Tunisie Medicale最新文献

Introduction: Clinical Reasoning Learning (CRL) is one of the most important methods of active learning in medicine. This instruction is designed for small groups of students.

Objectives and methods: We conducted a prospective descriptive study with the primary goal of adapting this instruction for large groups of students. The secondary objective was to compare two methods of adapting this instruction (fish bowl technique and whole-group participation), and the comparison was conducted using an evaluation questionnaire with a Likert scale.

Results: Our sample included 130 students, divided into 2 groups: the Fish bowl CRL group (57 students) and the group with the participation of all students (73 students). Strengthening of prior knowledge, the working atmosphere, assimilation of information, and supervision were the strengths of this instruction. The negatives were related to insufficient time. The analysis found a statistically significant difference in averages between the 2 groups, and this difference pertained to the variables of participation and appreciation of the atmosphere, with a p-value of 0.01 for both.

Conclusion: CRL can be adapted for large groups in the form of fish bowl learning. Currently, it is challenging to measure the actual impact of educational activities on the development of clinical reasoning due to the lack of precise measurement instruments. Evaluation questionnaires can be a first step in measuring the impact of these instructions with modified structures. It would be interesting in future studies to create assessment tools for these restructured instructions.

Introduction-Aim: Postpartum septic osteoarthritis is a rare but serious condition often misdiagnosed due to overlap with common postpartum symptoms like pelvic pain and joint stiffness. This case series aims to describe the clinical, bacteriological, and radiological characteristics of postpartum septic osteoarthritis, as well as the treatment approaches and patient outcomes. Methods: A retrospective case series was conducted at Farhat Hached University Hospital, from 2006 to 2022, involving patients with confirmed postpartum septic osteoarthritis. Clinical data, laboratory findings, imaging results, treatments, and outcomes were analyzed Results: The mean age of the seven patients was 31.4 years. All patients presented with joint pain, with fever and functional impairment where each was observed in 85.7% of cases. The average diagnostic delay was 17 days. MRI findings revealed bone marrow edema in all patients, Abscesses in 28.5% of cases, periarticular soft tissue edema, and intra-articular effusions in 71.4% of cases. The pubic symphysis was the most commonly affected site (57.1%), followed by the sacroiliac joints (28.6%). Only one pathogen, Streptococcus pyogenes, was isolated. Nearly all patients received dual antibiotic therapy for an average duration of 4 to 6 weeks. Satisfactory clinical progress without sequelae was noted and maintained after an average follow-up of 5 to 6 months. .Conclusion: Our results revealed that postpartum septic osteoarthritis requires prompt diagnosis and early treatment to prevent severe complications. MRI plays a critical role in early detection, while timely antibiotic therapy leads to favorable long-term outcomes.

Introduction: Epistaxis is a prevalent clinical condition that can be associated with significant morbidity and places a considerable burden on the healthcare system.

Aim: To ascertain the prevalence of epistaxis in our center and to identify the predictive factors of severity.

Methods: This is a retrospective cross-sectional analytical study of patients who presented to and/or were admitted for epistaxis at our department of Ear, Nose and Throat (ENT) during the period from January 2015 to December 2022.

Results: A total of 720 patients were included out of a total of 100,378 consultations, resulting in a prevalence of 0.7%. The mean age of the patients was 51.6 years (±18,73 Standard Deviation (SD)) and the sex ratio H/F was 1.43. The majority (87.9%) of cases were benign and treated on an outpatient basis, while 12.1% of patients presented with severe epistaxis and required hospitalization. The median duration of hospitalization was 5 days. The outcome was favourable in 99.4% of cases. Nevertheless, two cases of death due to severe epistaxis complicated by hemorrhagic shock were observed. A multivariate analysis identified several independent factors associated with severe epistaxis. These included male gender, recurrent epistaxis, a history of hematological disorders, the use of anticoagulant therapy, and an increased International Normalized Ratio (INR) level.

Conclusion: These results have made a significant contribution to our understanding of the severity factors associated with epistaxis, enabling a more targeted and personalized approach to prevention and treatment.

Introduction: Endobronchial metastases (EBMs) are rare, with primary tumours predominantly of breast, renal, and colorectal origin. Bronchoscopy is the diagnostic gold standard, with histological confirmation through immunohistochemical study.

