La Tunisie Médicale

Impact of hypnosis during coronarography

Hela Bouzidi — 2026-01-22

Background: Although coronarography is common and relatively with low risk, patients may experience anxiety about the procedure and about the implications that some diagnosis may have. Hypnosis is an alternative technique with rising interest to prevent anxiety during this procedure.

Aim: The aim of this study is to better understand the effectiveness of hypnosis in reducing anxiety and discomfort in patients undergoing coronarography.

Methods : A total of 60 patients with nonemergency indication for coronarography were randomly divided into two groups: one control group (CTRL), and one experimental group of patients who underwent coronarography under hypnosis (HYP).

Results : Results of our study suggest that hypnosis reduces significantly anxiety. Average Visual analogue scale (VAS) score was significantly lower in HYP group (0.7 ± 0.47 vs 1.66 ± 0.9 in CTRL group, (P=0.037)). Average Verbal rating scale (VRS) score was also significantly lower in HYP group (0.23±0.13 vs 0.83 ±0.6 in CTRL group; (P=0.03)). Need for morphine hydrochloride infusion was significantly lower in HYP group compared to CTRL group (6.7% vs 30% p= 0.02). There was no difference in the occurrence of adverse events between the two groups. For the physician performing the coronarography, procedure quality was similar in both groups (P= 0.59), although right radial puncture was more successful in HYP group (one failure of right radial puncture (3.3%) versus 6 (20%) in the CTRL group (p =0.044)).

Conclusion : Our results demonstrated a significant reduction of perceived ....(Abstrat truncated at 250 words)

Management of Adrenal Incidentalomas: A Survey of Physicians from the Middle East and Africa.

Salem A Beshyah — 2026-01-22

Introduction: Adrenal incidentaloma (AI) is a common finding from increased imaging use. Several guidelines direct evaluation and management, but limited data exist on real-world practices.

Aim: To describe the knowledge and practices of physicians from the Middle East and Africa (MEA) in AI.

Methods: An online survey evaluated the definition of AI, diagnostic investigations, management approach, and long-term follow-up of patients with AI.

Results: 171 questionnaires were analysed. Adult and pediatric endocrinologists represented 71.4% of participants. A homogenous mass, < 4 cm and < 10HU, was considered benign by 57.9% of the respondents. The threshold of 4 cm for tumor size was considered suggestive of malignity by 64%. A minority, 34 (19.9%), indicated that no further imaging was required if a non-contrast CT scan was consistent with a benign adrenal mass. Most important endocrinopathies would routinely be excluded: hypercortisolism (97.7%), pheochromocytoma (95.3%), and primary hyperaldosteronism (87.1%). In a lesion considered biochemically inactive at the outset, 56.4% of the respondents would have recommended repeated biochemical testing, and 42.8% would have followed up the patients for 4 and 5 years, irrespective of radiological features.

Conclusions: There is an under-appreciation of the risk of malignancy of AI > 4 cm and a tendency of over-investigating patients in whom a benign tumor has been established, with repeated unnecessary biochemical and radiological evaluation, revealing sub-optimal adherence to guidelines regarding AI in this region.

The relationship between power, speed and agility in youth volleyball players

Karim Ben Ayed — 2026-01-22

Introduction: In youth volleyball players, no previous study has investigated the relationships between the components of the force-velocity test (FVt) and those of the horizontal jump approach, speed test, and agility test.

Aim: To determine the relationships that exist between lower-body power measured via a laboratory test (i.e.; FVt) and some field tests [horizontal jump (i.e.; 5-jump test (5JT)), speed test (i.e.; 20-m sprint) and agility test (i.e.; changing of direction (CoD)] in youth volleyball players. Methods: Thirty-one youth volleyball players were investigated for CoD, 5JT, and absolute/relative peak leg power (P_peak) during the FVt. Speeds (s) during a 20-m sprint were measured at 5, 10, and 20 m (T₅, T₁₀ and T₂₀, respectively). 5JT performance was expressed in absolute terms (5JT_A, m), and relative to leg length and body-mass. Pearson correlation coefficient (r) was performed among the variables of the FVt, 20-m sprint, CoD, and 5JT tests. “r” was considered “high” when it was > 0.70, “good” when it was between 0.50-0.70, “fair” when it was between 0.30-0.50, and “weak or no association” when it was < 0.30.

