Positive urine culture prior to transrectal prostate biopsy was not associated with infectious complications development.

OBJECTIVE: Prostate cancer is one of the most common cancers worldwide. Its histological diagnosis is based on prostate biopsy. The transrectal procedure is one of the most common procedures performed by urologists. Although it is considered safe, post-biopsy infectious complications are frequently observed in practice. The aim of this study is to investigate the value of urine culture before the transrectal biopsy. Secondly, we assessed potential risk factors for infectious complications following TR-PB. METHODS: We performed a retrospective analysis of all patients who underwent urine culture tests before transrectal prostate biopsy between January 2019 and July 2020. The inclusion criteria for the study were all indications for prostate biopsy (PSA>4ng/mL or abnormal digital rectal examination). Baseline characteristics and the incidence of post-biopsy urinary tract infection were compared between patients showing positive pre-biopsy culture results and those showing negative findings. Multivariate logistic regression analyses were used to determine risk factors for infectious complications following TR-PB. RESULTS: Out of 163 patients included in our study, 19 patients (11.65%) had positive urine culture results before the biopsy. Age (P=0.068); history of hospitalization (P>0.999), history previous of quinolone use (P=0.75), history of UTI (P=0.64); median PSA level at diagnosis (P=0.267); prostate volume (P=0.78); post-void residual volume (P=0.374); percentage of patients testing positive for cancer on biopsy (P=0.81); and percentages of patients with a history of biopsy (P=0.889), diabetes mellitus (P=0.524), hypertension (P=0.714) and immunosuppressive medication use (P>0.999) were similar between the two groups. One patient in the positive urine culture group had post-biopsy prostatitis. However, 3.24% (five patients) of the negative urine culture group had the disease (P=0.789) (four patients with prostatitis and one with epididymitis). Among them, four patients were diagnosed by urine culture at the time of post-biopsy urinary tract infection. Multivariate logistic regression analysis demonstrated that history of hospitalization and history of previous quinolone use were risk factors for infection after transrectal prostate biopsy. CONCLUSION: Our study suggests that systematically performing urine cultures before transrectal prostate biopsy does not reduce the rate of infectious complications after biopsy. Positive pre-biopsy cultures were not associated with the development of post-biopsy infectious complications.

Metachronous isolated locally advanced pancreatic metastasis from chromophobe renal cell carcinoma.

INTRODUCTION: Metastasis to the pancreas is relatively uncommon occurrence. Isolated pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare and it's usually seen in clear cell renal cell carcinoma (CCRCC), but its occurrence from chromophobe renal cell carcinoma (chRCC) is extremely rare, due to its relatively low-grade metastatic potential. PRESENTATION OF CASE: The authors report an unusual case of metachronous isolated pancreatic metastasis, in a 65-year-old female patient two years after left nephrectomy for chRCC, diagnosed during routine surveillance imaging and confirmed after a CT-guided pancreatic biopsy. DISCUSSION: The pancreas is an elective site for metastases from RCC, and this particularity has been reported by several studies, but only described for CCRCC. In the English literature there is only one case of pancreatic metastasis from chRCC diagnosed in an autopsy study. Surgical resection of metastasis remains the most effective treatment, particularly for pancreatic metastases from chRCC, since radiotherapy, chemotherapy, hormonal therapy, and targeted therapy have generally proved ineffective for metastatic chRCC. In case of an unresectable disease, surgical or endoscopic palliation in association with palliative chemotherapy can improve the quality of life but not survival. CONCLUSION: This case highlights the unique behavior of chRCC with an unusual site of metastasis, and the necessity of long-term follow-up after primary tumor removal, even if it is known for a low-grade metastatic potential and a relatively good prognosis.

[Do the nephrolithometry scoring systems predict the success of percutaneous nephrolithotomy. Comparison of 4 scores: The Guy's stone score, STONE Score, CROES nomogram and S-ReSC score]. / Les scores radiologiques peuvent-t-ils prédire le succès de la NLPC ? Étude comparative du Guy's stone score, du STONE score, du CROES nomogram, et du S-ReSc score.

