloticus) in order to preserve their quality for consumers. Fillets were treated with rosemary and thyme at two concentrations (1% and 1.5%) and then were stored at 4°C. Samples were analyzed over 4 days for bacteriological (aerobic plate count, psychotropic count, and coliform count), chemical (determination of pH, thiobarbituric acid reactive substances-TBARS, and total volatile base nitrogen-TVB-N), and sensory quality examination (color, texture, and odor). Significant differences (P<0.05) were observed among different groups in terms of aerobic plate count, psychotropic count, and coliform count during the storage. Moreover, pH, TVB-N, and TBARS mean values in the treated groups were lower than those in the untreated group. The best sensory quality was obtained at the highest concentrations (1.5%) of thyme and rosemary oil.(AU)

A indústria de alimentos e o setor de peixes congelados, em particular, se beneficiaram dos avanços nas tecnologias de processamento de alimentos. Este estudo investigou o efeito da adição de antioxidantes naturais, como óleo de alecrim e tomilho, a filetes congelados de tilápia do Nilo (Oreochromis niloticus), a fim de preservar sua qualidade para os consumidores. Os filés foram tratados com alecrim e tomilho em duas concentrações (1% e 1,5%) e, em seguida, foram armazenados a 4°C. As amostras foram analisadas durante 4 dias para análises bacteriológicas (contagem de placas aeróbicas, psicotrópicas e coliformes), químicas (determinação do pH, substâncias reativas ao ácido tiobarbitúrico-TBARS e nitrogênio base volátil total-TVB-N) e exame da qualidade sensorial (cor, textura e odor). Diferenças significativas (P<0,05) foram observadas entre os diferentes grupos na contagem aeróbia de placas, contagem psicotrópica e contagem de coliformes durante o armazenamento. Além disso, os valores médios de pH, TVB-N e TBARS nos grupos tratados foram inferiores aos do grupo não tratado. A melhor qualidade sensorial foi obtida nas maiores concentrações (1,5%) de tomilho e óleo de alecrim.(AU)

A novel large deletion in CCM1 gene in a Tunisian family.

Familial CCM is a rare entity associated with the mutation of three genes: CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10). We report here the first description of a Tunisian familial CCMs composed of six members. The father and two daughters were affected and symptomatic. The two other kindred were healthy. Surgical treatment was performed in only one affected patient. Molecular analysis of KRIT1, MGC4607 and PDCD10 genes identified a large KRIT1 deletion of the first ten exons. To the best of our knowledge, this large deletion has never been reported before.

Severe perineal morbidity of instrumental deliveries using Thierry's spatulas and vacuum extraction: A prospective observational cohort study.

OBJECTIVES: To evaluate the risk of severe perineal tear following instrumental vaginal delivery (IVD) performed with spatulas and vacuum extraction. Secondary objectives were to estimate the impact of episiotomy on this risk. METHODS: From December 2008 to October 2012, women who underwent spatulas or vacuum were prospectively included. Each spontaneous vaginal delivery (SVD) following each included IVD were included as control cases (1-1 ratio). Careful perineal examination was systematically performed. Severe perineal tear was defined by the occurrence of anal sphincter rupture with or without anal mucosa tear. RESULTS: A total of 761 patients were included in the current study: 248 (64%) spatulas, 137 (36%) vacuums and 381 (49%) SVDs. Severe perineal tear was diagnosed in 19 (2.5%) cases. Episiotomy had been performed in 276 (36.9%) patients. Only spatulas extraction was found to significantly increase the risk of severe perineal tear (AOR=7.66; 95% CI: 2.06-28; P=0.02). Although vacuum extraction seemed to increase this risk, it was not found to be significant (AOR=3.25; 95% CI: 0.65-16.24; P=0.15). No significant difference was observed between the risk of severe perineal tear following spatulas and vacuum (AOR=2.36; 95% CI: 0.63-8.82; P=0.202). Finally, neither foetal macrosomia, nor episiotomy, nor foetal extraction with the head in the deep pelvis, nor delivery at night had a significant impact on the probability of severe perineal tear. CONCLUSIONS: Spatulas extraction is an independent risk factor for severe perineal tear. The practice of episiotomy was not shown to have any significant impact on this risk.

[Association between sperm abnormalities and occupational environment among male consulting for couple infertility]. / Association entre anomalies spermatiques et environnement professionnel chez les hommes consultant pour infertilité de couple.

Alteration of sperm parameters related to occupational exposures is the subject of several studies, often on a case-control approach. The study populations usually comprise men consulting in infertility clinics for couple infertility. The objective of this review is to identify, from these case-control studies, the main occupational factors that may be associated with altered sperm parameters. We selected 13 articles in the PubMed database. Participation in these studies varied from 61 to 2619 subjects, with great methodological heterogeneity, particularly in the characterization of exposure. The main occupations that appear significantly associated with a risk of altered sperm parameters are workmen, painters, farmers, welders, plumbers and technicians. When analysis focuses on occupational exposures, a significant result is reported for solvents, heavy metals, heat, vibrations and non-ionizing radiation. None of the selected studies has found a link with exposure to pesticides.

