Tunisie Medicale最新文献

Introduction: The order on request is a legal procedure allowing a party to request a judicial decision quickly and without prior notification to the opposing party. This study aims to explore the legal framework governing the order on request in Tunisia, examine the medico-legal concerns and evaluate the associated risks and challenges for both healthcare professionals and patients.

Methods: This study employs a doctrinal and analytical methodology, focusing on an examination of Tunisian legislative texts, particularly the Code of Civil and Commercial Procedure. Additionally, a comparative approach will be used to analyze similar legal frameworks in other countries.

Results: In Tunisia, the order on request enables swift judicial decisions without adversarial proceedings in urgent matters. In this framework, the judge plays a crucial supervisory role to maintain a balance between expediency and the right to a fair trial. Physicians, bound by medical confidentiality, must navigate the tension between their duty of discretion and the obligation to comply with judicial orders. In cases where a physician believes a court order infringes on a patient's rights, they are not required to respond directly to the petitioner. Instead, they must address their concerns to the judge, reaffirming their duty to uphold medical confidentiality.

Conclusion: While the order on request serves as a crucial legal tool for addressing urgent situations, its application must be handled with caution and in strict adherence to legal and ethical standards. Maintaining a balance between procedural urgency and the protection of fundamental rights is essential.

Introduction: JAK inhibitors, a newer class of medications, work by blocking specific enzymes (Janus kinases) that play a key role in inflammation. By inhibiting these enzymes, JAK inhibitors help alleviate inflammation and symptoms, providing an alternative treatment option to conventional therapies like NSAIDs and biologics. Considering the lack of updated findings on cardiovascular effects in SpA patients treated with JAK inhibitors, we will perform a systematic review of the literature to investigate the safety of JAK inhibitors in SpA patients. The aim of this review is to evaluate cardiovascular safety of JAK inhibitors.

Methods: We will search multiple databases, including PubMed, Embase, and the Cochrane Library, using specific keywords such as "Janus kinase inhibitors," "JAK inhibitors," "spondyloarthritis," and "cardiac risk." Our inclusion criteria will focus on randomized controlled trials, that reports Major Adverse Cardiovascular Events (MACE), in patients treated with JAK inhibitors for spondyloarthritis. We will exclude cohort studies, and those without relevant cardiac data, as well as animal studies or those outside the scope of JAK inhibitor treatment. After screening titles and abstracts, we performed a full-text review of the selected articles to ensure the inclusion of studies with high methodological quality and relevant data on cardiac risk factors. The various stages of this literature search will be summarized using the Preferred Reporting of Systematic Reviews and Meta-Analysis (PRISMA) flow chart format to visualize the processes and findings of the review.

Results: The preliminary results demonstrated that the existing data indicated no significant change in cardiovascular risk for JAK inhibitors-treated patients with SpA. Data analyze find no notable difference in the occurrence of MACE between the interventions and the placebo groups. These finding are to interpret with caution, given the limitations of the study numbers and duration. However, these findings provide a foundation for further investigation in this area.

Conclusions: This systemic review highlights the safety of JAK inhibitors according to MACE occurrence in patients with SpA when compared to placebo. These results needs to be interpreted with caution regarding the limited long-term data and small sample sizes in clinical trials. Long-term studies are needed to clarify these risks.

Aim: To develop procedural documents of three gestures taught in endocrinology and to assess their contribution in the procedural learning of students.

Methods: Prospective randomized controlled study, comparing a self-learning tool combining a video and a procedural document (PD), with a guided teaching (GT) of a technical gesture by a teacher. The study involved 89 students randomized into: an intervention group (I1;n=47) and a control group (I0;n=42). All the participants had GT regarding blood pressure measurement, thyroid examination, and waist circumference measurement. Then, the GroupI1 received three PD and three videos illustrating the same gestures. A week later, an assessment was performed. Group I0 received the documents after the assessment. The student satisfaction with the two methods was evaluated.

