Immune activation and regulatory T cells in Mycobacterium tuberculosis infected lymph nodes.

BACKGROUND: Lymph node tuberculosis (LNTB) is the most frequent extrapulmonary form of tuberculosis (TB). Studies of human tuberculosis at sites of disease are limited. LNTB provides a unique opportunity to compare local in situ and peripheral blood immune response in active Mycobacterium tuberculosis (Mtb) disease. The present study analysed T regulatory cells (Treg) frequency and activation along with CD4+ T cell function in lymph nodes from LNTB patients. RESULTS: Lymph node mononuclear cells (LNMC) were compared to autologous peripheral blood mononuclear cells (PBMC). LNMC were enriched for CD4+ T cells with a late differentiated effector memory phenotype. No differences were noted in the frequency and mutifunctional profile of memory CD4+ T cells specific for Mtb. The proportion of activated CD4+ and Tregs in LNMC was increased compared to PBMC. The correlation between Tregs and activated CD4+ T cells was stronger in LNMC than PBMC. Tregs in LNMC showed a strong positive correlation with Th1 cytokine production (IL2, IFNγ and TNFα) as well as MIP-1α after Mtb antigen stimulation. A subset of Tregs in LNMC co-expressed HLA-DR and CD38, markers of activation. CONCLUSION: Further research will determine the functional relationship between Treg and activated CD4+ T cells at lymph node sites of Mtb infection.

Aneurysm of the internal carotid artery after minor trauma.

We report a rare case of posttraumatic aneurysm of the internal carotid artery. The aneurysm was surgically removed, followed by a simple postoperative course. Such lesions should be highly suspected in cases of penetration into the retroangulomandibular neck region.

[Primary laryngeal lymphoma: a case report]. / Lymphome primitif laryngé: à propos d'un cas.

Primary laryngeal lymphoma is rare, accounting for less than 1% of all laryngeal cancers. Treatment depends on the stage and severity of the disease. We here report the exceptional case of a 64-year-old woman, non-smoker, suffering from dysphagia for solids and a foreign body sensation. Laryngoscopy and biopsies revealed polyploid tumor of the left epiglottic fold. The diagnosis of diffuse large B-cell lymphoma was made. The patient underwent chemotherapy followed by radiotherapy, with significant improvement at 2-year follow-up, with no local recurrence. Due to the rarity of this disease and the variety of symptoms, the optimal management strategy for this type of cancer is controversial, requiring a specific diagnostic and therapeutic approach.

The Performance of GeneXpert in the Diagnosis of Lymph Node Tuberculosis: A Prospective Study Comparing GeneXpert and Culture Findings.

Background and objective Lymph node tuberculosis (LNTB) is a common manifestation of extrapulmonary tuberculosis (EPTB). GeneXpert is a rapid diagnostic molecular test that simultaneously detects tuberculosis and rifampicin (RIF) resistance. In this study, we aimed to assess the epidemiology of LNTB and diagnostic performance parameters of the GeneXpert in routine ENT practice. Methods We conducted a cross-sectional prospective study from January to July 2019, in the Department of Otorhinolaryngology and Head Neck Surgery at the Hassan II University Hospital Center of Fez, Morocco. The samples were collected using lymph node biopsy and subjected to GeneXpert assay, culture, and histopathology. Diagnostic performance parameters of the GeneXpert were calculated and compared with culture. Results All patients with cervical adenopathy were included. Lymph node biopsies were performed for all patients. The performance of the GeneXpert was assessed according to culture findings. Among the 75 cases, the mean age was 21.6 ± 12.7 years with a female predominance (60%). GeneXpert was positive in 66.7% of specimens. The sensitivity and specificity of the GeneXpert assay were 78.6% and 40.4% respectively. GeneXpert accuracy was 54.6%. The positive predictive value (PPV) and negative predictive value (NPV) were found to be 44% (95% CI: 30.2-57.8) and 76% (95% CI: 59.3-92.7) respectively. Mycobacterium bovis was isolated in all samples, with no case of resistance to RIF found. Conclusions The performance of GeneXpert was found to be superior in terms of establishing the diagnosis of LNTB. It offers speedy and prompt results and clinicians should adopt it in routine clinical practice.

[Cancer patient satisfaction survey in a Moroccan university hospital]. / Enquête de satisfaction des patients atteints de cancer dans un hôpital universitaire au Maroc.

