Tunisie Medicale最新文献

Introduction and importance: Arhinia syndrome (AS) is an extremely rare malformation characterized by typical clinical signs such as a lack of nose, with difficulty in breathing and inability to feed due to airway obstruction. The ortho-surgical management of AS is a big challenge and it requires an interdisciplinary relationship between the orthodontist and a maxillofacial surgeon. The authors reported a case of AS. Case presentation: The only case in Morocco among fewer than 30 cases described in the whole world, male child, 7-year-old. Clinical findings and investigations: Complete absence of the external nose, nasal cavities, and other characteristic signs. This diagnosis was genetically confirmed. Interventions and outcome: A LeFort II maxillary osteotomy was done in combination with a facemask and miniscrew followed by a parietal bone graft and maxillary expansion with a customer expander. An internal and external nasal reconstruction was undergone with orthodontic management of unerupted teeth. An acceptable morphology for the newly created external nose was obtained, this reconstruction was viable and esthetically acceptable. A slight external restenosis of a left nave was observed. This result was stable over three years. Relevance and impact: AS is a rare condition with a pathogenesis not been fully understood. The ideal treatment should have the lowest possible morbidity and a low relapse rate. The most difficulty in the approach is the creation and maintenance of a nasal cavity. These therapeutic aspects will be discussed through this case. The use of facemask therapy with a miniscrew potentiated the effect of osteotomy and stabilized the parietal bone graft which allowed nasal reconstruction and orthodontic management of unerupted teeth in this case.

Antibiotic resistance is a major concern for health systems worldwide, due to the irrational use of antibiotics. Honey can be considered an alternative therapy to antibiotics. Our study aims to evaluate the microbiological quality and presumed antibacterial activity of 7 natural honeys of different floral origins. Aerobic bacteria grew in 3 samples of honey: (jujube honey ( Bacillus subtilis ), fig honey ( Staphylococcus hominis , S. epidermidis, and S. pettenkoferi ) and holm oak honey ( Aerococcus viridans )). Only holm oak honey contained a yeast ( Cryptococcus neoformans ), while the other honeys were free of yeasts and molds. Holm oak honey was most effective on most bacterial strains studied, particularly S. pyogenes . The other honeys were mainly active against S. pyogenes . None of the honeys showed activity against P. aeruginosa , K. pneumoniae , S. aureus and C. albicans . The MIC was 25% for holm oak honey against the 5 bacterial strains which showed a response. For fig honey, the MIC varied between 50% ( S. pyogenes , S. aureus and S. epidermidis ) and 100% ( S. hominis and E. coli ). For most other honeys, the MIC was 100%, meaning only the pure form of honey could prevent bacterial growth. In this study, honey, consistent with its traditional use in the ENT sphere, was found to be effective against S. pyogenes , a bacteria often responsible for bacterial tonsillitis which can limit the inappropriate use of antibiotics. These results could guide pharmaceutical research aimed at extracting active ingredients from honey to develop new antibacterial agents.

Introduction: Internet Gaming Disorder (IGD) is a recognized mental health condition associated with autonomic nervous system (ANS) dysregulation. While heart rate variability (HRV) has been studied, ventilatory responses remain poorly explored. This systematic review aims to evaluate the impact of IGD on cardiovascular (HRV) and pulmonary (respiratory rate) parameters.

Methods: To conduct this systematic review, a literature search will be conducted on PubMed, Scopus, and Embase. We will include studies assessing HRV and respiratory rate in individuals aged ≥12 years with IGD. Studies without objective ANS measurements or those with non-DSM-5-defined populations will be excluded. Data extraction will focus on HRV (continuous ECG) and respiratory rate variations, stratified by gaming context and IGD severity. The risk of bias will be assessed using ROBINS-I.

Concluson: This review will clarify ANS dysregulation patterns in IGD, informing clinical monitoring strategies. Limitations may include heterogeneity in measurement methods.