Isolation and identification of efficient Egyptian malathion-degrading bacterial isolates.

Bacterial isolates degrading malathion were isolated from the soil and agricultural waste water due to their ability to grow on minimal salt media amended with malathion as a sole carbon source. Efficiencies of native Egyptian bacterial malathion-degrading isolates were investigated and the study generated nine highly effective malathion-degrading bacterial strains among 40. Strains were identified by partial sequencing of 16S rDNA analysis. Comparative analysis of 16S rDNA sequences revealed that these bacteria are similar with the genus Acinetobacter and Bacillus spp. and RFLP based PCR of 16S rDNA gave four different RFLP patterns among strains with enzyme HinfI while with enzyme HaeI they gave two RFLP profiles. The degradation rate of malathion in liquid culture was estimated using gas chromatography. Bacterial strains could degrade more than 90% of the initial malathion concentration (1000 ppm) within 4 days.

[Hydatic cyst of the fallopian tube]. / Kyste hydatique tubaire unilatéral: à propos d'un cas.

Hydatic cyst of the Fallopian tube is an exceptional localization, the diagnosis of which is frequently confirmed preoperatively. A 44-year-old woman was addressed for pelvic mass with fortuitous discovery. The diagnosis preoperatively confirmed by the extemporaneous histological study was hydatic cyst of the Fallopian tube. Salpingectomy was required. The pelvic hydatic cyst, particularly in the Fallopian tube, is a rare complaint. Clinics and biology were very important for diagnosis but only anatomopathology can confirm diagnosis of hydatic cyst. The treatment of Fallopian tube hydatic cyst is surgival and often radical (salpingectomy).

[Single-port surgery and adnexal procedures: which indications in oncological surgery?]. / Cœlioscopie par mono-trocart et chirurgie annexielle : quelles applications en chirurgie oncologique ?

OBJECTIVE: To show the interest of single trocar in order to perform uni- or bilateral salpingo-oophorectomies. PATIENTS AND METHODS: A descriptive study monocentric. RESULTS: A total of 79 unilateral or bilateral salpingo-oophorectomies were performed by single-port laparoscopy between January 2010 and September 2012 at the Institut Paoli-Calmettes (Marseille). There are three surgical indications: diagnostic, therapeutic and prophylactic. The median age was 50 years (22-78 years). The median BMI was 22.4 kg/m(2) (17.5 to 37.7 kg/m(2)). The median blood loss was 0cc (0cc-50cc). The median hospital stay of patient was one day (0-6 days). The conversion rate in this study was 8.8%. DISCUSSION AND CONCLUSION: The single-port laparoscopic approach to perform uni- or bilateral salpingo-oophorectomies is a natural evolution of the conventional laparoscopy. If the cosmetic role seems obvious, its therapeutic value compared to traditional technique must be demonstrated by prospective studies with larger numbers.

[Listeriosis in Tunis: seven cases reports]. / Les infections à Listeria monocytogenes à Tunis: à propos de sept cas.

Listeria monocytogenesis a Gram positive facultative intracellular bacterium that can be responsible for severe infections, affecting essentially pregnant women, immunocompromised patients at the early and later stages of life. In Tunisia, invasive L. monocytogenes infections are thought to be exceptional and limited data are available about listeriosis. We reported seven cases (five newborn children and two infants) of human listeriosis that occurred in Tunis from 2000 to 2008. The newborn children were hospitalized for suspicion of maternofoetal infections. The two infants were hospitalized for fever associated with digestive signs in one case and neurological signs in the other. L. monocytogenes-was isolated from culture of cerebrospinal fluid in four cases, peripheral samples in two cases and from blood culture in one case. Isolates identification was based on conventional methods. Antimicrobial susceptibility was realized according to the recommendation of the "Comité de l'antibiogramme de la Société française de microbiologie". All L. monocytogenes isolates were sensitive to amoxicillin and aminoside but resistant to 3rd generation cephalosporins. Investigations of the immune system were realized for the two infants including phenotypic analysis of peripheral blood cells by flow cytometry, lymphocyte proliferation assays, phagocytic cell functions and measurement of immunoglobulins as well as complement. All these explorations were normal for both infants. The outcome was fatal in only one case (a newborn child), and all the other patients recovered after adapted antibiotic treatment. In conclusion, our study shows that listeriosis is not exceptional in Tunis. Thus, it is necessary to know how to evoke this diagnosis, at any age, in order to establish an early and adapted antibiotic treatment and to avoid fatal outcome.

[Tuberculous otitis media]. / Tuberculose de l'oreille moyenne.

Tuberculous otitis media is a rare disease. Its diagnosis is often made late. We report the case of a 13-year-old girl presenting with a right chronic otitis media and a massive and painful cervical adenitis. High resolution CT-scan revealed cervical and mediastinal adenitis associated with extensive lesions involving the middle ear, mastoid air cells, and sphenoidal bone. The diagnosis of tuberculous otitis media was made on a positive tuberculin skin test and on the identification of Mycobacterium tuberculosis in gastric juices. The young girl progressed well after 9 months of antituberculous chemotherapy.

