Tunisie Medicale最新文献

Introduction: The constant increase of both esthetic demands and advancement in materials and technologies have led to the development of guidelines to achieve optimal aesthetic results. These tools are useful to predict the teeth proportion and dimensions. Golden and Red proportion are the most described theories.

Aim: of present study was to evaluate the existence of both Golden and Red proportion in the maxillary anterior teeth among a North-African population.

Methods: This was an observational study performed at the Fixed Prosthetic department of the dental clinic of Monastir, Tunisia. The study included participants with full intact anterior dentition. Those with diastema or teeth crowding were excluded. For each one, an alginate impression was done. Measures were, including the perceived width and length, have been taken on casts using digital caliper. Width ratios of maxillary lateral incisor to maxillary central incisor and lateral incisor to canine were calculated.

Results: The study included 100 Tunisian participants including 97 females and 21 males. The maxillary central incisors were the largest (8.60±0.58mm) and the longest (99.71±1.14mm). The ratio was 0.89±0.09mm. Anterior teeth dimensions were not statistically not different between males and females. Significant differences were observed between calculated ratios with GP and to each other's. (p=0).

Conclusions: Either GP nor RP is applicable amongst the Tunisian Population.

Isolated hepatic tuberculosis is a rare form of extrapulmonary tuberculosis. We report an exceptional case of a 51-year-old female patient complaining from right upper abdominal quadrant pain, who underwent laparoscopic surgery for millimetric gallbladder polyps. Preoperative ultrasound hepatic morphology and biochemical hepatic tests revealed no abnormalities. There were no clinical patterns for an active tuberculosis. During surgery time, scattered sub-centimeter whitish nodular lesions were discovered on the upper surface of the liver. Although gallbladder pathological examination did not reveal any significant abnormalities, per surgery hepatic biopsy indicated the presence of a giant cell granuloma with caseous necrosis highly suggestive of hepatic tuberculosis. Treatment by anti-bacillary drugs according to local standard protocol was conducted with favorable outcomes. Therefore, diagnosis of hepatic tuberculosis may be considered in endemic countries in totally asymptomatic patients or complaining from unexplained and isolated abdominal pain, in absence of any morphologic or biochemical hepatic abnormalities.

Introduction: The autistic population is expanding. It is generally recognized that executive function deficits (EFs) are at the core of this disorder. Working memory (WM) is considered a critical element in executive functioning. WM training is regarded as a promising new therapy that can improve EFs and reduce symptoms of autism by targeting WM through repetitive exercises.

Aim: To investigate the impact of WM training on WM, cognitive flexibility, planning, and clinical symptoms. Also, to examine whether age influences the remediation effects.

Methods: Only one group of 20 verbal autistic participants aged 6 to 21 years was included. They received 40 training sessions. The program used is called "Cogmed". Neuropsychological measures were administered before and after the intervention to assess the three EFs. The Social Communication Questionnaire (SCQ) was exploited to evaluate its effects on clinical symptoms.

Results: Only 17 participants have completed the training. They showed significant and large improvements in WM subtests (p<0.01, η^2>0.06), cognitive flexibility (p<0.05, η^2>0.06), planning (p<0.01, η^2 >0.06), and symptoms (p<0.01, η^2 >0.06). Also, the ANOVA test revealed that the age and the intervention effects are not correlated in our sample (p >0.05).

Conclusion: WM training influences EFs positively in autism and reduces the severity of its clinical characteristics. Thus, it's an effective therapy that can be added to the management of this disorder.

Introduction: improving performance is a major challenge for hospitals. Measuring it is an arduous task for managers, requiring the implementation of innovative management tools. Nevertheless, it is clear that performance in the Oujda University Hospital neonatology department is intuitively assessed according to a more medical logic that focuses on patient recovery, ignoring other dimensions. The deficit is noted in the use of performance measurement and analysis tools.

Aim: To design a balanced, multidimensional scorecard specific to the SN-CHU department and to make it available to managers to help them steer their performance and make decisions.

