Exposure of resident sparrows to West Nile virus evidenced in South Tunisia.

During the last few years, several cases of West Nile virus (WNV) infection in humans have been reported in Tunisia. However, detailed information on WNV infection in wild birds, the primary amplifying host of WNV, are lacking. In this work, we investigated the exposure of wild sparrows (hybrid Passer domesticus × hispaniolensis) living in two oases in southern Tunisia (Gabès and Kébili oases) to WNV, through the detection of WNV-specific antibodies by using ELISA and microneutralization tests. In total, 208 birds were sampled (54 from Kébili, 154 from Gabès). Anti-WNV antibodies were detected in two birds, corresponding to an overall seroprevalence of 1%. There was no significant difference between the two sampled populations [1·85% (1/54) in Kébili, 0·65% (1/154) in Gabès]. These data provide indirect evidence of the exposure of resident sparrows in southern Tunisia to WNV.

[Breast reconstruction using the free TRAM flap in a private practice setting. A review of 20 cases]. / La reconstruction mammaire par TRAM libre en chirurgie libérale : à propos de 20 cas consécutifs.

BACKGROUND: The breast reconstruction is an integral part of the treatment for breast cancer after mastectomy. A lot of methods were described like the free TRAM flap reconstruction. The technical difficulty, the length of the procedure and the post-operative monitoring of this reconstruction make it as an alternative used generally in a hospital setting. PURPOSE: The goal of this retrospective study is to document the validity of this technique in the private practice setting. PATIENTS AND METHOD: Between 2003 and 2006, 20 patients were operated on for a breast reconstruction using a free TRAM flap by a double "melting-pot" surgical team in a private clinic in Tunisia. The average age was 43 years and the average delay for the breast reconstruction was 16 months after mastectomy. We have always used the same surgical technique: a free TRAM flap plugged on the internal mammary vessels. The arterial anastomosis was stitched by a thread and the venous anastomosis was done by using a microvascular anastomotic coupler. The average operating time was 4 hours. The average stay in the clinic was 5 days. RESULTS: There was no total flap loss. We observed one partial necrosis that healed in 5 weeks with dressings, one hematoma that required a surgical evacuation at the second day and one case of abdominal wall weakness treated by a mesh repair at one year. CONCLUSION: The breast reconstruction using a free TRAM flap is a reliable and safe technique that can be used without any difficulties in a private practice setting if it is made by a surgical team familiar with microsurgery and respecting its criteria with also a good management and strategy for aftercare.

Thermomechanical Fractional Model of TEMHD Rotational Flow.

In this work, the fractional mathematical model of an unsteady rotational flow of Xanthan gum (XG) between two cylinders in the presence of a transverse magnetic field has been studied. This model consists of two fractional parameters α and ß representing thermomechanical effects. The Laplace transform is used to obtain the numerical solutions. The fractional parameter influence has been discussed graphically for the functions field distribution (temperature, velocity, stress and electric current distributions). The relationship between the rotation of both cylinders and the fractional parameters has been discussed on the functions field distribution for small and large values of time.

The hyperdense basilar artery sign: a case of locked-in syndrome.

BACKGROUND: Locked-in syndrome, although a notoriously famous clinical entity, the rarity of the condition coupled with the variability of clinical features on acute presentation represents a potential diagnostic pitfall for the emergency physician. CASE: A previously healthy 25-year-old female was brought to our Emergency Department after being found unresponsive. On examination, she was conscious and alert with a Glasgow Coma Score of 9; on neurological examination, the patient was quadriplegic and unable to speak but was able to move her eyes and blink. Non-contrast brain computed tomography (CT) revealed a hyperdense basilar artery, and CT cerebral angiography confirmed basilar artery thrombosis. CONCLUSION: This case highlights the need for a high index of suspicion to make a diagnosis of locked-in syndrome in the Emergency Department, especially in young patients with no apparent risk factors for an ischemic stroke. The hyperdense basilar artery sign is one of the earliest signs on non-contrast CT imaging and may be the only clue to guide further management in a patient with basilar artery occlusion.

