La Tunisie Médicale

Congress Abstracts 4SBC/3ASCAOC

Sat, 01 Feb 2025 00:00:00 +0000

Lysinuric protein intolerance associated Hemophagocytic Lymphohistiocytosis revealed by bone marrow atypical hemophagocytosis.

Sat, 01 Feb 2025 00:00:00 +0000

not required

Isoperistaltic versus antiperistaltic side-to-side ileocolic anastomosis in Crohn’s disease and right colon adenocarcinoma: Controlled clinical trial

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Ileocolonic anastomoses are frequent in colorectal surgeries, but anastomotic leakage remains a serious complication associated with increased morbidity and mortality. The optimal peristaltic orientation for anastomosis is still debated.

Aim: To evaluate and compare short- and long-term outcomes of isoperistaltic (IA) and antiperistaltic (AA) side-to-side ileocolic anastomoses after right colectomy or ileocecal resection for right-sided adenocarcinoma or Crohn’s disease.

Methods: A single-center retrospective clinical trial was conducted at Fattouma Bourguiba University Hospital, Monastir, involving patients with right-sided colon cancer or ileocecal Crohn’s disease who underwent elective resection with either IA or AA. The primary outcome was anastomotic leakage, while secondary outcomes included postoperative morbidity and long-term results.

Results: Ninety-four patients, including 55 with right-sided colon cancer and 39 with Crohn’s disease, were analyzed between January 2016 and July 2023. Of these, 48 underwent IA, and 46 underwent AA. Both anastomotic techniques exhibited similar leakage rates. Baseline and operative variables were comparable except for male predominance in AA for Crohn’s disease and a higher conversion rate in AA. No significant differences were noted regarding pathological variables, operative time, bowel transit recovery, oral tolerance, hospital stay, or postoperative complications. Multivariate analysis revealed that elevated white blood cell count, R2 resection, and mucinous adenocarcinoma were risk factors for anastomotic leakage, while albumin levels and staple line reinforcement were protective factors against postoperative morbidity.

Conclusion: IA and AA demonstrated comparable safety and feasibility, though AA had a higher conversion rate. Further studies are required to optimize AA safety.

Impact of Demographic Factors on the Treatment Response of Antidepressant Therapy: A Descriptive Cohort Study from Pakistan

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: The study is conducted in Pakistan to evaluate the impact of socio-demographic factors that might influence the treatment response to antidepressants in depressive disorder. Moreover, this study brings data from a South Asian developing country, to compete the existing literature gap, where the response to antidepressant treatment with respect to demographic factors is mostly from the western countries.

Aim: A prospective, open-label, descriptive cohort study is designed to signify the association of demographic factors on the treatment response of antidepressants.

Methods: The patients presented to outpatient department (OPD) of Psychiatry clinic at Pakistan Railway Hospital, Rawalpindi from October 05, 2022 to July 31, 2023 were included in the study. All the patients were diagnosed by a Consultant Psychiatrist, according to ICD-11 and were prescribed an antidepressant therapy. The demographic factors were divided into sub-categories i.e. age, gender, marital status, income status, geographical location, education, and comorbid conditions. The change in depressive scores were measured by Patient Health Questionnaire 9 (PHQ-9) on day 0, and 28. The data was analyzed using SPSS and results are reported in the subsequent section.

Results: Out of 88 patients, depression was found most widespread among females, married individuals, illiterate, above 41 years of age with comorbid conditions. The response to treatment was better in males (49.84%), single individuals (49.24%), educated (43.70%), and senior citizens (46.19%) in terms of percentage improvement.

Conclusions: It was concluded that the response to treatment was different among different subcategories in terms of percentage improvement...(abstract truncated at 25 words).

Predictors of thrombo-embolic events in Covid-19 Ambulatory Patients: Insights from the TUNACOV Study

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: There are no clear data on the incidence and predictors of arterial and venous thromboembolic (TE) events in COVID-19 ambulatory patients.

Aim: We conducted this study to analyze thromboembolic complications in this setting and to compare the efficacy and safety of Rivaroxaban to LMWHs as a thromboprophylaxis treatment.

Methods: This is an observational study including COVID-19 patients treated on an outpatient basis. We analysed the predictors of thromboembolic events.

