Tunisie Medicale最新文献

Introduction: Virtual reality is being used more and more in the healthcare field, particularly during treatment. In the context of pain management, the question arises as to the effectiveness of using virtual reality during care in reducing the perception of procedural pain.

Aim: To study the impact of using virtual reality on the perception of procedural pain and on the course of care in pediatric oncology.

Methods: A quasi-experimental, matched-case-control study conducted at the pediatric oncology unit of the Tunis Children's Hospital over a three-month period. Each child had two nursing care : with and without the use of virtual reality.

Results: Thirty-two children were enrolled. The sex ratio was 0.88. The edia nage was 96 ± 49 months. The care provided was peripheral venous line insertion (53%), blood sampling (32%) and port-a-catheter puncture (15%). The use of virtual reality significantly reduced heart rate (p<0.0001), respiratory rate (p<0.0001) and pain perception (p<0.0001). Workload was reduced, as evidenced by a drop in the duration of nursing care (p<0.0001) and in the number of people needed to carry out care (p<0.0001).

Conclusions: Virtual reality is a good non-pharmacological alternative for procedural pain control in a pediatric oncology unit.

Aims: This systematic review and meta-analysis aimed to determine the annual incidence rate of venous thromboembolism (VTE) and identify risk factors of VTE in amyotrophic lateral sclerosis (ALS) patients.

Methods: A comprehensive search of three databases was conducted up to April 8, 2024, to identify longitudinal studies reporting VTE incidence in ALS patients. The included studies were either prospective or retrospective, following up with ALS patients. Quality assessment was performed using the NIH tool for observational cohort studies. Meta-analysis was conducted using Open Meta Analyst, employing a random-effect model. Subgroup, Meta-regression, and sensitivity analyses were also carried out.

Results: Our analysis included eight studies comprising a total of 26,758 ALS patients that met the inclusion criteria. The pooled annual incidence of VTE across all studies was found to be 22 cases per 1,000 person-year (95% CI = 18 to 27). Subgroup analysis revealed that the annual incidence of VTE in males was 19 cases per 1,000 person-year (95% CI = 15 to 22), while in females, it was 20 cases per 1,000 person-year (95% CI = 16 to 25). Leave-one-out analysis demonstrated that the incidence ranged from 21 to 28 cases per 1,000 person-year when excluding each study individually. Meta-regression analysis did not find a significant association between age and the risk of VTE (P = 0.079). Based on the included studies, risk factors of VTE in ALS patients included a history of VTE, non-invasive ventilation, immobility, and decreased functional status.

Conclusion: Patients with ALS face a higher risk of developing VTE compared to individuals of the same age. These findings underscore the importance of implementing preventive measures and closely monitoring VTE in ALS patients.

Introduction: The therapeutic farm "GAIA" in Sidi Thabet is a non-profit organization created in 2009, situated in the North-Western suburbs of the capital Tunis/Tunisia. Its main aims are the day-care for and the socio-professional integration of children and young adults between age 6 and 30 with diverse types of disability through multiple activities, such as pet assisted therapy and horticulture.

Aim: to assess the potential benefits of therapeutic on-farm management.

Methods: We conducted a prospective study including 50 children and young adults aged 7 to 30 years with intellectual disabilities and/or autism spectrum disorders. Study participants were evaluated before inclusion and after 10 months of care using a self-established questionnaire collecting socio-demographic and clinical variables, an evaluation of competences, and the Child Behavior Checklist (CBCL).

Results: Mean sub scores (externalization/internalization) of CBCL decreased significantly (p<0.002). Competences were significantly improved in the following domains: understanding of verbal language, gross and fine motor skills, body hygiene, spatial and temporal orientation, preschool and school learning achievements and social integration.

Conclusions: These positive initial results should encourage the further development of this initiative with support of the community.

Introduction: Audiovisual distraction (AVD) is one of the non-pharmacological means of anxiety prevention. However, few studies have evaluated its perioperative effect in adults.

Aim: To evaluate the contribution of audio-visual distraction in the prevention of perioperative anxiety in adult patients proposed for surgery under spinal anesthesia.

Methods: This was a prospective randomized controlled study lasting three months from July 1, 2021. We included ASA I to III over 18 years patients, proposed for visceral or orthopedic surgery under spinal anesthesia. We didn't include patients operated in lateral or prone positions or with a history of anxiety disorders or communication difficulties. 90 patients were randomized into two groups: a control group T and a group A who had an AVD throughout the operation. The primary outcome was anxiety as assessed by the visual analogue scale (VAS).

