Model-based reconstruction of the Ulysse-Virginia oil spill, October-November 2018.

In response to the oil spill caused by the collision between the Ro-Ro ship Ulysse and CSL Virginia on 7th October 2018, the Lagrangian oil spill model MEDSLIK-II was utilized to predict spill transport and fate. Oil drift was forced by the high-resolution sea circulation provided by CMEMS and the ECMWF wind. Successive model runs were restarted 5 times with the distinct overflight- and satellite-derived observations provided by REMPEC and the Copernicus Sentinel-1 mission. The results were verified based on the ability to predict the first oil-beaching event that happened near Saint-Tropez (France) in the early afternoon of 16th October. Despite the general consistency among the runs, only the last initialization was able to forecast the oil beaching. Stochastic MEDSLIK-II simulations forced by the historical meteo-oceanographic datasets 2014-2018 revealed that the coastlines between Cap Lardier and the Gulf of Saint-Tropez were among the most impacted areas.

Timing of insulin basal rate reduction to reduce hypoglycemia during late post-prandial exercise in adults with type 1 diabetes using insulin pump therapy: A randomized crossover trial.

AIMS: To compare the efficacy of three timings to decrease basal insulin infusion rate to reduce exercise-induced hypoglycaemia in patients with type 1 diabetes (T1D) using pump therapy. METHODS: A single-blinded, randomized, 3-way crossover study in 22 adults that had T1D > 1 year and using insulin pump > 3 months (age, 40 ± 15 years; HbA1c, 56.3 ± 10.2 mmol/mol). Participants practiced three 45-min exercise sessions (ergocyle) at 60% VO2peak 3 hours after lunch comparing an 80% reduction of basal insulin applied 40 minutes before (T-40), 20 minutes before (T-20) or at exercise onset (T0). RESULTS: No significant difference was observed for percentage of time spent < 4.0 mmol/L (T-40: 16 ± 25%; T-20: 26 ± 27%; T0: 24 ± 29%) (main outcome) and time spent in target range 4.0-10.0 mmol/L (T-40: 63 ± 37%; T-20: 66 ± 25%; T0: 65 ± 31%). With T-40 strategy, although not significant, starting blood glucose (BG) was higher (T-40: 8.6 ± 3.6 mmol/L; T-20: 7.4 ± 2.5 mmol/L ; T0: 7.4 ± 2.7 mmol/L), fewer patients needed extra carbohydrates consumption prior to exercise for BG < 5.0 mmol/L (T-40: n = 3; T-20: n = 5; T0: n = 6) as well as during exercise for BG < 3.3 mmol/L [T-40: n = 6 (27%); T-20: n = 12 (55%); T0: n = 11 (50%)] while time to first hypoglycaemic episode was delayed (T-40: 28 ± 14 min; T-20: 24 ± 10 min; T0: 22 ± 11 min). CONCLUSION: Decreasing basal insulin infusion rate by 80% up to 40 minutes before exercise onset is insufficient to reduce exercise-induced hypoglycaemia.

Culture-independent genome sequencing of Coxiella burnetii from a native heart valve of a Tunisian patient with severe infective endocarditis.

We report draft genome of a Coxiella burnetii strain sequenced from the native valve of a patient presenting with severe endocarditis in Tunisia. The genome could be sequenced without a cellular or axenic culture step. The MST5 strain was demonstrated to be closely related to the published reference genome of C. burnetii CbuK_Q154.

Antepartum detection of macrosomic fetus: the effect of misdiagnosis.

AIM: To determine the effect of misdiagnosis of macrosomia on maternal and perinatal outcomes. METHODS: We conducted a retrospective study ,between January 2007 and December 2008 of women (n = 464) who delivered singleton neonates with actual birth weight over 4000g and in whom fetal weight was estimated, by both methods :sonographic and clinical, up to 3 days before delivery.Statistical comparisons were made between patients in whom fetal macrosomia was predicted : «prediction ¼ group (n=336)and those in whom it was not « non prediction ¼group (n=128) for outcome variables. RESULTS: The cesarean delivery was performed in 35.9% in « non predicted ¼ group, and in 35.7% in the « predicted ¼ group.The difference was not statistically significant. Failure to detect macrosomia was associated with higher rates of maternal and fetal complications in the group « non predicted ¼ compared with the group « predicted ¼ :perineal trauma,post partum hemorrhage, 5- minute Apgar scores less than 7, and shoulder dystocia, mostly related to the higher rate of surgical vaginal deliveries. CONCLUSIONS: The misdiagnosis of fetal macrosomia substantially did not modify the cesarean section rate but leads to increase the maternal and neonatal complications.

