Tunisie Medicale最新文献

Introduction: Tuberculosis (TB) remains a global health problem. Its treatment usually involves a combination of antibiotics over a prolonged period, exposing patients to a range of adverse drug reactions (ADRs).

Aim: To investigate the epidemiology and outcomes of tuberculosis patients in Rabat (Morocco), with particular emphasis on assessing the ADRs of treatment and factors contributing to their occurrence.

Methods: This retrospective study was conducted at Moulay Youssef Hospital in Rabat, from January 2021 to May 2022. Only patients hospitalized in the intensive phase of tuberculosis treatment, with known HIV status, and aged 15 or over were included. Sociodemographic characteristics, clinical presentations, manifestations of ADRs, and patient outcomes were analyzed. Uni- and multivariate logistic regression were conducted to identify factors associated with ADR occurrence.

Results: In this study, 144 patients were included. The mean age of patients was 45.82±19.26 years. A male predominance was observed with a sex ratio of 1.4. Almost one-third of the patients (31.5%) experienced at least one ADR during treatment, with gastrointestinal symptoms (50%) being prominent. Logistic regression identified higher ADR incidence in females (p-value=0.046, OR=2.123; 95%CI: 1.013-4.448) and patients with addictive habits (p-value=0.019, OR=3.358; 95%CI:1.478-8.419). Treatment success was observed in 64.58% of the cases, with ADRs showing no significant difference between patients with successful treatment and those with failed treatment.

Conclusion: The occurrence of ADR poses a significant challenge to tuberculosis patients, highlighting the need for personalized approaches to mitigate these complications and ensure treatment success.

Introduction: Carbon monoxide (CO) poisoning is a frequent and potentially fatal medical emergency, accounting for significant global morbidity and mortality.

Aim: This study aims to determine the epidemiological and clinical characteristics of patients presenting to the emergency department (ED) with acute CO poisoning in Tunisia.

Methods: A retrospective, descriptive, single-center study was conducted at the ED of Mahmoud Yacoub Center for Urgent Medical Assistance in Tunis over two years. Patients aged over 12 years with acute CO poisoning were included. Epidemiological data, clinical presentation, severity, laboratory findings, and management were analyzed.

Results: A total of 660 cases were included, all secondary to accidental exposure. The mean age was 35 ±15 years, with a female predominance (73%). CO poisoning was most frequent during winter (70.4%). The main source was gas water heaters (78.2%). Severe cases of CO poisoning were observed in 27.9% of patients, with neurological symptoms in 90.8% of them. The median carboxyhemoglobin level was 21% [13-29]. In univariate analysis, age ≥50, asthenia, chest pain, carboxyhemoglobin ≥25%, and hyperleukocytosis were associated with severe CO poisoning, with hyperleukocytosis remaining an independent predictor in multivariate analysis. Oxygen therapy was administered to all patients, and hyperbaric oxygen therapy was performed in 10.6%. Hospitalization was required in 21% cases. No deaths were recorded in our series.

Conclusion: CO poisoning remains a significant public health concern in Tunisia, predominantly affecting young adults, with water heaters as the leading source. Neurological and cardiac manifestations predominate in severe cases.

Introduction: Globally, nasopharyngeal cancer has a varied geographic distribution, occurring more frequently in certain areas and less often in others (1).

Aim: This article presents the epidemiological situation of this cancer in the Marrakech-Safi region, Morocco.

Methods: Our retrospective study analyzed the epidemiological profile of nasopharyngeal cancer in the Marrakech-Safi region (Morocco) based on 226 cases evaluated at the University Hospital Center MOHAMMED VI of Marrakech from 2014 to 2018. We used descriptive and analytical statistics to create this profile.  Results: The cases studied were 61.9% male (140 cases), and 38.1% female (86 cases), with a mean age of 47.95 ± 16.54 years and a sex ratio of 1.62 (p <0.001). The majority, 76.5%, were married, 16.4% single, 5.8% widowed and 1.3% divorced. The Medical Assistance Plan (RAMED) was the most widespread medical coverage (86.73%). The provinces most affected were Marrakech (42.92%), Safi (10.62%) and El Kelaa (9.73%). These cases were without profession (55.31%), housewives (13.72%), farmers (7.08%), and workers (3.98%). This may be due to the multifactorial etiology of the disease, including occupational exposure to chemical carcinogens.

