Bioconversion of alperujo into an alternative feed for ruminants by pretreatment with live yeasts and/or exogenous fibrolytic enzymes.

Extraction of olive oil through a two-stage centrifugation process produces a large amount of phytotoxic waste known as alperujo. This research was performed to bioconvert alperujo into enriched ruminant feed by pretreatment with exogenous fibrolytic enzymes (EFE) or/and live yeasts (LY). These additives were used in a completely randomized design with 3 EFE doses (0, 4, and 8 µl/g dry matter) and 3 LY doses (0, 4, and 8 mg/g dry matter) in a 3 × 3 factorial arrangement. Fermented alperujo with both EFE doses converted some of their hemicellulose and cellulose to simple sugars and increased bacterial abundance in the rumen. As a result, it shortens the lag time of rumen fermentation, increases the rate and amount of rumen fermentation, and improves digestibility. This improvement provides additional energy that can be used by ruminants to produce milk and by rumen microbiota to produce short-chain fatty acids. Fermented alperujo with a high dose of LY decreased their antinutritional compounds and reduced their high content of lipid. In the rumen, this waste became rapidly fermentable, and rumen bacteria became more abundance. Fermented alperujo with a high dose of LY + EFE accelerated rumen fermentation and improved rumen digestibility, energy available for milk production, and short-chain fatty acids compared to the use of LY or EFE alone. This synergistic interaction between these two additives increased protozoa abundance in rumen and the ability of rumen microbiota to bioconvert ammonia-nitrogen to microbial protein. Ultimately, fermentation alperujo with EFE + LY is a good strategy with minimum investment for a social sustainable economy and environment.

Study of the influence of exogenous fibrolytic enzyme additive on chemical composition, fermentation characteristics, and nutritional value of brewer's spent grain.

This study explores the influence of different doses of two exogenous fibrolytic enzyme (EFE) additives (liquid (EFE1: 1, 2, and 4 µΙ/g DM (dry matter)) and powder (EFE2: 1, 2, and 4 mg/g DM)) on the chemical composition, fermentation characteristics, and nutritional value of brewer's spent grain (BSG). The results indicate that EFE1 at low doses does not affect the chemical composition, fermentation characteristics, and the nutritional value of BSG. The medium dose EFE1 decreases the fiber compound but increases the nonfiber carbohydrates (NFC) and soluble dry matter. Also, this dose modified the fermentation of BSG by increasing the amount of gas and its fermentation rate and decreasing the time between the inoculation and start of fermentation. Therefore, it increases the digestibility, metabolizable energy, net energy-lactation (NEL), total volatile fatty acids, and the microbial crude protein production of BSG. The high dose of EFE1 decreases the fiber compound and increases the nonfiber carbohydrates and soluble dry matter; however, it also decreases the potential of gas production and does not affect the nutritional value of BSG. For EFE2, all the doses do not modify the chemical composition, fermentation characteristics, and the nutritional value of BSG. These results suggest that the effectiveness of EFE varied, depending on the type of EFE and dose. Increase in the nutritional value of BSG by EFE1 at the medium dose can encourage breeders to use these wastes as feed at low cost in cow nutrition.

In vitro study on the effects of exogenic fibrolytic enzymes produced from Trichoderma longibrachiatum on ruminal degradation of olive mill waste.

Olive mill waste is low-quality feed and rarely used in ruminant nutrition because of its high lignocellulose content, the existence of anti-nutritional factors such as total polyphenol and condensed tannin, and low protein contents. This in vitro research was conducted to valorize this waste (crude olive cake, extracted olive cake, and olive leaves) using an exogenous fibrolytic enzyme produced from Trichoderma longibrachiatum in ruminal nutrition. The enzymatic activity of this additive was 1161 units of endoglucanase per millilitre, 113 units of exoglucanase per millilitre, and 2267 units of xylanases per millilitre. This treatment was applied by spraying substrates with four doses: 0 (control), 1 (low), 2 (medium), and 4 µ L g - 1 µ L g - 1  (high) of dry matter olive mill waste in an air-conditioned room at 26  ∘ C for 12 h before in vitro incubation. For the crude olive cake, this additive at high doses increased degradation of 14 % of cellulose and 8 % of hemicellulose compared with the control at 12 h before the in vitro incubation. Consequently, it increased dry matter solubility and reduced sugars at this period compared to the control. Upon ruminal incubation, the high dose of exogenous fibrolytic enzyme increased the gas production from the immediately soluble fraction and insoluble fraction, the rate of gas production for the insoluble fraction, the dry matter degradability by 26 %, the organic matter degradability by 24 %, the metabolizable energy value by 28 %, and the microbial crude protein production by 24 % compared with the control. For olive leaves, an exogenous fibrolytic enzyme at medium dosage can also hydrolyse the hemicellulose compound, release fewer sugars, and increase dry matter solubility compared with the control at 12 h before the in vitro incubation. Upon in vitro incubation, the medium dose increased the gas production from immediately soluble and insoluble fractions, the rate of gas production for the insoluble fraction, the dry matter degradability by 13 %, the organic matter degradability by 11 %, the metabolizable energy value by 12 %, and the microbial crude protein production by 12 % compared with the control. However, the highest dose altered the gas production from insoluble fractions and decreased microbial crude protein production by 6 % compared with the control. Under the same conditions, an exogenous fibrolytic enzyme applied to extracted olive cake did not produce any effect in the chemical composition and nutritional value. These results showed clearly that effectiveness of exogenous fibrolytic enzyme varied with incubated waste. Increasing the nutritional value of crude olive cake and olive leaves using an exogenous fibrolytic enzyme can encourage breeders to use this waste as feed at a low cost in animal nutrition. This valorization of waste is a good solution to reduce pollution of soils and groundwater caused by throwing out this polluted waste into the environment.

