La Tunisie Médicale

Effects of Yoga-Like Exercises on Mild and Moderate Alzheimer Disease: A Randomized Controlled Trial Protocol

Rihab Moncer — 2025-01-02

Background: While aerobic exercises have demonstrated efficacy in slowing cognitive decline and improving psychological symptoms associated with cognitive impairments, they may not be feasible due to multiple disabilities. Other gentle exercises with mindful approaches, such as “Yoga-like”, have been explored but lack clear evidence.

Aim: To assess the efficacy of a "Yoga-like" intervention on cognitive and psychological features in patients with mild to moderate Alzheimer Disease (AD).

Methods: We propose a randomized controlled trial design. Patients with mild to moderate AD who are able to undergo neurocognitive assessment and do not have conditions contraindicating deep breathing or extreme postures will be randomly assigned to an intervention group (IG: Yoga-like) or a control group (CG: no intervention). The ‘Yoga-like’ intervention consists of 30 minutes of exercises combining breathing, postures, concentration, and meditation, conducted three times a week over eight weeks. Both groups will undergo neuropsychological tests at baseline and after eight weeks, including attention, problem-solving, visuospatial abilities, mood and neuropsychiatric symptoms.

Expected results: It is anticipated that the breathing, concentration, and meditation components of the intervention will improve attention, problem-solving abilities and behavioral symptoms. The postural components are expected to enhance visuospatial control and balance.

Predatory Journals: What Can We Do to Protect Their Prey?

Christin Laine — 2025-01-06

Tunisian Recommendations for Best Practices in the Management of Spondyloarthritis: Methodology

khadija Baccouche — 2025-01-02

This framework was developed under the auspices of the Tunisian League Against Rheumatism (LITAR), coordinated by a project leader. The primary objective is to formulate recommendations for the management of spondyloarthritis, grounded in the development of questions structured according to the PICO model. This model defines four essential elements of a clinical question: P: Patient or Population or Problem, I: Intervention (the proposed action), C: Comparison (between diagnostic tests, treatments, etc.), and O: Outcome (clinical results, measured events, judgment criteria, etc.). A working group was established, coordinated by a project leader appointed by LITAR. This group included rheumatologists recognized as experts in the disease by the scientific community, as well as a methodological and epidemiological rheumatologist. The bibliographic search focused on international literature (meta-analyses, randomized controlled trials, cohort studies, case-control studies, etc.) and other sources of information (HAS, clinical practice guidelines), as well as national literature (theses, dissertations, publications, conference presentations). In-person and virtual meetings of the working group enabled the formulation of the recommendations, following the presentation of literature data and extensive discussions among the experts. The draft of the recommendations was submitted to the same experts for validation and assessment of the level of agreement, which determined the strength of the recommendations. Subsequently, the recommendations were reviewed by a reading group appointed by the working group. The final version was adjusted based on feedback from both groups.

Tunisian recommendations for the diagnosis and evaluation of Spondyloarthritis

Wafa Hamdi — 2025-01-02

Advancements in understanding SpA have greatly improved patient quality of life through early detection and effective treatment. However, non-specialist physicians often face challenges in identifying the early symptoms of SpA.

Aim: This study aims to assist healthcare practitioners in the early detection of SpA and to streamline management strategies by employing a standardized assessment protocol for adult patients with SpA. LITAR collaborated with fifteen rheumatologists to adhere to INEAS guidelines. The team created a comprehensive repository based on seven PICO questions and their answers. To create this repository, the team combined local Tunisian data and insights from relevant literature sources using a synthesis method.

Results: This research culminated in the formulation of twelve evidence-based recommendations for best practices, encompassing three critical domains. Firstly, it addresses the clinical indications and signs that should alert primary care physicians to consider a SpA diagnosis and promptly refer patients to rheumatologists. Secondly, it outlines the diagnostic procedures involved in confirming SpA. Lastly, it presents standardized methods for evaluating and monitoring the progression of SpA. To ensure the robustness of these recommendations, an independent reading group of 19 experts from various related specialties validated them. Subsequently, a panel of 54 Tunisian rheumatologists practicing in diverse sectors, including public health, academia, and the private sector, evaluated the strength of these recommendations. The strength ratings ranged from 8 to 9, with a degree of agreement spanning from 72% to 100%.

