INTRODUCTION:Although glioblastoma (GBM) has a very poor prognosis, overall survival (OS) in treated patients shows great difference varying from few days to several months. Identifying factors explaining this difference would improve management of patient treatment. AIM:To determine the relevance of diffusion restriction in newly diagnosed treatment-naïve GBM patients. METHODS:Preoperative magnetic resonance scans of 33 patients with GBM were reviewed. Regions of interest including all the T2 hyperintense lesion were drawn on diffusion weighted B0 images and transferred to the apparent diffusion coefficient (ADC) map. For each patient, a histogram displaying the ADC values within in the regions of interest was generated. Volumetric parameters including tumor regions with restricted diffusion, parameters derived from histogram and mean ADC value of the tumor were calculated. Their relationship with OS was analyzed. RESULTS:Patients with mean ADC value < 1415x10-6 mm2/s had a significantly shorter OS (p=0.021). Among volumetric parameters, the percentage of volume within T2 lesion with a normalized ADC value <1.5 times that in white matter was significantly associated with OS (p=0.0045). Patients with a percentage>23.92% had a shorter OS. Among parameters derived from histogram, the 50th percentile showed a trend towards significance for OS (p=0.055) with patients living longer when having higher values of 50th percentile. A difference in OS was observed between patients according to ADC peak of histogram but this difference did not reach statistical significance (p=0.0959). CONCLUSION:Diffusion magnetic resonance imaging may provide useful information for predicting GBM prognosis.

In Tunisia, the recognition of the possibility of including longevity and disease resistance in dairy cattle selection objectives has been hypothesized as a useful strategy by both researchers and producers. However, in this paper, the state of the art, with a focus on health and longevity, is reviewed. Along the same lines, the heritability for the milk traits, fertility traits, and longevity of Tunisian Holstein dairy cows complies with the literature. Therefore, the influence of genetics on some diseases of the dairy cow was investigated. In addition, a decreasing efficiency in cow fertility has been observed over the last few years. The results showed that the risk of culling increased with common diseases. When analyzed with the Weibull model, functional lifespan was strongly influenced by milk yield; therefore, the risk increased with a reduced milk yield. In her first three lactations, the relative risk of selection increased gradually with lactation. Thus, the risk of thinning is highest at the beginning and end of the first feeding and the end of her second feeding. In conclusion, the risk of culling was reduced in parity. The factors that influence the life of the herd, such as health, husbandry, environmental conditions, and management, are often ignored when evaluating longevity.

During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?

ObjectiveWe aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument.Study design and settingWe searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 – November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions.ResultsWe retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%).ConclusionFuture CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.

Pial arteriovenous fistulas (AVFs) are rare neurovascular malformations. They differ from arteriovenous malformations (AVMs) in that they involve single or multiple feeding arteries, draining directly into a dilated cortical vein with no intervening nidus. Pial and dural AVFs differ in blood supply, as the first originate from pial or cortical arteries and the latter from outside the dural leaflets. Unlike dural AVFs, most of the pial AVFs are supratentorial. The vast majority are congenital, manifesting during infancy. Acquired pial AVFs are significantly rarer and occur after vasculopathy, head trauma, brain surgery, or cerebral vein thrombosis. We describe a unique case of an acquired pial AVF in a 50-year-old man secondary to a cortical vein thrombosis manifesting as a focal-onset seizure with secondary generalization. A cerebral digital subtraction angiography revealed a low-flow pial AVF fed by a postcentral branch of the left middle cerebral artery draining to the superior sagittal sinus via a cortical vein. It also showed a collateral venous circulation adjacent to the previously thrombosed left parietal vein. There was no evidence of an associated dural AVF or venous varix. Endovascular treatment was scheduled three months later, but the angiogram preceding the embolization showed spontaneous and complete closure of the malformation. To our knowledge, this is the first case illustrating acquired pure pial AVF unaccompanied by a dural component following cortical vein thrombosis, eventually resulting in an unprompted closure.