INTRODUCTION: The aim of the study is to investigate the factors predictive of surgical outcomes of PCNL and to compare the predictability and accuracy of the Guy's stone score, STONE nephrolithometry, CROES nomogram and S-ReSC score. PATIENTS AND METHODS: We reviewed retrospectively the surgical outcomes recorded consecutively and imaging data of preoperative computed tomography scans of patients who underwent PCNL from 2013 to 2016. Patients with asymptomatic residual fragments<4mm were considered stone-free. Preoperative abdominopelvic computerized tomography images of the patients were reviewed and scored according The Guy's stone score, STONE nephrolithometry, CROES nomogram, S-ReSC score by one urologist. RESULTS: A total of 157 PCNLs were reviewed. The overall stone-free rate was 59% (92/157) with a complication rate of 22% (35/157). Stone Burden<542mm3 is significantly associated with stone-free rate (SFR) (P=0.001). On univariate analysis, all the scoring systems were identified as significant factors in terms of SFR. The Guy's Stone Score, the CROES score and the S-ReSC score were associated with complications (P<0.02). The multivariate logistic regression analysis showed that the CROES score was identified as a significant factor in terms of SFR and complications (P<0.01). The area under the receiver operating characteristic (ROC) curves for stone burden, the Guy's, STONE score, CROES core and S-ReSC scores showed good results (0.737/0.674/0.762/0.746/0.710) respectively. CONCLUSION: Although the four scoring systems were significantly associated with SFR, the STONE score was a significant predictive factor for SFR and complications after PCNL. LEVEL OF EVIDENCE: 3.

Retroperitoneal extra-adrenal non-Hodgkin lymphoma: An uncommon presentation.

Primary retroperitoneal non Hodgkin lymphoma is extremely rare, its diagnosis is often difficult and it may requires a time consuming and a costly diagnostic workup. We report the case of a 46-year-old patient complaining of abdominal fullness and dorsal pain, who was diagnosed with an extra-nodal non-Hodgkin lymphoma presenting as a unique and large retroperitoneal mass. The suggested diagnosis was a malignant retroperitoneal tumor and the patient underwent an excision of the tumor throw a lombotomy followed by an R-CHOP chemotherapy regimen with good outcome.

Antioxidant effect of hydroxytyrosol on human sperm quality during in vitro incubation.

The aim of the study was to evaluate the antioxidant potential of hydroxytyrosol (HT) on human sperm quality during incubation in vitro. Semen samples collected from men attending the Laboratory of Histology-Embryology of Sfax Faculty of Medicine (Tunisia) for infertility investigations were evaluated for initial sperm parameters. Only normal selected ejaculates (n = 15) were centrifuged and incubated further with or without HT (200ug ml-1 ) at room temperature for 45 min. After incubation, sperm motility and viability, DNA oxidation and reactive oxygen species (ROS) production were assessed. The results showed that centrifugation significantly influenced sperm motility and viability. The supplementation of HT in incubating media improved (P = 0.01) significantly sperm viability and decreased sperm DNA oxidation (P < 0.001) and ROS levels (P = 0.03) following centrifugation. It can be concluded that supplementation of HT might be helpful to maintain the human spermatozoon after centrifugation.

[Pneumocystis: epidemiology and molecular approaches]. / Pneumocystis : épidémiologie et approches moléculaires.

Pneumocystosis is a common opportunistic infection in immunocompromised patients, especially in AIDS patients. The diagnosis of this pneumonia has presented several difficulties due to the low sensitivity of conventional staining methods and the absence of culture system for Pneumocystis. The molecular biology techniques, especially the PCR, have improved the detection of DNA of this fungus in invasive and noninvasive samples, and in the environment which highlighted human transmission and the existence of environmental source of Pneumocystis. In addition, various molecular biology techniques were used for typing of Pneumocystis strains, especially P. jirovecii, which is characterized by a significant genetic biodiversity. Finally, the widespread use of cotrimoxazole for the treatment and prophylaxis of pneumocystosis has raised questions about possible resistance to sulfa drugs in P. jirovecii.

