La Tunisie Médicale

Salah Azaiez Institute 2025 Congress

2025-06-01

Epidemiology of schistosomiasis in Madagascar after thirty years of control program (1994-2024)

Charles Emile Ramarokoto — 2025-06-01

Introduction: Since the 60s, control programs initiated have not led to the expected results. Around the 90s, a new orientation was taken.

Aim: This study evaluates prevalence and epidemiology’s patterns of schistosomiasis following this reorientation.

Method: To find publications about schistosomiasis in Madagascar. The database consulted is Pubmed and Scopus. The search date is between 15th April 2024 to 15th June 2024 including publications between 1st January 1994 to 15th June 2024. Prevalence is represented as a proportion. Data are collected in Microsoft Excel® version 16 and analyzed with Epi Info™ version 7.2.5.0. A p-value < 0.05 is considered significant.

Results: This review includes 49 articles. The majority (51%) concern intestinal schistosomiasis. A total of 32,647 patients provided 55,690 samples, of which more than 75% were used for the diagnosis of intestinal schistosomiasis. The prevalence, regardless of the method of diagnosis, for intestinal and urinary schistosomiasis is 49.3% [28.7% - 72%, 95% CI] and 40.2% [14.7%-57% CI 95%] respectively.

Nearly half of the patients (47.4%) are school-age children and live in rural areas (45.6%).

Conclusion: The results of this study highlight the impacts of control measures after 30 years of implementation. Interventions must target the population of villages in hard-to-reach areas.

Determinants of quality of life among patients with breast cancer in Africa: a systematic review

Hanane LEMMIH — 2025-06-01

Aim: To detect and describe determinants influencing the quality of life among patients with breast cancer across Africa.
Methods: Applying the PRISMA methodology, we searched the PubMed, Scopus, and Web of Science databases from inception through January 2024 using the following search terms: breast cancer, quality of life, and Africa. The studies selected aimed to identify the factors that impact the quality of life of African women with breast cancer. The methodological rigour of each publication was assessed using the Newcastle-Ottawa Scale, which was adjusted for both cohort and cross-sectional study designs.
Results: 22 studies were included in this systematic review, consisting of 15 (68%) cross-sectional studies and 7 (32%) prospective studies. These studies investigated more than 34 different determinants influencing the quality of life among breast cancer. Comorbidities, chemotherapy, anxiety, and depression generally reported poorer quality of life initially, though it often showed improvement over time. Research findings varied regarding how age, marital status, income, and treatment types influence the quality-of-life outcomes among patients with breast cancer in Africa.
Conclusion: Breast cancer patients frequently experience a worse quality of life, particularly if they are receiving chemotherapy and have additional medical conditions. This situation highlights the importance of offering patients additional therapies to improve their overall quality of life, together with comprehensive psychological and social support.

Ending nuclear weapons, before they end us

Kamran Abbasi — 2025-06-01

The Infection Prevention and Control measures during the COVID-19 pandemic: Impact on the Prevalence of Hospital-Acquired Infections at Sahloul University Hospital, Sousse, Tunisia

Salma Balhi — 2025-06-01

Introduction: Hospital-acquired infections (HAI) represent a growing public health concern and are the most common adverse events in healthcare delivery. Improvements in infection prevention and control (IPC) practices at both national and facility levels are decisive for successfully preventing HAIs. The relevance of IPC in preventing the spread of disease was underscored during the COVID-19 pandemic. However, the impact of COVID-19 preventive measures on HAIs remains debated.

Aim: This study aims to investigate the impact of the IPC program implemented during the COVID-19 pandemic at Sahloul University Hospital in Tunisia on the prevalence of HAIs. Additionally, the study will assess compliance with IPC measures during the same period.

Methods: A pre-interventional study design will be conducted at Sahloul University Hospital in Sousse, Tunisia. The study will compare HAI prevalence over three periods : pre-pandemic (2019), during the pandemic (2020) and post-pandemic (2022). For the Point prevalence srvey, all hospital wards (units or departments) will be included in the survey, except the emergency department, hemodialysis unit and endoscopy units. Four key IPC program criteria will be analyzed: hand hygiene compliance, environmental cleaning, sanitary waste management, and the consumption of personal protective resources, including alcohol-based hand sanitizer, surgical masks and disposable gloves.

Expected results : This study specifically explores the effects of IPC measures implemented during the COVID-19 pandemic on HAIs prevlance. Its findings are expected to contribute valuable insights into sustainable strategies for maintaining high compliance rates and reducing HAI prevalence beyond crisis periods.

