La Tunisie Médicale

The Medical Illusio: Between Formal Rationality and Social Logic

Hanen Khanchel-Lakhoua — 2025-03-30

Introduction : The article examines the contemporary medical field through the prism of Bourdieu's illusio, testing the interaction between formal rationality and social logic. It offers a unique approach, combining technical and social perspectives often treated separately in medical research.

Objectives and method : The aim is to illustrate how illusio-professionals' investment in the value and meaningfulness of medicine-conditions medical practice as a complex interplay between formal rationality (standardized procedures) and social logic (interactions and care provision). The article discusses the impact of this interplay on the professional identity of physicians, their interaction with patients, and the operation of medical institutions.
Results : The thematic analysis highlighted key tensions and dynamics at the heart of public health service delivery in Tunisia that have important ramifications not only for patient care, but also for physician well-being.

Conclusion : There is an antagonism between the search for standardization of formal rationality (FR) and the adaptation of individualized treatment according to the patients' situation. Although standardized protocols and procedures are in place to ensure fairness and efficiency, these can sometimes feel detached.

Contribution of fetopathological examination in identifying causes of neonatal deaths

Kaouther Nasri — 2025-03-30

Objectives: To determine the concordance between the causes of death reported in the neonatal departement and the data obtained from the fetopathologic examination.

Methods: We included all newborns admitted to the Neonatal Resuscitation Unit who died there before the 28th day of life and in whom a fetopathological examination was performed.

Results: The causes of neonatal deaths were characterized by the dominance of respiratory pathologies (31%) then palliative cares (18%), neurological causes (9%), heart disease (9%), inherited diseases of metabolism (6%) and sudden deaths (6%). A total concordance between fetopathological and neonatological examinations was noted in 27% of the cases, a partial concordance in 40%, a total discordance in 27%, and in only 6% of the cases the fetopathological examination didn’t show any abnormalities.

Conclusion: We emphasize of the importance of fetopathological examination in the determination of the cause of neonatal deaths by providing an exhaustive diagnosis essential to the management of future pregnancies.

Validation of EORTC QLQ-C30 questionnaire in its Tunisian version

Soraya Fenniche — 2025-03-30

Objective: To test the validity and reliability of The European Organization for Research and Treatment of Cancer (EORTC) core (QLQ-C30) in its Tunisian dialectal version for lung cancer patients.

Methods: A total of 300 patients under a chemotherapy regimen for lung cancer were enrolled in this cross-sectional study. Participants had to answer EORTC QLQ-C30 auto-questionnaire in the Tunisian version, then in the Arabic version 15 days later. Statistical analyses were performed by SPSS 22.

Results: The Tunisian version was found reliable and valid for Tunisian cancer patients. Seven of the 8 multi-item scales of QLQ-C30 had high reliability (Cronbach’s α >0.7). In our analysis, the most determinative subscales of QLQ-C30 on global health were physical functioning, cognitive functioning, fatigue, and dyspnea. Correlation with the Arabic version was nearly a perfect mismatching; all sub-scale mean scores were statistically correlated. The inter-class correlations confirmed the external convergent validity. Discriminant validity was supported since the correlation value of a symptom scale score with other similar scales was higher than any functional scale, and inversely.

Conclusions: The Tunisian version of EORTC QLQ-C30, recently written is a reliable and valid tool to assess the quality of life of Tunisian lung cancer patients.

Clinical Outcomes and Complications Rates at Mid-term Follow-Up of Cementless Reverse Shoulder Arthroplasty

Hamdi Kaziz — 2025-03-30

Introduction-Aim: Reverse shoulder arthroplasty (RSA) is a valid option for several degenerative conditions of the shoulder. This study aimed to analyze mid-term functional outcomes and complications rates of cementless stem.

Methods: From January 2016 to December 2020, retrospective review of cementless RSA for degenerative conditions was established. Clinical outcomes were assessed using visual analog scale (VAS), University of California Los Angeles (UCLA) score, Constant score and range of motion (ROM). Radiographic findings were evaluated during follow-up. Complications rates was reported.