Results: This study identified i) “high” correlations between FVtP_peak (W) and 20-m sprint [T₅(r=-0.858), T₁₀(r=-0.707), and T₂₀(r=-0.762)], and CoD (r=-0.745), ii) “good” correlations between FVtP_peak (W.kg) and 5JT_A(r=0.531), and iii) “fair” correlations between FVtP_peak (W) and 5JT_A(r=0.499), between FVtP_peak (W.kg^-0.67) and 5JT_A (r=0.489), and 20-m sprint [T₅(r=-0.370), T₁₀...( abstract truncated at 250 words).

Clinical and prognostic characteristics of obstructive sleep apnea among smokers

Emna Ben Jemia — 2026-01-22

Introduction:Smoking is a major public challenge, with profound implications for individual and societal health, intertwining with many medical issues such as the on growing of obstructive sleep apnea (OSA) incidence with studies highlighting a potential association between these two entities, suggesting that smoking may contribute to the pathophysiology of OSA and the worsening of the severity degree of OSA symptoms.

Aim:This study seeks to determine the clinical and prognostic characteristics of OSA among smokers and secondly to look for factors predictive of OSA severity.

Methods: A cross-sectional study carried out in the Pneumology Department at the Charles Nicolle University Hospital in Tunis from January 2023 to June 2024, enrolling 172 patients with a confirmed OSA by a respiratory polygraphy realized in hospital. We divided patients into two groups according to smoking status. G1: smoking patients and G2: non-smoking patients. Statistical analyses were performed to compare the results of the two groups.

Results: A total of 172 patients were included. Forty-seven patients (27.3%) were smokers (G1) with a sex ratio at 3 and a mean age at 59±13 years. Univariate study showed that smoking patients were predominantly men (p<0.001). There was no significant relation between smoking status and cardiovascular and metabolic comorbidities except for COPD that was prevalent among G1(p=0.001) and insomnia (p=0.04). Screening scores such NoSAS and StopBang were more performant in G1 (p=0.03 and p= 0.01 respectively). Polygraphyfinding showed that smoking patients had .....(abstract truncated at 250 words)

Allogeneic hematopoietic stem cel l transplantation in children’s acute myeloblastic leukemia:Survivaland relapse

Nour Ben Abdeljelil — 2026-01-22

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is indicated for children with high-risk (HR) acute myeloid leukemia (AML).
Objective: To evaluate over all survival (OS), event-free survival (EFS), relapse, and non-relapse mortality (NRM).
Methods: This was a retrospective descriptive studyincludingchildren (<18 years) with AML whounderwent allo-HSCT from an HLA-identical sibling donorbetween 1999 and 2023. Conditioningregimensconsisted of busulfan–cyclophosphamide (BuCy) or total body irradiation–cyclophosphamide (TBI–Cy). Stem cell sources were bone marrow (BM) or peripheral blood stem cells.
Results:Fifty-two children were included, with a medianage of 13 years (range: 3–17). Patients were classified as HR in 60.3% of cases. The median time fromdiagnosis to transplantation was 5 months (range: 3–40). At transplantation, 75% of patients were in first completeremission (CR1). The stem cell source was BM in 84.6% of cases, and BuCy wasusedin 90.4% of patients. The graft rejection rate was 5.8%. The cumulative incidences of acute and chronicgraft-versus-host disease (GVHD) were 20% and 23.4%, respectively. The cumulative incidence of NRM was 7.7%, while relapse occurred in 44.7% of patients. After a median follow-up of 30 months (range: 39 days–18 years), the 3-year OS and EFS were 51.6% and 47.8%, respectively.
Conclusion: Post–allo-HSCT relapse remains a major challenge in pediatric AML. Intensification of pre-transplant conditioning, busulfanpharmacokinetic monitoring, and the development of targetedtherapiesmay help reduce the risk of relapse.

Delineating the immunological profile of Algerian children with Down syndrome:A case series.

Linda Mokrane — 2026-01-22

Purpose:This study aimed to characterize the immunological profile of Algerian children with Down Syndrome (DS).

Methods: Serum immunoglobulin(Ig) levels were measure dusingnephelometry,and lymphocyte Subpopulations were analyzed by flow cytometry (FACSLyric™,BDBiosciences,US). The Lymphocyte phenotype in DS patients was compared to that of patients with combined

immunodeficiency(CID).

