Tunisie Medicale最新文献

Introduction: In trauma, we can perform a lateral radiography of the lumbosacral hinge taking the femoral heads if we include it in the initial lesion assessment. Thus, the pelvic incidence informs about the type of back as described by Roussouly.

Aim: To describe the clinical and radiological results of these types of back which are operated on for a thoracolumbar fracture.

Methods: We recorded the clinical, radiological data and the characteristics of the fracture of 120 patient operated on for a thoracolumbar spine fracture over a period of 14 years between February 2005 and July 2019. We studied the deformation according to Regional traumatic angulation (ART), Sagittal Farcy Index (SIF), Gardner Segment Kyphotic Deformity (GSKD). Functional evaluation was carried out according to the Denis Pain Scale. Radiological evaluation was based on relative gain and loss.

Results: In individuals with low pelvic incidence, a prevalence of 72% was observed for type A fracture, whereas types B and C accounted for 45.9% (P<0.05) for backs with high pelvic incidence. The Denis Pain Scale score indicated that 90% of individuals with low incidence backs had scores below 3, whereas only 65.6% of those with high incidences had scores below 3 (P<0.05). The loss of correction for backs with low incidences was measured at 1.2°, while for backs with high incidences, it was 3° (p<0.05).

Conclusion: Fractures on backs with low pelvic incidence considered as stiff backs are more frequently of type A, with better functional results and less losses.

Introduction: Childhood obesity, a true international epidemic, is a multifactorial pathology including genetic and environmental factors.

Aim: Determine the prevalence and risk factors of overweight in Tunisian schoolchildren in the Bardo region, an urban department of the Tunis governorate.

Methods: Descriptive and cross-sectional study involving schoolchildren aged between 10 and 12 years old. All students received questioning, anthropometric measurements and a food survey. According to the International Obesity Task Force (IOTF) body weight curves by gender, a Body Mass Index (BMI) in children ≥ 97th percentile defined overweight, and a BMI ≥ IOTF-30 defined obesity.

Results: The mean age of the 105 schoolchildren was 10.8±0.5 years. The average BMI was 19.68±3.86 kg/m². More than a third of students (35.3%) were overweight. Overweight affected 45% of girls and 29.2% of boys. The prevalence of obesity was 8.6% (7 boys and 2 girls). 55.6% of girls and 47.4% of the overweight boys had a high calorie diet. TV eating was reported in 40.5% of overweight students versus 19.4% of normal weight students. Prandial overeating increases the risk of overweight in children by 18.48 (p=0.0001). Parental obesity multiplies by 2.69 the risk of overweight in their offspring (p=0.023).

Conclusion: In addition to genetic heritability, children share rating habits with their parents. Therefore, management based on hygienic-dietary measures must involve the whole family.

Aims: To analyse the prescription of biologics (bDMARDs) in chronic inflammatory rheumatic diseases (CIRD) from Tunisian National Health Insurance (CNAM) data and to estimate their direct costs and associated factors.

Methods: One hundred and nine consecutive patients who received at least one bDMARDs during a six-month period from January to June 2022 were analysed. Clinical and therapeutic parameters as well as data related to the choice of bDMARDs were identified. Direct costs were assessed. Excess costs were considered if the monthly costs exceeded 2200 Tunisian dinars (TD) per patient.

Results: The most common CIRD was axial spondylarthritis (AS) in 44% and rheumatoid arthritis (RA) in 37.6% of cases. Juvenile idiopathic arthritis represented 2.7% of cases. In Tunisia, prescribing of bDMARDs is concentrated in the coastal regions and follows the distribution of rheumatologists. Certolizumab pegol was the most prescribed agent in 45% of cases. No significant association was found between the choice of bDMARD and the characteristics of patients, CIRD or prescribers. The total monthly cost of bDMARDs was 225,535 ± 1269 TD. Overspending was significantly associated with initial high DAS28 in RA and young age and total hip replacement in AS.