[Immunohistochemical study of endometrial stromal sarcoma and smooth-muscle tumors of the uterus]. / Etude immunohistochimique des sarcomes du stroma endométrial et des tumeurs musculaires lisses de l'utérus.

OBJECTIVES: Positive and differential diagnoses of mesenchymal tumors of the uterus may be sometimes problematic. The purpose of this study was to evaluate the utility of a panel of antibodies in this diagnosis. MATERIALS AND METHODS: The expression of AML, desmin, h-caldesmon and CD10 was studied in nine endometrial stromal sarcomas (SSE), two leiomyosarcomas (LMS) and 10 highly-cellular leiomyoma (HCL). RESULTS: AML positivity was found in five SSE, in all HCL and in only one LMS. Desmin expression was found in two SSE, in all HCL and LMS. H-caldesmon was negative in all SSE, positive in all HCL and in one case of LMS. CD10 was expressed in two-third of SSE. However, neither HCL nor LMS was marqued. CONCLUSION: CD10 is the most specific antibody of SSE. It seems to have the best value in the diagnosis of mesenchymal tumors in association with desmin and h-caldesmon, specific markers of smooth-muscle differentiation.

Allergic rhinitis in children with asthma: a questionnaire-based study.

BACKGROUND: Allergic rhinitis (AR) and asthma frequently coexist but has rarely been evaluated in children. OBJECTIVE: This prospective study aimed to estimate the prevalence of AR in asthmatic children, and ascertain whether AR is a risk factor for the severity of asthma. METHODS: The questionnaire, modified from the adult form of the score for allergic rhinitis (SFAR), was completed by 404 asthmatic children aged 3-18 years seen in the outpatient clinic between June 2005 and July 2007. Each item was assigned a number of points with a final score ranging from 0 to 17. AR and asthma were classified according to ARIA and GINA 2004 recommendations, respectively. RESULTS: AR was diagnosed in 237 patients (58.7%). It was intermittent in 57.8% of the patients and persistent in 42.2%. A total score >or=9 was discriminant for AR (sensitivity=91.1%, specificity=95.2%, positive predictive value=96.4%, negative predictive value=88.3%, Youden's Index=0.86). The proportion of children having mild or moderate-to-severe asthma was independent of the presence of AR, 61.6% of moderate-to-severe asthmatic children and 55.4% of intermittent and mild asthmatic children having AR. CONCLUSION: AR and asthma are frequently associated (58.7%). The SFAR adapted for children seems to be a simple and a reliable tool to detect AR in asthmatic children.

[Severe maternal morbidity]. / La morbidité maternelle grave.

OBJECTIVES: Severe maternal morbidity remains a public health issue in developing countries. We report in this retrospective study, patients' characteristics and frequency of pathologies responsible of severe maternal morbidity. MATERIALS AND METHODS: Between January 1999 and December 2003, 119 cases of severe maternal pathologies of pregnancy and delivery occurred among 19,736 live births. RESULTS: Severe maternal morbidity was 602.95 per 100,000 live births and obstetrical haemorrhages were the most frequent cause (39%) followed by hypertensive disease (25%). Maternal mortality rate was 30.4 per 100,000 live births, and hypertensive disease represents the first cause of mortality in our study, contrary to all Tunisian data where haemorrhage remains the first one. CONCLUSION: Improvement of prognostic of high risk pregnancies has allowed diminution of maternal mortality. Instead of this diminution, efforts must be done in the management of severe obstetrical pathologies responsible of high maternal morbidity notably complications of hypertensive disease.

[Subperiosteal hematoma in delivery]. / L'hématome sous-périosté de l'orbite au cours de l'accouchement.

Spontaneous subperiosteal hematoma of the orbit is uncommon and only five cases have been reported in literature. The aim is to report a new case of this exceptional complication of labour and delivery. A 28-year-old woman developed immediately after delivery exophthalmia, chemosis and diplopia. CT scan showed a subperiosteal hematoma of the orbit. Spontaneous evolution was good. For her second pregnancy, caesarean section was decided because of the risk of recurrence. Since no etiology is found, venous hyperpression occurring during labor could be the lone origin.

[Off-line exhaled nitric oxide measurement in children]. / Mesure de la fraction expirée de NO chez l'enfant par une analyse extemporanée.

INTRODUCTION: The objective is to test the validity of a tool allowing an offline measurement of the fraction of expired nitric oxide (FENO). The device is a T-tube on which a pressure gauge allows the control of the expiratory flow and whose two side branches have a gauge such as the bags assembled on each one of them fill successively. METHODS: The first phase aims to check that the sample collected in the second bag answers the criteria of analysis of NO during a single expiration and that this measurement can be delayed. The second phase aims to test the feasibility and the repeatability of the offline analysis in children. RESULTS: The device makes it possible to stabilize the expiratory flow at 100 ml/s. The NO concentration in the second bag is stable during 6 hours. The intra measurement coefficient of variation of delayed FENO 0.1 is 7% (N = 19). CONCLUSION: A off line measurement of the exhaled nitric oxide is reliable in asthmatic children.