Search results for: Hanen Mrabet

Authors: Hanen Ghabi, Youssef Oudhini, Hassen Mnif

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By reference to recent publications dealing with the same problem, and as a follow-up to this research work already published, we propose in this article a new original idea of tele supervision exploiting the opportunities offered by the DVB-H system. The objective is to exploit the RF channels of the DVB-H network in order to insert digital remote monitoring images dedicated to a remote solar power plant. Indeed, the DVB-H (Digital Video Broadcast-Handheld) broadcasting system was designed and deployed for digital broadcasting on the same platform as the parent system, DVB-T. We claim to be able to exploit this approach in order to satisfy the operator of remote photovoltaic sites (and others) in order to remotely control the components of isolated installations by means of video surveillance.

Keywords: video surveillance, digital video broadcast-handheld, photovoltaic sites, AVC

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Authors: Ferjani Hanen, El Arem Amira, Boussema Ayed Imen, Bacha Hassen

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Tacrolimus (TAC), a calcineurin inhibitor, is clinically used as an immunosuppressive agent in the transplant recipient, but its use associated-hepatotoxicity. Mycophenolate mofetil (MMF), an anti-metabolite, is a potent immunosuppressive drug. MMF is not hepatotoxic and is the most common adjunctive immunosuppressant for TAC. The effects of TAC and MMF combination in the liver is still not well understood. This work aimed to investigate their combined effect against in liver in rats Wistar after 24 h. The oral median lethal doses (LD50) of TAC and MMF alone were evaluated in rats are 240 mg/kg and 500 mg/kg respectively. Oral administration of the MMF at 50 mg/kg to male Wistar intoxicated with TAC at 60 mg/kg, demonstrated a significant protective effect by lowering the levels of hepatic markers enzymes (AST, ALT) in the serum rat. MMF attenuated oxidative stress by restoring the activities of SOD, CAT and by reducing the malondialdehyde (MDA) and protein carbonyl levels liver. This study provided evidence that MMF protects rat liver from TAC-induced injury and suggests a most combination use for organ transplantation.

Keywords: tacrolimus, mycophenolate mofetil, combination, liver, rat

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Authors: S. Kassou, R. El Mrabet, A. Belaaraj, P. Guionneau, N. Hadi, T. Lamcharfi

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The organic–inorganic hybrid perovskite-like [C₆H₅C₂H₄NH₃]₂ZnCl₄ (PEA-ZnCl₄) was synthesized by saturated solutions method. X-ray powder diffraction, Raman spectroscopy, UV-visible transmittance, and capacitance meter measurements have been used to characterize the structure, the functional groups, the optical parameters, and the dielectric constants of the material. The material has a layered structure. The optical transmittance (T %) was recorded and applied to deduce the absorption coefficient (α) and optical band gap (Eg). The hybrid shows an insulator character with a direct band gap about 4.46 eV, and presents high dielectric constants up to a frequency of about 10⁵ Hz, which suggests a ferroelectric behavior. The reported optical and dielectric properties can help to understand the fundamental properties of perovskite materials and also to be used for optimizing or designing new devices.

Keywords: dielectric constants, optical band gap (eg), optical parameters, Raman spectroscopy, self-assembly organic inorganic hybrid

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Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

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Authors: Lolwa Alansari, Abdelhamid Azhaghdani, Sufia Athar, Hanen Mrabet, Annaliza Cruz, Tamara Alshadafat, Almunzer Zakaria

