Tunisie Medicale最新文献

Objectives: In Tunisia, despite hemovigilance regulations since 2007, transfusion adverse events (TAEs) remain underreported. Here, we analyze and evaluate the reported TAEs over ten years in the blood transfusion center of Sfax (Tunisia).

Methods: This is a ten-year (2012-2021) descriptive and exhaustive report on TAE from the second largest blood center in Tunisia, where around 56,000 labile blood products are issued annually.

Results: Four-hundred-sixty-four TAEs were reported. The median age of the patients was 38 years (1 month to 94 years). The sex ratio was 0.68. The overall TAE annual incidence per issued labile blood product was 0.77‰ and ranged from 0.47 to 1.43‰. The most common TAE was a febrile non-hemolytic reaction (31.7%), followed by an allergic reaction (21.6%). The severity degree was informed in 433 cases (93.3%). Grade 1 severity was the most common (80.8%), followed by grades 3, 2 and 4 (10.6%, 1.3% and 0.6%, respectively). Packed red blood cells were the most implicated labile blood product (81.5%). Standard platelet concentrates and fresh frozen plasma accounted for 6.5% and 5% of the total adverse transfusion reactions, respectively.

Conclusion: The TAE incidence in our study seems to be underestimated compared to worldwide reported TAEs. The analysis of reported TAEs in our context illustrates the insufficiency of the regulation's implementation alone.

Introduction: Varicocele has a detrimental effect on testicular growth and spermatogenesis, hence the importance of its management. This management remains controversial among Tunisian urologists; diagnostic and therapeutic choices tend to vary from one urologist to another.

Aim: The aim of this survey is to evaluate the practices of Tunisian urologists regarding varicocele management compared to the latest international guidelines.

Methods: A cross-sectional study was conducted among Tunisian urologists, members of the Tunisian Association of Urology, using a computerized questionnaire available online.

Results: The response rate was 51.6%. Approximately 80% of Tunisian urologists reported that they diagnose and manage patients with varicocele at least once a week. Half of the Tunisian urologists use a grading system for classification. Over 75% of Tunisian urologists believe that scrotal ultrasound and semen analysis should be systematically requested. Half of them consider treatment starting from Dubin and Amelar grade 2, while the other half treat from Dubin and Amelar grade 3. The majority agreed that the results of varicocele repair are controversial, with 10% never performing bilateral varicocele repair. The vast majority planned surgical treatment (95%), with sub-inguinal approach and magnification used in only 16% of cases; 25% never froze sperm before varicocele repair.

Conclusion: Recent recommendations had clear messages to promote in terms of diagnosis, therapeutic indications, and modalities. This work highlights the existence of gaps between recommendations on certain aspects of varicocele management, suggesting a review of continuous medical education modalities regarding this pathology in particular.

Introduction: Medical ethics teaching is one of the pillars of medical education. Ethical reasoning learning (ERL) is one of the means of teaching medical ethics.

Objective: The aim of our study was to evaluate the pedagogical interest and the students' perceptions of ERL in directed teaching in internal medicine among fifth-year students.

Methods: This was a cross-sectional study conducted in the Internal Medicine Department of Habib Thameur Hospital during one academic year. The pedagogical interest and the student's perception were evaluated by comparing a pre-test and a post-test filled in by the students, respectively, before and after an ERL session.

Results: Our study included 44 students. Before the ERL session, almost two-thirds of the students (63.6%) found the ERL to be "extremely interesting" in medical training and practice. This extremely high level of educational interest in the ERL was statistically associated with previous participation in ERL sessions among our students. Prior to the ERL session, just over four-fifths of the students (84.1%) had a "favourable" perception of the ERL. After the ERL session, our study noted an improvement in students' pedagogical interest in ERL. Our study also showed an improvement in students' perceptions of the ERL. The improvement in students' pedagogical interest and perception of ERL exceeded 80% after the session.

Conclusion: Our study concluded that there was a significant pedagogical interest and a favourable perception of the students' point of view regarding the ERL in internal medicine- directed teaching among fifth-year medical students.

Background: COVID-19 lockdown measures have profoundly altered lifestyle habits, exposing individuals to significant health risks Aim: This study aims to assess the impact of quarantine measures in Tunisia, with a focus on examining changes in dietary habits, levels of physical activity, psychological patterns, and factors contributing to weight gain.

Methods: This is a cross-sectional study involving 1,016 participants and employed a mixed-methods approach to gather data on dietary habits, physical activity levels, and psychological indicators. Statistical analyses, including binary logistic regression, were conducted to identify independent risk factors associated with weight gain during the quarantine period.