Results: We included 2089 patients with COVID19 managed on an outpatient basis during the period from October 01, 2020 to December 31, 2021. The mean age of our patients was 43±16 years. The incidence of venous and arterial TE complications was 0.9%. Predictive factors for arteriovenous thromboembolic complications were hormonal contraception (OR=23), moderate clinical form (OR=3.5), recent surgery or miscarriage in the month preceding COVID-19 (OR=9.2) and CT signs of COVID-19 (OR=4.9). In contrast, physical activity proved to be a protective factor. Thromboprophylaxis was prescribed in 22.5% of cases: LMWH in 18.1%, Rivaroxaban in 3.7% and a combination of the two molecules successively in 0.6% of patients. There was no statistical difference in thromboembolic or major bleeding complications between the Rivaroxaban and LMWH groups.

Conclusion: Our study showed that the incidence of thromboembolic complications is very low in Covid-19 ambulatory patients.

Renal resistance index during septic shock

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Acute kidney Injury (AKI) is the most frequent complication of septic shock. Bedside ultrasound measurement of the renal resistance index (RRI) is an interesting way of assessment of renal hemodynamics.

Aims : To study the variability of RRI during septic shock and its correlation with the occurrence of AKI.

Methods: This is a prospective observational study including patients in septic shock and on mechanical ventilation. Data collection was carried out between October 2022 and July 2023. RRI was measured during the first five days of shock.

Results: Forty patients were enrolled in the study. Mean age was equal to 51 years ±13.4 and sex ratio was equal to 2.33. The mean RRI value was 0.704, with extremes ranging from 0.52 to 0.83. Patients were divided into two groups : AKI(+) and AKI (-). RRI in the group AKI (+) was higher than in the group AKI (-) (0.757 vs. 0.672; p=0.013). RRI predicted the occurrence of AKI, with an area under the ROC curve of 0.75 (p=0.007) and a cut-off value of 0.71 (specificity=64%, sensitivity=73%).

Conclusion: Assessment of RRI could be a useful technique of predicting the onset of AKI in association with the conventional markers. Its validation will guide management towards optimal renal protection in patients with septic shock.

Contribution of biological methods in the neonatal diagnosis of congenital toxoplasmosis in Tunisia

Sat, 01 Feb 2025 00:00:00 +0000

Introduction : At birth, the biological diagnosis of congenital toxoplasmosis (CT) is essentially serological.

Aim : To report the results of biological techniques used in the neonatal diagnosis of CT.

Methods: This was a descriptive study including newborns (NB) suspected of having CT who were referred to the Parasitology-Mycology laboratory of the Institut Pasteur of Tunis over a 17-year period. Newborns whose mothers had toxoplasmic infection during pregnancy, with either a negative or unperformed antenatal diagnosis, were included. The search for IgG and IgM antibodies was conducted using ELISA and western blot techniques.

Results: Among the 224 newborns included, the first sample was taken between days 1 and 3 of life in 58% of cases. In 181 newborns from our series, the disappearance of IgG was observed at an average age of 4.8 ± 1.6 months. IgM was positive after day 10 of life in 11 cases. A comparative mother-newborn western blot was performed for 216 newborns (96.4%). The diagnosis of CT was confirmed in 43 newborns (19.2%): either based on a positive western blot in 30 cases (69.8%), the presence of IgM by ELISA after day 10 of life in 11 cases (25.6%), or the persistence of IgG after 12 months of follow-up in two cases (4.6%).

Conclusion: Our study confirms the undeniable contribution of the comparative western blot in the diagnosis of CT at birth.

The direct anterior versus postero-lateral approach in total hip arthroplasty: Clinical and radiological outcomes

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Total hip arthroplasty (THA) is an effective surgical procedure. Several surgical approaches have been described.

Aim: To compare postero-lateral and anterior approaches in terms of postoperative care, functional and radiological outcomes in patients undergoing primary THA surgery.

Methods: Patients undergoing primary THA were included in a retrospective descriptive study and divided into two groups according to surgical approach: anterior approach (AA) and postero-lateral approach (PLA). We compared demographic, perioperative data and functional outcome at 6 weeks and 6 months postoperatively according to Postel Merle d'Aubigné (PMA) and Harris (HHS) scores, radiological positioning of implants and postoperative complications.

Results: Each group comprised 100 patients. In the AA group, operative time was shorter, patients had less pain, less bleeding and a shorter hospital stay, better PMA and Harris scores at six weeks post-operatively, with no difference at six months, better positioning of the acetabular cup, undersizing of the femoral stem and more iatrogenic fractures of the proximal femur. Patients in the PLA group had fewer skin and nerve complications and more prosthetic instability.

