Search results for: Nejla Fourati

Authors: Nejla Fourati, Zied Fessi, Fatma Dhouib, Wicem Siala, Leila Farhat, Afef Khanfir, Wafa Mnejja, Jamel Daoud

Abstract:

Purpose: Radiation induced hypothyroidism in nasopharyngeal cancer (NPC) ranged from 15% to 55%. In reported data, it is considered as a common late complication of definitive radiation and is mainly observed 2 years after the end of treatment. The aim of this study was to evaluate the incidence of early hypothyroidism within 6 months after radiotherapy. Patients and methods: From June 2017 to February 2020, 35 patients treated with concurrent chemo-radiotherapy (CCR) for NPC were included in this prospective study. Median age was 49 years [23-68] with a sex ratio of 2.88. All patients received intensity modulated radiotherapy (IMRT) at a dose of 69.96 Gy in 33 daily fractions with weekly cisplatin (40mg/m²) chemotherapy. Thyroid stimulating hormone (TSH) and Free Thyroxine 4 (FT4) dosage was performed before the start of radiotherapy and 6 months after. Different dosimetric parameters for the thyroid gland were reported: the volume (cc); the mean dose (Dmean) and the %age of volume receiving more than 45 Gy (V45Gy). Wilcoxon Test was used to compare these different parameters between patients with or without hypothyroidism. Results: At baseline, 5 patients (14.3%) had hypothyroidism and were excluded from the analysis. For the remaining 30 patients, 9 patients (30%) developed a hypothyroidism 6 months after the end of radiotherapy. The median thyroid volume was 10.3 cc [4.6-23]. The median Dmean and V45Gy were 48.3 Gy [43.15-55.4] and 74.8 [38.2-97.9] respectively. No significant difference was noted for all studied parameters. Conclusion: Early hypothyroidism occurring within 6 months after CCR for NPC seems to be a common complication (30%) that should be screened. Good patient monitoring with regular dosage of TSH and FT4 makes it possible to treat hypothyroidism in asymptomatic phase. This would be correlated with an improvement in the quality of life of these patients. The results of our study do not show a correlation between the thyroid doses and the occurrence of hypothyroidism. This is probably related to the high doses received by the thyroid in our series. These findings encourage more optimization to limit thyroid doses and then the risk of radiation-induced hypothyroidism

Keywords: nasopharyngeal carcinoma, hypothyroidism, early complication, thyroid dose

Procedia PDF Downloads 112

Authors: Omar Nouri, Wafa Mnejja, Nejla Fourati, Fatma Dhouib, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Jamel Daoud

Abstract:

Background and objective: Induction chemotherapy (IC) followed by concomitant chemo radiotherapy with intensity modulated radiation (IMRT) technique is actually the recommended treatment modality for locally advanced nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the prognostic factors predicting loco regional relapse with this new treatment protocol. Patients and methods: A retrospective study of 52 patients with NPC treated between June 2016 and July 2019. All patients received IC according to the protocol of the Head and Neck Radiotherapy Oncology Group (Gortec) NPC 2006 (3 TPF courses) followed by concomitant chemo radiotherapy with weekly cisplatin (40 mg / m2). Patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. Median age was 49 years (19-69) with a sex ratio of 3.3. Forty five tumors (86.5%) were classified as stages III - IV according to the 2017 UICC TNM classification. Loco regional relapse (LRR) was defined as a local and/or regional progression that occurs at least 6 months after the end of treatment. Survival analysis was performed according to Kaplan-Meier method and Log-rank test was used to compare anatomy clinical and therapeutic factors that may influence loco regional free survival (LRFS). Results: After a median follow up of 42 months, 6 patients (11.5%) experienced LRR. A metastatic relapse was also noted for 3 of these patients (50%). Target volumes coverage was optimal for all patient with LRR. Four relapses (66.6%) were in high-risk target volume and two (33.3%) were borderline. Three years LRFS was 85,9%. Four factors predicted loco regional relapses: histologic type other than undifferentiated (UCNT) (p=0.027), a macroscopic pre chemotherapy tumor volume exceeding 100 cm³ (p=0.005), a reduction in IC doses exceeding 20% (p=0.016) and a total cumulative cisplatin dose less than 380 mg/m² (p=0.0.34). TNM classification and response to IC did not impact loco regional relapses. Conclusion: For nasopharyngeal carcinoma, tumors with initial high volume and/or histologic type other than UCNT, have a higher risk of loco regional relapse. Therefore, they require a more aggressive therapeutic approaches and a suitable monitoring protocol.

