Epithelial advanced ovarian carcinoma in the central region of Tunisia: therapeutic results and prognostic factors on 104 patients

Between 1994 and 2004, 104 patients with epithelial advanced ovarian cancer were treated in the central region of Tunisia (81 stage III and 23 stage IV). Average age of patients was 54 years. Primary surgery was optimal (residue < 2 cm) in 40 cases (38,5 % of patients). Fifty nine patients were treated with neo adjuvant chemotherapy based on platinum, associated to paclitaxel in 19 % of cases. Interval debulking surgery interested 30 patients and was optimal in 66,7 % of cases. Global survive was 57 % at 2 years and 27 % at 5 years. Survival rate for patients treated with optimal debulking surgery was similar to that of those treated with initial optimal surgery. Prognostic factors for a better survive were : age < 40 years (p < 0,05), stage III (p < 0,01), a normal level of CA125 after surgery (p < 0,01), primary optimal initial surgery (p < 0,02) and response to neoadjuvant chemotherapy (p < 0,01). Prognosis of ovarian carcinoma is worse in Tunisia as like as in the world. In case of extensive tumor, the neoadjuvant chemotherapy before interval debulking surgery permits to improve survive and quality of life in some patients.     

Phenotyping and antibiotic susceptibility's study of Neisseria meningitidis strains isolated at the "Hôpital d'Enfants" of Tunis

A total of 23 invasive strains of Neisseria meningitidis were isolated between March 1998 and February 2004. 19 strains were recovered from cerebrospinal fluid (CSF) and 4 from blood. The majority of these strains were recovered from children with an age less to 4 years (86.9%). The antigenic formula'study (serogroup:serotype:serosubtype) of the strain's collection have shown there great diversity. The sero-group B was the most frequent (83%) followed by serogroup C (17%). The B:NT:NST phenotype was major among strains of the serogroup B and the C:4:P1-14 phenotype among strains of the serogroup C. No beta-lactamase activity was detected. 30.4% of the strains were of diminished susceptibility to penicillin G (CM190 = 0.38 Ig/ml). No resistance to amoxicillin (CMI90 = 0.19 microg/ml), to cefotaxime (CMI90 = 0.016 microg/ml) and to rifampin (CMI90-0.125 microg/ml) was detected; whereas 8.7% of strains-were resistant to chloramphenicol (CMI90=2 Ig/ml) and 65.2% to spiramycin.     

Microscopic colitis. A 20 cases series

Microscopic colitis are defined as a chronic inflammation of a normal macroscopic colonic mucosa. We report 20 cases of microscopic colitis. Chronic diarrhea revealed the diagnosis in 95% of cases. Endoscopic examination was normal in 95% of patients. We diagnosed collagenous colitis in 65% of cases and lymphocytic colitis in 35% of cases. The treatment was based on sulphasalazine in 16 patients, on 5 aminosalicylic acid in 1 case, on gluten free diet in 2 cases and a symptomatic treatment was prescribed to one patient. A clinical remission was observed in 41.2% of patients taking sulphasalazine.     

Association lichen planus and ulcerative colitis. A case report

Ulcerative colitis is a frequent chronic inflammatory boxel disease. Its cutaneous manifestation are varied. Some of them are frequent like pyoderma gangrenosum, erethema nodosum and oral ulceration. We report the case of an exceptional association of ulcerative colitis with lichen planus in a 40-year old woman with a 2 year history of ulcerative colitis, who had lesions on the buccal mucosa and the lower lip for which the diagnosis of lichen planus was made and confirmed histologically.     

Association of right heart thrombosis,endomyocardial fibrosis,and pulmonary artery aneurysm in Behçet's disease

A 29-year-old man with a 5-year history of Beh?et's disease was admitted for fever, dyspnae, chest pain, and hemoptysis. A diagnosis of right ventricle and atrial thrombosis associated with a pulmonary artery aneurysm was made. The patient was treated with anticoagulants and prednisone. Since hemoptysis persisted, surgical excision of the intracardiac thrombosis was performed and histological findings were consistent with organizing thrombus and endomyocardial fibrosis. Transesophageal echocardiography 6 months later showed recurrence of the right ventricle thrombosis. A course of 6-monthly boluses of intravenous cyclophosphamide was begun. Currently, at 2 years of follow-up, the patient is asymptomatic.     