Introduction: Rheumatoid arthritis (RA) is a chronic, destructive inflammatory rheumatic disease reported in populations of African origin. The aim of this study was to evaluate the epidemiological, clinical and paraclinical data of RA in Guinea with a registry from 2018 - 2022.

Method: This was a longitudinal, retrospective study conducted in the rheumatology department of CHU Ignace Deen between January 2018 and December 2022. The diagnosis of RA was based on the ACR and EULAR 2010 criteria.

Results: During the study period we collected 528 cases of RA out of 4213 observations (12.5%). There were 433 (82%) women with an average age of 47.3 years. The average number of painful joints was 8, ranging from 4 to 28, and the average number of swollen joints was 2 (ranging from 2 to 20). Rheumatoid factors were positive in 396 (75%) of cases, while anti-CCP antibodies were positive in 380 (72%) of patients. With DAS28, remission was noted in 53 (10%) of our patients, activity was low in 137 (26%) of cases, moderate in 259 (49%) and high in 79 (15%). Quality of life was assessed by the HAQ score, the mean value of which was 48 out of 60 (range 0 to 60).

Conclusion: Rheumatoid arthritis is the most common form of arthritis in Guinea. It mainly affects housewives, with significant functional repercussions.

Indonesia ministry of health data shows that 21.7% of the population has anemia, with a prevalence of 26.4% in the 5-14-year age group and 18.4% in the 15-24-year age group (Hb <12.0 g/dL). The Health Belief Model (HBM) is used to identify lifestyle patterns of anemic students and their risks to academic achievement.

Aims: This study examines the relationship between hemoglobin levels and academic achievement and assesses the relationship between the HBM construct and anemia.

Methodology: This study is a cross-sectional study with a sample of 80 grade VIII students at SMP Negeri 1 Lhokseumawe. This study examines the relationship between hemoglobin levels and academic achievement and assesses the relationship between the HBM construct and anemia.

Results: Chi-square test showed a significant relationship (p<0.05) between anemia and academic achievement, where students with normal hemoglobin levels had better achievements than those with anemia.

Conclusions: These findings confirm the impact of anemia on academic achievement, highlighting the importance of iron for brain function, concentration, and intelligence. The limited correlation of most HBM constructs with anemia suggests low student awareness, thus educational interventions are needed to improve preventive behavior.

Introduction: Therapeutic drug monitoring (TDM) of valproic acid (VPA) for epileptic children aims to optimize treatment, hence promoting seizure control, and to detect refractory cases that should be managed early. We aimed to identify a ceiling dose and a trough serum level of VPA in epileptic children in remission.

Methods: This retrospective study was carried out at Clinical Pharmacology, involving epileptic children (2-18 years) who were referred at least two times for a VPA trough level measurement over a 13-year period (2009-2022).

Results: We included 88 children, of whom 67% (n=59) were in remission (G1) and 33% (n=29) did not meet remission criteria (G2). Ten children (11%) experienced adverse events, predominantly gastrointestinal and neuropsychological disturbances. Mean weight-based dose of VPA in G1 (21.53±7.95 mg/kg/day) was significantly lower than in G2 (26.81±9.99 mg/kg/day), p=0.009. Mean VPA trough serum level was 60.76±20.22 µg/mL in G1 and 62.47±23.04 µg/mL in G2 with no significant difference. The ceiling daily dose of VPA to achieve remission was 44.44 mg/kg/day.

Conclusion: Our study showed that the average weight-based dose of VPA in children in remission was lower than that in G2. A ceiling dose of 44.44 mg/kg/day of VPA limiting treatment efficacy for achieving remission was identified.

Background: Acute pancreatitis (AP) is acute inflammatory process of the pancreas, commonly attributed to biliary or alcoholic causes. Drug-induced AP, although rare, is increasingly recognized as a potential etiology. However, there is limited literature on this topic.

Aim: This study aims to review the epidemiological, clinical, radiological, and management characteristics of drug-induced AP based on data from Tunisian databases.