Results: Approximately 36.4% of participants reported experiencing weight gain, with a notable prevalence among younger age groups. Increased consumption of sweets, pasta, and fried foods, coupled with reduced intake of water, vegetables, and fruits, were associated with weight gain. Furthermore, a decline in physical activity levels and elevated scores of anxiety and depression were observed among individuals who reported weight gain. Binary logistic regression highlighted snack frequency, fried food consumption, and pasta intake as significant independent risk factors for weight gain.

Conclusion: The results underscore the importance of understanding the complex impacts of lockdowns on lifestyle habits and mental health to guide future interventions, which are necessary to mitigate adverse health consequences and promote healthy lifestyles in the post-pandemic period.

Aim: To elaborate Tunisian recommendations for the therapeutic management in current practice of patients with spondyloarthritis who are candidates for treatment with a biological agent.

Methods: Following the standardized procedures of the INEAS (Instance Nationale de l'Evaluation et de l'Accréditation en Santé) and in collaboration with the LITAR (Tunisian League against Rheumatism), a systematic review of the literature, carried out by 6 rheumatologists, based on the questions individualized by the working group (15 expert rheumatologists), served as the basis for the working meetings, with determination of the strength of the recommendations and the degree of agreement of the experts. The recommendations were validated by an independent reading group comprising 19 experts from various related specialties.

Results: Ten recommendations for good practice were drawn up. The first 2 recommendations concern the pre-therapeutic assessment and the updating of immunisation status prior to the initiation of biotherapy. Recommendations 3 to 8 deal with the use of biologics, including the new classes, in their indications (active disease despite conventional treatment, and for non-radiographic axial forms, presence of objective signs of inflammation) and follow-up, and their management in the event of failure or in remission. Recommendations 9 and 10 concern management in the event of pregnancy or neoplasia. The strength of the recommendations ranged from 8 to 9, with a degree of agreement of between 72% and 100%.

Conclusion: This work, supported by LITAR and accredited by INEAS, takes into account the data in the literature and the predominant clinical presentation. It offers practical recommendations to physicians to facilitate the management of patients with spondyloarthritis who require the use of biological agents.

Introduction: Acute decompensation represents a remarkable event in cirrhotic patients, particularly if it is complicated by Acute-on-Chronic Liver Failure (ACLF). Epidemiological data of ACLF are limited.

Aim: To determine the prevalence and predictive factors of ACLF in patients hospitalized for decompensated cirrhosis.

Methods: We conducted a retrospective study. We included patients with decompensated cirrhosis. ACLF was defined according to the CLIF-C OF score. Prevalence and predictive factors of ACLF were determined.

Results: We included 100 patients. The prevalence of ACLF was 37%. Renal failure was the most frequent organ failure. In univariate analysis, predictive factors for the occurrence of ACLF were female gender, hepatic encephalopathy, upper digestive haemorrhage, the presence of an infection, CRP level, bilirubin level and creatinine level. Prognostic scores (Child-Pugh, MELD, and CLIF-C OF) were also predictive of ACLF. In multivariate analysis, only creatinine level was an independent predictive factor of ACLF. The most frequent precipitating factor of ACLF was infection. The overall mortality rate for patients with ACLF was 65%.

Conclusion: Our study showed that the prevalence of ACLF was 37 %. The main predictive factor of ACLF was creatinine level. The mortality rate was high at 65 %.

This framework was developed under the auspices of the Tunisian League Against Rheumatism (LITAR), coordinated by a project leader. The primary objective is to formulate recommendations for the management of spondyloarthritis, grounded in the development of questions structured according to the PICO model. This model defines four essential elements of a clinical question: P: Patient or Population or Problem, I: Intervention (the proposed action), C: Comparison (between diagnostic tests, treatments, etc.), and O: Outcome (clinical results, measured events, judgment criteria, etc.). A working group was established, coordinated by a project leader appointed by LITAR. This group included rheumatologists recognized as experts in the disease by the scientific community, as well as a methodological and epidemiological rheumatologist. The bibliographic search focused on international literature (meta-analyses, randomized controlled trials, cohort studies, case-control studies, etc.) and other sources of information (HAS, clinical practice guidelines), as well as national literature (theses, dissertations, publications, conference presentations). In-person and virtual meetings of the working group enabled the formulation of the recommendations, following the presentation of literature data and extensive discussions among the experts. The draft of the recommendations was submitted to the same experts for validation and assessment of the level of agreement, which determined the strength of the recommendations. Subsequently, the recommendations were reviewed by a reading group appointed by the working group. The final version was adjusted based on feedback from both groups.