Results: At mid-term follow up of 39 months, 40 shoulders were included with sex-ratio= 0.53 Mean age was 67.7 years (60 -82). VAS score improved from 5.0 to 2.2 (p = 0.014). UCLA score increased from 17.2 to 25.7 (p = 0.002) and Constant score improved from 31.89 to 70.2 (p < 0.001). Active anterior elevation, abduction, and external rotation showed enhancement respectively 80° to 141.2°, 71° to 132.2° and 5.8° to 19.7° (p values < <0.0001). The mean calcar filling ratio was 0.86 (0.32 – 1.17 +/- 0.22). The mean proximal and distal filling ratios were 0.62 (0.48 – 0.73 +/- 0.06) and 0.56 (0.36 – 0.71 +/- 0.09) respectively. The overall rate of postoperative complications was 22.5%.

Conclusion: Cementless stem improve functional outcomes at mid-term follow up. Stems were correctly aligned with the humeral axis and canal filling ratios were <0.7 in all cases. Stress-shielding was slightly higher without impact on clinical outcomes.

Improving access and utilization of sexual and reproductive health services by migrant women in Morocco: A qualitative study

Chaimaa Amaghdour — 2025-03-30

Introduction-Aim: Over the past decade, Morocco has become a major migratory corridor in the Mediterranean, hosting an increasing number of migrants, particularly from Sub-Saharan Africa. This study aims to identify the barriers and facilitators to accessing sexual and reproductive health (SRH) services for migrants in Morocco, while exploring the socio-cultural, economic, administrative, and linguistic factors that influence access.

Methods: We employed qualitative methods through focus group discussions (FGDs) with migrant women (n = 24) and men (n = 24). A total of 48 participants, residing in Morocco for at least three months, were selected, all of whom had experience with public healthcare facilities for SRH services. The study was conducted in July 2024 in two regions (Rabat and Casablanca).

Results: The majority of the 48 participants were young adults aged 18 to 34 (61%), mainly from Côte d'Ivoire (60%). Although all spoke French, only 6% had medical coverage, and 23% had a source of income. The main obstacles identified were lack of information, stigmatization, language and cultural barriers, as well as administrative and economic difficulties. Facilitators included a quality welcome, support from associations and NGOs, confidence in Moroccan health services, support from health professionals, and free access to certain services.

Conclusion: The results highlight significant difficulties migrants face in accessing healthcare in Morocco. Efforts are needed to enhance inclusion, reduce discrimination, and simplify administrative procedures to improve access to healthcare for migrants.

Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis: An Observational study.

Alia Fazaa — 2025-03-30

Introduction: Non-adherence or poor therapeutic adherence appears to be particularly prevalent in chronic inflammatory rheumatism, notably in Juvenile Idiopathic Arthritis (JIA). It reduces therapeutic efficacy, accelerates disease progression, and poses a significant public health and economic challenge.

Aim: To evaluate adherence to disease-modifying treatments in Tunisian patients with JIA and to identify factors influencing therapeutic adherence.

Methods: This cross-sectional study included patients with JIA (defined by ILAR criteria) who had been undergoing treatment with conventional synthetic (csDMARDs) and/or biologic (bDMARDs) disease-modifying anti-rheumatic drugs for at least three months. Socio-demographic, clinical, biological, radiological, and therapeutic data were collected. Therapeutic adherence was assessed using two methods: self-reported adherence by patients and their parents, and adherence measured via the Parent Adherence Report Questionnaire (PARQ) and the Child Adherence Report Questionnaire (CARQ).

Results: A total of 30 patients (16 girls, 14 boys) with a mean age of 24.8 ± 11 years [8-47] were included. csDMARDs were prescribed for 76.7% of patients while 26.7% received bDMARDs. Self-reported adherence was 80% among parents and 76.7% among patients. Mean adherence scores were 74.58 ± 36 [0-100] on the PARQ and 74 ± 34 [0-100] on the CARQ. Univariate analysis revealed that adherence measured by the PARQ was positively correlated with erythrocyte sedimentation rate (ESR) (p=0.001; r=0.643) and C-reactive protein (CRP) (p=0.008; r=0.561) and negatively correlated with maternal age (p=0.005; r=-0.572), difficulty in medication administration reported by the parent (p<0.0001; r=-0.698), and negative reactions to medication reported by both the patient (p=0.012; r=-0.506) ...(abstract truncated at 250 words).

Is percutaneous nephrolithotomy an effective and minimally invasive technique in the treatment of staghorn kidney stones?