OBJECTIVES: Assessment of patient satisfaction helps to guide hospital strategies concerning optimal patient management. The objective of this study was to evaluate the satisfaction of cancer patients hospitalised at Fez university hospital, to study the various components of satisfaction and to integrate the patient in quality of care improvement policies. METHODS: A prospective study was conducted in two voluntary wards of the hospital. An anonymous standardized questionnaire was administered to patients hospitalised for cancer surgery or treatment. RESULTS: 87.1% of patients reported that they were very satisfied with their hospitalisation, while 12.9% rated their stay as acceptable. 98.4% would recommend the hospital to their relatives. In contrast, 67.2% of patients surveyed considered that the cost of their stay was too expensive. CONCLUSION: The majority of items were declared as "Very satisfactory" by the patients. They represent a challenge to be maintained in the future: ward reception, comfortable accommodation, the behaviour and availability of staff, the doctor-patient relationship, respect for patient, the explanations provided concerning the health problem and treatment, psychological support and pain management. For items reported to be less satisfactory, recommendations should be implemented concerning the admissions office, administrative formalities on admission, the information provided at the time of discharge, quality of meals, development of nursing skills and dietary advice.

Current Management of Congenital Choanal Atresia: Litteratur Review.

Background: Congenital Choanal Artesia (CCA) is a rare cause of upper airway obstruction, yet it is the most common congenital anomaly of the nose. While the unilateral condition could be undiagnosed, bilateral CCA may be life-threatening, especially for newborns. Some CCA may be associated with other congenital abnormalities, which leads to a systematic screening during the diagnostic assessment. The diagnosis is easy. However, surgical management is still controversial. Methods: We conducted a retrospective study gathering data on management of CCA over 42 months. We reported epidemiological aspects and results of our series, and discussed management issues. Results: We operated 22 choanae using the endoscopic technique. The age of bilateral CCA patients on the day of surgery ranged from 8 to 21 days (mean 11.7+/_ 2.6 days). Their birth weight ranged from 2.9 to 4.5 kg (mean 3.4 +/_ 0.5 kg), and their gestational age ranged from 30 to 41 weeks. Surgery duration for neonatal bilateral CCA repair ranged from 75 to 110 min (mean 90 min +/_ 11.5 min). We performed an exclusive endonasal endoscopic approach for all patients with no stenting or mitomycin C application. We deplore one post operative complication related to minor palatal perforation resolved spontaneously. Conclusion: Since newborns solely depend on nasal breathing during the first month of life, bilateral CCA is an emergency. Endonasal endoscopic management is the primary procedure. Currently, surgery steps are standardized. However, how to prevent post-operative synechiae and restenosis is still controversial. The mainstream is meticulous post-operative nursing with frequent endonasal saline irrigation, regular removal of crust, and prevention of inflammation due to reflux or infection.

"OCTOPUS": An Intelligent Tool for Assisted Multidisciplinary ORL Oncology Meetings-Preliminary Study.

Current sessions of multidisciplinary team meetings (MDMs) have several limitations, including increased costs and duration, as well as limited discussion time for each case. To address these issues, we have developed a computer application called OCTOPUS, which helps manage the patients' list for MDMs. The application allows for the generation of automatic MDM decisions based on predetermined criteria filled in by the patient's doctor and algorithms that comply with the latest oncology guidelines from the National Comprehensive Cancer Network. These decisions must be validated by the MDM faculty members. In cases of nonagreement or complex cases, the application proposes a "face-to-face MDM." The internal mailing system connects all members and allows for the request of a second opinion regarding pathology or imaging results. Initial results suggest that this ergonomic tool provides more flexibility in time management and improved uniformity in selecting cases that would most benefit from face-to-face MDMs.

[Cervical tuberculous lymphadenitis: the location of surgery]. / Tuberculose ganglionnaire cervicale: place de la chirurgie.

INTRODUCTION: In spite of the current effectiveness of antibacillary chemotherapy in most tubercular sites, peripheral lymph node involvement continues to pose a challenge to treatment. PATIENTS AND METHODS: It is a retrospective study, from 2002 to 2005, of 326 patients treated at the otorhinolaryngology department of Hassan II University Hospital, Fez, Morocco, for cervical lymph node tuberculosis. RESULTS: The tuberculosis of lymph nodes accounts for more than 23% of all affections managed in our department. The mean age of our patients was 32 years. A slight female predominance was noted. All of our patients benefited from surgery with diagnostic and/or therapeutic purposes. The treatment was supplemented by two rifampicine-isoniazide-pyrazinamide/four rifampicine-isoniazide antibacillary chemotherapy. The course of disease was marked by lymph node recurrence and failure of medical treatment in 54 patients. DISCUSSION: In the absence of, or in waiting for, bacteriologic confirmation, the surgery keeps a place impossible to circumvent, either as a diagnostic or therapeutic operation, in first-line treatment in the presence of a cold abscess, an inexhaustible fistula, lymphadenitis with atypical mycobacteria, and a large and calcified lymph-node mass for which medical treatment will not be sufficient, or in secondary surgery in the event of failure or progress under medical treatment or in case of residual adenopathy at the end of an appropriate medical treatment. CONCLUSION: Surgery still has an important place in the management of tuberculosis of lymph nodes.

