Publications by authors named "A El Ouni"

28 Publications

Pheochromocytoma presenting as an authentic small vessel vasculitis and complicated with pulmonary embolism: An original presentation.

Ann Cardiol Angeiol (Paris) 2021 Jun 4;70(3):168-170. Epub 2021 May 4.

Service de médecine interne, Hôpital Mongi Slim La Marsa, Tunis, Tunisia.

Diagnosis of pheochromocytoma can be simple when classic manifestations are present. It can also be challenging and complicated in some cases because of its wide array of faces and presentations. We present a case of a 30-year-old female patient who came with acute respiratory distress, chest pain, hemoptysis, asthenia, anorexia, weight loss of 20kg, and paresthesia in her lower limbs. Clinical examination found high blood pressure, accelerated heart and respiratory rates, signs of acute right heart failure with jugular venous distention and ankle edema, reticularis livedo in the four limbs, ulcers in both knees and in the 3rd metacarpo-phalangeal articulations and necrotic lesions in both calcaneal tendons and in the right toes. Further investigations concluded on myocarditis associated with alveolar hemorrhage, pericardic and pleuritic effusions and a segmental pulmonary embolism of the right inferior lobe. Neuro-muscular biopsy was suggestive of myositis. Cutaneous biopsy found nonspecific chronic dermatitis. ANCA antibodies were tested twice and were negative. Cryoglobulinemia was also negative. Thoraco-abdomino-pelvic scan was performed showing a large right adrenal mass suggestive of pheochromocytoma. Diagnosis of right adrenal pheochromocytoma was confirmed by MIBG-I123 hyperfixation findings and urinary normetanephrin levels. The patient was treated surgically. Postoperative outcomes were remarkably favorable with a complete regression of the cutaneous lesions and normalization of the blood pressure. Paresthesia significantly decreased. Control echocardiography at 3 months showed an improved heart function with a persistent apical and septal akinesis.
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http://dx.doi.org/10.1016/j.ancard.2021.04.006DOI Listing
June 2021

Traffic Signal Control Using Hybrid Action Space Deep Reinforcement Learning.

Sensors (Basel) 2021 Mar 25;21(7). Epub 2021 Mar 25.

École de Technologie Supérieure, University of Quebec, Montreal, QC H3C 1K3, Canada.

Recent research works on intelligent traffic signal control (TSC) have been mainly focused on leveraging deep reinforcement learning (DRL) due to its proven capability and performance. DRL-based traffic signal control frameworks belong to either discrete or continuous controls. In discrete control, the DRL agent selects the appropriate traffic light phase from a finite set of phases. Whereas in continuous control approach, the agent decides the appropriate duration for each signal phase within a predetermined sequence of phases. Among the existing works, there are no prior approaches that propose a flexible framework combining both discrete and continuous DRL approaches in controlling traffic signal. Thus, our ultimate objective in this paper is to propose an approach capable of deciding simultaneously the proper phase and its associated duration. Our contribution resides in adapting a hybrid Deep Reinforcement Learning that considers at the same time discrete and continuous decisions. Precisely, we customize a Parameterized Deep Q-Networks (P-DQN) architecture that permits a hierarchical decision-making process that primarily decides the traffic light next phases and secondly specifies its the associated timing. The evaluation results of our approach using Simulation of Urban MObility (SUMO) shows its out-performance over the benchmarks. The proposed framework is able to reduce the average queue length of vehicles and the average travel time by 22.20% and 5.78%, respectively, over the alternative DRL-based TSC systems.
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http://dx.doi.org/10.3390/s21072302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037422PMC
March 2021

Dissemination of Gastroenterology and Hepatology Research on Social Media Platforms Is Associated With Increased Citation Count.

Am J Gastroenterol 2021 Mar 22. Epub 2021 Mar 22.

Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; Department of Medicine, University of Florida, Gainesville, Florida, USA.