Keywords: loco regional relapse, modulation intensity radiotherapy, nasopharyngeal carcinoma, prognostic factors

Procedia PDF Downloads 108

Authors: Omar Nouri, Wafa Mnejja, Fatma Dhouib, Syrine Zouari, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Leila Farhat, Nejla Fourati, Jamel Daoud

Abstract:

Purpose and Objective: Intensity modulated radiation (IMRT) technique, associated with induction chemotherapy (IC) and/or concomitant chemotherapy (CC), is actually the recommended treatment modality for nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the therapeutic results and the patterns of relapse with this treatment protocol. Material and methods: A retrospective monocentric study of 145 patients with NPC treated between June 2016 and July 2021. All patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. The high-risk volume dose was 66.5 Gy in children. Survival analysis was performed according to the Kaplan-Meier method, and the Log-rank test was used to compare factors that may influence survival. Results: Median age was 48 years (11-80) with a sex ratio of 2.9. One hundred-twenty tumors (82.7%) were classified as stages III-IV according to the 2017 UICC TNM classification. Ten patients (6.9%) were metastatic at diagnosis. One hundred-thirty-five patient (93.1%) received IC, 104 of which (77%) were TPF-based (taxanes, cisplatin and 5 fluoro-uracil). One hundred-thirty-eight patient (95.2%) received CC, mostly cisplatin in 134 cases (97%). After a median follow-up of 50 months [22-82], 46 patients (31.7%) had a relapse: 12 (8.2%) experienced local and/or regional relapse after a median of 18 months [6-43], 29 (20%) experienced distant relapse after a median of 9 months [2-24] and 5 patients (3.4%) had both. Thirty-five patients (24.1%) died, including 5 (3.4%) from a cause other than their cancer. Three-year overall survival (OS), cancer specific survival, disease free survival, metastasis free survival and loco-regional free survival were respectively 78.1%, 81.3%, 67.8%, 74.5% and 88.1%. Anatomo-clinic factors predicting OS were age > 50 years (88.7 vs. 70.5%; p=0.004), diabetes history (81.2 vs. 66.7%; p=0.027), UICC N classification (100 vs. 95 vs. 77.5 vs. 68.8% respectively for N0, N1, N2 and N3; p=0.008), the practice of a lymph node biopsy (84.2 vs. 57%; p=0.05), and UICC TNM stages III-IV (93.8 vs. 73.6% respectively for stage I-II vs. III-IV; p=0.044). Therapeutic factors predicting OS were a number of CC courses (less than 4 courses: 65.8 vs. 86%; p=0.03, less than 5 courses: 71.5 vs. 89%; p=0.041), a weight loss > 10% during treatment (84.1 vs. 60.9%; p=0.021) and a total cumulative cisplatin dose, including IC and CC, < 380 mg/m² (64.4 vs. 87.6%; p=0.003). Radiotherapy delay and total duration did not significantly affect OS. No grade 3-4 late side effects were noted in the evaluable 127 patients (87.6%). The most common toxicity was dry mouth which was grade 2 in 47 cases (37%) and grade 1 in 55 cases (43.3%).Conclusion: IMRT for nasopharyngeal carcinoma granted a high loco-regional control rate for patients during the last five years. However, distant relapses remain frequent and conditionate the prognosis. We identified many anatomo-clinic and therapeutic prognosis factors. Therefore, high-risk patients require a more aggressive therapeutic approach, such as radiotherapy dose escalation or adding adjuvant chemotherapy.