Conclusion: This guideline, developed with the support of LITAR and accredited by INEAS,...(abstract truncated at 250 words)

Tunisian recommendations of good practice for the therapeutic management of spondyloarthritis (excluding biological treatment)

Ahmed Laatar — 2025-01-02

Aim: To develop good practice recommendations (GPR) for the therapeutic management of patients with spondyloarthritis (SpA), including psoriatic arthritis.

Methods: Following standardised procedures, a systematic review of the literature was carried out on non-pharmacological and non-biological pharmacological treatments for SpA. The review was based on questions defined by a working group of 15 rheumatologists. The data was evaluated at group meetings, which led to the drafting of recommendations, the assignment of a grade to each recommendation and the determination of the level of agreement between the experts.

Results: A general principle and 11 recommendations were developed. The recommendations focus on treatment modalities, taking into account the dominant phenotype (axial, articular peripheral, enthesitic peripheral) and extra-articular manifestations (psoriasis, chronic inflammatory bowel disease (IBD)). The first recommendation concerns therapeutic patient education. Recommendations 2 to 4 focus on NSAIDs as the first-line pharmacological treatment for the various presentations of the disease, with the exception of those associated with IBD, as well as their prescribing modalities. Recommendation 5 deals with analgesics. Recommendation 6 limits the use of glucocorticoids to symptomatic peripheral arthritis and advises against their long-term use. Recommendation 7 deals with radioisotope synoviorthesis for refractory arthritis of the hips and knees. Conventional Synthetic Disease-Modifying AntiRheumatic Drugs (csDMARDs) are not recommended for SpA which is axial, enthesitic or involves dactylitis (recommendation 8). JAK inhibitors are recommended for axial SpA and for joint and skin involvement of psoriatic arthritis in failure of symptomatic treatment, csDMARDs and/or bDMARDs (recommendation 9). The latest ...(abstract truncated at 250 words).

Tunisian Good Clinical Practice Recommendations for the Management of Spondyloarthritis by Biological Agents

Rawdha Tekaya — 2025-01-02

Aim: To elaborate Tunisian recommendations for the therapeutic management in current practice of patients with spondyloarthritis who are candidates for treatment with a biological agent.

Methods : Following the standardized procedures of the INEAS (Instance Nationale de l'Evaluation et de l'Accréditation en Santé) and in collaboration with the LITAR (Tunisian League against Rheumatism), a systematic review of the literature, carried out by 6 rheumatologists, based on the questions individualized by the working group (15 expert rheumatologists), served as the basis for the working meetings, with determination of the strength of the recommendations and the degree of agreement of the experts. The recommendations were validated by an independent reading group comprising 19 experts from various related specialties.

Results: Ten recommendations for good practice were drawn up. The first 2 recommendations concern the pre-therapeutic assessment and the updating of immunisation status prior to the initiation of biotherapy. Recommendations 3 to 8 deal with the use of biologics, including the new classes, in their indications (active disease despite conventional treatment, and for non-radiographic axial forms, presence of objective signs of inflammation) and follow-up, and their management in the event of failure or in remission. Recommendations 9 and 10 concern management in the event of pregnancy or neoplasia. The strength of the recommendations ranged from 8 to 9, with a degree of agreement of between 72% and 100%.

Conclusion:This work, supported by LITAR and accredited by INEAS, takes into account the data in the literature and the predominant clinical presentation....( abstract truncated at 250 words).

An unusual cause of hypertrophic cardiomyopathy in an infant: A case report

Faiza Safi — 2025-01-02

Introduction: Nemaline myopathy (NM), also known as Nemalinosis, is a rare congenital muscle disease with an incidence of 1 in 50000. It is characterized by nemaline rods in muscle fibers, leading to muscle weakness. We reported a case of NM revealed by cardiac involvement, and we highlighted the challenges in diagnosing this condition as well as its poor prognosis.

Observation: The patient is a 7.5-month-old infant from a consanguineous marriage, with a history of bronchiolitis and psychomotor retardation. The infant was admitted to the paediatric intensive care unit due to respiratory distress, which necessitated intubation and mechanical ventilation. A chest X-ray revealed cardiomegaly and bilateral bronchial syndrome, while an electrocardiogram showed left ventricle hypertrophy. Emergency echocardiography revealed biventricular hypertrophy. Laboratory tests indicated significant rhabdomyolysis, hepatic cytolysis, microcytic hypochromic anaemia, negative troponins, and respiratory acidosis. The enzymatic activity of acid alpha-glucosidase was inconclusive. Genetic analysis for mutations in exon 2 associated with Pompe disease and congenital muscular dystrophy, the most common differential diagnoses, returned negative results. Given the presence of rhabdomyolysis, the emergence of tongue fasciculations, and pronounced axial and peripheral hypotonia, a muscle biopsy was performed. This revealed the presence of nemaline rods, confirming the diagnosis of NM. The patient’s condition deteriorated, marked by extubating failure due to severe muscle weakness. The infant passed away after 50 days of hospitalization.

