Epidemiological profile of burns in children in central and southern Tunisia: A 67-case series.

INTRODUCTION: Burns are among the most frequent injuries in children. They are a major cause of morbidity and mortality in low- and middle-income countries. This study aimed to describe the epidemiological aspects of burns in this environment and to propose preventive measures. PATIENTS AND METHODS: A retrospective study was conducted between 1 January 2012 and 31 December 2013. It included children less than 16 years old who were hospitalized for burn injuries in our department. We adopted the hospitalization criteria proposed by the French Society for the Study and Treatment of Burns. The data were collected from medical records and concerned both patients and burn characteristics. RESULTS: We recorded 67 cases, with 44.7% under 4 years old and boys (61%) more involved than girls (39%). The incidence of burns peaked in winter (31%) and summer (27%). Burns occurred at home in 95% of the cases. Hot liquids were the leading cause of children's burns. The time lapse between the accident and admission to the hospital was less than 24h in 57% of the cases. The average total body surface area (TBSA) burned was 8.8%. Only five patients presented a TBSA≥20%. The depth of the burns was superficial second-degree burns in 59% of cases. The burn involved mainly the upper limbs (65%). The average length of the hospital stay was 20.5 days. Only one patient died from severe sepsis. CONCLUSION: The lack of specialized burn centers in Tunisia associated with the low socioeconomic level of our population worsened the outcome of pediatric burns. The best solution lies in prevention.

La particularité de cicatrisation des pertes de substance cutanées dans les brûlures électriques: notre expérience.

Electrical burns are a major cause of bodily harm due to the mechanism and effect of the lesions. This prompts us to study these lesions and their management in order to reduce the morbidity caused by this type of accident. We conducted a retrospective descriptive observational study of patients hospitalized for electrical burns. This study includes 23 patients. The average age was 25.74 years. The most common occurrence was a domestic accident in 13 cases (56.5%), a work accident in 8 cases (34.8%), and a road traffic accident in 2 cases (8.7%). Fasciotomy was performed on six patients: five had high voltage injuries. Necrosis excision was performed at 8.26 days ± 5.55 days. Seven amputations were performed including 6 at the upper limb. Twenty flaps were used on 12 patients. Locoregional flaps were performed for 15 zones, and distant flaps as a solution in the event of locoregional flap failure. Five cases had immediate reconstruction because of exposure of noble elements, 3 showing necrosis of the flap. The average healing time was 45 days. Seven patients who underwent a reconstruction by flap healed after this period. The main results of the study show that conventional emergency decompression does not appear to reduce the amputation rate, the use of local and locoregional flaps in the initial phase (<21 days) carries a significant risk of suffering and necrosis, and that antithrombotic prevention or the use of flaps does not seem to have an impact on healing delays.

Les complications de l'expansion cutanée dans le traitement des séquelles de brulures.

Tissue expansion in burn sequelae has been associated with high complication rates. A critical analysis of 8 years (2008-2015) of experience with 45 expanders placed in 31 consecutive burns sequelae was performed to identify those factors that predispose to complications. Major and minor complications occurred in 33.4% of procedures. The factor associated with a statistically significant increase in complications was limbs localization. In addition, complications were significantly more likely to occur within the second stage. Factors that did not influence complication rate included patient age, the volume of the expander, and aesthetic or functional indications.

Statistical versus artificial intelligence -based modeling for the optimization of antifungal activity against Fusarium oxysporum using Streptomyces sp. strain TN71.

A Streptomyces sp. strain TN71 was isolated from Tunisian Saharan soil and selected for its antimicrobial activity against phytopathogenic fungi. In an attempt to increase its anti-Fusarium oxysporum activity, GYM+S (glucose, yeast extract, malt extract and starch) culture medium was selected out of five different production media. Plackett-Burman design (PBD) was used to select yeast extract, malt extract and calcium carbonate (CaCO3) as parameters having significant effects on antifungal activity, and a Box-Behnken design was applied for further optimization. The analysis revealed that the optimum concentrations for the anti-F. oxysporum activity of the tested variables were yeast extract 5.03g/L, malt extract 8.05g/L and CaCO3 4.51g/L. Artificial Neural Networks (ANNs): the Multilayer perceptron (MLP) and the Radial basis function (RBF) were created to predict the anti-F. oxysporum activity. The comparison between experimental and predicted outputs from ANN and Response Surface Methodology (RSM) were studied. The ANN model presents an improvement of 14.73%. To our knowledge, this is the first work reporting the statistical versus artificial intelligence -based modeling for the optimization of bioactive molecules against mycotoxigenic and phytopathogenic fungi.

[Digital lengthening by gradual distraction]. / Les allongements digitaux par distraction progressive.

The authors report their experience of digital lengthening and analyze the indications and results of 12 cases performed over 13 years in the plastic and reconstructive surgery service of the Kassab institute. Distraction was performed using a mini-orthofix device. In majority of cases, the procedure was performed on young people, manual workers and victims of industrial accidents. The lengthened osseous segment was the 1st metacarpal in 7 cases, the proximal phalanx of the index in 3 cases, the 3rd metacarpal once and the proximal phalanx of the middle finger in one case. Gradual distraction at the rate of 0.25 to 0.5 mm/day was carried out in 10 cases using the procedure of "callotasis". In 2 cases the distraction was performed at a rate of 1 mm/day followed by bone graft. Callotasis allowed us to obtain an average lengthening of 17 mm (61.5%) in distraction of the phalanx, and 26 mm (63.3%) in distraction of the first metacarpal. This technique avoids the spontaneous shortening observed after the use of bone graft alone. Complications are relatively frequent but had little influence on the final result.

