Tunisie Medicale最新文献

Introduction: Information on the use of tobacco and other illicit substances by young people is an essential element for the implementation of appropriate preventive measures.

Aim: To estimate the prevalence of smoking, alcohol and drug use among high school students in the city of Gabes.

Methods: Cross-sectional survey carried out in 2022 in 5 schools in the city of Gabes, southern Tunisia, by a self-administered questionnaire.

Results: We included a total of 507 students (47% male) with an average age of 15.6 years. The overall smoking prevalence was 22.1%. The respondents were daily smokers in 22.1% of cases with an average consumption of 10 cigarettes/day in 62.5% of cases. The age of onset of smoking was less than 10 years in 31.2% of cases. The prevalence of electronic cigarette use was 12%. The prevalence of chewing tobacco consumption (Neffa) was 9.1%. Seventy-four of the respondents (14.6%) used hookah. The prevalence of alcohol consumption was 5.9%. Twenty-four students (4.7%) used drugs: cannabis (87.5%) and psychotropic drugs without a medical prescription (12.5%).

Conclusion: The prevalence of smoking among high school students in the city of Gabes was high. This behavior was associated with the consumption of alcohol and psychoactive substances. These results should be used to set up primary prevention programs for young people in order to minimize the scourge of tobacco and psychoactive substance use in schools.

Introduction Invasive candidiasis (IC) is a widespread infection in intensive care. As culture-based diagnostic techniques take several days before positivity and leaks of sensitivity. (1,3)-β-D-glucan (BDG) was proposed as a mycological criterion for IC diagnosis in selected patients.

Aim: To determine the performance of BDG assay in the early diagnosis of IC in non-neutropenic critically ill patients Methods: We conducted a prospective evaluative study. All adults who were hospitalized in La Rabta Tertiary Hospital intensive care unit from January to June 2023 and at risk of IC were screened on a weekly basis. A true positive status corresponded to confirmed or highly probable IC and a positive BDG test (>80 pg/mL).

Results: A total of 123 BDG tests were performed on 85 patients with a median age of 58 years [41.5-67.5] and a median SOFA score=3 [2-5.5]. The median colonization index was 0.16 [0-0.33], and Candida albicans was the most common species isolated (71%). The median Candida score was 0.9 [0-2.9]. IC was retained in 30 cases. The median BDG level was 98 pg/mL [24-275]. Sixty-one patients had a positive BDG test, in whom only 21 had an IC. The performance of the BDG test in the diagnosis of IC was moderate (AUC/ROC=0.68 [0.575-0.788], p=0.003). The discriminatory power was better with the negative prediction (PNV=85.5%).

Conclusion: The major benefit of BDG test in intensive care seems to lie in its NPV allowing to roll out the invasive candidiasis diagnosis then withhold or interrupt antifungal therapy.

Introduction: The ingestion of foreign body (FB) is a common problem in paediatrics. Children are curious by nature and tend to explore environment by inserting objects into their mouths.

Aim: To update our epidemiological and clinical data and adapt clinical management in order to limit morbidity associated with this fairly frequent accidental pathology.

Methods: Retrospective descriptive study including children aged less than 15 years, hospitalized in the Children's Medicine Department B of the Tunis Children's Hospital from 1 January 2016 to 31 December 2021 having ingested a FB.

Results: Forty-four children were included and admitted for foreign body ingestion, with a sex ratio of 1.4. The mean age was 4 years 4 months. Most children were asymptomatic on admission. In the others, digestive forms predominated (n=19). The average consultation time was 10.8 hours. The FBs were mainly foams and corrosives (75%), represented by batteries in 52% of cases and coins in 22% of cases. Thoraco-abdominal X-rays carried out on all patients revealed a radio-opaque foreign body in 95% of cases. The most frequent location was the colon (n=17). Endoscopy was chosen in 14 patients and was extractive in five. The mean time from admission to endoscopic extraction was 10.6 hours. The mean time to expulsion by natural route was 49 hours. Complications were noted in two patients: ulceration of the oesophageal mucosa and dyspnoea following rigid endoscopy in one case.