Conclusion: This case underscores the severity and complexity of NM revealed by hypertrophic cardiomyopathy, emphasizing the importance of early diagnosis and prenatal genetic counseling.

Diagnosis of an Immunoglobulin D multiple myeloma with severe renal involvement a decade after a solitary plasmacytoma: A case report and literature review

Sanda Mrabet — 2025-01-02

Introduction: Immunoglobulin D (IgD) myeloma is a rare subtype often described as aggressive with advanced disease at diagnosis. Primary renal involvement is seen in scarce cases.

Observation: This case features a 55-year-old man with IgD lambda myeloma presenting severe renal failure at diagnosis. Examination revealed a 10-year-old sternal plasmacytoma and multiple others in the ribs. Despite benefiting from traditional chemotherapy, he remained dependent on hemodialysis

Conclusion: Through this case, unique in the literature, we conclude that plasma cells secreting IgD can remain inactive for a long time in the form of a solitary plasmacytoma. However, in the event of medullary involvement, they can induce a myeloma with serious organic lesions.

High performance COVID-19 screening using machine learning

Youssef Zied Elhechmi — 2025-01-02

Since the World Health Organization declared the Coronavirus Disease 2019 (COVID-19) pandemic as an international concern of public health emergency in the early 2020, several strategies have been initiated in many countries to prevent healthcare services breakdown and collapse of healthcare structures. The most important strategy was the increased testing, diagnosis, isolation, contact tracing to identify, quarantine and test close contacts. In this context, finding a rapid, reliable and affordable tool for COVID-19 screening was the main challenge to address the pandemic. Molecular diagnosis by reverse transcriptase polymerase chain reaction (RT-PCR), even though considered as the gold standard in the diagnosis of COVID-19, was time consuming and therefore does not fit the objective of rapid screening. In addition, serological tests to detect anti-severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) antibodies suffered from low sensitivity. Prediction models based on machine-learning (ML) that combined several clinical features to estimate the risk of COVID-19 have been developed. To address these screening challenges, we created a ML model (MLM) based on gradient boosting method. We included several clinical features and the daily geographic prevalence of COVID-19 cases in the MLM. The MLM was trained on 1554 cases (757 COVID-19), and tested on 547 cases (169 COVID-19). Our MLM successfully predicted RT-PCR positivity with an accuracy of 97.06%. Moreover, the variable sensitivity and specificity of our MLM depending on the disease geographic prevalence has introduced the concept of “dynamic” disease screening....(abstract truncated at 250 words).

Student interest and perception of ethical reasoning learning: Insights from medical education

Mehdi Somaï — 2025-01-02

Introduction: Medical ethics teaching is one of the pillars of medical education. Ethical

reasoning learning (ERL) is one of the means of teaching medical ethics.

Objective: The aim of our study was to evaluate the pedagogical interest and the students’

perceptions of ERL in directed teaching in internal medicine among fifth-year students.

Methods: This was a cross-sectional study conducted in the Internal Medicine Department of

Habib Thameur Hospital during one academic year. The pedagogical interest and the student's

perception were evaluated by comparing a pre-test and a post-test filled in by the students,

respectively, before and after an ERL session.

Results: Our study included 44 students. Before the ERL session, almost two-thirds of the

students (63.6%) found the ERL to be "extremely interesting" in medical training and practice.

This extremely high level of educational interest in the ERL was statistically associated with

previous participation in ERL sessions among our students. Prior to the ERL session, just over

four-fifths of the students (84.1%) had a "favourable" perception of the ERL.

After the ERL session, our study noted an improvement in students' pedagogical interest in

ERL. Our study also showed an improvement in students' perceptions of the ERL. The

improvement in students' pedagogical interest and perception of ERL exceeded 80% after the

session.

Conclusion: Our study concluded that there was a significant pedagogical interest and a

favourable perception of the students’ point of view regarding the ERL in internal medicine-

directed teaching among fifth-year medical students.