Methods: an intervention research based on a constructivist approach was carried out in the field through 12 interviews with CHU managers. The analysis of the care circuit and process was carried out by means of 37 interviews with carers, supplemented by 30 observations. A series of meetings has enabled to elaborate and validate a set of service performance indicators.

Results: The study revealed that a balanced, multi-dimensional dashboard model has been designed to be available to managers in the UHC-ND. It includes 29 clear, realistic, adapted, accurate, accessible, simple and ergonomic performance indicators. It reflects four measurement dimensions related to organisational development, internal processes, customers and finance. The tool is applicable according to a logic of causality between its axes and allows a descriptive and comparative interpretation of its results. The measures in the model converge mainly towards the satisfaction of patient needs.

Conclusion: the construction of such a model has been a real success, because of the determination of decision-makers. However, its translation could be confronted with a low level of commitment from operational staff. Which would require the vigilant passage through a preparation for implementation, taking into account the "player".

Introduction: The occupational infectious risk in the health care environment is potentially ubiquitous. Several infectious agents are transmitted to healthcare professionals, especially by blood and body fluids.

Aim: To describe the knowledge; attitudes and practices related to blood exposure accidents (BEA) among operating room nurses and to determine their associated factors.

Methods: A descriptive correlational study was conducted from February 24 to April 10, 2022, among nurses of the operating rooms in the two university hospitals of Sousse using an auto administrated questionnaire inspired from the literature.

Results: Our population was composed of 133 nurses. The average age was 38.79 ±7.75 years and the average length of work was 12.02 ±7.8 years. Overall, the respondents had moderate knowledge about BEA. Indeed, 17.3% did not know the meaning of the acronym BEA. Concerning the attitudes, almost (63.1%) had been the victim of at least one BEA. The most frequent types of BEA were pricks (81%), cuts (37%) and splashes (33.3%). The mechanisms of occurrence were mainly recapping (91.7%) and disposal of health care waste (74.4%). Only 48.1% of respondents had received training on BEA. The systematic use of gloves for health care procedures was unsatisfactory (66.2%). According to the studied practices, in case of injured skin, (82.7%) of the respondents wore gloves if they had any skin lesions. Almost all respondents (90.2%) were vaccinated against hepatitis B. Women had better knowledge about the meaning of the acronym BEA (p=0.011). The comparison of practices showed that recapping dirty needles after use was significantly higher among females than males (p=0.011).

Conclusion: The solid knowledge about the BEA and systematic application of standard precautions in health care settings must be concretely manifested in the daily practices of health professionals.

Aim: To describe characteristics of systemic lupus erythematosus (SLE) patients with infectious complications and to determine frequency, clinical and microbiological features and outcomes of reported infections.

Methods: This is a descriptive, retrospective study conducted over an 11-year period at the Internal Medicine Department La Rabta Hospital Tunis, collecting medical records of SLE patients who had experienced infectious complications.

Results: Fifty-six patients were included, consisting of 52 females and 4 males (gender ratio M/F= 0.07). The mean age at SLE diagnosis was 35±13.8 years. The mean duration of the disease was 4.8±3.1 years. A total of seventy-eight infections were documented. Infection revealed the disease in 12 patients (21%) and occurred after an average delay of 36 months [1-156 months] of SLE diagnosis. Forty-three patients (74%) were receiving corticosteroid therapy, associated in 37.5% of cases with immunosuppressive treatment. Urinary and pleuro-pulmonary infections were most common infectious sites. An infectious agent was identified in 59 cases (76%). Bacterial infections were the most common (76%), dominated by the enterobacteria pathogen agent. Viral infections (n=12) were mainly caused by varicella-zoster virus and cytomegalovirus. Five patients required intensive care. Twenty patients experienced a lupus flare during the infectious episode. The outcome was favorable in 52 (93%) patients. Three patients died, two due to septic shock caused by pulmonary infection in two cases and cutaneous infection in one patient. One patient died from a probable pulmonary embolism.

