Prevalence of AmpC, ESBL, and colistin resistance genes in Enterobacterales isolated from ready-to-eat food in Algeria

Antimicrobial resistance among bacteria present in ready-to-eat foods is an emerging concern. Hence, this study investigated the presence of extended-spectrum and AmpC β-lactamases (ESBL/AmpC)-producing Enterobacterales (ESBL-E) and the dissemination of mcr-1 in ESBL-E from ready-to-eat food samples (RTE) in Algeria. RTE food samples (n = 204) were aseptically collected and selectively cultured using MacConkey agar. The isolates were screened for ESBL production using the DDST test, confirmed ESBL-E isolates were identified using different conventional methods and MALDI-TOF MS, antibiotic susceptibility was determined using the disc diffusion and broth microdilution assay, ESBL-E isolates were analyzed for colistin and ESBL/AmpC encoding genes by PCR, and food samples were analyzed by univariate and multiple logistic regression. Overall, 48 (17.4%) of the 276 Enterobacterales were confirmed as ESBL producers, with a high prevalence in soups (40%), salads (25%), and cream-filled pastries (23.8%). Antibiotic susceptibility testing revealed that all the ESBL-E isolates were found multi-drug resistant. PCR revealed that blaTEM, blaCTX-M, blaCMY-2, blaOXA-1, and blaSHV were the most frequently detected. blaCTX-M-9 and blaCTX-M-1 were the predominant CTX-M types. Furthermore, four isolates were positive for mcr-1; three of them harbored the colistin resistance gene and ESBL/AmpC genes (2 E. cloacae and 1 S. enterica). To the best of our knowledge, this is the first report that detects the presence of the mcr-1 gene in ESBL-E strains isolated from RTE foods in Algeria. These findings suggest an urgent need for strict policies that prevent the spread and transmission of ESBL-E in food.

Individual factors associated with workaholism among Tunisian engineers

Introduction

Globalization and increased competition in the engineering profession induce to work longer and harder, which predisposes to workaholism or work addiction. Identifying individual factors associated with workaholism could help to maintain the mental health at work.

Objectives

The aim of this study was to assess the prevalence of workaholism and its associated socio-demographic and historic factors among Tunisian engineers.

Methods

A cross-sectional descriptive and analytical study conducted among Tunisian engineers during July 2021. The data were collected by an online questionnaire including the socio-demographic and historic information and the “the Work Addiction Risk Test” (WART) which was used to assess the workaholism.

Results

A total of 52 engineers participated in this study (40.4% female and 59.6% male). The average age was 30.75 years (SD=6.25 years). Concerning marital status, thirty-five engineers (67.3%) were single. Of the participants, 17.3% had a history of chronic somatic-disorders and 25 % of them had a history of a psychiatric disorder, such as depressive disorder in 11.5% of cases. The prevalence of workaholism in Tunisian engineers was 23.1%. Workaholism was associated to older age with no significant difference (p = 0.11). The analysis showed that workaholics had more history of depressive disorder (p = 0.02) compared to non-workaholics. However, no significant difference was found by the other socio-demographic factors according to workaholism.

Conclusions

Workaholism is a significant phenomenon among Tunisian engineers. It may depend of personal characteristics and induce negative consequences on mental health and lead to depression.

Disclosure

No significant relationships.

Working memory performance in euthymic bipolar patients

Introduction

Working memory (WM) deficit in bipolar disorder (BD) is heterogeneous and seems to be affected by both, demographic and clinical aspects, of the patient.

Objectives

To assess the WM performance in euthymic bipolar patients (BP) comparing to healthy controls (HC) and to identify demographic and clinical factors associated with it.

Methods

A case-control study was conducted among euthymic bipolar patients according to DSM-5. The recruitment of patients was performed in the outpatient psychiatric unit in the university hospital Hedi Chaker in Sfax during the period from January to December 2020. The HC were matched to BP on gender, age and education level. The Screening for Cognitive Impairment in Psychiatry scale (SCIP) was used to assess the WM performance by the WM test (WMT).

Results

We recruited 61 BP (37 males and 24 females) and 40 HC (20 males and 20 females). The average age of BP was 41.75 years (SD=11.6 years). The BD group included 47 BD type I and 14 BD type II patients. The mean duration of illness was 9.75 years (SD=7.93 years). Thirty-seven BP (60.7%) had a history of psychotic symptoms. The WMT score was significantly lower among BP than HC (p<0,001). The female gender, the type II of BD and the history of psychotic symptoms correlated with a poorer performance on WMT (p=0.019; 0.017 and 0.002, respectively).

Conclusions

BP have shown significant impaired performance in WM even during euthymia. Female gender of patient, type II of BD and psychotic symptoms seem to be the predictors of this impairment.

Disclosure

No significant relationships.

cognitive complaints in schizophrenia: characteristics and relationship with insight

Introduction

Patients with schizophrenia suffer from cognitive difficulties expressed in the form of complaints as well as poor insight. The interaction of these two factors makes the management of these patients more difficult.

Objectives

To assess subjective cognitive complaints in a population of schizophrenics and study its relationship to insight.

Methods

Our study was a cross-sectional, descriptive, and analytical study of 72 stabilized schizophrenics followed up at the outpatient clinic. Subjective cognitive complaints were assessed by the SSTICS, clinical symptoms by the PANSS, and insight by the SAI-E.

