Tunisie Medicale最新文献

Objective: the aim of this study is to report epidemiological data, clinical presentations and management of chronic immune thrombocytopenic purpura (ITP) in a single center in south of TUNISIA.

Methods: retrospective study collecting all cases of chronic ITP among children aged less than 14 years, in a department of pediatrics in south of Tunisia during a period of 13 years (from 1st January 2010 to 31 December 2022) Results: during the study period, 72 newly diagnosed ITP were recorded; 11 patients evolves chronic ITP (12 ,5%). They were 6 boys and 5 girls. Two patients were aged more than 10 years at the onset of the disease. Symptoms in the chronic stage were mucocutaneous bleeding. One patient developed post traumatic cerebral hemorragia. Three patients had severe form, and required second-line therapy. Two patients requested Eltrombopag with good response. One patient had spontaneous recovery after 3 years of follow up.

Conclusion: Management of chronic ITP represents a real challenge for pediatrician. Currently, there are some recommendations and guidelines which can guide management strategy of severe forms of Chronic ITP.

Introduction: In their practice, pharmacists are confronted with situations that may pose ethical problems. They must make decisions based on scientific knowledge as well as the principles of bioethics.

Aim: To evaluate pharmacists' attitudes towards specific ethical dilemmas.

Methods: We conducted our study using a validated English questionnaire, containing 9 ethical scenarios to be rated by participants on a 5-point Likert scale. The questionnaire was distributed via Google Forms on Facebook pages and Messenger and WhatsApp groups. The data were processed with Microsoft Excel and statistical tests were performed using SPSS version 23.

Results: The participants in our study achieved 70% of the total score for all encountered situations. We found that in response to the non-maleficence scenario of "Dispensing amphetamines to a medical student," pharmacists exhibited the most ethical attitude compared to other studied situations. In general, confidentiality scenarios received the highest number of "disagree" responses, while the least ethical attitude concerned justice scenarios. We also found a significant correlation between supplementary ethics training and the dimensions of confidentiality and non-maleficence .

Conclusion: Our study, the first of its kind in Tunisia, highlighted the need to strengthen medical ethics training for pharmacists.

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Introduction and aim: Status epilepticus (SE) in children is a critical condition that can be life-threatening. The objective of this study was to identify factors associated with the occurrence of SE after a first convulsive seizure in children.

Methods: A retrospective study was conducted at the pediatric department of BEN AROUS regional hospital between January 2015 and December 2019.

Results: A total of 300 patients admitted for a first epileptic seizure were included in this analysis. The mean age of the patients was 33 months. Seizures were generalized in 92.7%, with tonic-clonic seizures being the most common (54.8%). SE was diagnosed as inaugural in 29% of cases. Abnormalities in EEG were observed in 36.5% of cases, while MRI revealed abnormal results in 32.8% of patients. Factors associated with a risk of SE recurrence were age younger than 1 year (p = 0.003), neuromotor retardation (p = 0.001), EEG abnormalities (p < 0.001), MRI abnormalities (p = 0.001), and abrupte discontinuation of antiepileptic treatment (p < 0.001). Simple febrile seizure was identified as a protective factor (p = 0.038).

Conclusion: The study identified that age under 1 year, neuromotor delay, and abnormalities in EEG and MRI are significant risk factors for the recurrence of status epilepticus after a first epileptic seizure in children. These findings suggest targeted preventive strategies to improve the management and prognosis of these patients.

Introduction: Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. Falls are a serious health concern for persons with MS (PwMS).

Aim: To determine the frequency and associated factors of falls in PwMS.

Methods: A cross-sectional study was conducted in the Physical Medicine and Rehabilitation and Neurological Departments at the Military Hospital of Tunis between July and December 2022. Participants meeting the inclusion criteria completed a survey focusing on the prevalence and related factors of falls. In addition to the survey and a thorough clinical and functional examination, we used the 12-item MS Walking Scale (MSWS-12), the Fall Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB), and the 10-meter walk test for clinical assessment of balance. A baropodometric platform was employed for instrumental assessment.

