Sweet or Bland Dreams? Taste Loss in Isolated REM-Sleep Behavior Disorder and Parkinson's Disease.

BACKGROUND: Hyposmia and isolated REM sleep behavior disorder are well-established features of prodromal Parkinson's disease (PD). OBJECTIVES: The objective of the present study was to evaluate whether taste loss (reported in PD and possibly suggesting brain stem involvement) is present at the isolated REM sleep behavior disorder stage. METHODS: We assessed taste function using the Taste Strip Test (evaluating 4 concentrations of bitter, sweet, sour, and salty) in 44 participants with isolated REM sleep behavior disorder, 19 with PD, and 29 controls. All participants underwent video-polysomnography, standardized questionnaires, and clinical examination, including olfactory assessment. RESULTS: Participants with isolated REM sleep behavior disorder and PD had lower taste scores than controls. There was no difference between isolated REM sleep behavior disorder and PD cohorts, nor was there any correlation between taste and olfaction, age, disease duration, cognition, or autonomic function. CONCLUSION: This study demonstrates for the first time the presence of taste impairment in isolated REM sleep behavior disorder that is independent of olfactory dysfunction and comparable to participants with PD. © 2021 International Parkinson and Movement Disorder Society.

Utilization of Wheat Bran Acid Hydrolysate by Rhodotorula mucilaginosa Y-MG1 for Microbial Lipid Production as Feedstock for Biodiesel Synthesis.

The lignocellulosic hydrolysate was used as the fermentation feedstock of Rhodotorula mucilaginosa Y-MG1 for the production of microbial lipids as the potential raw material for biodiesel synthesis. On synthetic media and under nitrogen-limiting condition, the Y-MG1 strain produces 2.13 g/L of lipids corresponding to 32.7% of lipid content. This strain was able to assimilate a wide range of substrates, especially C5 and C6 sugars as well as glycerol and sucrose. Fatty acid composition shows a divergence depending on the nature of used carbon source with a predominance of oleic acid or linoleic acid. An effective hydrolysis process, based on diluted acid treatment, was established for providing the maximum of fermentable sugars from different characterized lignocellulosic wastes. The highest yield of reducing sugars (56.6 g/L) could be achieved when wheat bran was used as the raw material. Hydrolysate detoxification step was not required in this study since the Y-MG1 strain was shown to grow and produce lipids in the presence of inhibitors and without the addition of external elements. Operating by controlled fed-batch fermentation yielded a dry biomass and oil yield of up to 11 g/L and 38.7% (w/w), respectively. The relative fatty acid composition showed the presence of increased levels of monounsaturated (66.8%) and saturated (23.4%) fatty acids in lipids of Y-MG1 grown on wheat bran. The predictive determination of biodiesel properties suggests that this oil may effectively be used for biodiesel production.

Triacylglycerols accumulation and glycolipids secretion by the oleaginous yeast Rhodotorula babjevae Y-SL7: Structural identification and biotechnological applications.

The newly isolated oleaginous yeast, Rhodotorula babjevae Y-SL7, was shown to accumulate high intracellular content of microbial oil (mainly triacylglycerols) and to secret, under the same culture conditions, an atypical glycolipid. This unusual behavior was induced when the strain was subjected to nitrogen limitation and high amount of carbon. A series of analytical methods was adopted in order to structurally characterize the secreted glycolipid. The latter consists of a mixture of 9 molecules formed by a polyol head group, bound through the carboxyl end of an acetylated 3-hydroxy fatty acid with C18 or C16 chain length. In addition of their physicochemical properties such as emulsifying activity on hydrophobic substrates, Y-SL7 glycolipids have shown a therapeutically promising cytotoxic effect against different cancer cell lines. In fact, Y-SL7 strain can be used for the production of triacylglycerols as energetic molecules and for the secretion of a biosurfactant of therapeutic and environmental interest.

[Orthodontic intrusion using mini-screws]. / Ingression orthodontique sur mini-vis d'ancrage.

INTRODUCTION: Dental intrusion has long been considered one of the most difficult movements to induce in orthodontics. Using conventional mechanics, the main difficulty lies in the need to ensure anchorage control, which is highly complicated to achieve, so as to avoid parasitic movements. In this framework, mini-screws have proven to offer a very effective means of anchorage, allowing greater control over intrusion of the anterior and posterior teeth and a simpler biomechanical movement opening up new therapeutic perspectives for the orthodontist. OBJECTIVE: The aim of this study was to describe the clinical and biomechanical application of mini-screws for dental intrusion.

Financing health care in Tunisia. Current state of health care expenditure and socialization prospects, on the road to Universal Health Coverage.