Results

The mean age of our population was 46.83± 11.6 years. The patients had a low socio-economic level in 70.1%. They were unemployed in 46.9% , consumed alcohol in 23.6%, and consumed tobacco in 58,6% of the cases. the total score on the PANSS scale was 46. They had an average score of 25 on the total SSTICS score and 20,1 on the SAI-E. Cognitive complaint scores were significantly correlated with improved insight (p=0,00),low socio-economic level (p=0.04),alcoholism (p=0.001) and smoking (p=0.01)

Conclusions

Cognitive complaints in schizophrenia could be influenced by the level of clinical insight and reflect a deep malaise, requiring a more targeted and optimized management

Disclosure

No significant relationships.

Professional factors supporting workaholism among Tunisian engineers

Introduction

Workaholism or work addiction is a growing public health that may induce negative consequences on professional life. Engineers are at risk given the globalization and increased competition in their jobs.

Objectives

The aim of the study was to assess the different professional factors that promote wokaholism among Tunisian engineers.

Methods

A cross-sectional descriptive and analytical study conducted among Tunisian engineers during July 2021. The data were collected by an online questionnaire including the socio-demographic and professional information and the “the Work Addiction Risk Test” (WART) which was used to assess the workaholism.

Results

Participants were 52 engineers (31 males and 21 females), and aged from 23 to 55 years old (average age 30.75 years). Thirty-five engineers (67.3%) were single. Concerning professional data, 30.8% of engineers worked in the public and 51.9% of them were computer engineers. Of the participants, 11.7% worked more than 12 hours, 61.5% worked overtime and 92.3% had weekly rest. The prevalence of workaholism in Tunisian engineers was 23.1%. Engineers working in the public sector and working more than 12 hours had significantly higher proportion of work addiction with p <0.001 and p = 0.01, respectively. However, no significant difference was found by specialty, working overtime and having weekly rest according to workaholism.

Conclusions

In our study, we found that the public work sector and extended working hours promote work addiction. Addressing supporting factors in the work environment and periodic examination of the engineers and responding accordingly is required.

Disclosure

No significant relationships.

Perfectionism in academic settings and relationship to depression and socio-demographic characteristics

Introduction

Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we present the case of this patient.

Objectives

To assess perfectionism and depression and to study the relationship between these two parameters in a population of medical students.

Methods

We conducted a descriptive and analytical cross-sectional study among students of the Faculty of Medicine of Sfax during the months of June, July, and August 2020. The data were collected through a self-questionnaire disseminated on the social network “Facebook”.This questionnaire included identification of socio-demographic characteristics as well as the personal history of students. Perfectionism was assessed by the Rheaume scale and depression by the Beck scale.

Results

A total of 206 students participated in the survey. The mean age was 21.49 ± 1.37 years. The majority of students were female (57.2%) with a sex ratio (F/H) of 1.34. Of the participants, 39.8% were enrolled as undergraduates and 60.19% as graduate students. According to their scores on the Rheaume scale, the students were non-perfectionists (NP) in 21.4% of cases; moderately perfectionists (MP) in 70.38% of cases, and highly perfectionists (HP) in 8.25% of cases. Severe depression was objectified in 7.3% of the cases. Students living alone were less perfectionist (p=0.01). Perfectionism score was higher in depressed students (35 ± 6.34) versus (31.428 ± 6.37) with a statistically significant correlation ( p ≤ 0.001).

Conclusions

It is true that perfectionism is an essential element for academic success. However, screening and prevention of depression are deemed necessary given its significant association with perfectionism.

Disclosure

No significant relationships.

Anxiety among healthcare professionals during the COVID-19 pandemic: Predictive role of social support

Introduction

The COVID-19 pandemic may cause elevated levels of anxiety in healthcare professionals (HCP). Identifying factors that could help maintain mental health especially social support could be helpful in facing this stressful situation.

Objectives

The aim of this study was to asses the relationship between the trait-anxiety and perceived social support among Tunisian HCP in the current pandemic wave of COVID-19.

Methods

A cross- sectional descriptive and analytic study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire. The trait-anxiety was assessed using the “General Anxiety questionnaire of Spielberger” (STAI-Y-B). We used the “Social Support Questionnaire” to measure availability and satisfaction regarding perceived social support.

Results

Participants were 135 HCP, and aged from 24 to 61 years old (average age 31.98 years). The sex ratio was 1.1 (71 males and 64 females). Of HCP involved in the study, 61.5% were single, 36.3% were married and 2.2% were divorced. The average scores of availability and satisfaction regarding perceived social were 7.79 (SD=3.56) and 28.41 (SD=6.75), respectively. Seventy-two of the HCP had a trait-anxious. Analysis showed that social support satisfaction scores were significantly lower in trait-anxious HCP (p<0.001). However, there was no significant difference in the score of availability according to trait-anxiety (p=0.49).

Conclusions

Our study highlighted the existence of a deficit on perceived social support satisfaction among trait-anxious Tunisian HCP. Perceived social support as a determinant of trait anxiety should be the focus of social work in this period.

Disclosure

No significant relationships.

Trait-anxiety among healthcare professionals in COVID-19 pandemic

Introduction

Factors causing anxiety among healthcare professionals (HCP) are increasing, and psychosocial causes are the most common. During the COVID-19 pandemic, HCP are exposed to additional stressful factors.

