Tunisie Medicale最新文献

Introduction: Traditional heat therapy (HEAT) and emerging vibration therapy (VIB) have shown potential benefits in alleviating nonspecific back pain (NSBP). This randomized controlled study aimed to evaluate the efficacy of HEAT, VIB, and their combination (COMBI) in reducing pain levels and improving cardiovascular parameters in NSBP patients.

Methods: Fifty-nine patients with NSBP were randomly assigned to 3 groups: HEAT (n=19), VIB (n=20), and COMBI (n=20). The study included three visits (V1 to V3) with interventions in V2. Pain visual analogue scale scores (ie; primary outcome, with a minimal clinically important difference (MCID) set at 10 mm on a 100 mm scale), oxy-haemoglobin saturation (SpO2), heart-rate, blood-pressure, and perfusion-index were evaluated before (V2b) and after (V2a) each intervention. During V3 (ie; telephone call one day after the intervention) only pain score was evaluated. Changes (ie; V2a-V2b, V3-V2b) were calculated.

Results: All 3 therapies were clinically effective, with mean pain changes exceeding the MCID. The COMBI group showed the greatest pain reduction in mm (17 at V2, 23 at V3) compared to the VIB (15 at V2, 10 at V3) and HEAT (11 at V2, 10 at V3) groups. In comparison to the COMBI group, the VIB one exhibited a higher change in heart-rate (-2±4 vs. 3±5 bpm; -1±3 vs. 1±3 % of predicted maximum hear-rate, respectively). SpO2 change under COMBI decreased significantly by 1±1%. No significant changes were observed in blood-pressure or perfusion-index across the groups.

Conclusions: COMBI-therapy provides superior pain relief for NSBP compared to each therapy alone. RCT registration. ISRCTN registry (https://www.isrctn.com/); Trial Number: ISRCTN15769490 (https://doi.org/10.1186/ISRCTN15769490).

Introduction-Aim: Latent myeloproliferative neoplasms (MPNs) have been reported in splanchnic vein thrombosis (SVT). This is the first Tunisian study aimed at evaluating the frequency of JAK2V617F, MPL, and CALR mutations in SVT and analyzing their correlation with hematological parameters Methods: This study, conducted between 2013 and 2017, included non-malignant and non-cirrhotic SVT cases. JAK2V617F and MPL mutations were detected by real-time PCR, and the CALR mutation was screened by PCR and direct sequencing. Results: The JAK2V617F mutation was detected in 20.1% of 233 SVT cases, with a significantly higher prevalence in Budd-Chiari syndrome (BCS). MPL and CALR mutations were not detected. The frequency of latent MPN was 36.2% in SVT, 31.7% in portal vein thrombosis, and 66.6% in BCS. Patients with SVT and hemoglobin levels ≥14.5 g/dL in men, 11.4 g/dL in women, Leukocytes count ≥6100/mm³, and platelet count ≥238,000/mm³ could be tested for the JAK2V617F mutation. This strategy avoids 89.5% of unnecessary tests in patients below these thresholds. A platelet count ≥238,000/mm³ was an independent factor correlated with the JAK2V617F mutation and a strong predictor of latent MPN (OR=17.3; 95% CI [2.8-105.1]; p=0.002). Conclusion: Screening for JAK2V617F is useful for diagnosing latent MPNs revealed by SVT, while MPL and CALR mutations are rare and not recommended.

 Introduction: This work examines the influence of psychological working climate in explaining intentions to leave the organization, The interest in this theme is explained by the need to understand the factors that hinder the retention of nurses, The continuing shortage of nursing staff and the persistent recruitment difficulties are all problems that are currently affecting the institutions.

Aim: To explore the role of psychological work climate in nursing staff with the intention of leaving the organization.

Methods: we conducted an exploratory qualitative research with a thematic analysis. We conducted 20 semi-structured interviews during the period from 15 April to 15 May with nurses who have left or expressed their intentions to leave L'Hôpital.

Results: 20 nurses interviewed, the main factors of psychological climate that led these professionals to leave the organization: a) lack of recognition, b) style of leadership transactional (autocratic) , c) the lack of clarity in nursing role d) conflicts sit-in the work team, e) organizational bureaucracy, lack of support and administrative justice and weak support, f) lack of communication Conclusion: the prevention of the departure of nurses requires a definition of the own role of nurse, a participative leadership, cooperative and understanding relations between team members, a management policy based on listening, support for administrative justice and finally an organization that promotes innovation and skills development.

