Hydatid cysts of the brain stem. Two cases

Cerebral hydatid cysts represent 2-3% of all intracranial masses in endemic countries. Its incidence in posterior fossa is very rare. We report two cases of brainstem location. Clinically, the lesion exhibited signs of brainstem tumor. In two patients, CT scan showed a hypodense lesion. There was no enhancement after contrast administration. One patient was explored by MRI; on precontrast images, the lesion appeared homogeneous with hyposignal intensity and smooth limits. T2 weighted MRI and post contrast examination confirmed the cyst nature of the lesion. Surgery was performed in the two patients. The cyst was first aspirated and its membrane was then removed. Post operatively, one patient died, the other one is still alive but severely affected two years later. CT scan showed total disappearance of the cyst. The clinical presentation, radiological findings and surgical procedures are discussed.     

Testicular Synovial Sarcoma:A Case Report

This paper reports a case of testicular synovial sarcoma with molecular genetic analysis.A 24-year-old male presented with painless scrotal mass.Ultrasonography showed a heterogeneous mass of 66 mm×34 mm in size involving the inguinal region.Histological examination of a surgical biopsy showed a gradeⅢmonophasic growth pattern of spindle cell proliferation.Immunohistochemical analyses indicated positive staining for pancytokeratine and epithelial membrane antigen.Cytogenetic analysis showed the presence of CYT-SSX1 mutation,and CT scan showed non-specific pleural micro-nodules with a size of 7.5 mm.The patient had an extended left orchidectomy but was lost to follow-up for 1 year.A local recurrent scrotal mass of 32 mm×25 mm,multiple inguinal lymph nodes,and increased pleural nodules,which were confirmed by histological examination,were treated with three cycles of adriamycine and ifosfamide chemotherapy,surgical resection,and radiotherapy with complete response.After 3 months,the patient developed local recurrence and pulmonary metastases that did not respond to second-line chemotherapy based on gemcitabine and paclitaxel.The patient had dyspnea at the time of this writing and chest pain,and is under third-line chemotherapy based on Deticene after 30 months of following up.This patient died on November 16,2012 after a resperatory failure and malignant plural effusion. Synovial sarcoma should be considered in the differential diagnosis of soft tissue tumor and it should be aggressively treated to improve prognosis.Although our patient has shown numerous factors of bad prognosis,he has had a relatively long survival time.     

Diagnostic markers of postoperative morbidity after laparoscopic Roux-en-Y gastric bypass for obesity

Purpose

The main objective of this study was to detect subacute complications that can arise from laparoscopic Roux-en-Y gastric bypass and take a rational approach to manage these complications.

Methods

A prospective observational study was performed from November 2010 to December 2012. All patients undergoing gastric bypass surgery for morbid obesity were included in this study. Patients with complications before day 5 were excluded from the study. Clinical and laboratory data (C-reactive protein, leukocyte count) at postoperative day 5, 30-day morbidity, were recorded. The diagnostic value of C-reactive protein (CRP) and leukocytes were determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.

Results

One hundred and twenty-six patients were included. The overall incidence of 30-day morbidity was 8.7 %, and anastomotic leakage rate was 3.2 %. C-reactive protein at postoperative day 5 was a good predictor of complications (AUC was 0.862 (95 % CI [0.76; 0.96]; p?<?0.001) and anastomotic leakage (AUC was 0.863 (95 % CI [0.66; 1]; p?=?0.014). A CRP cutoff level of 136 mg/l at postoperative day 5 yielded a specificity of 95.5 % and a sensitivity of 57.1 % for the detection of postoperative complications. The negative predictive value was 94.6 %. A CRP level of 136 mg/l at day 5 was significantly associated with postoperative morbidity.

Conclusions

C-reactive protein dosage at postoperative day 5 is a relevant predictor of postoperative complications permitting to select patients at risk. Radiological examination and close monitoring could be restricted to patients with CRP level exceeding 136 mg/l.     

Evidence of Circulation of Several HAV Genetic Variants and Emergence of Potential Antigenic Variants in an Endemo-Epidemic Country before Vaccine Introduction

Similar to several other countries in the world, the epidemiology of hepatitis A virus changed from high to intermediate endemicity level in Tunisia, which led to the occurrence of outbreaks. This study aimed to determine the genetic and antigenic variability of HAV strains circulating in Tunisia during the last few years. Genotyping using complete VP1 gene and VP1-2A junction confirmed the predominance of genotype IA, with co-circulation of several genetic and antigenic variants. Phylogenetic analysis including Tunisian and strains from other regions of the world showed the presence of at least two IA-variants within IA subgenotype. Amino-acid analysis showed several mutations in or close to epitope regions in the VP1-region. This study provides a baseline on the genetic and antigenic variability of HAV circulating strains before the introduction of vaccination into the national immunization schedule.     