Objectives

The aim of this study was to assess the prevalence of trait-anxiety and its associated factors towards the COVID-19 outbreak among Tunisian HCP.

Methods

A cross-sectional descriptive and analytical study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire including the sociodemographic information and the “General anxiety questionnaire of Spielberger” (STAI-Y-B) which was used to assess the trait-anxiety.

Results

A total of 135 HCP participated in this study (47.4% female and 52.6% male). The average age was 31.98 years (SD=6.59). Of the participants, 3% were nurses, 8.1% were interns, 48.1% were residents, 34.8% were specialist doctors and 5.9% were generalist doctors. Concerning marital status, 61.5% were single, 36.3% were married and 2.2% were divorced. Of HCP involved in the study, 13.3% of the participants had a history of chronic somatic-disorder and 11.9 % of them had a history of a psychiatric disorder. The prevalence of trait-anxiety in HCP was 53.3%. The analysis showed that anxious HCP were more younger (p=0.002) and had history of a psychiatric disorder (p=0.017) compared to non-anxious HCP. However, no significant difference was found by gender, marital status and professional degree according to trait-anxiety.

Conclusions

In our study, we found that more than the half of HCP were anxious and these one were more younger and had history of psychiatric disorders.

Disclosure

No significant relationships.

Trait anxiety and coping strategies among healthcare professionals during the COVID-19 pandemic

Introduction

The current pandemic wave of COVID-19 has become a global threat. Healthcare professionals (HCP), by being on the front line in managing this pandemic, confronted high levels of stress and traumatic experiences.

Objectives

The aims of our study were to evaluate the trait-anxiety among Tunisian HCP and its impact on coping strategies.

Methods

A cross- sectional descriptive and analytic study conducted among Tunisian HCP during November and December 2020. The data was collected by an online questionnaire distributed through social media. The trait-anxiety was assessed using the “General Anxiety questionnaire of Spielberger” (STAI-Y-B) and the “Ways of coping checklist revised (WCC-R) questionnaire” identified three types of coping (problem-focused, emotion-focused and social-support seeking).

Results

Participants were 135 HCP (71 males and 64 females) and aged from 24 to 61 years old (average age 31.98 years; SD 6.59 years). Of HCP involved in the study, 61.5% were single, 36.3% were married and 2.2% were divorced. Seventy-two of them had a trait-anxious. As a coping style, 85.2% of participants used problem-focused style, 88.9% of them used emotion-focused style and 63% of them used social support seeking style. The analysis of WCC-R showed that anxious HCP used emotion-focused coping more than non anxious HCP (p= 0.028). However, there was no significant difference in problem-focused or social support seeking coping styles and presence of trait-anxiety.

Conclusions

In our study, we find that the most anxious Tunisian HCP focused on emotions strategies. Personality traits play on attitudes of coping strategies.

Disclosure

No significant relationships.

Non-compliance with IDSA guidelines for patients presenting with methicillin-susceptible Staphylococcus aureus prosthetic joint infection is a risk factor for treatment failure

OBJECTIVE

The long-term impact of treatment strategies proposed by the IDSA guidelines for patients presenting with methicillin-susceptible S. aureus (MSSA) prosthetic joint infection (PJI) is not well-known.

PATIENTS AND METHODS

Retrospective (2000-2010) cohort study including patients presenting with MSSA hip or knee PJI. A univariate Cox analysis was performed to determine if the non-compliance with IDSA surgical guidelines was a risk factor for treatment failure.

RESULTS

Eighty-nine patients with a mean follow-up of 2.8 years were included. Non-compliance with IDSA surgical guidelines was associated with treatment failure (hazard ratio 2.157; 95% CI [1.022-4.7]). The American Society of Anesthesiologists score, inadequate antimicrobial therapy, and a rifampicin-based regimen did not significantly influence patient outcome.

CONCLUSION

Based on the IDSA guidelines, if a patient presenting with MSSA PJI is not eligible for implant retention, complete implant removal is needed to limit treatment failure.

Antimicrobial activity and bioguided fractionation of Rumex tingitanus extracts for meat preservation

This study was undertaken to investigate the antibacterial and antifungal activities of Rumex tingitanus leaves extracts as well as the identification of bioactive components and their performance in meat preservation. Total phenolics and flavonoids showed the highest content of phenolics and flavonoids in the ethyl acetate fraction (Rt EtOAcF). For antimicrobial efficacy, leaves extract and derived fraction were tested for their capacity to inhibit bacterial and fungal proliferation in vitro and in vivo. The ethyl acetate fraction showed the most potent antibacterial and antifungal activities compared to the others extracts. Thus, the efficacy of this extract to inhibit the proliferation of Listeria monocytogenes in minced beef meat model was examined. This fraction eradicates the L. monocytogenes population in meat in a concentration- and time-dependent manner. A bio-guided purification of the Rt EtOAc fraction resulted in the isolation of the compound responsible for the observed antimicrobial activity. This compound was identified as luteolin by analysis of spectroscopic data.

CHEMICAL COMPOUNDS ISOLATED IN THIS ARTICLE

Luteolin (PubChem CID: 5280445); p-iodonitrotetrazolium chloride (PubChem CID: 64957); Amphotericin B (PubChem CID: 5280965); Gentamicin and (PubChem CID: 6419933); Hexane (PubChem CID: 8058); Methanol (PubChem CID: 887); Ethanol (PubChem CID: 702); Dimethylsulfoxide (PubChem CID: 679); Quercetin (PubChem CID: 5280343); Gallic acid (PubChem CID: 370).

