Primary breast lymphoma: a case series and review of the literature

BACKGROUND

Primary breast lymphoma (PBL) is a very rare form of non-Hodgkin's lymphoma (NHL), defined as a malignant primary lymphoma occurring in the breast in the absence of previously detected lymphoma localizations. Our study aims to retrospectively evaluate the epidemiological, clinical, and imaging findings and therapeutic features of breast lymphomas in patients with primary lymphoma of the breast.

MATERIALS AND METHODS

This is a retrospective study including 13 patients with primary non-Hodgkin's lymphoma of the breast treated at the Salah Azaiez Institute of Oncology from 2000 to 2019. This sample includes 1 case of follicular lymphoma, 2 cases of large T-cell lymphoma, and 10 cases of large B-cell lymphoma.

RESULTS

Patients included in the study were aged between 17 and 89 years (average age of 52.6 years). All patients were referred because of a lump in the breast, and only one patient consulted with inflammatory signs in the breast. The average clinical size of the tumor was 7.2 cm, with a maximum of 15 cm. Mammography showed an oval mass with circumscribed margins in the majority of cases. Ultrasound showed in most cases a hypoechoic irregular mass or multilobulated mass with irregular margins and hypervascular on color Doppler. Magnetic resonance imaging (MRI) was performed on only three patients and showed a spiculated lesion with polycyclic limits. Eight patients underwent surgery. In our study breast lymphomas involved 10 cases of large B-cell lymphoma, one case of follicular lymphoma, and two cases of large T-cell lymphoma. In this series, 11 patients had localized stages (I + II) at diagnosis, and 2 patients had disseminated stages (stage III) of primary breast lymphoma. Seven patients underwent chemotherapy treatment alone, and five had chemotherapy with radiotherapy. The median follow-up of our patients was 53 months, ranging from 1 to 177 months. Overall survival was 71% at 3 years and 51% at 5 years.

CONCLUSION

Primary breast lymphoma is an uncommon type of breast malignancy. The optimal treatment modality is still in question because of the rarity of this disease. However, the use of combination therapy produces the most favorable results. Surgery is not yet recommended.

Pure tubular carcinoma of the breast: a case series

BACKGROUND

Pure tubular breast carcinoma is a rare and well-differentiated tumor with high survival and low local recurrence rate. Our study aims to determine the clinical, radiological, appropriate management, and prognosis of this carcinoma.

MATERIALS AND METHODS

A review of Salah Azaiez institute registry from 2004 to 2019 was performed including seven cases of PTC of the breast.

RESULTS

Clinical-pathologic features and outcomes were analyzed. The median follow-up was 3 years. In our study, we found that the cohort presented more frequently with pT1 disease and pN0 disease. Conservative surgery was more frequently indicated (five cases). All patients had hormone-receptor positivity and Human Epidermal growth factor Receptor 2 (HER2) negativity. The majority of tumors had a molecular profile luminal A and a low-grade SBR. In one case we found axillary lymph node metastasis. Adjuvant radiotherapy was indicated in all cases of breast conservation and in only one case of radical surgery. One patient received chemotherapy. The mean follow-up was 4 years. We did not find any local or distant recurrence in our study.

CONCLUSION

PTC showed an excellent prognosis with a low SBR grade, a molecular profile luminal A, and a low incidence of recurrence.

Correlation between body mass index and electrocardiogram parameters in healthy adults

Funding Acknowledgements

Type of funding sources: None.

Background

The electrocardiogram (ECG) is a tool to evaluate cardiac function. Its interpretation depends on age, sex and race.

Aims

to evaluate the association between body mass index (BMI) and electrocardiogram parameters in healthy adults.

Methods

We conducted a prospective study that included apparently healthy volunteers aged between 18 and 65 years. Body mass index was calculated and standard 12-lead ECG was recorded for all participants. Subjects were classified into four groups according to BMI: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Pearson correlation coefficients were calculated to assess the relationship between ECG variables and BMI.

Results

 One hundred seventy-four apparently healthy volunteers (99 women and 75 men; age ranged from 18 to 65 years) were included in this study. The mean BMI was 26,36 ± 6,04 kg/m² with a minimum of 14,53 and a maximum of 49,27. Twenty-two (12,6%) subjects were in the underweight range; 53 (30,5%) in the normal weight range, 54 (31%) in the overweight range and 45 (25,9%) were obese. The results of our study showed a significant positive correlation between the ECG variables studied and the BMI except for HR and Sokolow index (table 1).