Influence of adding fibrolytic enzymes on the ruminal fermentation of date palm by-products.

This study was conducted in order to assess the influence of four doses (0, 0.5, 1, and 2 mg (g dry matter) - 1 of commercial fibrolytic enzymes (MAXFIBER-I ® , SHAUMANN GmbH, Wahlstedt, Germany) on in vitro fermentation of date palm (Phoenix dactylifera) by-products: date kernels, wasted dates, floral stems, and palm fronds. Rumen contents were obtained from two non-lactating Holstein cows. Enzyme supplementation to by-products was carried out 12 h prior to incubation. Compared to the control, the enzymatic supplementation quadratically increased the extent but not the gas production rate of date kernel fermentation. Indeed, the potential gas production increased notably by 14.8 % with the lowest enzymes dose following recorded gas production after 48, 72, and 96 h of incubation. The estimated organic-matter digestibility, metabolisable energy, and total volatile fatty acids in the incubation fluid tended to be increased with the lowest dose by 7.8 %, 8.4 %, and 13.9 % respectively. For the wasted dates, this feed additive tended to linearly increase the gas production rate of fermentation with the highest dose. On the other hand, this supplementation had no effect on the ruminal fermentation of the floral stems and palm fronds. The exogenous fibrolytic enzymes were more effective on fibrous but not on lignified date palm by-products.

Cutaneous adverse drug reactions in children. A series of 90 cases.

BACKGROUND: Cutaneous adverse drug reactions (CADR) are frequent in children. They have different clinical presentations and may be caused by several drugs. AIM: To evaluate the epidemioclinical features of cutaneous adverse drug reactions (CADR) and the different causative drugs in a Tunisian paediatric series. METHODS: We have retrospectively included 90 children (under 16 years old) with a well documented cutaneous drug reaction, seen in the Department of Dermatology of Charles Nicolle hospital of Tunis over 18 years (1991-2008). Age, gender, duration of skin disorders, type of cutaneous lesions, incriminated drugs, delay between drug consumption and eruption, validation by the national pharmacovigilance centre, treatment and outcome were recorded. RESULTS: Our patients were 6.9 year-aged (sex-ratio M/F 1.19). They had maculopapular eruption (MPE) (57.7%), acute urticaria (16.6%), fixed drug eruption (14.4%), erythema multiform (2.2%), photosensitization (1.1%) or severe cutaneous drug reactions (10%).Incriminated drugs were: Antibiotics (55.5%), non-steroidal antiinflammatory drugs (18.8%), antiepileptics (11.1%), and analgesics (5.5%). Betalactamins were the most commonly incriminated antibiotics (32 out of 50 patients; 64%). Barbiturates were the most commonly incriminated anti-epileptics (7/90 cases, 7.7%). Favourable outcome was noted in all patients, even those with severe drug reactions. CONCLUSION: MPE to antibiotics were the most common kinds of CADR in children. Drug responsibility should be based on solid criteria given the frequency of MPE of infectious origin and the frequent prescription of antibiotics in paediatric population.

Postvaccination morphea profunda in a child.

We report a new case of postvaccination morphea profunda (MP) in a child and discuss its different clinical presentations, prognosis, and therapy and its relationship with "solitary morphea profunda." A 2-year-old healthy girl presented with an induration of the anterior aspect of the left thigh of 9 months duration. The lesion had appeared 3 months after a third dose of diphtheria-tetanus-pertussis vaccine. Cutaneous examination showed an induration of 7 × 7 cm with an "orange peel" texture after pinching the skin. Histologic examination confirmed the diagnosis of MP. Systemic steroids (1 mg/kg/day) led to the stabilization of the lesion. After 4 months of treatment, we began the concomitant use of oral methotrexate (10 mg/wk) for 2 months. Methotrexate was then continued alone for 10 months, leading to a significant regression of the induration with no relapse.

