La Tunisie Médicale

A rare case of Kallmann syndrome in a female with pulmonary valve stenosis: Coincidence or genetic link?

Mariam Hamaichat — 2025-05-01

Introduction: Kallmann De Morsier syndrome (KS) is a rare genetic disorder characterized by congenital gonadotropic deficiency alongside anosmia or hyposmia, with a lower prevalence in females. Diagnosis relies on clinical and biological assessment, confirmed through pituitary magnetic resonance imaging (MRI). Cardiac involvement in this syndrome is uncommon, with only a few cases documented in the literature.

Observation: We reported the case of a 22-year-old female with a history of pulmonary valve stenosis for which she underwent balloon dilatation at the age of five years. She presented with primary amenorrhoea and a history of anosmia was noted. Hormonal investigations revealed hypogonadotropic hypogonadism and a hypothalamic-pituitary MRI identified complete agenesis of the olfactory bulbs. A diagnosis of KS was made. Genetic testing for the KAL1 gene was negative. The patient was put on hormone replacement therapy in order to achieve her puberty and promote general well-being

Conclusion: This case represents the first reported association between KS and pulmonary valve stenosis, highlighting the need for further molecular biological research to explore other genes that may explain this connection

Directed Teaching of Clinical Reasoning in the Fourth Year of Medical School: A Structured Summary of Genetic Observations

Houweyda Jilani — 2025-05-01

Introduction: Clinical reasoning (CR) encompasses diagnostic activity, treatment planning, execution, and monitoring, as well as prognosis establishment. It is a skill that needs to be taught rather than left to chance. Clinical rotations provide an ideal learning environment for CR.

Aim: To evaluate a directed teaching (DT) approach for CR learning, using structured summary of observation (SSO), based on a known case during a genetics rotation for fourth-year medical students (MS4).

Methods: This was a longitudinal, descriptive study involving MS4 on a genetics rotation during the first semester of the 2020/2021 academic year. Three DT sessions were conducted, focusing on the development of SSOs to teach Down syndrome, Turner syndrome, DiGeorge syndrome, and fragile X syndrome. The pedagogical approach was evaluated based on the grades assigned to the SSOs, a comparison of pre- and post-test averages, calculation of the relative gain for the average grades of the three DT sessions, calculation of the Cohen's d effect size, and calculation of the heterogeneity rate. Student evaluation of the teaching approach was done through a satisfaction questionnaire.

Results: Forty-nine students divided into 10 groups of four to six students participated in three DT sessions. The average grade for the SSOs was 14.12 [10.75-16.5] (p=0.15). The average grade for the pre-tests was 9.3 [7.16-11.23] (p=0.13), and for the post-tests, it was 13.22 [11.93-14.59] (p=0.034). The relative gain for the average grades of the three DT sessions was 35.81% [10.9-65.78]. The heterogeneity rate was 21.98% for the pre-test averages ...(abstract truncated at 250 words).

Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) in Cardiac Amyloidosis: A Systematic Review: Study protocol

Rim Bourguiba — 2025-05-01

Background: Sodium-glucose transport protein 2 inhibitors (SGLT2i) have revolutionized the management of heart failure and renal dysfunction. Cardiac amyloidosis, an underdiagnosed cause of heart failure, primarily results from light-chain (AL) or transthyretin (ATTR) deposition. Emerging evidence suggests that SGLT2i may improve cardiac and renal outcomes in these patients. However, data on their efficacy and safety in cardiac amyloidosis remain limited. This study aimed to conduct a systematic review to evaluate the efficacy and safety of SGLT2i in cardiac amyloidosis.

Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42024584183). A comprehensive search was performed across PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library databases, including studies involving adult patients with AL or ATTR cardiac amyloidosis. Outcomes analyzed included cardiovascular mortality, heart failure hospitalizations, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), NT-proBNP, renal parameters, and adverse events. Data were synthesized using a random-effects model to account for heterogeneity, with effect measures expressed as risk ratios (RR) or mean differences (MD) and 95% confidence intervals (CIs).

Results: Preliminary findings indicate that SGLT2i use in cardiac amyloidosis is associated with significant improvements in LVEF, NT-pro BNP levels, and renal parameters such as eGFR and albuminuria progression. A reduction in heart failure hospitalizations and stabilization of NYHA functional class were also observed. Adverse events, including genitourinary infections and orthostatic hypotension, were reported but were consistent with known SGLT2i safety profiles. However, heterogeneity in study designs and small sample ..(abstract truncated at 250 words).

