Tunisie Medicale最新文献

Introduction: Ileocolonic anastomoses are frequent in colorectal surgeries, but anastomotic leakage remains a serious complication associated with increased morbidity and mortality. The optimal peristaltic orientation for anastomosis is still debated.

Aim: To evaluate and compare short- and long-term outcomes of isoperistaltic (IA) and antiperistaltic (AA) side-to-side ileocolic anastomoses after right colectomy or ileocecal resection for right-sided adenocarcinoma or Crohn's disease.

Methods: A single-center retrospective clinical trial was conducted at Fattouma Bourguiba University Hospital, Monastir, involving patients with right-sided colon cancer or ileocecal Crohn's disease who underwent elective resection with either IA or AA. The primary outcome was anastomotic leakage, while secondary outcomes included postoperative morbidity and long-term results.

Results: Ninety-four patients, including 55 with right-sided colon cancer and 39 with Crohn's disease, were analyzed between January 2016 and July 2023. Of these, 48 underwent IA, and 46 underwent AA. Both anastomotic techniques exhibited similar leakage rates. Baseline and operative variables were comparable except for male predominance in AA for Crohn's disease and a higher conversion rate in AA. No significant differences were noted regarding pathological variables, operative time, bowel transit recovery, oral tolerance, hospital stay, or postoperative complications. Multivariate analysis revealed that elevated white blood cell count, R2 resection, and mucinous adenocarcinoma were risk factors for anastomotic leakage, while albumin levels and staple line reinforcement were protective factors against postoperative morbidity.

Conclusion: IA and AA demonstrated comparable safety and feasibility, though AA had a higher conversion rate. Further studies are required to optimize AA safety.

Introduction: The study is conducted in Pakistan to evaluate the impact of socio-demographic factors that might influence the treatment response to antidepressants in depressive disorder. Moreover, this study brings data from a South Asian developing country, to compete the existing literature gap, where the response to antidepressant treatment with respect to demographic factors is mostly from the western countries.

Aim: A prospective, open-label, descriptive cohort study is designed to signify the association of demographic factors on the treatment response of antidepressants.

Methods: The patients presented to outpatient department (OPD) of Psychiatry clinic at Pakistan Railway Hospital, Rawalpindi from October 05, 2022 to July 31, 2023 were included in the study. All the patients were diagnosed by a Consultant Psychiatrist, according to ICD-11 and were prescribed an antidepressant therapy. The demographic factors were divided into sub-categories i.e. age, gender, marital status, income status, geographical location, education, and comorbid conditions. The change in depressive scores were measured by Patient Health Questionnaire 9 (PHQ-9) on day 0, and 28. The data was analyzed using SPSS and results are reported in the subsequent section.

Results: Out of 88 patients, depression was found most widespread among females, married individuals, illiterate, above 41 years of age with comorbid conditions. The response to treatment was better in males (49.84%), single individuals (49.24%), educated (43.70%), and senior citizens (46.19%) in terms of percentage improvement.

Conclusions: It was concluded that the response to treatment was different among different subcategories in terms of percentage improvement. Female, illiterate, and single/divorced/widowed populations showed poor response to treatment. Moreover, geriatric population response was better as compared to all other age group. The patients having different comorbid conditions are more prone to develop depression, but the response to antidepressant therapy was comparable to those without any systemic illness.

Introduction: Family Medicine (FM) is undergoing global reform to address healthcare challenges and improve patient outcomes. Rehabilitation is a crucial component of primary care, yet FM training often lacks adequate emphasis on this area.

Aim: To determine the needs of FM residents in rehabilitation training and formulate corresponding training objectives.

Methods: A cross-sectional observational descriptive study was conducted among FM residents and practitioners in Sousse, Tunisia. The Delphi method was used to identify and prioritize training needs, subsequently translated into specific learning objectives. First authors identified 15 needs presented to FM residents of Faculty of medicine of Sousse. Then, the most chosen 10 needs were validated by experts in rehabilitation and preventive medicine. Finally based on the participants choices, experts formulated learning objectives in rehabilitation practice for FM residents.

Results: We included 391 residents of FM and general practitioners. Ten key training needs were identified among FM residents, focusing on common musculoskeletal and neurological conditions such as chronic low back pain, neck pain, and urinary incontinence. Corresponding objectives were developed encompassing cognitive, psychomotor, and affective domains.

Conclusion: This study provides a foundation for incorporating rehabilitation into FM training in Tunisia. Addressing identified needs and defining clear objectives leads to a systemic planning of training. Future research should focus on implementing these objectives and evaluating their impact on patient outcomes.

Introduction: At birth, the biological diagnosis of congenital toxoplasmosis (CT) is essentially serological.

Aim: To report the results of biological techniques used in the neonatal diagnosis of CT.

Methods: This was a descriptive study including newborns (NB) suspected of having CT who were referred to the Parasitology-Mycology laboratory of the Institut Pasteur of Tunis over a 17-year period. Newborns whose mothers had toxoplasmic infection during pregnancy, with either a negative or unperformed antenatal diagnosis, were included. The search for IgG and IgM antibodies was conducted using ELISA and western blot techniques.

Results: Among the 224 newborns included, the first sample was taken between days 1 and 3 of life in 58% of cases. In 181 newborns from our series, the disappearance of IgG was observed at an average age of 4.8 ± 1.6 months. IgM was positive after day 10 of life in 11 cases. A comparative mother-newborn western blot was performed for 216 newborns (96.4%). The diagnosis of CT was confirmed in 43 newborns (19.2%): either based on a positive western blot in 30 cases (69.8%), the presence of IgM by ELISA after day 10 of life in 11 cases (25.6%), or the persistence of IgG after 12 months of follow-up in two cases (4.6%).

