Baseline Characteristics of Patients with Symptomatic Carotid Webs: A Matched Case Control Study

Background and purposeThe baseline characteristics of patients with symptomatic carotid web (CaW) are unclear. We investigate demographic and cerebrovascular risk factors in patients with this overlooked stroke etiology.MethodsWe identified consecutive patients diagnosed with symptomatic CaW at a comprehensive stroke center from July 2014-December 2018. These patients were matched at a 1:4 ratio (based on age and NIHSS scores) to create a control group of acute ischemic stroke (AIS) patients with non-CaW etiologies from the local GetWithTheGuidelines stroke database.ResultsThirty patients with symptomatic CaW were compared to 120 AIS patients with non-CaW etiologies. Symptomatic CaW patients were more likely to be female (73.3 vs. 44.2%; p = 0.004) and black (86.7 vs. 64.2%; p = 0.02). Symptomatic CaWs patients had a fewer absolute number of modifiable cerebrovascular risk factors (1.7±1.1 vs. 2.5±1.2; p = 0.002), lower rates of hypertension (43.4 vs. 63.3%; p = 0.04), and a more favorable lipid profile with lower average LDL (89.5±30.3 vs. 111.2±43.7 mg/dL; p = 0.01) and higher average HDL (47.9±11.3 vs. 42.2±13.8 mg/dL; p = 0.01) as compared to strokes with non-CaW etiology. Symptomatic CaW patients were more likely to have a large vessel occlusion (80.0 vs. 51.7%; p = 0.005), despite similar e-ASPECTS between the groups (8.1±2.1 vs. 8.3±2.2; p = 0.30). On multivariable analysis, symptomatic CaW was an independent predictor of independence at discharge (OR 3.72; 95%CI 1.27–10.94).ConclusionA gender and racial predilection of symptomatic CaWs may exist as females and blacks were were found to be more likely affected. Symptomatic CaW patients have a more benign cerebrovascular risk factor profile corroborating the proposed mechanism of local stasis and thromboembolism. Despite presenting more commonly with LVO, symptomatic CaW was associated with good functional outcome, warranting further studies.     

Système RH : dépistage de D partiels avec RHD/RHCE gène hybride

Aim of the studyThe determination of the RhD phenotype is important in transfusion medicine. However, the complexity of the expression of the D antigen is the cause of the discrepancies observed between two serological determinations and the omission by serology of some variants that can be cause alloimmunization. Therefore, it is important to known in a population the RHD alleles responsible for partial D and weak D phenotype. The aim of the study was the screening of partial D with RHD/RHCE gene hybrid by PCR-multiplex.Materials and methodsOur study involved 308 blood donors from Tunisian Sahel (269 D positive and 39 D negative). We used the multiplex PCR assay to amplify specific exons of the RHD gene 3, 4, 5, 6, 7, 9 and 10. Further molecular investigations were carried to characterize the RHD variants that were detected by the multiplex.ResultsIn the 269 D positive samples, one case showed the absence of amplification of exons 4 and 5 of RHD gene. This variant was identified by PCR-SSP on weak D type 4. None of the RHD exons were amplified from DNA of 39 D negative samples in favor of a total deletion of the RHD gene.ConclusionWe have no found any partial D variant with RHD/RHCE gene hybrid. Results in D negative samples showed that RHD gene deletion is the most frequent mechanism of D negative phenotype in the Tunisian population.     

Incidence and Characteristics of Atypical Femoral Fractures: Clinical and Geometrical Data

Despite the multitude of studies published on atypical femoral fractures (AFFs), a profile for patients at risk does not exist. This study aimed first at estimating AFF incidence over a 19‐month‐period in Quebec City using the ASBMR Task force criteria to define AFF. The medical records of patients hospitalized for hip or femoral fracture between June 1, 2009, and December 31, 2010, were reviewed. Thirty‐six cases of atypical fractures were identified during the 19‐month period, representing an AFF incidence of 7.0 (range, 4.7 to 9.3) cases per 100,000 person‐years. In the second part of the study, data regarding the characteristics suspected of increasing the risks of AFF were collected from medical and pharmacological records, proximal femur radiographs, and patient interviews. The data regarding each patient with an AFF during years 2008‐2011 were compared to two controls with a hip or femoral fragility fracture or a traumatic fracture, paired for age and sex. Twenty patients with AFF were added to the 36 patients with AFF selected in the first part, thereby 56 patients with AFF were investigated. The association between the occurrence of AFF and bisphosphonates (BPs) use was proven statistically significant in multivariate analysis, odds ratio (OR) = 10.39 (95% CI, 2.22 to 48.58; p = 0.0029). Compared to controls, patients with AFF had excessive femoral offset (43.1 mm versus 38.3 mm, p = 0.0007), proximal femoral neck angle in varus (128.9 degrees versus 134.0 degrees, p < 0.0001), and had greater proximal cortical thickness. This retrospective study confirms the low incidence of AFF, confirms its significant association with exposure to BPs, and reveals the possible contribution of proximal femoral geometry in AFF occurrence. © 2016 American Society for Bone and Mineral Research.     