Introduction: Hospital-acquired infections (HAI) represent a growing public health concern and are the most common adverse events in healthcare delivery. Improvements in infection prevention and control (IPC) practices at both national and facility levels are decisive for  successfully preventing HAIs. The relevance of IPC in preventing the spread of disease was underscored during the COVID-19 pandemic. However, the impact of COVID-19 preventive measures on HAIs remains debated.

Aim: This study aims to investigate the impact of the IPC program implemented during the COVID-19 pandemic at Sahloul University Hospital in Tunisia on the prevalence of HAIs. Additionally, the study will assess compliance with IPC measures during the same period.

Methods: A pre-interventional study design will be conducted at Sahloul University Hospital in Sousse, Tunisia. The study will compare HAI prevalence over three periods : pre-pandemic (2019), during the pandemic (2020) and post-pandemic (2022). For the Point prevalence srvey, all hospital wards (units or departments) will be included in the survey, except the emergency department, hemodialysis unit and endoscopy units. Four key IPC program criteria will be analyzed: hand hygiene compliance, environmental cleaning, sanitary waste management, and the consumption of personal protective resources, including alcohol-based hand sanitizer, surgical masks and disposable gloves. Expected results : This study specifically explores the effects of IPC measures implemented during the COVID-19 pandemic on HAIs prevlance. Its findings are expected to contribute valuable insights into sustainable strategies for maintaining high compliance rates and reducing HAI prevalence beyond crisis periods.

Introduction-Aim: This study aimed to evaluate the role of echocardiographic left ventricular (LV) longitudinal strain (LS) in identifying the localization and extent of myocardial injury compared to edema and late gadolinium enhancement (LGE) detected on cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis (AM).

Methods: Patients -18years-old, with informed consent, and AM confirmed by CMR were prospectively enrolled between 1st November 2023 and 30th September 2024. Strain echocardiography with measurements of global (GLS) and segmental longitudinal strains (SLS) was performed. Number and localization of segments with impaired LS were compared with those with edema and/or LGE on CMR.

Results: 19 patients, 31.6±12.0 years old and 84.2% male were enrolled. Although LV ejection fraction (EF) was preserved in all patients, GLS was impaired in 63.2% of them. Impairment in regional LS was identified mainly in the anterolateral, inferolateral and inferior regions, in concordance with localization of edema and LGE detected by CMR, with strong correlation between extent of myocardial injury on CMR and number of segments with impaired SLS per patient (r=0.76; p=0.0002). Performance of SLS in the diagnosis of edema in AM patients was satisfactory with an AUC=0.725, CI 95% [0.67-0.78] and p-0.001. Cut-off value was -17.5% with a sensitivity of 71% and specificity of 65%.

Conclusion: In AM patients, analysis of LS identified impairment in LV myocardial deformation in patients with a normal LVEF. Comparison with CMR showed a very close topographical distribution between regions with impaired myocardial deformation and those of inflammatory tissue injury detected on CMR.

Introduction: Obesity and overweight result from excess fat, leading to health complications and a reduced life expectancy. This issue impact Morocco like all countries worldwide, due to several determinants such as dietary changes, lifestyle choices, sedentary behavior and socioeconomic parameters.

Aim: To evaluate the prevalence of overweight and obesity in Moroccan population, and their related socio-demographic factors.

Methods:  Our study is a cross-sectional study carried out among adult subjects aged 18 years and above, who were selected using cluster sampling. Data collection was conducted using a questionnaire that included sociodemographic parameters such as age, sex, and marital status, educational level…as well as anthropometric measurements. The statistical analysis was performed using SPSS.

Results: The total number of participants was 731 (51.8% women and 48.2% males). The age group 20-29 years constitutes 25.6% of the studied population followed by 30-39 years with 19.4%. According to the BMI the overall prevalence of obesity was 20.7%, with a female predominance (80.10 %). The results indicated that BMI increases with age up to 59 years (p<0.0001). We revealed a strong association between numerous factors and obesity such as age, sex, age, marital status, occupational activity, education level and housing.

Conclusion: Through our study, we found that the obesity was associated with a several sociodemographic factors such as: gender, age, marital status, occupational activity, education level and housing type and size with a female predominance. We suggest structural and supportive policies such as improving access to healthcare services that promotes healthy living and reduces obesity rates.

Introduction: The hospital sector is facing a human resources crisis marked by an increase in turnover, affecting the continuity and quality of care. This shortage of qualified personnel puts pressure on existing teams and complicates patient care.

Aim: The goal is to determine the specific causes of healthcare professionals' departures and identify organizational levers that could promote their retention, thereby contributing to better team stability in healthcare settings.