Increasing Prevalence of Multiple Sclerosis in Tunisia

Saloua Mrabet — 2025-06-01

Data on the prevalence of Multiple Sclerosis (MS) in Tunisia come back more than twenty years ago. Our study aimed to determine the prevalence of MS in Tunisia and to discuss the determining factors of its current status. The results suggested a trend towards an increase in the prevalence of MS in Tunisia reaching 58.3 per 100 000 inhabitants in 2020. It ranks Tunisia in a high prevalence MS zone but is still lower than that in the western countries and some MENA countries. The determining factors of this new MS prevalence need to be investigated to insure better management of healthcare resources.

Influence of heat therapy and/or vibration on nonspecific back pain: A prospective, open, randomized, controlled, parallel-group clinical study

Manfred Hartard — 2025-06-01

Introduction: Traditional heat therapy (HEAT) and emerging vibration therapy (VIB) have shown potential benefits in alleviating nonspecific back pain (NSBP). This randomized controlled study aimed to evaluate the efficacy of HEAT, VIB, and their combination (COMBI) in reducing pain levels and improving cardiovascular parameters in NSBP patients.

Methods: Fifty-nine patients with NSBP were randomly assigned to 3 groups: HEAT (n=19), VIB (n=20), and COMBI (n=20). The study included three visits (V₁ to V₃) with interventions in V₂. Pain visual analogue scale scores (ie; primary outcome, with a minimal clinically important difference (MCID) set at 10 mm on a 100 mm scale), oxy-haemoglobin saturation (SpO₂), heart-rate, blood-pressure, and perfusion-index were evaluated before (V_2b) and after (V_2a) each intervention. During V₃ (ie; telephone call one day after the intervention) only pain score was evaluated. Changes (ie; V_2a-V_2b, V₃-V_2b) were calculated.

Results: All 3 therapies were clinically effective, with mean pain changes exceeding the MCID. The COMBI group showed the greatest pain reduction in mm (17 at V₂, 23 at V₃) compared to the VIB (15 at V₂, 10 at V₃) and HEAT (11 at V₂, 10 at V₃) groups. In comparison to the COMBI group, the VIB one exhibited a higher change in heart-rate (-2±4 vs. 3±5 bpm; -1±3 vs. 1±3 % of predicted maximum hear-rate, respectively). SpO₂ change under COMBI decreased significantly by 1±1%. No significant changes were observed in blood-pressure or perfusion-index across the groups.

Conclusions: COMBI-therapy provides superior pain relief for NSBP compared...(abstract truncated at 250 words)

Buffered versus non-buffered lidocaine with epinephrine for subcutaneous implantable venous access devices insertion reduces pain: A randomized trial

Imtinene Belaid — 2025-06-01

Introduction: Implantable ports (Port-a-Caths) are a mainstay in the treatment of cancer patients. While these devices improve patient experience, their insertion can be painful.

Aim: To compare the analgesic efficacy of buffered and non-buffered lidocaine with epinephrine in reducing pain during Port-a-Caths insertion in cancer patients.

Methods: This study was a prospective, randomized, double-blind, controlled trial. One hundred twenty cancer patients scheduled for Port-a-Cath placement under local anesthesia were randomized to receive either buffered (pH=7.33) or non-buffered lidocaine with epinephrine (pH=3.50). The primary outcome was pain assessed during five procedural steps using a standardized 100-mm visual analog scale (VAS). Secondary outcomes included sensory block onset time and patient satisfaction.

Results: One hundred twenty patients were enrolled in this study, with sixty patients in each group. Mean pain scores during local anesthesia infiltration were significantly lower in the buffered lidocaine group (15.7 ± 7.6 mm) compared to the control group (46.9 ± 12.3 mm; p < 0.001). Mean VAS satisfaction scores were significantly higher in the buffered lidocaine group (95.75 ± 8 mm) compared to the control group (70.2 ± 20.1 mm; p < 0.001). Sensory block onset time, as determined by pinprick test, was significantly shorter in buffered lidocaine group (3.25 ± 1.3 min) compared to control group (5.5 ± 1.3 min; p < 0.001).

Conclusion: Alkalinizing lidocaine with epinephrine significantly reduced pain during Port-a-Cath placement in cancer patients, improving anesthesia quality and patient satisfaction.

A novel method for rapid determination of risperidone in human plasma using Reversed-Phase Liquid Chromatography with Ultra-Violet detection

Dhouha Sahnoun — 2025-06-01

Aim: A simple and sensitive High-Performance Liquid Chromatographic (HPLC) method with UV detection is described for the quantitation of risperidone in human plasma, using bisoprolol as internal standard.