Development of recombinant stable house dust mite allergen Der p 3 molecules for component-resolved diagnosis and specific immunotherapy

BACKGROUND

The allergen Der p 3 is underrepresented in house dust mite (HDM) extracts probably due to autolysis. Recombinant stable molecule of the allergen is thus needed to improve the diagnosis of allergy and the safety and efficacy of immunotherapy.

OBJECTIVE

The current study reports the immunological characterization of two recombinant molecules of the HDM allergen Der p 3 as useful tools for diagnosis and immunotherapy.

METHODS

Recombinant mature (rDer p 3) and immature (proDer p 3) Der p 3 and their corresponding S196A mutants were produced in Pichia pastoris and purified. The stability, IgE-binding capacity and allergenicity of the different proteins were analysed and compared with those of the major mite allergen Der p 1 used as a reference. Additionally, the immunogenicity of the different allergens was evaluated in a murine model of Der p 3 sensitization.

RESULTS

Compared to the IgE reactivity to recombinant and natural Der p 3 (nDer p 3), the mean IgE binding of patient's sera to rDer p 3-S196A (50%) was higher. The poorly binding to nDer p 3 or rDer p 3 was due to autolysis of the allergen. Contrary to Der p 3, proDer p 3 displayed very weak IgE reactivity, as measured by sandwich ELISA and competitive inhibition, rat basophil leukaemia degranulation and human basophil activation assays. Moreover, proDer p 3 induced a TH 1-biased immune response that prevented allergic response in mice but retained Der p 3-specific T-cell reactivity.

CONCLUSION

rDer p 3-S196A should be used for the diagnosis of HDM allergy elicited by Der p 3, and proDer p 3 may represent a hypoallergen of Der p 3.

Protective effects of Hammada scoparia flavonoid-enriched fraction on liver injury induced by warm ischemia/reperfusion

CONTEXT

Hepatic ischemia/reperfusion injury (IRI) is a major cause of liver damage during liver surgery and transplantation. Plants have historically been used in treating liver damage, and Hammada scoparia (Pomel) (Chenopodiaceae) has been reported to possess a broad spectrum of pharmacological and therapeutic activities.

OBJECTIVE

In this study, a flavonoid-enriched fraction was used before the warm ischemia (WI) process as pharmacological preconditioning and in combination with technical postconditioning to evaluate their protective effects.

MATERIALS AND METHODS

The rats were divided into five groups: a sham group; a control group (Control-IR) that was submitted to 60 min WI; a Pharmacological Preconditioning group (PreC-IR) that received flavonoid-enriched fraction (200 mg/kg body weight); a Postconditioning group (PostC) and a PreC + PostC group.

RESULTS

The use of the flavonoid-enriched fraction was noted to significantly (p < 0.05) reduce liver injury, as evidenced by the decrease in liver transaminase activities (AST and ALT) and lactic dehydrogenase (LDH), alkaline phosphatase (ALP), and lipid peroxidation (TBARS), levels as well as the enhancement of antioxidant enzymes (catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx)) responses. The results also indicated that, compared with the separate application of pharmacological preconditioning and postconditioning, the combination of both treatments was more effective in reducing tissue oxidative stress levels through modulating SOD, GSH-PX, and CAT activities. Furthermore, the combined protocol further decreased the liver morphological score compared with solo treatment.

DISCUSSION AND CONCLUSION

Overall, the results indicate that the H. scoparia flavonoid-enriched fraction could be a promising candidate for future application as a pharmacological preconditioning agent against hepatic IRI.

Delta-toxin production deficiency in Staphylococcus aureus: a diagnostic marker of bone and joint infection chronicity linked with osteoblast invasion and biofilm formation

Biofilm formation, intra-osteoblastic persistence, small-colony variants (SCVs) and the dysregulation of agr, the major virulence regulon, are possibly involved in staphylococcal bone and joint infection (BJI) pathogenesis. We aimed to investigate the contributions of these mechanisms among a collection of 95 Staphylococcus aureus clinical isolates from 64 acute (67.4%) and 31 chronic (32.6%) first episodes of BJI. The included isolates were compared for internalization rate, cell damage and SCV intracellular emergence using an ex vivo model of human osteoblast infection. Biofilm formation was assessed in a microbead immobilization assay (BioFilm Ring test). Virulence gene profiles were assessed by DNA microarray. Seventeen different clonal complexes were identified among the screened collection. The staphylococcal internalization rate in osteoblasts was significantly higher for chronic than acute BJI isolates, regardless of the genetic background. Conversely, no differences regarding cytotoxicity, SCV emergence, biofilm formation and virulence gene distribution were observed. Additionally, agr dysfunction, detected by the lack of delta-toxin production using whole-cell matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) analysis (n = 15; 15.8%), was significantly associated with BJI chronicity, osteoblast invasion and biofilm formation. These findings provide new insights into MSSA BJI pathogenesis, suggesting the correlation between chronicity and staphylococcal osteoblast invasion. This adaptive mechanism, along with biofilm formation, is associated with agr dysfunction, which can be routinely assessed by delta-toxin detection using MALDI-TOF spectrum analysis, possibly providing clinicians with a diagnostic marker of BJI chronicity at the time of diagnosis.