Keywords: therapeutic results, prognostic factors, intensity-modulated radiotherapy, nasopharyngeal carcinoma

Procedia PDF Downloads 47

Authors: Sonia Ben Hamza, Sabra Habli, Nejla Mahjoub Said, Hervé Bournot, Georges Le Palec

Abstract:

In this work, we determine the turbulent dynamic structure of pollutant dispersion in two-phase free surface flow. The numerical simulation was performed using ANSYS Fluent. The flow study is three-dimensional, unsteady and isothermal. The study area has been endowed with a rectangular obstacle to analyze its influence on the hydrodynamic variables and progression of the pollutant. The numerical results show that the hydrodynamic model provides prediction of the dispersion of a pollutant in an open channel flow and reproduces the recirculation and trapping the pollutant downstream near the obstacle.

Keywords: CFD, free surface, polluant dispersion, turbulent flows

Procedia PDF Downloads 514

Authors: Rim Ben Kalifa, Sabra Habli, Nejla Mahjoub Saïd, Hervé Bournot, Georges Le Palec

Abstract:

The present study treats different phenomena taking place in a configuration of air jet impinging on a flat surface in a coflow stream. A Computational Fluid Dynamics study is performed using the Reynolds-averaged Navier–Stokes equations by means of the Reynolds Stress Model (RSM) second order turbulent closure model. The results include mean and turbulent velocities and quantify the large effects of the coflow stream on an impinging air jet. The study of the jet in a no-directed coflow stream shows the presence of a phenomenon of recirculation near the flat plate. The influence of the coflow velocity ratio on the behavior of an impinging plane jet was also numerically investigated. The coflow stream imposed noticeable restrictions on the spreading of the impinging jet. The results show that the coflow stream decreases considerably the entrainment of air jet.

Keywords: turbulent jet, turbulence models, coflow stream, velocity ratio

Procedia PDF Downloads 215

Authors: Sonia Ben Hamza, Sabra Habli, Nejla Mahjoub Saïd, Hervé Bournot, Georges Le Palec

Abstract:

This paper spots light on the effect of a point source pollution on streams, stemming out from intentional release caused by unconscious facts. The consequences of such contamination on ecosystems are very serious. Accordingly, effective tools are highly demanded in this respect, which enable us to come across an accurate progress of pollutant and anticipate different measures to be applied in order to limit the degradation of the environmental surrounding. In this context, we are eager to model a pollutant dispersion of a free surface flow which is ejected by an outfall sewer of an urban sewerage network in coastal water taking into account the influence of climatic parameters on the spread of pollutant. Numerical results showed that pollutant dispersion is merely due to the presence of vortices and turbulence. Hence, it was realized that the pollutant spread in seawater is strongly correlated with climatic conditions in this region.

Keywords: coastal waters, numerical simulation, pollutant dispersion, turbulent flows

Procedia PDF Downloads 491

Authors: Nadia Chagtmi, Nejla Rejab, Noureddine Boulejfen

Abstract:

This paper presents a calibration approach based on artificial neural networks (ANN) to determine the envelop signal (I+jQ) of a six-port based receiver (SPR). The memory effects called also dynamic behavior and the nonlinearity brought by diode based power detector have been taken into consideration by the ANN. Experimental set-up has been performed to validate the efficiency of this method. The efficiency of this approach has been confirmed by the obtained results in terms of waveforms. Moreover, the obtained error vector magnitude (EVM) and the mean absolute error (MAE) have been calculated in order to confirm and to test the ANN’s performance to achieve I/Q recovery using the output voltage detected by the power based detector. The baseband signal has been recovered using ANN with EVMs no higher than 1 % and an MAE no higher than 17, 26 for the SPR excited different type of signals such QAM (quadrature amplitude modulation) and LTE (Long Term Evolution).

Keywords: six-port based receiver; calibration, nonlinearity, memory effect, artificial neural network

Procedia PDF Downloads 49

Authors: Sonia Ben Hamza, Sabra Habli, Nejla Mahjoub Said, Hervé Bournot, Georges Le Palec

Abstract:

The distribution characteristics of pollutants released at different vertical inlet positions of an open channel are investigated with a three-dimensional numerical model. Pollutants are injected from time-dependent sources in a turbulent free surface flow. Numerical computations were carried out using ANSYS Fluent which is based on the finite volume approach. The air/water interface was modeled with the volume of the fluid method (VOF). By focusing on investigating the influences of flow on pollutants, it is found that pollutant released from the bottom position of the channel takes more time to disperse in the longitudinal direction of the flow in comparison with the case of pollutant released near the free surface. On the other hand, the pollutant released from the bottom position generates a vertical dispersion with decreased amplitude. These findings may assist in cost-effective scientific countermeasures to be taken for accident or planned pollutant discharged into a river.