Methods: After sample alkalinization with 900 µl of NaOH, the test compounds were extracted from plasma using diethylether. The tubes were centrifuged twice and an evaporation to dryness under a gently stream of nitrogen at 50°C (~10 min) was done. 50 μl of the solution was injected into a C18 Nucleosyl analytical column (5 μm, 150×4.6 mm I.D). The mobile phase consisted of phosphate buffer (10 mM, pH 4.9 and 30% acetonitrile, (70:30, v/v), and was delivered at a flowrate of 1.0 ml/min. Results: The peaks were detected using a UV detector set at 279 nm and the total time for a chromatographic separation was about 8 min. This new method was validated for the concentration range 5–150 ng/ml. Mean recoveries were 92 % for risperidone. Intra- and inter-day relative standard deviations were less than 15% for our compound, while accuracy, expressed as percent error, ranged from 0.13 to 19 %. The limit of quantitation (LLOQ) was 3.23 ng/ml for the analyte.

Conclusion: The method shows good specificity with respect to commonly prescribed psychotropic drugs.

Epidemiological and clinical criteria for the diagnosis of cutaneous leishmaniasis in Tunisia

Karim Aoun — 2025-06-01

Introduction: Biological confirmation of cutaneous leishmaniosis (CL) and identification of species involved are not always available. Zoonotic CL (ZCL) in the center-south and sporadic CL (SCL) in the north are the main forms of the disease in Tunisia. They have recently spread and are now coexisting in several regions.

Aim: To establish simple epidemiological and clinical criteria to improve CL diagnosis and to assess the CL form.

Methods: Dermal smears of 227 patients suspected of CL were examined by microscopy and then scrapped, the DNAs were extracted and tested by PCR. Epidemiological and clinical data were anonymously collected.

Results: The diagnosis of CL was confirmed by at least one biological test in 76 patients infected in the center-south (ZCL) and 24 patients infected in the north (SCL). CL cases consulted mainly between october and january (66.3% versus 46%; p=0.003). Their lesions were more multiple (48.5% versus 32.5%; p=0.002).

Compared to SCL cases, a higher proportion of ZCL cases consulted between october and january (73.7% versus 45.8%; p<0.01). Their number of lesions was higher (3.3±0.4 versus 1.2±0.1; p<0.0001), with a preferential limb location (80.3% versus 25%; p<0.001). Lesions of SCL cases were older (6±1.2 versus 2.2±0.2 months; p<0.001) with less ulcerative-crusted presentation (41.6% versus 77.6%; p=0.009).

Conclusion: Some easy to collect epidemiological and clinical data would be suggestive of the diagnosis and the form of CL. Collecting these data could improve surveillance of the disease and case management especially in rural areas with few diagnostic facilities.

Prevalence and Predictive Factors for JAK2V617F, CALR, and MPL Mutations in Splanchnic Vein Thrombosis

Ikbel Ghachem — 2025-06-01

Introduction-Aim: Latent myeloproliferative neoplasms (MPNs) have been reported in splanchnic vein thrombosis (SVT). This is the first Tunisian study aimed at evaluating the frequency of JAK2V617F, MPL, and CALR mutations in SVT and analyzing their correlation with hematological parameters

Methods: This study, conducted between 2013 and 2017, included non-malignant and non-cirrhotic SVT cases. JAK2V617F and MPL mutations were detected by real-time PCR, and the CALR mutation was screened by PCR and direct sequencing.

Results: The JAK2V617F mutation was detected in 20.1% of 233 SVT cases, with a significantly higher prevalence in Budd-Chiari syndrome (BCS). MPL and CALR mutations were not detected. The frequency of latent MPN was 36.2% in SVT, 31.7% in portal vein thrombosis, and 66.6% in BCS. Patients with SVT and hemoglobin levels ≥14.5 g/dL in men, 11.4 g/dL in women, Leukocytes count ≥6100/mm³, and platelet count ≥238,000/mm³ could be tested for the JAK2V617F mutation. This strategy avoids 89.5% of unnecessary tests in patients below these thresholds. A platelet count ≥238,000/mm³ was an independent factor correlated with the JAK2V617F mutation and a strong predictor of latent MPN (OR=17.3; 95% CI [2.8-105.1]; p=0.002). Conclusion: Screening for JAK2V617F is useful for diagnosing latent MPNs revealed by SVT, while MPL and CALR mutations are rare and not recommended.

Psychological climate at work and intention to leave the organization: Qualitative study in University hospital in Morocco

Amal Zarir — 2025-06-01

Introduction: This work examines the influence of psychological working climate in explaining intentions to leave the organization, The interest in this theme is explained by the need to understand the factors that hinder the retention of nurses, The continuing shortage of nursing staff and the persistent recruitment difficulties are all problems that are currently affecting the institutions.