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Introduction: Improving the patient experience is a fundamental pillar of healthcare's quadruple aims. Recognizing the importance of patient experiences and perceptions in healthcare interactions is pivotal for driving quality improvement. This abstract centers around the Patient Experience Program, an endeavor crafted with the purpose of comprehending and elevating the experiences of patients in the Obstetrics & Gynecology Emergency Department (OB/GYN ED). Methodology: This comprehensive endeavor unfolded through a structured sequence of phases following Plan-Do-Study-Act (PDSA) model, spanning over 12 months, focused on enhancing patient experiences in the Obstetrics & Gynecology Emergency Department (OB/GYN ED). The study meticulously examined the journeys of patients with acute obstetrics and gynecological conditions, collecting data from over 100 participants monthly. The inclusive approach covered patients of different priority levels (1-5) admitted for acute conditions, with no exclusions. Historical data from March and April 2022 serves as a benchmark for comparison, strengthening causality claims by providing a baseline understanding of OB/GYN ED performance before interventions. Additionally, the methodology includes the incorporation of staff engagement surveys to comprehensively understand the experiences of healthcare professionals with the implemented improvements. Data extraction involved administering open-ended questions and comment sections to gather rich qualitative insights. The survey covered various aspects of the patient journey, including communication, emotional support, timely access to care, care coordination, and patient-centered decision-making. The project's data analysis utilized a mixed-methods approach, combining qualitative techniques to identify recurring themes and extract actionable insights and quantitative methods to assess patient satisfaction scores and relevant metrics over time, facilitating the measurement of intervention impact and longitudinal tracking of changes. From the themes we discovered in both the online and in-person patient experience surveys, several key findings emerged that guided us in initiating improvements, including effective communication and information sharing, providing emotional support and empathy, ensuring timely access to care, fostering care coordination and continuity, and promoting patient-centered decision-making. Results: The project yielded substantial positive outcomes, significantly improving patient experiences in the OB/GYN ED. Patient satisfaction levels rose from 62% to a consistent 98%, with notable improvements in satisfaction with care plan information and physician care. Waiting time satisfaction increased from 68% to a steady 97%. The project positively impacted nurses' and midwives' job satisfaction, increasing from 64% to an impressive 94%. Operational metrics displayed positive trends, including a decrease in the "left without being seen" rate from 3% to 1%, the discharge against medical advice rate dropping from 8% to 1%, and the absconded rate reducing from 3% to 0%. These outcomes underscore the project's effectiveness in enhancing both patient and staff experiences in the healthcare setting. Conclusion: The use of a patient experience questionnaire has been substantiated by evidence-based research as an effective tool for improving the patient experience, guiding interventions, and enhancing overall healthcare quality in the OB/GYN ED. The project's interventions have resulted in a more efficient allocation of resources, reduced hospital stays, and minimized unnecessary resource utilization. This, in turn, contributes to cost savings for the healthcare facility.

Keywords: patient experience, patient survey, person centered care, quality initiatives

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Authors: Chamseddine Barki, Salam Labidi, Hanen Boussi Rahmouni

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In this article, we present the principle and suitable methodology for the design of a medical ontology that highlights the radiological and dosimetric knowledge, applied in diagnostic radiology and radiation-therapy. Our ontology, which we named «Onto.Rap», is the subject of radiation protection in medical and radiology centers by providing a standardized regulatory oversight. Thanks to its added values of knowledge-sharing, reuse and the ease of maintenance, this ontology tends to solve many problems. Of which we name the confusion between radiological procedures a practitioner might face while performing a patient radiological exam. Adding to it, the difficulties they might have in interpreting applicable patient radioprotection standards. Here, the ontology, thanks to its concepts simplification and expressiveness capabilities, can ensure an efficient classification of radiological procedures. It also provides an explicit representation of the relations between the different components of the studied concept. In fact, an ontology based-radioprotection expert system, when used in radiological center, could implement systematic radioprotection best practices during patient exam and a regulatory compliance service auditing afterwards.

Keywords: knowledge, ontology, radiation protection, radiology

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Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

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Introduction: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease of unknown cause. Concomitant autoimmune disorders have been described in 30–50% of patients with AIH. The aim of our study is to determine the prevalence and the type of autoimmune disorders associated with AIH. Material and Methods: It is a retrospective study over a period of 16 years (2000-2015) including all patients followed for AIH. The diagnosis of AHI was based on the criteria of the revised International AIH group scoring system (IAIHG). Results: Twenty-for patients (21 women and 3 men) followed for AIH were collected. The mean age was 39 years (17-65 years). Among these patients, 11 patients(45.8%) had at least one autoimmune disease associated to AIH. These diseases were Hashimoto's thyroiditis (n = 5), Gougerot Sjogren syndrome (n=5), Primary biliary cirrhosis (n=2), Primitive sclerosant Cholangitis (n=1), Addison disease (n = 1) and systemic sclerosis (n=1). Patients were treated with corticosteroids alone or with azathioprine associated to the specific treatment of associated diseases with complete remission of AIH in 90% of cases and clinical improvement of other diseases. Conclusion: In our study, the prevalence of autoimmune diseases in AIH patients was 45.8%. These diseases were dominated by autoimmune thyroiditis and Gougerot Sjogren syndrome. The investigation of autoimmune diseases in autoimmune hepatitis must be systematic because of their frequency and the importance of adequate management.