The effect of Ambiant heat exposure early in pregnancy on the frequency of congenital heart defects: Systematic Review Protocol

Mouadh Benali — 2025-05-01

Introduction: Fetal development is highly sensitive to temperature extremes during pregnancy, partly due to the reduced thermoregulatory capacity of pregnant women. This vulnerability has been linked to an increased risk of congenital heart disease (CHD). With global warming expected to increase extreme heat events, understanding the relationship between maternal heat exposure and CHD risk has become increasingly urgent.

Objective: This systematic review aims to evaluate existing evidence on the impact of maternal high-temperature exposure on the incidence of CHD.

Methods: We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be conducted in PubMed, Embase, Scopus, and Google Scholar databases using tested and validated search algorithms. We will include any type of study, published in English or French, involving pregnant women and/or neonates that directly evaluates the relationship between high-temperature exposure during pregnancy and CHD. Experimental or modelling studies involving animals and those examining the association between maternal fever and CHD will be excluded. Study selection, data extraction, and risk of bias assessment will be conducted by two independent reviewers. The quality and risk of bias will be assessed using the Newcastle-Ottawa Scale. The main outcomes are the incidence and types of CHD diagnosed in infant.

PROSPERO registration number : CRD42024584967

Effect of paracetamol on blood pressure: A systematic review protocol

Saoussen Miladi — 2025-05-01

Introduction: Paracetamol is widely used as a first-line treatment for chronic pain because it is thought to be safe. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol is thought to have no cardiovascular effects and specially no effect on blood pressure (BP). However, some studies suggest that paracetamol may increase BP. Thus, our aim was to address a systematic review in order to investigate the effects of regular paracetamol intake on BP.

Methods: To address this systematic review, a search on PubMed, Cochrane and Scopus is planned. A search on grey literature, registries, thesis and congress abstracts will be performed. We will include randomized clinical trials, interventional studies and observational studies. Studies on child bearing women and those with eclampsia or preeclampsia will be excluded. Besides, only studies using recommended dosage of paracetamol will be included. The primary outcomes of interest will be the change of BP before and after the intake of paracetamol.

Discussion: Change of BP will be assessed on patients taking paracetamol. Any previous cardiovascular disease or hypertension will be raised in order to identify if there are risk factors of hypertension under paracetamol.

Development and validation of a risk score predicting acute uncomplicated appendicitis

Amine Ben Safta — 2025-05-01

Introduction-Aim: Acute appendicitis (AA) is the most frequent emergency among non-traumatic abdominal emergencies. The aim of this study was to identify independent predictive factors for acute uncomplicated appendicitis (UCAA) and to define a predictive score.

Methods: A retrospective study was conducted in the surgical department B of Charles Nicolle’s Hospital of Tunis from January 1, 2013 to December 31, 2014. All consecutive patients operated on for AA were included. The diagnosis was confirmed by operative findings, macroscopic and histological examination of the removed appendix. Complicated acute appendicitis (CAA) was defined by the intraoperative findings of an appendicular abscess or generalized peritonitis. The Score was developed based on a logistic regression to identify the independent and predictive factors among the pre, intra and postoperative variables.

Results: This study (335 patients) allowed us to identify the independent factors predictive of CAA, i.e. the duration of pain evolution in the right lower quadrant (OR = 1,444; 95% IC = [1,204 - 1.725]; p < 10^-3), guarding of the right lower quadrant (OR = 2.234; 95% CI = [1.051 - 4.749]; p = 0.037) and CRP > 86,8 mg/l (OR = 1.012; 95% CI = [1.008 - 1.016]; p < 10^-3). The area under the curve of the score was 0.884 with a 95% CI [0.837 - 0.980]; p < 0.001. This score was validated on a sample of 236 patients culled between January 1, 2015 to May 16, 2016.

Conclusion: Patients admitted for AA with a duration ..(abstract truncated at 250 words).

Acute Carbon Monoxide Poisoning in the Emergency Department: A Descriptive Study of 660 Cases in Tunisia

Sabrine Khelifa — 2025-05-01

Introduction: Carbon monoxide (CO) poisoning is a frequent and potentially fatal medical emergency, accounting for significant global morbidity and mortality.

Aim: This study aims to determine the epidemiological and clinical characteristics of patients presenting to the emergency department (ED) with acute CO poisoning in Tunisia.

Methods: A retrospective, descriptive, single-center study was conducted at the ED of Mahmoud Yacoub Center for Urgent Medical Assistance in Tunis over two years. Patients aged over 12 years with acute CO poisoning were included. Epidemiological data, clinical presentation, severity, laboratory findings, and management were analyzed.