Cases: We presented three cases of EBMs, one secondary to colorectal cancer and two associated with renal tumours. EBM unveiled the extra-thoracic neoplasm in colorectal cancer and was incidentally discovered during renal cancer follow-up. Bronchoscopy revealed an obstructive endobronchial mass in two cases. Histological diagnosis was established via bronchial biopsies (collecting duct renal carcinoma), computed tomography-guided transparietal lung biopsy (clear cell renal carcinoma), and endobronchial mass resection through rigid bronchoscopy (colorectal adenocarcinoma).

Conclusion: In case of an endobronchial lesion, the diagnosis of EBM should be evoked especially when the medical history reports extra-thoracic neoplasms. This diagnostic hypothesis guides the histological diagnosis and leads to an appropriate treatment.

Introduction: The use of urine cytobacteriological examination is a common and essential practice in medicine which helps guide therapeutic management in case of urinary tract infection. The cytological examination of urine samples can be done using the manual (microscopic) or automated technique. The automated approach, which involves the use of artificial intelligence, is faster, more reliable, and more efficient for laboratories.

Aim: This work aims to evaluate the performance of the DxU-850 Iris automate by comparing it to the microscopic method.

Methods: Using a four-month prospective study from May to August 2023, we analyzed urine samples received during this period by the Microbiology laboratory of Mohammed VI University Hospital in Oujda. Strict quality standards were respected when obtaining the results. Several elements were analyzed, and various parameters calculated to evaluate the performance of this automaton.

Results: The present study investigated 1000 CBEU samples, mainly from outpatient clinics (46.34%) and emergency departments (21.72%). Most patients were males (50.58%) and asymptomatic (72.9%). The samples' culture showed varied results: concordance between the results of automaton and microscopic count was satisfactory except for crystals and yeasts in turbid samples.

Conclusion: Automation has advantages like speed, traceability, error reduction, and time optimization. The results reveal a satisfactory concordance between the two methods despite discordances occurring mainly with crystals and yeasts, especially in turbid urine samples. The DxU-850 Iris automaton is an effective way to screen for urinary tract infections. We recommend that automated and manual techniques be considered complementary.

Introduction: Corneal foreign bodies account for nearly one-third of all eye injuries and are a common emergency in ophthalmology. While many cases are straightforward, involving clear diagnosis and treatment, some present significant challenges due to the complexity of the foreign body involved.

Observation: A 20-year-old male presented with discomfort in his right eye following an accident while cutting a tree without wearing protective eyewear. Examination using slit-lamp biomicroscopy revealed a reed foreign body embedded in the cornea. Anterior Segment Optical Coherence Tomography (AS-OCT) provided detailed images, showing the foreign body embedded 300 µm beneath the corneal epithelium but not affecting deeper layers. The foreign body was surgically removed under topical anesthesia, followed by thorough cleansing and suturing of the wound.

Conclusion: AS-OCT is invaluable in the diagnosis and management of complex corneal foreign bodies, enabling precise treatment planning and successful outcomes, as demonstrated in this case.

Introduction: Globally and in Morocco, viral hepatitis is a major public health priority, and knowledge and awareness are essential in the combat against this disease.

Aim: To assess the knowledge, attitudes and practices of university students regarding viral hepatitis.

Methods: A descriptive and analytical cross-sectional study was conducted among students enrolled at Mohammed Premier University in Oujda, for the 2023-2024 academic year, using a self-administered and anonymous online questionnaire.

Results: 503 students completed the online questionnaire. The results showed that hepatitis B (73.6%) and C (67.4%) are better known than hepatitis A (52.0%) and E (24.3%). The majority of students (78.0%) knew that HBV can be transmitted by blood, and 62.0% by sexual transmission. For the main mode of transmission of hepatitis C, around two-thirds of respondents (69.0%) indicated transmission by contact with infected blood. Transmission of HVA and HVE viruses was known by 43.5%. The level of knowledge about hepatitis was significantly associated with education levels, medical school affiliation and socio-economic status. Students' preventive practices were positive, but their attitudes towards people with viral hepatitis were negative.

Conclusion: Our results suggest that knowledge of hepatitis needs to be improved through awareness and education campaigns, in order to combat these diseases, especially as Morocco has committed to a global movement to eliminate viral hepatitis by 2030.