Results: Demographic characteristics, Amsterdam preoperative anxiety and information scale (APAIS) and pain levels were comparable between the two groups. During the surgery, 22 (48.9 %) patients in group T versus 3 (6.7 %) in group A required Midazolam (p < 0.001). Anxiety assessed by VAS at the end of the act was lower in group A (p < 0.001). The pain levels also were lower in patients who received AVD (p = 0.004). A patient satisfaction score (Iowa Satisfaction with Anesthesia Scale French version) ≥ 5.4 was more frequently observed in group A (p < 0.001).

Conclusion: AVD reduced perioperative anxiety and decreased the use of midazolam during surgery performed under spinal anesthesia.

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, characterized by a clear female predominance and a major clinical polymorphism. Some initial presentations, particularly in children and adolescents are exceptional. Our objective was to report an unusual initial presentation of SLE in a male adolescent.

Observation: We reported the case of a 16-year- old tunisian boy who was referred to the hematology emergency department because of a hemorrhagic syndrome. The evolution was marked by pancytopenia, prolonged fever and an anasarca with recurrent cardiac tamponade. Explorations concluded to SLE. The patient was started on pulse therapy of dexamethasone followed by immunoglobulin. He was also provided with pericardiocentesis with a favorable outcome.

Conclusion: SLE is characterized by clinical polymorphism, that's why diagnosis and management of complications could be difficult. SLE should be considered in differential diagnosis of many disorders, such as pancytopenia and cardiac tamponade.

Introduction: Intestinal parasitoses are very common in school and in Mauritania few external studies address the issue. Several risk factors are known for intestinal parasitosis, including fecal danger, promiscuity and contaminated food Objective: To describe the epidemiology of intestinal parasitosis in school-age children in the Moughatâa (department) of Riyadh in Nouakchott (Mauritania) and the associated risk factors.

Methods: This was a descriptive cross-sectional study lasting three months, at the level of a random sample of pupils enrolled in five primary schools in the Moughatâa of Riyadh, as well as the foods sold in front of the establishments included. The data was collected through an anamnestic and clinical observation grid, as well as stool and food samples exposed in front of the schools included. The parasitological examination of the stools was carried out at the National Institute of Public Health Research (INRSP) in Nouakchott, by the methods of modified Ritchie and Kato-Katz. For food, a microbiological analysis looking for fecal colibacilli is carried out.

Results: The study population was composed of 337 students with a sex ratio of 0.76. The prevalence of parasitosis in the study population was 46% (95% CI [40.75%-51.33%]): Boys (48.6%), 95% CI [40.66%-56.67%]); Girls (43.9%), 95% CI [37.13%-51.07%]. The spectrum of these parasitic intestinal diseases was dominated by protozoa (51.6%) and helminthiasis represented 10.4% and characterized by mono parasitism (31.8%). The food sold in front of the schools studied was contaminated with coli bacteria, in 54.5% of cases.

Conclusion: The high prevalence of intestinal parasitosis in the primary schools studied and the contamination of food sold to students, require the strengthening of the strategy to fight against diseases of fecal peril and school and public hygiene, in the Moughatâa of Riyadh (Nouakchott).

Aim: to describe and analyze peripapillary microvascular changes in eyes with optic neuropathies using optical coherence tomography angiography (OCTA).

Methods: In this cross-sectional observational study, 63 eyes of 48 patients with different causes of optic neuropathy and 36 healthy control eyes were evaluated by optical coherence tomography (OCT) and OCTA (Topcon DRI OCT; Triton) between January 2018 and December 2018 at the Fattouma Bourguiba ophthalmology department in Monastir.

Results: Vascular changes were more frequent in acute non arteritic anterior ischemic optic neuropathy (NAION) than in optic neuritis. Eyes with optic atrophy had capillary rarefaction corresponding to the area of thinning of the peripapillary optic fiber layer (RNFL). The peripapillary vascular density (PVD) was lower (p=0.036) in case of optic atrophy compared to normal eyes. For non arteritic ischemic optic neuropathy and for chronic retrobulbar optic neuritis (NORB), a positive correlation between visual acuity and PVD was observed (p<0.05). An inversely proportional correlation between the PVD and the duration of evolution was noted. In the multivariate study, high blood pressure was a systemic factor correlated with peripapillary microvascular damages.

Conclusion: OCTA showed a reduction in PVD and greater vascular changes in acute non-arteritic ischemic optic neuropathy than in edematous optic neuritis. At the atrophic stage, the PVD was reduced. Hypertension was an independent factor correlated with peripapillary microvascular damages.

Introduction: Parents' knowledge is an integral part of healthcare quality, impacting treatment adherence, patient loyalty and healthcare utilisation in pediatric asthma. Parental knowledge is particularly crucial as parents influence decision-making for their child's healthcare.