Results: Thirty individuals with an average age of 33,6 [SD: 7,7], completed the survey with a mean Expanded Disability Status Scale = 2,5. Twenty-one patients reported falling at least once since the diagnosis. The MSWS-12 mean score was 61 % and the FES-I scored an average of 33.8. The average total score of the SPPB was 8. Total boli of corticosteroids prescribed during disease flare-ups (p=0,022), magnetic resonance imaging lesions of the basal ganglia (p=0,047), vestibular syndrome (p=0,048), MSWS-12 score (p=0,022), and the chair lift test of SPPB (p=0,018) were significantly associated with the prevalence of falling. No significant differences were observed for the instrumental assessment.

Conclusion: Falls are frequent in PwMS. MSWS-12, the FES-I, and the SPPB, can be used by clinicians to predict potential fallers of the PwMS.

Objective: The objective of this study was to assess the relationship between Body Mass Index (BMI), dietary habits, physical activity, and health perception among female university students in Morocco.

Methods: The study was conducted at a Moroccan university among female students from the Faculty of Sciences Ain-Chock in Casablanca. Participants were given a self-administered questionnaire that evaluated sociodemographic factors, dietary habits, food group consumption, physical activity, and self-assessed health status. Data collection took place from February 2023 through the end of April 2023.

Results: A total of 335 students aged 18 to 29 years participated in the survey. The study revealed that 72.5% of the participants were within the normal weight range (BMI 18.5-24.9 kg/m²), while 15.9% were classified as overweight and 3.9% as obese. Additionally, 47.9% of the participants engaged in physical activity, with 30.2% dedicating more than 45 minutes to their activities. The health perception was found to be related to weight classification, with poor health perception most commonly associated with the "18.5-25" BMI range (57.8%).

Conclusion: The study sheds light on the intricate interaction between weight, health, and lifestyle in Morocco. The frequency of normal-weight persons and active participation indicates university students' health awareness. The prevalence of overweight and obesity, on the other hand, need ongoing health measures. These findings help to build focused methods for promoting healthier lives in Morocco, utilizing educational institutions as health promotion platforms.

Introduction: Severe pain is a therapeutic emergency that can be life-threatening by its location, its repercussions or the misdiagnosis it can cause.

Aim: To investigate the efficacy of analgesia by morphine versus that by low-dose ketamine in severe pain in emergency department.

Methods: We conducted a randomized open study. We included patients over 18 years-old who consulted for severe pain defined by numeric rating scale (NRS) ≥6. Patients of M group received a titration of 10 mg morphine while those of LDK group, received a bolus of 30 mg of ketamine. The primary endpoint was obtaining a NRS of less than 4 within 10 minutes.

Results: We included 120 patients, 66 in the M group and 54 in the LDK group. The mean baseline NRS was 8.8 ± 1.3 in the M group and 8.6 ± 1.4 in the LDK group (p₌ 0.7). At 10 minutes, the same number of patients in both groups achieved a NRS less than 4 (p = 0.09). However, the mean NRS was significantly lower in the LDK group (p = 0.008). More adverse effects were noted in the LDK group (p <10-3).

Conclusions: Low-dose ketamine appears to be non-inferior to morphine in achieving effective analgesia for severe pain in the emergency department.

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Aim: To determine the impact of a therapeutic patient education (TPE) program on the quality of life of coronary patients at the Sahloul University Hospital in Sousse.

Methods: an interventional study was conducted over a period of seven months from May 2022 to November 2022, with patients hospitalized in the cardiology department of the Sahloul University Hospital. Participants were divided into two groups, intervention and control. The task force benefited from a TPE program. The control group followed the usual consultations at the hospital. The health-related quality of life assessment was done three months after the end of the educational program, using the validated Tunisian version of SF-12.

Results: Of the 129 patients included, 38 followed the education program while 91 were in the control group. Sociodemographic characteristics revealed a male predominance in the study population, with a similar average age between the two groups. The main cardiovascular risk factors identified were smoking, hypertension and diabetes. This program has led to an improvement in the quality of life of patients. Thus, patients who participated in the TPE program had significantly higher scores than the control group in the headings of physical role, emotional role, body pain, social function, and physical health and mental health scores with statistically significant differences.

Conclusion: Our study highlights the crucial importance of therapeutic education in improving the health status and quality of life of coronary patients. It calls for its widespread integration into cardiovascular care protocols, highlighting its central role in a proactive and personalized approach to medical care.