Conclusion: This study has shown that the ingestion of foreign body in children is a frequent and potentially serious accident.

Aim: describe the epidemiological, clinical, etiological and therapeutic aspects of hypercalcemia seen in the rheumatology department of Cocody University Hospital.

Methods: Descriptive cross-sectional study carried out in the rheumatology department of Cocody University Hospital from January 2013 to July 2022 and covering the files of patients with hypercalcemia.

Results: The hospital frequency of hypercalcemia was 0.88%, or 60 cases out of 6771 hospitalizations during the study period. The workforce included 35 men and 25 women (M/F ratio=0.14), aged on average 56±11.52 years (range 25 and 80 years). The main reason for consultation related to the underlying disease was osteoarticular pain syndrome. The signs related to symptomatic hypercalcemia were digestive (23.33%), neurological (8.33%) and cardiovascular (5%). The main extra-articular signs were asthenia (90%) and weight loss (78.33%). On the biological level, there was a clear predominance of mild hypercalcemia (76.67%), followed by moderate hypercalcemia (10%) and severe hypercalcemia (13.33%). The etiologies were dominated by multiple myeloma (45%), followed by bone metastases (40%), granulomatosis (13.33%) and secondary hyperparathyroidism (1.67%). The molecules used for the treatment of hypercalcemia were corticosteroids and biophosphonates. The outcome was favorable in 18.33% of patients, and unspecified in 66.67% of cases due to the patient's transfer to another department. There were 9 deaths, or 15% of cases.

Conclusion: Hypercalcemia is rare and most often asymptomatic in rheumatological hospitalizations in Abidjan. Multiple myeloma is the main etiology.

Introduction: The cover letter is a critical component of medical journal submissions, often influencing acceptance decisions. However, authors frequently underestimate its importance. This narrative review aimed to provide guidance for authors on writing effective and succinct cover letters.

Methods: We conducted a narrative review of literature on the recommended structure and content for drafting a cover letter.

Results: An effective and succinct cover letter should include the names of the editor in chief and journal, submission details, ethical statements, authors' agreement, and contact information. Additional elements such as declarations of conflicts of interest, funding sources, and permissions may also be necessary. The cover letter should emphasize the manuscript's uniqueness without merely duplicating the abstract.

Conclusion: Cover letters remain pivotal for manuscript acceptance and must adhere to specific guidelines.

Background: Vulvar cancer is a rare tumor whose prognosis depends on early treatment.

Aim: The study aimed to evaluate the role of adjuvant radiotherapy (RT) in the treatment of vulvar cancer and to identify the prognostic factors influencing the tumor evolution.

Methods: descriptive and analytical study included 38 patients treated by adjuvant RT, during the period from 1995 to 2020, for vulvar cancer in the oncological radiotherapy department of Farhat Hached University Hospital in Sousse.

Results: All patients underwent adjuvant RT. After a median follow-up of 55 months, 24 patients are in complete remission (63.2%). We noted local and regional recurrences in 23.7% and 13.2% of cases. Two patients had distant bone progression. Overall survival (OS) was 72% at five years and 51% at ten years. The 5-year local (SSRL) and regional (SSRR) recurrence-free survival was 76% and 87%, respectively. In univariate analysis, the factors associated with OS were the size of the tumor (p=0.02), the quality of excision (p=0.000) and age (p=0.04). The quality of excision (p = 0.001) and inguinal dissection (p = 0.05) was associated with SSRL. In addition, those influencing the SSRR were lymph node invasion and the quality of excision.

Conclusion: vulvar cancer requires early diagnosis in order to consider less invasive treatment with advances in RT techniques.

Introduction: Lupus nephritis (LN) is an immune complex glomerulonephritis, caused by systemic lupus erythematosus. It is associated with an increase of morbidity and mortality. In LN, the immune responses dysregulation is one of the crucial pathogenic pathways. Annexin A1 (AnxA1), as an anti-inflammatory mediator, plays a critical role in immune responses, in addition to a variety of pathological processes.

Aim: This study aimed to evaluate the AnxA1 expression in renal tissues, in order to explore its potential role in LN pathogenesis.