Age-specific seroprevalence of hepatitis a among school children in central Tunisia

Hepatitis A virus (HAV) has different epidemiologic and clinical patterns, depending on the level of endemicity in a given geographic area. Tunisia is considered a region of high endemicity for hepatitis. Improvement of socioeconomic conditions in this country has made a determination of the seroprevalence of this disease advisable. We assessed the seroprevalence of HAV in Sousse in central Tunisia. A total of 2,400 school children 5-20 years of age (mean +/- SD age = 11.7 +/- 3.5 years) were selected by two-stage cluster sampling and tested serologically for IgG antibody to HAV by using an enzyme-linked immunosorbent assay. The overall seroprevalence among this population was 60% (44%, in children < 10 years old, 58% in those 10-15 years of age, and 83% in those > 15 years of age. Seroprevalence also varied according to area of residence. At the age of 10, 21.3% of school children living in the urban areas and 87.7% of those living in rural areas had antibodies to HAV. Other factors that increased seroprevalence included non-potable water, crowding, and a low education level of parents with odds ratios of 4.37, 2.96, and 2.62, respectively. This study has shown an increase of seroprevalence with age, suggesting that transmission among younger children has decreased, particularly in urban areas. Programs to prevent hepatitis A may need to be modified based upon the changing age distribution of the disease and mass vaccination program could be indicated if additional incidence and prevalence data confirm the intermediate endemicity of HAV.     

Improving the coverage of the cyanobacterial phylum using diversity-driven genome sequencing

The cyanobacterial phylum encompasses oxygenic photosynthetic prokaryotes of a great breadth of morphologies and ecologies; they play key roles in global carbon and nitrogen cycles. The chloroplasts of all photosynthetic eukaryotes can trace their ancestry to cyanobacteria. Cyanobacteria also attract considerable interest as platforms for “green” biotechnology and biofuels. To explore the molecular basis of their different phenotypes and biochemical capabilities, we sequenced the genomes of 54 phylogenetically and phenotypically diverse cyanobacterial strains. Comparison of cyanobacterial genomes reveals the molecular basis for many aspects of cyanobacterial ecophysiological diversity, as well as the convergence of complex morphologies without the acquisition of novel proteins. This phylum-wide study highlights the benefits of diversity-driven genome sequencing, identifying more than 21,000 cyanobacterial proteins with no detectable similarity to known proteins, and foregrounds the diversity of light-harvesting proteins and gene clusters for secondary metabolite biosynthesis. Additionally, our results provide insight into the distribution of genes of cyanobacterial origin in eukaryotic nuclear genomes. Moreover, this study doubles both the amount and the phylogenetic diversity of cyanobacterial genome sequence data. Given the exponentially growing number of sequenced genomes, this diversity-driven study demonstrates the perspective gained by comparing disparate yet related genomes in a phylum-wide context and the insights that are gained from it.The Cyanobacteria are one of the most diverse and widely distributed phyla of bacteria. Among photosynthetic prokaryotes, they uniquely have the ability to perform oxygenic photosynthesis; they are considered to be the progenitor of the chloroplast, the photosynthetic organelle found in eukaryotes. Cyanobacteria contribute greatly to global primary production, fixing a substantial amount of biologically available carbon, especially in nutrient-limited environmental niches, from oligotrophic marine surfaces to desert crusts (1, 2). In addition, cyanobacteria are key contributors to global nitrogen fixation (3), and many produce unique secondary metabolites (4). Despite these important traits and substantial interest in developing cyanobacterial strains for biotechnology, there is a paucity and unbalanced distribution of publicly available genomic information from the Cyanobacteria: 40% (29 of 72 species) of the available genomes fall within the closely related marine Prochlorococcus/Synechococcus subclade. Improvements in coverage of sequenced genomes will enable a more accurate and comprehensive understanding of cyanobacterial morphology, niche-adaptation, and evolution.Taxonomic studies organized the Cyanobacteria into five subsections based on morphological complexity (5). Unicellular forms are split between those that undergo solely binary fission (subsection I, Chroococcales) and those that reproduce through multiple fissions in three planes to create smaller daughter cells, baeocytes (subsection II, Pleurocapsales). Strains in subsection III (Oscillatoriales) divide the vegetative cell solely perpendicular to the growing axis. Organisms in subsections IV (Nostocales) and V (Stigonematales) are able to differentiate specific cells [i.e., heterocysts (for nitrogen fixation)] and may form akinetes (dormant cells) and hormogonia (for dispersal and symbiosis competence). Subsection V is further distinguished by the ability to form branching filaments. Before this study, two subsections (II and V) had no representative genomes, underscoring the dearth in our understanding of these more complex morphological phenotypes.In this study, 54 strains of cyanobacteria were chosen to improve the distribution of sequenced genomes. The approach is modeled on the phylogenetically driven Genomic Encyclopedia of Bacteria and Archaea (GEBA) (6), and so we refer to our data as the CyanoGEBA dataset (SI Appendix, Table S1 and Dataset S1). The results highlight the value of phylum-wide genome sequencing based on phylogenetic coverage.