Kays Chaker — 2025-03-30

Introduction: With the advent of percutaneous nephrolithotomy (PCNL), the use of traditional surgery for the treatment of staghorn kidney stones has become rarer.

Objective: The objective of this study was to report the outcomes of percutaneous nephrolithotomy in the treatment of staghorn kidney stones.

Methods: This is a retrospective longitudinal descriptive and analytical study. It included all patients treated for a staghorn stone who underwent PNL between January 2015 and December 2021.

Results: We included 44 patients. Six patients experienced intraoperative bleeding. We reported the occurrence of postoperative infectious complications in 15 patients. The stone-free rate was 42%. Predictive factors for residual fragments were complete staghorn stone (p=0.02) and large stone volume (p=0.001). Predictive factors for hemorrhagic complications were the use of anticoagulant therapy (p=0.01), renal cavity dilation (p=0.01), complete staghorn stone (p=0.02), and large stone mass (p<0.001). Predictive factors for postoperative infectious complications were diabetes (p=0.048), positive preoperative urine culture (p=0.03), renal cavity dilation (p=0.04), complete staghorn stone (p=0.02), and postoperative drainage by ureteral stent (p<0.001).

Conclusion: PCNL is a minimally invasive and effective technique when safety conditions are met, and it has become the standard in the treatment of staghorn stones.

Therapeutic Inertia in arterial Hypertension: Study Among Primary Care Physicians

Saoussen Antit — 2025-03-30

Background: Therapeutic inertia is a major cause of uncontrolled hypertension.

The aim of our work study is to describe the knowledge, attitudes, and practices of primary care physicians in the management of hypertension and to describe the factors of therapeutic inertia.

Methods: This was a descriptive study among primary care physicians conducted through an online questionnaire created using Google Forms during the period from March 15 to May 15, 2022.

Results: Our population included 232 physicians with an average age of 39 years. They mainly worked in the public sector (83%). Only 24% of the physicians knew the diagnostic thresholds for hypertension using all methods. Fifty percent knew the therapeutic objectives. Initiation with monotherapy was chosen by 49% of physicians. Angiotensin converting enzyme inhibitors and calcium channel blockers were chosen by 79.3% and 60.8% of physicians, respectively. The main reasons for therapeutic inertia were cost (78.4%), drug shortage (72.8%), non-adherence to therapy (61.2%), follow-up by another specialist (46.5%), fear of side effects of antihypertensive drugs (48.7%), patient's age (40.5%), lack of organization of patient follow-up (36.6%), and the presence of other comorbidities (35%). Renal failure was the main comorbidity involved (78.4%).

Conclusions: Our study concludes that there was a lack of knowledge and application of the new recommendations for hypertension. It would be necessary to promote continuous training of primary care physicians, to insist on therapeutic education of patients, to reform the public health system in Tunisia to cover the provisions of hypertensive patients, and to introduce combination therapy.

Acute interstitial nephritis in adults: A retrospective case series from a nephrology center in Tunisia

Sanda Mrabet — 2025-03-30

Introduction-Aim: Acute interstitial nephritis (AIN) shows variability in incidence and etiology based on geography. The study aimed to understand the characteristics and root causes of AIN, its diagnosis methods, treatment strategies, and results within a Tunisian population.

Method: We retrospectively gathered data on biopsy-proven AIN from a Nephrology center over 16 years.

Results: We gathered 36 confirmed cases of biopsy-proven AIN. The average age of the patients was 50.58 years. The predominant clinical signs were fatigue (58%) and fever (22%). The mean level of creatinine was 691.58 µmol/l. Interstitial infiltrate was significant in 52.77% of cases, with eosinophils present in only 5.55% of cases and fibrosis noted in 27.77% of cases. Drug-related causes accounted for 46.66% of AIN cases, while infections and systemic diseases accounted for 16.66% and 11.11%, respectively. We have identified two exceptional causes of AIN, one associated with treatment with Rituximab and the other with a triple parasitic infection. Some cases (25%) lacked an identifiable cause. Corticosteroid treatment was recommended for 93.33% of cases. The median follow-up duration was 2.2 years. Seven patients required hemodialysis, and 71.42% recovered renal function. The presence of interstitial fibrosis correlated with the progression to chronic kidney disease.

Conclusion: AIN is a leading cause of acute kidney injury that can progress to chronicity. Interstitial fibrosis is associated with the progression of chronic kidney disease. The primary etiology is drug intake, and some causes are yet to be identified.