Results: A total of 660 cases were included, all secondary to accidental exposure. The mean age was 35 ±15 years, with a female predominance (73%). CO poisoning was most frequent during winter (70.4%). The main source was gas water heaters (78.2%). Severe cases of CO poisoning were observed in 27.9% of patients, with neurological symptoms in 90.8% of them. The median carboxyhemoglobin level was 21% [13–29]. In univariate analysis, age ≥50, asthenia, chest pain, carboxyhemoglobin ≥25%, and hyperleukocytosis were associated with severe CO poisoning, with hyperleukocytosis remaining an independent predictor in multivariate analysis. Oxygen therapy was administered to all patients, and hyperbaric oxygen therapy was performed in 10.6%. Hospitalization was required in 21% cases. No deaths were recorded in our series.

Conclusion: CO poisoning remains a significant public health concern in Tunisia, predominantly affecting young adults, with water heaters as the leading source. Neurological and cardiac manifestations predominate in severe cases.

Physicians’ attitudes towards pharmaceutical promotion: investigation in endocrinology

Ines Kammoun — 2025-05-01

Background: Recently, special attention has been paid to the relationship between health professionals and the pharmaceutical industry, which could influence medical prescriptions. The aim of this work was to evaluate the attitude of Tunisian endocrinologists towards pharmaceutical promotion.

Methods: It was a cross-sectional study based on an anonymous 9-item survey about the attitudes and behaviors of physicians towards the pharmaceutical promotion. The study included 120 residents and endocrinology specialists.

Results: One-third of the physicians did not complete the survey. We analyzed 75 responses of 32 residents and 43 specialists. The inexpensive gifts were appreciated by most participants. Costly gifts were judged less frequently appropriate. However, these expensive gifts were received or desired by many participants.

Among residents, 9.4% thought that their prescriptions would be very influenced by the promotion while they estimated that 15.6% of their colleagues would be (p=ns). This difference was significant among the specialists: respectively 4.7% and 35.3% (p=0.002). Training about conflict of interest is insufficient according to 96.8% of residents and 97.6% of specialists (p=ns). Contact between learners and medical visitors should be prohibited according to 9.4% of residents and 36.6% of specialists (p=0.007).

Conclusions: Most participants confirmed that they had links of interest with the pharmaceutical industry, but they thought that this had no influence on their prescriptions. Many studies have shown that gifts, even small ones, are very effective in subtly influencing doctors' therapeutic attitudes. Awareness is needed to ensure an independent medical prescription.

Standardization of pathological reports of cancers: Choice or obligation?

Imen Helal — 2025-05-01

Introduction: The management of cancers requires complete and accurate pathology reports. Recent literature refers to the importance of synoptic report in cancer pathologies. In Tunisia, we still adopt the narrative report.

Aim: To evaluate the quality of narrative pathology reports of carcinomas diagnosed on surgical excision specimens at the Pathology Laboratory of Habib Thameur Hospital.

Methods: A retrospective descriptive study including pathology reports of carcinomas diagnosed on surgical excision specimens was performed at the Pathology Laboratory of Habib Thameur Hospital over four and a half years. The essential anatomopathological data to be formulated in a pathology report, set by the learned societies for each type of cancer, were recorded in the reports and analyzed using Excel and PSPP software.

Results: Five hundred and seventy-six pathology reports for nine types of carcinoma were collated. Evaluation of the anatomopathological data showed that the minimum data were 100% complete in 9% of carcinomas of the larynx, 7% of gastric carcinomas, 6.4% of thyroid carcinomas, 1.3% of colon carcinomas and 0% of carcinomas of the rectum, breast, endometrium, ovary, and kidney.

Conclusion: The low rate of completeness of narrative reports issued by our laboratory should be improved by adopting the synoptic reports to ensure that diagnostic and theranostic data are complete and, consequently, that patients are appropriately managed.

Conventional regimen versus split-dose regimen in bowel preparation: Results of a randomized controlled trial

Soumaya Nsibi — 2025-05-01

Introduction-Aim: Good bowel preparation is essential for colonoscopies. This study aimed to compare the quality of bowel preparation between the split-dose regimen (SD), recommended by European endoscopy societies, and the conventional regimen (CR) in Tunisia, where SD is not routinely adopted, and to identify factors leading to poor preparation in both groups.

Methods: We performed a randomized controlled trial, spread over four months (January-April 2019). Patients were randomly assigned to two groups at a 1:1 ratio: SD or CR.

Results: One hundred and thirty-three patients were included: 65 in the SD group and 68 in the CR group. SD showed better bowel cleansing than CR by comparing the mean Boston score in the two groups (6.05 versus 4.75, p =<0.001). Tolerance of the preparations was comparable between the groups. Factors associated with poor preparation in the SD group were constipation (p=0.04) colonoscopy indication (screening) (p=0, 01) and public transport (p=0.001). In multivariate analysis, constipation and public transport were independent factors in poor preparation with a relative risk of 4.9 and 26 respectively. For the CR group, age <65 years (p=0.022), low level of education (p=0.03) and unemployment (p=0.015) were predictive factors for poor preparation. In multivariate analysis the low level of education was an independent risk factor for poor preparation with a relative risk of 20.