Conclusion: Infectious complications are responsible for significant morbidity and mortality during SLE. Hence the importance of early diagnosis and adequate management.

Introduction: Ocular manifestations of Mycoplasma Pneumoniae infection are rare. We present a case of Mycoplasma Pneumoniae infection revealed by a recurrent retro-bulbar optic neuritis.

Case description: A 38-year-old woman, initially treated for a typical retro-bulbar optic neuritis of the right eye with corticosteroid therapy at high doses, presented for a recurrent decreased vision in the same eye, associated with blepharospasm and conjunctival hyperemia. The etiological assessment revealed a recent Mycoplasma Pneumoniae infection. The patient was treated with corticosteroids and fluorquinolones. Her visual acuity improved to 20/20 and the other symptoms disappeared. She did not develop any recurrence during follow-up.

Conclusions: Management of atypical optic neuritis in a young adult requires consideration and serologic testing for Mycoplasma Pneumoniae especially in endemic regions.

Introduction: Severe trauma is a frequent condition encountered in Emergency department (ED) in which vital prognosis can easily be engaged. This condition could be responsible for unusual injuries occurrence. Emergency physician must be aware of these situations where adequate management is urgently required. We report a case of e 45-year-old patient who was admitted to the ED after a high velocity road traffic accident resulting in multiple injuries and fracture dislocation and migrating humeral head into intra thoracic position.

Observation: We report the clinical case of a patient aged 45 years without medical history admitted to the ED after being involved in a high-velocity road traffic accident. On clinical presentation, the patient was dyspneic and desaturated on ambient air room, he presented moreover clinical signs of blunt right shoulder trauma and deformation of the 2 thighs. Final screening of injuries by radiological and a tomographic exams retained a polytrauma status with fracture dislocation and migration of humeral head, homolateral hemothorax and double femur fracture. Patient was managed by multidisciplinary surgical approaches. Discusssion et conclusion: We illustrated by this case a very rare post trauma condition represented by a fracture dislocation of the humeral head resulting in an intrathoracic migration and a homolateral hemothorax. This diagnosis was reported only a few times by the literature within last decades and management suffers from lack of treatment guidelines, which remain team-dependent. At the very early stage of management and before surgical step, emergency physician must be aware of the possibility of this clinical condition with evolution into some threatening clinical presentations with specific management.

Introduction: Skills in critical appraisal of medical literature are compulsory to achieve in medical practice. This step is the third step of the evidence-based medicine process whose main role is to bridge a gap between scientific evidence and practice. Acquiring skills in critical appraisal of the literature has been reported to be challenging for the trainees with different limits according to their levels, backgrounds or specialties.

Aim: To assess the limits and factors influencing the practice of appraising literature of different students from the same faculty. This faculty included training of biostatistics and preventive medicine in the curriculum during the first 2 years of medical education without linking this learning to the evidence-based medicine practice.

Methods: The authors performed a qualitative study including volunteers who attended voluntarily the same training about critical appraisal of medical literature. The study was based on a satisfaction questionnaire fulfilled by all the participants at the end of the training and on an individual semi-structured interviews programmed 3 months after the training. The satisfaction questionnaire was rated by the authors. The authors proceeded also to a content analysis of the interviews following 3 steps: pre-analysis, treatment of the results, and interpretation.

Results: All the participants (95) fulfilled the questionnaire. The satisfaction's mean score revealed a general moderate satisfaction. Eleven students agreed to be interviewed: Five students from the third year of medical education, 2 students from the second year of medical education, 2 postgraduate students and 2 family doctors. The main themes discussed by the interviewees consisted of training organization, the assessment, the impact on research and the impact on the care process.

Conclusion: To promote EBM learning, medical students first need to actively participate to interactive learning, introduced early and gradually into the curriculum and integrating all specialties including postgraduate students.