Keywords: numerical simulation, pollutant release, turbulent free surface flow, VOF model

Procedia PDF Downloads 494

Authors: Amani Amamou, Sabra Habli, Nejla Mahjoub Saïd, Georges Le Palec

Abstract:

Round jets have been widely studied due to their important application in industry. Many configurations of round jet were encountered in literature as free jet, co-flow jet, couterflowing jet and cross flow jet. In this paper, we are concerned with turbulent round jet in uniform counterflow stream which is known to enhance mixing and dispersion efficiency owing to flow reversal. This type of flow configuration is a typical application in environmental engineering such as the disposal of wastewater into seas or rivers. A computational study of a turbulent circular jet discharging into a uniform counterflow is conducted in order to investigate the characteristics of the diffusion field of the jet effluent. The investigation is carried out for three different cases of jet-to-current velocity ratios; low, medium and high velocity ratios. The Reynolds Stress Model (RSM) is used in the comparison with available experimental measurements. The decay of the center line velocity and the dynamic proprieties of the flow together with the centerline dilution of the passive scalar and the other characteristics of the concentration field are computationally analyzed in this paper.

Keywords: Counterflow stream, jet, velocity, concentration

Procedia PDF Downloads 366

Authors: Sonia Ben Hamza, Sabra Habli, Nejla Mahjoub Saïd, Hervé Bournot, Georges Le Palec

Abstract:

Free surface flows caused by dam breaks in channels or rivers is an attention-getting subject to the engineering practice, however, the studies are few to be reported. In this paper, a numerical investigation of unsteady free surface flows resulting from a dam-breaking in a rectangular channel is studied. Numerical computations were carried out using ANSYS Fluent which is based on the finite volume approach. The air/water interface was modeled with the volume of fluid method (VOF). Verification for a typical dam-break problem is analyzed by comparing the present results with others and very good agreement is obtained. The present approach is then used to predict the characteristics of free surface flow due to the dam breaking in channel. The characteristics of complex unsteady free surface flow in these examples are clearly explained. The numerical results show that the flow became more disturbed after impacting the vertical wall, then a recirculation zone, as well as turbulence phenomena, were created. At this instant, a cavity of air was included on the flow. The results agree well with the experimental data found in the literature.

Keywords: CFD, dam-break, free surface, turbulent flows, VOF

Procedia PDF Downloads 291

Authors: Amani Amamou, Sabra Habli, Nejla Mahjoub Saïd, Philippe Bournot, Georges Le Palec

Abstract:

A counterflowing jet is a particular configuration of turbulent jets issuing into a moving ambient which has not carried much attention in literature compared with jet in a coflow or in a crossflow. This is due to the marked instability of the jet in a counterflow coupled with experimental and theoretical difficulties related to the flow inversion phenomenon. Nevertheless, jets in a counterflow are encountered in many engineering applications which required enhanced mixing as combustion, process and environmental engineering. In this work, we propose to investigate a round turbulent jet flowing into a uniform counterflow stream through a numerical approach. A hydrodynamic and thermal study of a slightly oblique round jets issuing into a uniform counterflow stream is carried out for different jet-to-counterflow velocity ratios ranging between 3.1 and 15. It is found that even a slight inclination of the jet in the vertical direction of the flow affects the structure and the velocity field of the counterflowing jet. In addition, the evolution of passive scalar temperature and pertinent length scales are presented at various velocity ratios, confirming that the flow is sensitive to directional perturbations.