Keywords: autoimmune diseases, autoimmune hepatitis, autoimmune thyroiditis, gougerot sjogren syndrome

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Authors: Hanen Filali, Mohamed Hachicha

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Treated grey water (TGW) reuse emerged as an alternative resource to meet the growing demand for water for agricultural irrigation and reduce the pressure on limited existing fresh water. However, this reuse needs adapted management in order to avoid environmental and health risks. In this work, the treatment of grey water (GW) was studied from a cyclic treatment system that we designed and implemented in the greenhouse of National Research Institute for Rural Engineering, Water and Forests (INRGREF). This system is composed of three levels for treatment (TGW 1, TGW 2, and TGW 3). Each level includes a sandy soil box. The use of grey water was moderated depending on the chemical and microbiological quality obtained. Different samples of soils and treated grey water were performed and analyzed for 14 irrigation cycles. TGW through cyclic treatment showed physicochemical parameters like pH, electrical conductivity (EC), chemical oxygen demand (COD), biological oxygen demand (BOD5) in the range of 7,35-7,91, 1,69-5,03 dS/m, 102,6-54,2 mgO2/l, and 31,33-15,74 mgO2/l, respectively. Results showed a reduction in the pollutant load with a significant effect on the three treatment levels; however, an increase in salinity was observed during all irrigation cycles. Microbiological results showed good grey water treatment with low health risk on irrigated soil. Treated water quality was below permissible Tunisian standards (NT106.03), and treated water is suitable for non-potable options.

Keywords: treated grey water, irrigation, cyclic treatment, soils, physico-chemical parameters, microbiological parameters

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Authors: Hanen Khaldi

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This paper aims to study the impact of international migration on human security in the Southeastern region of Asia, especially after Asian Financial Crisis 1997-98. International migration has impacts on many dimensions of security: the state security (sovereignty and autonomy); international relationships security (conflicts, terrorism, etc); and immigrants security. The paper aims to improve our comprehension of the impact of international migration on immigrant security in the region of Southeast Asia, particularly “vulnerable workers’’ whose number is growing very fast in the region. The literature review carried out on this matter led us to ask the following two question: 1) Did the creation of ASEAN Community matter on the evolution of immigrants in the region? And How governments try to resolve the gap between economic objectifs and security of immigrants in the region? To answer these two questions, the paper is subdivided in three parts: Firstly, we will show how the creation of the ASEAN Community, especially ASEAN Economic Community, had a significant impact on the pattern of evolution of immigration in this region. Secondly, we will paint a portrait illustrating the vulnerability of immigrants in Southeast Asia, particularly unskilled workers. Finally, using the theories of regional integration, we will assess how governments try to ensure the security and safety of the immigrants. Overall, our analysis illustrate the significant change of the official discourse of the leaders of the ASEAN member states, now more conciliator and especially more open to cooperation, as well as the proliferation of meetings and initiatives between these countries to control mobility flows in the region, and the ensure immigrants security.

Keywords: migrant workers, human security, human rights

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Authors: Hanen Bouaziz, Françoise Croute, Najiba Zeghal

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In order to investigate the toxic effects of fluoride on cerebrum maturity of suckling mice, we treated adult female mice of Swiss Albinos strain by 500 ppm NaF in their drinking water from the 15th day of pregnancy until the day 14 after delivery. All mice were sacrificed on day 14 after parturition. During treatment, levels of thiobarbituric acid reactive substances, the marker of lipid peroxidation extend, increased, while the activities of the antioxidant enzymes such as glutathione peroxidase, superoxide dismutase and catalase and the level of glutathione decreased significantly in cerebellum compared with those of the control group. These results suggested that fluoride enhanced oxidative stress, thereby disturbing the antioxidant defense of nursing pups. In addition, acetylcholinesterase activity in cerebellum was inhibited after treatment with fluoride. In cerebellum of mice, migration of neurons from the external granular layer to the internal granular layer occurred postnatally. Key guidance signals to these migrating neurons were provided by laminin, an extracellular matrix protein fixed to the surface of astrocytes. In the present study, we examined the expression and distribution of laminin in cerebellum of 14-day-old mice. Immunoreactive laminin was disappeared by postnatal day 14 in cerebellum parenchyma of control pups and was restricted to vasculature despite the continued presence of granular cells in the external granular layer. In contrast, in cerebellum of NaF treated pups, laminin was deposited in organised punctuate clusters in the molecular layer. These data indicated that the disruption of laminin distribution might play a major role in the profound derangement of neuronal migration observed in cerebellum of NaF treated pups.