Methods: A retrospective study was conducted at the Department of Digestive and Visceral Surgery, spanning five years. Thirteen cases of drug-induced AP out of 1580 admitted patients with AP were analyzed. Data collection included clinical characteristics, diagnosis methods, therapeutic approaches, and outcomes.

Results: We report a series of 13 cases of drug-induced acute pancreatitis (AP). Due to the rarity of this event, our small sample size limits the statistical power of our findings. However, each case provides valuable insight into potential drug associations with AP. The mean age of affected patients was 55.62 years, with a male predominance (77%). Common symptoms included sudden onset epigastric abdominal pain (100% of cases) and elevated lipase levels (92.3%). Implicated medications included captopril (38.5%), atorvastatin (23.1%), azathioprine (23.1%), metformin, and olanzapine (7.7% each). Management involved pain management and proton pump inhibitors, with favorable outcomes in 84% of cases.

Conclusion: Drug-induced pancreatitis is a recognized entity requiring multidisciplinary management. Early recognition and reporting of suspected cases are essential for improved pharmacovigilance.

Introduction-Aim: Children with kidney failure (KF) are prompt to undernutrition with subsequent growth failure. The aim of this study was to assess probable correlates of normalized protein catabolic rate (nPCR) in children on chronic hemodialysis (HD).

Methods: This prospective study included all 20-year-old or less patients undergoing chronic HD at our pediatric HD unit between 1st January 2024 and 30th April 2024. Patients included had been on HD for more than 3 months and were clinically stable. For each patient, baseline characteristics were recorded along with their echocardiogram findings. Mean nPCR was calculated and potential predictive factors were simultaneously evaluated. Our study included a univariate and a multivariate analysis. A p value less than 0.05 was considered statistically significant.

Results: A total of 40 patients were included with a mean age of 14.4 ± 3.7 years old and a sex-ratio M/F of 1.9. Twenty-two (55%) had a mean nPCR <1g/kg/day. A strong positive correlation between nPCR and the 3-months body mass index variation percentage was found with a correlation ratio of 0.82. On multivariate analysis, Patients with a single pool KT/V < 1.2 and those exhibiting left ventricular hypertrophy were more likely to have a nPCR value <1g/kg/day (OR: 7.2 and 11.1, 95% CI: 2.28 - 75.23 and 5.5-98,08, respectively). A first hour refill index > 1.7 ml/kg/h/% was also correlated with a low nPCR (Adjusted OR:5.5- 95% CI: 3.2-65.2).

Conclusion: Pressure and volume control along with dialysis adequacy are promising factors in improving nutritional status and clinical outcomes in children with KF.

Introduction . The epidemiology and management of lacrimal tract trauma (LTT) vary depending on the populations, the skills, and resources of the healthcare team. Aim . To examine the epidemiological and therapeutic aspects of LTT and their prognostic factors in southern Tunisia. Methods . The study included 35 patients with LTT treated in the ophthalmology department of the Habib Bourguiba Hospital in Sfax. The postoperative result was evaluated functionally, anatomically, and aesthetically, and classified as good, average, or poor. Results . Patients were aged 28±18 years, with a sex ratio of 3.4. Domestic and road accidents and fights represented 93% of the causes of LTT. The lesions affected more frequently both the left side (71%) and the inferior canaliculus (74%). Most patients (91%) were operated on within the first 48 hours. The internal fragment was identified by the Bowman probe (in 83% of cases) and sutured in all patients with true monocanalicular intubation by mini-Monoka probe in 94% of cases. The post-operative result was good in 83% of patients. Younger age, loss of eyelid substance, delay in surgical intervention, and lacrimal suture without intubation were associated with unsatisfactory postoperative results. Conclusions . LTT affects mostly young male adults. Age under 20 years, post-traumatic operative delay above 48 hours, loss of eyelid substance, as well as suture of the wound without intubation are the main risk factors for a poor postoperative result. Good awareness and respect for the means of protection would make it possible to reduce LTT and their harmful impact.