The primary mechanisms underlying atopic dermatitis

Sara Missaoui — 2025-01-02

Introduction: Atopic dermatitis (AD) is a complex skin disease frequently linked with other atopic symptoms such allergic rhinitis and asthma. The disease's history consists of persistent relapses with extreme pruritus, which lowers quality of life. AD has become a global health concern as its incidence has increased over the last few decades. It ranks as the third most common dermatologic disorder.

Aim: There are several open questions about the mechanisms underlying atopic dermatitis (AD), This review aims to emphasize the recent advances in scientific research regarding the pathophysiologic mechanism of AD and the clinical application of these factors.

Methods: A PubMed search was performed using the keywords “Atopic Dermatitis (AD)”,

“epidemiology”, “clinical presentation”, “diagnosis”, “pathophysiology”, “genetic defect”, “impaired skin barrier”, “immune dysregulation”. The search strategy included meta-analyses, clinical trial, observational studies, and reviews.

Results: Atopic dermatitis affects over 2 million children worldwide, with a lifetime incidence of up to 20%.

New data suggest that its incidence is still growing, particularly in low-income nations. AD is diagnosed clinically using the patient's medical history, particular clinical symptoms, and the elimination of other non-inflammatory skin conditions. The pathogenesis of AD is extremely complicated and involves several etiologies, including genetics, the microbiome, abnormalities in the skin barrier, along with dysfunctional innate and adaptive immune systems.

Conclusion: Recent research has improved our understanding of disease pathophysiology in atopic dermatitis.

Current and future clinical trials are expected to continue clarifying this complex and heterogeneous skin disease, and to develop medications that promise more effective therapy, particularly for individuals with limited response to ...(abstract truncated at 250 words)

Comparison of Mesotherapy and Transcutaneous Electrical Nerve Stimulation (TENS) in the Management of Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial

Najla Mouhli — 2025-01-02

Introduction-Aim: Chronic low back pain affects 80% of individuals at some point in their lives and has significant socioeconomic impacts. This study aims to compare the efficacy of mesotherapy with transcutaneous electrical nerve stimulation (TENS) in treating chronic low back pain.

Methods: A randomized bicentric study was conducted at the Military Hospital of Tunis and the Multidisciplinary Military Polyclinic of Mefeteh Saadallah between August 2023 and June 2024. Sixty patients (40 men and 20 women) with chronic low back pain were included. Group 1 (TENS) received 6 sessions of neurostimulation twice a week for 3 weeks. Group 2 (mesotherapy) received 3 sessions of mesotherapy. Measurements included pain, analgesic consumption, physical examination, Oswestry Disability Index, Hospital Anxiety and Depression (HAD) score, and patient satisfaction.

Results: Out of 293 patients consulted, 60 were included and randomized. Both groups showed significant pain improvement (p<0.001) with no notable difference between them (p=0.05). Analgesic consumption decreased more significantly with mesotherapy (p<0.001). Improvements in physical examination, Oswestry score, and HAD score were significant in both groups without significant differences between them. Patient satisfaction was high in both groups with an average score of 88/100 for TENS and 77/100 for mesotherapy (p=0.154).

Discussion: Mesotherapy and TENS are effective in treating chronic low back pain, reducing pain and improving functional and psycho-emotional scores with no significant difference between them. Mesotherapy reduces analgesic consumption more. Further studies are needed to confirm these results.

Prevalence of pathogenic variants of inborn errors of immunity in critically ill children admitted to the pediatric intensive care unit for sepsis: A Moroccan cohort study

Ouissal Aissaoui — 2025-01-02

Introduction: Pediatric sepsis remains a leading cause of morbidity and mortality in Africa. Nearly half of pediatric sepsis deaths occur in previously healthy children. The role of inborn errors of immunity (IEI) in susceptibility to sepsis is yet to be identified and their prevalence amongst previously healthy children admitted to the pediatric intensive care unit (PICU) is unclear. We aimed to assess prevalence of IEI among a cohort of children admitted to the PICU for community acquired sepsis and to describe demographic, microbiological, and genetic features of this cohort.

Methods: We listed a cohort of children admitted to our PICU for sepsis from January 2021 to March 2023. Demographic data was collected, and microbiological tests were performed. Written consent was obtained and whole exome sequencing (WES) was performed after DNA extraction.