Conclusions: The study reveals the incidence of nasopharyngeal cancer and identifies the age group most affected in the region studied, highlighting a link with formaldehyde. Further studies are recommended to determine the probable risk factors for this cancer.

Introduction: Hip and femoral shaft fractures are extremely painful injuries, usually occurring in elderly, multimorbid patients who are vulnerable to opioids. In this context ultrasound-guided locoregional analgesia (LRA) could be an interesting alternative.

Aim: To study pain variation (Delta numerical scale) in hip and thigh trauma patients treated with ultrasound-guided Fascia Iliaca block (FIB) in the emergency department.

Methods: We conducted an observational study over a period of 10 months, including all patients aged 16 and over, who consulted us for isolated hip or thigh trauma, in whom the numeric rating scale (NRS) could be assessed. The primary endpoint was a significant reduction in pain (ΔNRS ≥2). Secondary endpoints were local or general complications and the use of rescue analgesia.

Results: Forty-two patients were included. Mean age was 66±17 years, with a sex ratio of 0.9. The mean initial NRS was 9.12±1.3. Mean NRS value was 5.6 at 30 minutes and 3.9 at 120 minutes. Eighty-five percent of patients had a significant reduction in pain after 30 minutes of IFB, and six patients required rescue analgesia with morphine. No adverse effects were recorded.

Conclusion: Ultrasound-guided FIB can be safely performed by emergency physicians in an emergency department, after appropriate training in the technique.

Introduction-Aim :Lower limb amputation can lead to subclinical gait impairment secondary to muscle weakness. Hence the aim of our work, which was the instrumental assessment of isokinetic thigh muscle strength in traumatic military transtibial amputees.

Methods: This was a descriptive cross-sectional study carried out in physical medicine and rehabilitation department over a 6-months period. Our study included only military lower limb amputees caused by mine explosion. All patients had a functional evaluation (walking speed and the 2-minute walk test) associated to an isokinetic evaluation of the couple quadriceps(Q)-hamstring(H) on both lower limbs on the concentric mode at 90°/s, 120°/s and 180°/s.

Results: Forty patients were included. The mean age was 30.15 ± 7 years with male exclusivity. Muscle testing revealed no motor deficiencies, and all patients had thigh amyotrophy. Functional evaluation showed a mean walking speed of 1.4 m/s ± 0.3 and a 2-minute walk test of 161 meter ± 24.6. Q peak torque (PT) on the healthy side was greater than on the amputated side at all velocities with a significant association between PT (Q), PT(H) and Q muscle test and 2-min walk test. The ratio (H/Q) was higher for the healthy side for all velocities.

Conclusion: The quality of standing and walking depends on muscle strength of the lower limbs. Isokinetic assessment and instrumental rehabilitation should be systematically included in the management of military amputees.

Introduction: Non-adherence or poor therapeutic adherence appears to be particularly prevalent in chronic inflammatory rheumatism, notably in Juvenile Idiopathic Arthritis (JIA). It reduces therapeutic efficacy, accelerates disease progression, and poses a significant public health and economic challenge.

Aim: To evaluate adherence to disease-modifying treatments in Tunisian patients with JIA and to identify factors influencing therapeutic adherence.

