Cyclophosphamide and horse anti-thymocyte globulin versus fludarabine, reduced cyclophosphamide and rabbit anti-thymocyte globulin conditioning regimen for allogeneic hematopoietic stem cell transplantation from matched sibling donors in patients with acquired aplastic anemia.

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for acquired aplastic anemia (acquired AA) in young patients. The objective of the study was to compare patient outcomes after Cyclophosphamide and horse antithymocyte globulin (Cy-hATG) versus Fludarabine-cyclophosphamide and rabbit ATG (Flu-Cy-rATG) as part of conditioning regimen in allo-HSCT for acquired AA. RESEARCH DESIGN AND METHODS: Descriptive retrospective study conducted on patients with acquired AA who received allo-HSCT from HLA-matched sibling donors between January 2008 and August 2022 after conditioning regimen with Cy-hATG or Flu-Cy-rATG. RESULTS: A total of 121 patients were enrolled. Cumulative incidence of graft failure was 11.2% in Cy-hATG and 5.3% Flu-Cy-rATG group. There were no significant differences between the two groups in terms of acute GVHD, chronic GVHD and transplant related mortality. Flu-Cy-rATG group was associated with significantly higher CMV and EBV reactivation(s) compared to Cy-hATG group (p = 0.008 and 0.035, respectively). After a median follow-up of 58 months, estimated overall survival, event-free survival and graft rejection-free survival were not statistically different between the two groups. CONCLUSIONS: In high-risk population, Flu-Cy-rATG is associated with comparable outcomes to Cy-hATG in allo-HSCT from MSD. However, it seems to be associated with significant risk of viral infections.

Pre- and Post-treatment Serum BAFF Levels and BAFF Gene Polymorphisms in Patients with Graves' Disease.

BACKGROUND: B cell activating factor (BAFF), a crucial factor for B cell survival and differentiation, has been linked to several autoimmune conditions. The aim of this study was to evaluate the association of BAFF gene's polymorphisms with its serum levels and to assess their effect on Graves' disease (GD) susceptibility and presentation. METHODS: Sixty-two GD patients and 152 healthy controls have been enrolled to investigate BAFF rs9514827 (-2841 T/C), rs1041569 (-2701 T/A) and rs9514828 (-871 C/T) gene's polymorphism by PCR-RFLP and serum BAFF level's kinetics under medical treatment by ELISA. RESULTS: Median serum BAFF level at baseline was significantly higher in GD patients (841.7 pg/ml [685.23-1058.32]) comparatively to controls (495.75 pg/ml [383.17-595.7]), p = 7.29 E-25. A ROC curve was used to assess BAFF performances in GD diagnosis and revealed an AUC of 94.9% [0.919-0.979], p = 7.29 E-25. At a cutoff value of 654.9 pg/ml of BAFF at baseline, the sensitivity and the specificity were, respectively, 83.9% and 90.8%. BAFF level was significantly increased in smoking patients (1079.55 pg/ml [875.35-1203]) comparatively to nonsmokers (746.95 pg/ml [643.2-915.7]), p = 3.1 E-5. While -2841 T/C and -2701 T/A genotypes and alleles frequencies were similar between patients and controls, the -871*T allele was significantly more prevalent in patients (0.613) than in controls (0.477); p = .01, OR [95% CI] = 1.73 [1.13-2.65]. The three studied polymorphisms were not associated with serum BAFF level at baseline. CONCLUSION: Serum BAFF level is significantly increased in GD especially in smoking patients. rs9514828 - 871*T allele might be a susceptibility variant for GD.

Vitamin B12 levels in type 2 diabetic patients on Metformin compared to those never on Metformin: a cross sectional study in Tunisia.

INTRODUCTION: Recent studies suggest that long-term use of metformin may decrease the plasma level of Vitamin B12. AIM: To assess the Vitamin B12 status in Tunisian patients treated with metformin and to study its association with the dose, the duration of metformin use, and the clinical and biological parameters. METHODS: It was a cross-sectional, comparative study on 200 type 2 diabetic (T2D) patients. A vitamin B12 assay was performed with a neurological examination and a Complete blood count. RESULTS: The mean level of Vitamin B12 assayed in our population was 398.5±188.3 pg/ml. The serum Vitamin B12 levels were 356.9±153.5 pg/ml in the metformin group and 460.9±218.6 pg/ml in the no metformin group (p <0.01). Metformin intake was associated with an increased prevalence of Vitamin B12 deficiency and borderline level. The level of Vitamin B12 was correlated with the duration and the dose of metformin. Vitamin B12 deficiency was significantly associated with anemia, macrocytosis, and diabetic neuropathy. Multivariate analysis concluded that Vitamin B12 deficiency was significantly associated with the duration, cumulative metformin dose, clinical neuropathy, anemia, and macrocytosis. CONCLUSION: Our study showed an association of Vitamin B12 deficiency with the dose and duration of metformin intake in Tunisian T2D patients, with hematological and neurological repercussions.

