Tunisie Medicale最新文献

Introduction: Diabetes mellitus has emerged as a global public health issue due to its increasing prevalence and the increased risk of developing cancers. Pancreatic cancer is believed to be both a consequence of pre-existing diabetes and a potential cause of new-onset diabetes.

Aim: This study aims to compare the characteristics of patients with pancreatic ductal adenocarcinoma and newly diagnosed or long-standing diabetes mellitus.

Methods: A multicentric retrospective study was conducted over 13 years at two university hospitals in Sousse, Tunisia. Included patients had whether a newly diagnosed or a long-standing diabetes mellitus with histologically confirmed pancreatic ductal adenocarcinoma. Statistical analysis using appropriate tests was conducted.

Results: The prevalence of diabetes mellitus was 44.6% among three hundred and seven patients with pancreatic cancer. The male-to-female ratio in patients with pancreatic ductal adenocarcinoma was 2.6:1. Patients' mean age was 63.9 years, with the majority being over 50 years old. Most patients had no family history of diabetes and exhibited significant weight loss, low body mass index, and uncontrolled diabetes. The comparison between individuals with newly diagnosed diabetes and those with long-standing diabetes revealed numerous similarities, apart from significant differences in drinking patterns (p = 0.03), tumor size (p = 0.018), and smoking in the subgroup of males (p = 0.044).

Conclusion: Patients over 50 with newly diagnosed diabetes mellitus, particularly those who consume alcohol occasionally and men who are not heavy smokers, should undergo further evaluation to identify potential early-stage pancreatic ductal adenocarcinoma.

Introduction: Pediatric sepsis remains a leading cause of morbidity and mortality in Africa. Nearly half of pediatric sepsis deaths occur in previously healthy children. The role of inborn errors of immunity (IEI) in susceptibility to sepsis is yet to be identified and their prevalence amongst previously healthy children admitted to the pediatric intensive care unit (PICU) is unclear. We aimed to assess prevalence of IEI among a cohort of children admitted to the PICU for community acquired sepsis and to describe demographic, microbiological, and genetic features of this cohort.

Methods: We listed a cohort of children admitted to our PICU for sepsis from January 2021 to March 2023. Demographic data was collected, and microbiological tests were performed. Written consent was obtained and whole exome sequencing (WES) was performed after DNA extraction.

Results: Thirty cases were included. Mean age at admission was 46 months (1-180), microorganisms were identified in 20 cases (66%). Bacterial sepsis was identified in 8 cases, viral sepsis in 6 cases and fungal sepsis in 2 cases. Mean pediatric sequential sepsis related organ failure assessment (pSOFA) score at admission was 6,46 (2-18). Mechanical ventilation was necessary in 18 cases. Inotropes were used in 17 cases and renal replacement therapy initiated in 3 cases. Pathogenic variants of IEI were identified in 5 out of 30 cases (17%). These variants were identified in the following genes BACH2, TLR7, TINF2, NFK2B and MAGT1. Overall mortality was 50% and mean intensive care unit (ICU) stay was 9,26 (1-60) days.

Conclusion: Prevalence of pathogenic variants of IEI among children admitted to the PICU for sepsis was 17%. Our study findings support systematic screening of IEI amongst critically ill children admitted to the PICU for sepsis in order to increase our comprehension of sepsis phenotypes and improve outcomes in this group of critically ill children.

Introduction: Immunoglobulin D (IgD) myeloma is a rare subtype often described as aggressive with advanced disease at diagnosis. Primary renal involvement is seen in scarce cases.

Observation: This case features a 55-year-old man with IgD lambda myeloma presenting severe renal failure at diagnosis. Examination revealed a 10-year-old sternal plasmacytoma and multiple others in the ribs. Despite benefiting from traditional chemotherapy, he remained dependent on hemodialysis Conclusion: Through this case, unique in the literature, we conclude that plasma cells secreting IgD can remain inactive for a long time in the form of a solitary plasmacytoma. However, in the event of medullary involvement, they can induce a myeloma with serious organic lesions.

Background: While aerobic exercises have demonstrated efficacy in slowing cognitive decline and improving psychological symptoms associated with cognitive impairments, they may not be feasible due to multiple disabilities. Other gentle exercises with mindful approaches, such as "Yoga-like", have been explored but lack clear evidence.

Aim: To assess the efficacy of a "Yoga-like" intervention on cognitive and psychological features in patients with mild to moderate Alzheimer Disease (AD).