Management of emerging multidrug-resistant tuberculosis in a low-prevalence setting

Multidrug-resistant (MDR) tuberculosis (TB) is an emerging concern in communities with a low TB prevalence and a high standard of public health. Twenty-three consecutive adult MDR TB patients who were treated at our institution between 2007 and 2013 were reviewed for demographic characteristics and anti-TB treatment management, which included surgical procedures and long-term patient follow-up. This report of our experience emphasizes the need for an individualized approach as MDR TB brings mycobacterial disease management to a higher level of expertise, and for a balance to be found between international current guidelines and patient-tailored treatment strategies.

SimPhy: a simulation game to lessen the impact of phytosanitaries on health and the environment--the case of Merja Zerga in Morocco

Diffuse phytosanitary pollution is a complex phenomenon to manage. Reducing this type of pollution is one of today's key socio-economic and environmental challenges. At the regional level, few approaches enable the actors concerned to implement agricultural management strategies to reduce the use and impact of phytosanitary products. Our research problem focused on the consequences of intensive agriculture and, in particular, how to evaluate the impact of phytosanitary products on human health and the environment. In this article, we present the SimPhy simulation game which places the actors from a given region directly into a situation in which they manage farms whilst under pressure to reduce phytosanitaries (quantity and toxicity). The application focused on the Merja Zerga catchment area in Morocco. The region is dominated by intensive agriculture which is located upstream from a Ramsar-classified wetland area. The SimPhy simulation game is based on a decision support system-type tool. It allows us to anticipate the impact of regulations on farming systems. It also enables us to analyse the consequences of the actors' strategies on farm economies, human health and the quality of ecosystems. Initial results from the SimPhy simulation game enabled the technicians from Agricultural Development Center (CDA) themselves to learn about managing agricultural production systems in a dynamic and interactive fashion. With the simulation game, it was possible to learn about the farmer's ability to adapt to new regulatory constraints, and the involved consequences for toxicity risks for human health and the environment.

Oral involvement in sarcoidosis: report of 12 cases

AIM

To assess the clinical features, treatment and outcome of oral sarcoidosis and to determine whether oral involvement is associated with a particular clinical phenotype of sarcoidosis.

DESIGN

Multicentric retrospective study.

METHODS

Retrospective chart review. Each patient was matched with four controls.

RESULTS

Twelve patients (9 women, 3 men) were identified. Their median age at sarcoidosis diagnosis was 38 years. Oral involvement was the first clinical evidence of sarcoidosis in seven cases and was a relapse symptom in five cases. Clinical presentations were nodules (n = 7) or ulcers (n = 5) and were mostly solitary. The tongue was the commonest site affected (n = 4), followed by lips (n = 3), oral mucosa (n = 2), palate (n = 2) and gingiva (n = 1). Patients with oral sarcoidosis were significantly younger and had more frequent lacrimal or salivary glands and upper airway tract clinical involvement than the controls; increased angiotensin-converting enzyme was less frequent in oral sarcoidosis. Multiple treatments of oral sarcoidosis were used: no treatment (n = 3), surgery (n = 2), corticosteroids (n = 7), hydroxychloroquine (n = 3), methotrexate (n = 2), doxycycline (n = 1). Methotrexate was efficient in one patient, hydroxychloroquine showed benefit in only 1 out of 3 patients. Three patients presented oral relapses. After a mean follow-up of 6 years, 10 patients experienced a complete (n = 7) or partial (n = 3) remission of oral sarcoidosis; stability was observed in the remaining two cases.

CONCLUSION

Although oral manifestations of sarcoidosis are unusual, physicians should be aware that this specific localization is frequently the first manifestation of the disease. Treatment modalities range from observation in asymptomatic patients to immunosuppressants for severe involvement.

Golimumab and immunogenicity? 2010 and beyond

Immunogenicity is a frequent adverse event observed with biological agents' therapy. Challenges of management in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis treated with golimumab, an anti-TNF-alpha blocker, include limited generation of antibodies like anti-nuclear, anti-golimumab, and anti-double stranded DNA antibodies. We conducted here a meta-analysis study in order to evaluate and compare the newly generated antibody levels after golimumab therapy. The examination of original clinical trials revealed that their levels were neither higher nor significant. Moreover, no evident associations between the induced-antibodies and lupus-like syndromes and/or infusion site reaction were reported. The reduced patients cohort and the absence of systematic newly generated antibodies follow-up might be implicated in the difficulty to evaluate their risk in delaying diseases therapy, and/or predicting for their worse prognosis. Hence, further studies are required to ascertain the real impact of the induced antibodies after golimumab's therapy.

[Necrotic lesions of the face in Kawasaki disease]

Kawasaki disease (KD) is a multisystemic vasculitis disorder in children. The dermatological manifestations are described as polymorphic and nonspecific. However, they are important for diagnosis. They correspond to 3 out of the 5 major criteria that may be associated with the disease's constant fever. We report the case of a child aged 3 years 8 months who showed necrotic lesions on the cheeks and the nose, associated with an erythematous, macular eruption on the rest of the body. Necrotic lesions have been exceptionally reported. These misleading cutaneous aspects should not delay or rule out the diagnosis of KD, especially in atypical or incomplete forms. Early diagnosis of KD should be made before the onset of coronary lesions.