Synchronous parathyroid carcinoma and papillary thyroid carcinoma.

The simultaneous occurrence of parathyroid carcinoma and nonmedullary thyroid carcinoma is unusual. We report the case of 60-year-old woman who was found to have concurrent parathyroid carcinoma with severe clinical manifestations of primary hyperparthyroidism in addition to an incidental papillary thyroid carcinoma. Parathyroid hormone level was 569 pg/ml (normal range 10-65), and the serum calcium concentration was 13.83 mg/dl (normal range, 8.8-10.4). Preoperative investigation found a large 3 cm anterior cervical nodule suggestive of parathyroid adenoma. Total thyroidectomy and left parathyroidectomy were performed, and the final anatomopathological examination of the operative specimen concluded the coexistence of papillary microcarcinoma and parathyroid carcinoma. Although parathyroid carcinoma is an uncommon cause of hypercalcemia, it should be considered when severe hypercalcemia is observed, and in case of coexistence of thyroid nodules. The possibility of both malignancies must also be considered since parathyroid and nonmedullary thyroid carcinoma rare cases have previously been reported.

Langerhans Cell Histiocytosis of the Thyroid Leading to the Diagnosis of a Disseminated Form.

Langerhans cell histiocytosis (LCH) is a rare sporadic proliferative disorder of Langerhans cells. LCH rarely involves the thyroid gland. We report herein a case of a disseminated chronic form of LCH with a diagnosis established by histological examination of the thyroid gland. It is about a 37-year-old female who underwent total thyroidectomy for a thyroid nodule of the right lobe. Histological study showed a granulomatous thyroiditis, and the immunohistochemistry study revealed a strong positivity of histiocytes for the CD1 antigen and for the S100 protein. The incidence of LCH involving the thyroid gland, either as an isolated lesion or as a part of multisystemic disease, is extremely rare.

Occurrence of halogenated flame retardants in sediments and sea urchins (Paracentrotus lividus) from a North African Mediterranean coastal lagoon (Bizerte, Tunisia).

Classic (polybromodiphenyl ethers, PBDEs) and emerging halogenated flame retardants (HFRs) such as hexabromobenzenze (HBB), pentabromoetilbenzene (PBEB), decabromodiphenyl ethane (DBDPE) and halogenated norbornenes (HNs), as well as naturally produced methoxylated-PBDEs (MeO-PBDEs), were analyzed in 12 sediment and 30 urchin (Paracentrotus lividus) samples collected from Bizerte Lagoon in northern Tunisia. Levels of HFRs in the sediments ranged from nd to 51.8 ng/g dry weight (dw), while MeO-PBDEs were not detected. As regards levels in urchins, concentrations of PBDEs, HNs and MeO-PBDEs ranged from 3.67 to 56.9, 4.52 to 116 and nd to 364 ng/g lipid weight (lw), respectively. Thus, levels of naturally occurring compounds were higher than those of an anthropogenic origin. As regards HFRs, the highest contribution comes from HNs with levels ranging between 9.98 and 143 ng/g lw. HN and PBDE concentrations in sea urchin are similar or slightly lower than other reports for other species, while total MeO-PBDE concentrations are higher. The comsumption of sea urchins in Bizerte city is not a threat to public health concerning PBDE intakes.

Optimization of Hydrothermal and Diluted Acid Pretreatments of Tunisian Luffa cylindrica (L.) Fibers for 2G Bioethanol Production through the Cubic Central Composite Experimental Design CCD: Response Surface Methodology.

This paper opens up a new issue dealing with Luffa cylindrica (LC) lignocellulosic biomass recovery in order to produce 2G bioethanol. LC fibers are composed of three principal fractions, namely, α-cellulose (45.80% ± 1.3), hemicelluloses (20.76% ± 0.3), and lignins (13.15% ± 0.6). The optimization of LC fibers hydrothermal and diluted acid pretreatments duration and temperature were achieved through the cubic central composite experimental design CCD. The pretreatments optimization was monitored via the determination of reducing sugars. Then, the 2G bioethanol process feasibility was tested by means of three successive steps, namely, LC fibers hydrothermal pretreatment performed at 96°C during 54 minutes, enzymatic saccharification carried out by means of a commercial enzyme AP2, and the alcoholic fermentation fulfilled with Saccharomyces cerevisiae. LC fibers hydrothermal pretreatment liberated 33.55 g/kg of reducing sugars. Enzymatic hydrolysis allowed achieving 59.4 g/kg of reducing sugars. The conversion yield of reducing sugar to ethanol was 88.66%. After the distillation step, concentration of ethanol was 1.58% with a volumetric yield about 70%.