Methods: We propose a randomized controlled trial design. Patients with mild to moderate AD who are able to undergo neurocognitive assessment and do not have conditions contraindicating deep breathing or extreme postures will be randomly assigned to an intervention group (IG: Yoga-like) or a control group (CG: no intervention). The 'Yoga-like' intervention consists of 30 minutes of exercises combining breathing, postures, concentration, and meditation, conducted three times a week over eight weeks. Both groups will undergo neuropsychological tests at baseline and after eight weeks, including attention, problem-solving, visuospatial abilities, mood and neuropsychiatric symptoms.

Expected results: It is anticipated that the breathing, concentration, and meditation components of the intervention will improve attention, problem-solving abilities and behavioral symptoms. The postural components are expected to enhance visuospatial control and balance.

Trial registration: PACTR202407721329710 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30602).

Introduction-Aim: Validated triage tools such as the Vittel criteria are essential to improve the care of trauma patients. The aim of this study was to evaluate the correlation between the Vittel triage criteria and the Injury Severity Score (ISS) to improve the accuracy of pre-hospital triage.

Methods: We conducted a longitudinal study of all trauma patients transported by EMS over a two-year period (November 2021- November 2023). Vittel and (ISS) scores were calculated on admission. Predictive Vittel criteria were defined by independent risk factors for ISS>15 using a multiple logistic regression model with p-value < 0.05 and/or sensitivity (se)>50%, with positive Youden index (Yi).

Results: A total of 461 trauma patients were transported by EMS during the study period were included. The sex ratio was 5.3 and road traffic accidents accounted for 77.2%. An ISS>15 was found in 41% of participants, 25% required ICU admission and 23.9% died within 30 days. Using the above selection criteria, we identified seven key predictive criteria (OR CI 95%, se%, Yi) Glasgow coma scale<13(3.16 [1.91 5.24],44,0.25); fall>6 m(4.031[1.61-10.08],10,0.07); severe burn(23.89[10.21-55.93],6,0.02); Pelvic fracture (4.93 [1.19-20.32], 28, 0.25),suspected spinal cord injury(6.89 [2.79-16.96], 6, 0.05); Fluid resuscitation>1000 ml(-, 60.0. 11); Catecholamine (2.02 [1.09-3.75],51.0.27). Physiological variables (se 30%, Yi 0.16) and pre-hospital resuscitation(se 46%, Yi 0.18) were among the most relevant categories for predicting severity, similar to the full Vittel score.

Conclusion: Seven criteria were associated with severe trauma (ISS score >15). Physiological variables and pre-hospital resuscitation were significant categories that may help to predict the severity of trauma and its impact on patients.

Introduction: Interstitial lung disease (ILD) is the most common extra-articular manifestation in rheumatoid arthritis (RA). Studies have concluded that there is an association between rs35705950 polymorphism of the MUC5B gene and RA-ILD.

Aim: To explore this polymorphism in a cohort of Tunisian patients suffering from RA with or without ILD and stufdy its association to ILD during RA.

Methods: A case-control study involving 61 patients followed for RA, 26 with ILD and 35 without pulmonary involvement and 62 healthy controls. This was an association study between genetic marker and RA-ILD by genotyping the rs35705950 polymorphism using PCR-RFLP.

Results: No association was found between rs35705950 polymorphism and RA. However, the comparison of RA-ILD patients with controls showed a significant association with the allele frequencies of rs35705950 polymorphism (p=0.008; OR=2.61; CI [1.2-5.66]). Indeed, the minor T allele increased the risk of developing ILD by 2.61 for RA patients compared to the controls. Comparison of allele frequencies in RA-ILD patients and RA patients without ILD showed a significant association between the minor T allele of the studied polymorphism and RA-ILD (p= 0.02; OR= 2.66; CI [1.09-6.5]). In the adjusted model, this risk increased in case of smoking (p=0.025; OR=3,84; CI [1,13-13,08]) and/or female gender (p=0.013; OR = 4,63; CI [1,33-16,17]).

Conclusion: Our work has confirmed the role of the polymorphism of MUC5B promoter in the appearance of ILD during RA in Tunisian patients. This variant could be used to early detect preclinical ILD in patients with RA.

Background: Cochlear implantation is an effective method of auditory rehabilitation. Nevertheless, the results show individual variations depending on several factors.