Tunisian Barbary sheep are well-known for their rusticity and adaptation to harsh environmental conditions, especially, those of the arid climate. Morphometric characteristics of this main breed, although, have not been extensively investigated. In this study, we provide a morphological characterization, via eight body measures, of 249 ewes, aged from one to nine years, and sampled from farms, belonging to two locations, which have been maintained a purebred nucleus of this breed. Analysis of variance revealed that morphometric traits are partially influenced by age group and location with different significance levels. Ewes reached the full morphological dimension broadly between 4 and 6 years of age, except for the tail part that tends to be longer precociously at 1-2 years of age. Thus, having a longer tail at an early age (<2 years), in the genetic architecture of this fat-tailed breed, could represent a form of adaptation to the arid climate, which is the main hypothesis-driven from the present morphometric analysis. This study provides insights into the morphological peculiarities of purebred Barbary ewes under the particular arid environment and reflects some possible adaptive properties, giving rusticity to this indigenous fat-tailed sheep resource.

Arbi is one of the main local goat breeds in Tunisia, representing an important economic resource in arid and hot areas where cattle and sheep cannot thrive successfully. In the current work, we have characterized the mitochondrial diversity of 26 Arbi goats by partially sequencing the mitochondrial D-loop region. These sequences plus 10 retrieved from GenBank were analyzed with the DnaSP v.5.10.1, evidencing the existence of 12 different haplotypes. Nucleotide and haplotype diversities were 0.02 and 0.96. Moreover, median-joining network analysis showed that all D-loop sequences from Arbi goats correspond to haplogroup A and that in general they do not cluster with sequences from other goat breeds. The high diversity that has been observed in North African goats is compatible with the maritime diffusion of the Neolithic package 10,000–7000 YBP. Moreover, there are evidences that local Tunisian breeds have been extensively crossed with highly productive transboundary breeds in order to improve meat and milk yields. These uncontrolled crossing practices may lead to the loss of alleles that play key roles in the adaptation of Tunisian local breeds to a harsh environment.

Abstract Ce document a été réalisé dans le cadre d'une collaboration entre l'Instance Nationale de l’Évaluation et de l'Accréditation en Santé (INEAS), la Société Tunisienne de Cardiologie et de Chirurgie Cardiovasculaire (STCCCV) et la Caisse Nationale d’Assurance Maladie (CNAM).

Background: In response to the COVID-19 pandemic, a host of rapid guidelines (RGs) have been published to inform clinicians and decision-makers on best management for people with COVID-19. We assessed the quality of RGs for management of critically ill patients with COVID-19. Methods: We performed a rapid systematic review of RGs for the critical care patients with COVID-19. Medline (OVID), CINAHL (EBSCO), EMBASE, CNKI, CBM, WanFang, and relevant databases and websites were systematically searched through 31 st July 2020. The AGREE II instrument was used to assess the quality of included RGs and summarize relevant therapeutic interventions. Results: A total of 45 RGs for critically ill patients with COVID-19 were included. Ten were multinational and the remaining from individual countries. The clinical topics included in each RG varied: 41 were for general critical care unit management, two covered patients with tracheostomy, six covered children, four covered women, five covered cardiovascular diseases, 12 covered emergencies, 19 covered patients with pneumonia, and one was for patients receiving renal replacement therapy. Average scores for the six domains of the AGREE II instrument were 70%, 40%, 26%, 74%, 28%, 41% for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence, respectively. Recommendations for therapeutic interventions were summarized. Interpretation: Most of the RGs for critical care in response to COVID-19 included in the review showed a low overall quality (less than 40%). Future RGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.Funding Statement: This work was supported by the Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.Declaration of Interests: None.