Conclusion

We concluded that BMI caused a significant modification in several ECG parameters in healthy adults. Increased BMI leads to lengthening of conduction times and ventricular repolarization. Largest investigation on the use of BMI-specific ECG norms is warranted. Table 1 ECG parameters BMI R-value P value HR -0,041 0,590 P wave duration 0,222 0,003 PR Interval 0,200 0,008 QRS duration 0,235 0,002 QT Interval 0,152 0,045 QTcorrected (QTc) 0,150 0,049 Sokolow index 0,102 0,182 Pearson correlation coefficients of various ECG parameters with BMI in the study population (n = 174)

Speckle tracking echocardiography in systemic sclerosis: A useful method for detection of myocardial involvement

BACKGROUND

Systemic sclerosis is a multisystem disorder characterized by tissue fibrosis and organ damage. Heart involvement is one of the main factors shortening survival, which may be underestimated by conventional echocardiography measurements. Two-dimensional speckle-tracking echocardiography is a powerful novel modality to assess subclinical myocardial dysfunction.

AIM

The aim of this study is to investigate heart involvement in systemic sclerosis patients, and to determine the usefulness of ventricular longitudinal deformation using the Two-dimensional speckle tracking technology for an early detection of ventricular dysfunction.

PATIENTS AND METHODS

Between May 2016 and September 2016, 25 patients with systemic sclerosis and 25 healthy subjects underwent echocardiography to assess heart abnormalities and the strain of the two ventricles using two dimensions' speckle tracking echography.

RESULTS

The two groups were comparable in age and gender. Despite comparable left ventricle systolic function (left ventricular ejection fraction patients 64.58±8.87 vs. in healthy 68.2±7.41, P=0.19), patients presented altered longitudinal peak systolic strain values (global longitudinal strain: patients -17.42±1.62 vs. healthy -19.24±8.85, P<0.0001). Despite comparable pulmonary artery systolic pressure, there was a significant alteration in right ventricular systolic and diastolic function assessed by standard measurement. Longitudinal peak systolic strain of the right ventricle was significantly lower in patients compared with controls (P<0.01).

CONCLUSION

Ventricular deformation analysis by two dimensions' speckle tracking echocardiography appears to be a sensitive method to detect early ventricular impairment in patients with systemic sclerosis.

[Not Available]

Chemical corneal burns are a common pathology. Those with strong bases penetrate deeply into the anterior segment and are particularly severe. We report the case of a patient suffering from corneal perforation secondary to an accidental projection of soda, and we propose to discuss the clinical and therapeutic particularities.

[Home non-invasive ventilation for chronic obstructive pulmonary disease]

INTRODUCTION

The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial.

AIM

To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population.

METHODS

We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital.

RESULTS

There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10^-3). There was no non-significant decrease of PaCO₂ (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months.

CONCLUSIONS

Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

[Management of patients treated for acute ST-elevation myocardial infarction in Tunisia: Preliminary results of FAST-MI Tunisia Registry from Tunisian Society of Cardiology and Cardiovascular Surgery]

FAST-MI Tunisian registry was initiated by the Tunisian Society of Cardiology and Cardio-vascular Surgery to assess characteristics, management, and hospital outcomes in patients with ST-elevation myocardial infarction (STEMI).

METHODS

We prospectively collected data from 203 consecutive patients (mean age 60.3 years, 79.8 % male) with STEMI who were treated in 15 public hospitals (representing 68.2 % of Tunisian public centres treating STEMI patients) during a 3-month period at the end of 2014. The most common risk factor was tobacco (64.9 %), hypertension (38.6 %), diabetes (36.9 %) and dyslipidemia (24.6 %).

RESULTS

Among these patients, 66 % received reperfusion therapy, 35 % with primary percutaneous coronary interventions (PAMI), 31 % with thrombolysis (28.6 % of them by pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 and 358 min for PAMI, respectively. The in-hospital mortality was 7.0 %. Patients enrolled in interventional centers (n=156) were more likely to receive any reperfusion therapy (19.8 % vs 44.6 %; p<0.001) than at the regional system of care with less thrombolysis (26.9 % vs 44.6 %; p=0.008) and more PAMI (52.8 % vs 8.5 %; p<0.0001). Also the in-hospital mortality was lower (6.4 % vs 9.3 %) but not significant.

CONCLUSIONS

Preliminary results from FAST-MI in Tunisia show that the pharmaco- invasive strategy should be promoted in non-interventional centers.

Structural basis of pathogen recognition by an integrated HMA domain in a plant NLR immune receptor

Plants have evolved intracellular immune receptors to detect pathogen proteins known as effectors. How these immune receptors detect effectors remains poorly understood. Here we describe the structural basis for direct recognition of AVR-Pik, an effector from the rice blast pathogen, by the rice intracellular NLR immune receptor Pik. AVR-PikD binds a dimer of the Pikp-1 HMA integrated domain with nanomolar affinity. The crystal structure of the Pikp-HMA/AVR-PikD complex enabled design of mutations to alter protein interaction in yeast and in vitro, and perturb effector-mediated response both in a rice cultivar containing Pikp and upon expression of AVR-PikD and Pikp in the model plant Nicotiana benthamiana. These data reveal the molecular details of a recognition event, mediated by a novel integrated domain in an NLR, which initiates a plant immune response and resistance to rice blast disease. Such studies underpin novel opportunities for engineering disease resistance to plant pathogens in staple food crops.