Conclusion: Our study showed that SD provides better bowel preparation than CR without altering the tolerance. In addition, factors predictive of poor preparation in the SD group were modifiable, unlike those of CR.

Predictive factors of adverse outcomes of atrial fibrillation in elderly patients: Results of the National Tunisian Registry of Atrial Fibrillation (NATURE-AF)

Souhir Ouali — 2025-05-01

Introduction: Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia. Data related to its clinical characteristics, management, and predictive factors of poor outcomes in elderly in Tunisia remain scarce. We aimed to evaluate the predictive factors of adverse outcomes in the elderly at 12 months follow-up among AF patients in Tunisia including thromboembolic (TE) events, hemorrhagic events, and all-cause death.

Methods: We conducted a national, prospective, and analytic multicentric study based on NATURE-AF with a 12-month follow-up period between March 1, 2017, and May 31, 2017. We evaluated the predictive factors of adverse outcomes of AF in the elderly (≥ 75 years old).

Results: We included 915 patients with AF. We studied the elderly who represented 24% of the population. Females represented 52% of the elderly. Hypertension was present in 57% of the elderly, diabetes mellitus in 22.4%, dyslipidemia in 16%, obesity in 75.8%, chronic kidney disease in 22.8% and smoking in 13.2%. Prior TE accidents and hemorrhagic accidents happened in 12.8% and 3.7% respectively. The mean CHA2DS2-VASc score was 3.92±1.28. Vitamin-K-Antagonist was used in 59.8%. The mean TTR was 47.53±26.78. The rate control strategy was adopted in 68% of patients and beta-blockers were used in 37.9%. Hospitalization during the follow-up for adverse causes occurred in 13.4%. Adverse outcomes occurred in 19.6% including 3.2% TE events, 5% hemorrhagic events, and 11.4% deaths. After multivariate analyses, prior TE accidents (ORa=3.218; p=0.025; 95%CI [1.157-8.946]) and hospitalization during the follow-up (ORa=6.489; p=0.002; 95%CI [2.035-20.697]) were independent prognostic ...(abstract truncated at 250 words).

Adverse drug reactions and patients’ outcomes in Moroccan tuberculosis cases

Ouassima Erefai — 2025-05-01

Introduction: Tuberculosis (TB) remains a global health problem. Its treatment usually involves a combination of antibiotics over a prolonged period, exposing patients to a range of adverse drug reactions (ADRs).

Aim: To investigate the epidemiology and outcomes of tuberculosis patients in Rabat (Morocco), with particular emphasis on assessing the ADRs of treatment and factors contributing to their occurrence.

Methods: This retrospective study was conducted at Moulay Youssef Hospital in Rabat, from January 2021 to May 2022. Only patients hospitalized in the intensive phase of tuberculosis treatment, with known HIV status, and aged 15 or over were included. Sociodemographic characteristics, clinical presentations, manifestations of ADRs, and patient outcomes were analyzed. Uni- and multivariate logistic regression were conducted to identify factors associated with ADR occurrence.

Results: In this study, 144 patients were included. The mean age of patients was 45.82±19.26 years. A male predominance was observed with a sex ratio of 1.4. Almost one-third of the patients (31.5%) experienced at least one ADR during treatment, with gastrointestinal symptoms (50%) being prominent. Logistic regression identified higher ADR incidence in females (p-value=0.046, OR=2.123; 95%CI: 1.013-4.448) and patients with addictive habits (p-value=0.019, OR=3.358; 95%CI:1.478-8.419). Treatment success was observed in 64.58% of the cases, with ADRs showing no significant difference between patients with successful treatment and those with failed treatment.

Conclusion: The occurrence of ADR poses a significant challenge to tuberculosis patients, highlighting the need for personalized approaches to mitigate these complications and ensure treatment success.

Body Esteem and Associated Factors Among Tunisian Adolescents

Hela Rezgui — 2025-05-01

Introduction-Aim: Adolescents go through morphological and psychosocial changes that greatly influence body perception and body esteem. The aim of this study was to explore and describe body esteem among Tunisian adolescents.

Methods: We conducted a cross-sectional study involving 340 adolescents who attend Tunisian high school. We collected the age, sex, weight, and height of each participant and we used Tunisian validated version of BESAA, the Arabic version of Rosenberg Self Esteem Scale and the F-SCOFF questionnaire to assess each participant's body esteem, self-esteem and eating disorders respectively.

