Tunisie Medicale最新文献

Introduction: The COVID-19 is defined as a respiratory and endothelial disease caused by Severe Acute Respiratory Syndrome Coronavirus 2. Endostatin is a molecule bound to collagen in the basal membrane of endothelial cells.

Objective: The aim of this study was to measure the serum endostatin levels of patients diagnosed with COVID-19 in the emergency department.

Methods: This study was conducted in the emergency department with two groups: COVID-19 PCR-positive patients and healthy adults. Complete blood count, serum biochemistry values, and radiological imaging results were evaluated. Serum endostatin levels were measured from venous blood samples collected during the emergency department visits. Data were analyzed using the SPSS 19.0 software.

Results: A total of 148 COVID-19 patients and 35 healthy controls were included in the study. The serum endostatin levels of the COVID-19 patient group were significantly lower compared to the healthy control group (p<0.05). The Chest CT Severity Score, 4C-Mortality Score, Quick SOFA, and Quick COVID-19 Severity Index were significantly higher in the patients with a fatal outcome compared to those who survived (p<0.001). Although serum endostatin levels were slightly higher in the fatal outcome group, no statistically significant difference was observed (p>0.05).

Conclusion: There is no increase in serum endostatin levels in patients with COVID-19 presenting to the emergency department. While a slight increase in endostatin levels was observed in patients with a fatal outcome, it is believed that endostatin will not be effective in predicting prognosis.

Introduction: Polycystic Ovary Syndrome (PCOS) is a common cause of menstrual disorders, infertility, and hyperandrogenism, often associated with insulin resistance and an increased risk of metabolic disorders. This study aimed to assess the metabolic and nutritional characteristics of overweight women with PCOS.

Methods: This was a descriptive, cross-sectional, and retrospective case-control study that included 61 overweight women, divided into two groups: 31 women with PCOS and 30 controls without PCOS. Data were gathered through review of the patients' medical records.

Results: High blood pressure, type 2 diabetes, dyslipidemia, and metabolic syndrome were significantly more frequent in the PCOS group compared to the control group (p<0.001; p<0.001; p=0.002; and p=<00001, respectively). Eating disorders were more frequently observed in women with PCOS, with a significantly higher occurrence of binge eating behaviors in these patients compared to the control group (p=0.009). The intake of saturated fatty acids was higher in women with PCOS (p=0.01). Regarding micronutrients, intakes of vitamin C and vitamin B1 were significantly lower in PCOS patients (p=0.01 and p=0.04, respectively). However, significantly more prevalent nutrient deficiencies in omega-6 fatty acids (p=0.001), vitamin C (p=0.002), vitamin B1 (p=0.03), vitamin B3 (p=0.003), vitamin B6 (p=0.03), and iron (p=0.02) were noted in the PCOS group.

Conclusions: Women with PCOS exhibit a higher occurrence of cardio-metabolic risk factors and multiple nutritional deficiencies. Early and personalized management is crucial to improve their long-term health outcomes and quality of life.

The act of publishing research is not just a procedural step; it is a fundamental part of the scientific process. It ensures transparency, accountability, and the continuous evolution of knowledge. This perspective paper aimed to revisit the theoretical reasons/motivations that lead researchers in the medical field to engaging in the publication process, and to determine those of researchers from a low-income country (Tunisia). When researchers publish their findings, they provide a foundation upon which others can build. This iterative process is what drives innovation and discovery. Moreover, the global nature of scientific research means that publications often transcend borders, enabling international collaboration. In addition, the societal impact of research cannot be overstated. Publications often serve as the bridge between scientific discovery and real-world application. Finally, the ethical dimension of publishing is also significant. By sharing their work, researchers contribute to the democratization of knowledge, ensuring that scientific advancements are accessible to all, rather than being confined to a select few. This is particularly important in addressing global challenges such as climate change, pandemics, and inequality. The responses of a 44 university hospital doctors and doctoral students from a low-income country to the question "why publish?", show a lack of awareness of the importance of publishing, both academically and economically. In summary, the publication of research is a multifaceted endeavor that serves both the scientific community and society. It is a testament to the collaborative and progressive nature of human inquiry, driving us toward a better understanding of the world and our place within it.

Introduction: Internet Gaming Disorder (IGD) is a behavioral addiction characterized by impaired control over gaming. While its psychological aspects are well-documented, its physiological correlates, particularly those governed by the autonomic nervous system (ANS), are less well-synthesized. Heart rate variability (HRV) and pulmonary function are key indicators of cardiorespiratory health and ANS regulation. This systematic review aimed to evaluate the impact of IGD on chronotropic (as measured by HRV) and ventilatory responses, both at rest and during active gaming.

Methods: We searched PubMed, Embase, and Scopus from database inception to December 2024 seeking for observational studies published in English or French. We included studies that diagnosed IGD using formal criteria (DSM-5/ICD-11) and objectively measured HRV and/or pulmonary function in individuals with IGD compared to healthy controls. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the ROBINS-I tool.

Results: The search yielded 249 records, from which four case-control studies met the inclusion criteria, comprising 162 participants (77 IGD, 85 controls). The overall risk of bias was judged to be low. At rest (k=3 studies), baseline HRV parameters including the natural logarithm of high-frequency power (lnHF), root mean square of successive differences (RMSSD), and standard deviation of normal-to-normal intervals (SDNN) did not differ significantly between the IGD and control groups. During active gaming (k=2 studies), a blunted parasympathetic reactivity was observed in the IGD group, characterized by a significant drop in lnHF not observed in controls. Regarding pulmonary function (k=1 study), while lung volumes were similar, individuals with IGD showed significantly lower respiratory muscle strength compared to controls.