Golimumab therapy of rheumatoid arthritis: an overview

Golimumab is a new approved humanized antibody for the treatment of rheumatoid arthritis (RA). This antibody belonging to biologic agents is raised against the pro-inflammatory cytokine tumour necrosis factor-alpha playing an essential role in the initiation of RA. To date, Golimumab administration for patients with RA, as indicated by USA Food and Drug Administration, is subcutaneous combined with methotrexate (MTX). Here, we have reviewed current literature with a focus on characteristics of Golimumab and also have exposed the clinical trials either using MTX or not using MTX. We have also highlighted the incoming clinical trials on Golimumab and have proposed some indications for the future studies based on a setting of clinical data and post-marketing observational studies. These studies will advance rheumatologists' decisions in the beginning of RA therapeutic interventions to insure the best outcomes for patients with RA and to improve their quality of life.

N-(Hydroxymethyl)ibogaine

THE TITLE COMPOUND (SYSTEMATIC NAME

16-hydroxy-methyl-12-methoxy-ibogamine), C(21)H(28)N(2)O(2), was prepared by reaction of ibogaine with a formaldehyde-acetic acid solution (pH = 4). The crystal structure of this new product, belonging to the iboga indole family, is stabilized by an inter-molecular O-H⋯N hydrogen bond. The identity of the compound was confirmed by one- and two-dimensional NMR spectroscopic techniques.

N-Methyl-isosalsoline from Hammada scoparia

THE TITLE COMPOUND (SYSTEMATIC NAME

1,2-dimethyl-6-meth-oxy-1,2,3,4-tetra-hydro-isoquinolin-7-ol), C(12)H(17)NO(2), is a major alkaloid isolated from Hammada scoparia leaves. It belongs to the isoquinoline family and it was characterized by NMR spectroscopy and X-ray crystallographic techniques. The absolute configuration could not be reliably determined. An intermolecular O-H⋯N hydrogen bond is present in the crystal structure.

Laboratory evaluation of Bacillus thuringiensis (Vectobac WDG) against mosquito larvae, Culex pipiens and Culiseta longiareolata

Mosquitoes are vectors of many human diseases and cause environmental nuisances. Due to their Large geographical distribution and abundance, Culex pipiens and Culiseta longiareolata represent the most important mosquito species in ALgeria and many countries in the world. They are generally controlled by conventional insecticides. The high reproductive ability and development of insecticide resistance of mosquito species are Leading to a search for novel molecules. As so, Vectobac that is based on the insecticidal toxins of Bacillus thuringiensis isroelensis (Bti), may provide economical control of mosquito larvae. In this study, we tested the activity of Vectobac (WDG) at different concentrations, ranging between 2 and 30 microg/L, against the different Larval stages (L1-L4) of Cx. pipiens and C. longiareolata. Bioassays were done on newly moulted Larvae under Laboratory conditions according to the guidelines of WHO. In Cx. pipiens, mortality was scored already after 24 h, and in addition developmental effects were observed like inhibition of growth with incomplete moulting and failure of adult emergence. From a dose-response curve LC50 were calculated: 9.22 microg/L for L1 and 35.33 microg/L for L4. For C. longiareolata, the respective LC50's were 6.05 microg/L and 23 microg/L for L1 and L4. The results are discussed in relation to the susceptibility of the two mosquito species tested, lethaL doses, direct toxicity, and effects on growth and development.

Cinnamtannin B-1 from bay wood exhibits antiapoptotic effects in human platelets

Proanthocyanidins, such as cinnamtannin B-1, are polyphenolic compounds with antioxidant activity that induce apoptosis in a number of tumoral cells. We have now investigated the pro- or anti-apoptotic effects of cinnamtannin B-1 in human platelets. Platelet stimulation with thrombin induced cellular apoptosis, as detected by phosphatidylserine exposure and the activation of caspases-3 and -9. Pretreatment for 30 min with cinnamtannin B-1 impaired thrombin-induced apoptosis in platelets. Thrombin has been shown to induce H(2)O(2) generation in platelets, which induced similar apoptotic events than thrombin in these cells. Pretreatment with cinnamtannin B-1 reduced H(2)O(2)-induced phosphatidylserine exposure and caspase activation. Finally, platelet stimulation with thrombin induced translocation of caspases-3 and -9 to the cytoskeletal (Triton-insoluble) fraction, which is important for their activation and the development of apoptotic events. Pretreatment with cinnamtannin B-1 impaired translocation of caspases-3 and -9 to the cytoskeleton and, as a result, procaspases are accumulated in the Triton-soluble fraction. Our results provide evidence for the antiapoptotic actions of cinnamtannin B-1 in human platelets.

Cinnamtannin B-1 from bay wood reduces abnormal intracellular Ca2+ homeostasis and platelet hyperaggregability in type 2 diabetes mellitus patients

Type 2 diabetes mellitus induces a number of cardiovascular disorders, including platelet hyperactivity and hyperaggregability, which is associated to an increased oxidant production and abnormal cytosolic Ca2+ mobilization. In the present study, we have investigated the effect of cinnamtannin B-1 obtained from bay wood on oxidants production, Ca2+ mobilization and aggregation in platelets from type 2 diabetic donors. Pretreatment of platelets with cinnamtannin B-1 reversed the enhanced oxidants production and Ca2+ mobilization, including Ca2+ entry, evoked by thapsigargin plus ionomycin or thrombin, observed in platelets from diabetic subjects, so that in the presence of cinnamtannin B-1 Ca2+ entry was similar in platelets from healthy and diabetic subjects. In addition, cinnamtannin B-1 reduced thrombin-induced aggregation in platelets from type 2 diabetic subjects. We conclude that cinnamtannin B-1 exerts an effective antioxidant action in platelets from patients with type 2 diabetes mellitus and reverses the enhanced Ca2+ mobilization and hyperaggregability.