Results: Thirty cases were included. Mean age at admission was 46 months (1-180), microorganisms were identified in 20 cases (66%). Bacterial sepsis was identified in 8 cases, viral sepsis in 6 cases and fungal sepsis in 2 cases. Mean pediatric sequential sepsis related organ failure assessment (pSOFA) score at admission was 6,46 (2-18). Mechanical ventilation was necessary in 18 cases. Inotropes were used in 17 cases and renal replacement therapy initiated in 3 cases. Pathogenic variants of IEI were identified in 5 out of 30 cases (17%). These variants were identified in the following genes BACH2, TLR7, TINF2, NFK2B and MAGT1. Overall mortality was 50% and mean intensive care unit (ICU) stay ....(abstract truncated at 250 words)

Work-related open globe injuries: demographic characteristics and prognostic factors in southern Tunisia

Amel Ben Abid — 2025-01-02

Introduction: Work-related open-globe injuries are a major cause of preventable vision loss worldwide with a significant socioeconomic impact.

Aim: To describe the demographics and clinical characteristics, identify the prognostic factors of work-related open-globe injuries and suggest preventive measures to minimize the incidence of these accidents.

Methods: A retrospective study of patients hospitalized in the Ophthalmology Department of Habib Bourguiba University Hospital, Sfax, Tunisia, for occupational open-globe injuries, between January 2020 and December 2022.

A medical history and a complete ophthalmological examination were performed on all patients. Initial visual acuity (IVA) was systematically measured. We also studied the factors associated with poor final visual acuity (FVA). Poor visual prognosis was defined as an FVA of less than 1/10 six months after the trauma.

Statistical analysis was performed using the system of Statistical Products and Services Solution (SPSS 26.0). A p-value less than 0.05 indicated statistical significance.

Results: Thirty-three eyes of 33 patients with work-related open-globe injuries were analyzed. The mean age was 39 ± 11.75 years, with male predominance. Almost half of them, 48.5% were welders. Mechanism of injury was penetrating trauma in 72.7% of cases. The mean presenting IVA was 1/25. Corneal wounds were present in 20 cases. Traumatic cataract was the most common associated lesion and was found in 36.4% of the patients. Intraocular foreign body was noted in 24.2%. The mean FVA was 1.6/10. Initial VA (p=0.04) and VH (p=0.004) was the significant predictive factors for final visual outcome in work-related ..( abstract truncated at 250 words)

Risk factors of the appearance of anencephaly in Tunisia

Kaouther Nasri — 2025-01-02

Introduction: Anencephaly is a serious developmental defect of the central nervous system in which the brain and cranial vault are grossly malformed. The cerebrum and cerebellum are reduced or absent, but the hindbrain is present. Anencephaly is a part of the neural tube defect spectrum. This defect results when the neural tube fails to close during the third to fourth weeks of development, leading to fetal loss, stillbirth, or neonatal death.

Aim: To find out probable principal risk factors for the appearance of anencephaly.

Methods: This study was conducted to compare between pregnancies affected by anencephaly in 2002-2011 with those notified in the period 1991–2001. Statistical analysis was undertaken using chi-squared tests.

Results: Results had shown that anencephaly fetuses with a weight less than 1500 g were significantly higher in the period 2002-2011 than in 1991-2001 (P=0.003; OR= 4.32; CI= 1.62-11.53). Anencephaly cases aged more than 20 weeks of gestation (WG) were statistically elevated than cases aged less than 20 WG (P= 0.003). Maternal parity was associated with the appearance of anencephaly, where uni- or multiparous cases mothers were more likely to have an offspring with anencephaly than nulliparous mothers. Consanguinity presented a significant risk factor for the occurrence of anencephaly (P= 0.003). A logistic regression was run to examine the impact of several variables, only the maternal age was statistically significant.

Conclusion: This study clarified fields where efforts should be intensified, and surveillance data developed to prevent this malformation.

Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of outcome in acute heart failure

Saoussen Antit — 2025-01-02

Introduction Acute heart failure (AHF) is a life-threatening condition that requires swift diagnosis and tailored management to enhance patient outcomes. In the pursuit of more precise prognostic indicators, Tricuspid Annular Plane Systolic Excursion (TAPSE) and Pulmonary Arterial Systolic Pressure (PASP) have emerged as potential significant advancements. The TAPSE/PASP ratio, a novel parameter, has recently gained attention as a promising predictor of outcomes in acute heart failure.

Aim: This study delves into the significance of TAPSE/PASP as a predictive tool, shedding light on its potential to revolutionize the landscape of AHF management.