Conclusion: This review suggested that IGD is associated with preserved tonic autonomic function at rest but impaired phasic parasympathetic reactivity during gaming engagement. Furthermore, IGD may be linked to reduced respiratory muscle strength, potentially indicating a physical deconditioning. These physiological alterations highlight the systemic impact of IGD and may serve as potential biomarkers for diagnosis and monitoring.

Introduction: Cardiac amyloidosis is an underdiagnosed cause of heart failure characterized by extracellular deposition of misfolded proteins, most commonly transthyretin (ATTR) or immunoglobulin light chains (AL). Despite recent advances in disease-modifying therapies, prognosis remains poor. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits. However, evidence regarding their safety and efficacy in cardiac amyloidosis remains limited.

Aim: This systematic review aimed to synthesize current evidence on the clinical outcomes and safety of SGLT2 inhibitors in patients with cardiac amyloidosis.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library through June 2025, in accordance with PRISMA guidelines. Studies evaluating the use of SGLT2i in cardiac amyloidosis were included. Outcomes assessed were all-cause mortality, stroke, hospitalization for heart failure, and kidney failure. Data extraction and quality assessment were performed independently by two reviewers. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled when appropriate.

Results: Five studies comprising 17,416 patients met inclusion criteria. The mean age was 76.8 years, and 78% were male. Use of SGLT2 inhibitors was associated with a significant reduction in all-cause mortality (HR 0.64; 95% CI 0.57-0.71) and stroke risk (HR 0.64; 95% CI 0.54-0.77). For hospitalization due to heart failure, there was a trend toward benefit (HR 0.88; 95% CI 0.76-1.02), though this did not reach statistical significance. The risk of kidney failure was modestly reduced (HR 0.91; 95% CI 0.71-1.08). Overall study quality was moderate.

Conclusions: SGLT2 inhibitors appear to be a promising therapeutic option in cardiac amyloidosis, potentially improving survival and reducing cerebrovascular events while maintaining a favorable safety profile. However, current evidence is limited by observational study designs and heterogeneity. High-quality randomized controlled trials are needed to confirm these findings and guide clinical practice.

Introduction: Heated tobacco products (HTPs) are marketed as reduced-risk alternatives to conventional cigarettes, yet their true cardiovascular safety profile remains unclear. This systematic review aimed to evaluate the acute and short-term cardiovascular effects of HTPs compared to traditional cigarettes.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Embase from inception to March 2024. Eligible studies included randomized controlled trials and observational studies reporting on cardiovascular outcomes in adult users of HTPs compared to conventional smokers. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Data were synthesized qualitatively; a meta-analysis was not feasible due to heterogeneity.

Results: Five studies (n = 460 participants) met the inclusion criteria. Risk of bias ranged from low to serious, with one industry-sponsored study. Acute HTP exposure induced hemodynamic and vascular changes comparable to those observed with conventional cigarettes. Endothelial dysfunction and persistent oxidative stress were reported across studies. One study (Ikonomidis et al.) suggested a minor reduction in oxidative biomarkers with HTP use, though clinical significance was uncertain. No study assessed mid- or long-term outcomes.

Conclusions: HTPs do not appear to offer meaningful cardiovascular benefit over conventional cigarettes in the short term. The similarity in acute harmful effects raises concern over their widespread use and marketing. These findings underscore the urgent need for independent, long-term studies assessing clinically relevant cardiovascular endpoints.

Background: Schizophrenia is increasingly recognized as a multisystemic disorder. Cardiac anomalies, including autonomic, electrophysiological, and structural heart abnormalities, are frequently reported in patients with schizophrenia. However, the distinction between phenotypes and endophenotypes remains unclear.

Methods: In this review, we synthesized clinical, neurobiological, and genetic evidence to assess cardiac alterations in schizophrenia and evaluate their potential as endophenotypes.

Results: Autonomic dysfunction, especially reduced heart rate variability (HRV) and impaired parasympathetic regulation, emerged as the most consistent cardiac phenotype, and the only one that fulfills the criteria for an endophenotype. In contrast, electrophysiological anomalies such as QT/QTc prolongation, T-wave changes, and some structural heart anomalies show genetic associations with schizophrenia but lack sufficient heritability and longitudinal data to be classified as endophenotypes.

Conclusion: Among all cardiac anomalies reported in schizophrenia, autonomic dysfunction, particularly HRV impairment, was the only one that fulfilled the endophenotype criteria. However, most of the reviewed studies were observational, which limits the robustness of our conclusions. Future heritability and multi-omic studies are needed to understand the complex pathogenomic interlink between mental and heart diseases.

The sinonasal inverted papilloma is a rare benign tumor which is distinguished from the other sinonasal tumors by some characteristics such as a slow developement, local aggressiveness, a high rate of recurrence after surgical resection and the possibility of malignant transformation. It should be considered in the presence of any unilateral polypoid symptomatology or lesion. Its treatment is surgical. In this update, we discuss the radiological specificities of sinonasal inverted papillomas as well as the contribution of imaging in the diagnosis and post-treatment monitoring of these tumors.