Tunisie Medicale最新文献

Introduction-Aim: Acute interstitial nephritis (AIN) shows variability in incidence and etiology based on geography.  The study aimed to understand the characteristics and root causes of AIN, its diagnosis methods, treatment strategies, and results within a Tunisian population. Method: We retrospectively gathered data on biopsy-proven AIN from a Nephrology center over 16 years.  Results: We gathered 36 confirmed cases of biopsy-proven AIN. The average age of the patients was 50.58 years. The predominant clinical signs were fatigue (58%) and fever (22%). The mean level of creatinine was 691.58 µmol/l. Interstitial infiltrate was significant in 52.77% of cases, with eosinophils present in only 5.55% of cases and fibrosis noted in 27.77% of cases. Drug-related causes accounted for 46.66% of AIN cases, while infections and systemic diseases accounted for 16.66% and 11.11%, respectively. We have identified two exceptional causes of AIN, one associated with treatment with Rituximab and the other with a triple parasitic infection. Some cases (25%) lacked an identifiable cause. Corticosteroid treatment was recommended for 93.33% of cases. The median follow-up duration was 2.2 years. Seven patients required hemodialysis, and 71.42% recovered renal function. The presence of interstitial fibrosis correlated with the progression to chronic kidney disease. Conclusion: AIN is a leading cause of acute kidney injury that can progress to chronicity. Interstitial fibrosis is associated with the progression of chronic kidney disease. The primary etiology is drug intake, and some causes are yet to be identified.

Background: Therapeutic inertia is a major cause of uncontrolled hypertension. The aim of our work study is to describe the knowledge, attitudes, and practices of primary care physicians in the management of hypertension and to describe the factors of therapeutic inertia.

Methods: This was a descriptive study among primary care physicians conducted through an online questionnaire created using Google Forms during the period from March 15 to May 15, 2022.

Results: Our population included 232 physicians with an average age of 39 years. They mainly worked in the public sector (83%). Only 24% of the physicians knew the diagnostic thresholds for hypertension using all methods. Fifty percent knew the therapeutic objectives. Initiation with monotherapy was chosen by 49% of physicians. Angiotensin converting enzyme inhibitors and calcium channel blockers were chosen by 79.3% and 60.8% of physicians, respectively. The main reasons for therapeutic inertia were cost (78.4%), drug shortage (72.8%), non-adherence to therapy (61.2%), follow-up by another specialist (46.5%), fear of side effects of antihypertensive drugs (48.7%), patient's age (40.5%), lack of organization of patient follow-up (36.6%), and the presence of other comorbidities (35%). Renal failure was the main comorbidity involved (78.4%).

Conclusions: Our study concludes that there was a lack of knowledge and application of the new recommendations for hypertension. It would be necessary to promote continuous training of primary care physicians, to insist on therapeutic education of patients, to reform the public health system in Tunisia to cover the provisions of hypertensive patients, and to introduce combination therapy.

Introduction: Epilepsy is a chronic and disabling pathology which begins, in more than 50% of cases, before the age of 10. Patients who are resistant to AEDs suffer from poor quality of life and socio-professional disintegration. Therapeutic pharmacological monitoring (TDM) of lamotrigine (LMT) in epileptic children is particularly useful in complex situations where it is difficult to assess the response and thus allows to improve the management of epilepsy and improve the quality of life of epileptic children. The aims of this study were to identify drug-resistant children on LMT and to assess demographic, clinical and pharmacokinetic factors associated with drug resistance in these children.

Methods: This retrospective descriptive study was conducted at Clinical Pharmacology (2012-2021). We included children under 18 years old with epilepsy, on LMT, referred for trough plasma level (C0) measurement as part of the TDM of LMT.

Results: We included 114 epileptic children prescribed LMT. Drug resistance was reported in 38.6% (n=44) and was higher in boys (73%). LMT C0 were significantly higher in drug resistant epileptic children (4.75 µg/mL versus 8.7 µg/mL, p=0.000). Bioavailability was low in 20.5% of the cases of drug resistant epileptic children.

Conclusions: Drug resistance was observed in 38.6% of epileptic children treated with LMT, the majority of whom were boys. Residual LMT concentrations were higher in drug-resistant epileptic children on LMT.

Introduction: Osteoid osteoma and osteoblastoma are benign bone tumors with similar histologic features, often distinguished by size and clinical behavior. Their relationship remains a topic of debate.

Observation: An 8-year-old boy presented with a femoral diaphyseal lesion initially diagnosed as osteoid osteoma based on resection biopsy. However, within six months, the boy experienced increased pain and rapid growth, with subsequent biopsy revealing aggressive osteoblastoma. This suggests the initial lesion may have been an early-stage osteoblastoma.

Conclusion: This case challenges the concept of osteoid osteoma transforming into osteoblastoma. While histologically similar, these tumors should be considered distinct entities, and size alone may not be a reliable differentiating factor. Careful clinical and pathological correlation, with attention to growth rate, is crucial for accurate diagnosis and management.

Introduction-Aim: Over the past decade, Morocco has become a major migratory corridor in the Mediterranean, hosting an increasing number of migrants, particularly from Sub-Saharan Africa. This study aims to identify the barriers and facilitators to accessing sexual and reproductive health (SRH) services for migrants in Morocco, while exploring the socio-cultural, economic, administrative, and linguistic factors that influence access.