Effector biology of plant-associated organisms: concepts and perspectives

Every plant is closely associated with a variety of living organisms. Therefore, deciphering how plants interact with mutualistic and parasitic organisms is essential for a comprehensive understanding of the biology of plants. The field of plant-biotic interactions has recently coalesced around an integrated model. Major classes of molecular players both from plants and their associated organisms have been revealed. These include cell surface and intracellular immune receptors of plants as well as apoplastic and host-cell-translocated (cytoplasmic) effectors of the invading organism. This article focuses on effectors, molecules secreted by plant-associated organisms that alter plant processes. Effectors have emerged as a central class of molecules in our integrated view of plant-microbe interactions. Their study has significantly contributed to advancing our knowledge of plant hormones, plant development, plant receptors, and epigenetics. Many pathogen effectors are extraordinary examples of biological innovation; they include some of the most remarkable proteins known to function inside plant cells. Here, we review some of the key concepts that have emerged from the study of the effectors of plant-associated organisms. In particular, we focus on how effectors function in plant tissues and discuss future perspectives in the field of effector biology.

[Immediate results of repeat percutaneous mitral valvuloplasty]

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy. However, this technique is costly, is not devoid of complication and success is not guaranteed. Indications of an attempted redo percutaneous mitral valvuloplasty (redo-PMV) are not well established. Hence the idea to study the immediate results of (re-PMV).

PURPOSE OF WORK

The purpose of this study is to evaluate the immediate results of the re-PMV in patients with mitral restenosis and analyze the different clinical and laboratory findings to determine predictors of success of re-PMV to better selection of candidates for a new attempt PMV.

METHODS

Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon succeeding a successful initial procedure, collected in the cardiology department of Habib Thameur hospital of Tunis between 1996 and 2011, in which we identified the data of clinical and paraclinical examinations.

RESULTS

The mean age of patients was 43 ± 11 years [23; 63]. Of the population, 87.5% were female (five men and 35 women). The average time between the two procedures was 8 ± 4 years [1; 15]. The immediate procedural success defined by a mitral valve area greater or equal to 1.5 cm(2) and a grade less than or equal to 2 mitral regurgitation was obtained in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in three patients (7.5%). A cerebrovascular stroke occurred in one patient (2.5%). No death or cardiac tamponade were noted. Class III or IV of NYHA, a pre-procedural MR, pulmonary hypertension and an overall score of Padial greater than 10 were retained as predictors of failure. More the overall score of Wilkins is high (>8), more it is predictive of failure. The two components of the Wilkins score: valvular mobility and subvalvular apparatus (SVA) and the parameter of the redesign of the SVA score of Padial considered separately are also predictive of failure. Only a left atrial area less than or equal to 25 cm(2) was linked to high risk of severe MR.

CONCLUSION

Redo percutaneous mitral valvuloplasty is a therapeutic alternative to surgery that is effective and promising interesting immediate results. Analysis of clinical and mainly echographic parameters is useful for predicting the success of the gesture, which will allow a better selection of candidates for re-PMV.

[Sperm immobilizing effect of leaves extracts of Cestrum parqui]

OBJECTIVE

The leaves extracts of Cestrum parqui were reported to have spermicidal activity. The current investigation identified the spermicidal component of the extracts and evaluated its spermicidal potential in vitro, particularly the effects on sperm motility and vitality.

METHODS

Sperms were prepared by discontinuous buoyant density gradient centrifugation and incubated with varying concentrations of extract from C. parqui (40-250 μg/ml) at 37°C and 5% CO(2). The mode of spermicidal action was evaluated by sperm motility and vitality at different intervals ranging from 5 to 240 minutes. Morphological changes in human spermatozoa after exposure to the extract were evaluated under transmission electron microscope.

RESULTS

A dose- and time-dependent effect of this extract on sperm motility and viability was observed. The mean effective concentration of extracts that induced irreversible immobilization was 250 μg/ml. Transmission electron microscope revealed a significant damage to sperm membrane in head and acrosomal membranes, notable swelling and disruption.

CONCLUSION

Our study indicates that this natural extract has potential spermicidal effect in vitro. It can adequately replace nonoxynol-9 in vaginal contraceptives to make them more vaginally safe and ecofriendly.