[Chondrosarcoma of the hand]. / Les chondrosarcomes de la main.

The authors report 5 cases of chondrosarcoma of the hand brought together over a period of 20 years. The series comprises 3 men and 2 woman of average age 42 years. In two cases the tumour arose from degeneration in a preexisting lesion of Ollier's disease. Diagnosis was made on clinical and radiological criteria. Confirmation of the diagnosis by histological examination proved to be difficult in 2 cases. The treatment was surgical, with ray amputation in 3 cases and curettage with bone graft in the other 2. None of the patients had a recurrence at 4.5 years mean follow-up.

[Carpal scaphoid chondroma complicated by fracture: a case report]. / Chondrome du scaphoïde carpien compliqué d'une fracture: à propos d'un cas.

The carpal scaphoid is an uncommon localization for chondroma. Ten cases have been reported in the literature. We report a new case of right carpal scaphoid chondroma complicated by fracture in a 30 year-old man. The diagnosis was strongly suggested by the computed tomography scan and confirmed at pathology examination of the operative specimen. Treatment consisted in tumor enucleation and a cortico-cancellous graft to fill the gap followed by plaster case immobilization. Clinical and radiological outcome was favorable.

Effect of positioning on the incidence of abnormalities of muscle tone in low-risk, preterm infants.

UNLABELLED: BACKGROUND. The preterm infant is subject to the force of gravity: when its body lies pressed against the mattress on which it is placed. AIMS: The purpose of this study was to investigate short-term effects of varied post-natal lying positions in order to prevent neuromuscular and postural abnormalities. METHODS: 60 low risk preterm infants of 31-36 weeks gestational age were enrolled for this randomised clinical trial. Initially each child underwent neurological and psychomotor assessments which included tonus and reflex protocols as well as behavioral, sensory motor and postural examinations. The lying positions of the treated group were varied (back, prone, and side) using a specially designed moldable mattress that maintained the functional position of the infant's body. The control group was placed on their stomachs, (the standard lying position used in 1994) with a standard orthopaedic bolster support under their hips. All infants underwent a second round of examinations upon discharge to assess any changes in neurological and psychomotor outcomes. RESULTS: The sensory-motor skills examinations showed significant abnormalities in the control group: (1) dominance of the extensor muscles due to muscle shortening, (2) hyper abduction and flexion of the arms, and (3) global neuromuscular rigidity. Psychomotor and neurological exams of the control and treatment groups showed delayed developmental muscular acquisitions for infants in the control group. CONCLUSION: Regular changes in posture, while retaining correct functional positions, allowed maintenance of normal neuromuscular and osteo-articular function and permitted the development of spontaneous and functional motor activity in low-risk perterm infants.

[Foreign bodies in the hand]. / Corps étrangers de la main.

The strange body at the hand level is frequent consultation pattern. Its extraction seems easy, however it's not. The authors reported one observation of the hand which is penetrated by a ig strange body. It's ablation is performed in a surgical room under anaesthesia, respecting the tension lines at the hand level and avoiding the nerves ramification of the cubital nerve that was hung by the harpoon.

[Treatment of pseudarthrosis of the carpal scaphoid bone by percutaneous pinning. Apropos of 74 cases]. / Traitement des pseudarthroses du scaphoïde carpien par enclouage percutané. A propos de 74 cas.

From 1985 to 1997, 74 patients was operated of scaphoid non union at the Kassab Institute by a percutaneous pinning as described by Galluccio. The average age is 30 years with an extreme from 17 to 48 years. Union was obtained after an average of two years and six months. In 12 cases the delay was superior than three years. Functionally, pain is a constant cause of consultations and the majority of patients presented a reduction of the mobility sector (80%) and the strength of grasp (70%). Anatomically, it is particularly a pseudarthrosis stage II a of Alnot, and type I b of our classification. An immobilisation post-operative during one month is the rule. The analysis of results at an average of four years, revealed 91% of clinical recovery. Radiographically, the union is obtained in 89% of cases. Our fails (11%), are explained by an inadequate mounting and particularly by the length of pseudarthrosis. Compared to other means of synthesis, the percutaneous pinning of Galluccio, is an inexpensive technique, easily and rapid, which permit to obtain an interesting results particularly in the recent pseudarthrosis (evolution delay below three years).

Effects of iontophoretically applied monoamines on somatosensory cortical neurons of unanesthetized rats.

The response of somatosensory cortical neurons to iontophoretic applications of monoamines was studied in unanesthetized rats. The animal's head was held in a stereotaxic apparatus by means of a painless head-restraining system implanted 8 days prior to the recording sessions. The electrodes consisted of a recording micropipette attached to a multibarreled iontophoresis micropipette. The electrode penetrations were reconstructed on camera lucida drawings of frontal brain sections. The percentage of cortical neurons responding to application of monoamines were 76% after noradrenaline, 58% after dopamine and 66% after serotonin. The differences observed among percentages of responses seemingly correlate with the relative abundance of terminal axons and receptors for each of the three monoamines in the somatosensory cortex. The vast majority of the responding neurons were inhibited by monoamines and this inhibitory effect was independent of the level of spontaneous activity. The depressant effect of the monoamines on glutamate and acetylcholine-evoked responses supports a modulatory role for these substances. Serotonin was the most potent, followed by noradrenaline and dopamine. The present study shows that when the influence of anesthesia is eliminated, the predominant effect of monoamines on cortical first somatosensory neurons is one of inhibition. These findings contrast with results obtained under some anesthetic conditions, as well as under in vitro conditions.