Results:Our cohort included 33 patients with DS(20 males),and 40 patients withCID(24 males). All Patients had aclinical history of recurrent or severe infections, including upper and lower respiratory Tract infections in 25 patients(76%).Serum Ig were measured in 29 patients, with normal levels of

IgG,IgA,and Ig Min 83%,73%,and 80% of patients,respectively. Elevated IgG,IgA,and IgM levels. Were found in14%,17%,and 3% of patients,while reduced levels were see nin3%,10%,and17% of patients, respectively. Lymphocyte phenotype analysis revealed CD4l ymphopenia in 24(73%) patients, CD8 lymphopeniain19(58%) patients,B-cell lymphopenia in16(48%) patients, and reduced

NK cells in 7 (21%) patients. Naïve CD4+and CD8+T cells were analyzed in nine patients, with low Percentages observed in three. Patients with DS exhibited significantly milder CD3 and CD4

Lymphopenia compared to those with CID.

Conclusion: Children with D Stypically present withT-andB-cell lymphopenia,while maintaining

Generally normal Ig levels. T-cell lymphopenia in DSis less pronounced thaninCID,and the increased Susceptibility to infections stems from both immunological and non-immunological factors linked to trisomy 21.

Congenital thrombopathies in southern Tunisia : a multicenter study

Ines Maaloul — 2026-01-22

Introduction : congenital thrombopathies (CTs) are rare bleeding disorders resulting from platelet dysfunction which may also be associated with thrombocytopenia. To date, the prevalence of CT in Tunisia has not been established.

Aim : The aim of this study was to describe the various types of CT and the associated hemorrhagic manifestations observed in a cohort from southern Tunisia.

Methods : We retrospectively collected clinical and laboratory data of patients with CT who were followed up over 43 years (1982 - 2024) in the pediatric and hematology departements of a university hospital center in southern Tunisia. The diagnosis of thrombopathy was established based on flow cytometry analysis and/or light transmission aggregometry and/or molecular analysis.

Results : We identified 60 patients (35 men and 25 women). The mean age at diagnosis was 61.7 months (1 month-70 years). Consanguinity was noted in 71.6% of cases (n=43). A family history of thrombopathy was reported in 51.6% of cases (n=31). The presenting symptoms at diagnosis were spontaneous or provoked bleeding (n=56) and easy bruising associated with thrombocytopenia within the first 48 hours of life (n=1). The etiologies of the thrombopathies were as follows : Glanzmann thrombasthenia (n=54), Bernard Soulier syndrome (n=5) and Wiskott Aldrich syndrome (n=1).

Conclusion : Glanzmann thrombasthenia was the most prevalent thrombopathy

in our cohort, likely attributed to the high rate of consanguinity in our region.

Drowning Among Tunisian Children: Clinical Patterns and Outcomes

Safa Mdimegh — 2026-01-22

Purpose: Describe clinical and therapeutic aspects of pediatric drowning and analyse predictive factors of mortality.

Methods: We conducted a retrospective analysis of patients under 16 years of age admitted between 2018 and 2022 to the Pediatric Intensive Care Unit at Farhat Hached University Hospital.

Results: Our study included 64 patients. The sex ratio was 1.46. The mean age was 7.1 ± 4.3 years. Most drowning occurred during the summer (92.2%), in seawater (76.6%). The mean estimated immersion time was 4 ± 5.8 minutes. The majority of these drownings (70.3%) were severe (stage 3, 4, 5, or 6). The most frequent clinical signs were: tachypnea (93.8%), auscultation abnormalities (93.8%), oxygen saturation < 92% (73.4%), and tachycardia (71.9%). Chest X-ray was abnormal in 75% of cases. Mechanical ventilation was indicated in 14.1% of cases. Vasopressor drugs were used in 12.5% of cases. Antibiotic therapy was initiated in 70.3% of patients. The mortality rate was 10.9%. In multivariate analysis, predictive factors for mortality were: a Szpilman stage equal to 6 (p <0.005), a Glasgow score < 8 (p <0.005), pupillary abnormalities (p <0.005), hypothermia < 35 (p<0.005), hepatic cytolysis (p = 0.02), and blood pH < 7.1 (p <0.005).

Conclusions: Drowning is a fatal, yet preventable global public health problem, particularly touching children and young adults. Mortality depends on several epidemiological, clinical and biological factors.

Understanding the Correlation of Cotinine on Early Vascular Function Decline via Monocyte Chemotactic Protein-1 Activation in Smokers

Kumboyono Kumboyono — 2026-01-22

Introduction:Oxidative stress describes an imbalance of pro-oxidant and antioxidant levels in cells. This study aimed to investigate the significant correlation of Cotinine on Monocyte Chemotactic Protein-1 (MCP-1) and Nitric Oxide (NO) as an indicator of vascular function.