Results: We included 340 adolescents with a sex-ratio 0.7, among the 340 participants, 58.2% had a normal BMI. We found that 78.6% and 79.7% of adolescents have respectively good body esteem and high self-esteem with a similar distribution between girls and boys.

Body esteem was associated with a variety of factors, including age, self-esteem, the practice of regular sports activities and BMI, however, it was not associated with the F-SCOFF questionnaire.

Conclusions: The increasing preoccupation of teenagers with their body image makes it essential to study body esteem in this population to detect disorders that may stem from body dissatisfaction.

Ultrasound-guided Fascia Iliaca Block (FIB) in the emergency department: Efficiency and safety

Aymen Zoubli — 2025-05-01

Introduction: Hip and femoral shaft fractures are extremely painful injuries, usually occurring in
elderly, multi-talented patients who are vulnerable to opioids. In this context
ultrasound-guided locoregional analgesia (LRA) could be an interesting alternative.
Aim : To study pain variation (Delta numerical scale) in hip and
thigh trauma patients treated with ultrasound-guided Fascia Iliaca block (FIB) in the emergency department.
Methods: We conducted an observational study over a period of 10 months, including all patients aged 16 and over, who consulted us for isolated hip or thigh trauma, in whom the numeric rating scale (NRS) could be assessed. The primary endpoint was a significant reduction in pain (ΔNRS ≥2). Secondary endpoints were local or general complications and the use of rescue analgesia.
Results: Forty-two patients were included. Mean age was 66±17 years, with a sex ratio of
0.9. The mean initial NRS was 9.12±1.3. Mean NRS value was 5.6 at 30 minutes and 3.9 at 120 minutes. Eighty-five percent of patients had a significant reduction in pain after 30 minutes of IFB, and six patients required rescue analgesia with morphine. No adverse effects were recorded.
Conclusion: Ultrasound-guided FIB can be safely performed by emergency physicians in an emergency department, after appropriate training in the technique

Isokinetic evaluation of the muscular strength of the thigh in military traumatic transtibial amputees

Ghada Wechtati — 2025-05-01

Introduction-Aim :Lower limb amputation can lead to subclinical gait impairment secondary to muscle weakness. Hence the aim of our work, which was the instrumental assessment of isokinetic thigh muscle strength in traumatic military transtibial amputees.

Methods: This was a descriptive cross-sectional study carried out in physical medicine and rehabilitation department over a 6-months period. Our study included only military lower limb amputees caused by mine explosion. All patients had a functional evaluation (walking speed and the 2-minute walk test) associated to an isokinetic evaluation of the couple quadriceps(Q)-hamstring(H) on both lower limbs on the concentric mode at 90°/s, 120°/s and 180°/s.

Results: Forty patients were included. The mean age was 30.15 ± 7 years with male exclusivity. Muscle testing revealed no motor deficiencies, and all patients had thigh amyotrophy.

Functional evaluation showed a mean walking speed of 1.4 m/s ± 0.3 and a 2-minute walk test of 161 meter ± 24.6.

Q peak torque (PT) on the healthy side was greater than on the amputated side at all velocities with a significant association between PT (Q), PT(H) and Q muscle test and 2-min walk test. The ratio (H/Q) was higher for the healthy side for all velocities.

Conclusion: The quality of standing and walking depends on muscle strength of the lower limbs. Isokinetic assessment and instrumental rehabilitation should be systematically included in the management of military amputees.

Before/after epidemiological study of the impact of sleeve gastrectomy on weight response at five years

Faten Mahjoub — 2025-05-01

Introduction-Aim: Facing the failures of the medical management of obesity, bariatric surgery offers a promising therapeutic option. The aim of our study was to study the evolution of anthropometric parameters five years after sleeve gastrectomy.

Methods: This was a prospective longitudinal descriptive study conducted at the obesity research unit of the National Institute of Nutrition in Tunis on obese patients who had undergone weight loss surgery. At 5 years post-operatively, the patients answered questionnaires assessing eating behavior, eating disorders, taste, smell, appetite, food preferences and anxiety-depressive disorders and the anthropometric parameters were measured.

Results: We included 30 patients aged 43.2 ± 9.57 years. The average weight increased from 133.04 ± 18.36 kg to 94.63 ± 19.81 kg after five years, an average weight reduction of 28.8% compared to the initial weight (p<10-3). We noted a statistically significant negative correlation between preoperative fat mass and excess weight loss (PEP) (r=-0.79; p<10-3). The correlation between the depression score and the PEP was statistically significant, the higher the depression score, the lower the PEP (r= -0.48; p=0.007). However, no statistically significant correlation was found between anxiety score and PEP.