Crystal structure of catena-poly[[(dimethyl sulfoxide-κO)(pyridine-2,6-di-carboxyl-ato-κ(3) O,N,O')nickel(II)]-µ-pyrazine-κ(2) N:N'].

The title coordination polymer, [Ni(C7H3NO4)(C4H4N2)(C2H6OS)] n , consists of [010] chains composed of Ni(II) ions linked by bis-monodentate-bridging pyrazine mol-ecules. Each of the two crystallographically distinct Ni(II) ions is located on a mirror plane and is additionally coordinated by a dimethyl sulfoxide (DMSO) ligand through the oxygen atom and by a tridentate 2,6-pyridine-di-carb-oxy-lic acid dianion through one of each of the carboxyl-ate oxygen atoms and the pyridine nitro-gen atom, leading to a distorted octa-hedral coordination environment. The title structure exhibits an inter-esting complementarity between coordinative bonding and π-π stacking where the Ni-Ni distance of 7.0296 (4) Šacross bridging pyrazine ligands allows the pyridine moieties on two adjacent chains to inter-digitate at halfway of the Ni-Ni distance, resulting in π-π stacking between pyridine moieties with a centroid-to-plane distance of 3.5148 (2) Å. The double-chain thus formed also exhibits C-H⋯π inter-actions between pyridine C-H groups on one chain and pyrazine mol-ecules on the other chain. As a result, the inter-ior of the double-chain structure is dominated by π-π stacking and C-H⋯ π inter-actions, while the space between the double-chains is occupied by a C-H⋯O hydrogen-bonding network involving DMSO ligands and carboxyl-ate groups located on the exterior of the double-chains. This separation of dissimilar inter-actions in the inter-ior and exterior of the double-chains further stabilizes the crystal structure.

[Chondrosarcoma of the mandible. Clinicopathological study of a case]. / Le chondrosarcome de la mandibule. Etude anatomoclinique d'un cas.

The authors report a new case of chondrosarcoma of the mandible in a 24 year-old female patient. They insist on the rareness of this entity and on the difficulties in establishing this diagnosis from the clinical, radiological and pathological points of view. Elements of prognosis are discussed through a review of the literature.

Patient satisfaction about using patient controlled analgesia in managing pain post surgical intervention.

Management of postoperative pain using patient controlled analgesia (PCA) has increased for its proven advantages over conventional methods of pain control. The purpose of this study was to investigate patients' satisfaction about using PCA post surgical intervention among patients at Saudi health care settings. A cross-sectional, descriptive correlational design was used to collect data from patients using PCA post surgical interventions. The analysis showed that patients had a moderate to high level of perception about efficacy of PCA, and had a moderate level of knowledge about PCA use and its function. The duration of using a PCA pump, patients' age, gender, marital status, educational level, type of surgery, and their work status were significant predictors (F 7, 76 = 5.13, p < .001; R(2) = 0.59). PCA offers patients with an individualized analgesic therapy that meets the patients' demand of pain control. The implications for nurses and medical staff are discussed.

High-dose darbepoetin alpha in the treatment of anaemia of lower risk myelodysplastic syndrome results of a phase II study.

An open-label, phase II non-randomised trial was conducted with darbepoetin (DAR), an erythropoiesis-stimulating factor with prolonged half-life, at a weekly dose of 300 mug subcutaneously in 62 anaemic patients with myelodysplastic syndrome (MDS) with an endogenous erythropoietin (EPO) level <500 mU/ml. Most of the patients were classified as low or intermediate 1 according to the International Prognostic Scoring System. After 12 weeks, 44 (71%) patients had an erythroid response (34 major and 10 minor), including eight of 13 patients who were previous non-responders to conventional EPO. Two additional responses (one minor and one major) occurred, in 10 non-responders, after the addition of granulocyte colony-stimulating factor (G-CSF). Thirty-six of the 46 total responders (31/35 major and 5/11 minor) continued to respond on maintenance DAR after a median of 40 weeks (range 4-84). Median dose of DAR required to maintain response was 300 microg every 14 d. The only prognostic factors of favourable response were low endogenous EPO level and low or absent red blood cell transfusion requirement. Those results suggest that high-dose DAR alone yields high erythroid response rates in anaemia of lower risk MDS, possibly equivalent to those obtained with conventional EPO + G-CSF, although this will need to be confirmed in larger and randomised trials.