A delayed diagnosis of lepromatous leprosy: pitfalls and clues to early recognition.

PURPOSE: To remind special attention to atypical symptoms of Hansen's disease, we report a case of an atypical case due to a delayed diagnosis. BACKGROUND: Clinical features of leprosy are well known, cutaneous lesions and involvement of the peripheral nerves being the cardinal clinical signs. Among these presentations, systemic involvement, including mucous membranes of the upper respiratory tract and eyes, is rarely reported even if it is still commonly seen in endemic areas, in particular lepromatous leprosy. CASE REPORT: We describe here a new case of Hansen's disease in a 51-year-old Tunisian woman with an atypical presentation and a delayed diagnosis. The early symptoms of the disease were different from the main clinical signs of Hansen's disease since they involved the upper respiratory tract and the eyes. A nasal smear was positive for acid-fast bacilli, thus confirming the diagnosis of bacilliferous leprosy. Histological findings suggested the diagnosis of leprosy and were somewhat more characteristic of the borderline lepromatous type. CONCLUSION: Diagnosis of Hansen's disease in patients with neither apparent skin lesions nor neurological signs is still problematic. Clinicians should not only pay attention to the more obvious signs in their own fields of expertise but should be aware of the possible systemic involvement of leprosy.

Chronic actinic dermatitis: two patients with successful management using narrowband ultraviolet B phototherapy with systemic steroids.

BACKGROUND: Chronic actinic dermatitis (CAD) is a debilitating photodermatosis with characteristic clinical, histological and photobiological features (reduced minimal erythema dose: MED). Its management involves various therapeutic approaches, among them there is phototherapy. Efficacy of psoralen ultraviolet therapy (PUVA therapy) was previously demonstrated but there are no current data on the use of narrowband ultra violet B (UVB) therapy (NB-UVB) in CAD. NB-UVB has already been proven to be effective and safe in several other photodermatoses. CASE REPORTS: We report here two dark-skinned patients (skin type IV and V) with CAD, successfully treated with an incremental regimen of NB-UVB phototherapy coupled to a 3 month-course of systemic steroids (1mg/Kg/day). CONCLUSION: Our protocol of NB-UVB with steroids seems to be effective for the management of CAD with a good short term safety profile.

Transient symptomatic zinc deficiency in a breast-fed infant: relevance of a genetic study.

OBJECTIVE: We present a case of acrodermatitis enteropathica in a full-term, breast-fed, 7-mo-old infant born from consanguineous parents with a family history of acrodermatitis enteropathica. METHODS: The patient presented with periorificial and symmetric acral lesions, which prompted us to review the clinical features of acrodermatitis enteropathica and its pathogenesis. Laboratory investigations showed low zinc levels in the infant's and mother's sera and in the mothers' milk. RESULTS: A diagnosis of acrodermatitis enteropathica was made. A mutation screening of the SLC39A4 gene in the patient and his mother showed heterozygosity for the deletion c.1223_1227delCCGGG. The diagnosis of transient symptomatic zinc deficiency was then established. CONCLUSION: Transient symptomatic zinc deficiency is generally reported in premature infants but should also be considered in full-term, breast-fed infants, as in the present case.

[Kindler syndrome: clinical and ultra-structural particularities, a propos of three cases]. / Le syndrome de Kindler, particularités cliniques et ultrastucturales à travers trois nouvelles observations familiales.

INTRODUCTION: Kindler's syndrome is a rare type of genetic skin condition belonging to the class of bullous poikilodermia. We report three new sibling cases of this rare syndrome. CASES REPORTS: The condition was seen in three sisters aged 12, 16 and 20 years, born of a first-degree consanguineous marriage with no family history of Kindler's syndrome. The three patients presented spontaneously regressive bullous eruptions, poikilodermia of gradual onset, major cutaneous atrophy on the back of the hands and the feet, photosensitivity and gingival hypertrophy. Electron microscopy examination of poikilodermic skin showed normal anchoring filaments and intraepidermal cleavage. DISCUSSION: Diagnosis of Kindler's syndrome is based upon clinical evidence. Kidler's syndrome is a well defined clinical entity. Ultra-structural studies show intraepidermal, junctional, and dermal cleavage. This syndrome must be differentiated from congenital epidermolysis bullosa, Weary's syndrome, and other bullous hereditary poikilodermas.

Erythema elevatum diutinum: an "idiopathic" case.

Erythema elevatum diutinum (EED) is a rare condition with an unclear pathogenesis. Initially classified within neutrophilic dermatoses, it is now considered as a leukocytoclastic vasculitis accordingly to its histopathologic pattern. Several clinical presentations as well as many associated diseases are reported in the literature. We report a new case of EED in a 58-year-old man who presented with a three-month history of plaques and nodules on the extensor surfaces of hands, elbows, knees, ankles, forearms, and buttocks. Histology showed a leucocytoclastic vasculitis, suggestive of the diagnosis of EED. Screening for an associated pathology, namely a paraproteinemia or a solid cancer, was negative. Treatment with dapsone leads to amelioration within few weeks.