Keywords: acetylcholinesterase activity, cerebellum, laminin, oxidative stress, suckling mice

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Authors: Hanen Bouaziz-Ketata, Ghada Ben Salah, Hichem Ben Salah, Kamel Jamoussi, Najiba Zeghal

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The present study investigated the protective role of Hyparrhenia hirta on nitrate-induced liver damage. Experiments were carried out on adult rats divided into 3 groups, a control group and two treated groups. NaNO3 was administered daily by oral gavage at a dose of 400 mg/kg bw in treated groups either alone or coadministered with Hyparrhenia hirta methanolic extract via drinking water at a dose of 200 mg/kg bw for 50 days. Liver toxicity induced by NaNO3 was characterized by higher serum levels of glucose, total cholesterol and triglyceride and lower serum total protein than those of controls. Transaminases and lactate deshydrogenase activities in serum were elevated indicating hepatic cells’ damage after treatment with NaNO3. The hyperbilirubinemia and the increased serum gamma glutamyl transferase activities suggested the presence of cholestasis in NaNO3 exposed rats. In parallel, NaNO3 caused oxidant/antioxidant imbalance in the liver as reflected by the increased lipid peroxidation, the decreased total glutathione content and superoxide dismutase, catalase and glutathione peroxidase activities. Nitrate caused also a significant induction of DNA fragmentation as evidenced by the presence of a smear without ladder formation on agarose gel. Hyparrhenia hirta supplementation showed an improvement of all parameters cited above. We conclude that the present work provides ethnopharmacological relevance of Hyparrhenia hirta against the toxic effect of nitrate, suggesting its role as a potential antioxidant.

Keywords: Hyparrhenia hirta, liver, nitrate toxicity, oxidative stress, rat

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Authors: Tahar Ghnaya, Majda Mnasri, Hanen Zaier, Rim Ghabriche, Chedly Abdelly

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It is known that the symbiotic association between plant and microorganisms are beneficial for plant growth and resistance to metal stress. Hence, it was demonstrated that Arbuscular mycorrhizal fungi have a positive effect on host plants growing in metal polluted soils. Legume plants are those which normally associate to rhizobacteria in order to fix atmospheric nitrogen. The aim of this work was to evaluate the effect this type of symbiosis on the tolerance and the accumulation of Cd. We chose Medicago sativa, as a modal for host legume plants and Rhizobium mililoti 2011 as rhizobial strain. Inoculated and non-inoculated plants of M. sativa were submitted during three month to 0, 50, and 100 mgCd/kg dry soil. Results showed that the presence of Cd in the medium induced, in both inoculated and non-inoculated plants, a chlorosis and necrosis. However, these symptoms were more pronounced in non-inoculated plants. The beneficial effect of inoculation of M. sativa with R. meliloti, on plant growth was confirmed by the measurement of biomass production which showed that the symbiotic association between host plant and rhizobacteria alleviates significantly Cd effect on biomass production, so inoculated plants produced more dry weight as compared to non-inoculated ones in the presence of all Cd tretments. On the other hand, under symbiosis conditions, Cd was more accumulated in different plant organs. Hence, in these plants, shoot Cd concentration reached 425 and it was 280 µg/gDW in non-inoculated ones in the presence of 100 ppm Cd. This result suggests that symbiosis enhances the absorption and translocation of Cd in this plant. In nodules and roots, we detected the highest Cd concentrations, demonstrating that these organs are able to concentrate Cd in their tissues. These data confirm that M. sataiva, cultivated in symbiosis with Rhizobium mililoti could be used in phytoextraction of Cd from contaminated soils.

Keywords: Cd, phytoremediation, Medicago sativa, Arbuscular mycorrhizal

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Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

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Introduction: Primary biliary cirrhosis (PBC) is a cholestatic cholangitis of unknown etiology. It is frequently associated with autoimmune diseases, which explains their systematic screening. The aim of our study was to determine the prevalence and the type of autoimmune disorders associated with PBC and to assess their impact on the prognosis of the disease. Material and methods: It is a retrospective study over a period of 16 years (2000-2015) including all patients followed for PBC. In all these patients we have systematically researched: dysthyroidism (thyroid balance, antithyroid autoantibodies), type 1 diabetes, dry syndrome (ophthalmologic examination, Schirmer test and lip biopsy in case of Presence of suggestive clinical signs), celiac disease(celiac disease serology and duodenal biopsies) and dermatological involvement (clinical examination). Results: Fifty-one patients (50 women and one men) followed for PBC were collected. The Mean age was 54 years (37-77 years). Among these patients, 30 patients(58.8%) had at least one autoimmune disease associated with PBC. The discovery of these autoimmune diseases preceded the diagnosis of PBC in 8 cases (26.6%) and was concomitant, through systematic screening, in the remaining cases. Autoimmune hepatitis was found in 12 patients (40%), defining thus an overlap syndrome. Other diseases were Hashimoto's thyroiditis (n = 10), dry syndrome (n = 7), Gougerot Sjogren syndrome (n=6), celiac disease (n = 3), insulin-dependent diabetes (n = 1), scleroderma (n = 1), rheumatoid arthritis (n = 1), Biermer Anemia (n=1) and Systemic erythematosus lupus (n=1). The two groups of patients with PBC with or without associated autoimmune disorders were comparable for bilirubin levels, Child-Pugh score, and response to treatment. Conclusion: In our series, the prevalence of autoimmune diseases in PBC was 58.8%. These diseases were dominated by autoimmune hepatitis and Hashimoto's thyroiditis. Even if their association does not seem to alter the prognosis, screening should be systematic in order to institute an early and adequate management.