Methods: We included 152 patients with AHF. Echocardiographic evaluation for left ventricle systolic and diastolic function was performed at the time of admission. RV functions were evaluated by calculating the following (TAPSE, PASP, TAPSE/PASP ratio). Data were analyzed to find the predictors of mortality and/or rehospitalization.

Results: The TAPSE/PASP ratio emerged as a significant independent predictor of clinical outcomes in AHF patients (HR=2.6; 95%CI: 1.04-6.47; p=0.04). Furthermore, it was the sole predictor of rehospitalization for AHF (HR=3.97; 95%CI: 1.38-11.40; p=0.01). It also independently predicted all-cause mortality in AHF, with an HR of 2.73 (95% CI: 1.25-9.12; p=0.03). When evaluating its predictive accuracy, the TAPSE/PASP ratio with a cutoff value <0.35 mm/mmHg demonstrated a sensitivity of 65%, specificity of 70%, and an area under the receiver operating characteristic curve of 0.70 for forecasting adverse outcomes.

Conclusion: The non-invasive TAPSE/PASP ratio is an independent predictor of mortality and /or rehospitalization in patients with acute heart failure.

Microbiological profile of ascitic fluid infection at Mohammed VI University Hospital in Oujda: A prospective and descriptive study

Kaoutar Ghomari — 2025-01-02

Introduction-Aim: Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients and is associated with a high mortality rate. The aim of this study is to determine the epidemiological and bacteriological profile of spontaneous bacterial peritonitis, as well as antibiotic resistance among hospitalized patients at CHU Mohammed VI, in order to guide empirical antibiotic choices for better management.

Methods: This is a prospective study conducted over a period of 12 months, from January to December 2023, focusing on all requests for bacteriological examination of ascitic fluid samples. All samples received at the microbiology laboratory were processed according to the Medical Microbiology Reference Standard (Remic)

Results: A total of 137 ascitic fluid samples were included. The main etiologies implicated in ascites were cirrhosis (50.36% of cases), followed by neoplastic pathology (24.1% of cases). The prevalence of spontaneous bacterial peritonitis was 13.87%, of which 63.16% corresponded to neutrocytic ascites with negative culture. The rate of bacterascite was 74.07%. Gram-positive cocci constituted the majority of pathogens (56.67%), with 43.33% corresponding to Gram-negative bacilli. 28.57% of coagulase-negative Staphylococci were methicillin-resistant. Quinolone resistance was observed in 23.53% of Gram-positive cocci, and 69.23% of isolated Enterobacteriaceae were multidrug-resistant.

Conclusion: The prevalence of SBP due to Gram-positive and multidrug-resistant bacteria has increased in recent years. The currently recommended empirical antibiotic therapy, based on third-generation cephalosporins, carries a high risk of failure and may need to be reassessed.

Varicocele management in Tunisia: Overview of practices and comparison with latest international guidelines

Kamel Ktari — 2025-01-02

Introduction: Varicocele has a detrimental effect on testicular growth and spermatogenesis, hence the importance of its management. This management remains controversial among Tunisian urologists; diagnostic and therapeutic choices tend to vary from one urologist to another.

Aim: The aim of this survey is to evaluate the practices of Tunisian urologists regarding varicocele management compared to the latest international guidelines.

Methods: A cross-sectional study was conducted among Tunisian urologists, members of the Tunisian Association of Urology, using a computerized questionnaire available online.

Results: The response rate was 51.6%. Approximately 80% of Tunisian urologists reported that they diagnose and manage patients with varicocele at least once a week. Half of the Tunisian urologists use a grading system for classification. Over 75% of Tunisian urologists believe that scrotal ultrasound and semen analysis should be systematically requested. Half of them consider treatment starting from Dubin and Amelar grade 2, while the other half treat from Dubin and Amelar grade 3. The majority agreed that the results of varicocele repair are controversial, with 10% never performing bilateral varicocele repair. The vast majority planned surgical treatment (95%), with sub-inguinal approach and magnification used in only 16% of cases; 25% never froze sperm before varicocele repair.

Conclusion: Recent recommendations had clear messages to promote in terms of diagnosis, therapeutic indications, and modalities. This work highlights the existence of gaps between recommendations on certain aspects of varicocele management, suggesting a review of continuous medical education modalities regarding this pathology in particular.