Methods: AnxA1 expression was performed by immunohistochemistry staining in renal biopsies of 24 LN patients compared to 8 controls.

Results: LN patient's biopsies showed an increased distribution of AnxA1 in glomeruli compared to controls (p=0.00019). When comparing AnxA1 expression in different LN classes, a high AnxA1 intensity score was positively correlated with glomerular proliferation.

Conclusion: Our data suggest AnxA1 as a useful marker to differentiate between severe proliferative and non severe proliferative classes of LN.

Dyslipidemia in infants is a rare condition characterized by abnormal levels of lipids in the blood, such as cholesterol and triglycerides. Early diagnosis poses a challenge due to nonspecific symptoms and lipid criteria differing from adults. Through two clinical cases of familial dyslipidemia (Type 1 Familial Hypercholesterolemia and Type 2b Combined Familial Hyperlipidemia), we highlight the diagnostic and therapeutic challenges encountered in infants, emphasizing the importance of a multidisciplinary approach in care and early screening. In the first case, a 3-month-old boy with a family history of dyslipidemia was diagnosed during bronchiolitis, revealing milky serum, pseudohyponatremia, and abnormal lipid profile. His Type 1 familial hyperlipidemia was confirmed by lipid electrophoresis. Despite dietary management and breastfeeding, he developed severe pancreatitis, successfully treated with intensive care. The second case involved a girl who presented at 3 months with vomiting and irritability. Laboratory tests indicated pseudohyponatremia, hematologic abnormalities, and lipid disturbances. Her Type 2b familial hyperlipidemia was confirmed by lipid electrophoresis. She responded well to a specialized diet, experiencing few pancreatitis episodes without meeting clinical or radiological severity criteria.

Objectives: To evaluate survival after osteoporotic fractures of the upper femur and determine its associated factors.

Methods: Cross-sectional study of patients hospitalized for fractures of the upper end of the femur during 2020 at Monastir University Hospital. Outcome was determined up to 2 years. The Kaplan-Meier curve is used for survival analysis.

Results: Eighty one patients with mean age of 77.46 ± 17,36 years and a sex ratio of 0.61 were evaluated. The femoral neck fracture was observed in54% of cases. Overall survival was 84.6% at 6 months, 75.4% at 1 year and 63.4% at 2 years. Median survival was 30 months. Patients older than 75 years had a shorter survival (68% versus 83% at one year and 55% versus 72% at 2 years ; p < 10-3).

Conclusion: The osteoporotic fracture of the upper femur is serious due to its severe outcome. One-year mortality was aboutt 25%. Increased mortality was associated to elderly population.

Introduction: Metabolic syndrome (MS) is responsible for the increased cardiovascular risk in patients with type 2 diabetes. Few studies have focused on MS in type 1 diabetes mellitus (T1DM).

Aim: To describe the clinical, biochemical and therapeutic characteristics of T1DM patients affected by MS.

Methods: A retrospective study was carried out. It included 36 patients, suffering from T1DM and MS, hospitalized in the Endocrinology-Diabetology Department of the Hédi Chaker University Hospital of Sfax-Tunisia, from 1997 to 2020. MS was defined according to the NCEP-ATP III criteria.

Results: The mean age of the patients was 53 years. The mean duration of diabetes was 15 years. The MS appeared after a mean duration of diabetes of 13.7 years. Hypertension was reported in 21 patients (58.3%). The mean BMI was 26 kg/m2. The mean total cholesterol level was 4.59 mmol/l ±1.18, and the mean triglycerides level was 1.67 mmol/l ±0.81. The mean HDL-cholesterol level was 0.96 mmol/l ±0.29. In the majority of cases (80%), MS was the combination of dyslipidemia, hypertension and diabetes. Therapeutically, the average dose of insulin used was 0.8 IU/kg/day. The combination of metformin was necessary in 18 cases (50%). Microvascular complications were present in all patients. The cardiovascular risk was very high in all patients.

Conclusion: The prevalence of MS during T1DM is increasing. It indicates an increased risk of micro and macrovascular complications.