[Sydenham's chorea in Tunisia: a report on 65 cases (author's transl)]. / La chorée de Sydenham en Tunisie. Etude de 65 observations.

Sydenham's chorea was observed in 65 patients in Tunisia during the period 1971-1976. The average age of onset was 10.8 years, and girls were affected twice as often as boys. Sydenham's chorea is a seasonal disorder; it usually develops between the months of november and march, and its frequency is closely related to that of Bouillaud's disease. A study of the past history of infections disease or rheumatic disorder (ARF), and biological tests for inflammation (sedimentation rate, blood fibrin levels, antistreptolysins O, and culture of throat swabs), showed that it is possible to distinguish cases of true chorea occurring alone from those in which it is associated with a rheumatic affection. These facts are discussed in the light of the data published in the literature. The authors conclude that sydenham's chorea and acute rheumatic fever are but two unrelated expressions of a streptococcal infection. Anti-inlammatory treatment with corticoids, therefore, is only indicated in the presence of signs of rheumatic affection.

The surgical management of cranio-orbital neurofibromatosis.

Experience with the surgical management of cranio-orbital neurofibromatosis in 14 patients is reported (age range, 6-40 years). The skeletal abnormality of the orbit that occurs in a small proportion (less than 1%) of patients with neurofibromatosis is, in essence, the absence of the membranous portions of the sphenoid and the adjacent bone forming the boundaries between the cranium and the orbit. The goal of surgery is tumor resection and reconstruction of the posterior bony defect by bone graft. Two additional procedures are also described that better enhance aesthetically-the mask lift and facial tissue expansion.

[Tissue expansion. Presentation of a model of external filling valve]. / Expansion tissulaire. Présentation d'un modèle de valve externe.

Based on their experience of facial tissue expansion, the authors present a model of an external filling valve and illustrate its advantages in 9 cases in which 13 external valve were used: painful injection, absence of leakage, fast and confortable filling. The indications are sequelae of facial burns, face scars, treatment of orbito-temporal neurofibromatosis. The major advantage is rapid tissue expansion which reduces the problems of infection and skin loss.

[The association of diabetes and celiac disease: the value of assaying antireticulin antibodies]. / Association diabète et maladie coeliaque: intérêt du dosage des anticorps antiréticuline.

The authors studied the specificity and the sensitivity of serum anti-reticulin IgA type antibody determination for the diagnosis of coeliac disease in diabetic patients. They observed a frequency of 11.1% coeliac disease among a group of 54 type I juvenile diabetic patients. The search for serum antireticulin IgA type antibodies appears to be an efficient method for identifying patients with coeliac disease; it has a specificity of 98% and a sensitivity of 95%. This marker appears to be particularly well suited for the identification of asymptomatic forms, and also for surveillance of diet during the course of coeliac disease.

[Bilateral brown tumor of the jaw. Apropos of a case]. / Tumeur brune bilatérale des maxillaires. A propos d'un cas.

A 42 years old woman was seen October 1987 because of tumor on the left maxilla. Removal of the lesion and histologic examination conclude at myeloplaxe tumor. A second giant cell lesion appears in the right maxilla 2 years later. The diagnosis of brown tumor was confirmed by the discovery of a parathyroid adenoma. We discuss about this case diagnosis difficulty of brown tumor from the others giant cell lesions of the jaws.