Tunisie Medicale最新文献

Introduction: The management of intracranial aneurysms has evolved in the recent years, and endovascular coiling has become the first treatment option in many countries. In Tunisia, this neuroendovascular treatment meets a progressive but slow development, slowed down, by the economic component.

Aim: This study aimed to evaluate the global cost of endovascular treatment of cerebral aneurysms and determine the factors influencing the variation of direct medical cost.

Methods: A prospective study including patients who underwent interventional neuroradiology procedures for intracranial aneurysms between March 2019 and June 2019. Total cost (direct medical and non medical cost) was assessed using the micro-costing method. Statistical analysis (descriptive followed by a multivariate analysis) was performed by PSPP software with a p-value< 0.05 considered statistically significant.

Results: Twenty-nine patients were included (mean age 54±14 years). The average overall cost of treatment was 15 877 DT (5 081€), ranging from 8 005 DT (2 562 €) to 36 325 DT (11 624 €). The average cost of medical devices used during the procedure was 13 548 DT (4 335 €) which represents 85.3% of the total cost. The direct medical cost was particularly influenced by aneurysm's and neck's size, and by the total cost of coils.

Conclusions: The medical devices used during the procedure greatly influenced the direct medical cost of the management of intracranial aneurysms.

Introduction: The relationship between epilepsy and psychiatric disorders has been highlighted for a long time. Idiopathic epilepsy is known to have a benign course in most cases. However, the association of psychiatric disturbances could worsen the disease outcome.

Aim: To study the frequency of psychiatric symptoms in patients with idiopathic epilepsy, and to assess the determinant factors in the patient group with these manifestations.

Methods: In one-year prospective study, consecutive patients diagnosed with idiopathic epilepsy were included. Those with a known psychiatric follow-up or with post ictal psychiatric disturbances were excluded. Psychiatric symptoms were evaluated with the Neurological Disorders Depression Inventory for Epilepsy, the Generalized Anxiety Disorder - 7 and the Neuropsychiatric Inventory Scale. Demographic and clinical data were collected and analyzed.

Results: Among 101 consecutive patients with idiopathic epilepsy, psychiatric symptoms were diagnosed in 61% of them. Anxiety (36.6%), psychotic features (21%) and depression (15.8 %) were the most commonly found psychiatric manifestations. Female gender (p < 10-3) and longer duration of epilepsy (p = 0.046) were significantly associated with occurrence of psychiatric disturbances. Patients under Carbamazepine and Valproic acid showed a lower frequency of depression (respectively p = 0.018 and p = 0.003).

Conclusions: Occurrence of psychiatric disturbances was frequent in idiopathic epilepsy, with psychotic manifestations and anxiety being the most common of them. Female gender and long disease course were the main determining factors of psychiatric manifestations and should be considered in management of idiopathic epilepsy.

Introduction: Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.

Aim: To evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome.

Methods: We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements.

Results: The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17±2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9±2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa=9.42), insufficient prenatal care (ORa=2.85), delayed maternal reporting of decreased fetal movement (ORa=1.29), complications during pregnancy (ORa=3.01), small symphysiofundal height for gestational age (ORa=6.17), pathological cardiotocography (ORa=1.66), fetal growth restriction (ORa=6.17), abnormal Umbilical Artery Doppler (ORa=6.51).

Conclusion: Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management.

Introduction: Falls from great heights constitute a violent trauma that can lead to death. This represents a suspicious death, leading to initiate legal proceedings with in particular the practice of an autopsy.

Aims: to determine the features of victims of falls from height and relations between medico-legal form of the death, the height of the fall and the nature of traumatic injuries Methods: A retrospective study about 141 cases of death after fall from great height. Data were collected at the Legal Medicine Department of the Farhat Hached University Hospital in Sousse (Tunisia) over a period of 14 years from 2007 to 2020.

Results: The average age of the victims was 37±12.8 years with a sex ratio of 6.05. Half of them were day laborers. The majority had no history of psychiatric illness (91.5%). The majority of victims (41.8%) fell from a height of 3 to 6 meters. Regarding injuries, rib fractures (52.4) were predominant, especially on the right side followed by skull fractures (31.2%). A significant difference in the prevalence of rib cage lesions in the groups over 9 meters in height (p<0.05) was found. The lesions of the lower limbs were proportional to the increase in the height of the fall. Deaths were accidental in 80.8% and suicides in 13.5%.

Conclusion: In cases of high falls, a forensic autopsy is essential to make a complete evaluation of the injuries, to search a correlation between severity of injuries and height of the fall and finally to orientate towards the medico legal form of the fall.

Aim: This research design protocol outlines the methodology for a thorough evaluation of workload monitoring and management strategies in football.