Keywords: autoimmune diseases, autoimmune hepatitis, primary biliary cirrhosis, prognosis

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Authors: Hanen Bouaziz, Moez Rafrafi, Ghada Ben Salah, Kamel Jamoussi, Tahia Boudawara, Najiba Zeghal

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The present study investigated the protective role of Hyparrhenia hirta against sodium nitrate (NaNO3)-induced nephrotoxicity. A high-performance liquid chromatography coupled with a mass spectrometer (HPLC-MS) method was developed to separate and identify flavonoids in Hyparrhenia hirta. Seven flavonoids were identified as 3-O-methylquercetin, luteolin-7-O-glucoside, luteolin, apigenin-7-O-glucoside, apigenin-8-C-glucoside, luteolin-8-C-glucoside and luteolin-6-C-glucoside. Wistar rats were randomly divided into three groups: a control group and two treated groups during 50 days with NaNO3 administered either alone in drinking water or co-administered with Hyparrhenia hirta. NaNO3 treatment induced a significant increase in plasma levels of creatinine, urea and uric while urinary level decreased significantly. Nephrotoxicity induced by NaNO3 was characterized by significant increase in creatinine clearance. In parallel, a significant increase in malondialdehyde level along with a concomitant decrease in total glutathione content and superoxide dismutase, catalase and glutathione peroxidase activities were observed in the kidney after NaNO3 treatment. The histopathological changes in kidney after NaNO3 administration were shrunken. There were renal tubule cell degeneration and infiltration of mononuclear cells. Most glomeruli revealed shrinkage, a wide capsular space and a peri-glomerular mononuclear cells infiltration. Hyparrhenia hirta supplementation showed a remarkable amelioration of the abnormalities cited above. The results concluded that the treatment with Hyparrhenia hirta had a significant role in protecting the animals from nitrate-induced kidney dysfunction.

Keywords: flavonoids, hyparrhenia hirta, kidney, nitrate toxicity, oxidative stress, rat

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Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

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Introduction: Celiac disease (CD) is a chronic autoimmune inflammatory enteropathy caused by gluten. The clinical presentation is very variable. Malabsorption in the MC is responsible for an alteration of the bone metabolism. Our purpose is to study the osteoarticular manifestations related to this condition. Material and methods: It is a retrospective study of 41 cases of CD diagnosed on clinical, immunological, endoscopic and histological arguments, in the Internal Medicine and Gastroenterology Department of Farhat Hached Hospital between September 2005 and January 2016. Results: Osteoarticular manifestations were found in 9 patients (22%) among 41 patients presenting CD. These were 7 women and 2 men with an average age of 35.7 years (25 to 67 years). These manifestations were revelatory of CD in 3 cases. Abdominal pain and diarrhea were present in 6 cases. Inflammatory polyarthralgia of wrists and knees has been reported in 7 patients. Mechanical mono arthralgia was noted in 2 patients. Biological tests revealed microcytic anemia by iron deficiency in 7 cases, hypocalcemia in 5 cases, Hypophosphatemia in 3 cases and elevated alkaline phosphatases in 3 cases. Upper gastrointestinal endoscopy with duodenal biopsy found villous atrophy in all cases. In immunology, Anti-transglutaminase antibodies were positive in all patients, Anti-endomysium in 7 cases. Measurement of bone mineral density (BMD) by biphotonic X-ray absorptiometer with evaluation of the T-score and the Z-score was performed in Twenty patients (48.8%). It was normal in 7 cases (33%) and showed osteopenia in 5 patients (25%) and osteoporosis in 2 patients (10%). All patients were treated with a Gluten-free diet associated with vitamin D and calcium substitution in 5 cases. The evolution was favorable in all cases with reduction of bone pain and normalization of the phosphocalcic balance. Conclusion: The bone impact of CD is frequent but often asymptomatic. Patients with CD should be evaluated by the measurement of bone mineral density and monitored for calcium and vitamin D deficiencies.