Keratoconus in children in Tunisia: Epidemiological, clinical and therapeutic features

Sonda Kammoun — 2025-01-02

Aim: To report the clinical and therapeutic particularities of pediatric keratoconus (KC).

Methods: Retrospective study focusing on patients aged less than 18 years, presenting with KC and followed in a tertiary reference center in Sfax, Tunisia.

Results: Our study involved 38 eyes of 20 children. We found a mean age of 12.8 years, a family history of keratoconus for 25% of cases and an atopic background in 30% of children. The mean best-corrected visual acuity was 5.3/10, the mean myopia was -6.3D and the mean total astigmatism was -4.9D. The average maximum simulated keratometry (Kmax) was 54.6 D. The visual acuity decrease was correlated with the presence of corneal opacities, with all keratometric indices except Skewed Radial Axes (SRAX) at 3 and 5 mm, with all elevation parameters and those of pachymetry except the delocalization of the thinnest point. 71.1% of eyes were classified as clinical KC and 47% of eyes were classified as Amlser-Krumeich stage 4. 42.1% of eyes were fitted with glasses and 57.9% with contact lenses. Six patients (10 eyes) underwent cross-linking (CXL). We noted an evolution of the KC for 64.29% of eyes not treated with CXL and a stabilization of 80% of eyes treated with CXL. The difference in follow-up parameters between the two groups was significant.

Conclusion: Pediatric KC is a severe disease, often diagnosed at a late stage. CXL is a safe and effective way to stop the disease.

Chronic total occlusion- Percutaneous coronary intervention (CTO-PCI) experience in a single, multi-operator Tunisian center : A Five-Year Report

Hakim Lamine — 2025-01-02

Introduction: In recent years, advancements in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have been notable, improving procedural techniques, imaging, and management of complications.

Aim: We sought to assess the performance and the practice of a high-volume Tunisian PCI center in treating patients with a CTO.

Methods: We retrospectively evaluated data from consecutive CTO patients who underwent percutaneous revascularization from October 2019 to January 2024 at the cardiology department of Habib Thameur Teaching Hospital, Tunisia. Operators’ experience and CTO-PCI volume were also documented.

Results: The cohort consisted of 58 patients, predominantly male (86.2%), with an average age of 59.8±9.6 years. The right coronary artery was the most common CTO site (56.9%). The antegrade approach was adopted in 96.5% of the cases, with the antegrade wiring (AW) being the preferred technique (81%). Key procedural characteristics included the use of multiple access sites and dual coronary injection in 44.8% of the cases, multiple guidewires in 50%, additional support modality in 68.9% and drug-eluting stents in all instances. The procedural success rate was 75.9%, with an in-hospital adverse outcome rate of 13.8% and a major adverse cardiac event (MACE) rate of 3.4%. A significant impact of operator experience and volume on success rates (85.3% vs 62.5%, p=0.04) and adverse outcomes (25% vs 5.8%, p=0.03) was observed, with trained operators and higher-volume practitioners achieving better results.

Conclusion: In a single-center setting with a conservative CTO cohort, acceptable PCI success rates were achieved. We highlighted the positive impact .....(abstract truncated at 250 words).

Comparative Analysis of Long-Standing and Newly Diagnosed Diabetes Mellitus in Patients with Pancreatic Ductal Adenocarcinoma: A Tunisian Multicenter Study

Hamza Elfekih — 2025-01-02

Introduction: Diabetes mellitus has emerged as a global public health issue due to its increasing prevalence and the increased risk of developing cancers. Pancreatic cancer is believed to be both a consequence of pre-existing diabetes and a potential cause of new-onset diabetes.

Aim: This study aims to compare the characteristics of patients with pancreatic ductal adenocarcinoma and newly diagnosed or long-standing diabetes mellitus.

Methods: A multicentric retrospective study was conducted over 13 years at two university hospitals in Sousse, Tunisia. Included patients had whether a newly diagnosed or a long-standing diabetes mellitus with histologically confirmed pancreatic ductal adenocarcinoma. Statistical analysis using appropriate tests was conducted.

Results: The prevalence of diabetes mellitus was 44.6% among three hundred and seven patients with pancreatic cancer. The male-to-female ratio in patients with pancreatic ductal adenocarcinoma was 2.6:1. Patients’ mean age was 63.9 years, with the majority being over 50 years old. Most patients had no family history of diabetes and exhibited significant weight loss, low body mass index, and uncontrolled diabetes. The comparison between individuals with newly diagnosed diabetes and those with long-standing diabetes revealed numerous similarities, apart from significant differences in drinking patterns (p = 0.03), tumor size (p = 0.018), and smoking in the subgroup of males (p = 0.044).