[The effect of apolipoprotein e polymorphism on plasma cholesteryl ester transfer protein activity in type 2 diabetic patients].

We studied the relationship between apo E polymorphism and cholesteryl ester transfer protein (CETP) activity in 127 type 2 diabetic patients who did not take lipid lowering drugs. Furthermore, we studied the relationship between apo E and CETP in modulating plasma triglyceride and HDL cholesterol. Apo E genotypes were determined by PCR-RFLP and CETP activity was measured using an exogenous way. Our results showed that the CETP activity increased significantly in E2 carrier group compared to E4 carriers and E3E3 homozygous (84.7 +/- 43.9 vs 62.5 +/- 35.9 vs 52.6 +/- 23.6 nmol CE/ml 2h respectively; p = 0.015). However, there was no association between apoE polymorphism and lipid parameter variations. Even after adjustment for CETP activity the results remained unchanged showing that CETP did not step in the relationship between apo E and lipid parameter variations. In conclusion there is an association between apo E polymorphism and CETP activity and this association did not affect the relationship between apo E polymorphism and triglyceride and HDL cholesterol concentrations.

Hyperhomocysteinemia and elevated ox-LDL in Tunisian type 2 diabetic patients: role of genetic and dietary factors.

INTRODUCTION: Total plasma homocysteine (tHcy) is an emerging risk factor for the development of atherosclerosis. However, its relationship with diabetes is still unclear. OBJECTIVES: We evaluated the association between tHcy levels and methylenetetrahydrofolate reductase (MTHFR) 677C-->T genotype in a type 2 diabetes mellitus (DM) population and their relationship with oxidized LDL (ox-LDL) according to dietary habits and vascular complications. DESIGN AND METHODS: Eighty-six DM patients were compared to 120 healthy volunteers. RESULTS: Associated higher tHcy levels and significantly higher ox-LDL levels (p<0.001) were found in DM patients compared to healthy subjects. Homozygosity for the T allele of MTHFR was more frequent in diabetics than in healthy subjects (12.8% vs. 7.2%) and it was associated with higher tHcy levels. Moreover, this elevated level was associated with significantly higher ox-LDL levels in DM patients with hypertension (p<0.05). Improving folate and vitamin C intakes could have beneficial effects on lowering the tHcy and ox-LDL levels. CONCLUSIONS: The interplay of genetic and dietary factors modulates the effect of homocysteine on cardiovascular risk factors.

[Paradoxal growth hormone and cortisol response to hypoglycemia caused by endogenous hyperinsulinemia: a case report]. / Inhibition paradoxale de la réponse somatotrope et corticotrope à l'hypoglycémie par hyperinsulinisme endogène: à propos d'une observation.

Growth hormone (GH) together with cortisol are two important counter-regulatory hormones maintaining normal glycemia. Hyperinsulinemic hypoglycemia is a disorder of this counter-regulation described in neonates. We report here a rare case of reversible dissociated hypopituitarism secondary to an insulinoma in a 38-year-old man referred for investigation of hypoglycemic episodes. Hormonal investigations were in favour of dissociated anterior pituitary failure, with growth hormone and corticotroph deficiency. The hypothalamic-pituitary MRI was normal. The fasting test argued in favour of a hyperinsulinemic hypoglycemia. The abdominal scan and the endoscopic ultrasound showed a mass within the tail of the pancreas. Distal pancreatectomy was performed. Histology disclosed an insulinoma. On follow-up, no hypoglycemic episodes recurred and cortisol and GH response to induced hypoglycemia was normal. Our clinical case shows that hyperinsulinemia and hypoglycemia in patients with insulinoma can give rise to functional growth hormone and corticotrophin deficiency. The pathophysiological mechanism of this defective counter-regulation remains to be clarified; some studies suggest it could be related to hyperinsulinemia-induced decreased in CRF secretion and GHRH pulse.