Keywords: bone mineral density, celiac disease, osteoarticular manifestations, vitamin D and calcium

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Authors: Soumaya Mrabet, Taieb Ach, Imen Akkari, Amira Atig, Neirouz Ghannouchi, Koussay Ach, Elhem Ben Jazia

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Introduction: Celiac disease (CD) is an immune-mediated small intestinal disorder that occurs in genetically susceptible people. It is significantly associated with other autoimmune disorders represented mainly by type 1 diabetes and autoimmune dysthyroidism. The aim of our study is to determine the prevalence and the type of the various autoimmune diseases associated with CD in adult patients. Material and methods: This is a retrospective study including patients diagnosed with CD, explored in Internal Medicine, Gastroenterology and Endocrinology and Diabetology Departments of the Farhat Hached University Hospital, between January 2005 and January 2016. The diagnosis of CD was confirmed by serological tests and duodenal biopsy. The screening of autoimmune diseases was based on physical examination, biological and serological tests. Results: Sixty five patients with a female predominance were included, 48women (73.8%) and 17 men (26.2%). The mean age was 31.8 years (17-75). A family history of CD or other autoimmune diseases was present in 5 and 10 patients respectively. Clinical presentation of CD was made by recurrent abdominal pain in 49 cases, diarrhea in 29 cases, bloating in 17 cases, constipation in 25 cases and vomiting in 8 cases. Autoimmune diseases associated with CD were found in 30 cases (46.1%): type 1 diabetes in 15 patients attested by the positivity of anti-GAD antibodies in 11 cases and anti-IA2 in 4 cases, Hashimoto thyroiditis in 8 cases confirmed by the positivity of anti-TPO antibodies, Addison's disease in 2 patients, Anemia of Biermer in 2 patients, autoimmune hepatitis, Systemic erythematosus lupus, Gougerot Sjögren syndrome, rheumatoid arthritis, Vitiligo and antiphospholipid syndrome in one patient each. CD was associated with more than one autoimmune disease defining multiple autoimmune syndrome in 2 female patients. The first patient had Basedow disease, Addison disease and type 1 diabetes. The second patient had systemic erythematosus lupus and Gougerot Sjögren syndrome. Conclusion: In our study autoimmune diseases were associated with CD in 46.1% of cases and were dominated by diabetes and dysthroidism. After establishing the diagnosis of CD the search of associated autoimmune diseases is necessary in order to avoid any therapeutic delay which can alter the prognosis of the patient.

Keywords: association, autoimmune thyroiditis, celiac disease, diabetes

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Authors: Soumaya Mrabet, Taieb Ach, Imen Akkari, Amira Atig, Neirouz Ghannouchi, Koussay Ach, Elhem Ben Jazia

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Introduction: Celiac disease (CD) and type 1 diabetes mellitus (T1D) are complex disorders with shared genetic components. The association between CD and T1D has been reported in many pediatric series. The aim of our study is to describe the epidemiological, clinical and evolutive characteristics of adult patients presenting this association. Material and Methods: This is a retrospective study including patients diagnosed with CD and T1D, explored in Internal Medicine, Gastroenterology and Endocrinology and Diabetology Departments of the Farhat Hached University Hospital, between January 2005 and June 2016. Results: Among 57 patients with CD, 15 patients had also T1D (26.3%). There are 11 women and 4 men with a median age of 27 years (16-48). All patients developed T1D prior to the diagnosis of CD with an average duration of 47 months between the two diagnosis (6 months-5 years). CD was revealed by recurrent abdominal pain in 11 cases, diarrhea in 10 cases, bloating in 8 cases, constipation in 6 cases and vomiting in 2 cases. Three patients presented cycle disorders with secondary amenorrhea in 2 patients. Anti-Endomysium, anti-transglutaminase and Anti-gliadin antibodies were positive respectively in 57, 54 and 11 cases. The biological tests revealed anemia in 10 cases, secondary to iron deficiency in 6 cases and folate and vitamin B12 deficiency in 4 cases, hypoalbuminaemia in 4 cases, hypocalcemia in 3 cases and hypocholesterolemia in 1 patient. Upper gastrointestinal endoscopy showed an effacement of the folds of the duodenal mucosa in 6 cases and a congestive duodenal mucosa in 3 cases. The macroscopic appearance was normal in the others cases. Microscopic examination showed an aspect of villous atrophy in 57 cases, which was partial in 10 cases and total in 47 cases. After an average follow-up of 3 years 2 months, the evolution was favorable in all patients under gluten-free diet with the necessity of less important doses of insulin in 10 patients. Conclusion: In our study, the prevalence of T1D in adult patients with CD was 26.3%. This association can be attributed to overlapping genetic HLA risk loci. In recent studies, the role of gluten as an important player in the pathogenesis of CD and T1D has been also suggested.