Conclusion: Prescription of bDMARDs in CIRD is mainly for AS and in the coastal regions of Tunisia. The burden is considerable, partly due to the high cost of biologics. Data from this study may enable public health managers to better allocate the limited resources available for patient care and to develop medico-economic strategies to reduce health care costs.

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Introduction: Sarcoidosis is a chronic inflammatory disease characterized by non-caseous necrotizing epithelial cell granulomas that can affect any organ. Ear, nose, and throat (ENT) involvement is rare. We report two cases of systemic sarcoidosis with ENT onset.

Observation: A 39-year-old woman with no medical history, presented with right submaxillary lymphadenopathy, associated with a nasopharyngeal swelling on the nasopharyngoscopy. Lymph node biopsy revealed numerous granulomas with epithelioid and giant cells. The computed tomography (CT) showed multiple lymph nodes along with interstitial lung disease. The diagnosis of sarcoidosis with pulmonary, mediastinal, lymph node, and nasopharyngeal involvement was retained and the patient was treated with glucocorticoids with disappearance of the submaxillary swelling and of the lymph nodes on the CT. Another 39-year-old woman, with no medical history, presented to the ENT clinic with a three-month history of bilateral nasal obstruction. Nasal endoscopy revealed hyperemia of the nasal mucosa. She was treated with antibiotics without clinical improvement. CT scan of the cranial and facial bones revealed a focal bulge at the nasopharynx's posterior wall, associated with a mucosal thickening of maxillary, frontal, and ethmoid sinuses. A nasal and a lymph node biopsy were then performed, revealing granulomatous inflammation without caseous necrosis. The diagnosis of sarcoidosis with pulmonary, lymph node, and sinonasal involvement was established. The patient was treated with glucocorticoids with clinical improvement.

Conclusion: Nasopharyngeal and sinus involvement may be rare in sarcoidosis but can be part of the initial clinical picture of the disease. Therefore, it should put the flea in the ear in case of ENT granulomatosis.

Introduction: Epistaxis in children is a very common reason for consultation in ENT and pediatric emergencies. Most of these epistaxis are benign, but it is their recurrence that motivates anxious parents, to consult. Allergic rhinitis is a common pathology among children in Tunisia, it seemed interesting to us to study the association between allergic rhinitis and epistaxis.

Aim: Identify the clinical features and the risk factors for epistaxis in children with allergic rhinitis.

Methods: Retrospective descriptive cohort study over a period of 4 years, including children, who consulted for epistaxis at the ENT and CCF department of FSI Hospital, La Marsa Tunis. All cases were divided into 2 groups: ERA+ Group: epistaxis with allergic rhinitis versus ERA- Group: epistaxis without allergic rhinitis.

Results: 79 children were included, including 21 (26.6%) meeting the diagnostic criteria for allergic rhinitis. A female predominance was noted in the ERA+ group. In the ERA+ group, epistaxis mainly occurred in summer and autumn (38% and 28%) while it predominated in winter and summer in the ERA- group. Rhinorrhea and nasal pruritus were factors significantly associated with epistaxis in children with allergic rhinitis.

Conclusion: the ENT doctor must think about allergic rhinitis in case of Repetitive epistaxis in a child, and look for suggestive symptoms, particularly rhinorrhea and nasal prurit.

Introduction: Stereotactic Body Radiation Therapy (SBRT) has transformed lung cancer care, delivering precise treatment with minimal harm to healthy tissue.

Aim: This study examined the experience at the Salah Azaiez Institute (SAI) in lung cancer patients.

Methodology: we conducted a retrospective study on patients treated with SBRT from 2019 to 2022. Planification imaging included four-dimensional CT scans and delineation of target volumes and organs-at-risk was done as per international guidelines. Treatment doses were tailored based on tumour location.