Methods:The research, designed as a comprehensive cross-sectional study, included a sample of non-smokers (n=100) and smokers (n=100). The study utilised Cotinine, MCP-1 Human MCP-1 ELISA kit, and Nitric Oxide Colorimetric Assay kit, with data analysis conducted using Wrap Partial Least Square.

Results: This study showed a significant effect between Cotinine with MCP-1 (p-value <0.001) and Cotinine with NO (p-value <0.029). The impact of MCP-1 on NO resulted in a p-value of <0.001. Indirectly, it can be known that the effect of Cotinine on NO through MCP-1 produces a p-value of <0.001.The study concluded a significant direct association between Cotinine and MCP-1, Cotinine and NO, and MCP-1 and NO. Meanwhile, the indirect relationship of Cotinine on NO through MCP-1 is paramount.

Conclusion:These findings underscore Cotinine's direct and indirect results on vascular function decline, contributing significantly to our understanding of vascular inflammation and providing a new perspective on the impact of smoking on cardiovascular health.

Academic burnout, resilience and alexithymia among first-year medical students

Rim Feki — 2026-01-22

School burnout is a state of physical and emotional exhaustion caused by chronic stress related to studies. It is particularly common among first-year medical students due to high academic demands and the emotional stress associated with the initiation into medicine. Resilience can help prevent burnout by allowing students to better manage stress and bounce back more quickly after failure, thereby managing stress better by reducing the risk of exhaustion. On the other hand, alexithymia, which is characterized by difficulty identifying and expressing emotions, can weaken resilience and lead to burnout. This study aimed to assess the level of school burnout among first-year medical students and identify factors associated with burnout and its link to alexithymia and resilience. A total of 127 students enrolled at the Faculty of Medicine in Sfax, Tunisia, participated in the study, responding to a questionnaire that included the school burnout inventory, the Connor-Davidson resilience scale, and the Toronto alexithymia scale. Half of the students met the criteria for school burnout. This burnout was significantly associated with several factors: living in Sfax for the first time, poor adjustment to university, being forced into medical studies against their will, and lack of regular physical activity. Burnout was also linked to the presence of alexithymia and lower resilience scores.

Eating Disorders in Healthcare Professionals : Prevalence of High-Risk Cases and Associated Factors

Maryam Naifar — 2026-01-22

Introduction: Eating disorders (EDs) are a growing concern among healthcare professionals, a population often exposed to high levels of stress. Despite their role in promoting health, the well-being of healthcare professionals themselves is sometimes overlooked. This study aimed to estimate the prevalence of healthcare professionals at high risk of EDs and to identify the associated factors.

Methods: A cross-sectional study was conducted among HCPs working at Hedi Chaker University Hospital in Sfax, Tunisia. To screen for HCPs at high risk of EDs, we used the validated French version of the Eating Attitude Test (EAT-26).

Results: Among the 370 HCPs included, females represented 74.6% of the sample (n=276). The median age was 30 years. The mean Body Mass Index (BMI) was 24.79±3.74 kg/m², and 151 cases (40.8%) were overweight or obese. The median EAT-26 score was 10, and 91 participants (24.6%) were at high risk of EDs. Multivariate analysis showed that factors independently associated with EDs were paramedical profession (Adjusted Odds Ratio (AOR) = 3.02; p<0.001), personal history of chronic illness (AOR = 2.17; p = 0.015), abnormal perception of body image (AOR = 1.99; p = 0.012), and exercising more than 60 minutes per day to control body shape (AOR = 5.69; p < 0.001).

Conclusion: These findings highlight the importance of identifying high-risk professionals. Early preventive measures should be established at the workplace to prevent EDs such as promoting work-life balance and reducing job-related stress, implementing training ...( abstract truncated at 250 words)

The correlation between Occlusal Vertical Dimension and Anthropometric Finger Measurements

Manel Ferjani — 2026-01-22

Introduction: The occlusion vertical dimension (OVD) is a fundamental parameter in prosthetic rehabilitation. The clinicians use a variety of methods to restore it. In this scope, finger length is a new method to predict OVD in many populations.

Aim: This study aimed to check the correlation between the anthropometric finger measurements and the occlusal vertical dimension among a sample of the Tunisian population.