Aim :To explore the role of psychological work climate in nursing staff with the intention of leaving the organization.

Methods: we conducted an exploratory qualitative research with a thematic analysis. We conducted 20 semi-structured interviews during the period from 15 April to 15 May with nurses who have left or expressed their intentions to leave L’Hôpital.

Results: 20 nurses interviewed, the main factors of psychological climate that led these professionals to leave the organization: a) lack of recognition, b) style of leadership transactional (autocratic) , c) the lack of clarity in nursing role d) conflicts sit-in the work team, e) organizational bureaucracy, lack of support and administrative justice and weak support, f) lack of communication

Conclusion: the prevention of the departure of nurses requires a definition of the own role of nurse, a participative leadership, cooperative and understanding relations between team members, a management policy based on listening, support for administrative justice and finally an organization that promotes innovation and skills development.

Role of ultrasound parameters in the prediction of failure of induction of labor using Dinoprostone

Hana Hakim — 2025-06-01

Introductio-Aim: Labor induction is the artificial induction of uterine contractions in a woman who was not already in labor in order to achieve a vaginal birth. The main objective of our study was to analyze the role of ultrasound parameters in the prediction of failure of induction of labor.

Methods: This was a prospective observational study performed in a tertiary care maternity. For all the women who met our inclusion criteria, we measured these ultrasound parameters: Cervical length (CL), cervical dilation, cervical posterior angle (CPA), fetal head-perineum distance (FHPD), fetal occiput position, biparietal diameter (BPD) and estimated fetal weight (EFW). We defined failure of induction of labor as the occurrence of a cesarean section at any moment after the start of the induction.

Results: we collected 150 cases of induction of labor that met our inclusion criteria. Failure of induction rate was 45 %. Ultrasound parameters that were significantly associated to failure of induction were Cervical length (p=0.003), cervical dilation (p=0.002), cervical posterior angle (p<10-3), fetal head-perineum distance (p<10-3) and estimated fetal weight (p=0.006). Multivariate regression analysis found that posterior cervical angle and fetal head-perineum distance were the variables independently affecting the outcome of the induction of labor with respective thresholds of 105° and 55mm.

Conclusion: Ultrasound can be very useful in predicting the failure of labor induction. The threshold values that we found should be tested and validated in future studies to create a model to predict failure of labor.

The room of errors: An innovative learning tool to enhance patient safety in intensive care

Imen Ben Saida — 2025-06-01

Introduction : Patient safety is a major concern in healthcare, particularly in intensive care units. While the room of errors (RoE) has proven to be an effective pedagogical tool for preventing medical errors, its application in the initial medical training of healthcare professionals in Tunisia remains under-explored.

Aims. To i) Describe the methods used to implement a RoE in a Tunisian university setting, ii) Analyze the errors made by learners, and iii) Evaluate the impact of RoE on participants' knowledge and satisfaction.

Methods : This was a cross-sectional descriptive study conducted on May, 2024, at the simulation center of the Faculty of Medicine of Sousse (Tunisia), involving third-year students in the anesthesia and resuscitation section of the private university of health sciences in Tunisia (n=20), and first-year students of the second cycle of medical studies (n=11), who were completing their anesthesia and resuscitation medicine internship at Sahloul hospital (Sousse, Tunisia).

Results : Twenty-six students were included in the study. The median [interquartile range] of detected errors was 3.5 [3.0-5.0]. Pre- and post- tests showed an improvement in participants' theoretical knowledge regarding hemorrhagic shock after the debriefing session. Nevertheless, some gaps persisted, suggesting the need to delve deeper into certain points in future sessions. The evaluation results showed that the RoE was highly appreciated by most participants.

Conclusion : RoE is an innovative and particularly effective pedagogical tool to promote a positive error culture and enhance patient safety.

Enhancing pre-analytical phase efficiency in a tertiary Parasitology-Mycology Laboratory: A methodological approach

Fouad Assi — 2025-06-01

Introduction: The pre-analytical phase is a crucial step in the workflow of medical laboratories, as errors during this stage can significantly impact the subsequent analytical and post-analytical phases.

Aim: This study provides a comprehensive analysis of the causes of pre-analytical non-conformities and the corrective procedures implemented in the Parasitology-Mycology Central Laboratory of the Ibn Sina University Hospital Center in Rabat.