Conclusion: Our study confirms the undeniable contribution of the comparative western blot in the diagnosis of CT at birth.

Introduction: The 22q11.2 deletion syndrome (22q11DS) is an autosomal dominant genetic syndrome, frequently due to a microdeletion located on chromosome 22, presenting a wide variety of clinical manifestations. Cytogenetic methods, such as fluorescence in situ hybridization (FISH), and molecular biology techniques, such as multiplex ligation-dependent probe amplification (MLPA), are used to identify chromosomal deletions specific to the 22q11.2 region.

Aim: This study aimed to describe the first series of pediatric patients in Morocco, selected for their strong suspicion of DiGeorge syndrome.

Methods: As part of a collaboration between the University Hospital Center Hassan II in Fez and the University Hospital Center Abderrahim El Harouchi Ibn Rochd in Casablanca, Morocco, a prospective study was carried out from January 2021 to January 2024 on 30 patients screened for DiGeorge syndrome (DGS). The children included had at least two major signs of DGS. Diagnostic confirmation of 22q11DS was obtained by FISH analysis for all patients. In addition, MLPA analysis was performed on five patients among those confirmed by FISH. The MLPA process included DNA extraction, PCR amplification and capillary electrophoresis, with results analyzed using GeneMapper and Coffalyser software.

Results: Of the 30 patients selected, 22 were confirmed as having a 22q11DS. Among these, 19 had congenital heart disease and 17 had hypocalcemia, which was often associated with hypoparathyroidism. Facial dysmorphia was almost constant, and thymic abnormalities were observed in half the patients. Recurrent infections, hematological disorders and immune abnormalities were also common, underlining the clinical complexity of the syndrome.

Conclusion: Advances in molecular cytogenetics have enabled precise detection of microdeletions associated with 22q11DS, highlighting its global importance, but also revealing regional diagnostic challenges. Larger cohort studies are needed to strengthen the validity of results and improve clinical management approaches.

Introduction: Agenesis of the dorsal pancreas (ADP) is a rare congenital abnormality characterized by the absence of the body and tail of the pancreas. This condition is often asymptomatic. While many patients exhibit nonspecific symptoms, some may experience more severe manifestations complicating the diagnostic process.

Observation: We presented the case of a 27-year-old man who was diagnosed with type 1 diabetes mellitus three years ago. He was experiencing considerable weight loss, abdominal pain, and diarrhea despite effectively managed insulin therapy. The patient appeared emaciated and malnourished. Investigations revealed a normal thyroid function, negative celiac disease serology, and negative pancreatic antibodies. Abdominal imaging demonstrated ADP. After treatment with insulin and pancreatic enzymes, we noted a significant improvement in the patient's condition.

Conclusion: This case emphasizes diagnostic challenges in young patients presenting with pancreatic diabetes. Early recognition and appropriate management are crucial to prevent complications of both exocrine and endocrine deficiencies.

For decades, community participation (CP) in primary health care (PHC) and health programs (HP) has played a crucial role in improving health services and their sustainability. This article examines the successes and challenges of CP in the Intergovernmental Authority on Development (IGAD) region, which includes Djibouti, Ethiopia, Eritrea, Kenya, Somalia, Sudan, South Sudan, and Uganda, focusing on the factors influencing and levels of community engagement. This study employs a scoping review based on the Arksey and O'Malley framework and the IAP2 public participation spectrum. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published up to April 2024. Relevant articles on CP mechanisms in PHC and HP in the IGAD region were selected. In total, 64 articles were included in this scoping review. The studies highlighted various forms and mechanisms of CP, such as the establishment of community health committees and the mobilization of volunteers. Successes included improvements in disease prevention, crisis management, community resilience, and access to maternal and child health services. However, challenges remain, such as communication gaps, resource limitations, cultural barriers, and political instability. Community participation is essential for the success of health programs in the IGAD region. Although significant progress has been made, persistent challenges must be addressed to optimize the impact and sustainability of CP initiatives.

Introduction: There are no clear data on the incidence and predictors of arterial and venous thromboembolic (TE) events in COVID-19 ambulatory patients.

Aim: We conducted this study to analyze thromboembolic complications in this setting and to compare the efficacy and safety of Rivaroxaban to LMWHs as a thromboprophylaxis treatment.

Methods: This is an observational study including COVID-19 patients treated on an outpatient basis. We analysed the predictors of thromboembolic events.

Results: We included 2089 patients with COVID19 managed on an outpatient basis during the period from October 01, 2020 to December 31, 2021. The mean age of our patients was 43±16 years. The incidence of venous and arterial TE complications was 0.9%. Predictive factors for arteriovenous thromboembolic complications were hormonal contraception (OR=23), moderate clinical form (OR=3.5), recent surgery or miscarriage in the month preceding COVID-19 (OR=9.2) and CT signs of COVID-19 (OR=4.9). In contrast, physical activity proved to be a protective factor. Thromboprophylaxis was prescribed in 22.5% of cases: LMWH in 18.1%, Rivaroxaban in 3.7% and a combination of the two molecules successively in 0.6% of patients. There was no statistical difference in thromboembolic or major bleeding complications between the Rivaroxaban and LMWH groups.

Conclusion: Our study showed that the incidence of thromboembolic complications is very low in Covid-19 ambulatory patients.