Epstein-Barr virus infection in gliomas.

PURPOSE OF THE STUDY: Epstein-Barr virus (EBV) has been involved in the development of some tumors, including Burkitt's lymphoma and Hodgkin's lymphoma. However, its potential role in glioma tumorigenesis remains debated. In this study, we investigated the EBV infection in gliomas from Tunisian patients. PATIENTS AND METHODS: We conducted a retrospective study of 112 gliomas on archival material. The EBV DNA sequence was analyzed by polymerase chain reaction (PCR). Latent membrane protein 1 (LMP1) was detected by immunohistochemistry. In situ hybridization was used to detect EBV encoded small RNA (EBER). Clinicopathological features were recorded. Survival analysis was carried out using the Kaplan-Meier method and the Log-Rank test to compare EBV-positive and EBV-negative patients. RESULTS: Overall, there were twenty-four EBV-positive gliomas (21.4%). EBV DNA was identified in 24 cases. LMP1 and EBER were detected in four EBV DNA-positive cases. All EBV-positive cases were glioblastomas multiforme (GBM). Median overall survival and recurrence-free survival of EBV-negative patients were better than those of EBV-positive patients (Log Rank p = 0.006). CONCLUSION: Altogether, these findings support the occurrence of EBV infection in Tunisian GBM. Furthermore, when compared to EBV-negative tumors, EBV infection seems to be associated with the worst patient prognosis. Advanced molecular studies are recommended to confirm these results and to shed further light on the potential role of EBV in these devastating tumors.

Interaction between canine and human visceral leishmaniases in a holoendemic focus of Central Tunisia.

Canine visceral leishmaniasis (CVL) is endemic in the Mediterranean basin. In Tunisia, CVL is spatially associated with human visceral leishmaniasis (HVL) affecting mostly children younger than 5 years old. In this study, seroprevalence of Leishmania infantum infection in dogs was assessed in highly endemic districts of the governorate of Kairouan where more than 50% of HVL cases in Tunisia were reported. An entomological investigation was also carried out in two endemic districts (Bouhajla and Haffouz) to assess sand fly fauna and infection status of sand flies with Leishmania. A total of 191 serum samples were collected from healthy dogs and tested for anti-L. infantum antibodies by indirect immunofluorescence antibody test (IFAT). Overall seroprevalence for L. infantum was 26.7% being highest among dogs in the district of Bouhajla (52.7%) and the lowest in the district of Chbika (5.2%). In dogs, seroprevalence did not differ significantly based on gender or age, with dogs younger than 1 year showing a higher seroprevalence compared to older dogs. These findings suggest strong force of infection in naïve animals in holoendemic regions leading to emerging high incidence of HVL. Concomitant to the high CVL prevalence observed in the Bouhajla district, a significantly high cumulative HVL incidence also was observed in this district. Phlebotomus perniciosus and Phlebotomus longicuspis were the most abundant sand fly species in Bouhajla and Haffouz districts. The rate of Leishmania-DNA infection in sand flies was 9.4%. This finding points to spatial correlation between the occurrence of disease in humans, a high rate of infection in dogs and a high abundance of P. pernicious and P. longicuspis. Thus, CVL is the main risk factor for transmission to humans and subsequently, it is an important parameter for controlling transmission to humans.

[Prognostic factors and survival of metastatic colorectal cancer in the Sousse University Hospital (Tunisia): comparative study of two treatment period of 200 patients]. / Facteurs pronostiques et survie des cancers colorectaux métastatiques au CHU de Sousse (Tunisie): etude comparative de deux périodes de traitement de 200 patients.

UNLABELLED: Between 1994 and 2005, 200 patients with metastatic colo-rectal cancers were treated in the Sousse CHU (Tunisia), we analysed two groups of patients, the group 1 was treated in the period after 1999 (N = 64), the group 2 was treated in the period between 1999 and 2005 (N = 136). PATIENTS AND METHODS: Mean age of the patients was 50 years, localisation of metastases was liver in 67.3% of cases, 23% of patients had multiple metastases, 44% of cases developed metastases after a median period of 11.4 months. All patients had received first line of chemotherapy, the regimen of chemotherapy was in the group 1, Fufol in the majority of cases (76%), the regimen of chemotherapy was in the group 2, simplified LV5FU2 associated to irinotecan in the majority of cases (83%), 28% of all patients received second line of chemotherapy. RESULTS: The median survival was 13.8 months in the group 1 and 19 months in the group 2. Overall survival rates at 2 years were 35% and 42% (p = 0.02) in group 1 and 2, respectively. Prognostic factors for a better survival using univariate analysis were: normal ACE (P < 0.01), normal liver analysis (P < 0.001), response after 3 cycles of chemotherapy (P < 0.0005), resection of liver metastases (P < 0.05). The multivariate analysis (cox model) revealed only one independent factor: radiologic response after 3 cycles of chemotherapy (P < 0.03). CONCLUSION: The prognostic of patients with metastatic disease is poor, although palliative chemotherapy after the recent advances and the use of new drugs have been shown to be able to prolong survival and to improve the quality of life over best supportive care. This study report amelioration of prognostic and survival of metastatic colorectal cancers in Tunisia.

[Chemotherapy-induced febrile neutropenia: about 200 episodes. Clinical, microbiological and therapeutic characteristics]. / Les neutropénies fébriles chimio-induites : à propos de 200 épisodes. Profil clinique, microbiologique et thérapeutique.

Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.

Particularites du cancer du sein dans le centre tunisien

Il s'agit d'une etude retrospective a propos 1135 cas de cancer du sein colliges dans le centre tunisien sur une periode de 12 ans (janvier 1990 a decembre 2001). L'age moyen des patientes etait de 49;6 ans. La taille tumorale clinique moyenne etait de 49;9 mm; 43des tumeurs etaient classees T2; 50des patientes avaient une adenopathie axillaire homolaterale et 17presentaient une metastase d'emblee. Le taux de survie a 5 ans etait de 66et la survie moyenne de 43;7 mois. Les facteurs pronostiques significatifs etaient : le delai de consultation; la taille tumorale; l'atteinte ganglionnaire; les metastases; le stade T4d; le type histologique de la tumeur primitive; le grade SBR; les embolies vasculaires et lymphatiques; la rupture capsulaire et le traitement conservateur