Keywords: jet, counterflow, velocity, temperature, jet inclination

Procedia PDF Downloads 250

Authors: Rim Sghiri, Samia Al Shouli, Hana Benhassine, Nejla Elamri, Zahid Shakoor, Foued Slama, Adel Almogren, Hala Zeglaoui, Elyes Bouajina, Ramzi Zemni

Abstract:

Objectives: Little is known about genes predisposing to systemic bone loss (SBL) in rheumatoid arthritis (RA). Therefore, we examined the association between SBL and a variant of CD40 gene, which is known to play a critical role in both immune response and bone homeostasis among patients with RA. Methods: CD40 rs48104850 was genotyped in 176 adult RA patients. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). Results: Low BMD was observed in 116 (65.9%) patients. Among them, 60 (34.1%) had low femoral neck (FN) Z score, 72 (40.9%) had low total femur (TF) Z score, and 105 (59.6%) had low lumbar spine (LS) Z score. CD40 rs4810485 was found to be associated with reduced TF Z score with the CD40 rs4810485 T allele protecting against reduced TF Z score (OR = 0.40, 95% CI = 0.23-0.68, p = 0.0005). This association was confirmed in the multivariate logistic regression analysis (OR=0.31, 95% CI= 0.16-0.59, p=3.84 x 10₋₄). Moreover, median FN BMD was reduced among RA patients with CD40 rs4810485 GG genotype compared to RA patients harbouring CD40 rs4810485 TT and GT genotypes (0.788± 0.136 versus 0.826± 0.146g/cm², p=0.001). Conclusion: This study, for the first time ever, demonstrated an association between a CD40 genetic variant and SBL among patients with RA.

Keywords: rheumatoid arthritis, CD40 gene, bone mineral density, systemic bone loss, rs48104850

Procedia PDF Downloads 435

Authors: Yosra Makni Fourati, Sana Masmoudi Mardassi

Abstract:

This paper investigates the effect of Book-tax conformity on audit quality regarding the proxies of audit fees, auditors’ industry specialization and audit report lag. Using a sample of Canadian firms listed on the Toronto Stock Exchange spanning the years 2006- 2016, we applied an Ordinary Least Squares (OLS) regression to test hypotheses of this research. The authors find that higher Book-tax conformity leads to lower audit fees. They also provide evidence that there is a negative association between Book-tax conformity and auditors’ industry specialization, whereas there is a positive association between Book-tax conformity and audit report lag. Overall, the findings are prominent to better understanding the effect of Book-tax conformity on audit quality and are relevant for academic researchers, practitioners, and regulators. As the paper investigates the relationship of Book-tax conformity and audit quality using a sample of Canadian firms, it brings original insights regarding the importance of audit fees and Book-tax conformity. In addition, it considers the role of auditor’s industry specialization in the relation between audit quality and Book-tax conformity by considering a sample listed on the Toronto Stock Exchange. This paper contributes to the existing literature by highlighting the Canadian setting, to our best knowledge. In addition, our results are prominent to the auditing literature as they introduce a different determinant of auditors’ industry specialization and audit report lag.

Keywords: audit fees, auditors' industry specialization, audit report lag, book-tax conformity

Procedia PDF Downloads 131

Authors: Sana Masmoudi Mardassi, Yosra Makni Fourati

Abstract:

Regulators highlight the importance of the Audit Committee (AC) as a key internal corporate governance mechanism. One of the most important roles of this committee is to oversee the financial reporting process. The purpose of this paper is to examine the link between the characteristics of an audit committee and the financial reporting quality by investigating whether the characteristics of audit committees are associated with improved financial reporting quality, especially the Real Earnings Management. In the current study, a panel data from 80 nonfinancial companies listed on the Amsterdam Stock Exchange during the period between 2010 and 2017 were used. To measure audit committee characteristics, four proxies have been used, specifically, audit committee independence, financial expertise, gender diversity and AC meetings. For this research, a linear regression model was used to identify the influence of a set of board characteristics of the audit committee on real earnings management after controlling for firm audit committee size, leverage, size, loss, growth and board size. This research provides empirical evidence of the association between audit committee independence, financial expertise, gender diversity and meetings and Real Earnings Management (REM) as a proxy of financial reporting quality. The study finds that independence and AC Gender diversity are strongly related to financial reporting quality. In fact, these two characteristics constrain REM. The results also suggest that AC- financial expertise reduces to some extent, the likelihood of engaging in REM. These conclusions provide support then to the audit committee requirement under the Dutch Corporate Governance Code rules regarding gender diversity and AC meetings.