Methods: This cross-sectional study included patients with JIA (defined by ILAR criteria) who had been undergoing treatment with conventional synthetic (csDMARDs) and/or biologic (bDMARDs) disease-modifying anti-rheumatic drugs for at least three months. Socio-demographic, clinical, biological, radiological, and therapeutic data were collected. Therapeutic adherence was assessed using two methods: self-reported adherence by patients and their parents, and adherence measured via the Parent Adherence Report Questionnaire (PARQ) and the Child Adherence Report Questionnaire (CARQ).

Results: A total of 30 patients (16 girls, 14 boys) with a mean age of 24.8 ± 11 years [8-47] were included. csDMARDs were prescribed for 76.7% of patients while 26.7% received bDMARDs. Self-reported adherence was 80% among parents and 76.7% among patients. Mean adherence scores were 74.58 ± 36 [0-100] on the PARQ and 74 ± 34 [0-100] on the CARQ. Univariate analysis revealed that adherence measured by the PARQ was positively correlated with erythrocyte sedimentation rate (ESR) (p=0.001; r=0.643) and C-reactive protein (CRP) (p=0.008; r=0.561) and negatively correlated with maternal age (p=0.005; r=-0.572), difficulty in medication administration reported by the parent (p0.0001; r=-0.698), and negative reactions to medication reported by both the patient (p=0.012; r=-0.506) and the parent (p=0.001; r=-0.651). Adherence measured by the CARQ was significantly associated with indigent health insurance status (p=0.019). In multivariate analysis, predictors of non-adherence on the PARQ included advanced maternal age (p=0.004), low ESR (p=0.029), and negative reactions to medications (p0.0001). On the CARQ, difficulty in adhering to the treatment regimen (p=0.042) was the only significant predictor.

Conclusion: This study demonstrates good therapeutic adherence among Tunisian patients with JIA. Predictors of non-adherence included advanced maternal age, low disease activity, negative reactions to medications, and difficulties in following treatment regimens. Educational strategies targeting these factors may improve adherence and enhance patient outcomes.

Introduction: Spinal Cord Injury (SCI) is a pressing global health issue, with a notable increase in incidence in Tunisia primarily attributed to traffic accidents. The repercussions of SCI extend beyond physical impairments, significantly affecting patient mental health and quality of life, and pose substantial economic challenges.

Objectives:  This study aims to provide an in-depth analysis of the current landscape of SCI management in Tunisia, identifying key challenges faced by patients and healthcare providers while offering actionable recommendations for improvement.

Methods: A comprehensive review of existing literature was conducted to assess the SCI management framework in Tunisia. The study focused on evaluating the rehabilitation system, healthcare provider training, and the implementation of disability rights in the country, while identifying barriers to effective care.

Results: Findings indicate a critical shortage of specialized rehabilitation facilities, with only 13 out of 24 governorates of the country providing adequate services. Additionally, there is a significant lack of trained healthcare professionals and inconsistent application of disability rights. Social stigmas further complicate the situation, hindering access to comprehensive care for SCI patients.

Conclusion:  To enhance SCI care in Tunisia, it is essential to expand rehabilitation services, improve healthcare providers training in disability management, and strengthen disability support systems. Implementing policy reforms, increasing data collection efforts, promoting research and peer support programs are vital steps toward addressing the multifaceted challenges of SCI management and improving the quality of life for affected individuals.

Introduction: The article examines the contemporary medical field through the prism of Bourdieu's illusio, testing the interaction between formal rationality and social logic. It offers a unique approach, combining technical and social perspectives often treated separately in medical research. Objectives and method : The aim is to illustrate how illusio-professionals' investment in the value and meaningfulness of medicine-conditions medical practice as a complex interplay between formal rationality (standardized procedures) and social logic (interactions and care provision). The article discusses the impact of this interplay on the professional identity of physicians, their interaction with patients, and the operation of medical institutions.

Results: The thematic analysis highlighted key tensions and dynamics at the heart of public health service delivery in Tunisia that have important ramifications not only for patient care, but also for physician well-being.