Methods: Over a 30-month period, we evaluated compliance with ISO 15189:2022 standards using a self-assessment grid to identify areas for improvement. Non-conformities were categorized based on their root causes to gain insight into the underlying issues. We conducted a Pareto analysis to identify the most significant problems in the pre-analytical phase. Additionally, we employed Failure Modes and Effects Analysis (FMEA) to assess potential risks associated with these non-conformities.

Results: The most frequent non-conformities identified included delays in sample transportation, reagent shortages, and identification-prescription errors. The FMEA categorized these non-conformities as high-risk, leading to several proposed corrective actions: enhancing transport protocols, implementing automated alerts for reagent shortages, improving staff training, and establishing better communication between departments and the laboratory.

Conclusion: This study emphasizes the need for a comprehensive approach to managing non-conformities in the pre-analytical phase. Involving everyone in the process and creating a culture of quality and responsibility are essential for improving laboratory efficiency and ensuring better patient outcomes. Additionally, continuous monitoring and evaluation through established quality indicators will support ongoing improvements in laboratory practices.

Utility of segmental and regional left ventricular longitudinal strain in identifying localization and extent of myocardial injury in patients with acute myocarditis confirmed by cardiac magnetic resonance

Faten El Ayech Boudiche — 2025-06-01

Introduction-Aim: This study aimed to evaluate the role of echocardiographic left ventricular (LV) longitudinal strain (LS) in identifying the localization and extent of myocardial injury compared to edema and late gadolinium enhancement (LGE) detected on cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis (AM).

Methods: Patients >18years-old, with informed consent, and AM confirmed by CMR were prospectively enrolled between 1^st November 2023 and 30^th September 2024. Strain echocardiography with measurements of global (GLS) and segmental longitudinal strains (SLS) was performed. Number and localization of segments with impaired LS were compared with those with edema and/or LGE on CMR.

Results: 19 patients, 31.6±12.0 years old and 84.2% male were enrolled. Although LV ejection fraction (EF) was preserved in all patients, GLS was impaired in 63.2% of them. Impairment in regional LS was identified mainly in the anterolateral, inferolateral and inferior regions, in concordance with localization of edema and LGE detected by CMR, with strong correlation between extent of myocardial injury on CMR and number of segments with impaired SLS per patient (r=0.76; p=0.0002). Performance of SLS in the diagnosis of edema in AM patients was satisfactory with an AUC=0.725, CI 95% [0.67-0.78] and p<0.001. Cut-off value was -17.5% with a sensitivity of 71% and specificity of 65%.

Conclusion: In AM patients, analysis of LS identified impairment in LV myocardial deformation in patients with a normal LVEF. Comparison with CMR showed a very close topographical distribution between regions with impaired myocardial deformation and those ..(abstract truncated at 250 words).

Assessment of biochemical markers associated with inflammation in patients with type 2 diabetes mellitus.

Wafaa Hufdhy Ajam — 2025-06-01

Introduction-Objective: Diabetes mellitus type 2 is a chronic and progressive metabolic disorder characterized by hyperglycemia and long-term inflammation. Vitamin D has anti-inflammatory properties that reduce the production of pro-inflammatory cytokines IL-6 and TNF-α. This study aimed to investigate the role of serum vitamin D, parathyroid hormone, and homeostatic model assessment for insulin resistance (HOMA-IR) on individuals with type 2 diabetes mellitus. Additionally, study the relationship between these factors and interleukin-6 (IL-6), tumour necrosis factorα (TNF-α), and C-reactive protein (CRP).

Method: This case–control study included a total of 100 participants within the age range of 45 to 65 years. There were 50 participants diagnosed with type 2 diabetes mellitus (T2DM) and 50 healthy individuals (control).

Results: The levels of serum IL-6 were significantly increased in the T2DM group compared to the control groups (p < 0.05). Additionally, the T2DM group were increased levels of HOMA-IR, TNF-α, and CRP compared to the control group (p < 0.05). The patient group showed a decreased in 25-OH vitamin D levels (P > 0.05). Although the mean serum PTH level increased, this increase was significantly greater in the T2DM group compared to the control group.

Conclusion: The study revealed a significant negative correlation between vitamin D, HBA1C, and HOMA-IR. There is also a strong positive correlation between HOMA-IR and HBA1c, TNF-α, IL-6, and CRP. This suggests that vitamin D and PTH play a role in glycemic control.

Thoughts and considerations on Elderly onset Rheumatoid Arthritis: A case-control study of a North African population.

Kaouther Maatallah — 2025-06-01

Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease, and elderly onset RA starting after age 65 (EORA) is on the rise constituting approximately one-third of RA cases.

Aim: To identify the clinical and therapeutic specificities of EORA.