Methods: We employed qualitative methods through focus group discussions (FGDs) with migrant women (n = 24) and men (n = 24). A total of 48 participants, residing in Morocco for at least three months, were selected, all of whom had experience with public healthcare facilities for SRH services. The study was conducted in July 2024 in two regions (Rabat and Casablanca).

Results: The majority of the 48 participants were young adults aged 18 to 34 (61%), mainly from Côte d'Ivoire (60%). Although all spoke French, only 6% had medical coverage, and 23% had a source of income. The main obstacles identified were lack of information, stigmatization, language and cultural barriers, as well as administrative and economic difficulties. Facilitators included a quality welcome, support from associations and NGOs, confidence in Moroccan health services, support from health professionals, and free access to certain services.

Conclusion: The results highlight significant difficulties migrants face in accessing healthcare in Morocco. Efforts are needed to enhance inclusion, reduce discrimination, and simplify administrative procedures to improve access to healthcare for migrants.

Objectives: To determine the concordance between the causes of death reported in the neonatal departement and the data obtained from the fetopathologic examination.

Methods: We included all newborns admitted to the Neonatal Resuscitation Unit who died there before the 28th day of life and in whom a fetopathological examination was performed.

Results: The causes of neonatal deaths were characterized by the dominance of respiratory pathologies (31%) then palliative cares (18%), neurological causes (9%), heart disease (9%), inherited diseases of metabolism (6%) and sudden deaths (6%). A total concordance between fetopathological and neonatological examinations was noted in 27% of the cases, a partial concordance in 40%, a total discordance in 27%, and in only 6% of the cases the fetopathological examination didn't show any abnormalities.

Conclusion: We emphasize of the importance of fetopathological examination in the determination of the cause of neonatal deaths by providing an exhaustive diagnosis essential to the management of future pregnancies.

The Presidential Decree-Law No. 318/2022 of April 8, 2022, established new specific legal foundations for telemedicine in Tunisia. In the field of mental health, telemedicine offers a significant opportunity to democratize care by making psychiatric services more accessible to a larger population. In a recent study, we assessed Tunisian psychiatrists' knowledge of telemedicine. Although they have a still limited understanding of the legal framework, they expressed a willingness to explore telemedicine for the management of mental disorders, thus demonstrating a growing interest in this new practice. The adoption of telepsychiatry facilitates a rapid response to care demands, particularly in underserved and remote areas. However, this evolution presents a series of new challenges. Legal, ethical, and administrative issues are emerging, requiring robust frameworks to ensure patient confidentiality, data security, and compliance with medical regulations. Moreover, ethical and deontological concerns must be addressed to maintain the integrity and professionalism of psychiatric practice. In this article, we will detail the main points of the decree-law and its application in psychiatry, as well as the potential challenges associated with implementing telemedicine in the continuity of care in Tunisia, while navigating the complex landscape of new issues related to its application in psychiatry.

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Introduction: The announcement of a chronic autoimmune disease is a delicate situation in our practice. The main objective of our work was to explore the felt experience of the lupus patient when faced with the announcement of the disease.

Methods: Qualitative prospective study carried out from individual interviews with patients. suffering from SLE and followed in a department of internal medicine.

Results: We collected 60 patients (50 women and 10 men). The average age was 44.6 years. Thirty-five (65%) were married. The diagnosis was announced by an internist in 66% of cases. At the announcement of the diagnosis, 70% were hospitalized, alone (48%) and in the presence of a loved one (51%). The announcement took place in the doctor's office in 40%. The duration of the announcement of the diagnosis was sufficient (56%). The doctor offered a second close consultation to complete the information (18%). The initial reaction was acceptance (54%), despair (31%), denial and refusal to disclose the diagnosis (3 cases). Around 36% thought that a consultation with a psychiatrist is necessary. The presence of a loved one is useful (45%). Patients suggested giving more information about the disease (58%), its progress (36%) and the treatment (5%). The analytical study showed that patients accept the diagnosis of SLE better when they are supported (P=0.026), married (P=0.01) and when the duration of the announcement is sufficient (P=0.045).

Conclusion: The announcement of the diagnosis of systemic lupus erythematosus must be made under appropriate conditions, clear and complete. Personal satisfaction, however, remains subjective.

Introduction: In a context where the public hospital organization is experiencing severe pressure on resources, in particular human resources, with a shortage in staff capacity, especially in the nursing profile, digital transformation is an avenue that has yet to be explored, given that "it is a radical organizational change driven by new technologies that requires collaboration between the various stakeholders" (1), facilitating "organizations' capacity for innovation" (2).

Aim: The aim is to find out the degree of understanding of the change to come in the era of digital transformation not only on the part of decision makers, but above all on the part of the operational level to see their degree of predisposition to accept, resist, or appropriate the changes.

Methods: we opted for intervention research in line with the constructivist paradigm, using a questionnaire assigned to 105 people.

Results: The quantitative study highlights contradictory representations marked by situations of acceptance and resistance to the IIS, which need to be managed in order to converge towards the tool's appropriation by the players.

Conclusion: We have clarified the difficulties of implementing changes that were not initially grasped by the project's decision-makers, by avoiding areas of resistance and reinforcing areas of appropriation by all organizational strata, in order to have a collective creation of meaning and maintain order in a context of disorder.