Conclusion: The mid-term weight loss results after sleeve gastrectomy were satisfying. However, it would be interesting to continue the research with larger-scale studies.

The implementation of a manual pretreatment phase increases the efficacy of automated reprocessing procedures in postprocedural bronchoscopes

Lamia Melalka — 2025-05-01

Introduction: The reprocessing of flexible endoscopes has become a major research topic in

recent decades. The risk of endoscopy-related bacterial, fungal or viral outbreaks is increasing,

particularly those involving multi-resistant strains.

Aim: The aim of the present study was to assess the importance of implementing a manual pre-

treatment phase in conjunction with HDL (High Level Disinfection) cleaning using a Steelco

automated washer-disinfector. The aim of the study was to determine whether neglecting the

manual pre-treatment phase, despite the use of a high-quality automated disinfector, leads to the spread of biofilms and of germs likely to cause healthcare-associated infections.

Methods: To achieve this objective, an extensive microbiological sampling process was carried

out on bronchoscopes under normal cleaning and disinfection conditions prior to the introduction

of the pre-treatment phase.

Based on the results of these samplings, the Quality Control Circle (QCC) team proceeded to

identify and analyze potential causes using the ISHIKAWA diagram during brainstorming

sessions, following which microbiological sampling of the bronchoscopes after implementation

of the results of the cause analysis was carried out.

Results: The results indicate complete elimination of bacterial strains after implementation of

manual pretreatment followed by automated treatment, in line with international disinfection

standards.

Conclusion: The implementation of a pre-treatment phase followed by a Steelco

automated washer-disinfector significantly reduced microbial contamination in bronchoscopes.

Nutritional profile of diabetic women at two months postpartum

Chaima Sdiri — 2025-05-01

Background: The mother's diet may have an impact on the quantity and/or quality of the milk produced. The aim of our study was to evaluate the nutritional profile of a group of diabetic women consulting at two months postpartum.

Methods: We conducted a descriptive observational cross-sectional study in women with type 1 and type 2 diabetes followed at the National Institute of Nutrition and Food Technology of Tunis. Each patient underwent an anamnesis, a clinical examination, and completed a food questionnaire.

Results: Fifty-two patients were included in the study. The mean age of patients was 35.4±0.4 years, with extremes ranging from 23 to 44 years. The majority (80%) had type 2 diabetes, while 20% had type 1 diabetes, diagnosed before pregnancy. We noted exclusive and partial breastfeeding rates of 44% and 33%, respectively. Women who exclusively breastfed their babies had a lower caloric intake compared to women who did not breastfeed or partially breastfed their babies(p<0.001).

Nearly half of the women had a hypercarbohydrate and hyperprotein diet, regardless of breastfeeding modality. Half of the non-breastfeeding women had a hyperlipidic diet, whereas only 25% of the breastfeeding women had an excessive lipid intake. Most patients had an insufficient intake of magnesium, potassium, vitamin B9, dietary fiber, and water.

Conclusion: These findings highlight the importance of nutritional education for all breastfeeding diabetic women.

Epidemiological study on nasopharyngeal cancer in Morocco: Case of the University Hospital Center Mohammed VI in Marrakech.

Kaoutar Anejdam — 2025-05-01

Introduction: Globally, nasopharyngeal cancer has a varied geographic distribution, occurring more frequently in certain areas and less often in others (1).

Aim: This article presents the epidemiological situation of this cancer in the Marrakech-Safi region, Morocco.

Methods: Our retrospective study analyzed the epidemiological profile of nasopharyngeal cancer in the Marrakech-Safi region (Morocco) based on 226 cases evaluated at the University Hospital Center MOHAMMED VI of Marrakech from 2014 to 2018. We used descriptive and analytical statistics to create this profile.

Results: The cases studied were 61.9% male (140 cases), and 38.1% female (86 cases), with a mean age of 47.95 ± 16.54 years and a sex ratio of 1.62 (p <0.001). The majority, 76.5%, were married, 16.4% single, 5.8% widowed and 1.3% divorced. The Medical Assistance Plan (RAMED) was the most widespread medical coverage (86.73%). The provinces most affected were Marrakech (42.92%), Safi (10.62%) and El Kelaa (9.73%). These cases were without profession (55.31%), housewives (13.72%), farmers (7.08%), and workers (3.98%). This may be due to the multifactorial etiology of the disease, including occupational exposure to chemical carcinogens.

Conclusions: The study reveals the incidence of nasopharyngeal cancer and identifies the age group most affected in the region studied, highlighting a link with formaldehyde. Further studies are recommended to determine the probable risk factors for this cancer.