Introduction: Anencephaly is a serious developmental defect of the central nervous system in which the brain and cranial vault are grossly malformed. The cerebrum and cerebellum are reduced or absent, but the hindbrain is present. Anencephaly is a part of the neural tube defect spectrum. This defect results when the neural tube fails to close during the third to fourth weeks of development, leading to fetal loss, stillbirth, or neonatal death.

Aim: To find out probable principal risk factors for the appearance of anencephaly.

Methods: This study was conducted to compare between pregnancies affected by anencephaly in 2002-2011 with those notified in the period 1991-2001. Statistical analysis was undertaken using chi-squared tests.

Results: Results had shown that anencephaly fetuses with a weight less than 1500 g were significantly higher in the period 2002-2011 than in 1991-2001 (P=0.003; OR= 4.32; CI= 1.62-11.53). Anencephaly cases aged more than 20 weeks of gestation (WG) were statistically elevated than cases aged less than 20 WG (P= 0.003). Maternal parity was associated with the appearance of anencephaly, where uni- or multiparous cases mothers were more likely to have an offspring with anencephaly than nulliparous mothers. Consanguinity presented a significant risk factor for the occurrence of anencephaly (P= 0.003). A logistic regression was run to examine the impact of several variables, only the maternal age was statistically significant.

Conclusion: This study clarified fields where efforts should be intensified, and surveillance data developed to prevent this malformation.

Introduction-Aim: Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients and is associated with a high mortality rate. The aim of this study is to determine the epidemiological and bacteriological profile of spontaneous bacterial peritonitis, as well as antibiotic resistance among hospitalized patients at CHU Mohammed VI, in order to guide empirical antibiotic choices for better management. Methods: This is a prospective study conducted over a period of 12 months, from January to December 2023, focusing on all requests for bacteriological examination of ascitic fluid samples. All samples received at the microbiology laboratory were processed according to the Medical Microbiology Reference Standard (Remic) Results: A total of 137 ascitic fluid samples were included. The main etiologies implicated in ascites were cirrhosis (50.36% of cases), followed by neoplastic pathology (24.1% of cases). The prevalence of spontaneous bacterial peritonitis was 13.87%, of which 63.16% corresponded to neutrocytic ascites with negative culture. The rate of bacterascite was 74.07%. Gram-positive cocci constituted the majority of pathogens (56.67%), with 43.33% corresponding to Gram-negative bacilli. 28.57% of coagulase-negative Staphylococci were methicillin-resistant. Quinolone resistance was observed in 23.53% of Gram-positive cocci, and 69.23% of isolated Enterobacteriaceae were multidrug-resistant. Conclusion: The prevalence of SBP due to Gram-positive and multidrug-resistant bacteria has increased in recent years. The currently recommended empirical antibiotic therapy, based on third-generation cephalosporins, carries a high risk of failure and may need to be reassessed.

Advancements in understanding SpA have greatly improved patient quality of life through early detection and effective treatment. However, non-specialist physicians often face challenges in identifying the early symptoms of SpA.

Aim: This study aims to assist healthcare practitioners in the early detection of SpA and to streamline management strategies by employing a standardized assessment protocol for adult patients with SpA. LITAR collaborated with fifteen rheumatologists to adhere to INEAS guidelines. The team created a comprehensive repository based on seven PICO questions and their answers. To create this repository, the team combined local Tunisian data and insights from relevant literature sources using a synthesis method.

Results: This research culminated in the formulation of twelve evidence-based recommendations for best practices, encompassing three critical domains. Firstly, it addresses the clinical indications and signs that should alert primary care physicians to consider a SpA diagnosis and promptly refer patients to rheumatologists. Secondly, it outlines the diagnostic procedures involved in confirming SpA. Lastly, it presents standardized methods for evaluating and monitoring the progression of SpA. To ensure the robustness of these recommendations, an independent reading group of 19 experts from various related specialties validated them. Subsequently, a panel of 54 Tunisian rheumatologists practicing in diverse sectors, including public health, academia, and the private sector, evaluated the strength of these recommendations. The strength ratings ranged from 8 to 9, with a degree of agreement spanning from 72% to 100%.

Conclusion: This guideline, developed with the support of LITAR and accredited by INEAS, serves the overarching goal of facilitating the early diagnosis and comprehensive evaluation of all SpA phenotypes and associated comorbidities.