Background: The fat-tailed Barbary sheep are the main breed of Tunisia and their morphometry has not been deeply investigated. This study aims to estimate the degree of relationship between eight quantitative measures across eight age classes, from one to eight years. Methods: Pearson’s product-moment was calculated to evaluate the correlation among eight morphological measures, collected from 249 purebred Tunisian Barbary ewes reared under arid climate. Result: The magnitude of pairwise phenotypic correlation among morphological traits showed a strong positive correlation (r = 0.84, P less than 0.001) between the shoulder and rump height at 6-7 years. The body weight was highly correlated to the height at rump during the first five years of age, whereas, it becomes more correlated to the heart girth when the ewe reaches its heavyweight at 5-6 years and older. The results of this study indicated that the rump height is the most correlated parameter to BW during the early life of this fat-tailed breed and are encouraging to fit live body weight from morphometric traits with accuracy.

The activity of the Reproductive Medicine poses a dilemma in this pandemic Covid-19. In fact, this is a theoretically non-emergency activity except for fertility preservation with oncological reasons. The majority of fertility societies in the world such as the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) recommended stopping the inclusion of new patients and continuing only the In Vitro Fertilization (IVF) cycles that have already been initiated by promoting Freeze-all as much as possible. Initilaly, the "Société Tunisienne de Gynécologie Obstétrique" (STGO) issued national recommendations that echo the international recommendations. These recommendations were followed by the majority of IVF center in Tunisia. However, a number of new data are prompting us to update these recommendations.

Dairy herds are raised under dry climate in Tunisia which make them subject to heat stress which is known to considerably decline their milk yield. This paper aimed to evaluate heat stress impact on the dairy performances of the Tunisian North West cows. We used 4789 test-day recorded between 2008 and 2011 on 585 Holstein cows in their first three parities, calved between 2007 and 2011 and belong to 10 herds from the Tunisian North-West area. Temperature and humidity data were associated to each test-day and Thermal Humidity Indexes (THI) were calculated. First, the effect of temperature and humidity factors were assessed separately, then the effect of their interaction and finally the effect of their THI using three statistical models. For model 2 and 3, all fixed factors were significant (P<0.001) while for model 1 the humidity didn’t show a significant on the milk performances. The highest milk yield was 51 kg and was found to be reached during the lowest daily temperature and the highest humidity; corresponding to the lowest THI index. The lowest milk yield was 1 kg and was found to be recorded during the hottest temperature and the lowest humidity; resulting in the highest THI; which have significantly exceeded the THIThreshold. Our analysis has showed that Tunisian dairy cows in the North West area undergo moderate heat stress during one third of the year and that the average milk yield decline is about 5 kg/day.

Merino sheep represents a valuable genetic resource worldwide. In this study, we investigated selection signatures in Merino (and Merino-derived) sheep breeds using genome-wide SNP data and two different approaches: a classical FST-outlier method and an approach based on the analysis of local ancestry in admixed populations. In order to capture the most reliable signals, we adopted a combined, multi-cohort approach. In particular, scenarios involving four Merino breeds (Spanish Merino, Australian Merino, Chinese Merino, and Sopravissana) were tested via the local ancestry approach, while nine pair-wise breed comparisons contrasting the above breeds, as well as the Gentile di Puglia breed, with non-Merino breeds from the same geographic area were tested via the FST-outlier method. Signals observed using both methods were compared with genome-wide patterns of distribution of runs of homozygosity (ROH) islands. Novel and known selection signatures were detected. The most reliable signals were observed on OAR 3 (MSRB3 and LEMD3), OAR10 (FRY and RXFP2), OAR 13 (RALY), OAR17 (FAM101A), and OAR18 (NFKBIA, SEC23A, and PAX9). All the above overlapped with known QTLs for wool traits, and evidences from the literature of their involvement in skin/hair/wool biology, as well as gene network analysis, further corroborated these results. The signal on OAR10 also contains well known evidence for association with horn morphology and polledness. More elusive biological evidences of association with the Merino phenotype were observed for a number of other genes, notably LOC101120019 and TMEM132B (OAR17), LOC105609948 (OAR3), LOC101110773 (OAR10), and EIF2S2 (OAR17). Taken together, the above results further contribute to decipher the genetic basis underlying the Merino phenotype.

