This paper proposes an adaptive sliding mode control (ASMC) framework for Type 1 Diabetes blood glucose regulation, integrating Taylor-series-based online meal-disturbance estimation in a unified adaptive structure. The unknown disturbance amplitude A is estimated via a Lyapunov-based adaptive law using a Taylor-parameterized regressor without requiring prior knowledge of disturbance bounds. This estimate is embedded in the adaptive sliding mode control (ASMC) law, which achieves finite-time convergence, as proven by a strict Lyapunov analysis. A simulation validation across multiple patient profiles demonstrates that the ASMC reduces postprandial peaks by 60.6 % 270.58 - 106.74mg/dL, achieves 28.2, % faster settling time 102, min, vs, 142, min, and eliminates chattering with continuous insulin delivery. Theoretical convergence bounds are validated with errors of <5%. The proposed framework offers robust, computationally efficient, and clinically reliable glucose regulation for artificial pancreas systems.
Purpose. To describe preoperative clinical, biological, and sonographic factors associated with complicated appendicitis in a North African pediatric cohort and to characterize the diagnostic performance of established clinical scores. Methods. Single-center retrospective cohort study of 619 patients aged ≤ 14 years operated for acute appendicitis between January 2014 and December 2024. The primary outcome was complicated appendicitis (gangrene, perforation, abscess, or peritonitis), per the European Association for Endoscopic Surgery classification, confirmed histopathologically (89.7%) or intraoperatively. Univariate and multivariable logistic regression identified independent associations. Results. Among 619 patients (60.4% boys; mean age 9.8 years), 114 (18.5%) had complicated appendicitis. Factors independently associated with complicated disease were consultation delay > 48 hours (AOR = 4.11, p < .001), leukocytosis ≥ 14,000/µL (AOR = 1.93, p = .01), CRP ≥ 24 mg/L (AOR = 1.64, p = .03), appendiceal diameter ≥ 8.5 mm (AOR = 2.21, p = .002), and periappendiceal fat infiltration (AOR = 2.41, p = .005). Age < 6 years was significant in univariate analysis only. Conclusion. Consultation delay, inflammatory biomarkers, and specific sonographic findings were independently associated with complicated appendicitis. These factors may support preoperative risk stratification; prospective external validation is required before integration into clinical decision pathways.
Background Mastocytosis is a rare disorder characterized by abnormal proliferation and accumulation of mast cells. In children, it is most often limited to the skin. Diffuse cutaneous mastocytosis is the rarest form and typically presents during infancy, frequently with extensive bullous lesions. Due to its rarity and clinical resemblance to other bullous dermatoses, early diagnosis remains challenging. Case presentation We report the case of a 9-month-old female infant admitted for an extensive pruritic bullous and ecchymotic eruption involving the thorax, limbs, and scalp. Physical examination revealed thickened infiltrated skin and a positive Darier’s sign, while mucous membranes were spared. Routine laboratory investigations were normal. Skin biopsy showed a dense subepidermal dermal infiltrate composed predominantly of mast cells arranged in confluent sheets. Immunohistochemical staining demonstrated strong and diffuse CD117 positivity. Serum tryptase levels were elevated, supporting the diagnosis of diffuse cutaneous mastocytosis. The patient was treated with topical corticosteroids, sterile dressings, and oral antihistamines, with complete resolution of skin lesions and no systemic complications. Conclusion Diffuse cutaneous mastocytosis should be considered in infants presenting with bullous skin lesions. Histological and immunohistochemical confirmation is essential for diagnosis. Although prognosis is generally favorable, careful follow-up is required due to the risk of severe mediator-related manifestations. Clinical trial number: not applicable
Abstract Background Osteoarticular (OA) brucellosis represent the most frequently described form of the sub-acute brucellosis. We aimed to study the clinical, laboratory and evolutionary features of non-osteoarticular (NOA) brucellosis in comparaison with OA cases. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for sub-acute brucellosis between 1995 and 2022. Standard agglutination test titer > 1/160 and/or positive blood cultures to Brucella spp confirmed the diagnosis of brucellosis. Results We encountered 108 cases among which 30 cases had NOA brucellosis (27.8%). In total, NOA cases included neurobrucellosis (60%), Brucella endocarditis (23.3%) and genitourinary brucellosis (16.7%). Patients with NOA were significantly younger (30[21-44] years vs 52[37-60] years; p< 0.001). Vomiting (30% vs 2.6% ; p< 0.001) and nausea (16.7% vs 3.8%; p=0.036) were significantly more frequent among NOA cases, while night sweats (46.7% vs 70.5%; p=0.021) was significantly less frequent among NOA cases. Fever (86.7% vs 80.8%; p =0.471), weight loss (24.1% vs 38.5%; p= 0.166), myalgia (13.3% vs 23.1%; p=0.26) and asthenia (53.3% vs 44.9%; p=0.43) were noted among NOA and OA cases. Hepatomegaly was significantly more frequent among NOA cases (13.3% vs 2.6% ; p=0.049). A negative C-reactive protein (67.9% vs 24.2%; p< 0.001) and a normal erythrocyte sedimentation rate (75% vs 50.7%; p=0.027) were significantly more frequent among NOA cases. Leucopenia (6.7% vs 7.8%; p=1), thrombopenia (13.3% vs 6.4%; p=0.244) and hepatic cytolysis (6.7% vs 10.3%; p=0.723) were noted among NOA and OA cases. Treatment duration was significantly shorter among NOA cases (4[3-6] months vs 6[4-9] months; p< 0.001). Sequelae were significantly less frequent among NOA cases (3.3% vs 20.8%; p=0.37). A favorable disease evolution (83.3% vs 90.9%; p=0.311) and relapse (3.3% vs 9.1%; p=0.437) were noted among NOA and OA cases. Conclusion Clinical presentation of NOA brucellosis included vomiting and nausea more frequently, the presence of hepatomegaly and the absence of inflammatory markers, among younger patients. The treatment duration was significantly shorter in comparaison with OA brucellosis cases. Disclosures All Authors: No reported disclosures
Abstract Background Although malaria has been eradicated in Tunisia since 1979, our country remains exposed to the potential risk of resurgence. We aimed to study clinical, laboratory and therapeutic features of malaria. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for malaria between 2000 and 2022. Results We encountered 92 cases, among whom 85 were males (92.4%). The mean age was 30±11 years. Fifteen patients received malaria chemoprophylaxis (16.3%). Returned travellers developed symoptoms after 10[5-25] days of returning home. Countries involved in importation were Ivory Coast (31.5%), Mauritania (8.9%) and Senegal (6.5%). The revealing symptoms included fever (90.2%), chills (87%), cephalalgia (79.3%) and diarrhea (26.1%). Arthromyalgia and vomiting were noted 46 cases (50%), each. Thrombopenia (65.2%), elevated C-reactive protein levels (43.5%), lymphopenia (39.1%), anemia (31.5%) and hepatic cytolysis (27.1%) were reported. There were 23 cases of severe malaria (25%). Palsmodium falciparum was identified in 68 cases (74%) and Plasmodium vivax in 8 cases (8.9%). Gametocytes were detected in 8.9% of the cases. Patients were treated with artemether/lumefantrine (71.7%) or quinine (19.6%). The disease evolution was favorable in 90 cases (97.8%). Apyrexia was noted after 2±1 days of treatment. Two patients were dead (2.2%). Conclusion Travellers to malaria endemic countries should be aware of the risk of malaria in order to follow preventive measures and to promptly consult in case of symptoms. An early diagnosis followed by the adequate treatment might prevent severe forms and death. Disclosures All Authors: No reported disclosures
