Tunisie Medicale最新文献

Introduction: Talonavicular coalition (TC) is a rare cause of foot pain, less frequent than talocalcaneal or calcaneonavicular coalitions. Symptomatic coalitions can significantly impact a patient's mobility and quality of life.

Observation: We presented the case of a 14-year-old boy with bilateral TCs presenting with medial foot pain. Surgical resection of the distal navicular coalition and tibialis posterior repositioning were performed. At 12-month follow-up, the patient reported complete resolution of pain.

Conclusion: This case highlights the importance of considering TC in the differential diagnosis of medial foot pain in adolescents. Surgical intervention can provide effective and long-lasting pain relief in these patients.

Purpose: To investigate factors associated with Pediatric Intensive Care Unit (PICU) admission in children with severe MIS-C.

Methods: We conducted an observational cohort study between July 1, 2020, and May 31, 2021, in the only pediatric hospital in Tunisia.

Results: A total of 45 children (33 males) with no recent history of COVID-19 infection were included. Mean age was 7±3.2 years. Sixteen patients (35%) required PICU admission. There was no significant difference in mean age of patients with and without PICU admission (7.5±2.7 vs. 6.76±3.46 years; p=0.4). The frequency of respiratory distress (p=0.001), shock (p=0.001), cardiac dysfunction (p=0.003), mean CRP (p=0.001), and median troponin (p=0.003) were significantly higher in patients with PICU admission than in those without. The independent predictive factor for PICU admission was cardiac dysfunction; adjusted Odds Ratio (aOR) = 12.8, 95% CI = (2.1-76.4), p=0.002.

Conclusion: The only independent risk factor for PICU admission in patients with MIS-C was cardiac dysfunction.

Introduction-Aim: Bronchiectasis, which was once considered an orphan disease in developed countries, is common in Tunisia as in all emerging countries. The purpose of the present study is to determine radio-clinical features, etiologies and evolution of bronchiectasis.

Methods: Monocentric, retrospective and descriptive study including all patients followed in the pulmonology department, Gabes University Hospital, for bronchiectasis confirmed by a chest CT scan between January 2016 and December 2023.

Results: A total of 70 patients were included in the study. The mean age was 60.39±18.68 years. Symptomatology was dominated by cough and morning bronchorrhea. The diagnosis of bronchiectasis was confirmed in all patients. Chest CT scan showed diffused bronchiectasis in 85.7% cases, localized in 14.2% cases and bilateral in 87% cases. Bronchiectasis was secondary to pulmonary tuberculosis in 62.8% of cases and idiopathic in 12.8% of cases. Complications were dominated by bronchopulmonary infections (21.4% of cases) and hemoptysis (28.5% of cases). Ten patients (14.2%) with diffuse and bilateral bronchiectasis progressed to chronic respiratory failure.

Conclusion: Our study shows that the etiologies of bronchiectasis are dominated in our context by tuberculosis despite the national tuberculosis control program. Diffuse and bilateral bronchiectasis are frequent and associated with a poor prognosis.

Introduction: Kidney biopsy continues to be an essential diagnostic instrument for assessing both acute and chronic kidney disorders, although progress in alternative diagnostic methods.

Aim: This review offers a thorough analysis of the contemporary significance, methodologies, indications, contraindications, and consequences related to native kidney biopsy, as well as addressing the possible alternatives being studied as of now.

Methods: We incorporated research that examine human participants undergoing native kidney biopsy, employing diverse techniques like ultrasound, computed tomography-guided, percutaneous, or laparoscopic methods.

Results: Improvements in biopsy needle design and imaging methodologies have markedly enhanced the safety and precision of biopsies, while problems such as hemorrhage and infections continue to occur. Furthermore, we examined prospective developments in kidney biopsy, namely the possible applications of artificial intelligence, non-invasive biomarkers, and genetic testing. Exome sequencing has demonstrated potential in elucidating genetic etiologies of idiopathic renal illnesses, while artificial intelligence technologies are commencing to improve diagnostic precision.

Conclusion: Although developing technology may eventually diminish the necessity for conventional biopsies, kidney biopsy now remains an essential part of a nephrologist's work, especially for unusual and intricate situations.

Introduction: Cannabis or delta-9-tetrahydrocannabinol (THC) is responsible for psycho-affective effects. Even though it has been legalized in some countries around the world, it remains illegal in Tunisia although its consumption has alarmingly increased. Although its ingestion is known to be asymptomatic in adults, among infants/preschool children, its ingestion has been reported to cause drowsiness and coma. We reported the first cases of accidental cannabis ingestion complicated with drowsiness and coma, occurring in infants/preschool children in Tunisia.

Observations: We reported three cases of accidental cannabis ingestion in three infants/preschool children aged 7, 10, and 30 months. These were ingestions called into the Tunisian poison control center over a period of one year. Two patients were drowsy on admission and the third patient was comatose requiring mechanical ventilation. All three patients had positive urinary drug screen for cannabis. After surveillance and stabilization, the patients were discharged and no further complications were reported.

