Patterns of unintentional fatal drowning among children in North Tunisia : A 10-year study.

AIMS: This study aims to better understand patterns of unintentional fatal drowning among children in North Tunisia. METHODS: A cross-sectional retrospective study including all unintentional fatal drowning among children was conducted in the Legal and Forensic Medicine department in the Charles Nicolle Hospital, Tunis, between January 2010 and December 2019. Socio-demographic variables, as well as death circumstances, were documented for each victim and analyzed. RESULTS: A total of 200 casualties were included in this study. The highest rate of deaths was observed in the summer (N=44). Most of the victims were males and 55.5% were aged between 13 and 18 years. The drowning occurred in a canal or the sea in 33.5 % and 29.5 % of the cases respectively. The distribution of drowning sites varied significantly by season and place of living: drowning in the sea was more likely to occur in the summer and in urban areas (p < 0.05). In the first years of life, drowning occurred mostly in buckets and wells (N=9 and N=10, respectively) while between 7 and 18 years, it was more frequent in a canal or the sea. Swimming was the leading activity before death in 50% of the cases. CONCLUSIONS: Unintentional fatal drowning among children remains an underestimated major health problem in Tunisia especially in the population aged from 7 to 18 years. Effective prevention measures should be implemented nationwide, especially around seas and canals.

Comparison of non-invasive peripheral venous saturations with venous blood co-oximetry.

The estimation of venous oxygen saturations using photoplethysmography (PPG) may be useful as a noninvasive continuous method of detecting changes in regional oxygen supply and demand (e.g. in the splanchnic circulation). The aim of this research was to compare PPG-derived peripheral venous oxygen saturations directly with venous saturation measured from co-oximetry blood samples, to assess the feasibility of non-invasive local venous oxygen saturation. This paper comprises two similar studies: one in healthy spontaneously-breathing volunteers and one in mechanically ventilated anaesthetised patients. In both studies, PPG-derived estimates of peripheral venous oxygen saturations (SxvO2) were compared with co-oximetry samples (ScovO2) of venous blood from the dorsum of the hand. The results were analysed and correlation between the PPG-derived results and co-oximetry was tested for. In the volunteer subjects,moderate correlation (r = 0.81) was seen between SxvO2 values and co-oximetry derived venous saturations (ScovO2), with a mean (±SD) difference of +5.65 ± 14.3% observed between the two methods. In the anaesthetised patients SxvO2 values were only 3.81% lower than SpO2 and tended to underestimate venous saturation (mean difference = -2.67 ± 5.89%) while correlating weakly with ScovO2 (r = 0.10). The results suggest that significant refinement of the technique is needed to sufficiently improve accuracy to produce clinically meaningful measurement of peripheral venous oxygen saturation. In anaesthetised patients the use of the technique may be severely limited by cutaneous arteriovenous shunting.

Feasibility of laparoscopic resection of mesenteric cysts: two case reports.

INTRODUCTION: Mesenteric cysts (MC) are rare intra-abdominal tumors. The incidence has been estimated to be 1/100000 in the adult population and 1/20000 in children, with a male: female ratio of 1:1. The first successful laparoscopic resection of a MC was reported by MACKENZIE et al. in 1993. The malignant transformation appears in 3% of cases. In our study, we presented the feasibility and results of laparoscopic resection. CASE REPORTS: We report two cases of mesenteric cysts removed by a laparoscopic procedure. RESULTS: Laparoscopic approach in the two cases was successful. No conversion was observed. No complication occurred. The histopathological studies revealed no malignancy. After 18 months of follow-up the 2 patients remained free of disease. CONCLUSION: In selected cases, safe and complete resection of MC could be achieved by laparoscopic approach. Complete surgical resection of MC is the treatment of choice when the cyst becomes symptomatic or when complications occur.

[Sudden cardiac death in women, data from the northern Tunisian sudden cardiac-death registry]. / La mort subite cardiaque chez la femme, registre du nord de la Tunisie.

BACKGROUND: Sudden cardiac death is a major public health problem. Epidemiological and clinical differences according to gender have been described in sudden cardiac death. The aim of this study was to examine the gender differences between autopsy findings and circumstance of occurrence associated with sudden cardiac death. METHODS: We prospectively collected epidemiological and autopsy data of victims of sudden cardiac death occurring in the northern governorates of Tunisia between January 2013 and December 2019. Symptoms preceding death, circadian, weekly and seasonal variations of sudden death were also analyzed. RESULTS: The study population included 1834 men and 468 women with a mean age of 56.5±14.2 years. All cardiovascular risk factors except smoking were significantly more frequent among women but ischemic heart disease was the most common cause of death in men (51.3 %, versus 28 %, P<0.001). Women were more likely to have a negative macroscopic autopsy than men (34 % versus 23.6 %, P<0.001). Chest pain preceding sudden death was more frequent in male (24 % versus 13.2 %, P<0.001). In contrast, women were more likely to have dyspnea (8.1 % versus 15.6 %, P<0.001). Sudden death in women occurred indoors more often than in men (63.9 % versus 54.5 %, P<0.001) and also more often during night (midnight to 6 am). We also recorded an excess cardiac mortality in winter in both sexes. CONCLUSIONS: Women had considerably more cardiovascular risk factors and more commonly negative macroscopic autopsy. Death occurred indoors and during night more often than in men.