Results: The percentage of students who used PD and videos was comparable between the two groups (68to79% in groupI1 and 76to86% in groupI0, p between0.161and0.827). The mean evaluation score respectively at the thyroid examination station, blood pressure and waist circumference measurement was 8.07±1.28 in groupI1 versus7.94±1.01 in group I0(p=0.634),7.51±1.11versus7.68±0.96(p=0.466) and7.41±1.37versus6.94±1.34(p=0.132). The mean satisfaction score of the two teaching tools was respectively in group I1 versus I0, of (9.38±1.53 and 8.88±1.63; p=0.195), (9.39±1,65 and 9.25±0.76, p=0.658) and (9.43±1.59 and9.24±0.82,p=0.543).The GT satisfaction score was 9.34±1.40 in I1group versus 9.62±0.46 in I0group, p=0.227. The power of the statistical test was less than 10%.

Conclusion: The lack of significant difference between the evaluation scores of the two groups could be explained by the low rate of consultation of the educational tools and the small sample size.

Introduction: Perioperative use of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) has been linked to early postinduction hypotension requiring vasopressor use under general anesthesia, potentially leading to complications like acute renal injury, myocardial injury, or stroke. However, the relationship between perioperative ACEI/ARB use and major morbidity remains uncertain.

Aim: This meta-analysis assessed the differences between the continuation or discontinuation of ACE inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) therapy during the perioperative period and hemodynamical instability, mortality, and major morbidity outcomes.

Methods: The protocol was registered in the PROSPERO database (ID: CRD42024519162). Literature searches of electronic databases and manual searches on the Medline, Embase, Scopus, and Web of Science databases up to August 30, 2024, will be performed. Case-control studies, cohort studies, non-randomized controlled trials, and randomized controlled trials (RCTs) involving adult patients aged over 18 years, who were chronically using ACEIs or ARBs due to chronic hypertension, undergoing non-cardiac surgery, where ACEIs or ARB therapy was either withheld or continued less than 10 hours before surgery will be included. The primary outcome will be the incidence of intraoperative hypotension. Secondary outcomes will be the intraoperative use of vasoactive agent (incidence, dose of ephedrine (mg) and dose of phenylephrine (ng)), the incidence of severe hypotension, hospital length of stay, intraoperative and postoperative hypertension, the incidence of acute kidney injury, 30-day postoperative all-cause mortality and incidence of major cardio-cerebral events.

Conclusion: The results of this systematic review and meta-analysis should provide evidence for withholding or continuing perioperative ACE-I or ARB in noncardiac surgery.

Introduction: Inappropriate prescriptions (IP) and omission of prescriptions (OP) are sources of adverse events in pediatrics. The pediatric prescription optimization grid (GOPP tool) was developed in the Ivorian pediatric environment for the detection and management of IP and OP. Our aim was to analyze the reliability between pharmacists, when using the GOPP tool for the detection of IP and OP in the Ivorian hospital context.

Methods: A cross-sectional study with a descriptive aim was carried out. The treatments of 881 patients were analyzed using the GOPP tool by clinical pharmacists (reference group) for the detection of IP and OP. Thirty (30) cases with at least 1 IP or OP were selected. These cases were also examined independently using GOPP tool by ten (10) pharmacists and interns (evaluator group) having no prior experience with this tool. Inter-user reliability for PI and OP detection using the GOPP tool was determined using the kappa (κ) test of agreement.

Result: The selected cases concerned patients with a median age of 25.5 months. The numbers of PI lines and OP detected by pharmacists in the "reference" group were 50 and 6, respectively. The median levels of agreement for PI and OP detection were judged as very good (Kappa=0.92) and good (Kappa=0.77), respectively.

Conclusion: The GOPP tool is a reliable tool for the detection of PI and OP by pharmacists working in the Ivorian hospital context. Its use is relevant in routine for the pharmaceutical analysis of prescriptions in pediatric departments in Côte d'Ivoire.

Artificial intelligence is a rapidly evolving technology in higher education. It is being integrated into the sector through a wide range of applications, each of which has a significant impact on the educational process. This impact can be both positive and negative. On the one hand, artificial intelligence offers opportunities for personalizing learning and teaching, improving administrative services, and supporting mental health. However, its integration into higher education institutions raises challenges and ethical issues that threaten students' privacy. This literature review aims to explore the different applications of artificial intelligence, as an innovative technology, in the academic field while highlighting its advantages and disadvantages as well as the challenges and issues it raises. It also addresses the guidelines for an ethical integration of artificial intelligence in higher education, highlighting the fundamental principles to ensure a responsible and respectful adoption of human values.

