Since the 2011 revolution, Tunisia has undergone a transformative phase characterized by emerging models of governance that prioritize grassroots initiatives and community participation in local ...affairs. Despite its manifold challenges, this political renewal has unfolded during political, socioeconomic, and security crises. Through a case study of the commune of Mhamdia, this article aims to examine two key aspects: (1) how communes can approach built heritage amidst the presence of national, international, governmental, non-governmental, profit, and non-profit actors, and (2) how heritage management can pose challenges, occasionally leading to the destruction of historical elements. This qualitative analysis, rooted in practitioner research, explores shifting paradigms and evolving dynamics within traditional and novel practices, shedding light on their impact on built heritage. The results demonstrate that, similar to national players, local elites also leverage built heritage to fortify their legitimacy, albeit through different means.
Takayasu arteritis is a rare and chronic granulomatous vasculitis that affects the large vessels. Takayasu arteritis targets the aorta and its branches and is still of unknown etiology. It often ...affects female patients under 50 years of age. A relationship between Takayasu arteritis and tuberculosis has been suggested for a long time.
We report a severe case of Takayasu arteritis in a 10-year-old Tunisian child revealed by renovascular hypertension with concomitant pulmonary tuberculosis.
Our patient is among only a few cases of Takayasu arteritis published worldwide affecting young infants and adolescents, which underlines the strong relationship between Takayasu arteritis and tuberculosis.
Consistent forest loss estimates are important to enforce forest management regulations. In Tunisia, recent evidence has suggested that the deforestation rate is increasing, especially since the ...2011's Revolution. However, no spatially explicit data on the extent of deforestation before and after the Revolution exists. Here, we quantify deforestation in the country for the period 2001-2014 and we propose a novel spatio-temporal pattern-based sequence classification framework for forest loss estimation. To do so, expert knowledge and spatial techniques are applied to identify deforestation drivers. Then, we adopt sequential pattern mining to extract sets of patterns sharing similar spatiotemporal behavior. The sequence miner generates multidimensional-closed sequential patterns at different time granularities. Then, a discriminative filter is employed to decide on patterns to use as relevant classification features. Lastly, the classifier is trained using random forest and shows an improved result.
Arndt‐Gottron (S‐AG) syndrome or scleromyxedema is a scarce disease characterized by a generalized papular and sclerodermoid eruption and systemic manifestations that can lead to significant ...morbid‐mortality. Interesting, S‐AG can be associated with a paraprotein. We report an exceptional scleromyxedema case associated with a benign monoclonal gammapathy in an old woman.
Background. Renal amyloidosis is one of the main differential diagnoses of nephrotic proteinuria in adults and the elderly. The aim of this study with the most important series in our country is to ...contribute to the epidemiological, clinical, and etiological study of the renal amyloidosis. Methods. In a retrospective study carried out between 1975 and 2019, 310 cases of histologically proven and typed renal amyloidosis were selected for this study. Results. There were 209 men and 101 women with a mean age of 53.8 ± 15.4 years (range, 17–84 years). Of the 310 cases, 255 (82.3%) were diagnosed with AA renal amyloidosis and 55 (17.7%) with non-AA amyloidosis. Infections were the main cause of AA amyloidosis, and tuberculosis was the most frequent etiology. The period from the onset of the underlying disease to diagnosis of the renal amyloidosis was an average of 177 months. The most frequent manifestations at the time of diagnosis were nephrotic syndrome (84%), chronic renal failure (30.3%), and end-stage renal disease (37.8%). After a medium follow-up of 16 months (range, 0–68 months), mortality occurred in 60 cases. Conclusions. Given the high frequency of AA amyloidosis in our country, awareness of the proper management of infectious and chronic inflammatory diseases remains a priority in reducing the occurrence of this serious disease.
The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating ...12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.
Fulminant lupus pneumonitis is a rare complication of SLE. We report a case of 75 years‐old male patient with SLE who developed pneumonia and severe respiratory failure requiring mechanical ...ventilation. Refractory respiratory distress complicating noninfectious fulminant lupus pneumonitis did not respond to methylprednisolone and intravenous immunoglobulin treatment.
FLP in SLE of the elderly is a rare and severe condition. Each practitioner has to focus on respiratory failure, which is severe and life‐threatening.
Tuberculous tenosynovitis of the hand is a very rare condition. Herein, we report the case of tuberculous tenosynovitis of the hand in a 32‐year‐old woman. We highlight the success of anti ...tuberculosis drugs alone without resort to surgical treatment.
T1 weighted MRI images showed thickening of flexor sheaths (A), intensely enhanced after injection of gadolinium (B), conforming with flexor tenosynovitis of the left hand.
Hughes-Stovin syndrome is a scarce pathology associating pulmonary artery aneurysms and deep venous thrombosis and affecting commonly the young patient. A 27 year old man was hospitalised for ...recurrent hemoptysis and a left femoral vein thrombosis. Besides, he had oral ulcers. The ophthalmological examination was normal. Laboratory studies found a microcytic hypochromic anemia (hemoglobin: 11g/dl).The coagulation tests, the renal and the hepatic functions were normal. Besides, the bacteriological examination in search for mycobacterium tuberculosis and the immunological investigations were negative. The chest radiograph revealed a left surrounded para-hilar opacity. The CT of the chest confirmed the presence of a giant aneurysm in the left lower lobe pulmonary artery of 90 mm/72 mm, partially thrombosed, occupying the quasi-totality of the left pulmonary field. All abnormalities of hemostasis, a tumoral origin, a vasculitis like Behçet's disease and an infectious etiology were eliminated in our patient. Therefore, Hughes-Stovin syndrome was our diagnosis. The patient was put on oral corticosteroid (1 mg/kg/day), and intravenous cyclophosphamide; the steroids were subsequently tapered and withdrawn after 6 months until reaching a minimal dose of 10 mg/day. There has been no recurrence of deep venous thrombosis or hemoptysis. There was no evidence of enlargement of the pulmonary artery aneurysms on chest CT scan control. He was programmed for an embolization because of the giant aspect of the aneurysm.
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