Methods: A cross-sectional study was conducted on 154 dental students randomly selected from the faculty of dental medicine in Monastir, Tunisia. The OVD was clinically recorded using a sliding vernier caliper. Each participant was invited to put his right hand on a piece of paper to measure the five finger’s lengths. The correlation between OVD and the finger length was analyzed using Pearson’s coefficient and linear regression analysis through the SPSS version 20 software

Results: The mean OVD was 69.69± 6.06 mm. Statistically no significant differences were reported according to sex. OVD was significantly and positively correlated with the thumb length, the index length and the Middle finger length in females with respectively r=0.270 r=0.269, r=0.297. No significant correlations were found in males.

Conclusion: The length of the thumb, the index, and the middle finger could be suggested to estimate the occlusal vertical dimension, and it could be used as an alternative measure to obtain the lost occlusal vertical in female patients. However, larger sample studies are needed to find precise reproducible regression equations.

Outcomes after Balloon Pulmonary Valvuloplasty for Critical Pulmonary Stenosis: A Tunisian reference center experience

Ines Boudiche — 2026-01-22

Introduction: Balloon pulmonary valvuloplasty (BPV) has emerged as the standard of care for critical pulmonary stenosis (CPS) in newborns. The aim of this study was to describe BVP results for CPS in a North African country where data are scarce.

Methods: A monocentric retrospective descriptive study was conducted on neonates who underwent BPV for CPS between 2000 and 2023, with a minimum clinical and echocardiographic follow-up of 12 months. Primary endpoint was immediate procedural success rate, and secondary endpoints were early additional procedures and late reinterventions.

Results: Thirty-four newborns were included. Median age was 10 days [4-17]. Gender-ratio was 1.4. Procedural success was observed in 73%. Six deaths (18%) were noted (two per-procedural and four during in-hospital phase). Early additional procedures were required in 16 patients (50%) consisting of prolonged prostaglandin-E1 infusion, three early BPV-redo and one early Blalock-Taussig shunt surgery. At 3-year median follow-up [1-5], six late reinterventions were reported in five patients (18%), for recurrent valvular or fixed subvalvular obstruction of the right ventricle (RV) outflow tract. These included four late BPV-redo and two late surgeries.

Incomplete results, bipartite RV and severe dynamic infundibular stenosis were associated with early additional procedures. The balloon-to-annulus ratio was significantly smaller in those requiring late reintervention (1.12±0.17 vs. 1.33±0.17, p=0.004).

Conclusion: BPV was an effective treatment for neonatal CPS, with an incompressible rate of additional early procedures related to incomplete results or bipartite RV, and late reinterventions often driven by recurrent valvular or fixed subvalvular obstruction of the RV outflow tract.

Prevalence and predictors of self-care practices among diabetic patients in Southern Tunisia

Dhoha Ben Salah — 2026-01-22

Introduction: Diabetic self-care practices (DSCP) refer to behavioral actions by people with diabetes to manage their condition effectively. This study aimed to determine the prevalence of inadequate DSCP among Tunisian diabetics and identify associated predictors.

Methods: A cross-sectional study was conducted from March to April 2022 at the University Hospital Center of Sfax, covering southern Tunisia. Adults with type 1 or type 2 diabetes attending the Endocrinology outpatient clinic during the study period were included. The validated SCODI questionnaire with a cut-off of 70 was used to assess DSCP.

Results: A total of 200 patients were enrolled to the study with a response rate of 93.8%. Median age was 55 years with IQR= [42-63] years. There were 128 females (64%) and 153 married patients (76.5%). The prevalence of inadequate self-care practice was 51 % (N=102 cases). Inadequate self-care maintenance, inadequate self-care monitoring, inadequate self-care management and inadequate self-care confidence were noted in 35 cases (17.5%), 127 cases (63.5%), 155 cases (77.5%) and 73 cases (36.5%), respectively. Independent factors of inadequate DSCP were male gender (AOR=2.8; CI=[1.3-6.1]), low income (AOR=5; CI= [2-10]), irregular physical activity (AOR=4; CI= [2-8]), irregular follow-up (AOR=5; CI= [1.6-16.6]), and irregular blood sugar monitoring (AOR=11.3; CI=[5-25]). Besides, being on insulin (AOR=0.27; CI= [0.1-0.7]) or mixed regimen (AOR=0.35; CI=[0.15-0.9]) was independently associated with better DSCP.

Conclusion: This study revealed a high prevalence of inadequate DSCP. It highlights the need for targeted interventions to promote healthier lifestyles, improve patient education, and enhance disease self-management among patients with diabetes.

Evaluating Knowledge, Attitudes and Practices regarding Dental Erosion among Tunisian Dental Partitioners.