CONTEXT: As part of its strategy of Universal Health Coverage (UHC), Tunisia has calculated, after its revolution, its Health Accounts (HA), in a standardized and interdepartmental way. OBJECTIVES: Describe the current structure of care financing in Tunisia, through the HA reports, from 2012 to 2014, and assess its compliance with the principles of socialization of health insurance. METHODS: Crude data on health care expenditures were collected by a multi-departmental group that is responsible for calculating health accounts, using a methodology developed by WHO. On the basis of these data, a dozen of indicators that serve to monitor the financing of care, were determined, especially the proportion of public care expenditure (state and insurance), the proportion of direct payments of households in total care expenditure. and the share of expenses of the National Diseases Insurance Fund (CNAM) in the private sector. RESULTS: During the 2012-2014 trienniums, the total health expenditure represented 7% of GDP. Public expenditure on health care did not exceed 57% of the total health expenditure, which is 4% of GDP. Households paid directly, from their pockets, 39% of current care expenditures. About half of the expenses of the CNAM, was released for the reimbursement of consultations, explorations and hospitalizations in private clinics and medical needs (drugs and medical material) in private pharmacies. CONCLUSION: The financing of the post-revolution care system in Tunisia was characterized by a dangerous triad for its survival, performance and equity: excessive spending compared to the country's growth, a very high contribution of households exceeding the cutoff of "catastrophic" spending, and a marked shift in the social policy of the CNAM, in favor of the private sector. This profile, proof of low socialization of healthcare financing, would be a limiting factor in the implementation of the CSU strategy in Tunisia.

Private public partnership: a solution for the development of health system in Tunisia.

In a context of economic difficulties, the Tunisian government is required to find solutions to meet the expectations of the population. Health sector is one of the critical areas requiring radical reform. The objective of this paper is to find the place of public private partnership project in the harmonious development of both public and private sectors in Tunisia. Indeed, the Tunisian health system consists of two main sectors: the public sector, and the private sector, booming since the 90s. Tunisian infrastructure and staff resources distribution is characterised by a very significant regional disparity, to the detriment of the interior regions, which is more pronounced in the private sector. This area, considered innovative and responsive, captures the local wealthy clientele, and the foreign highly specialized care seekers. It wins over the best healthcare providers, inspite of some reported claims against pricing abuses leading to user's lack of confidence. As for the public sector under funded, handicapped by red tape and some forms of lack of transparency and lobbying, it can not cope with the influx of customers of poor and middle classes. The relationship between the two sectors misses often. The current challenge in the Tunisian health sector is how can public and private sectors combine and harmonize their efforts to achieve common interest objectives. The public-private partnership, is a process helping the state to involve private investors in the realization of public interest projects and develop long term contracts. So, the two sectors will share resources and technical expertise and will access to further advantages. However, it is essential to establish clear and effective legal and institutional frameworks governing private participation in the public sector.

Single cell oil production from a newly isolated Candida viswanathii Y-E4 and agro-industrial by-products valorization.

Microbial lipids have drawn increasing attention in recent years as promising raw materials for biodiesel and added-value compounds production. To this end, new oleaginous yeast, Candida viswanathii Y-E4 was isolated, characterized and used for single cell oil (SCO) production. Physiologic and nutritional parameters optimization was carried out for improved biomass and lipid production. Y-E4 strain was able to use a wide range of substrates, especially C5 and C6 sugars as well as glycerol and hydrophobic substrates. The fatty acid profile analysis showed that oleic acid was the main component produced using different substrates. Batch and fed-bath fermentation were conducted using glucose as carbon source. Lipid production rate is twice higher in fed-batch culture providing a lipid content of 50 % (w/w). To minimize the SCO production cost, C. viswanathii Y-E4 was evaluated for its capacity to use different agro-industrial by-products for microbial oil production and changes in the fatty acid profile were monitored.

Primary Burkitt lymphoma in the posterior mediastinum.

A 13-year-old boy was admitted to our hospital with complaints of posterior chest pain and dyspnea. Computed tomography and magnetic resonance imaging of the chest revealed a mass in the posterior mediastinum, extending from T8 to T11 with intraspinal involvement. A percutaneous core needle biopsy confirmed the diagnosis of Burkitt lymphoma. He was treated according to the Lymphoma Malignancy B protocol 2001 arm C3, but he presented with liver and brain relapses and died 7.5 months after admission. Although lymphoma is rarely localized in the posterior mediastinum, it should be considered in the differential diagnosis of posterior mediastinal masses in children.

Impact of breast cancer stage, time from diagnosis and chemotherapy on plasma and cellular biomarkers of hypercoagulability.