[Gastric adenocarcinoma following "silastic vertical ring gastroplasty": case report]. / Survenue d'un adénocarcinome gastrique 10 ans après une "silastic ring vertical gastroplasty ": cas isolé ou lien de cause à effet?

OBJECTIVES: Bariatric surgery is considered as the most effective therapy for morbid obesity. But, each procedure carries both short-and long-term complications. And, it remains unclear if the late occurrence of gastric adenocarcinoma could be linked to bariatric surgery. We described a case of a female who developed a gastric adenocarcinoma after a silastic ring vertical gastroplasty (SRVG). METHODS: A 54-year-old female presented with postprandial vomiting, poor appetite, dysphagia and weight loss 10 year after a SRVG. A gastroscopy with biopsy disclosed a juxta-pyloric adenocarcinoma. No distant metastasis was found. After 3 cycles of neoadjuvant chemotherapy, a subtotal gastrectomy with Roux-en-Y anastomosis was performed. RESULTS: After the surgery, a minor anastomotic leak was treated conservatively and a parietal abscess was drained. The pathological studies demonstrated a T2bN1 adenocarcinoma with negative margins. Adjuvant chemotherapy was administered. At the last work up, the patient is disease-free. CONCLUSION: The association between a gastric adenocarcinoma and a bariatric procedure such as a SRVG is difficult to assess without a case-control or a cross-sectional study. Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be bear in mind.

Potassium channels in rat prostate epithelial cells.

Voltage-dependent K(+) channels were identified and characterized in primary culture of rat prostate epithelial cells. A voltage-dependent, inactivating K(+) channel was the most commonly observed ion channel in both lateral and dorsal cells. The K(+) current exhibited a voltage threshold at -40 mV. Averaged half-inactivation potential (V(1/2)) and the slope factor (k) values were -26 mV and 6, respectively. It showed a monoexponential decay with an inactivation time constant of about 600 ms at +60 mV. The deactivation time constant at -60 mV was 30 ms and the reversal potential was estimated at -80 mV, suggesting that current was carried by potassium ions. The scorpion venom peptides charybdotoxin (5 nM) and margatoxin (1 nM), inhibited K(+) current at all membrane potentials with a rapid and a slow reversibility respectively. Both tetraethylammonium (10 mM) and 4-aminopyridine (50 microM) reduced K(+) current by approximately 40%. We conclude that plasma membranes of lateral and dorsal rat prostate epithelial cells contain Kv K(+) channels that have biophysical and pharmacological properties consistent with those of the Kv1.3 family.

[A case of an adult triatrial heart, associated with partial abnormal venous return from the left lung]. / A propos d'un cas de coeur triatrial de l'adulte associé à un retour veineux anormal partiel du poumon gauche.

The authors underline the value of echocardiography in the diagnosis and postoperative management of a case of cor triatrium. The patient was a 22 year old male who presented with dyspnoea of effort (stage III of the NYHA classification) and clinical signs of an infundibulo-pulmonary syndrome with tricuspid regurgitation. Chest X-ray revealed cardiomegaly (CTI = 61%) and filling-in of the aorto-pulmonary window. The electrocardiogram showed left atrial and right ventricular hypertrophy. The echocardiogram, the key to diagnosis, showed an abnormal echogenic structure within the left atrium. Cardiac catheterisation demonstrated pulmonary hypertension and a difference of pressure between the two lungs. The membrane dividing the left atrium and partial anomalous pulmonary venous drainage from the left lung into the superior vena cava were visualised on late stage pulmonary angiography. Surgical excision of the membrane in the left atrium and ligation of the anomalous venous drainage provided a radical cure to all these malformations.

[Study of ninety strains of serogroup A Neisseria meningitidis isolated from cerebrospinal fluid (25) and rhinopharynx (65) in Morocco (December 1989-April 1990)]. / Etude de quatre-vingt dix souches de Neisseria meningitidis de sérogroupe a isolées du liquide céphalorachidien (25) et du rhinopharynx (65) au Maroc (décembre 1989-avril 1990).

Ninety strains of Neisseria meningitidis were recovered from cerebrospinal fluid and nasopharyngeal specimens during the outbreak which occurred in Morocco between December 1989 and April 1990. All the strains recovered belonged to serogroup A. Serotype determination carried out using the "whole cell ELISA" method showed that all strains were serotype 4, subtype P1.9. Antigenic formula of the strains was therefore A:4:P1.9. Electrophoretic characterization of outer membrane proteins demonstrated proteins belonging to classes 1, 3, 4, 5 and 6, with a few rare exceptions which are discussed.

Incidence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Tunisian populations.

Screening for glucose-6-phosphate dehydrogenase (G6PD) deficiency was performed on male students originating from several towns in Tunisia. Three hundred and twenty-five assays were made, allowing calculation of the mean value and standard deviation of G6PD (6.32 +/- 0.72 U/g Hb), the incidence of the deficiency (1.84%) and its geographic distribution in Tunisia. G6PD electrophoresis in 54 subjects showed marked predominance of the B+ type (96.2%) compared with the A+ type (1.96%). Three deficient subjects displayed an electrophotetic mobility identical to that of the A+ type of G6PD.