Screening for Familial Hypercholesterolemia in Tunisia using Whole Exome Sequencing: Importance in diagnosis and healthcare management

Faten Mahjoub — 2025-03-30

Aim: To determine pathogenic variants linked to Familial Hypercholesterolemia (FH) among a southern Tunisian family using Whole Exome Sequencing (WES).

Methods: Genomic DNA was extracted from whole blood among the index case as well as other affected and unaffected family members. Then, WES was performed only in the proband. The pathogenicity of genetic variation was assessed in a set of 13 genes reported as associated with FH using combined filtering and bioinformatics prediction tools. Finally, sanger sequencing was done to verify the probands' likely pathogenic predicted mutations and to check for familial segregation among all family subjects.

Results: Our results showed the presence of a pathogenic splice site mutation (c.1186+1G>A) in the LDLR gene among the proband and other affected family members. The following up of the family, revealed the effectiveness of the combination of rosuvastatin and ezetimibe with healthy diet to meet the LDL-c treatment goal with approximately 50% of decrease for the proband.

Conclusion: This study is the first of its kind using WES for FH screening and diagnosis in Tunisia. Here, we point up the importance of molecular analysis for a better health care management of FH patients and their families.

Drug resistant epileptic children and therapeutic drug monitoring of lamotrigine

Syrine Moussa — 2025-03-30

Introduction: Epilepsy is a chronic and disabling pathology which begins, in more than 50% of cases, before the age of 10. Patients who are resistant to AEDs suffer from poor quality of life and socio-professional disintegration. Therapeutic pharmacological monitoring (TDM) of lamotrigine (LMT) in epileptic children is particularly useful in complex situations where it is difficult to assess the response and thus allows to improve the management of epilepsy and improve the quality of life of epileptic children.

The aims of this study were to identify drug-resistant children on LMT and to assess demographic, clinical and pharmacokinetic factors associated with drug resistance in these children.

Methods: This retrospective descriptive study was conducted at Clinical Pharmacology (2012-2021). We included children under 18 years old with epilepsy, on LMT, referred for trough plasma level (C0) measurement as part of the TDM of LMT.

Results: We included 114 epileptic children prescribed LMT. Drug resistance was reported in 38.6% (n=44) and was higher in boys (73%).

LMT C0 were significantly higher in drug resistant epileptic children (4.75 µg/mL versus 8.7 µg/mL, p=0.000). Bioavailability was low in 20.5% of the cases of drug resistant epileptic children.

Conclusions: Drug resistance was observed in 38.6% of epileptic children treated with LMT, the majority of whom were boys. Residual LMT concentrations were higher in drug-resistant epileptic children on LMT.

Impact of micronutrients on anxiety-depressive disorders in type 2 diabetics

Olfa Berriche — 2025-03-30

Introduction : Micronutrient deficiencies are common in type 2 diabetics (T2D), promoting the occurrence of anxiety-depressive disorders.

Aim : The objectives of this study were to evaluate the micronutrient status of patients with type 2 diabetes (T2D), screen them for anxiety-depressive disorders, and investigate associations between these disorders and micronutrient intake.

Methods : This was a descriptive cross-sectional study involving 115 type 2 diabetics. They underwent a dietary survey and completed the Hospital Anxiety and Depression Scale (HAD) and Dopamine/Norepinephrine/Serotonin (DNS) questionnaires assessing anxiety-depressive disorders.

Results : Deficiencies in the intake of vitamins (A, E, C, B) and minerals (magnesium, copper, iron, zinc) were noted. Negative and significant associations were found between depression scores and the intake of vitamin B1 (p=0.01) and vitamin B6 (p=0.024). Similarly, negative and significant associations were found between anxiety scores and the intake of vitamin B6 (p=0.049), vitamin B9 (p=0.019), and vitamin B12 (p=0.01). Referring to the DNS score, we found negative associations between the dopamine score and the intake of vitamin B9 (p=0.002), magnesium (p=0.003), and copper (p=0.007) ; between the norepinephrine score and the intake of vitamin C (p=0.046), vitamin B6 (p<0.001), magnesium (p=0.024), and zinc (p=0.009); and between the serotonin score and the intake of vitamin B12 (p=0.001), magnesium (p=0.027), and zinc (p=0.047).