BACKGROUND: In breast cancer patients routine thromboprophylaxis is not recommended but individualized risk assessment is encouraged. The incorporation of hypercoagulability biomarkers could increase the sensitivity of risk assessment models (RAM) to identify patients at VTE risk. To this aim we investigated the impact of cancer-related characteristics on hypercoagulability biomarkers. METHODS: Thrombin generation (TG) assessed with the Thrombogramme-Thrombinoscope®, levels of platelet derived microparticles (Pd-MP) assessed with flow cytometry, procoagulant phospholid dependent clotting time (PPL-ct) measured with a clotting assay and D-Dimers (were assessed in a cohort of 62 women with breast cancer and in 30 age matched healthy women. RESULTS: Patients showed significantly higher TG, Pd-MP, D-Dimers levels and shortened PPL-ct compared to the controls. The PPL-ct was inversely correlated with the levels of Pd-MP, which were increased in 97% of patients. TG and D-Dimers were increased in 76% and 59% of patients respectively. In any stage of the disease TG was significantly increased as compared to the controls. There was no significant difference of TG in patients with local, regional of metastatic stage. There was no significant difference in Pd-MP or Pd-MP/PS+ between the subgroups of patients with local or regional stage of cancer. Patients with metastatic disease had significantly higher levels of Pd-MP and Pd-MP/PS+ compared to those with regional stage. The D-Dimers increased in patients with metastatic stage. In patients on chemotherapy with less than 6 months since diagnosis TG was significantly higher compared to those on chemotherapy who diagnosed in interval > 6 months. Patients with metastatic disease had significantly higher levels of Pd-MP and D-Dimers compared to those with non-metastatic disease. CONCLUSION: In breast cancer patients the stage, the time elapsed since the diagnosis and the administration of chemotherapy are determinants of cellular and plasma hypercoagulability. The levels and the procoagulant activity of Pd-MP are interconnected with the biological activity and the overall burden of cancer. TG reflects the procoagulant properties of both breast cancer and chemotherapy in the initial period of cancer diagnosis. Thus the weighted incorporation of the biomarkers of cellular and plasma hypercoagulabilty in RAM for VTE might improve their predictive value.

[Study of a Tunisian population of children with learning disorders]. / Etude d'une population tunisienne d'enfants en difficultés scolaires.

BACKGROUND: Learning disorders are increasingly a concern for Tunisians parents. These difficulties are divided into two groups: specific learning disabilities and non-specific learning disorders. AIM: Our work is part of a federated research project. Our aim is to determine the incidence, etiology and management of learning disorders in the region of Sfax. METHODS: We conducted a descriptive cross-sectional study on a population of 304 children assessed by their teachers as having academic difficulty. A multidisciplinary assessment including a neurological examination, an assessment of score of intelligence and language assessment has been performed for 209 children. RESULTS: Referring to our sample, learning disorders affect 21.3% of children in the region Sfax. The frequency of specific learning disorder is estimated at 10.3% (reading disorder 5.9%, dyscalculia 2.4%, reading disorder associated with dyscalculia 2%). Non-specific learning disorders were found in 11% of children. Etiologies in this group were dominated by mental retardation (2.1%), inappropriate education (2.3%). CONCLUSION: Our study revealed the high frequency of learning difficulties. It allows us to distinguish between specific learning disabilities and non specific learning disorders secondary to neurological or precarious socio-economic conditions. However, the profile and severity of specific learning disorders could not be studied due to the lack of standardized Arabic tests in Tunisia. In countries with a lack of professional and specialized unit care as in Tunisia, reading interventions in school should be proposed. Only children with remaining difficulties after this training will be sent to specialized professionals.

A novel mutation in FGD4/FRABIN causes Charcot Marie Tooth disease type 4H in patients from a consanguineous Tunisian family.

Charcot-Marie-Tooth (CMT) disease constitutes a clinically and genetically heterogeneous group of hereditary neuropathies characterized by progressive muscular and sensory loss in the distal extremities with chronic distal weakness, deformation of the feet, and loss of deep tendon reflexes. CMT4H is an autosomal recessive demyelinating subtype of CMT, due to mutations in FGD4/FRABIN, for which nine mutations are described to date. In this study, we describe three patients from a consanguineous Tunisian family, presenting with severe, early onset, slowly progressive, autosomal recessive demyelinating CMT, complicated by mild to severe kyphoscoliosis, consistent with CMT4H. In these patients, we report the identification of a novel homozygous frameshift mutation in FGD4: c.514_515insG; p.Ala172Glyfs*27. Our study reports the first mutation identified in FGD4 in Tunisian patients affected with CMT. It further confirms the important clinical heterogeneity observed in patients with mutations in FGD4 and the lack of phenotype/genotype correlations in CMT4H. Our results suggest that FGD4 should be screened in other early-onset CMT subtypes, regardless of the severity of the phenotype, and particularly in patients of consanguineous descent. In Tunisians, as in other populations with high consanguinity rates, screening of genes responsible for rare autosomal recessive CMT subtypes should be prioritized.