Introduction RNA polymerase III (Pol III)-related leukodystrophies are a group of autosomal recessive neurodegenerative disorders caused by mutations in POLR3A and POLR3B. Recently a recessive mutation in POLR1C causative of Pol III-related leukodystrophies was identified. Methods We report the case of a Tunisian girl of 14 years of age who was referred to our department for evaluation of progressive ataxia that began at the age of 5. Genetic diagnosis was performed by NGS and Sanger analysis. In silico predictions were performed using SIFT, PolyPhen-2, and Mutation Taster. Results Neurological examination showed cerebellar and tetrapyramidal syndrome, mixed movement disorders with generalized dystonia and severe myoclonus leading to death at 25 years. Brain MRI scans showed diffuse hypomyelination associated with cerebellar atrophy. It also showed bilateral T2 hypointensity of the ventrolateral thalamus, part of the posterior limb of the internal capsule, the substantia nigra and the subthalamic nucleus. Next generation sequencing leukodystrophy panel including POLR3A and POLR3B was negative. Sanger sequencing of the coding regions of POLR1C revealed a novel homozygous mutation. Conclusion The clinical and imaging findings of patients with POLR1C hypomyelinating leukodystrophy are reviewed. Interestingly, severe myoclonic dystonia and T2 hypointensity of the substantia nigra and the subthalamic nucleus are not reported yet and could be helpful for the diagnosis of POLR1C hypomyelinating leukodystrophy.

The effect of prolificacy on mother–young mutual recognition is still largely unknown in sheep. The aim of the present study was to investigate the ability of prolific ewes to develop an exclusive bond with their neonate and to recognize each other from alien subjects. Observations were performed on 11 D’man and 16 Romanov ewes with, respectively, 19 and 37 of their lambs. Maternal selectivity was tested at 24 h postpartum during two consecutive periods of 3 min. All mothers accepted their own lambs at suckling, while 21 out of 27 (78%) rejected the alien, thus displaying mostly selective nursing. To assess mother–young recognition, a two-choice test was performed at 36 h postpartum. Ewes clearly preferred their own lambs to an alien lamb and behavioral differences were not found between mothers of small (singletons and twins) and large litters (triplets and quadruplets). Romanov ewes reached their own lambsmore rapidly and spent more time near them than D’man ewes. Lambs from small litters, in particular light lambs, clearly preferred their mothers to an alien dam; however, both light and heavy lambs in large litters did not discriminate between the two stimulus ewes. D’man lambs clearly preferred their mothers to an alien dam; in contrast, such a preference was not as clearly demonstrated in Romanov lambs.

Les encéphalites limbiques autoimmunes (ELAI) sont sous diagnostiquées chez l’enfant. Les aspects neuroradiologiques de ces affections peuvent être déroutantes. Rapporter les aspects neuroradiologiques des ELAI dans une série hospitalière d’enfants tunisiens. Il s’agit d’une étude rétrospective (2004–2016) ayant inclus tous les enfants porteurs d’ELAI confirmée par le dosage d’anticorps correspondant, et suivis au service de neurologie de l’enfant et de l’adolescent (Tunis). Les données de l’IRM encéphalique ont été analysées et discutées. Dix enfants (4 garçons/6 filles) ont été inclus. L’âge moyen était de 8 ans. Les crises épileptiques et la détérioration cognitive étaient présentes chez tous les patients. L’IRM encéphalique était anormale dans 7/10 cas: des hypersignaux T2 et FLAIR hippocampiques, des pédoncules cérébelleux, du tronc cérébral et des noyaux gris dans 3/10 cas respectivement. Les anticorps en cause étaient des anti-NMDA (7/10 cas) et des anti-Ma2 (3/10 cas). Notre cohorte reflète l’hétérogénéité neuroradiologique au cours des ELAI. Les hyper signaux T2 et FLAIR au niveau du lobe temporal, représentent les anomalies les plus fréquentes. L’atteinte de la fosse postérieure chez nos patients est exceptionnelle et assez déroutante. Ces anomalies à l’IRM encéphalique sont inconstantes d’où l’intérêt de la confrontation clinico-radiologique et la recherche d’anticorps antineuronaux. L’élargissement du spectre des ELAI chez l’enfant et leur hétérogénéité clinico-radiologique doivent être pris en considération afin de réduire l’errance diagnostique et d’optimiser la prise en charge thérapeutique.