Conclusion: In the cases of infants/preschool children presenting with drowsiness or coma, physicians must search for accidental ingestion of THC or a history of illicit substance use in the infant/preschool child's entourage.

Introduction: Modern obstetrics faces the challenge of effectively training practitioners for the management of rare but critical obstetric emergencies, such as shoulder dystocia. Simulation has become an essential educational tool, allowing healthcare professionals in initial and continuing education to practice in a controlled environment, thereby promoting learning without risk to patients.

Aim: This article explores the effectiveness of simulation in improving practical skills and team management during obstetric emergencies.

Methods: A structured training program was implemented for 14 first-year obstetrics-gynecology residents, consisting of three monthly simulation sessions using both high-fidelity (SimMOM) and low-fidelity mannequins for shoulder dystocia management, supervised by a specialized 5-member team and followed by structured three-phase debriefings.

Results: Our study demonstrates a significant improvement in the management of shoulder dystocia following simulation training, with positive impacts on clinical outcomes and maternal-fetal safety. Despite its advantages, obstetric simulation presents challenges such as financial costs and the need for adequate expertise among trainers.

Conclusion: Simulation offers a promising solution to enhance clinical skills and interprofessional coordination in obstetrics, thereby contributing to better quality of care and the reduction of preventable complications.

Introduction: Stroke (Cerebrovascular Accident, CVA), whether ischemic or hemorrhagic, is one of the main causes of epilepsy in the elderly. This condition leads to an increased risk of post-stroke seizures, affecting both patients' functional recovery and their quality of life. (1,2) Aim: To clarify and simplify the management of vascular epilepsy, based on recent expert recommendations. This study seeks to address the specific challenges related to the incidence of post-stroke seizures, considering the clinical characteristics and therapeutic needs of patients who have experienced a stroke.

Methods: An analysis of available studies was conducted, considering different stroke subtypes, timing of seizure onset, and risk factors such as age, comorbidities, and stroke severity. Current recommendations for managing vascular epilepsy were also included.

Results: The results show variability in the incidence of seizures depending on stroke subtype and timing post-stroke. They also highlight a lack of consensus regarding certain risk factors and suitable management strategies.

Conclusion: This study emphasizes the need for clear guidelines for managing post-stroke epilepsy, especially for high-risk elderly patients. Current recommendations provide useful insights, but further research is needed to better define risk factors and optimize management strategies.

Aims: In Tunisia, during the Coronavirus Disease 19 pandemic, the transition to e-learning was brutal. The aim of this study was to assess undergraduate medical students (UMSs)' perception of the e-learning experience at the Faculty of Medicine of Sousse, and to derive some determinants of its implementation.

Methods: Eligible participants were all UMSs (n=1397). The data was collected from an email questionnaire distributed in January/March 2021. The questionnaire consisted of 89 items exploring three main parameters: institution role, students' personal experience, and environment impact.

Results: A total of 419 UMSs responded (30% response rate). Half of the UMSs described this transition as difficult, and three-quarters felt concerned about the credibility of their degrees. Logistical issues negatively affected the transition to e-learning, particularly those related to Internet speed. Understanding difficulty via the screen interface was reported by 40% of UMSs. ''Face-to-face" sessions were described as more conducive to assimilation by 64% of UMSs. As far as "information retrieval" is concerned, 83% of UMSs turned to social networks and adopted Wikipedia as a reference.

Conclusions: In Tunisia, as an example of North African country, the transition to exclusive e-learning has been largely impacted by the drawbacks of limited logistics. This study highlights the multiple facets to be considered in the future for the successful implementation of e-learning in medical education.

Introduction: Transfusion is the medical act of transferring blood or its constituents from one individual to another. The pre-transfusion bedside test is mandatory before any transfusion well codified in circular 32/15.

Aims: To evaluate the theoretical and practical knowledge concerning the ultimate bedside test of medical and paramedical staff of the Adult clinical hematology department of the Aziza Othmana hospital (HAO).

Methods: It's a single-center descriptive study, in the form of theoretical and practical test, during June 2024 among paramedical and medical staff working during this period at the adult clinical hematology department of (HAO).

Results: We included 62 respondents, of whom 3,2% thought that the ultimate bed test replaced the compatibility test in the laboratory, 4,8% that it was obligatory before transfusion, 19,4% that it did not allow the detection of ABO incompatibility, 41,9% that it did not require the determination of the patient's blood group and only one questioned that it did not require the identity of the patient against 61 questioned (98,4%) who checked it. Among those questioned, 69,4% knew that this test is the last key to transfusion safety, 80,6% knew that it is the responsibility of the doctor compared to 19,4% who were unaware of this. All those interviewed checked the concordance between the identity of the recipient and that mentioned on the grouping documents.

Conclusions: This study made it possible to show an average theoretical and good practical level of the staff of the adult clinical hematology department of the (HAO) and to target theoretical gaps during training.