Tunisie Medicale最新文献

Introduction: The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol.

Aim: To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them.

Methods: This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included.

Result: Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%). We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients.

Conclusion: These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.

Introduction: Telemedicine has become a fundamental pillar of the evolution of healthcare worldwide. In Tunisia, the challenges of the health system, amplified by the COVID-19 pandemic, have highlighted the urgency to adopt innovative solutions. In this regard, the publication of Presidential Decree No. 318/2022 on April 8 in the Official Journal of the Tunisian Republic represents a significant advance in the regulation of telemedicine.

Aim: To assess the knowledge of Tunisian psychiatrists and child psychiatrists regarding telemedicine, its legal framework, and their perceptions of this new medical practice.

Methods: A descriptive cross-sectional study was conducted 8 months after the issuance of the presidential decree. The survey was conducted online through an electronic questionnaire on Google Forms.

Results: A total of 68 participants were included in this survey. The median number of professional years was 5±7 years. Among the participants, 82% worked in psychiatry and 18% worked in child psychiatry. The sector of practice was public in 69% and private in 31% of cases. Most of them (62%) did not know about the different telemedicine acts, and 57% of doctors were unaware of the existence of the presidential decree. The majority of doctors (84%) expressed a favorable opinion regarding the adoption of telepsychiatry, regardless of sex (p=0.69), professional status (p=0.512), specialty (p=1), years of experience (p=0.83), and practice sector (p=1).

Conclusion: Despite a low level of knowledge regarding telemedicine, the study highlights the interest of the participants in integrating telepsychiatry into their clinical practices.

Introduction: The electrocardiogram (ECG) is a fundamental tool in medical practice. At the Faculty of Medicine of Tunis (FMT), it is usually taught during a lecture. FMT's Physiology Department has innovated its teaching by introducing simulation workshops.

Aim: This study aimed to assess the students' satisfaction with teaching ECG by simulation.

Methods: This was a cross-sectional descriptive study, carried out in April 2018, including 160 students in the first year of the first cycle of medical studies, divided into 10 groups. The students attended an ECG simulation workshop at the FMT media library and then answered a satisfaction form and a self-assessment questionnaire for the workshop.

Results: More than 50% of the students answered either satisfied or very satisfied with the duration of the course, the room, the method of the teacher, and their participation in the course of the session. Regarding teaching support, 19.3% of the students were very satisfied with the practice of the ECG on a mannequin versus 25% for the practice on a voluntary student. For the number of students per group, 42.1% of students were dissatisfied.

Conclusion: This study highlights the weak points of this simulation workshop in order to improve it. Then, it helps to build students' confidence and encourage their adherence to the feedback process. Finally, it shows students' enthusiasm for new teaching methods such as simulation. It would be interesting to generalize this evaluation process for the improvement of medical education and the training of future doctors.

Introduction: Ethical reasoning is an important skill for all physicians who often face complex ethical dilemmas in their daily practice. Therefore, medical training should include methods for learning ethical theories and concepts, as well as how to apply them in practical situations.

Aim: Assess the contribution of an Ethical Reasoning Learning session to fifth medical students' training through a comparison of results of the same objective and structured clinical examination (OSCE) in the form of simulated interview before and after sessions.

Methods: Four 45- minutes' sessions of Ethical Reasoning Learning (ERL) were implemented during a psychiatry internship for four groups of 5th-year students of the faculty of medicine of Monastir (Tunisia). Each session was divided into 7 parts: introduction, reading of a clinical vignette, brainstorming concerning the problems posed by this clinical situation, classification of the problems, identification of the principles of medical ethics, construction of the ethical matrix, and a conclusion.

Results: Fifty-seven students participated in the study divided into 4 groups. We found a significant difference in the means of the OSCE scores before and after the ERL session and a significant difference between the probability of respecting medical secrecy during pre and post-ethical reasoning learning sessions (p <0.001). We have found an effect of ERL sessions on the acquisition of this ethical competence by medical students.

Conclusion: We learned that an ERL session has improved medical training in ethics applied to psychiatry. Other sessions dealing with other ethical skills are necessary to confirm these results.

Introduction-aim: Flexible insulin therapy is currently considered the gold standard therapy of type 1 diabetes. We aimed to study the evolution of glycemic control, weight and nutritional intake of a group of patients with type 1 diabetes, three months after the initiation of functional insulin therapy (FIT).

Methods: This was a prospective longitudinal study having included 30 type 1 diabetic patients hospitalized for education to FIT. Each patient underwent an assessment of glycemic control (glycated hemoglobin (A1C) and number of hypoglycemia), weight and nutritional intake before FIT and 3 months after the initiation of this educative approach.

Results: The mean age of patients was 21,8 ± 7,9 years and the sex ratio was 0,5. The mean duration of diabetes was 7,2 ± 6 years. Three months after initiation of FIT, we observed a significant lowering of A1C, which went from 9,2 ± 1,6% to 8,3 ± 1,4% (p<0,001) of the number of minor hypoglycemia (p=0,001) and that of severe hypoglycemia (p= 0,021). the average weight went from 64,6 ± 13,1 kg to 65,5 ± 13,5 kg (p = 0,040) with a significant increase in BMI (p = 0,041). Weight gain was observed in 67% of patients. This weight gain contrasted with a significant decrease in caloric (p = 0,040) and in carbohydrates intakes (p = 0,027).