A comparison of capillary electrophoresis and direct sequencing in upstream conserved sequence region analysis of Pneumocystis jirovecii strains.

The major surface glycoprotein (MSG) of Pneumocystis jirovecii is the most abundant surface protein and appears to play a critical role in the pathogenesis of pneumocystosis. The expressed MSG gene is located immediately downstream of a region called the upstream conserved sequence (UCS). The UCS contains a region of tandem repeats that vary in number and sequence. In the present study, we have used capillary electrophoresis and direct sequencing to detect the variability in the repeat units of UCS. By direct sequencing the PCR products from samples of 13 patients, we have identified three types of repeat units which consisted of 10 nt and three different patterns in the UCS region with three and four repeats: 1, 2, 3 (84.6 %); 1, 2, 3, 3 (8.2 %); and a new genotype 2, 2, 3, 3 (8.2 %). The same samples were analysed by capillary electrophoresis. Three samples (23 %) contained a mixture of two or three different patterns of UCS repeats. In conclusion, quantifying the number of repeat units in the UCS by capillary electrophoresis provides a potential new method for the rapid typing of P. jirovecii and the detection of mixed infection.

Pathogenic free-living amoebae: epidemiology and clinical review.

Free-living amoebae are widely distributed in soil and water. Small number of them was implicated in human disease: Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris and Sappinia diploidea. Some of the infections were opportunistic, occurring mainly in immunocompromised hosts (Acanthamoeba and Balamuthia encephalitis) while others are non opportunistic (Acanthamoeba keratitis, Naegleria meningoencephalitis and some cases of Balamuthia encephalitis). Although, the number of infections caused by these amoebae is low, their diagnosis was still difficult to confirm and so there was a higher mortality, particularly, associated with encephalitis. In this review, we present some information about epidemiology, ecology and the types of diseases caused by these pathogens amoebae.

Candida glabrata strain relatedness by new microsatellite markers.

We investigated six microsatellite markers to type 85 unrelated and 118 related isolates of Candida glabrata from 36 patients. Three new markers were selected from the complete sequence of CBS138 and three previously described markers, RPM2, MTI and ERG3 were used. We found a genetic diversity of 0.949 by combining four of them. By applying the new microsatellite markers GLM4, GLM5 and GLM6 we were able to discriminate 29 isolates, originally identified by the more established markers, RPM2, MTI and ERG3. When epidemiologically closely related isolates from 36 patients were typed, 25 patients (72%) exhibited identical or highly related multilocus genotypes. We noted a microvariation in 4 of the patients. This minor change of one locus could be explained by a single step mutation. Since one of these patients had not received antifungal treatment; thus, the relationship between genome variation and antifungal therapy remains controversial. We can conclude from our analysis of these new microsatellite markers that they are highly selective and therefore should be considered as a useful typing system for differentiating related and unrelated isolates of C. glabrata, as well as being able to detect microvariation.

The CAG repeat polymorphism of mitochondrial polymerase gamma (POLG) is associated with male infertility in Tunisia.

Male fertility largely depends on sperm quality, which may be affected by environmental and genetic factors. Recent data emphasised the implication of the polymorphism of mitochondrial DNA polymerase gamma (POLG) CAG repeats in male infertility. In this report, we explored a possible role of the (POLG) gene polymorphism in male infertility in Tunisian men. The polymorphic CAG repeat in the nuclear POLG gene was studied in 339 male subjects (216 patients with infertility (69 azoospermic, 115 oligoasthenoteratospermic and 32 normospermic) and 123 fertile) after DNA amplification by PCR, followed by genotyping using an automatic sequencer. The heterozygous and the homozygous mutant genotypes (10/ ≠ 10 and ≠ 10/ ≠ 10) were significantly more frequent among infertile patients than among fertile controls (11.2% versus 1.6%, P = 1.3 × 10(-3) and 4.6% versus 0.8%, P = 4.2 × 10(-7) respectively). We also found a significant difference between the frequencies of 10/ ≠ 10 genotype in azoospermic (4.4%) and in oligoasthenoteratospermic (15.6%) infertile patients (P = 2.6 × 10(-2) ). However, the homozygous mutant genotype (≠ 10/ ≠ 10) was seen at similar frequencies in azoospermic, normospermic and oligoasthenospermic men (4.4%, 3.1% and 5.2% respectively). Under our conditions, the findings showed an association between POLG CAG repeat polymorphism and male infertility in Tunisian population.