Aim: To assess parents' knowledge and perceptions of their children's asthma and to identify areas for weakness in therapeutic education.

Methods: This is transversal survey study based on validated and translated self-administered questionnaire (Arabic asthma knowledge questionnaire AAKQ). The study was conducted in 2 departments: pediatric primary care department at Elomrane and pediatric pneumology outpatient clinics at Bechir Hamza children's hospital of Tunis during 6 months (March2022- October2022).

Results: One hundred forty-four parents were involved in the study. Most of the participants were mothers. The mean age was 38 years. Only 27,0% had higher education and smoking in parents was observed in 58% of cases. Our results showed moderate knowledge in 67,9% of participants. The mean of the total knowledge score was 57,7/85. Forty-six per cent of parents had poor knowledge for the first category of the questionnaire. The second category was the most successful part where only 14% had poor knowledge. The mean score of the third category was 13,5/20 with 35,4% of parents having poor knowledge. The mean of total knowledge was found to be higher among participants with higher education (P=0,000), when the gender of the child is masculine (P=0,038), when the parents were asked in Hospital of children of Tunis (P=0,003) and when there is a history of asthma in the siblings (P=0,05). No difference in caregiver's knowledge was based on their age or gender or history of asthma, on the age of the child, his hospitalization for asthma, his asthma control level or his compliance with medication.

Conclusion: Knowledge of parents and their children suffering from asthma is acceptable but insufficient. An approach focusing on improving patient education skills is needed to help families understand and accept the disease and achieve optimal control.

Introduction: Hyper-IgE syndrome is a group of inborn errors of immunity, some of which are syndromic, characterized clinically by the classic triad of chronic eczema, cutaneous and/or pulmonary staphylococcal infections and high serum IgE concentrations (> 2000 IU/ml or > 10 x normal for age).

Aim: We report here the clinical and immunological aspects of Moroccan patients presenting probable or possible HIES according to NIH-HIES score.

Methods: This retrospective study covers the period from 1998 to 2023 and includes Moroccan patients with a clinical presentation suggestive of HIES (skin and/or pulmonary infections, eczema, high IgE levels) and an NIH score ≥ 20. We attempted to classify the patients phenotypically according to the 2022 IUIS IEI Expert Committee classification.

Results: Median age at symptom onset was 0.5 years and median age at diagnosis was 5.5 years. The main clinical signs were eczema (66%), skin abscesses (32.5%), pneumonia (32.5%), otitis (20%), mucocutaneous candidiasis (19%), diarrhea (12%), facial dysmorphism (10.3%), lymphadenopathy (9.5%), bronchial dilation (8%), pneumatoceles (8%), conjunctivitis (7.1%), rhinitis (6.3%), psychomotor delay (5.6%), pathological fractures (4%), retention of deciduous teeth (4%), cognitive delay (3.2%).

Conclusion: This is the first clinical description of a cohort of Moroccan patients presenting HIES according to NIH criteria. Phenotype can sometimes orient towards identification of the mutated gene, but the overlapping clinical signs make molecular analysis necessary for genetic counseling and appropriate treatment.

Introduction: Children undergoing long-term hemodialysis (HD) face a reduction in life expectancy mostly due to cardiovascular mortality. Effects of HD on cardiac function have not been fully elucidated in pediatric population.

Aim: This study aimed to assess HD session impact on cardiac function in pediatric patients using conventional and strain echocardiography.

Methods: We performed a prospective, comparative study of echocardiographic parameters before and after single HD session in a chronic HD pediatric population. We enrolled between the 1st and 30th September 2023, all consecutive patients with end-stage renal disease (ESRD) aged up to 18 years old on maintenance HD three times weekly for at least three months. All patients underwent conventional and left ventricular (LV) longitudinal strain echocardiography in a window of 30-60 minutes before and after HD.

Results: 23 patients, 14.8 ± 2.1 years old and 47.8% male, were enrolled. Reductions in body weight and blood pressure were observed after HD, whereas heart rate increased. Significant decrease in LV and left atrial diameters and volumes after HD session were observed. Mitral peak E velocity, as well as average E/e' were significantly lower after HD. Although LV ejection fraction was unchanged, global longitudinal strain for LV was significantly reduced after dialysis (-17.3 ± 3.0% vs. -14.9 ± 2.4%, p=4.10-8).

Conclusion: Patent deterioration in LV systolic function following HD was identified by speckle tracking echocardiography (STE). STE has the potential to unmask early myocardial dysfunction even when there is no evident alteration in conventional systolic function parameters in children with ESRD.