Biomedicine & Healthcare Research

Editorial

2026-07-25T09:39:09+00:00

It is with great pleasure that we present the seventh volume of Biomedicine & Healthcare Research, which once again reflects the richness and diversity of biomedical research being conducted in Tunisia and the broader region. This issue brings together eight original articles and three case reports, spanning a wide range of disciplines — from psychiatric genetics to ENT surgery, pharmacology, fundamental oncology, medical imaging, and nursing sciences.

Genetics and Psychiatry. The volume opens with the work of Aflouk and colleagues, who investigate the association between MYD88 gene polymorphism and schizophrenia in a Tunisian cohort, shedding further light on the neuro-immune underpinnings of this complex disorder.

Cancer Biology. Jemaa and his team present an elegant mechanistic study on Mps1 inhibition, demonstrating how this approach preferentially induces DNA damage in tetraploid cancer cells — a promising strategy for selectively targeting tumor cells with chromosomal abnormalities.

Renal Protection and Oxidative Stress. The study by Nasrallah et al. highlights the role of AMPK activation in mediating the antioxidant and anti-inflammatory effects of oleuropein during renal ischemia–reperfusion injury, opening interesting therapeutic avenues in transplantation and vascular surgery.

Nursing Science and Palliative Care. Hamdi and colleagues offer a valuable qualitative study on nurses' experiences facing terminally ill patients in Tunisian intensive care units, underscoring the critical importance of human and psychological support for healthcare staff confronting these emotionally demanding situations.

Dermatopathology. The team led by Mokni contributes a clinicopathologic study on the diagnostic value of TCRγ rearrangement analysis by PCR in early mycosis fungoides, reinforcing the molecular tools available for early diagnosis of this cutaneous lymphoma.

Imaging and ENT Pathology. Two studies by El Omri and colleagues enrich this issue: the first evaluates the contribution of multiparametric MRI (DWI and DCE-MRI) in differentiating parotid tumors, while the second presents a retrospective review of esophageal foreign bodies managed at a Tunisian tertiary care center.

Pharmacology and Experimental Models. Sassi et al. describe the development of an innovative ex vivo model simulating the human urethra, designed for studying drug diffusion — a useful methodological tool for urological and pharmaceutical research.

On the clinical case front, this volume features three rare and instructive reports: a uterine endometrioid carcinoma

with shadow cell differentiation (Guesmi et al.), torsion of a wandering spleen as an uncommon cause of acute abdomen (Touarhi et al.), and a possible overlap syndrome linking autoimmune pancreatitis with allergic disorders (Bacha et al.).

This seventh volume once again illustrates the sustained commitment of the Tunisian scientific and medical community to rigorous, diverse research firmly grounded in clinical realities. We warmly thank all the authors for their valuable contributions, as well as the reviewers for their thorough evaluation work, which upholds the scientific integrity of our journal.

We wish you an enriching read of this issue and look forward to sharing our next volume with you.

The Editorial Board

Biomedicine & Healthcare Research

Faculty of Medicine of Sousse,

University of Sousse,

Tunisia

The association of MYD88 polymorphism with schizophrenia in the Tunisian population