[Small-cell lung cancer and rapidly fatal nephritic syndrome]. / Carcinome à petites cellules du poumon et syndrome néphrotique d'évolution rapidement fatale.

Nephrotic syndrome due to membranous glomerulonephritis is observed in 1 to 3% of patients with lung cancer. The nephrotic syndrome usually precedes the discovery of the causal tumor, but diagnosis can be concomitant or during the disease course. We describe a case of small-cell carcinoma of the lung without metastases revealed by a paraneoplastic nephrotic syndrome. Complete remission of the tumor was achieved with chemotherapy and radiotherapy with resolution of the nephrotic syndrome, but tumor progression occurred together with rapidly fatal renal failure. In this case, and the review of the literature, illustrate the association between paraneoplastic nephrotic syndrome and lung cancer, as well as the disease course and prognosis of the lung cancer and the accompanying glomerulopathy.

[Massive hemoptysis: experience of a surgical unit]. / Hémoptysies massives: expérience d'une unité chirurgicale.

Massive hemoptysis is a clinical entity characterized by its unpredictable and potential lethal course. We studied retrospectively the observations of 25 patients hospitalized in our surgical unit. We collected all the demographic, clinical and surgical data. A male predominance with a sex-ratio of 2,1 was noted. The average age was 45 years, with extremes of 17 and 75. The dominant cause was bronchiectasis. Twenty patients were operated on. The surgery consisted of a pulmonary resection in 9 cases (45%), an atypical lung resection in 4 cases (20%), a resection of an aspergilloma in 2 cases (10%), a kystectomy of hydatic cyst in 4 cases (20%) and one arterial ligature (5%). Five patients (25%) had emergent surgery, and 15 (75%) delayed surgery. Hospital mortality was 20% in the first group and 6.66% in the second. No recurrence of bleeding was observed after an average follow-up of 7 months. Surgery remains a therapy of choice for massive hemopysis. It must as far as possible be avoided during active bleeding.

Association between dietary fat and antioxidant status of Tunisian type 2 diabetic patients.

BACKGROUND: The antioxidant enzymes: superoxide dismutase (Cu/Zn SOD) and glutathione peroxidase (GSH-Px) provide a defense against the damage of cells by reactive oxygen species, which increased in diabetic state. It was demonstrated that dietary treatment could improve the antioxidant status in patients with type 2 diabetes mellitus. This study was undertaken to determine if erythrocyte Cu/Zn SOD and GSH-Px activities correlate with dietary nutrients in 35 selected type 2 diabetic patients (21 women and 14 men) without diabetic complications. RESULTS: We found that erythrocyte Cu/Zn SOD was diminished in patients with poor controlled diabetes and GSH-Px activity was significantly decreased in obese compared with non-obese type 2 diabetic patients (1.07+/-0.87 and 2.36+/-1.99 U/ml, respectively; P=0.024). Both erythrocyte Cu/Zn SOD and GSH-Px activities were positively correlated to erythrocyte omega3-polyunsaturated fatty acids (PUFA). In non-obese diabetic patients, only GSH-Px activity was correlated negatively to the fraction of linoleic acid (18:2omega6) and arachidonic acid (20:4omega6) in erythrocytes phospholipids. CONCLUSIONS: The data of this study reveal that activities of erythrocyte antioxidant enzymes were altered in type 2 diabetic patients. Further studies are needed to determine if diet supplemented with omega3-PUFA is required to improve antioxidant defense system in diabetic state.

Modulation of plasma cholesteryl ester transfer protein activity by unsaturated fatty acids in Tunisian type 2 diabetic women.

