Tunisie Medicale最新文献

Introduction: During a role-play simulation session, despite supporting observer learning, educators disagree about whether the learning outcomes of observers are like those of active participants.

Aim: Evaluation of the degree of knowledge acquisition by these two types of learners during the same role-play session.

Methods: We carried out a quasi-experimental pre-post intervention study to identify the learning outcomes among learners serving in observer (group 1) and active (group 2) roles during a role-play simulation session.

Results: The role play involved 29 learners. In both groups, 65% of learners improved their overall score. The median post-test score was significantly higher in both groups (p=0.0001). Likewise, learners in group 1 (p=0.023) and in group 2 (p=0.008) showed an improvement in the overall score in the within-group evaluation study. The between-group evaluation study showed no statistically significant difference in overall score improvement (p=0.58), number of learners improving (p=0.05) or percentage improvement (p=0.3).

Conclusion: Based on these findings, it is suggested that role-playing method is effective in achieving student-learning outcomes regardless of their status as active or observer.

Introduction: The benchmark of a medical thesis' success is often its acceptance for publication in an indexed journal.

Aim: To determine the publication rate of practice theses in the field of Cardiology at the Faculty of Medicine of Sousse (FMSo) in Tunisia and to identify predictive factors for successful publication.

Methods: We conducted a descriptive bibliometric analysis of Cardiology theses defended at FMSo from 2000 to 2019. Data were extracted from the theses' cover pages, abstracts, and conclusions. The publication status was ascertained via searches in "MEDLINE", "Scopus", and "Google Scholar". Predictive factors for publication were identified using multivariate analysis with a 90% Confidence Interval (CI).

Results: Of the 111 Cardiology theses defended at FMSo between 2000 and 2019, 36 were published yielding 42 scientific articles (publication rate of 32%). Notably, 86% of these articles were indexed in "MEDLINE" and/or "Scopus". In 79% of cases, doctoral candidates were co-authors of the resultant publications. Publication was significantly influenced by three factors: scientific mentorship by an Assistant or Associate Professor (aOR=3.021; 90%CI: 1.06-10.14; p=0.082), a prospective study design (aOR=2.536; 90%CI: 1.07-6.02; p=0.076), and a satisfactory quality of writing (aOR=2.384; 90%CI: 1.11-5.11; p=0.061).

Conclusion: The publication of Cardiology theses at FMSo was found to be associated with the prospective design of the study and the quality of writing. Thus, it is imperative to enhance the research methodology and scientific communication skills of medical thesis candidates and their mentors to facilitate the transition from academic dissertations to medical articles.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition strongly related to oxidative stress. Recent studies have explored the potential benefits of nutritional supplementation in managing several conditions.

Aim: To investigate the effects of zinc-enriched Spirulina Supplementation (ZSS) on patients with COPD.

Methods: This study is a monocentric randomized controlled clinical trial. COPD-eligible adult male patients under 65 years of age, receiving regular medical treatment, will be included. They will continue their conventional medical treatment following the GOLD 2023 guidelines for COPD. Ninety subjects will be randomly assigned to either the experimental group (G1) or the control group (G2) in a 1:1 ratio. G1 will receive ZSS (1 g/day) for 2 months, while G2 will continue only basic medical treatment. The study will assess oxidant-antioxidant balance, lung function through pulmonary function tests, functional capacity via the 6-minute walking test, lipid profile, dyspnea, and health-related quality of life. All outcomes will be measured at baseline and two months later after supplementation completion. After the 8-week treatment, patients will be followed up for an additional 4 weeks. Ethics approval was obtained from the faculty of medicine of Sousse ethics committee.

Expected results: It is expected that ZSS can positively impact the oxidant/antioxidant balance in patients with COPD after two months of supplementation. The authors anticipate that ZSS may improve various physiological parameters, such as lung function, exercise capacity, endothelial function, and metabolic profile, leading to an overall improvement in the quality of life of patients with COPD.

Introduction: Intravenous leiomyomatosis (IVL), a rare type of uterine leiomyoma (its incidence is about 0.25% to 0.40% of patients who present uterine fibroma), is characterized by the formation and growth of benign leiomyoma tissue within the vascular wall or lymphatic lumen. Herein, we presented a case of early stage of IVL successfully treated by surgical removal and a review of actual medical recommendations.