2026-01-05T16:56:10+00:00

Since abnormal inflammation triggered by Toll-like receptors was well described in schizophrenia pathophysiology, the altered activation of MyD88, the adaptor protein of the majority of these receptors, has gained attention. However, the genetic predisposition through MYD88 variants to schizophrenia is still unexplored. Therefore, we investigated the possible association between rs4988457 and schizophrenia in the Tunisian population. We performed a case-control study including 145 schizophrenic patients and 157 controls. All participants were genotyped for rs4988457 by PCR-RFLP. The genotypic and allelic frequencies were compared between patients and controls based on clinical characteristics. The statistical analysis of our results revealed a significant decrease of GG+CG genotypes and G allele frequencies in patients with the undifferentiated type of schizophrenia compared to controls (p-value=0.03; OR=0.4, p-value=0.02; OR=0.4, respectively) according to the dominant model. Further analyses showed that SANS and SAPS scores, before treatment, were significantly lower in patients carrying CC+CG compared to patients with CC (p-value=0.00007, p-value=0.003, respectively). After treatment, psychiatric scales scores decreased significantly in CC carriers (SANS: p-value=0.0001, SAPS: p-value=0.000002, BPRS: p-value=0.000001); meanwhile, these scores did not differ in CC+CG carriers (p-value=0.9, p-value=0.3, p-value=0.8, respectively). In addition, BPRS scores were significantly higher in CC+CG carriers compared to CC carriers (p-value=0.01) after treatment. In conclusion, the current study suggests that MYD88 rs4988457 could be associated with protection from the undifferentiated type and positive and negative symptoms of schizophrenia in the Tunisian population. Additionally, rs4988457 could be a pharmacogenetic marker of decreased efficiency of antipsychotic treatment against brief symptoms of schizophrenia.

Mps1 Inhibition Preferentially Induces DNA Damage in Tetraploid Cancer Cells

2026-06-17T10:23:43+00:00

Background: Tetraploidy, a state of whole-genome duplication, is frequently observed in human cancers and confers resistance to conventional DNA-damaging therapies. The spindle assembly checkpoint (SAC) kinase Mps1 (TTK) is essential for mitotic fidelity and has emerged as a promising anticancer target. However, whether Mps1 inhibition differentially induces DNA damage in tetraploid versus diploid cancer cells, and whether this response engages the p53 pathway, remains unknown.

Methods: Using isogenic diploid and tetraploid RKO colon carcinoma cells, we assessed the effects of pharmacological (Reversine) and genetic (siRNA) Mps1 inhibition on cell viability, clonogenic potential, and DNA damage induction. DNA double-strand breaks (DSBs) were quantified by γH2AX immunofluorescence and western blot analysis of γH2AX and phosphorylated CHK2 (T68). The involvement of the p53/p21 axis was examined using immunoblot and functional validation in p53-proficient and p53-deficient isogenic HCT116 cells.

Results: Tetraploid RKO cells exhibited significantly greater resistance to bleomycin, cisplatin, etoposide, and camptothecin compared to diploid cells (p < 0.001). Conversely, Mps1 inhibition or depletion preferentially compromised tetraploid cell viability and clonogenic potential. Mechanistically, Mps1 knockdown induced a marked increase in γH2AX foci and pCHK2 (T68) specifically in tetraploid cells, indicative of a robust double-strand break (DSB) response. Notably, this occurred without significant changes in p53 or p21 expression, and p53-deficient tetraploid cells remained sensitive to Mps1 targeting, suggesting a p53-independent mechanism.

Conclusion: Mps1 inhibition preferentially induces enhanced DNA damage in tetraploid cancer cells via a p53-independent pathway. These new findings position Mps1 as a promising therapeutic target for tetraploid-rich tumors and potentially including those with p53 mutations.

AMPK activation mediates the antioxidant and anti-inflammatory effects of oleuropein in renal ischemia–reperfusion injury

2026-01-03T06:23:05+00:00

In the present study, we investigated the protective effect of OLE in a renal ischemia/reperfusion (I/R) rat model. We assessed whether OLE action depends on the modulation of AMPK-mediated oxidative stress and inflammation pathways. Rats were subjected to 60-min of renal ischemia followed by 120-min of reperfusion. OLE (50 mg/kg, per os) was administered for three consecutive days before I/R. Ara-A, an AMPK inhibitor, was infused at a rate of 100 μg/kg per min for 10 min before the onset of ischemia. Our results showed that OLE treatment improved significantly renal function, cell integrity and antioxidant status. These effects were completely blunted after Ara-A administration. Rats’ pretreatment with OLE reduced NF-κB pathway through the phosphorylation of AMPK and its downstream target molecule COX 2, an effect that was abolished following AMPK inhibition. In conclusion, this study reveals that OLE pretreatment attenuates kidney injury after I/R and this beneficial effect is related to the activation of AMPK pathway. These results emphasize oleuropein therapeutic potential for limiting oxidative and inflammatory damages associated with renal I/R.