Linda Ayedi — 2026-01-22

Introduction. Dental erosion is characterized by the irreversible loss of tooth structure due to non-bacterial acids. Despite its prevalence, the level of awareness and understanding among dental practitioners remains unclear, particularly in Tunisia.

Aim. This study aimed to assess the Knowledge, Attitudes, and Practices of dental practitioners in Tunisia regarding the causes, risk factors, symptoms, and management of dental erosion.

Methods. A cross-sectional, descriptive, observational and analytical study conducted over 12 months (January 2024 to January 2025) among dental practitioners in Sousse, Tunisia, working in both public and private sectors. The target population included licensed private dentists, hospital-university practitioners, dental residents, and thesis-level dental students, selected through convenience sampling across dental offices and university hospitals. Data were collected using a structured, self-administered 21-question online questionnaire developed from literature and expert input, and validated through a pilot study. The survey assessed demographic data, theoretical knowledge, attitudes through clinical case scenarios, and professional practices regarding dental erosion. Statistical analysis was conducted using SPSS version 19, employing descriptive statistics, t-tests, Chi-square tests, ANOVA, Fisher’s exact test, and Pearson correlation, with significance set at p < 0.05.

Results. The study revealed a significant lack of knowledge among dental practitioners regarding the etiology, symptoms, and prevalence of dental erosion, as indicated by statistically significant p values. Furthermore, the majority of practitioners demonstrated an inadequate attitude towards dental erosion management, with 64.40% showing insufficient understanding or approach in clinical scenarios. Additionally, most practitioners neither implemented preventive measures nor utilized ...( Abstract truncated at 250 words).

Evaluation of Inhalation Chamber Usage Practices in Asthmatic Children

Khadija Belcadi — 2026-01-22

Introduction-Aim :Asthma, the leading chronic illness among children, requires precise management to prevent exacerbations. This study examines the inhalation chamber usage practices among 402 asthmatic children at the Children’s Hospital of Rabat, identifying common errors and risk factors.

Methods : A prospective study was conducted with 402 children aged 2 to 16, all with a confirmed asthma diagnosis, using an inhalation chamber and having attended at least one therapeutic education session. Data were entered into Microsoft Office Excel 2019 and analyzed using JAMOVI Project. A p-value < 0.05 was considered statistically significant.

Results: Among the 402 children included, approximately 50% did not correctly master the inhalation technique. The most common errors were shallow breathing (38%), an insufficient number of respiratory cycles (19%), and failure to shake the inhaler before use (12%). Better technique mastery was significantly associated with age (better in adolescents), parental education level, the number of therapeutic education sessions received, and the time since the last medical consultation. Finally, asthma control was significantly better in children who demonstrated good inhalation technique mastery.

Conclusion : Proper inhalation chamber technique is essential for effective asthma control. The frequent errors observed highlight the need to strengthen therapeutic education, particularly for younger children and families with limited educational backgrounds. Targeted interventions could enhance device usage and improve clinical

Risk factors for secondary cataract

Lotfi Chaabani — 2026-01-22

Introduction: Posterior capsule opacification represents a major public health concern, particularly in developing countries. It is the most common complication after cataract surgery. Its pathogenesis involves multifactorial mechanisms, including surgical, biomolecular, and patient-related factors.

Aim:A retrospective case-control study was initiated to identify the risk factors for the development of posterior capsule opacification.

Subjects and methods: Two hundred eyesundergoing cataract surgery at the ophthalmology department of Kasserine Regional Hospital between 2019 and 2023, operated by a single surgeon:one hundredcases of patients with secondary cataract compared with 100 controls (without posterior capsule opacification). We evaluated the risk factors related to the patient, the primary cataract, the surgical technique, intraoperative and postoperative complications. Statistical analysis was done in 3 steps: a univariate analysis, then a bivariate analysis using chi-square and the student tests and finally, we performed a multivariate analysis with a logistic regression.

Results: The bivariate analysis identified 16 risk factors: age, female sex, glaucoma, uveitis, high myopia, exfoliation syndrome, white cataract, age related cataract, extracapsular extraction, type of the lens, biconvex lens, multipiece IOL lens, corneal opacities, ciliary sulcus implantation and persistence of residual cortical material. The multivariate analysis selected four principal factors: exfoliation syndrome, age related cataract, white cataract and ciliary sulcus implantation.

Conclusion: The main independent risk factors for posterior capsule opacification identified in this study were exfoliation syndrome, age-related cataract, white cataract, and ciliary sulcus implantation. Awareness of these factors enables targeted prevention, which may explain the current decline in secondary cataract incidence.