Methods: This was a cross-sectional case-control study of 224 RA patients (recruitment was done over a 30-month period between 2018 and 2021). Two groups were evaluated:

Elderly onset rheumatoid arthritis (EORA): patients in whom the disease started after the age of 65 and the young-onset rheumatoid arthritis (YORA) control group: patients with disease onset before the age of 65. We collected the clinical characteristics and we compared the therapeutic modalities between both groups:

Results: Our study included 59 patients in the EORA group and 165 patients in the YORA group. The onset of RA in both groups was predominantly progressive and polyarticular. However, in the EORA group, rhizomelic involvement and abrupt onset were significantly more frequent than in the YORA group, with respectively (ORa=4.8 CI=1.5-15.6; p<0.01) and (ORa=5.1 CI=1.8-14; p<0.01). Methotrexate (MTX) was the most frequently used background treatment in both groups. There was no significant difference between the two groups in the prescription of the other conventional DMARDs.

Adverse events were more frequently found in the EORA group (ORa=4.7 CI=1.3-16.4, p<0.05) and consisted mainly of gastrointestinal intolerance.

Rehabilitation was advocated in 6.7% of the EORA group versus 16.9% of the YORA group, with a significant difference (ORa=4.73 [1.36-16.47), p=0.02)...( abstract truncated at 250 words)

Epidemiology and sociodemographic determinants of Obesity in Moroccan Adult Population

Karima Mohtadi — 2025-06-01

Introduction : Obesity and overweight result from excess fat, leading to health complications and a reduced life expectancy. This issue impact Morocco like all countries worldwide, due to several determinants such as dietary changes, lifestyle choices, sedentary behavior and socioeconomic parameters.

Aim: To evaluate the prevalence of overweight and obesity in Moroccan population, and their related socio-demographic factors.

Methods: Our study is a cross-sectional study carried out among adult subjects aged 18 years and above, who were selected using cluster sampling. Data collection was conducted using a questionnaire that included sociodemographic parameters such as age, sex, and marital status, educational level…as well as anthropometric measurements. The statistical analysis was performed using SPSS.

Results: The total number of participants was 731 (51.8% women and 48.2% males). The age group 20-29 years constitutes 25.6% of the studied population followed by 30-39 years with 19.4%. According to the BMI the overall prevalence of obesity was 20.7%, with a female predominance (80.10 %). The results indicated that BMI increases with age up to 59 years (p<0.0001). We revealed a strong association between numerous factors and obesity such as age, sex, age, marital status, occupational activity, education level and housing.

Conclusion: Through our study, we found that the obesity was associated with a several sociodemographic factors such as: gender, age, marital status, occupational activity, education level and housing type and size with a female predominance. We suggest structural and supportive policies such as improving access to healthcare services that promotes healthy living and reduces obesity rates.

Clinical, therapeutic and evolutionary profile of spontaneous pneumothorax

Sabrine Majdoub Fehri — 2025-06-01

Introduction: Pneumothorax (PNO) is a common pathology in clinical practice. The therapeutic approach to PNO depends on the patient's clinical conditions, the extent of the disease, and the presence or absence of underlying pulmonary comorbidity.

Aim: To report the epidemiological and therapeutic profile of patients treated for spontaneous pneumothorax in a university hospital in a city in southern Tunisia.

Method: This is a retrospective descriptive study involving patients hospitalized for spontaneous PNO in the pulmonology department between January 2020 and December 2021.

Results: During the study period, there were 56 admissions for spontaneous PNO. Men were more affected than women (94.6%). The average age of the patients was 43 years old. Seventy-four percent of patients lived within a 10 km radius of the Gabes industrial zone. Smoking was noted in 85.71% of patients. Nineteen patients (33.9%) had respiratory comorbidities such as PNO (21.4%), chronic obstructive pulmonary disease (COPD) (7.1%) and covid19 pneumonia (7.1%). PNO was classified as primary in 41 patients (73.21%) and secondary in 15 patients (26.78%). The clinical symptoms were dominated by chest pain in 98.2% of cases, dyspnea 82.1% and cough 41.1%. The clinical tolerance of PNO was good in 80.4% of cases. The course of action was bed rest with high-flow oxygen therapy in 12 patients (21.4%) with partial and well-tolerated PNO. Chest drainage was performed as first intention in 44 patients (78.6%). The average time to return to the wall was 4 days. A pleurodesis procedure was indicated....( abstract truncated at 250 words).

Knowledge of Tunisian medical personnel on the prevention of imported malaria

Fatma Gassara — 2025-06-01

Introduction : Malaria remains one of the most widespread parasitic diseases in the world. It is crucial for medical personnel to be well-informed about the preventive methods of imported malaria in order to effectively fulfill their role.