Nurses’ Experience Facing Terminally Ill Patients in Tunisian Intensive Care Units: A Qualitative Study

2025-11-18T05:44:10+00:00

Background: Palliative care is essential in Intensive Care Units (ICUs), where many patients face life-threatening conditions and may not survive. ICU nurses are at the frontline of End-Of-Life (EOL) care, requiring strong competencies in communication, empathy, and symptom management. They also face significant emotional and ethical burdens when caring for dying patients. A deeper understanding of their experiences is crucial to improving the quality and delivery of EOL care in critical care settings. This study aimed to explore the experiences of nurses caring for terminally ill patients in the Intensive Care Units (ICUs).

Methods: This qualitative descriptive study was conducted in the ICUs of Sahloul University Hospital in Sousse, Tunisia. Five experienced nurses from three different units were purposively selected. Data were collected through semi-structured interviews using a semi-structured interview guide, inspired by Jean Watson’s philosophy, which comprises fourteen open-ended questions examining perceptions, emotions, support practices, and barriers. Data were analysed inductively using Paille’s five-step model.

Results: The data analysis revealed five main themes: (1) The representation of the concept of "End-of-life" by healthcare staff, (2) The emotions experienced, (3) The specific support provided, (4) The barriers raised, and (5) The psychological support for the patient and family. These five themes covered fourteen sub-themes.

Conclusion: This Research emphasizes the need for strong interpersonal skills, patient-centred strategies, and effective communication with both family and patient, to improve care and support caregivers in their crucial roles to provide palliative care.

Diagnostic value of TCRγ rearrangement analysis by PCR in early mycosis fungoides: A clinicopathologic study

2026-03-29T19:02:00+00:00

Background: Mycosis fungoides (MF) is the most common type of primary cutaneous T-cell lymphoma. Diagnosing early-stage MF remains challenging because its clinical and histopathological features frequently mimic benign inflammatory dermatoses. Molecular analysis of T-cell receptor (TCR) gene rearrangements has emerged as a valuable adjunctive tool in this context. The objective of this study was to evaluate the diagnostic value of polymerase chain reaction (PCR) detection of TCR gamma (TCRγ) gene rearrangements in patients with suspected early MF, and to determine its utility within an integrated clinicopathological approach.

Methods: This retrospective study included 16 patients who underwent skin biopsy for lesions suspicious for MF between 2019 and 2021 at the Farhat Hached University Hospital, Sousse. Clinical data, histopathological findings, immunohistochemical profiles, and molecular analyses were reviewed. T-cell clonality was assessed via PCR amplification of TCRγ gene rearrangements using formalin-fixed paraffin-embedded tissue.

Results: The study population comprised 16 patients aged 4 to 73 years (mean age: 43.5 years). Histopathological examination revealed superficial lymphoid infiltrates with varying degrees of epidermotropism, which were suggestive of but not definitive for MF. Immunohistochemical analysis showed a predominance of CD3-positive T lymphocytes with CD4 predominance in most cases. PCR analysis detected clonal TCRγ rearrangements in 8 cases (50%), polyclonal patterns in 7 cases, and an oligoclonal pattern in 1 case. After integrating clinical, histological, immunophenotypic, and molecular findings, the final diagnosis was MF in 13 patients and chronic inflammatory dermatosis in 3 patients.

Conclusion: PCR detection of TCRγ gene rearrangements represents a valuable ancillary technique in the diagnostic evaluation of suspected early MF. However, molecular results must always be interpreted in conjunction with clinical, histological, and immunophenotypic findings to avoid diagnostic pitfalls.