Pemphigus vegetans: a clinical, histological, immunopathological and prognostic study.

BACKGROUND: Pemphigus vegetans (P Veg) is a rare clinical form of pemphigus. Studies on P Veg are rare in the literature and none has so far evaluated the prognostic parameters. OBJECTIVE: In this retrospective study of P Veg, we aimed to analyse epidemiological, clinical, immunopathological and therapeutic data. Study of prognostic factors with accuracy of patient survival was also carried out. METHODS: This is a retrospective study (1981-2009) including 17 cases of P Veg. Statistical analysis was performed with chi-square and Fisher tests looking for a possible relationship between clinical data and prognostic factors. Follow-up time and disease-free survival time were estimated using Kaplan-Meier methods. Clinical data were evaluated in univariate analysis looking for a significant association with survival. Equality of survival distribution was studied using log rank test. RESULTS: The hospital prevalence of P Veg was 0.084‰ with a frequency of 9.1% among pemphigus. The mean age at onset was 47.6 years, with a sex-ratio (F/M) about 4.66. Neumann P Veg was the predominant clinical form (11/17). Clinically, the lesions were multifocal (16/17), prevailed on folds and mucous membranes. Under corticosteroids the mean period for healing was 24 ± 9 days. During the follow-up time, three patients died and 11 patients relapsed. Median of overall relapse-free survival was 13 ± 1.7 months. No significant association between clinical data and prognostic factors was found. LIMITATIONS: This study was a retrospective chart analysis and the number of patients was small. CONCLUSION: The P Veg seems to be more frequent in Tunisia with high rate of mortality.

First environmental isolations of Cryptococcus neoformans and Cryptococcus gattii in Tunisia and review of published studies on environmental isolations in Africa.

Cryptococcus neoformans and Cryptococcus gattii are pathogenic yeasts that cause cryptococcosis. These fungi were commonly associated with pigeon droppings and plant materials. The habitat of these pathogens has not been yet studied in Tunisia, although the ecology of these yeasts must be elucidated in order to establish surveillance programs and to prevent infections. The aim of this survey was to recover C. neoformans and C. gattii environmental isolates from pigeon droppings and plant materials in different areas of Sfax region, Tunisia. Nine hundred and fifty samples from leaves, wood, flowers, fruits and soil around trunk bases of 40 almond (Prunus dulcis) and 60 eucalyptus trees were collected as well as 250 pigeon droppings samples from different sites: buildings (n = 150), houses (n = 50) and zoo (n = 50). The identification of Cryptococcus neoformans complex was confirmed using the ID32C auxanogram panel (BioMérieux, Marcy l'Etoile, France); species were determined by multiplex PCR using the CN70 and CN49 primers, and mating type was determined by PCR. C. neoformans was recovered from 26 specimens of pigeon droppings (10.4%). This yeast was obtained more frequently from dry droppings (9.2%) than from moist droppings (1.2%). The mating type was determined. All the 31 environmental strains of C. neoformans and C. gattii were MATα. Out of 700 samples tested from 100 trees, only 5 isolates of Cryptococcus neoformans species complex were recovered (0.6%), two isolates of C. gattii and one isolate of C. neoformans were recovered from the wood of E. camaldulensis trees, and only two isolates of C. gattii were recovered from the wood of almond trees (Prunus dulcis Mill. var. zaaf and var. achek). These two Tunisian almond tree varieties were recorded for the first time in Africa as hosts for C. gattii. These results add new information to the ecology and epidemiology of C. neoformans species complex in Tunisia.