BACKGROUND AND AIM: Type 2 diabetes mellitus is associated with atherosclerosis, which has been, in part, ascribed to abnormalities in the reverse cholesterol transport system. Among the key actors involved in this pathway is cholesteryl ester transfer protein (CETP) which mediates the transfer of cholesteryl esters (CE) from HDL to apoB-containing lipoproteins. METHODS AND RESULTS: The purpose of this study was to examine CETP activity in 220 patients with type 2 diabetes mellitus (type 2 DM) treated with diet alone or diet and sulphonylurea drugs and to identify the factors that may regulate it in the diabetic state. We also examined the effect of diet on the activity of plasma CETP in a subgroup of type 2 DM women. CETP activity was assessed by measuring plasma-mediated cholesteryl ester transfer (CET) between pooled exogenous HDL and apoB-containing lipoproteins. In 220 patients with type 2 DM, CET was significantly higher in conjunction with higher plasma triglycerides and lower HDL-cholesterol compared to 100 matched healthy controls. Correlation analysis showed that CETP activity was significantly correlated with the HDL-C to apoA1 ratio (r = -0.205, P = 0.003) and to LDL-C to HDL-C ratio in diabetic women (P = 0.010). Furthermore, CETP activity was correlated marginally with total energy intake (P = 0.052) but to a statistically significant extent with the amount of fat consumed daily (P = 0.008). A significant negative correlation was found between plasma CETP activity and MUFA of plasma phospholipids or free PUFA (P = 0.032), especially with omega3-fatty acids (P = 0.001). CONCLUSION: Our findings indicate that CET is accelerated in patients with type 2 DM and that this may be regulated by dietary fatty acids in the diabetic state.

[Corneal graft rejection: donor and receiver implication]. / Le rejet de greffe de cornée: implication du donneur et du receveur.

PURPOSE: The purpose of our study was to evaluate the relationship between corneal graft failure and different factors related to both donors and recipients. PATIENTS: and methods: We conducted a retrospective control study on cases treated from January 1998 to December 2000. All records for donors to the eye bank unit of the Sfax forensic medicine department and all records for penetrating keratoplasty operations done in the Sfax Ophthalmology department were reviewed. For every donor we specified age, sex, cause of death, time and corneal deduction technique, as well as storage delay. For every recipient we specified age, sex, keratoplasty indication, state of the cornea, type of anesthetics and intervention. We analyzed the factors for graft rejection taking into consideration all parameters related to donors and recipients using the chi square test, with alpha=0.01. We defined graft rejection as the irreversible corneal edema despite local or general treatment combining corticoids and antivirals. RESULTS: Of the 184 cases followed up, 22 cases (12%) of graft rejection were recorded. Concerning the donor, a statistically significant relation was found between young age and short storage time indicating an increase in the rate of graft rejection. The younger the patient was, the greater the risk, and the longer the tissue had been preserved, the lower the risk of rejection. For the recipient, old age, a history of graft rejection and the state of the receiver bed significantly increased the rate of graft rejection. In terms of surgical stage, the suturing technique and a graft diameter 8 mm or greater increased the rate of graft rejection. CONCLUSION: In addition to neovascularization of the corneal bed and a history of graft rejection, universally recognized as risk factors for transplant rejection, other parameters related to both donors and receivers, such as age, storage time, graft diameter, and suturing technique, must be taken into account in order to ensure the survival of the graft.

Association of plasma cholesteryl ester transfer protein activity and polymorphism with coronary artery disease extent in Tunisian type II diabetic patients.

INTRODUCTION: Cholesteryl ester transfer protein (CETP), a key protein in reverse cholesterol transport, has a controversial role in atherosclerosis. OBJECTIVES: : We investigated CETP activity and polymorphism in Tunisian type II diabetes and its relationship with coronary artery disease (CAD). DESIGN AND METHODS: 173 type II diabetic patients with or without CAD were compared to 67 controls. RESULTS: The HDL cholesterol concentration was low in a Tunisian population. The B1 allele of the CETP gene was associated with a low concentration of HDL cholesterol and was more frequent in Tunisians than in other populations. In type II diabetic patients, the B1 allele was associated with increased prevalence of CAD only in men (OR=0.357, CI=0.161-0.791, P=0.01). The CETP activity increased in type II diabetic patients compared to controls (P=0.05). Furthermore, the CETP activity was increased in patients with double or triple vessel disease compared to those with single vessel disease (P=0.025). CONCLUSIONS: Our data are in favour of an association between CETP and developing CAD, as well as the extent of CAD.

Lipids and lipoprotein(a) concentrations in Tunisian type 2 diabetic patients; Relationship to glycemic control and coronary heart disease.