Methods: The study involves conducting a global survey to fitness coaches, sports scientists, analysts, and physicians with experience in load monitoring within football. The research adheres to the principles of the Helsinki Declaration and complies with General Data Protection Regulation standards, with ethical approvals obtained from multiple Ethics Committees across various countries, including Tunisia. A consortium of professionals collaboratively crafted the survey instrument, dividing it into seven sections, each addressing specific aspects of workload monitoring in football. Survey reliability will undergo evaluation in a pilot study utilizing Cronbach's alpha and intraclass correlation coefficient. To ensure inclusivity, the survey will be translated into multiple languages, facilitating participation from diverse regions. As such, survey distribution will consider online platforms (such as social media) and email invitations, with a specific focus on engaging football clubs, federations, and professional networks. The targeted sample size will remain at 385 participants. Statistical analysis planning encompasses descriptive examination, exploration of variable relationships, hypothesis testing, and qualitative analyses of participant feedback and recommendations regarding load monitoring practices.

Expected results: Expected outcomes include i) A comprehensive global overview of training and match load monitoring practices in football, ii) The identification of emerging trends, an improved understanding of training optimization processes, and iii) The development of practical recommendations to enhance player well-being and performance.

Conclusion: This study will contribute to the ongoing development of knowledge in the field of football workload monitoring.

Introduction: Medical simulation is a crucial educational tool for training healthcare professionals, renowned for its effectiveness in learning. However, its application as an assessment tool remains uncommon.

Aim: To evaluate simulation as a tool for assessing training in the management of COVID-19 patients.

Methods: This descriptive cross-sectional study was conducted in June 2021 at the Department of Pediatrics, Sahloul University Hospital in Sousse, Tunisia. All medical and paramedical staff in the department underwent comprehensive training in the management of COVID-19 patients, including video training for donning and doffing protective equipment when in contact with infected patients. A simulation-based assessment of these procedures was carried out among the department staff having received this training.

Results: Our study included a total of 67 participants, comprising 28 medical staff (41.8%) and 39 paramedical staff (58.2%). During the assessment scenario, over 50% of participants successfully completed the main steps for both donning (8 out of 11 steps) and doffing procedures (10 out of 11 steps). However, there were instances of incorrect execution in some critical steps. In the doffing test, only 16.4% of participants performed the fitcheck correctly, with a notable difference between paramedical staff and medical staff (25.6% vs 3.6%, p=0.02). The practice of double gloving was observed in only 38.8% of cases, with higher adherence among physicians compared to paramedical staff (57.1% vs 25.6%, p=0.009). Regarding the doffing procedure, we observed that not all staff performed hydroalcoholic friction adequately. Similarly, only 22.4% of participants followed the recommended sequence of gestures, with a significantly higher compliance rate among doctors compared to paramedical staff (50% vs 2.6%, p<0.001).

Conclusions: Simulation is a swiftly expanding assessment tool. In our study, it helped reveal specific skill deficiencies that would have gone unnoticed in written or oral assessments.

Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM.

Method: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system.

Results: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year.

Conclusion: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.

Introduction: Pediatric radiotherapy (PR) faces several issues in middle- and low-income countries.

Aim: Our study is a cross-sectional observation which aimed to describe the current situation of PR in Morocco in order to identify the needs and to propose an organizational shema for this discipline.

Methods: The collection of data used two surveys, one of which was intended to the heads of the radiotherapy department of all university hospital centers (UHC) in Morocco concerning the hospital's infrastructure, human resources, technical and the course of radiotherapy. A second survey was intended for all radiation oncologists trained and working in Morocco with data related to the practice of PR.

Results: In 2021, 295 children were treated in the radiotherapy departments of the seven university hospitals in Morocco. One hundred and two radiation oncologists responded to our survey. The multidisciplinary consultation board is held in five university hospitals, four of which have a complete multidisciplinary team. The children are sent to another structure by default of anesthesia according to 21% of the radiotherapists questioned. The three-dimensional technique is available in all university hospitals. Intensity modulated radiotherapy is available in 5 UHC. Additional training in radiotherapy after residency was necessary according to 60% of the radiotherapists questioned.

Conclusion: Despite the progress that Morocco has made in terms of infrastructure and radiotherapy equipment, this first national survey has identified some weaknesses and developed some recommendations for the organization of PR.

Introduction: Trachyonychia means rough, longitudinally ridged nails with a sandy, brittle and thin aspect. It is a rare condition that occurs mainly in children. Studies on trachyonychia are rare. We aimed to describe the clinical aspects and outcome of trachyonychia, as well as its treatment.

Cases: Two boys aged 11 and 14 years old and a girl aged 6 years presented with nail dystrophy of the fingers and toes. Patient 1 had also a scaly patch on the glans penis, and patient 2 was atopic. Trachyonychia associated with psoriasis was suspected in patient 1 and the idiopathic form was retained in the other two patients. All patients were treated with topical steroids for a few months. The patients did not show any improvement at the six-month follow-up. Only one patient was contacted again after two years and showed spontaneous healing.

Commentaries: The diagnosis of trachyonychia is mainly clinical. In the literature, 62% of pediatric patients had an idiopathic form. However, a strong association was observed between trachyonychia and alopecia areata. Trachyonychia of childhood appears to have a good prognosis, with spontaneous improvement within six months to two years. Therapeutic abstention is the rule.