Introduction: The purpose of this study was to find out whether dissemination of gastroenterology and hepatology (GI) research on social media networks correlates with citation count at 5 years.

Methods: We correlated the Altmetric Attention Score with Web of Science citation counts at 5 years for scholarly work published in the 10 highest impact factor GI journals in 2014.

Results: In 4,026 analyzed items, the correlation (r) between Altmetric Attention Score and citations at 5 years was 0.62 (P < 0.001), representing strong correlation. Twitter was the platform with the strongest correlation with citations.

Discussion: Social media attention garnered by GI scholarly work strongly correlates with the number of citations at 5 years.
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http://dx.doi.org/10.14309/ajg.0000000000001240DOI Listing
March 2021

[Characteristics of cardiac involvement in eosinophilic granulomatosis with polyangiitis].

Ann Cardiol Angeiol (Paris) 2021 Feb 23. Epub 2021 Feb 23.

Service de médecine interne, centre hospitalier universitaire Mongi-Slim, 2070 La Marsa, Tunisie.

Aim Of The Study: Our study aimed to identify the characteristics of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA).

Methods: We conducted a retrospective analytic study including EGPA cases diagnosed between 2000 and 2019 in an internal medicine department. Diagnosis was made according to the 1990 American College of Rheumatology criteria and the 2012 Chapel Hill Concensus.

Results: Eleven EGPA cases were included, 64% of patients were female. Median age at diagnosis was 52 years [42-58]. Heart damage revealed EGPA in 55% of cases with a significant predominance of women (p=0.015). The main cardiac manifestations were myocarditis, ischemic cardiomyopathy due to small vessel vasculitis, cardiac tamponade and intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) mainly showed subendocardial hyposignal in early infusion and late enhancement in the same areas, nodular by locations, associated with impaired left ventricle function and micro-infarctions by distal vasculitis. Cardiac damage was associated to ANCA negativity in 83.3% of cases. The median Birmingham Vasculitis Activity Score version3 (BVAS v3) was 16 [10-17]. Under conventional treatment, no relapses had occurred. The median vasculitis damage index (VDI) was 2 [1-2.3] and the mortality rate was zero after a mean follow-up of 43 months.

Conclusion: Cardiomyopathy is a frequent revealing mode of EGPA. A late onset asthma and hypereosinophilia should guide the diagnosis. As ANCA research often turns out to be negative, histological evidence is recommended in this context. The contribution of cardiac MRI in the diagnosis of EGPA remains to be defined.
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http://dx.doi.org/10.1016/j.ancard.2020.12.002DOI Listing
February 2021

Performance of FIB4 and APRI scores for the prediction of fibrosis in patients with chronic hepatitis B virus infection.

Tunis Med 2020 Dec;98(12):998-1004

Background: The evaluation of hepatic fibrosis is essential in the therapeutic management of chronic hepatitis B virus infection. The development of non-invasive tests for liver fibrosis assessement has allowed to avoid liver biops in some cases.

Aim: To assess the performance of the scores APRI and FIB-4 in the assessment of significant fibrosis in chronic hepatitis B virus infection.

Methods: Evaluation study, including patients with chronic hepatitis B virus infection who had a liver biopsy. The accuracy of APRI and FIB4  for the detection of significant fibrosis was compared with  the liver biopsy data.

Results: One hundred and one patients were included. Significant fibrosis was found in 10.9% of patients. For a cut-off value of 0.49, the APRI score predicted significant fibrosis with a sensitivity of 54%, a specificity of 93% and a negative predictive value of 94%. For a cut-off value of 1.01, the FIB-4 score predicted significant fibrosis with a sensitivity of 64%, a specificity of 84% and a negative predictive value of 95%. Performance of both scores was influenced by age, the body mass index, and cytolysis.

Conclusion: The APRI and FIB-4 scores had a good accuracy to exclude significant fibrosis in chronic hepatitis B virus infection.
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December 2020