Keywords: celiac disease, gluten, prevalence, type 1 diabetes

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Authors: Hanen Khanchel, Karim Ben Kahla

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Pharmaceutical companies are facing competition. Indeed, the price differences between competing products can be such that it becomes difficult to compensate them by differences in value added. The conditions of competition are no longer homogeneous for the players involved. The price of a product is a given that puts a company and its customer face to face. However, price fixing obliges the company to consider internal factors relating to production costs and external factors such as customer attitudes, the existence of regulations and the structure of the market on which the firm evolved. In setting the selling price, the company must first take into account internal factors relating to its costs: costs of production fall into two categories, fixed costs and variable costs that depend on the quantities produced. The company cannot consider selling below what it costs the product. It, therefore, calculates the unit cost of production to which it adds the unit cost of distribution, enabling it to know the unit cost of production of the product. The company adds its margin and thus determines its selling price. The margin is used to remunerate the capital providers and to finance the activity of the company and its investments. Production costs are related to the quantities produced: large-scale production generally reduces the unit cost of production, which is an asset for companies with mass production markets. This shows that small and medium-sized companies with limited market segments need to make greater efforts to ensure their profit margins. As a result, and faced with high and low market prices for raw materials and increasing staff costs, the company must seek to optimize its production time in order to reduce loads and eliminate waste. Then, the customer pays only value added. Thus, and based on this principle we decided to create a project that deals with the problem of waste in our company, and having as objectives the reduction of production costs and improvement of performance indicators. This paper presents the implementation of the Value Stream Mapping (VSM) project in a pharmaceutical company. It is structured as follows: 1) determination of the family of products, 2) drawing of the current state, 3) drawing of the future state, 4) action plan and implementation.

Keywords: VSM, waste, production time, kaizen, cartography, improvement

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Authors: R. Rahmoun-Mrabet

Abstract:

It is acknowledged that our style of speaking changes according to a wide range of variables such as gender, setting, the age of both the addresser and the addressee, the conversation topic, and the aim of the interaction. These differences in style are noticeable in monolingual and multilingual speech communities. Yet, they are more observable in speech communities where two or more codes coexist. The linguistic situation in Algeria reflects a state of bilingualism because of the coexistence of Arabic and French. Nevertheless, like all Arab countries, it is characterized by diglossia i.e. the concomitance of Modern Standard Arabic (MSA) and Algerian Arabic (AA), the former standing for the ‘high variety’ and the latter for the ‘low variety’. The two varieties are derived from the same source but are used to fulfil distinct functions that is, MSA is used in the domains of religion, literature, education and formal settings. AA, on the other hand, is used in informal settings, in everyday speech. French has strongly affected the Algerian language and culture because of the historical background of Algeria, thus, what can easily be noticed in Algeria is that everyday speech is characterized by code-switching from dialectal Arabic and French or by the use of borrowings. Tamazight is also very present in many regions of Algeria and is the mother tongue of many Algerians. Yet, it is not used in the west of Algeria, where the study has been conducted. The present work, which was directed in the speech community of Tlemcen-Algeria, aims at depicting some of the outcomes of the contact of Arabic with French such as code-switching, borrowing and interference. The question that has been asked is whether Algerians are aware of their use of borrowings or not. Three steps are followed in this research; the first one is to depict the sociolinguistic situation in Algeria and to describe the linguistic characteristics of the dialect of Tlemcen, which are specific to this city. The second one is concerned with data collection. Data have been collected from 57 informants who were given questionnaires and who have then been classified according to their age, gender and level of education. Information has also been collected through observation, and note taking. The third step is devoted to analysis. The results obtained reveal that most Algerians are aware of their use of borrowings. The present work clarifies how words are borrowed from French, and then adapted to Arabic. It also illustrates the way in which singular words inflect into plural. The results expose the main characteristics of borrowing as opposed to code-switching. The study also clarifies how interference occurs at the level of nouns, verbs and adjectives.

Keywords: bilingualism, borrowing, code-switching, interference, language contact

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Authors: masmoudi Jabri Khaoula, Zitouni Hana, Bousselmi Latifa, Akrout Hanen

Abstract:

Mathematical modeling has become an essential tool for sustainable wastewater management, particularly for the simulation and the optimization of complex processes involved in activated sludge systems. In this context, the activated sludge model (ASM3h) was used for the simulation of a Biological Membrane Reactor (MBR) as it includes the integration of biological wastewater treatment and physical separation by membrane filtration. In this study, the MBR with a useful volume of 12.5 L was fed continuously with poultry slaughterhouse wastewater (PSWW) for 50 days at a feed rate of 2 L/h and for a hydraulic retention time (HRT) of 6.25h. Throughout its operation, High removal efficiency was observed for the removal of organic pollutants in terms of COD with 84% of efficiency. Moreover, the MBR has generated a treated effluent which fits with the limits of discharge into the public sewer according to the Tunisian standards which were set in March 2018. In fact, for the nitrogenous compounds, average concentrations of nitrate and nitrite in the permeat reached 0.26±0.3 mg. L-1 and 2.2±2.53 mg. L-1, respectively. The simulation of the MBR process was performed using SIMBA software v 5.0. The state variables employed in the steady state calibration of the ASM3h were determined using physical and respirometric methods. The model calibration was performed using experimental data obtained during the first 20 days of the MBR operation. Afterwards, kinetic parameters of the model were adjusted and the simulated values of COD, N-NH4+and N- NOx were compared with those reported from the experiment. A good prediction was observed for the COD, N-NH4+and N- NOx concentrations with 467 g COD/m³, 110.2 g N/m³, 3.2 g N/m³ compared to the experimental data which were 436.4 g COD/m³, 114.7 g N/m³ and 3 g N/m³, respectively. For the validation of the model under dynamic simulation, the results of the experiments obtained during the second treatment phase of 30 days were used. It was demonstrated that the model simulated the conditions accurately by yielding a similar pattern on the variation of the COD concentration. On the other hand, an underestimation of the N-NH4+ concentration was observed during the simulation compared to the experimental results and the measured N-NO3 concentrations were lower than the predicted ones, this difference could be explained by the fact that the ASM models were mainly designed for the simulation of biological processes in the activated sludge systems. In addition, more treatment time could be required by the autotrophic bacteria to achieve a complete and stable nitrification. Overall, this study demonstrated the effectiveness of mathematical modeling in the prediction of the performance of the MBR systems with respect to organic pollution, the model can be further improved for the simulation of nutrients removal for a longer treatment period.

Keywords: activated sludge model (ASM3h), membrane bioreactor (MBR), poultry slaughter wastewater (PSWW), reuse

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Authors: Lamia Bouzgarrou, Amira Omrane, Leila Mrabet, Taoufik Khalfallah

Abstract:

Background and aims: School accidents are one of the leading causes of morbidity and mortality among pupils and students. Indeed, they may induce an elevated number of lost school days, heavy emotional and physical disabilities, and financial costs on the victims and their families. This study aims to evaluate the annual incidence of school accidents in the central Tunisian governorate of Mahdia and to identify the epidemiological profile of victims and risk factors of these accidents. Methods: A retrospective study was conducted over the period of 5 school years, focusing on school accidents that occurred in public educational institutions (primary, basic, secondary and university) in the governorate of Mahdia (area = 2 966 km² and number of inhabitants in 2014 = 410 812). All accidents declared near the only official insurance of this type of injuries (MASU: Mutual School and University Accidents), and initially taken in charge at the University Hospital of Mahdia were included. Data was collected from the MASU reporting forms and the medical records of emergency and other specialized hospital departments. Results: With 3248 identified victims, the annual incidence of school accidents was equal to 0.69 per 100 pupils and students per year. The average age of victims was 14.51 ± 0.059 years and the sex ratio was 1.58. Pupils aged between 12 and 15 years, were concerned by 46.7% of the identified accidents. The practice of sports was the most relevant circumstances of these accidents (76.2 %). In 56.58 % of cases, falls were the leading mechanism. Bruises and fractures were the most frequent lesions (32.43 % and 30.51 %). Serious school accidents were noted in 28% of cases with hospitalization in 2.27 % of them. The average lost school days, was 12.23±1.73 days. Accidents occurring during sports or leisure activities were significantly more serious (p= 0.021). Furthermore, the frequency of hospitalization was significantly higher among boys (2.81% vs. 1.43%; p= 0.035), students ≤11 years (p= 0.008), and following crush trauma (p= 0.000). In addition, the surgical interventions were statistically more frequent among male victims (p=0.00), accidents occurring during physical education sessions (p=0.000); those associated to falls (p=0.000) and to crushes mechanisms (p=0.002), and injuries affecting lower limbs (p=0.000). Following this Multi-varied analysis concluded that the severity of school accident is correlated to the activity practiced during the trauma and the geographical location of the school. Conclusion: Children and adolescents are one of the most vulnerable groups against incidents with the risk of permanent disability, mainly related to the perturbation of the growth process and physiological limitations. Our five-year study, objectified a real elevate incidence of school accident among children and adolescents, with a considerable rate of severe injuries. In any community, the promotion of adolescents and children’s health is an important indicator of the public health level. Thus, it’s important to develop a multidisciplinary prevention strategy of school accident, based on safety and security rules and adapted to the specificity of our context.

Keywords: children and adolescents, children health, injuries and disability, school accident

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