Prevention of Respiratory SyncytialBronchiolitis

Jihene Bouguila — 2026-01-22

Acute bronchiolitis is the leading cause of hospital admissions among infants worldwide and is associated with increased morbidity. The respiratory syncytial virus (RSV) is the most common causative agent and is often linked to a more severe and prolonged form than that caused by other viral agents. The annual outbreaks of bronchiolitis place substantial strain on pediatric emergency departments, hospital bed availability, and saturation of resuscitation beds. Most RSV bronchiolitis hospitalizations occur during the first three months of life in healthy term neonates. Management for RSV-related lower respiratory tract disease is mainly supportive.

Recent advancements in RSV prevention strategies have emerged, including the approval of two new effective options: a maternal vaccine (RSVpreF) and a long-acting monoclonal antibody (Nirsevimab).

The aim of this review is to screen recent literature and Tunisian data regarding RSV Bronchiolitis and summarize current evidence concerning knowledge and attitudes regarding RSV prevention strategies.

New therapeutic approaches based on modulation of the intestinal microbiota to correct dysbiosis in patients with type 2 diabetes.

Hanane Lerhzouli — 2026-01-22

Type 2 diabetes is a chronic disease characterized by insulin resistance and reduced insulin production in pancreatic cells. Conventional treatment of type 2 diabetes relies on hypoglycemic drugs, physical activity and a balanced low-carbohydrate diet, but with technological advances in metagenomics and metabolomics researchers have developed new therapeutic approaches aimed to modulate, the gut microbiota to correct the dysbiosis confirmed in people with type 2 diabetes. This literature review provides an update on therapies aimed to modulate the gut microbiota to correct dysbiosis in type 2 diabetics and summarizes the latest advances in this field.

Can generative AI improve academic journal selection decisions? Assessing traditional and algorithmic approaches in medical research

Jabeur Methnani — 2026-01-22

Introduction: Journal selection is a critical step in the scientific publishing process, influencing the visibility, impact, and credibility of the published work. This task has become increasingly complex due to the proliferation of journals, predatory practices, and the diversity of editorial criteria. This narrative review presented an overview of classical tools, artificial intelligence (AI)-driven platforms, and generative models (ChatGPT, Grok) used to recommend suitable journals for an unpublished manuscript.

Methods: Six tools were tested (Springer Journal Finder, Jane, Manuscript Matcher, Trinka Journal Finder, ChatGPT, and Grok) using either the abstract or full text of a clinical article on nonspecific low back pain. The results were compared based on thematic relevance, availability of bibliometric indicators, and transparency of the recommendations.

Results: Classical tools are limited by their narrow editorial scope and the absence of key indicators. AI platforms offer broader coverage but sometimes lack precision for targeted topics. Generative tools stand out for their ability to structure recommendations, although the data provided (impact factor, fees, timelines) are often inaccurate or unverifiable. Several technological biases and algorithmic limitations impact the overall reliability of these systems.

Conclusion: While AI tools expedite initial journal identification, they frequently suggest journals outside the manuscript's scope and provide incorrect journal metrics. These systems function best as exploratory instruments rather than authoritative advisors. The most successful approach positions the researcher as the primary decision-maker who employs computational assistance to survey options while exercising scholarly judgment for final determinations.

How to Publish? Strategies for successful medical publication drawing on the experiences of North African researchers

Rym Fakhfakh — 2026-01-22

Background. Publication is crucial for disseminating research findings and advancing scientific knowledge. However, medical researchers in developing countries face significant challenges in publishing their work due to limited resources, mentorship, and access to high-impact journals. This study aimed to identify strategies for successful medical publication, drawing on the experiences of Tunisian researchers.

Methods. This perspective-based study combines a comprehensive literature review with expert-facilitated group discussions. A research session held at the Faculty of Medicine of Sousse (Tunisia) brought together 44 participants from diverse medical specialties. The session included group discussions and expert presentations to explore strategies for successful medical publication.

Results. Key strategies for successful publication were identified, including defining the target manuscript, choosing the appropriate journal, preparing a structured manuscript, ensuring clear and concise writing, following journal-specific guidelines, and adhering to ethical considerations. Other important aspects, such as identifying authorship, avoiding predatory journals, disclosure of conflicts, acknowledgements, cover letters, and responses to peer reviews, were often neglected in the feedback of Tunisian researchers.

Conclusion. Strengthening the publishing capacity of researchers in developing countries requires targeted training programs and institutional support. By implementing best practices in manuscript preparation and submission, researchers can enhance their chances of publication in high-quality medical journals.