Methods: A quantitative survey was supplemented by a qualitative study, using interviews and focus groups to obtain comprehensive and nuanced data on the reasons for departure. This dual approach helps to deepen the understanding of healthcare workers' perceptions.

Results: The main reasons for leaving identified include workload overload due to staff shortages, leading to stress and burnout; limited career advancement opportunities; lack of recognition and unsatisfactory working conditions; organizational constraints, and inadequate remuneration. These factors drive many healthcare professionals to consider working in the private sector or moving abroad. To improve retention, it is essential to implement actions to stabilize teams and enhance the quality of care.

Conclusion: In light of the human resources crisis in the hospital sector, it is imperative to adopt concrete measures to improve staff retention by offering better career prospects and optimal working conditions.

Aim: To develop and validate a model predicting surgical treatment of intussusception in children.

Methods: Design: Retrospective study of charts and development of a model for predicting surgical treatment using logistic regression and machine learning using''Knime'' platform.

Setting: Data collection occurred in the Department of Pediatric Surgery between January 2013 and December 2022.

Patients: Children aged less than 3 years old with the diagnosis of ileocolic intussusception.

Results: One hundred and nine children were assigned to the training set, and 47 were assigned to the validation set. There were no significant differences between the two sets in clinical characteristics and surgical reduction. Surgical reduction was performed in 64 patients in the training set and 23 patients in the validation set (p=0.259). The univariate analysis showed that the duration of symptoms, mental state, palpable abdominal mass, bloody stools, elevated white blood cells, intraperitoneal effusion on ultrasound, and mass length were significantly associated with surgical treatment. After Logistic regression, bloody stools (p=0.033; OR=2.61), the duration of symptoms (p=0.028; OR=1.02), and the length of the intussusception (p=0.014; OR=1.265) were identified as independent risk factors for surgical treatment. The clinic-pathologic risk factors incorporated in the machine learning model were bloody stools, the duration of symptoms, and the length of the intussusception. This model was highly predictive, with a sensitivity and specificity of 95% for the SVM-derived model.

Conclusions: This model may be applied to facilitate pre-surgery decisions for children with intussusception. Larger prospective multicenter studies are needed to validate the model.

Introduction: Postpoliomyelitis syndrome (PPS) is defined as secondary onset of new neuromuscular symptoms, following recovery from an initial episode of Acute Anterior Poliomyelitis with no other possible causes, which may lead to altered quality of life.

Objective: To assess the quality of life (QoL) of Tunisian PPS patients and determine its associated factors.

Methods: A cross-sectional study conducted over a 24 month period. Sociodemographic variables as well as clinical data evaluating the severity of PPS and QoL were collected using SF-36 scale. Associations between different clinical variables and QoL were studied.

Results: We included 45 patients with a mean age of 52.4 ± 7.5 years. All aspects of QoL were affected. The most affected domain was PF with an average score of 32.5±11.8. QoL was better for the mental component (MCS) compared to the physical component (PCS) with mean scores of 43.7±7 and 35.6±12.1 respectively. The alteration of the PF and MH domains was significantly associated with MCS score (p = 0.01 and r = -0.38) and increased BMI (p = 0.04; r = -0.31). Pain intensity was associated with an alteration of all the domains of QoL except for the RP domain. QoL was significantly associated with Functional capacity (p = 0.018 and r = 0.35) and vitality (p = 0.038; r = 0.31).   Conclusion: All aspects of QoL were affected in PPS patients. The general PCS component was the most affected and the PF domain was the most affected.

Introduction: Kallmann De Morsier syndrome (KS) is a rare genetic disorder characterized by congenital gonadotropic deficiency alongside anosmia or hyposmia, with a lower prevalence in females. Diagnosis relies on clinical and biological assessment, confirmed through pituitary magnetic resonance imaging (MRI). Cardiac involvement in this syndrome is uncommon, with only a few cases documented in the literature.

Observation: We reported the case of a 22-year-old female with a history of pulmonary valve stenosis for which she underwent balloon dilatation at the age of five years. She presented with primary amenorrhoea and a history of anosmia was noted. Hormonal investigations revealed hypogonadotropic hypogonadism and a hypothalamic-pituitary MRI identified complete agenesis of the olfactory bulbs. A diagnosis of KS was made. Genetic testing for the KAL1 gene was negative. The patient was put on hormone replacement therapy in order to achieve her puberty and promote general well-being Conclusion: This case represents the first reported association between KS and pulmonary valve stenosis, highlighting the need for further molecular biological research to explore other genes that may explain this connection.