Quality of life and associated factors in tunisian postpoliomyelitis syndrome patients

Houda Migaou — 2025-05-01

Introduction: Postpoliomyelitis syndrome (PPS) is defined as secondary onset of new neuromuscular symptoms, following recovery from an initial episode of Acute Anterior Poliomyelitis with no other possible causes, which may lead to altered quality of life.

Objective: To assess the quality of life (QoL) of Tunisian PPS patients and determine its associated factors.

Methods: A cross-sectional study conducted over a 24 month period. Sociodemographic variables as well as clinical data evaluating the severity of PPS and QoL were collected using SF-36 scale. Associations between different clinical variables and QoL were studied.

Results: We included 45 patients with a mean age of 52.4 ± 7.5 years. All aspects of QoL were affected. The most affected domain was PF with an average score of 32.5±11.8. QoL was better for the mental component (MCS) compared to the physical component (PCS) with mean scores of 43.7±7 and 35.6±12.1 respectively. The alteration of the PF and MH domains was significantly associated with MCS score (p = 0.01 and r = -0.38) and increased BMI (p = 0.04; r = -0.31). Pain intensity was associated with an alteration of all the domains of QoL except for the RP domain. QoL was significantly associated with Functional capacity (p = 0.018 and r = 0.35) and vitality (p = 0.038; r = 0.31).

Conclusion: All aspects of QoL were affected in PPS patients. The general PCS component was the most affected and the PF domain was the most affected.

Quality assessment of labile blood products: An experience from a tertiary care hospital

Najeh Sghair — 2025-05-01

Introduction-Aim : Quality control of blood products (BP) is a fundamental element in guaranteeing transfusion efficacy. The aim of our study was to evaluate the quality of red blood cell concentrates (RBCs) and fresh plasma (FP) produced at the Zaghouan blood bank, with reference to the requirements of the guide to good transfusion practices and international standards.

Methods : This is a cross-sectional study carried out at the Zaghouan blood bank. The first six bags of whole blood collected were selected. The volume of RBCs and FP were measured with an electronic balance and the hematocrit rate and hemoglobin content of RBCs were determined using a Mindray BC-5800 automated system.

Results : According to Tunisian standards, RBC volume, haemoglobin content, and haematocrit were compliant in 94.25%, 60.75%, and 95.5% of cases, respectively. These parameters met the European standards in 91.5%, 60.75%, and 44% of cases, respectively. The volume of 300 FPs complied with 93.6% and 100% of the European and Tunisian standards, respectively. Among 400 RBC units, 60.75% and 41.25% were compliant with Tunisian and international standards, respectively.

Conclusions : Quality control enabled us to identify non-conformities in the RBCs produced. We therefore recommend adjusting the volume of plasma extracted after whole blood centrifugation, including pre-donation haemoglobin levels in donor eligibility criteria, and extending the interval between two successive donations.

Predictive factors of significant fibrosis in metabolic dysfunction-associated steatotic liver disease

Asma Mensi — 2025-05-01

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), now recognized as one of the leading causes of chronic liver disease, affects more than 25% of the global population. The degree of fibrosis is the primary predictor of hepatic and extra-hepatic morbidity and mortality, becoming significant when fibrosis reaches or exceeds stage F2, a condition referred to as "At-risk MASH."

Aim: To investigate factors contributing to fibrosis progression in patients with MASLD.

Methods: We carried out a retrospective study in the Hepato-Gastroenterology Department at Charles Nicolle Hospital in Tunisia from 2016 to 2022, including 202 patients with hepatic steatosis confirmed by abdominal ultrasoundwith at least one cardiometabolic risk factor. Fibrosis assessment was performed using FibroScan®. Significant fibrosis was defined as hepatic fibrosis ≥ F2.The association between various studied variables and significant fibrosis was assessed using the Chi-square test and Fisher's exact test.

Results: A total of 202 patients with MASLD were included. Their average age was 56.14±10.98 years, with a male-to-female ratio of 0.43. The average liver stiffness measurement was 7.36±7.18 kPa. The distribution of fibrosis stages was: F0-F1=79.7%, F2=5.4%, F3=5%, and F4=9.9%. In univariate analysis, several parameters were significantly associated with significant fibrosis (≥F2): older age (p=0.028), type 2 diabetes (p=0.03), hypertension (p=0.037), elevated levels of AST (p<0.001), ALT (p<0.001), GGT (p<0.001), and fasting glucose (p=0.047). Lower platelet count (p<0.001), prothrombin time (p=0.001), and albumin levels (p=0.039) were also significantly associated with significant fibrosis. In multivariate analysis, age >52 years, elevated GGT levels (>41 U/L), ...( abstract truncated at 250 words).