Conclusion: Weight gain, associated with better glycemic control, should encourage the healthcare team to strengthen therapeutic education of patients undergoing FIT in order to limit weight gain.

Introduction: Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment.

Aim: This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis.

Methods: A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months.

Results: Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment.

Conclusion: Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

Introduction: Ischemic Stroke in young adults is a real public health problem; it's a major cause of disability, alters quality of life and has a great socio-economic impact.

Aim: determine risk factors and specify the etiology of arterial ischemic stroke in young Tunisian adults.

Methods: In this 5 years retrospective study (2015-2020), we included all young adults (18-50 years) admitted for arterial ischemic stroke (AIS). Risk factors were registered and analyzed. All patients were investigated using a standard protocol: biological tests, brain imaging, carotid ultrasound and cardiac assessment. Additional investigations were carried out at the discretion of the treating physician. The cause of ischemic stroke was classified according to the TOAST criteria.

Results: We collected 200 patients with AIS. The mean age was 41.37 years ± 6.99. Traditional vascular risk factors were observed in more than 1⁄4 patients. A definite cause of stroke was identified in 120 patients. Cardio-embolic causes were the most common among our patients (19%) followed by atherosclerosis of the large arteries (11.5%). Other determined etiologies were found in 27.5% of patients. The etiology remained unclear in 40% of cases: undetermined despite complete investigation in 17.5%, undetermined and incompletely investigated 14.5 % and more than one potential pathomechanisms in 8%.

Conclusion: Through this study, we demonstrated the diversity of etiology of stroke in young Tunisian adults. Changes of lifestyle are responsible for the occurrence of the traditional risk factors at an early age. Rheumatic heart diseases remain a frequent cause of AIS in our area.

Introduction: The valorisation of thesis through its publication is necessary to enhance its visibility. Few data exist concerning the characteristics of theses defended at the Tunis faculty of medicine.

Aim: Examine the publication rate of pediatric theses and identify factors associated with an increased publication rate.

Methods: We conducted a cross-sectional descriptive bibliometric study of pediatric theses defended at the Faculty of Medicine of Tunis over 15 years, from 2006 to 2020. Theses were retrieved from the catalog of the faculty library. Publications had been searched in databases "Pub Med ", and "Google Scholar" until December2021.

Results: The study involved 235 pediatric theses. Sixty-eight theses were published, representing 29% of the total. The main topics of published theses were neonatology (16%) and hematology (15%). The language of publication was French and English in 55% and 45% of cases, respectively. All publications in Q1 and Q2 journals were written in English. The only independent factor predicting publication of theses was the very honourable mention with congratulations of the jury and proposal for the thesis prize (p=0,007).

Conclusion: Additional assessments will be necessary to identify the obstacles to the publication of theses.

Introduction: Toll-like- receptors (TLR) control important aspects of innate and adaptive immune responses. Renal cells are among the non-immune cells that express (TLR). Therefore, their activation might be implicated in renal tubulo-interstitial injury.

Aim: The study aimed to compare TLR9 expression in patients with primary membranous nephropathy (MN) to patients with lupus membranous nephropathy.

Methods: Kidney sections from 10 Lupus nephritis (LN) patients and ten patients with primary MN were analyzed by immunohistochemistry using anti-human TLR9 antibody.

Results: Results showed that TLR9 expression was weak and exclusively tubular in primary MN patients' biopsies. There was a significant difference between LN patients' biopsies and primary MN patients' biopsies. TLR9 expression was more diffused in LN patients' specimen than in those with primary MN.

Conclusion: This study focuses on molecular level pathogenesis of MN. The data suggest that the receptors TLR9 may play role in tubulointerstitial injury in the pathogenesis of LN but not primary membranous nephropathy.

Introduction: Musculoskeletal disorders (MSDs) are as the primary occupational disease (OD) in Tunisia. They can touch the elbow and cause occupational disability.

Aims: Describe the epidemiological and clinical characteristics of elbow MSDs recognized in Tunisia, identify the factors associated with these MSDs and assess their socio-professional impact.

Methods: Retrospective descriptive study of elbow MSDs recognized as compensable OD by the Committees for the Recognition of Occupational Diseases of National Health Insurance Fund, in Tunisia, from 2012 to 2018.

Results: We collected 431 cases of elbow MSDs or 8.35% of all recognized MSDs and 11.8% of recognized MSDs during the same period. The average annual incidence was 4.3 cases. Patients had a mean age of 43.59 years and a clear female predominance (82.2%). The largest provider was the textile industry (60.6%). The average length of employment was 16.78 years. Biomechanical factors were repetitive movements (92.8%), forced movements (67.1%) and prolonged static posture (7.4%). These were lateral epicondylitis (79.1%), medial epicondylitis (14.2%) and ulnar nerve syndrome (10.7%). These pathologies were associated with other MSDs including carpal tunnel syndrome (25.8%). These MSDs were responsible for 15,342 days of lost work. The rate of permanent partial incapacity was 10.6% with a job loss in 15.63%.

Conclusion: Elbow MSDs are responsible for heavy economic and socio-professional consequences justifying the implementation of a preventive strategy adapted within risk sectors.