Les accidents vasculaires cérébraux (AVC) constituent un mode de révélation des vascularités du système nerveux central (VSNC). Leurs aspects clinico-radiologiques sont méconnus dans la population pédiatrique tunisienne. Rapporter les caractéristiques clinico-radiologiques et évolutives des AVC secondaires aux VSNC dans une série hospitalière d’enfants tunisiens. Il s’agit d’une étude rétrospective (2004–2016) ayant inclus tous les enfants présentant un AVC secondaire à une VSNC et suivis au service de Neurologie de l’Enfant et de l’Adolescent de l’Institut National Mongi Ben Hmida de Neurologie de Tunis. Une IRM encéphalique a été réalisée chez tous les patients. Les données clinico-radiologiques, biologiques et évolutives ont été analysées. Six enfants (3 garçons/3 filles) ont été inclus. L’âge moyen était de 8 ans. Le tableau clinique était dominé par un AVC ischémique dans le territoire sylvien (5/6 cas). L’IRM encéphalique a montré des lésions d’âges différents avec un aspect grêle de l’artère sylvienne (5/6 cas) et en chapelet de l’artère carotide interne (1/6 cas). Les étiologies étaient dominées par les vascularités systémiques (3/6 cas). L’évolution était marquée par une épilepsie séquellaire dans 2/6 cas. Notre étude reflète la fréquence de l’AVCI comme signe majeur des VSNC. L’imagerie encéphalique (IRM, angiographie conventionnelle) constitue l’examen clé du diagnostic positif. Les étiologies sont réparties en vascularites monophasiques souvent dues aux infections et chroniques (primitives du SNC ou systémiques). Le traitement et l’évolution dépendent de l’étiologie et de la précocité du traitement étiologique. L’AVC ischémique constitue le signe le plus fréquent aux cours des VSNC de l’enfant. Un bilan étiologique exhaustif permet d’instituer un traitement adapté et précoce afin d’améliorer le pronostic.

Le syndrome de régression caudale est un syndrome malformatif rare, associant à des degrés variables une agénésie des vertèbres sacrées et coccygiennes avec un raccourcissement du fémur et des anomalies génito-urinaires et cardiovasculaires. Son étiopathogénie demeure inconnue. Le diabète maternel et la prédisposition génétique seraient des facteurs étiologiques probables. L’imagerie est la clé du diagnostic positif. Elle est représentée par l’échographie en anténatal et par l’imagerie par résonance magnétique (IRM) après la naissance. Étude rétrospective incluant deux patientes ayant été explorées par IRM cérébro-médullaire (3-Tesla). L’âge de nos patientes était de 3 et 7 ans. Une patiente avait une dérivation ventriculo-péritonéale pour une hydrocéphalie. La symptomatologie clinique était variable associant une encoprésie et une énurésie primaire dans un cas et un retard psychomoteur dans un autre cas. L’imagerie par résonance magnétique a permis de poser le diagnostic d’une agénésie caudale chez les deux enfants. Elle a montré également une sténose associée de l’aqueduc de Sylvius chez l’une de nos patientes. L’IRM est l’examen de choix à réaliser en cas de suspicion d’un syndrome d’agénésie caudale. Elle permet d’effectuer un bilan lésionnel complet et précis des différentes malformations vertébrales, médullaires et cérébrales associées.