Aim: To assess the knowledge of medical personnel regarding anti-vectorial prophylaxis and anti-malarial chemoprophylaxis.

Methods: From December 1st to December 20th, 2023, a cross-sectional survey was carried out among Tunisian medical staff using an anonymous questionnaire through Google Forms to evaluate their understanding of three key areas: malaria prevention during travel, chemoprophylaxis, and available prevention measures in Tunisia.

Results: Two hundred and five responses were included in the study. The average age of the participants was 31.5±6.6 years with a gender ratio of 0.47. The participants consisted of young doctors (64.4%) and senior doctors (35.6%). The majority of the respondents were specialist doctors (87.3%) practicing in Tunisia (93.2%). On a total score of 40 points, the average evaluation score was 19.1±5.6 points. More than half (57.6%) had a score below the average. The knowledge about the prevention of imported malaria was categorized as excellent (4.4%), good (38%), fair (55.1%), and limited (2.5%). The data analysis revealed that doctors working in the public sector (p=0.009), specialists in infectious diseases and parasitology, and doctors with expertise in travel medicine (p<0.001) had better knowledge. On the other hand, family doctors had a lower level of knowledge (p=0.003).

Conclusions: Gaps in the knowledge of Tunisian doctors regarding imported malaria prevention were identified. ....(abstract truncated at 250 words).

Predicting surgical intervention in pediatric intussusception using machine learning model

Saloua Ammar — 2025-06-01

Aim: To develop and validate a model predicting surgical treatment of intussusception in children.

Methods: Design: Retrospective study of charts and development of a model for predicting surgical treatment using logistic regression and machine learning using’’Knime’’ platform. Setting: Data collection occurred in the Department of Pediatric Surgery between January 2013 and December 2022. Patients: Children aged less than 3 years old with the diagnosis of ileocolic intussusception.

Results: One hundred and nine children were assigned to the training set, and 47 were assigned to the validation set. There were no significant differences between the two sets in clinical characteristics and surgical reduction. Surgical reduction was performed in 64 patients in the training set and 23 patients in the validation set (p=0.259). The univariate analysis showed that the duration of symptoms, mental state, palpable abdominal mass, bloody stools, elevated white blood cells, intraperitoneal effusion on ultrasound, and mass length were significantly associated with surgical treatment. After Logistic regression, bloody stools (p=0.033; OR=2.61), the duration of symptoms (p=0.028; OR=1.02), and the length of the intussusception (p=0.014; OR=1.265) were identified as independent risk factors for surgical treatment. The clinic-pathologic risk factors incorporated in the machine learning model were bloody stools, the duration of symptoms, and the length of the intussusception. This model was highly predictive, with a sensitivity and specificity of 95% for the SVM-derived model.

Conclusions: This model may be applied to facilitate pre-surgery decisions for children with intussusception. Larger prospective multicenter studies are needed to validate the model.

Enhanced Heart Failure Management: Impact of the therapeutic unit for heart failure (TUNI-HF) on mid-term prognosis

Houdhayfa Hermassi — 2025-06-01

Background: Chronic heart failure (CHF) is a global and increasing problem responsible of uncontrolled rates of mortality and readmission. A therapeutic Unit of heart failure (TUNI-HF) was established to assume a treatment optimization, comorbidities management and education in order to improve heart failure (HF) prognosis.

Aim: This study aimed to describe the impact of the TUNI-HF on treatment optimization, mortality and readmission rates at 12 months in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: A retrospective study was conducted in the military hospital of Tunis, Tunisia. Two groups were compared: Group “C” included patients followed from March 2018 for 12 months with usual care. Group “U” included patients followed from Mars 2021 for 12 months in the TUNI-HF.

Results: Groups “C” and “U” enrolled 108 and 110 patients respectively. At baseline, patients’ characteristics were comparable. Prescription rates of guideline directed medical treatment (GDMT) at optimal doses were low in two groups. After 12 months, prescription rates of beta-blockers (BB) and mineralocorticoid receptor antagonist (MRA) were higher in group “U”. In addition, optimal doses of BB, renin angiotensin aldosterone system inhibitors (RAASI) and MRA were more achieved in the same group “U”. Loop diuretics were less prescribed in the group “U” and cardiac implantable devices rate was higher in the same group. Kaplan Meier analysis showed significantly lower rates of readmission and all-cause mortality rates in the group “U”.

Conclusion: The management of HF in a specialized unit, compared with usual care,...(abstract truncated at 250 words).