Conclusion: Patients over 50 with newly diagnosed diabetes mellitus, particularly those who consume alcohol occasionally and men who are not heavy smokers, should undergo further evaluation to identify potential early-stage pancreatic ductal adenocarcinoma

Evaluation of therapeutic adherence to antihyperglycemic agents in patients with type 2 diabetes

Bilel Benamor — 2025-01-02

Introduction-Aim: Type 2 diabetes (T2D) is a major public health problem. To succeed its management and prevent its complications, good therapeutic adherence must be ensured. The objectives of our work were to estimate the prevalence of poor therapeutic adherence in our patients and to identify its associated factors.

Methods: we conducted a cross-sectional, single-center study that included type 2 diabetic outpatients. Therapeutic adherence to antihyperglycemic agents was assessed by the 8-item Morisky Medication Adherence Scale (MMAS-8).

Results: We included 172 patients. The mean age was 59.7±9.5 years. The mean duration of T2D was 11.7±8.5 years. Glycemic targets were achieved in 35% of patients with a mean HbA1c of 8.5±1.8%. The prevalence of poor adherence was 66.1%. Factors associated with poor adherence were age <65 years (p=0.007), low educational level (p=0.026), diabetes follow-up < 2 consultations/year (p=0.004), non-practice of self-monitoring of blood glucose (p=0.008) and ignorance of glycemic targets (p=0.001).

Conclusion: Poor adherence affects a large proportion of our T2D patients. In order to improve it, therapeutic adherence should be an important theme in the education of patient

Impact of COVID-19 lockdown on dietary habits and weight among Tunisian adults

Yosra Hasni — 2025-01-02

Background: COVID-19 lockdown measures have profoundly altered lifestyle habits, exposing individuals to significant health risks

Aim: This study aims to assess the impact of quarantine measures in Tunisia, with a focus on examining changes in dietary habits, levels of physical activity, psychological patterns, and factors contributing to weight gain.

Methods: This is a cross-sectional study involving 1,016 participants and employed a mixed-methods approach to gather data on dietary habits, physical activity levels, and psychological indicators. Statistical analyses, including binary logistic regression, were conducted to identify independent risk factors associated with weight gain during the quarantine period.

Results: Approximately 36.4% of participants reported experiencing weight gain, with a notable prevalence among younger age groups. Increased consumption of sweets, pasta, and fried foods, coupled with reduced intake of water, vegetables, and fruits, were associated with weight gain. Furthermore, a decline in physical activity levels and elevated scores of anxiety and depression were observed among individuals who reported weight gain. Binary logistic regression highlighted snack frequency, fried food consumption, and pasta intake as significant independent risk factors for weight gain.

Conclusion: The results underscore the importance of understanding the complex impacts of lockdowns on lifestyle habits and mental health to guide future interventions, which are necessary to mitigate adverse health consequences and promote healthy lifestyles in the post-pandemic period.

Acute on chronic liver failure: Diagnosis and evolution profile

Asma Mensi — 2025-01-02

Introduction: Acute decompensation represents a remarkable event in cirrhotic patients, particularly if it is complicated by Acute-on-Chronic Liver Failure (ACLF). Epidemiological data of ACLF are limited.

Aim: To determine the prevalence and predictive factors of ACLF in patients hospitalized for decompensated cirrhosis.

Methods: We conducted a retrospective study. We included patients with decompensated cirrhosis. ACLF was defined according to the CLIF-C OF score. Prevalence and predictive factors of ACLF were determined.

Results: We included 100 patients. The prevalence of ACLF was 37%. Renal failure was the most frequent organ failure. In univariate analysis, predictive factors for the occurrence of ACLF were female gender, hepatic encephalopathy, upper digestive haemorrhage, the presence of an infection, CRP level, bilirubin level and creatinine level. Prognostic scores (Child-Pugh, MELD, and CLIF-C OF) were also predictive of ACLF. In multivariate analysis, only creatinine level was an independent predictive factor of ACLF. The most frequent precipitating factor of ACLF was infection. The overall mortality rate for patients with ACLF was 65%.

Conclusion: Our study showed that the prevalence of ACLF was 37 %. The main predictive factor of ACLF was creatinine level. The mortality rate was high at 65 %.