Conclusion: There is an antagonism between the search for standardization of formal rationality (FR) and the adaptation of individualized treatment according to the patients' situation. Although standardized protocols and procedures are in place to ensure fairness and efficiency, these can sometimes feel detached.

Introduction-Aim: Reverse shoulder arthroplasty (RSA) is a valid option for several degenerative conditions of the shoulder. This study aimed to analyze mid-term functional outcomes and complications rates of cementless stem.

Methods: From January 2016 to December 2020, retrospective review of cementless RSA for degenerative conditions was established. Clinical outcomes were assessed using visual analog scale (VAS), University of California Los Angeles (UCLA) score, Constant score and range of motion (ROM). Radiographic findings were evaluated during follow-up. Complications rates was reported.

Results: At mid-term follow up of 39 months, 40 shoulders were included with sex-ratio= 0.53 Mean age was 67.7 years (60 -82). VAS score improved from 5.0 to 2.2 (p = 0.014). UCLA score increased from 17.2 to 25.7 (p = 0.002) and Constant score improved from 31.89 to 70.2 (p < 0.001). Active anterior elevation, abduction, and external rotation showed enhancement respectively 80° to 141.2°, 71° to 132.2° and 5.8° to 19.7° (p values < <0.0001). The mean calcar filling ratio was 0.86 (0.32 - 1.17 +/- 0.22). The mean proximal and distal filling ratios were 0.62 (0.48 - 0.73 +/- 0.06) and 0.56 (0.36 - 0.71 +/- 0.09) respectively. The overall rate of postoperative complications was 22.5%.

Conclusion: Cementless stem improve functional outcomes at mid-term follow up. Stems were correctly aligned with the humeral axis and canal filling ratios were <0.7 in all cases. Stress-shielding was slightly higher without impact on clinical outcomes.

Introduction: Chronic obstructive pulmonary disease (COPD) acute exacerbation (AE) increases morbidity and has an impact on health status. Inflammation plays a key role in these events. Current evidence supports use of biomarkers to guide corticosteroid therapy, which is included in the treatments of COPD AE.

Aim: The aim of our study was to determine the prognostic value of hypereosinophilia (HEo +) in patients admitted to emergency department (ED) with COPD AE in terms of recurrence (Recurrence+).

Methods: A prospective and observational study was conducted over nine months including patients admitted to ED with COPD AE. Patient history, clinical, paraclinical and therapeutic data was collected. HEo+, was defined as blood eosinophil count (BEC)≥200 cells/mm3. One month follow-up was performed. We compared two groups: Recurrence+ vs Recurrence- patients and HEo+ vs HEo- patients. Both univariate and multivariate analysis were performed to identify factors associated with COPD AE recurrence at one month.

Results: We included 252 patients. Prevalence of HEo+ was 50%. Patients with HEo+ had less severe clinical signs on admission (p=0.03), less COPD AE recurrence (p <0.001) and required less hospitalization at one month (p=0.003). Mortality was higher in HEo- patients (p=0.05). Recurrence- patients had HEo+ more frequently (61% vs 19% ; p<0.001). In multivariate analysis, we identified two predictors of recurrence of COPD: COPD group D (adjusted OR 2,3; [95% IC 1,5-3,7]; p<0,001) and non-invasive ventilation on admission (adjusted OR 3,9; [95% IC 1,1-13]; p=0,03). HEo+ was a protective factor of COPD group D (adjusted OR 2,3; [95% IC 1,5-3,7]; p-0,001) and non-invasive ventilation on admission (adjusted OR 3,9; [95% IC 1,1-13]; p=0,03). HEo+ was a protective factor of COPD AE recurrence (adjusted OR 0,3; [95% CI] [0,17-0,4]; p-0,001).

Conclusion: Recurrence of COPD AE one month after ED visit was less frequent in patients with HEo+. BEC may predict systemic corticosteroid treatment failure or success. Identification of responders to corticotherapy can lead to less prescription of prednisone or equivalent and could be integrated into a therapeutic management algorithm.