Effect of combined Pain Neuroscience Education with Conventionnel Physiotherapy for patients with Chronic Low Back Pain: A Study Protocol for a Randomized Controlled Trial.

Ali Iken — 2026-01-22

Background: Chronic low back pain (CLBP) presents a major challenge for healthcare systems due to its significant physical, psychological, and economic impacts. Most affected patients have already tried various treatment methods, including physiotherapy, without significant benefit [1]. Thus, determining the best treatment method for these patients has always been a priority in clinical research.

Aim: to determine whether a conventional physiotherapy program (CPP) combined with pain neuroscience education (PNE) is superior to a CPP alone in patients with CLBP.

Methods: This study is a single-blind randomized controlled clinical. Forty participants (n = 40) with CLBP will be randomly assigned equally between the two study groups (intervention group: "PNE + CPP," and control group: "CPP alone") according to the inclusion criteria. The primary outcome measure of the clinical trial is pain intensity. Secondary outcome measures will assess functional disability, kinesiophobia, pain catastrophizing, and quality of life. Results will be evaluated at baseline and at 4 weeks post-intervention.

Expected results : PNE, as a complementary therapy, is expected to have a positive impact on pain in patients with CLBP. The authors anticipate that PNE, when combined with a CPP, could improve functional capacity, reduce kinesiophobia and catastrophizing, and contribute to the overall improvement of quality of life in patients with CLBP.

Trial registration: PACTR202405901603120 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30450)

The University of Jendouba's Comprehensive Digital Framework for Research Ethics Management: An Integrated System with Real-Time Verification, Surprise Audits, and Public Access through QR Codes and DOIs

Ismail Dergaa — 2026-01-22

The University of Jendouba is implementing a novel digital framework to transform how Institutional Review Board (IRB) approvals are managed, with phased deployment commenced on June 13th, 2025, tackling pressing global issues in research integrity and transparency. Built on international standards like the Declaration of Helsinki and Good Clinical Practice (GCP), this system employs advanced tools such as QR codes and Digital Object Identifiers (DOIs) to enable real-time verification and public access to approved protocols. Crucially, the system extends its oversight beyond IRB approvals, monitoring the entire research process to ensure ethical compliance from the initial protocol submission through to the final publication of results.

This framework addresses critical challenges, including the falsification of IRB approvals, data manipulation, and undisclosed changes to research protocols. It features automated compliance checks, risk-based evaluations of protocols, and real-time tracking of research activities to ensure studies adhere to their approved plans. Additionally, surprise audits and continuous oversight mechanisms are in place to detect and prevent unethical practices at every stage of the research process.

As the first system of its kind in North Africa, this platform aligns with both local and international research ethics guidelines, fostering collaboration and standardization across disciplines. It also integrates blockchain technology and connects with global ethics databases to enhance transparency and trust in research outcomes.

Effectiveness of Simulation-Based Training in Enhancing Knowledge and Performance of Paramedical Personnel in Basic Life Support in a Developing Country

Ferdaous Yangui — 2026-01-22

Introduction: Basic life support is important for increasing patient survival after a cardiac arrest. However, it was demonstrated that healthcare professionals lacked certain knowledge and skills in basic life support. This study aimed to evaluate the effectiveness of a low-fidelity simulation training session in improving paramedical personnelknowledge and performance inBasic life support.

Methods: A cross-sectional quasi-experimental single-group pre-post intervention study was conducted at the Internal Security Forces Hospital in Tunisia in January 2024. All paramedical personnel providing direct patient care were included. The training program involved a theoretical course and a simulation training session. Participants filled out pre-tests and post-tests before and after the theoretical course. A practical simulation test with a skill assessment sheet occurred after the basic life support simulation training session.

Results: Fifty-five paramedical personnel participated in the study. Participants’ mean age was 39.7±10.3 years and 72.7% of the participants were women. Most participants were nurses (50.9%). Comparing the pre-test (M=1.73, SD= 0.7) with the post-test scores (M=2.77, SD=1.02,) showed a significant improvement in basic life support knowledge after the theoretical course (p< 10-6). After the basic life support simulation training session, a significant improvement in the practical test score (M=4.04, SD= 0.7) compared to the post-test score was observed (p< 10-6).

Conclusions: Simulation training has a positive effect on improving paramedical personnel's knowledge and performance. To enhance their knowledge and practice in cardiopulmonary resuscitation, a basic life support training program is recommended for all paramedical personnel.