Introduction: The incidence of early-onset colorectal cancer (EO-CRC), defined as occurring before 50 years, is rising significantly. While genetic syndromes account for a minority of cases, the majority are sporadic and influenced by both genetic and environmental factors. This study aimed to identify the epidemiological and clinical characteristics of EO-CRC.

Methods: We conducted a single-center, retrospective, comparative study over seven years, including all patients diagnosed with colorectal cancer (CRC). Patients were classified into two groups: <50 years (G1) and ≥50 years (G2). Clinical data, tumor characteristics, and treatment strategies were compared.

Results: Among 180 patients, 26.1% were under 50 years (G1). No significant differences were observed in sex ratio, smoking, alcohol consumption, obesity, or family history of cancer. Both groups presented with bowel transit disorders and general health deterioration, but diarrhea (p = 0.015) and rectal bleeding (p = 0.026) were more frequent in G1. Rectal localization was significantly more common in G1 (p < 0.001). Histologically, EO-CRC was more often poorly differentiated, exhibited greater lymph node involvement, and was diagnosed at more advanced stages, though differences were not statistically significant. A curative approach was more frequently proposed in younger patients, without significant difference.

Conclusion: EO-CRC represented over one-quarter of CRC cases in our cohort. It was predominantly rectal and frequently diagnosed at an advanced stage. These findings highlight the need for increased awareness, early diagnosis, and tailored management strategies for younger patients.

Introduction: Intermittent fasting (IF) is gaining interest as an effective method to combat obesity Objective : to compare the effects of 16:8 intermittent fasting (IF 16:8) and continuous caloric restriction (CCR) on anthropometric parameters and components of metabolic syndrome in obese women.

Methods: A non-randomized controlled clinical trial was conducted with obese women followed for three months. The patients were divided into two groups: IF (45 patients) and CCR (55 patients), each undergoing a 25% reduction in caloric intake. Anthropometric parameters, body composition and metabolic profile were evaluated.

Results: The average age was 34.10 ± 8.44 years in the IF group and 34.62 ± 8.80 years in the CCR group, with BMI values of 38.63 ± 5.15 kg/m² and 34.84 ± 6.69 kg/m², respectively. Both groups experienced significant weight loss after three months, with the IF group showing greater weight change (-7.38 ± 4.1 kg vs. -5.41 ± 3.84 kg, p=0.03). Fat mass and waist circumference reductions were more pronounced in the IF group (p=0.04 and p=0.0001, respectively). Furthermore, IF was more effective than CCR in reducing blood glucose (p=0.04) and triglyceride levels (p=0.02) and increasing HDL-cholesterol (p=0.01). The early feeding window (8h to 16h) in the IF group was associated with greater reductions in weight, fat mass, waist circumference and HOMA insulin resistance index (p=0.001 for all) compared to the 12h to 20h window.

Conclusion: The study suggests that 16:8 intermittent fasting could be a viable alternative to continuous caloric restriction for managing obesity and associated metabolic disorders.

Introduction: Cervical cancer is a public health issue in Algeria, it ranks at second position among female cancers.

Aim: This study sought to identify risk factors for cervical cancer and to determine their impact on patient survival Methods: This is a retrospective study on 200 patients diagnosed during a 3-years period between January 1, 2016 and December 31, 2018. This study investigated cervical cancer risk factors and survival outcomes associations. The analysis was made by Chi Square test. The progression-free survival rate was estimated using the Kaplan-Meier method.

Results: Our study revealed that squamous cell carcinoma was the most frequent diagnosis (69.9%), it also points to early sexual activity as a significant associated risk factor (P=0.05). This finding contrasts with the relatively small proportion of cases (12.12%) linked to hereditary causes. Patients with adenocarcinoma had a lower progression-free survival (PFS) (Log-Rank test P = 0.04). Poorer PFS was associated with earlier FIGO stages (Breslow: P =0.04; Tarone-Ware: P =0.04). Age at first sexual encounter and parity, however, did not significantly predict PFS. PFS was substantially better in T1-T2 pathological stages (P = 0.000).

Conclusion: The prognosis depends on knowing these risk factors. Understanding these characteristics is crucial for improved therapy and results. We provide an up-to-date insight of current cervical cancer risk factors in oran city. These results highlight how crucial it is to comprehend risk variables and how they affect the prognosis of cervical cancer.