Conclusion : micronutrient deficiencies can exacerbate pre-existing anxiety and depressive disorders in type 2 diabetics. Systematic nutritional education is recommended, emphasizing a balanced and varied diet rich in vitamins and minerals.

Chronic obstructive pulmonary disease acute exacerbation: prognostic value of eosinophilia in terms of recurrence

Ines Chermiti — 2025-03-30

Introduction : Chronic obstructive pulmonary disease (COPD) acute exacerbation (AE) increases morbidity and has an impact on health status. Inflammation plays a key role in these events. Current evidence supports use of biomarkers to guide corticosteroid therapy, which is included in the treatments of COPD AE.

Aim : The aim of our study was to determine the prognostic value of hypereosinophilia (HEo +) in patients admitted to emergency department (ED) with COPD AE in terms of recurrence (Recurrence+).

Methods: A prospective and observational study was conducted over nine months including patients admitted to ED with COPD AE. Patient history, clinical, paraclinical and therapeutic data was collected. HEo+, was defined as blood eosinophil count (BEC)≥200 cells/mm³. One month follow-up was performed. We compared two groups: Recurrence+ vs Recurrence- patients and HEo+ vs HEo- patients. Both univariate and multivariate analysis were performed to identify factors associated with COPD AE recurrence at one month.

Results: We included 252 patients. Prevalence of HEo+ was 50%. Patients with HEo+ had less severe clinical signs on admission (p=0.03), less COPD AE recurrence (p <0.001) and required less hospitalization at one month (p=0.003). Mortality was higher in HEo- patients (p=0.05). Recurrence- patients had HEo+ more frequently (61% vs 19% ; p<0.001). In multivariate analysis, we identified two predictors of recurrence of COPD: COPD group D (adjusted OR 2,3; [95% IC 1,5-3,7]; p<0,001) and non-invasive ventilation on admission (adjusted OR 3,9; [95% IC 1,1-13]; p=0,03). HEo+ was a protective factor of COPD...(abstract truncated at 250 words).

A comparison between alpha and delta waves of COVID-19, in Tunisia

Bouthaina Trabelsi — 2025-03-30

Introduction: Several nations have seen an increase in COVID-19 cases in 2020, exhibiting a wave pattern. Different COVID-19 variants caused these waves. In this perspective, the aim of the study was to compare epidemiological, clinical and evolutive profile of COVID-19 infection during two waves of COVID-19.

Methods: Data collection was carried out using a questionnaire self-administered in French and Arabic developed with Google Forms and shared online via social media with weekly reminders. Duration of one month was enough to get the necessary number of participants calculated. The study included all Tunisians who were infected with COVID-19 at least once and agreed to participate in the study.

Results: In total, 1328 COVID-19 patients were included. Eight hundred eighty-three patients were infected during the Alpha wave (66.5%) and 445 were infected during the Delta wave (33.5%). The median age was 37 years (interquartile range (IQR): 30–41 years). Clinically, during delta wave, these symptoms were more frequent; fever (57.8% versus 51.9%, p= 0.042), loss of smell (75.1% versus 65.1%, p On the other hand, aches were more frequent during Alpha wave (65.2% versus 56.2%, p = 0.001) and the impact of health professionals was greater (27.6% versus 15.7%, p≤10^-3).

Conclusion:The Alpha variant had more pronounced clinical symptoms than the Delta variant. This can be explained by the high vaccination coverage during the pandemic by the Delta variant.

Contribution of hybrid imaging in benign osteopetrosis: A case report and litterature review

Sihem Mensi — 2025-03-30

Introduction : Benign osteopetrosis is a rare metabolic bone disorder characterized by a generalized and symmetrical increase in bone density. While the radiographic features of osteopetrosis are well-known, scintigraphic aspects, particularly in hybrid imaging (single-photon emission computed tomography coupled with computed tomography (SPECT/CT), have been rarely described in the literature.

Observation : A 16-year-old adolescent boy presented with chronic diffuse osteoarticular pain. Radiological exploration revealed osteosclerosis in the femoral heads, distal ends of the femurs, and upper ends of the tibiae, suggesting the diagnosis of osteopetrosis. Planar bone scintigraphy supplemented by SPECT/CT confirmed the diagnosis, mapped the various bone locations, and ruled out fractures.