The Role of Multiparametric Magnetic Resonance Imaging (MRI) (DWI and DCE-MRI) in Differentiating Parotid Tumors: A Retrospective Study of 42 Cases

2026-03-17T15:35:10+00:00

Background: Tumors of the parotid gland are complex. The surgical approach depends on the histology, location, and size of the tumor. Magnetic resonance imaging (MRI) is an important tool for accurate preoperative assessment of topography and infiltration; however, its role in pathological differentiation remains controversial.

Purpose: Our study aims to illustrate the results of MRI in parotid tumors and correlate them with histopathological findings.

Materials and Methods: A retrospective and analytical study was conducted on 42 patients with clinically suspected parotid tumors, collected over 12 years from 2011 to 2023. All patients underwent a multiparametric MRI protocol, including conventional sequences, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement, and dynamic contrast-enhanced (DCE-MRI) sequences. MRI results were then correlated with the definitive histopathological findings obtained after surgery. Statistical analysis was performed using SPSS software. The concordance between MRI and histology was assessed using the kappa coefficient.

Results: Histopathology revealed 31 benign tumors (73.8%), 5 malignant tumors (11.9%), and 6 pseudotumors (14.2%). For distinguishing benign from malignant tumors, MRI showed moderate agreement with histology (kappa = 0.58). However, excellent concordance was observed for specific diagnoses: pleomorphic adenoma (kappa = 0.85) and Warthin tumor (kappa = 0.91). Mean ADC values were significantly lower in malignant tumors compared to benign tumors (p < 0.05). Pleomorphic adenoma typically demonstrated a Type A dynamic enhancement curve, Warthin tumor a Type B curve, and mucoepidermoid carcinoma a Type C curve.

Conclusion: Multiparametric MRI with gadolinium enhancement and ADC assessment demonstrates high diagnostic accuracy for specific benign parotid tumors, particularly pleomorphic adenoma and Warthin tumor, despite a moderate overall performance in distinguishing benign from malignant lesions. These findings can guide surgeons in preoperative planning when specific benign entities are suspected.

Foreign Bodies in the Esophagus in a Tertiary Center of Tunisia

2025-12-17T08:31:18+00:00

Introduction: Esophageal foreign body (EFB) ingestion is a frequent medical emergency encountered in otorhinolaryngology, particularly in children and adults with specific risk factors. Prompt diagnosis and timely intervention are essential to prevent potentially life-threatening complications. The objective is to describe the epidemiological, clinical, radiological, and therapeutic characteristics of EFB ingestion and to identify factors associated with delayed consultation and complications.

Methods: A retrospective study was conducted from January 2006 to December 2022, including all patients with EFB ingestion. Clinical, radiological, and therapeutic data were analyzed, with statistical evaluation of factors linked to delayed consultation.

Results: A total of 360 patients were included with an incidence of 15 cases per 1,000 hospitalizations. Children accounted for 52.2% of cases (median age: 5 years), while adults represented 47.8% (median age: 58 years). Most patients (91.8%) presented within 24 hours of ingestion. The upper third of the esophagus was the most frequent site of impaction (86.1%). Esophagoscopy was performed in all patients. Extraction was successful in 93.3% of cases using rigid esophagoscopy. Surgical intervention was required in only 0.8% of cases. Mucosal injury was observed in 11.4% of patients, with major complications (2.2%) including perforation, abscesses, and mediastinitis. Most patients (96.1%) were discharged within 24 hours. Univariate and multivariate analyses identified neuropsychiatric comorbidities, vomiting, sharp-edged objects, and middle esophageal location as factors independently associated with delayed consultation, while food-related foreign bodies and hypersalivation were protective factors.

Conclusion: EFBs represent a common but potentially serious clinical situation. Early diagnosis and management via rigid esophagoscopy yield excellent outcomes. Targeted preventive strategies, particularly education of caregivers and high-risk adult populations, are essential to reduce consultation delays and prevent complications.