Aim: To evaluate cochlear implantation results based on the APCEI profile (Acceptance, Perception, Comprehension, Oral Expression and Intelligibility) and audiometric results.

Methods: This was a cross-sectional study including children under 18 years of age who had a unilateral cochlear implant and whose implants had been activated at least 1 year prior to the start of the study. During this study period, 75 children underwent unilateral cochlear implantation. Among them, 44 patients had reached one year after the activation of the implant at the time of the evaluation and were then included in the analytical part. A speech-language pathology assessment using the APCEI scale was conducted for 44 cases. Thirty-eight cases had an audiometric assessment (free-field tone audiometry and speech audiometry). We assessed the results of the APCEI profile based on various factors.

Results: The mean cochlear implantation age was 5 years and 2 months. The electrode insertion was complete in all cases. The APCEI profile average was 3.6. Four children had poor results, 27 children had good results, and 13 children had excellent results. The average hearing threshold in tonal audiometry was 39dB. In voice audiometry, the average intelligibility threshold was 65% with the cochlear implant versus 75% with the cochlear implant and the contra lateral hearing aid. According to the statistical study, only two factors were considered to have a positive influence on the success rate of cochlear implantation: the regular use of preoperative amplificative prostheses and the follow-up of speech therapy sessions in pre-operative.

Conclusion: The effectiveness of cochlear implantation depends on several factors. Multidisciplinary management improves the results.

Introduction: Bloodstream infections are serious conditions requiring precise bacterial identification for effective treatment. Traditional culture-based methods, while reliable, are time-consuming. The direct identification method by MALDI-TOF MS promises rapid and accurate identification directly from positive blood cultures.

Aim: To evaluate and compare the direct MALDI-TOF MS identification method for positive blood culture samples with the post-culture MALDI-TOF MS method, which is currently recognized as the gold standard in bacteriological identification.

Methods: during the study period, 324 positive blood culture samples received at the Central Laboratory of Bacteriology, Serology, and Hygiene of the IBN SINA Hospital Center in Rabat were included in the study. Each sample was processed for microorganism identification by MALDI-TOF MS using both direct and post-culture methods.

Results: The direct identification method by MALDI-TOF MS showed a lower overall identification success rate (64.8%) compared to the post-culture method (100%). However, it allowed for bacterial identification in less than one hour without the need for a sub-culturing step, highlighting the technique's potential to enhance the diagnostic process.

Conclusion: The direct identification method by MALDI-TOF MS has the potential to improve the speed of bacterial identification in positive blood cultures compared to the current gold standard of identification after culture. Despite its limitations, the direct method offers an opportunity to improve diagnosis and patient management, especially when combined with the standard method.

Introduction-Aim: Full-polyethylene glenosphere reverse shoulder arthroplasty (FP-RSA) known commonly as inverted-bearing concept utilizes a polyethylene glenosphere and metallic humeral liner. The aim was to assess mid-term outcomes of FP-RSA focusing on the incidence of scapular notching.

Methods: A retrospective analysis of 24 consecutive primary FP-RSA performed between 2017 and 2020 was conducted. At a minimum follow-up of 2 years, cases underwent clinical evaluation using Constant score (CS), Subjective Shoulder Value (SSV), American Shoulder and Elbow Score (ASES), pain assessment, range of motion (ROM) and radiological findings evaluating baseplate position, implant stability, and scapular notching.

Results: At a mean follow-up of 3.2 ± 0.6 years, all clinical parameters showed significant improvement except external rotation (p < 0.05). Scapular notching rate was 20.83% all grade1 and 2. High glenoid position (p < 0.001) was significantly associated with scapular notching, which is correlated with lower CS (69 ± 16 vs. 51 ± 19; p = 0.049), SSV (80 ± 15vs. 67 ± 22; p = 0.026), ASES (85 ± 16 vs. 71 ± 21; p = 0.033), and anterior elevation (147◦ ± 24◦vs. 116◦ ± 38◦; p = 0.007). The use of a large glenosphere compared to small glenosphere was associated with better CS (79 ± 10vs. 65 ± 19; p = 0.006), external rotation (21 ± 11◦vs. 13 ± 9°; p = 0.036).

Conclusions: FP-RSA demonstrates favorable safety and efficacy at mid-term follow-up. Scapular notching, associated with high baseplate position, negatively impacts range of motion and clinical outcomes.