The aim of this study was to evaluate plasma lipoprotein(a) [Lp(a)] concentrations in Tunisian patients with type 2 diabetes mellitus (DM), to correlate the values with other lipid parameters, and to examine the relationship to glycemic control and coronary heart disease (CHD). Diabetic patients with and without CHD (n=200) had significantly higher levels of Lp(a) (327.94+/-239.93 mg/l) and a greater proportion of elevated (>300 mg/l) Lp(a) concentrations (46%) compared with 100 healthy nondiabetic controls (269.83+/-225.6 mg/l, P<.01, and 26%, P<.01), while there were no statistically significant difference between diabetics without CHD (n=100) and controls. No significant association of Lp(a) with glycemic control (HbAlc or fasting blood glucose) was noted in diabetic patients. Positive correlations were observed between Lp(a) levels and total cholesterol and LDL-C in all diabetic patients and particularly in diabetic men. Male patients with CHD showed significantly higher plasma Lp(a) levels than those without CHD (P=.023), and 57.3% of patients with CHD showed increase (>300 mg/l) Lp(a) compared with 33.3% of patients without CHD. Elevated levels of Lp (a) and abnormal lipid profile in diabetic men suggest their involvement in atherogenesis and subsequent development of CHD.

[Lipoprotein (a) and ischemic heart diseases in patients with type 2 diabetes]. / Lipoprotéine (a) et cardiopathies ischémiques chez les patients diabétiques de type 2.

Lipoprotein (a) is a new independent coronary risk factor, but the role of lipoprotein (a) in type 2 diabetes remains controversial. The objective of this study was to demonstrate the relationship between the level of lipoprotein (a) and the coronary artery diseases (CAD) in type 2 diabetes. Recruitment was carried out in 3 groups of patients: Group 1: 110 control subjects, Group 2: 115 diabetics (D), Group 3: 105 diabetics with CAD (DC). The mean age was, 51 + 7; 52 + 6; 56 + 6 respectively. Total cholesterol, triglyceride, HDL-C, LDL-C, Apo A-I, Apo B and lipoprotein (a) were measured for the patients. The Lp (a) level was significantly higher in the diabetic groups as compared to the controls (p < 0.05), but this level was different between D and DC: 312 + 232 vs 347.8 + (NS). However, when the Lp (a) level is higher than 300 mg/ml, there is a significant difference between DC and D (53% vs 42% p = 0.05). There is no correlation between Lp level and total cholesterol; however, there is a significant variation of Lp (a) level with LDL-C (r = -0.14, P = 0.01). There is a negative correlation between Lp (a) and HDL-C (r = -0.13, p = 0.03), Lp (a) and ApoA-I (r = - 0.11, p = 0.05); but there is a positive correlation between Lp (a) and ApoB (r = 0.14, p = 0.02). Lp(a) level higher than 300 mg/L constitutes a coronary risk factor in type 2 diabetes. This contributes, with the other lipid disorders, to the increase of the coronary risk factors in diabetes.

[Effects of automobile lead on the general growth and sexual activity of the rat]. / Effets du plomb d'origine automobile sur la croissance générale et l'activité sexuelle du rat.

To identify the active element of automotive exhaust gas responsible for masculine infertility, previously proved by our laboratory, we undertook these experiments. Four hundred young male and female rats were exposed during two months (30 min/d) to three types of automotive exhaust gases. The first type emanated from an engine running on gasoline with lead, the second from an unleaded gasoline engine, the third from a diesel engine. These three engines had the same power (5 horsepower vehicles < 3.5 tons). For the first type of emissions, some lead deposits were found in the lungs by histologic techniques. This gas also induced in male rats the atrophy of the testicle, seminal vesicle and epididym, certain pathological changes in spermatogenesis shown by the histologic study, and a decrease of the serum's testosterone level. In female rats, the relative weights of the ovary and uterus, as well as the percentage of the arrival of oestrus, were not affected by the gaseous treatment. Both the second and third types of gases seemed less active on the masculine sex as far as these parameters are concerned. Our study suggests that, for light vehicles, leaded gasoline pollutes more than unleaded gasoline or diesel fuels, and that the lead present only in the first type would be the active element responsible for the masculine infertility and body weight gain reduction in rats.