Development of an Ex Vivo Model Simulating the Human Urethra: Application to Drug Diffusion

2026-06-17T09:58:33+00:00

The development of topically applied drugs for the human urethra requires experimental models that simulate the urethra's structural characteristics and assess drug diffusion through its various tissue layers. This study aimed to describe a novel ex vivo model that simulates the different layers of the male urethral wall and to evaluate its applicability for investigating drug diffusion using a halofuginone (HF)-containing intraurethral gel as a model formulation, to support the future development of intraurethral therapies. The study used the human ureter as a substitute for the urethra because both tissues share a similar histological structure and the ureter is more readily available. The experimental model consisted of two parts. The first part employed a diffusion cell to investigate the diffusion kinetics of three HF gel formulations over a period of 2 hours. The second part used the formulation selected from the first phase to evaluate the three-dimensional (3D) distribution of HF following ex vivo intraurethral instillation. Three gel formulations with different viscosities were prepared. A high-performance liquid chromatography (HPLC) method was used to determine the concentration of HF diffused into the human ureteral wall. Following ex vivo intraurethral instillation, HF was uniformly distributed throughout the tissue. No HF was detected in the receiver compartment during the 2-hour diffusion period. These findings suggest that topical delivery of HF via an intraurethral gel may be a promising therapeutic approach for treating and preventing urethral stricture recurrence. The development and characterization of this ex vivo urethral model may facilitate the evaluation and development of new intraurethral therapies for urethral diseases.

Torsion of a wandering spleen: an uncommon cause of acute abdomen

2026-02-16T05:49:07+00:00

Background: Wandering spleen is a rare clinical entity caused by congenital or acquired laxity or absence of the splenic suspensory ligaments, resulting in excessive splenic mobility and an increased risk of vascular pedicle torsion. This condition may progress to splenic infarction and represent a surgical emergency. Because its clinical presentation is often nonspecific, diagnosis is frequently delayed unless characteristic imaging findings are recognized. In this case report, we highlight the clinical and radiological features suggestive of splenic torsion, with particular emphasis on the diagnostic value of computed tomography and the surgical decision-making process.

Case Presentation: We report on the case of a 15-year-old patient who presented with acute abdominal pain and vomiting. Physical examination revealed diffuse abdominal tenderness associated with a mobile abdominal mass. Laboratory investigations showed elevated inflammatory markers. Contrast-enhanced computed tomography revealed an absent spleen in the left upper quadrant with an ectopic pelvic splenic mass associated with twisting of the vascular pedicle (whirl sign), suggesting splenic torsion. Emergency laparotomy confirmed complete torsion with splenic infarction. Detorsion was attempted; however, due to lack of reperfusion, splenectomy was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day seven.

Conclusion: Torsion of a wandering spleen is an uncommon but potentially life-threatening cause of acute abdomen in children and adolescents. Early recognition and prompt CT imaging are crucial for diagnosis. Surgical management is mandatory, with spleen-preserving procedures recommended whenever splenic viability is maintained.

An Association of Autoimmune Pancreatitis and Allergic Disorders: A Possible Overlap Syndrome

2025-10-10T04:10:17+00:00

Autoimmune pancreatitis (AIP) is a rare and distinct form of chronic pancreatitis, characterized by unique clinical, radiological, and histopathological features. Its prevalence is 2–4 per 100,000, with up to 40% of patients showing eosinophilia or other allergic manifestations (1). The association between AIP and allergic disorders accompanied by pancreatic eosinophilia is rare and poorly characterized, with few documented cases in the literature, making its recognition particularly challenging. We describe a case of AIP in a 65-year-old woman with asthma, diabetes, and chronic renal insufficiency. The patient presented with symptoms mimicking pancreatic malignancy, but further investigations revealed AIP with significant peripheral and tissue eosinophilia. She demonstrated marked clinical and radiological improvement following corticosteroid therapy, with rapid resolution of symptoms and normalization of eosinophil counts within 10 days, and remained in remission during a 6-month follow-up. This case highlights the rare overlap between AIP and eosinophilic disorders, suggesting a possible link with allergic conditions that deserves further study