Phenotypic Switching Affecting Chemotaxis, Xanthan Production, and Virulence in Xanthomonas campestris

The chemotaxis towards sucrose and yeast extract of nine strains of Xanthomonas campestris representing pathovars campestris, armoraciae, translucens, vesicatoria, and pelargonii was analyzed by using swarm plates. Unexpectedly, each of these strains formed small or reduced swarms typical of nonmotile or nonchemotactic bacteria. With time, however, chemotactic cells appeared on the swarm plates as blebs of bacteria. These cells were strongly chemotactic and were concomitantly deficient in exopolysaccharide production. The switch from the wild type (exopolysaccharide producing and nonchemotactic) to the swarmer type (exopolysaccharide deficient and chemotactic) appeared irreversible ex planta in bacteriological medium. However, in radish leaves swarmer-type strains of X. campestris pv. campestris were able to revert to the wild type. Swarmer-type derivatives of two X. campestris pv. campestris wild-type isolates showed reduced virulence and growth in the host plants cauliflower and radish. However, exocellular complementation of X. campestris pv. campestris Hrp (nonpathogenic) mutant was achieved by coinoculation with a swarmer-type strain.

[Catecholaminergic polymorphic ventricular tachycardia in adult: a case report]

BACKGROUND

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a primary electrical myocardial disease characterized by exercise- and stress-related ventricular lachycardia manifested as syncope and sudden death usually in child and teenager and was rarely described in adults. The management includes betablockade, with the use of implantable cardioverter defibrillators if medical treatment is insufficient.

AIM

Report a new case of CPVT.

OBSERVATION

We report a case of a 43 years old patient in whom CPVT diagnosis was made during his exploration for palpitations occurring with the effort. Registration Holter ECG revealed several episodes of supraventricular tachycardia and episodes of nocturnal sino-atrial block. The patient had an ICD and betablockade treatment.

CONCLUSION

The TVPC in adult can manifest with attenuated symptoms that can be summarized with palpitations with the exertion. The supraventricular arrhythmias and sinus dysfunction may be at the forefront of Electrocardiographic manifestations. The prognosis of this form seems better than the TVPC of the child. Treatment with betablockade appears to be effective but existing dysfunction sinus facilitates decision to implant the ICD.

Systemic Modulation of Gene Expression in Tomato by Trichoderma hamatum 382

ABSTRACT A light sphagnum peat mix inoculated with Trichoderma hamatum 382 consistently provided a significant (P = 0.05) degree of protection against bacterial spot of tomato and its pathogen Xanthomonas euvesicatoria 110c compared with the control peat mix, even though this biocontrol agent did not colonize aboveground plant parts. To gain insight into the mechanism by which T. hamatum 382 induced resistance in tomato, high-density oligonucleotide microarrays were used to determine its effect on the expression pattern of 15,925 genes in leaves just before they were inoculated with the pathogen. T. hamatum 382 consistently modulated the expression of genes in tomato leaves. We identified 45 genes to be differentially expressed across the replicated treatments, and 41 of these genes could be assigned to at least one of seven functional categories. T. hamatum 382-induced genes have functions associated with biotic or abiotic stress, as well as RNA, DNA, and protein metabolism. Four extensin and extensin-like proteins were induced. However, besides pathogenesis-related protein 5, the main markers of systemic acquired resistance were not significantly induced. This work showed that T. hamatum 382 actively induces systemic changes in plant physiology and disease resistance through systemic modulation of the expression of stress and metabolism genes.

[Bacteriological profile of infectious endocarditis in the area of Sfax (Tunisia)]

We performed a study to analyze epidemiological characteristics and bacteriological profile of infectious endocarditis (I.E) in the area of Sfax (Tunisia). We analyzed, retrospectively, all cases of I.E, according to Duke Criteria, hospitalized in the CHU Hédi Chaker of Sfax between January 1997 and December 2000. Bacteriological investigation included blood culture, cardiac valve culture and serology. Seventy-two cases of I.E were diagnosed. The average of age was 32.3 years. 47.3% of the patients did not have cardiac disease, 25% had a valvular prosthesis, 20.8% a native valvulopathy and 6.9% a congenital cardiopathy. Antecedent of acute rheumatic fever was noted in 66% of I.E on native valvulopathy and in 55.5% of I.E on prosthesis. The mitral valve was involved in 39%, the aortic in 27.5% and the two in 26% of the cases. The origin of bacteremia was found or supposed in 55.5% of the cases and was commonly dental (33 % of EI). The bacteriological diagnosis was positive in 51 cases (70.8%). Staphylococci were isolated in 17 cases (23.6%), Streptococci in 17 cases (23.6%) and dominated by oral streptococci (12 cases). Chlamydial serology was positive in 8 cases (11.1%). Diagnosis of infectious endocarditis due to Chlamydia pneumoniae was confirmed in a case by genomic amplification (PCR) and in situ hybridization on the valve. Endocarditis in Tunisia remains frequent. It reaches with predilection the young person in particular with rheumatic heart diseases. The bacteriological profile remains dominated by Streptococci and the Staphylococci.