Turnover: Factors influencing the intentions of healthcare professionals. “Case of a healthcare establishment”

Zineb Senhaji — 2025-06-01

Introduction: The hospital sector is facing a human resources crisis marked by an increase in turnover, affecting the continuity and quality of care. This shortage of qualified personnel puts pressure on existing teams and complicates patient care.

Aim: The goal is to determine the specific causes of healthcare professionals’ departures and identify organizational levers that could promote their retention, thereby contributing to better team stability in healthcare settings.

Methods: A quantitative survey was supplemented by a qualitative study, using interviews and focus groups to obtain comprehensive and nuanced data on the reasons for departure. This dual approach helps to deepen the understanding of healthcare workers' perceptions.

Results: The main reasons for leaving identified include workload overload due to staff shortages, leading to stress and burnout; limited career advancement opportunities; lack of recognition and unsatisfactory working conditions; organizational constraints, and inadequate remuneration. These factors drive many healthcare professionals to consider working in the private sector or moving abroad. To improve retention, it is essential to implement actions to stabilize teams and enhance the quality of care.

Conclusion: In light of the human resources crisis in the hospital sector, it is imperative to adopt concrete measures to improve staff retention by offering better career prospects and optimal working conditions.

Evaluation of the impact of natural help at the end of life and coping strategies

Rahma Gargouri — 2025-06-01

Introduction : When medicine is no longer able to offer hope to a patient, we come up against the dreaded feeling of incurability and the end of life. This frustrating situation is experienced by the doctor and the patient but also by the caregivers who find themselves forced to adapt to it.

Aim: This work was done to study the impact of aid on the lives of caregivers of cancer patients, to measure the burden and study their coping strategies.

Methods : This was a two-month cross-sectional study of primary caregivers of patients with lung cancer. Burden was measured using the ZARIT abbreviated scale. Anxiety was assessed using the STAI-Y anxiety inventory. Depression was assessed using the BDI questionnaire. Coping mechanisms were assessed using the Brief-COPE.

Results : Seventy-four caregivers were included in the study. Among them, 66% were women, with a mean age of 47.7 years. In 58% of cases, the carer was a spouse. Smoking was noted in 12 carers (16%). Co-addiction to alcohol and tobacco was noted in 5 parents (7%). In 40.5% of cases, help had been provided for 3 to 6 months, and in 70.3% of cases it was provided on a daily basis. In 37.8% of cases, the help lasted more than two hours a day. Carers complained about the lack of information provided about the disease, treatments and what to do in the event of incidents in 41.9% of cases. Welcoming a caregiver at home was reported in 14.8%...(abstract truncated at 250 words).

Prevalence and associated factors of healthcare associated infections in Habib Bourguiba university hospital, Sfax, Tunisia, 2024

Emna Mziou — 2025-06-01

Introduction-Aim: Healthcare-associated infections (HCAIs) are a major public health issue due to significant related morbidity, mortality and increased costs. This study aimed to determine the prevalence of HCAI in a Tunisian university hospital in 2024 and to determine its associated factors.

Methods: A point-prevalence study was conducted from 10th to 22nd of June 2024 in Habib-Bourguiba hospital in Sfax-Tunisia. It included all patients hospitalised for a minimum of 48 hours.

Results: Of 227 patients, 40 patients had at least one HCAIs, giving a HCAIs prevalence of 17.6% (95%CI 12.8-22.5). The HCAIs prevalence was 46.7% (95%CI 29.2-65.4) in ICU (Intensive care units) versus 13.9% (95%CI 8.9-19.6) in non-ICU.

Urinary tract infections (40.6%) were the most common, followed by respiratory tract infections and surgical site infections (both 17.4%). The main identified microorganisms among HCAIs were Pseudomonas Aeruginosa (19.3%), Klebsiella Pneumoniae and Proteus Mirabilis (both 14.8%).

Factors independently associated with having at least one HCAI were admission in ICU (aOR=5.7, 95%CI: 2.4-13.3), obesity (aOR = 4.2, 95%CI: 1.5-12.1), age 60 years and older (aOR=2.7, 95%CI: 1.1-7.4), antibiotic use in the past six months (aOR = 2.5, 95%CI: 1.1-5.7), and the number of days of peripheral venous catheter (aOR = 1.6, 95%CI: 1.1-2.5).

Conclusion: Our study fills a critical gap in the literature on the national and regional levels. It revealed a high prevalence of HCAI in Habib-Bourguiba Hospital compared to similar studies in other regions. We, therefore, recommend setting up operational hospital hygiene programmes for healthcare ..(abstract truncated at 250 words)