Circulation and Molecular Epidemiology of Enteroviruses in Paralyzed,Immunodeficient and Healthy Individuals in Tunisia,a Country with a Polio-Free Status for Decades

This report is an overview of enterovirus (EV) detection in Tunisian polio-suspected paralytic cases (acute flaccid paralysis (AFP) cases), healthy contacts and patients with primary immunodeficiencies (PID) during an 11-year period. A total of 2735 clinical samples were analyzed for EV isolation and type identification, according to the recommended protocols of the World Health Organization. Three poliovirus (PV) serotypes and 28 different nonpolio enteroviruses (NPEVs) were detected. The NPEV detection rate was 4.3%, 2.8% and 12.4% in AFP cases, healthy contacts and PID patients, respectively. The predominant species was EV-B, and the circulation of viruses from species EV-A was noted since 2011. All PVs detected were of Sabin origin. The PV detection rate was higher in PID patients compared to AFP cases and contacts (6.8%, 1.5% and 1.3% respectively). PV2 was not detected since 2015. Using nucleotide sequencing of the entire VP1 region, 61 strains were characterized as Sabin-like. Among them, six strains of types 1 and 3 PV were identified as pre-vaccine-derived polioviruses (VDPVs). Five type 2 PV, four strains belonging to type 1 PV and two strains belonging to type 3 PV, were classified as iVDPVs. The data presented provide a comprehensive picture of EVs circulating in Tunisia over an 11-year period, reveal changes in their epidemiology as compared to previous studies and highlight the need to set up a warning system to avoid unnoticed PVs.     

Unusual localization of chondrocalcinosis: The sternoclavicular joint: Case report and review of the literature

BackgroundChondrocalcinosis is a metabolic arthropathy rarely affecting the anterior chest wall (ACW).Aim of the workTo report here a case of a polyarticular chondrocalcinosis with an uncommon localization in the sternoclavicular joints (SCJs), revealed by computed tomography (CT).Case reportA 76-year old female presented to the Rheumatology outpatient clinic Kassab orthopedics institute with low back pain. The history goes back to 4 months prior to her presentation when she developed mechanical back pain that progressively worsened during the last month, becoming inflammatory with prolonged morning stiffness. She had no history of fever or weight loss and no symptoms in the cervical spine, shoulders, chest wall, hips or knees. Physical examination revealed limited range of motion of hips, cervical and lumbar spine and bilateral swelling of SCJs without tenderness on pressure or mobilization. Biochemical investigations showed normal levels of inflammatory markers, phosphorus and calcium. Conventional radiographs showed multiple areas of calcification in the intra-vertebral discs, joint space narrowing of sacroiliac (SI) and coxofemoral joints. Chest wall radiograph appeared normal. ACW and pelvic CT were done to further delineate the cause. It showed intra-cartilaginous bilateral calcifications of SCJs, sacroilliac, intervertebral discs, coxofemoral joints and pubic symphysis. The final diagnosis was polyarticular chondrocalcinosis. The patient received analgesics, non-steroidal anti-inflammatory drugs and had functional rehabilitation sessions. Conclusion: This case points to the rare localization of chondrocalcinosis in the SCJ and should be considered especially in an elderly female. Early recognition is necessary in order to initiate an appropriate and prompt treatment.     

Molecular Epidemiology of SARS-CoV-2 in Tunisia (North Africa) through Several Successive Waves of COVID-19

Documenting the circulation dynamics of SARS-CoV-2 variants in different regions of the world is crucial for monitoring virus transmission worldwide and contributing to global efforts towards combating the pandemic. Tunisia has experienced several waves of COVID-19 with a significant number of infections and deaths. The present study provides genetic information on the different lineages of SARS-CoV-2 that circulated in Tunisia over 17 months. Lineages were assigned for 1359 samples using whole-genome sequencing, partial S gene sequencing and variant-specific real-time RT-PCR tests. Forty-eight different lineages of SARS-CoV-2 were identified, including variants of concern (VOCs), variants of interest (VOIs) and variants under monitoring (VUMs), particularly Alpha, Beta, Delta, A.27, Zeta and Eta. The first wave, limited to imported and import-related cases, was characterized by a small number of positive samples and lineages. During the second wave, a large number of lineages were detected; the third wave was marked by the predominance of the Alpha VOC, and the fourth wave was characterized by the predominance of the Delta VOC. This study adds new genomic data to the global context of COVID-19, particularly from the North African region, and highlights the importance of the timely molecular characterization of circulating strains.