Conclusion : Current data do not demonstrate superiority of one approach over another in primary THA. We recommend the choice of surgical approach according to the patient's characteristics and surgeons’ convictions.

Prevention of bleeding in total hip and knee replacement: Contribution of combined route in tranexamic acid administration.

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Tranexamic acid (TXA) has revolutionized perioperative blood management of total hip (THA) and knee arthroplasties (TKA). However, there is currently no consensus on the optimal administration route.

Aim: To compare the combined administration of TXA (intravenously (IV) and topically) versus IV alone on the reduction of postoperative bleeding in THA and TKA.

Methods: A nine-month double-blind randomized trial was conducted. Adult consenting patients scheduled for primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were included. The primary outcome measure was the decrease in hemoglobin levels 24 hours after surgery. They were randomized either to the IV group (51 patients) receiving 2 doses of 1 g of IV TXA 3 hours apart, or to the Combined group (50 patients) receiving 1 g of IV TXA and a topical dose of 1.5 g.

Results: The mean decrease in hemoglobin 24 hours after surgery was similar for both groups in THA (p=0.91) and TKA (p=0.19). There was no difference in perioperative transfusion rate between the two THA groups (p=0.6). In TKA, no perioperative transfusion was required. Total and measured blood losses were similar in both groups. Immediate and 3-month postoperative complications were similar.

Conclusion: Compared to IV TXA alone, the combined route does not reduce the risk of bleeding in prosthetic surgery

Investigation of 22q11.2 Deletion Syndrome in the first Moroccan Pediatric Patients series

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: The 22q11.2 deletion syndrome (22q11DS) is an autosomal dominant genetic syndrome, frequently due to a microdeletion located on chromosome 22, presenting a wide variety of clinical manifestations. Cytogenetic methods, such as fluorescence in situ hybridization (FISH), and molecular biology techniques, such as multiplex ligation-dependent probe amplification (MLPA), are used to identify chromosomal deletions specific to the 22q11.2 region.

Aim: This study aimed to describe the first series of pediatric patients in Morocco, selected for their strong suspicion of DiGeorge syndrome.

Methods: As part of a collaboration between the University Hospital Center Hassan II in Fez and the University Hospital Center Abderrahim El Harouchi Ibn Rochd in Casablanca, Morocco, a prospective study was carried out from January 2021 to January 2024 on 30 patients screened for DiGeorge syndrome (DGS). The children included had at least two major signs of DGS. Diagnostic confirmation of 22q11DS was obtained by FISH analysis for all patients. In addition, MLPA analysis was performed on five patients among those confirmed by FISH. The MLPA process included DNA extraction, PCR amplification and capillary electrophoresis, with results analyzed using GeneMapper and Coffalyser software.

Results: Of the 30 patients selected, 22 were confirmed as having a 22q11DS. Among these, 19 had congenital heart disease and 17 had hypocalcemia, which was often associated with hypoparathyroidism. Facial dysmorphia was almost constant, and thymic abnormalities were observed in half the patients. Recurrent infections, hematological disorders and immune abnormalities were also common, underlining the clinical complexity of the syndrome...(abstract truncated at 250 words)

Poor sleep quality in chronic obstructive pulmonary disease

Amal Chennoufi, Chirine Moussa, Houda Rouis, Sonia Maalej — Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Chronic obstructive pulmonary disease (COPD) patients frequently complain of poor sleep quality, but the factors responsible for disturbed sleep are not well identified.

Aim: To determine the frequency of poor sleep quality and to investigate the demographic, clinical, and spirometric factors impacting sleep quality in COPD patients.

Methods: A descriptive, cross-sectional, single-center study was conducted in department 1 of Abderrahmane Mami Hospital of Ariana from January to June 2022 including COPD patients followed up at the external consultation. After their oral consent, all patients answered the questionnaire assessing sleep quality: Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined by a PSQI score≥5.

Results: The mean age was 66 years, with a sex ratio of 24. Our study included 100 patients. We counted 68 patients with comorbidities at admission. The most frequently reported comorbidity was arterial hypertension. A mean PSQI score was 6.59. Poor sleep quality was noted in 63% of the patients. The patients with arterial hypertension had significantly more impaired sleep quality (p=0.031). Chronic sputum was significantly associated with poor sleep quality (p<0.001). A CAT score≥ 10 was associated with poor sleep quality (p<0.001). The percentage of patients with significantly impaired sleep quality who belonged to group D was 65% (p<0.001).