Insecticidal activity of a nonsteroidal moulting hormone agonist on mosquito larvae and effects on ecdysteroid amounts

The secondary effects of conventional insecticides on the environment, vertebrates and beneficial organisms have caused a move to the use of more target-specific chemicals such as insect growth regulators. Halofenozide (RH-0345) is a novel nonsteroidal ecdysteroid agonist that induces a precocious and incomplete moult in several insect orders. In the present study, the insecticidal activity of a commercial formulation of halofenozide (23% EC) was evaluated at different concentrations ranging between 8 and 32 micrograms/l. Treatment was made on newly moulted fourth-instar larvae of the mosquito, Culex pipiens (Diptera: Culicidae), and mortality was scored until adult emergence. Results showed that death in the larval stage was relatively important. Moreover, treatment caused a significant reduction in the length of the larval and pupal stage. In a second series of experiments, halofenozide was tested at two doses (LC50 = 12.58 micrograms/l and LC90 = 28.58 micrograms/l) and the ecdysteroid amounts during the fourth instar were evaluated in an enzyme immunoassay. We noted that halofenozide did not shifted the moment of the single larval ecdysteroid peak, but it caused an increase of the titre values. Finally, the compound at the highest concentration was found to increase significantly the cuticle thickness recorded at day 4 following treatment.

[Tuberculosis in hemodialysis patients in Tunisia]

BACKGROUND

Because of the immunity depression, patients with chronic renal failure undergoing haemodialysis are at increased risk for developing infections, Mycobacterium tuberculosis (MTb) in particular.

OBJECTIVE

To evaluate, in a prospective longitudinal study over 36 months period, the frequency of Tb among these patients and underline the diagnostic difficulties.

PATIENTS AND METHODS

Sixty dialysis patients were interested. The Tb assessment comprised: a questionnaire, a meticulous clinical examination, a chest X-ray, a tuberculin skin testing, as well as MT bacilli screening in biological fluids.

RESULTS

Tb was seen in six among dialysis patients(10%), this rate represents 15 times the general population tuberculosis incidence in our country (23/100,000). Tb has occurred early compared to the beginning of the haemodialysis. The Tb localizations were: 4 cases of extra-pulmonary tuberculosis (3 peritoneal and one ganglionic) and only 2 cases of pleuro-pulmonary localization. The positive diagnosis represents a real problem: no bacteriological confirmation in all patients and only in one, the histological diagnosis was obtained.

CONCLUSION

There was a high rate of tuberculosis in our study. The prognosis appears to be closely related to therapeutic precocity, thus specific chemotherapy started sometimes without diagnostic confirmation.

Direct physical factors and PGI2 and TXA2 secretions by a human endothelial cell line: in vitro investigation of pressure and shear stress applied independently or in synergy

The direct effect of two types of mechanical stress was measured through the prostacyclin (PGI2) and thromboxane A2 (TXA2) secretions by a confluent monolayer of cells from the EA.hy926 line. Eight values of constant pressure were applied in the gas phase above the culture medium, around atmospheric pressure taken as a control (0 mm Hg), from -500 to +760 mm Hg. Three amplitudes of sinewave modulated pressure (+/- 40; +/- 80; +/- 160 mm Hg) were explored at a frequency of 1 Hz. Modulated pressure (+/- 40 mm Hg) was also applied synergetically to a shear stress generated under steady state conditions by a rectilinear laminar motion of the medium. The cells remained adherent and exhibited unchanged morphology and viability. Constant pressure or depressure increased both PGI2 and TXA2 release but to an extent depending on the pressure value. Under pressure, the PGI2/TXA2 ratio was unchanged, but was higher under depressure, compared to the control. Pressure modulation strongly stimulated the secretion of PGI2 but had no effect on TXA2. Modulation strongly increased the PGI2/TXA2 ratio to a similar extent for the three amplitudes. Pressure-shear synergy enhanced secretion of PGI2 markedly more than shear stress alone, but the level reached was similar to the one induced by pressure modulation. No cumulative effect on the secretion of PGI2 was observed, whereas TXA2 synthesis undergoes a more than cumulative effect. The PGI2/TXA2 ratio remained unchanged under shear alone or under combined shear-pressure modulation but was higher with the modulated pressure alone. These results demonstrate that pressure has an outstanding effect on secretion that may be origin to local disturbances of the vascular system, thus inducing pathologies such as thrombosis or atherosclerosis.