Keywords: audit committee, financial expertise, independence, real earnings management

Procedia PDF Downloads 146

Authors: Mariam Dammak, Yosra Makni Fourati, Rania Mnejja

Abstract:

This paper aims to highlight the conditions and the context of the birth and the implementation of the Chartered Certified Accountants in Tunisian universities. For this purpose, we present an historical overview of the establishment of institutions that started the courses of Chartered accounting, including the Institute of Higher Commercial Studies (IHEC) of Carthage, the Higher Institute of Management (ISG) of Tunis, the Faculty of Economics and Management (FSEG) of Sfax and later the Higher Institute of Accounting and Administration of Enterprises (ISCAE) of Tunis. Then, it would be relevant to examine the changes, carried out by the Tunisian government, of the regulations in force relating to this academic path, from its birth during the 1970s until nowadays. We conducted a documentary study (archival documents, official documents, etc.) accompanied by semi-structured interviews with key actors (accountants, academics, officials of the Ministry of Higher Education) who marked the history of the studies of Tunisian charted accounting. Addressing this research question in Tunisia may contribute to the literature in three ways. First, previous researches dealing with the history of charted accounting-education are scared. Second, this paper allows us to understand the circumstances and context of the birth and teaching of accounting in Tunisia. Eventually, it helps to position the accounting curriculum in relation to international requirements. In fact, the training of accountants is closely related to the practice of the profession, regulated by the Order of Chartered Accountants in Tunisia (OECT). This Order is a member of the International Federation of Accountants (IFAC), since its creation in the 80s, has obligations to align with international requirements, particularly those relating to higher education, set up in 2005 and updated in 2015 (International Standard Education: IES).

Keywords: accounting history, chartered certified accountants, higher accounting education, Tunisian context

Procedia PDF Downloads 124

Authors: Ali Assoudi, Sabra Habli, Nejla Mahjoub Saïd, Philippe Bournot, Georges Le Palec

Abstract:

Studying the flow characteristics of a turbulent offset jet is an important topic among researchers across the world because of its various engineering applications. Some of the common examples include: injection and carburetor systems, entrainment and mixing process in gas turbine and boiler combustion chambers, Thrust-augmenting ejectors for V/STOL aircrafts and HVAC systems, environmental dischargers, film cooling and many others. An offset jet is formed when a jet discharges into a medium above a horizontal solid wall parallel to the axis of the jet exit but which is offset by a certain distance. The structure of a turbulent offset-jet can be described by three main regions. Close to the nozzle exit, an offset jet possesses characteristic features similar to those of free jets. Then, the entrainment of fluid between the jet, the offset wall and the bottom wall creates a low pressure zone, forcing the jet to deflect towards the wall and eventually attaches to it at the impingement point. This is referred to as the Coanda effect. Further downstream after the reattachment point, the offset jet has the characteristics of a wall jet flow. Therefore, the offset jet has characteristics of free, impingement and wall jets, and it is relatively more complex compared to these types of flows. The present study examines the dynamic and thermal evolution of a 3D turbulent offset jet with different offset height ratio (the ratio of the distance from the jet exit to the impingement bottom wall and the jet nozzle diameter). To achieve this purpose a numerical study was conducted to investigate a three-dimensional offset jet flow through the resolution of the different governing Navier–Stokes’ equations by means of the finite volume method and the RSM second-order turbulent closure model. A detailed discussion has been provided on the flow and thermal characteristics in the form of streamlines, mean velocity vector, pressure field and Reynolds stresses.

Keywords: offset jet, offset ratio, numerical simulation, RSM

Procedia PDF Downloads 285

Authors: Sultan Çağırıcı, Arsida Bajrami, Beyza Aslan, Hacı Ali Erdoğan, Nejla Sözer Topçular, Dilek Bozkurt, Vildan Yayla

Abstract:

Objective: Corticobasal syndrome (CBS) is phenotypically characterized by asymmetric rigidity, apraxia, alien-limb phenomenon, cortical sensory loss, dystonia and myoclonus. The underlying pathologies consists of corticobasal degeneration (CBD), progressive supra nuclear palsy, Alzheimer's, Creutzfeldt-Jakob and frontotemporal degeneration. CBD is a degenerative disease with clinical symptoms related to the prominent involvement of cerebral cortex and basal ganglia. CBD is a pathological diagnosis and antemortem clinical diagnosis may change many times. In this paper, we described the clinical features and discussed a cases diagnosed with symmetric CBS because of its rarity. Case: Seventy-five-year-old woman presented with a three years history of difficulty in speaking and reading. Involuntary hand jerks and slowness of movement also had began in the last six months. In the neurological examination the patient was alert but not fully oriented. The speech was non-fluent, word finding difficulties were present. Bilateral limited upgaze, bradimimia, bilateral positive cogwheel' rigidity but prominent in the right side, postural tremor and negative myoclonus during action on the left side were detected. Receptive language was normal but expressive language and repetition were impaired. Acalculia, alexia, agraphia and apraxia were also present. CSF findings were unremarkable except for elevated protein level (75 mg/dL). MRI revealed bilateral symmetric cortical atrophy prominent in the frontoparietal region. PET showed hypometabolism in the left caudate nucleus. Conclusion: The increase of data related to neurodegenerative disorders associated with dementia, movement disorders and other findings results in an expanded range of diagnosis and transitions between clinical diagnosis. When considered the age of onset, clinical symptoms, imaging findings and prognosis of this patient, clinical diagnosis was CBS and pathologic diagnosis as probable CBD. Imaging of CBD usually consist of typical asymmetry between hemispheres. Still few cases with clinical appearance of CBD may show symmetrical cortical cerebral atrophy. It is presented this case who was diagnosed with CBD although we found symmetrical cortical cerebral atrophy in MRI.

Keywords: symmetric cortical atrophy, corticobasal degeneration, corticobasal syndrome

Procedia PDF Downloads 431

Authors: Neil Fourati

Abstract:

Collaboration between public and private stakeholders for agricultural development are today lacking in Tunisia. The last dictatorship witnessed by the country has deteriorated the necessary trust between the state and small farmers for the realization of development projects, in particular in the interior, disadvantaged regions of the country. These regions, where the youth unemployment rate is above 30%, have been the heart of the uprising that preceded the revolution. The transitional period that the country is going through since 2011 is an opportunity for the emergence of new governance systems in the context of the decentralization. The latter is recognized in the 2nd Tunisian Republic constitution as the basis of regional management. Civil society participation to the decision-making process is considered as a mean to identify measures that are more coherent with local populations’ needs. The development of agriculture and food value chains in rural areas is relevant within the framework of the implementation of new decisions systems that require public-private collaborations. These new systems can lead to actions in favor of improving living conditions of rural populations. The diverisification of activities around agriculture can be a solution for job creation and local value creation. The project for the promotion of sustainable agriculture and rural development in Tunisia has designed and implemented a multi-stakeholder dialogue process for the development of local value chains platforms in disadvantaged areas of the country. The platforms gather public and private organizations ; as well civil society organizations ; that intervene in a locality in relation to the production transformation or product’s commercialization. The role of these platforms is to formulate realize and evaluate collaborative actions or projects for the promotion of the concerned product and territory. The dialogue process steps allow to create the necessary collaboration conditions in order to promote viable collectivities, dynamic economies and healthy environments. Effectively, the dialogue process steps allow to identify the local leaders. These leaders recognize the development constraints and opportunities. They deal with key and gathering subjects around the collaborative projects or actions. They take common decisions in order to create effective coalitions for the implementation of common actions. The plateforms realize quick success so as to build trust. The project has supported the formulation of 22 collaborative projects. Seven priority collaborative projects have been realized. Each collaborative project includes 3 parts : the signature of the collaboration conventions between public and private organizations, investment in the relevant material in order to increase productivity and the quality of local and products and finally management and technical training in favour of producers’ organizations for the promotion of local products. The implementation of this process has enabled to enhance the capacities of collaboration between local actors : producers, traders, processors and support structures from public sector and civil society. It also allowed to improve the efficiency and relevance of actions and measures for agriculture and rural development programs. Thus, the process for the development of local value chain platform is a basis for sustainable development of agriculture.

Keywords: governance, public private collaboration, rural development, value chains

Procedia PDF Downloads 261