Conclusion : Although rare, benign osteopetrosis should be recognized because it causes bone integrity impairment, leading to various bone complications, including spontaneous fractures. SPECT/CT plays an important role in assessing the extent of bone lesions and identifying complications.

As highlighted, this case underscores the utility of combining functional and anatomical imaging modalities in one examination, which decreases the time to diagnosis and offers a comprehensive assessment of benign osteopetrosis.

A recurring osteoblastoma that initially presents as a typical osteoid osteoma: a case report

Mohamed Achraf Ferjani — 2025-03-30

Introduction: Osteoid osteoma and osteoblastoma are benign bone tumors with similar histologic features, often distinguished by size and clinical behavior. Their relationship remains a topic of debate.

Observation: An 8-year-old boy presented with a femoral diaphyseal lesion initially diagnosed as osteoid osteoma based on resection biopsy. However, within six months, the boy experienced increased pain and rapid growth, with subsequent biopsy revealing aggressive osteoblastoma. This suggests the initial lesion may have been an early-stage osteoblastoma.

Conclusion: This case challenges the concept of osteoid osteoma transforming into osteoblastoma. While histologically similar, these tumors should be considered distinct entities, and size alone may not be a reliable differentiating factor. Careful clinical and pathological correlation, with attention to growth rate, is crucial for accurate diagnosis and management.

Posterior Reversible Encephalopathy Syndrome in children/ adolescents with hematologic malignancies: Case reports

Rim Aidli — 2025-03-30

Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is one of the most common neurological complications in pediatric onco-hematology. Hematologic malignancies and cytotoxic chemotherapy are involved in its pathogenesis. It’s a clinical and radiological entity: the diagnosis of PRES is based on both clinical symptoms and neuroimaging data.

Observation: Here we reported a series of four cases of children/ adolescents treated by cytotoxic chemotherapy for hematologic malignancies who developed neurologic disorders and their magnetic resonance imaging findings were in favor of PRES.

Conclusion:In onco-hematology, children/ adolescents who present with new seizures, visual deficits, or other neurologic signs, PRES should be considered as a part of the differential diagnosis as a good outcome relies on rapid management of this complication

Biologic National Registry (BINAR) protocol: Design and Rationale of the Tunisian clinical multicentric study of efficacy and safety of biologics in Rheumatoid arthritis and Spondyloarthritis

Haifa Hachfi — 2025-03-30

Introduction: The advent of biological therapies has greatly improved the treatment and management of rheumatoid arthritis (RA) and spondyloarthritis (SpA). However, evaluating the efficacy and long-term safety of these therapies is a necessity. So far in Tunisia, no large prospective multicentric trial reflecting national data has been published. Thus, the objective of the study was to collect data on sociodemographic characteristics of Tunisian patients with RA and SpA receiving biologics and to evaluate the clinical efficacy and safety of this therapy.

Methods: BINAR is a prospective, observational registry with a 2-year follow-up period. A total of 600 consecutive patients treated with biologic for RA or SpA form different regions of Tunisia, are included until the end of the recruitment period, set at one year.

Patients are officially included in BINAR only if they are aged 18 years and older. All patients monitored for RA according to ACR-EULAR criteria or SpA according to ASAS Criteria starting biological treatment at the time of inclusion or within two years before the inclusion date are eligible to be enrolled. All patients provided written informed consent.

The primary end point is the safety and tolerability assessment of biologics and the incidence of adverse events over 2 years. The secondary end points are the assessment of RA and SpA activity at baseline and at two years of follow-up.

Results: One hundred rheumatologists are involved in this study. Ten departments participated in the registry. Demographic profile, activity ..(abstract truncated at 250 words).

Exploring Diaphragmatic Ultrasonography as a Diagnostic Tool for Hyperinflation in COPD Patients: A protocol study

Hela Cherif — 2025-03-30

Introduction: Chronic obstructive pulmonary disease (COPD) is a widespread global health problem marked by chronic inflammation, emphysematous lung damage, and persistent airflow limitation. In COPD, hyperinflation exacerbates respiratory muscle weakness by causing diaphragmatic dysfunction. Diaphragmatic ultrasonography (US) is a non-invasive tool for evaluating diaphragmatic function, which may provide insight into the severity of hyperinflation in COPD. The purpose of this study is to evaluate the effectiveness of diaphragmatic ultrasonography in assessing lung hyperinflation in patients with COPD .