Influence of a constant or a modulated pressure on insulin secretion by intact murine islets of Langerhans: existence of a threshold effect

Pressure effect on cultured islets was investigated to simulate the behavior of the endocrine pancreas when subjected to an anatomical change in its environment. Insulin secretion from islets seeded on glass was determined by radioimmunoassays after 12-h exposure to constant or sine-wave pressure perturbation, at 37 degrees C and pH 7.4, under well-defined conditions applied through the culture medium. A specially devised setup allowed control of the constant component Po, the amplitude A, and the frequency f of the pressure perturbation. Under constant conditions, three Po values (760, 760 + 110, 760 + 250 mm Hg) were explored. Under sine-wave conditions, two frequencies (f = 0.2 and 4.33 Hz) were investigated for Po = 760 + 110 mm Hg and A = 10 mm Hg, as well as three amplitude values (A = +/-10, +/-50, and +/-110 mm Hg) for Po = 760 mm Hg and f = 0.2 Hz. Constant pressure inhibits secretion, by a factor of up to 60%, as well as low frequency (also by approximately 60%). Low amplitudes enhance secretion (by 41 and 31%), whereas a higher amplitude has a marked inhibiting effect (by 70%). In all cases, no linearity was observed, showing the existence of a threshold pressure effect. These results suggest that pressure may be an important parameter in certain forms of endocrine pancreatic dysfunctions.

Vascular endothelial cell responses to different electrically charged poly(vinylidene fluoride) supports under static and oscillating flow conditions

We investigated the effect of electrically charged surface copolymers on endothelialization of four types of poly(vinylidene fluoride) (PVDF) copolymer surface films with different electrical characteristics. PVDF films without a surface charge, with a remanent surface (5 and 7 microC) and with piezoelectric characteristics were studied through the secretion by an endothelial cell (EC) line culture, under static and oscillating flow conditions of prostacyclin (PGI2) and thromboxane (TXA2), two metabolites which have directly opposing actions on platelet function. The surface electrical properties of PVDF are suitable for promoting cell adhesion. Secretion of thrombomodulatory mediators varied, depending on the surface electrical charge and on the molecular structure of the PVDF substrate. Under static conditions the ECs respond to the substrates by a similar increase of PGI2. Under oscillating flow conditions, the ratio of PGI2 to TXA2 is higher with the piezoelectric PVDF film. The piezoelectricity generated from shear stress along the entire length of the fibres may be appropriate in vivo to keep the [PGI2]/[TXA2] ratio at a level which could counteract the build-up of surface deposits which could be at the origin of thrombosis.

Morphological aspects of endothelial cells cultured in the absence of fetal calf serum under controlled electrical charges applied to the support

The effect of constant and modulated electrical charges applied through the culture support on endothelial cell (EC) morphology was investigated. Endothelial cells tolerated electrical charges for 48 hours, in a serum-free medium. The EC had normal morphology, except at high stationary charges, for which nucleus and cell size increased. The observed cell divisions and cellular secretions indicated that the cells rapidly adapted to the imposed stresses.

Effect of constant and modulated electrical charges applied to the culture material on PGI2 and TXA2 secretion by endothelial cells

Electrical stimulation of an endothelial cell culture applied through the culture support biomaterial induced strong secretion of prostaglandin I2 (PGI2) and, to a lesser extent, thromboxane A2 (TXA2), which varied with time, the sign of the stationary electrical charge and the amplitude and frequency of a superimposed sine wave. In stationary conditions, the response is more rapid at positive electrical charges (+ some tens of microC cm-2) than at negative ones (-some tens of microC cm-2). In sine wave conditions, the ratio [PGI2]/[TXA2] is strongly increased and is maximum for an amplitude of 50 mV and a frequency of 1 Hz. These results suggest that the extracellular matrix is not only involved in cellular anchoring but also participates actively in secretion of thrombomodulatory substances, an effect apparently related to the piezoelectric properties of its components.

[CHARGE association]

BACKGROUND

The spectrum of CHARGE association includes coloboma, heart disease, choanal atresia, retarded growth and development and/or CNS anomalies, genital anomalies and/or hypogonadism and ear anomalies and/or deafness.

CASE REPORT

A 4 1/2 month-old boy was admitted suffering from microphthalmia. His weight was 6 kg (-1 SD), height 60 cm (-2 SD) and his head circumference was 44 cm (+ 2 SD). He had hypotonia. Examination showed low-set ears, micrognathia, coloboma, left choanal atresia and genital hypoplasia. His heart was normal.

CONCLUSION

The CHARGE association must be recognized early since it may be complicated by respiratory and feeding difficulties which can be lethal.

[Protée syndrome associated with renal lithiasis and vesico-ureteral reflux]

BACKGROUND

Proteus syndrome is characterized by a range of various manifestations. The main ones are partial gigantism of hands and feet, nevi, hemihypertrophy, macrocephaly. Urinary tract abnormalities are exceptional.

CASE REPORT

A 6 year-old boy was examined because he had presented numerous abnormalities from birth. His weight was 26 kg (+3 SD) and his height was 135 cm (+4 SD). The main abnormalities were ptosis, pterygium colli, nevi of the cervical area, plagiocephaly, frontal bossing, scoliosis, hemihypertrophy involving the skin, mucosa and bones, macrodactyly, varicose veins and lipomatosis. He underwent surgery at the age of 3 years for urinary lithiasis associated with an ureterovesical reflux on the left side, i.e. the side of hemihypertrophy.

CONCLUSION

This case suggests that Proteus syndrome may be an example of ectomesodermal dysembryoplasy but it requires confirmation by a report of at least one other case of obstruction of the ureteropelvic junction on the same side as hemihypertrophy.