Results: A total of 10 cases were included. The male-to-female sex ratio was 4:1, with a median age of 69.5 years. Three had unconfirmed primary lung tumours, while five had inoperable stage I-IIA adenocarcinomas primarily due to compromised respiratory function. Two had oligometastatic lung diseases. All underwent recent thoracic-CT and PET-CT evaluations to exclude pulmonary fibrosis. The median lesion size was 40mm. Karnofsky's performance status ranged from 70 to 90, with no contraindications to the supine position. Eight out of 10 patients received 8 fractions of 7.5 Gy at the 80% isodose. For that regimen, the D95%, D99%, and Dmax were respectively, 60 Gy, 56 Gy, 73 Gy. All organs-at-risk dosimetric criteria were met. Acute toxicities included worsened coughs in 2 patients and fatigue in 6. After a mean follow-up of 23 months, no rib fractures or haemoptysis were observed, and no local recurrence was reported on the last chest CT scan.

Conclusion: SBRT demonstrates promise for lung cancer treatment, though challenges persist in precise targeting and motion management. Effective multidisciplinary collaboration and local protocols are crucial for successful implementation.

Introduction-Aim: Clinical reasoning in situations of uncertainty is a skill to be acquired from initial training. The aim of this study was to evaluate the clinical reasoning ability in a context of uncertainty of health science students using the Script Concordance Test (SCT).

Methods: This was a cross-sectional and descriptive study which included students in the third year of the National License in Anesthesia-Resuscitation, with their consent, and a panel of experts made up of ten members. The tool chosen was a TCS composed of 60 items which dealt with frequent and serious themes in general Anesthesia-Resuscitation.

Results: We included 16 students. The average time to complete the test was 46.7 minutes±12.42 [95% CI; 37.81 -55.59] for experts and 54.38 minutes ±8.92 [95% CI; 49.62-59.13] for students. The average score obtained by the experts, reported out of 100, was 80.8±4.09 [95% CI; 77.90-83.75]. The average score of the students was 54.78±9.14 [95% CI; 49.91-59.65].

Conclusion: With the implementation of TCS as an assessment tool in health sciences, students demonstrated an increased capacity for reasoning in complex situations, as reflected in their average scores.

Objective: the aim of this study is to report epidemiological data, clinical presentations and management of chronic immune thrombocytopenic purpura (ITP) in a single center in south of TUNISIA.

Methods: retrospective study collecting all cases of chronic ITP among children aged less than 14 years, in a department of pediatrics in south of Tunisia during a period of 13 years (from 1st January 2010 to 31 December 2022) Results: during the study period, 72 newly diagnosed ITP were recorded; 11 patients evolves chronic ITP (12 ,5%). They were 6 boys and 5 girls. Two patients were aged more than 10 years at the onset of the disease. Symptoms in the chronic stage were mucocutaneous bleeding. One patient developed post traumatic cerebral hemorragia. Three patients had severe form, and required second-line therapy. Two patients requested Eltrombopag with good response. One patient had spontaneous recovery after 3 years of follow up.

Conclusion: Management of chronic ITP represents a real challenge for pediatrician. Currently, there are some recommendations and guidelines which can guide management strategy of severe forms of Chronic ITP.

Introduction: In their practice, pharmacists are confronted with situations that may pose ethical problems. They must make decisions based on scientific knowledge as well as the principles of bioethics.

Aim: To evaluate pharmacists' attitudes towards specific ethical dilemmas.

Methods: We conducted our study using a validated English questionnaire, containing 9 ethical scenarios to be rated by participants on a 5-point Likert scale. The questionnaire was distributed via Google Forms on Facebook pages and Messenger and WhatsApp groups. The data were processed with Microsoft Excel and statistical tests were performed using SPSS version 23.

Results: The participants in our study achieved 70% of the total score for all encountered situations. We found that in response to the non-maleficence scenario of "Dispensing amphetamines to a medical student," pharmacists exhibited the most ethical attitude compared to other studied situations. In general, confidentiality scenarios received the highest number of "disagree" responses, while the least ethical attitude concerned justice scenarios. We also found a significant correlation between supplementary ethics training and the dimensions of confidentiality and non-maleficence .

Conclusion: Our study, the first of its kind in Tunisia, highlighted the need to strengthen medical ethics training for pharmacists.