Linear IgA bullous dermatosis in tunisian children: 31 cases.

BACKGROUND: Linear IgA bullous dermatosis (LAD) of children is relatively frequent in Africa. AIM: We undertook this study to evaluate the frequency of this disease among autoimmune bullous diseases (AIBDs) in Tunisian children. MATERIALS AND METHODS: We present a 32-year retrospective study (January 1976 to December 2007). Children with chronic acquired bullous diseases seen at the Charles Nicolle Hospital of Tunis and for who direct immunofluorescence (DIF) of the perilesional skin demonstrated linear IgA immunoglobulin deposits were included in the study population. RESULTS: Thirty-one children with LAD were selected representing 65.9% of all AIBDs of children selected in the same period, with a mean age of 5.5 years and a sex ratio (M/F) of 2.4. Most of the children had generalized eruption (28/31), more profuse on the face, pelvic region, buttocks and limbs. Mucosal lesions happened in only four children (12.9%). The mean duration of the disease was 14 months. DIF demonstrated linear IgA deposits along the dermal-epidermal junction in all patients. IgG, IgM, and complement were also seen (20/31). Indirect immunofluorescence was negative in 67% of cases. Eight patients responded to dapsone; however, prednisone had to be added in seven children to control the disease and erythromycin in four others. A long-term remission period was achieved in 76.1% of patients. CONCLUSION: This study confirms that LAD is the most common AIBD in children in Tunisia which frequently occurs in preschool-aged males. Independently of the used drug, a long-term remission is frequently observed.

Giant trichoblastoma of the scalp.

BACKGROUND: Trichoblastoma is a rare and benign adnexial tumor with characteristic histological features. It occurs on any hair folliclebearing location, and usually presents as a solitary lesion most often less than 2 cm in size. Giant trichoblastoma has been rarely reported in the literature. AIM: To report a new case of giant trichoblastoma, misleading for malignancy. CASE REPORT: A 57-year-old woman presented with a 5 cm-solitary asymptomatic nodular lesion of the scalp, of 28 years. It had been previously excised with recurrence and progressive regrowth. On examination, it was a dome-shaped, erythematous, firm, papillomatous, non infiltrated nodule. Full body work up revealed no metastases. Cutaneous biopsy concluded to trichoblastoma but failed to eliminate malignancy. After excision with secondary skin graft, histological examination confirmed the benignity with clear margins. There was no evidence of recurrence after a 5 year-follow-up period. CONCLUSION: This case illustrates a rare clinical variant of trichoblastoma with an unusual important size. This can be misleading for malignancy, but the slowly progressive course of the tumour in our patient, together with histological benignity led to the correct diagnosis. This tumour is considered as a distinct entity by some authors.

Chronic linear ulcerations of the inguino-crural and buttocks folds.

Vulvo-perineal Crohn's disease is a rare condition either when it is isolated or associated with digestive manifestations. In the former condition named metastatic Crohn's disease, it may constitute a diagnostic challenge and may be confused especially with other infectious or inflammatory disorders. We report a case of vulvo-perineal Crohn's disease in a 46-year-old woman. A 46-year-old woman was diagnosed with a vulvo-perineal Crohn's disease without digestive involvement. There was a chronic edema of the vulva with linear ulcerations on the inguino-crural regions and the buttocks fold, of 3 years. Treatment with metronidazole (1 g/day for 6 months) led to almost complete healing of the ulcerations with a sustained result. Physicians must be aware of the diverse manifestations and confusing presentations of vulvo-perineal Crohn's disease.

[Hydroxyurea induced-leg ulcer in polycythemia vera]. / Ulcère de jambe induit par l'hydroxyurée dans la cadre d'une thrombocythémie essentielle.

BACKGROUND: Hydroxyurea (HU) is an antineoplastic drug commonly used to treat chronic myeloproliferative disorders. Dermatological side effects are frequent and usually benign. Leg ulceration following HU therapy is less common. AIM: To describe epidemioclinical and therapeutic features of leg ulcers induced by HU. CASE REPORT: A 70-year-old woman is treated with hydroxyurea for polycythemia vera. One year later; she presented with a malleolar painful ulcer, initially healed without discontinuation of the treatment, but has been recurred 2 months later, becoming multiple and bilateral. HU has been discontinued and ulcers were completely cured. CONCLUSION: Leg ulcers induced by hydroxyurea are rare. Pathogenesis of HU-induced ulcers remains unknown and is multi factorial. Discontinuation of treatment is still the option of choice for complete recovery.