Structure properties and dielectric relaxation of Ca0.1Na0.9Ti0.1Nb0.9O3 ceramic

In this paper, the synthesis of Ca_0.1Na_0.9Ti_0.1Nb_0.9O₃ (CNTN) ceramic by a solid-state reaction method is reported. The results of Rietveld refinement of X-ray diffraction (XRD) patterns at room temperature showed a pure tetragonal perovskite (P4mm space group). Raman spectroscopy analysis, ranging from of 50 to 1000 cm⁻¹, at room temperature, validates the results of XRD. The dielectric properties was studied by complex impedance spectroscopy examined in broad frequency range, 100 Hz to 200 kHz, at different temperatures. The dielectric permittivity for our CNTN compound confirms the typical relaxor behavior. The investigation of the diffuseness of the transition was conducted by fitting the experimental data with modified Curie–Weiss law; Gaussian distribution and Power law confirm the presence of a short-range association between the polar nanoregions (PNRs). The obtained values of the diffuseness coefficient are of the order 1.6, which corresponds to the diffuse phase transition (DPT) ascribed to the existence of various states of polarization, thus various relaxation times in different regions. The value of diffuseness is of the order 85 and the degree of relaxor (ΔT_cm = 65 K) is interesting as far as microelectric applications are concerned. Moreover, based on the frequency dependence of temperature at dielectric maxima using Vogel–Fulcher relationship, a strong evidence for a static freezing temperature with regards to thermally-activated polarization fluctuations was found.

In this paper, the synthesis of Ca_0.1Na_0.9Ti_0.1Nb_0.9O₃ (CNTN) ceramic by a solid-state reaction is reported. The results of Rietveld refinement of X-ray diffraction patterns at room temperature showed a pure tetragonal perovskite (P4mm space group).     

Profil clinico-biologique et immunohématologique des patients atteints de β-thalassémie en Tunisie : à propos de 26 cas

Aim of the studyTo study the clinical and biological profile of β-thalassemic patients in our region, reflecting the quality of their care.Patients and methodsA retrospective study (2010–2011) on 26 β-thalassemic patients followed in the pediatrics service at CHU Farhat Hached Sousse, Tunisia. Epidemiological, clinical and biological data were collected from medical records and transfusion files of patients. The transfusion protocol adopted was to maintain a hemoglobin level > 10 g/dL by regular transfusions every 3–4 weeks. Iron chelation therapy, in order to maintain serum ferritin < 1500 ng/mL, was introduced when serum ferritin exceeded 800–1000 ng/mL.ResultsThe mean age of patients at diagnosis was 15 months. The clinical impact of anemia had resulted in failure to thrive in 54% of patients and facial dysmorphism in 23%. The average transfusion requirement was estimated at 311.02 mL/kg/year with 6 cases of hyperconsumption. The immunohaematological monitoring showed the appearance of anti-RBC alloimmunization in one patient and 4 cases of autoimmunization. Poor adherence of chelation therapy was 62% and causing 5 cases of cardiac complications, 4 cases of liver injury and 14 cases of endocrine complications.ConclusionImproving the therapeutic care of β-thalassemic children requires better monitoring of transfusion recovery and improved adherence to chelation therapy.     

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.     

Epidemiology of cardiovascular risk factors among schoolchildren in Sousse, Tunisia

BACKGROUND: In Tunisia, where the epidemiological transition phenomenon is well established, there are no data available at the population level on the cardiovascular disease (CVD) risk profile for children, although it is well known that risk factor development takes place in childhood. METHODS: We report an epidemiological survey based on a representative sample of 1569 urban schoolchildren of Sousse in Tunisia to assess the following CVD risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and tobacco consumption. RESULTS: The main results showed that girls had significantly higher levels of body mass index (BMI), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol than boys, who however had significantly higher levels of systolic blood pressure (SBP). Total cholesterol was significantly correlated to BMI and decreased with age. Obesity (BMI = 27) was found in 7.9% of the study population and was significantly higher for girls (9.7%) than for boys (6%): chi 2 = 9.02, DF = 2, P = 0.011. Overweight (BMI = 25) was also significantly higher for girls (16%) than for boys (11.1%): chi 2 = 8.21, DF = 1, P = 0.0041. Smoking habit concerned 7.6% of the study population; it was significantly higher for boys (14.7%) than for girls (1.1%): chi 2 = 103.4, DF = 1, P < 0.00001. CONCLUSION: This study showed to some extent that Tunisia's urban population of schoolchildren is exposed early to CVD risk factors and all should be done to avoid the worsening of this profile. These results will serve as a baseline for assessment of future trends in the risk factors studied.