The proper folding of a long C-terminal segment of the yeast Lys14p regulator is required for activation of LYS genes in response to the metabolic effector.

Transcription of lysine genes in Saccharomyces cerevisiae is dependent on Lys14p and on alpha-aminoadipate semialdehyde (alphaAASA), an intermediate of the pathway. The two-thirds C-terminal end of Lys14p is sufficient to ensure the activation function of the protein and its modulation by alphaAASA. Here, we show that no single discrete domain of Lys14p is able to activate transcription and that most of the deleted LexA-Lys14p proteins are inactive even in the presence of a high alphaAASA concentration. The point mutations abolishing the activation capacity of Lys14p are distributed all over the entire C-terminal segment. Although the deletion of 20 residues rich in leucine and located downstream of the DNA-binding domain converts Lys14p to a constitutive transcriptional activator, our analysis provides evidence that the modulation process of Lys14p activity does not involve an effector-dependent masking/unmasking mechanism. Furthermore, we show that the protein chaperone Hsp82p is required for full activation of LYS genes by the alphaAASA-activated Lys14p as well as by the constitutive Lys14p. Our results suggest that the proper folding of the two-thirds C-terminal portion of Lys14p is essential not only to activate transcription but also to modulate it according to alphaAASA concentration.

Arg82p is a bifunctional protein whose inositol polyphosphate kinase activity is essential for nitrogen and PHO gene expression but not for Mcm1p chaperoning in yeast.

In Saccharomyces cerevisiae, the synthesis of inositol pyrophosphates is essential for vacuole biogenesis and the cell's response to certain environmental stresses. The kinase activity of Arg82p and Kcs1p is required for the production of soluble inositol phosphates. To define physiologically relevant targets of the catalytic products of Arg82p and Kcs1p, we used DNA microarray technology. In arg82delta or kcs1delta cells, we observed a derepressed expression of genes regulated by phosphate (PHO) on high phosphate medium and a strong decrease in the expression of genes regulated by the quality of nitrogen source (NCR). Arg82p and Kcs1p are required for activation of NCR-regulated genes in response to nitrogen availability, mainly through Nil1p, and for repression of PHO genes by phosphate. Only the catalytic activity of both kinases was required for PHO gene repression by phosphate and for NCR gene activation in response to nitrogen availability, indicating a role for inositol pyrophosphates in these controls. Arg82p also controls expression of arginine-responsive genes by interacting with Arg80p and Mcm1p, and expression of Mcm1-dependent genes by interacting with Mcm1p. We show here that Mcm1p and Arg80p chaperoning by Arg82p does not involve the inositol polyphosphate kinase activity of Arg82p, but requires its polyaspartate domain. Our results indicate that Arg82p is a bifunctional protein whose inositol kinase activity plays a role in multiple signalling cascades, and whose acidic domain protects two MADS-box proteins against degradation.

Yeast epiarginase regulation, an enzyme-enzyme activity control: identification of residues of ornithine carbamoyltransferase and arginase responsible for enzyme catalytic and regulatory activities.

In the presence of ornithine and arginine, ornithine carbamoyltransferase (OTCase) and arginase form a one-to-one enzyme complex in which the activity of OTCase is inhibited whereas arginase remains catalytically active. The mechanism by which these nonallosteric enzymes form a stable complex triggered by the binding of their respective substrates raises the question of how such a cooperative association is induced. Analyses of mutations in both enzymes identify residues that are required for their association, some of them being important for catalysis. In arginase, two cysteines at the C terminus of the protein are crucial for its epiarginase function but not for its catalytic activity and trimeric structure. In OTCase, mutations of putative ornithine binding residues, Asp-182, Asn-184, Asn-185, Cys-289, and Glu-256 greatly reduced the affinity for ornithine and impaired the interaction with arginase. The four lysine residues located in the SMG loop, Lys-260, Lys-263, Lys-265, and Lys-268, also play an important role in mediating the sensitivity of OTCase to ornithine and to arginase and appear to be involved in transducing and enhancing the signal given by ornithine for the closure of the catalytic domain.