Observation: A 49-year-old woman, gravida 2 para 2, presented to our department with hypogastric pain. On physical examination, a palpable mass in the hypogastrium was noted. Pelvic ultrasound showed a huge uterus with multiple heterogeneous leiomyomas. As the patient was symptomatic and as she had completed their family plan, the decision to perform a total abdominal hysterectomy with bilateral salpingo-oophorectomy was taken. On pathological examination, intravascular growth of benign smooth muscle cell was found within venous channels lined by endothelium. The diagnosis of IVL of the uterus without malignant transformation was confirmed. The patient was monitored for 14 months, and subsequent computed tomography did not reveal any evidence of tumor recurrence.

Conclusion: IVL is a benign, rare and potentially lethal pathology. Clinical manifestations are nonspecific. IVL needs surgical treatment for diagnosis and therapeutic purposes. They require close and prolonged follow-up because of the high risk of recurrence.

Introduction: Several non-invasive tests (NIT) have been reported for predicting liver fibrosis to avoid percutaneous liver biopsy (PLB).

Aim: To evaluate the performance of NIT in Tunisian patients with chronic hepatitis B (CHB).

Methods: We calculated the ASAT/platelet ratio index (APRI), GGT-to-platelet ratio (GPR), Fibrosis-4 score (FIB-4), and RDW/platelet ratio (RPR). The accuracy of NIT was compared with the Metavir score for the detection of liver fibrosis stage using the area under the ROC curves (AUROC).

Results: Seventy-seven CHB patients were included. For predicting significant fibrosis, the AUROC of GPR (0.81; CI95% [0.68-0.93]; P < 0.001) was significantly higher than that of RPR (0.67; CI95% [0.52-0.82]; P = 0.03) and FIB-4 (0.746; CI95% [0.61-0.88]; P = 0.002), but was similar to APRI (0.88; CI95% [0.79-0.97]; P < 0.001). For advanced fibrosis, the AUROC of GPR (0.93; CI95% [0.84-1]; P < 0.001) was higher than that of RPR (0.83; CI95% [0.69-0.97]; P < 0.001) and FIB-4 (0.88; CI95% [0.76-0.99]; P < 0.001), but similar to APRI (0.93; CI95% [0.87-0.99]; P < 0.001). For predicting cirrhosis, the AUROC of GPR (0.98; CI95% [0.95-1]; P < 0.001) was higher than that of APRI (0.95; CI95% [0.90-1]; P = 0.02), similar to RPR (0.99; CI95% [0.98-1]; P < 0.001) but lower than that of FIB-4 (1; CI95% [1-1]; P < 0.001). In multivariate analysis, APRI (OR = 3.78; P = 0.002) and FIB-4 (OR = 2.65; P = 0.01) were independent predictors of significant fibrosis. GPR was the only independent predictor of advanced fibrosis (OR = 4.64; P = 0.001) and FIB-4 was the independent predictor of cirrhosis (OR = 2.85; P < 0.001).

Conclusion: GPR does not demonstrate significant advantages over APRI, FIB-4, and RPR in identifying liver fibrosis in patients with chronic hepatitis B (CHB).

Introduction: Peri-implant fractures (PIFs) are uncommon yet critical complications following orthopedic surgery. These complications can significantly impact a patient's psychological well-being and overall quality of life.

Aim: This study aimed to investigate the psychological effects of PIFs.

Methods: This was a cross-sectional study that involved 136 patients who underwent surgery for PIFs between 2018 and 2022. We utilized various validated scales and questionnaires such as Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Impact of Event Scale Revised (IES-R), 36-Item Short Form Survey (SF-36), and Brief COPE Inventory (BCI) to assess their psychological state.

Result: The results revealed that patients with PIFs experienced higher levels of anxiety, depression, stress, and post-traumatic stress compared to the general population. Additionally, they reported lower physical and mental health. Factors such as the number of surgeries, treatment delay, post-operative pain levels, and complications significantly influenced their psychological outcomes. Notably, acceptance, positive reframing, and seeking emotional support were the most common coping mechanisms employed by these patients. Conversely, denial, substance use, and self blame were the least employed strategies.