Methods: A diagnostic cross-sectional investigation will be carried out in two Tunisian pulmonology centers. COPD patients aged ≥40 years with confirmed diagnosis via spirometry and stable clinical status will be included. Exclusion criteria are other chronic respiratory diseases, neuromuscular diseases, or obesity. Diaphragmatic ultrasonography and whole-body plethysmography will be performed on the patients. During deep inspiration and forceful expiration, the diaphragmatic thickness and thickening fraction will be measured. RV > upper limit of normal (ULN) indicates lung hyperinflation. Pearson's or Spearman's correlation will be used to assess relationships between plethysmographic parameters and diaphragmatic ultrasound results. Diaphragmatic ultrasonography's diagnostic thershold for hyperinflation will be determined using ROC (receiver operating characteristic) curves.
Conclusion: If proven effective, diaphragmatic ultrasound could be a practical and cost-effective alternative to plethysmography for diagnosing hyperinflation in COPD.

Use of Generative AI in Medical Writing by Non-Native English Researchers

Hamza Gazzeh — 2025-03-30

Introduction: Generative Artificial Intelligence (AI) has increasingly found its way into scientific medical writing, which can be particularly inappropriate in non-native English-speaking countries. This study aimed to determine the occurrence of AI-generated texts in medical publications originating from the Greater Maghreb countries (Libya, Tunisia, Algeria, Morocco, and Mauritania).

Methods: This was a cross-sectional study that gathered all medical publications indexed on MEDLINE, published in the first week of July 2024, with first author affiliated with Greater Maghreb countries. The rate of AI-generated texts was calculated using the AI detection tool: ZeroGPT^®. Each article was analyzed in its entirety and each section separately (Abstract, Introduction, Methods, Results, and Discussion). Articles or sections were considered “suspects of AI generation” (sAI-g) if the rate was ≥25%. Results were presented as medians associated with their corresponding Inter Quartile Range (IQR).

Results: In all, 48 scientific medical articles were published by first authors from the Greater Maghreb countries. Articles were classified as “sAI-g” in 65% of cases, with a median rate of 36.2%[IQR=11.0%-49.4%]. AI-generated text was detected mainly in three sections: “Methods” (sAI-g=86%, median=59.3%[IQR=28.5%-71.7%]), “Abstract” (sAI-g=69%, median=52.2% [IQR=0.0%-90.2%]) and “Introduction” (sAI-g=58%, median=43.2%,[IQR=0.0%-79.4%]), while the "Discussion" section had the lowest median rate (sAI-g=30%, median=10.4%,[IQR=0.0%-27.9%]).

Conclusion: Scientific medical articles from the Greater Maghreb countries used Generative AI extensively. This requires, on one hand, advancing medical education and mandating dissertations in English to build capacities for non-native English-speaking researchers, and on the other hand, providing training on the responsible use of AI ..(abstract truncated at 250 words).

Management of Spinal Cord Injury in Tunisia: 2024 landscape and challenges

Sana Salah — 2025-03-30

Introduction: Spinal Cord Injury (SCI) is a pressing global health issue, with a notable increase in incidence in Tunisia primarily attributed to traffic accidents. The repercussions of SCI extend beyond physical impairments, significantly affecting patient mental health and quality of life, and pose substantial economic challenges.

Objectives: This study aims to provide an in-depth analysis of the current landscape of SCI management in Tunisia, identifying key challenges faced by patients and healthcare providers while offering actionable recommendations for improvement.

Methods: A comprehensive review of existing literature was conducted to assess the SCI management framework in Tunisia. The study focused on evaluating the rehabilitation system, healthcare provider training, and the implementation of disability rights in the country, while identifying barriers to effective care.

Results: Findings indicate a critical shortage of specialized rehabilitation facilities, with only 13 out of 24 governorates of the country providing adequate services. Additionally, there is a significant lack of trained healthcare professionals and inconsistent application of disability rights. Social stigmas further complicate the situation, hindering access to comprehensive care for SCI patients. Conclusion: To enhance SCI care in Tunisia, it is essential to expand rehabilitation services, improve healthcare providers training in disability management, and strengthen disability support systems. Implementing policy reforms, increasing data collection efforts, promoting research and peer support programs are vital steps toward addressing the multifaceted challenges of SCI management and improving the quality of life for affected individuals.