Actinomycosis: A diagnosis not to be forgotten

Salma Ben Hmida — 2025-05-01

Introduction: Actinomycosis is a bacterial infection that presents a significant diagnostic

challenge for clinicians due to its rarity and chronic progression. Diagnosis is usually made

through pathological or microbiological examination, sometimes at the cost of unnecessary

and costly interventions.

The aim of this study is to illustrate the diagnostic difficulties of this pathology and to evaluate its therapeutic and progression aspects.

Methods: This is a retrospective study of actinomycosis cases collected between 1991 and 2023.

Results: We collected 17 cases of actinomycosis. They were 7 men and 10 women, with a

sex ratio (M/F) of 0,7 The mean age was 43 ±13 years. The mean time to diagnosis was 110

(30-540) days. The different locations were cervicofacial (7 cases), abdominal (2 cases),

pelvic (1 case), cerebral (3 cases), and disseminated (3 cases). The diagnosis was made

microbiologically in 4 cases and pathologically in 13 cases. The mean duration of antibiotic

therapy was 18 (3-35) days. Eight patients received surgical treatment associated with

antibiotic therapy. The outcome was favorable in 16 cases.

Conclusion: Actinomycosis can be confused with tumors or infections due to its variable

clinical presentation. Anatomopathological examination plays a crucial role in the diagnosis.

Prompt and appropriate treatment leads to a favorable prognosis, highlighting the importance

of enhanced awareness of this condition to optimize disease management.

Hemovigilance and transfusion-related incidents in recipients: Frequency, etiologies, and improvement proposals

Houda Romdhane — 2025-05-01

Introduction-Aim : Blood transfusion can lead to transfusion-related incidents with varying degrees of severity. The aim of this study is to determine the frequency and causes of transfusion-related incidents, as well as to propose corrective actions to improve the hemovigilance system.

Methods : This is a descriptive, retrospective study conducted over a period of 4 years (from January 2019 to December 2022) at the regional blood transfusion center of Sousse. From the hemovigilance register and the patients' digitized transfusion records, socio-demographic, immuno-hematological, and clinical data were collected on a form specifically designed for this purpose.

Results : A total of 143 transfusion-related incidents were recorded. Red blood cell concentrates were the most implicated in these incidents (84,6%). The transfusion incident report form was used in 46,8% cases and was poorly filled out in 49,2% cases. The majority of patients came from hospitals (74,8%), with the pediatric department accounting for the largest share(26,1%), while private clinics reported 25,1% transfusion-related incidents. The average age was 36,2 years, with a female predominance (61,5%). The most common transfusion-related incident was non-hemolytic febrile reactions (40,5%), followed by allergic reactions (17,5%). Most transfusion-related incidents were benign (88,1%), although 3 deaths were reported.

Conclusion : This study revealed some gaps in the reporting of transfusion-related incidents. It is essential to plan a restructuring of the hemovigilance network with qualified personnel and continuous training

Quality improvement in hemodialysis: A systematic review

Abdelmounir El bachiri — 2025-05-01

The predominant modality of renal replacement therapy, hemodialysis (HD), is a specialized area associated with a heightened susceptibility to infections, partly due to patients' vulnerability, the invasiveness of procedures necessitating vascular access, and the cyclical nature of the treatment. These factors, along with a notable incidence of infections, present a significant public health challenge owing to their implications on both human health and economic resources.

Mortality rates in dialysis patients are markedly elevated, typically ranging from 10 to 20%, primarily linked to cardiovascular (40%) and infectious (10%) etiologies. Enhancing the caliber of care, patient safety, and clinical outcomes represents a pivotal focal point for healthcare systems globally. Nevertheless, could the adherence to universally acknowledged and validated benchmarks engender variability in outcomes within hemodialysis environments? Can interventions aim at improving quality lead to positive outcomes by reducing infections and improving results for patients undergoing hemodialysis? To respond to these inquiries, a systematic review based on the PRISMA guidelines was carried out over 14 years across various databases, identifying cases of quality improvement initiatives and detailing their effectiveness in infection prevention and quality-centred approaches to risk management. Multiple forms of interventions aimed at enhancing quality have been outlined and considered relevant, including (i) integrating the PDCA (Plan-Do-Check-Act) cycle with oversight of risk factors, (ii) utilizing the Failure Mode, Effects, and Criticality Analysis (FMECA) framework, (iii) applying LEAN management principles, and (iv) strictly following the guidelines established by the Centers for Disease Control and Prevention (CDC) and the kidney disease..(abstract truncated at 250 words).