Conclusion: This study suggests that psychological interventions could significantly benefit patients with PIFs, potentially reducing their distress and improving their quality of life.

not applicable, this is an editorial.

Introduction Alopecia areata (AA) is a common, chronic inflammatory, non-scarring form of hair loss affecting 0.1-0.2% of the population. It is a psychosomatic disease involving a T-cell-mediated immune reaction against hair follicle antigens during the anagen phase. Psychiatric morbidity in dermatological patients can significantly affect their quality of life and disease progression. Identifying and addressing these comorbidities in AA patients is crucial. Aim This study aimed to estimate the prevalence of depression and its associated factors among patients diagnosed with alopecia areata (AA). Methods The present study is a cross-sectional, descriptive, and analytical study conducted at Farhat Hached Hospital in Sousse, Tunisia, during the period from August to December 2019. Participants were recruited from the Dermatology Outpatient Department. The questionnaire covered socio-demographic characteristics, personal and family history, AA history, clinical presentation, disease severity (SALT score), nail involvement, and depression assessment using the Hamilton Depression Scale (validated Arabic version). Results A total of 60 AA patients were enrolled, with a mean age of 37.6 ± 12.9 years. Females exhibited a predominant representation, with a male to female ratio (M/F) of 0.76. According to the Hamilton Depression Scale (HAM-D), 31 cases (51.7%) were depressed, with a mean depression scale score of 11.33 (±6.57 SD). The presence of depression was significantly associated with younger age (p=0.018), the presence of the eyelashes/eyebrows form (p=0.035), nail involvement (p= 0.03), and a poor response to treatment (p=0.004). Conclusion Our research highlights the importance of providing psychological support to alopecia areata patients.

Introduction: Esophageal variceal bleeding (EVB) is one of the main causes of mortality and morbidity in cirrhotic patients. Non-invasive tests (NIT) of liver fibrosis have been developed to predict the presence of esophageal varices (EV).

Aim: To evaluate the performance of NIT of liver fibrosis such as liver transient elastography (TE) and serum scores in predicting EV.

Methods: We conducted a retrospective collecting patients with chronic liver disease. TE and serum scores were evaluated for all patients and correlated with endoscopic data.

Results: One hundred and fifty patients were included with an average age of 58.98 years and a sex ratio of 0.68. Sixty-seven patients were cirrhotic. Viral origin C was found in 72% of cases. Thirty-three patients had EV. NIT of liver fibrosis such as TE and serum scores were statistically correlated to the presence of EV. TE had the better performance for the prediction of EV with a Cut-off of 13.5 Kpa and AUC of 0.855. In multivariate analysis, TE, AST to ALT ratio and platelet count were independent predictors of EV.

Conclusion: The performance of TE and serum scores in the diagnosis of EV and LEV was demonstrated. These results suggest that NIT of liver fibrosis make it possible to select patients who are candidates for gastroscopy.

Objective: In this study, we aimed to assess main factors influencing the Valproic Acid (V.Acid) plasma trough levels (C0) and to determine their degree of influence on V.Acid C0 in children with epilepsy who had Therapeutic Drug Monitoring (TDM).

Methods: We conducted an observational study in the Department of Clinical Pharmacology including patients with generalized seizures' epilepsy aged between two and 18 years. Only the children that had benefited from at least two V.Acid C0 determinations were included. First, we assessed daily dose optimization, performed by the practitioners. Then we divided our population into two groups: group A with a final V.Acid C0 in the therapeutic range (TR) and group B with a final V. Acid C0 outside the TR to find out factors influencing V.Acid C0 journey.

Results: We included 805 patients (2537 V.Acid C0). The median age was 6.24 years and the sex ratio (M/F) was 1.45. The median V.Acid normalized daily dose was 27.27mg/kg/day and the median V.Acid C0 was 57µg/mL. The children's first V.Acid C0 was in the TR in 59.4% and V.Acid daily dose optimization was performed by the practitioners in 72.3%. Comparing GroupA and B, we found that age and the number of V.Acid C0 determinations increases the chance to reach the TR by respectively 3.79% and 7.39%.

Conclusion: Older children who benefit from higher number of performed V.Acid C0 were more likely to reach the TR. In children who beneficiate from a TDM of V.Acid, close follow-up is mandatory to reach and maintain therapeutic V.Acid C0.