Poor sleep quality was significantly associated with GOLD stage 4 (p=0.039) and lower spirometry data (p=0.001 for FEV1).

Conclusion: Poor sleep quality is frequent in COPD patients. It is associated with more severe disease. This calls for early diagnosis of ....(abstract truncated at 250 words)

NIFTP diagnostic and therapeutic approach

Sat, 01 Feb 2025 00:00:00 +0000

Background: Non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) still spark controversy regarding histological diagnostic criteria and therapeutic management.

Aim: To elucidate the clinicopathological characteristics of NIFTP tumors and discuss their therapeutic management.

Methods: A retrospective study including 23 patients (26 nodules) operated on and followed up for NIFTP tumors according to the 2017 WHO classification over a 5-year period (January 2016-December 2020). The 2017 EUTIRADS classification was used for ultrasound nodule characterization. Fine-needle aspiration cytology was reported according to the 2017 Bethesda system.

Results: All patients were female, with a mean age of 47 years [19-71]. The average consultation delay was 9 months [2 months–7 years]. Thyroid nodules were incidentally discovered in 6 cases (26%). Examination revealed a solitary thyroid nodule in 20 cases. Nodules were classified as EUTIRADS III or IV in 82%. Fine-needle aspiration cytology, performed in 61% of cases, showed Bethesda III in 64% and IV in 14%. Total thyroidectomy was performed in 74%. Three cases of bifocal NIFTP were identified. Association with thyroid carcinoma was noted in 7 cases. No locoregional or distant recurrence was reported during a mean follow-up of 3 and a half years.

Conclusion: Recent revisions of NIFTP morphological criteria underscore the importance of strict adherence to inclusion and exclusion histo-morphological criteria.

Clinical, radiological and therapeutic features of exogenous lipoid pneumonia

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Lipoid pneumonia is a rare disease affecting adults’ which frequency increases with age. Exogenous lipoid pneumonia results from the penetration, usually by inhalation, of oily substances into the pulmonary parenchyma.

Aim: To study the clinical and radiological features of exogenous lipoid pneumonia and to define therapeutic strategies.

Methods: We performed a monocentric, retrospective study of patients followed in the Pneumology Department of the Hedi Chaker Hospital in Sfax between 2004 and 2023. The diagnosis of exogenous lipoid pneumonia was confirmed by bronchoalveolar lavage with positive Oil Red O staining or by biopsy with anatomopathological examination showing lipid-laden foamy histiocytes.

Results: During this period, we collected nine patients with an average age of 46. Dyspnea and cough were the most frequent symptoms. Chest computed tomography revealed ground-glass opacity in five cases, parenchymal condensations in three cases and crazy paving in three cases. The frequent risk factors were occupational exposure to a lipid in five cases and consumption of a lipid product in four cases.

In terms of treatment, four patients underwent occupational reclassification and a declaration of occupational disease. Systemic corticotherapy was indicated in six patients.

Conclusion: Exogenous lipoid pneumonia is a rare entity. This study highlights the difficulty of making a diagnosis, due to misleading clinico-radiological presentation in the absence of exposure.

Labyrinthine Fistulas in cholesteatoma : Surgical outcome on auditory function.

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: A labyrinthine fistula (LF) is a challenging complication associated with cholesteatomatous chronic otitis media (CCOM).

Aim: To describe the clinical and audiometric characteristics of patients with cholesteatomatous LF and to evaluate the postoperative outcomes.

Methods: This was a retrospective study of 46 cases of LF, among 555 patients who underwent surgical treatment for CCOM at the Otolaryngology department of La Rabta Hospital, from 2010 to 2020.

Results: The mean age was 43.67 years. The incidence of LF was 8.3%. The most frequent symptoms were otorrhea and hearing loss (87%). Vertigo was present in 43.5% of patients. Facial nerve paralysis was observed in 5 patients (10.9%).

Preoperative tonal audiometry showed hearing impairment in all cases, with no significant relationship between bone conduction hearing thresholds and the type of fistula (p: 0.16).

LF diagnosis was made intraoperatively, involving the lateral semicircular canal (LSCC) in all cases, with or without other locations.

Favorable hearing outcome was noted in 73,9% of patients, with improvement of vestibular signs in all cases. There was no correlation between the fistula size and postoperative hearing loss (p: 0.09).

Conclusion : Cholesteatomatous labyrinthine fistulas pose a complex challenge in managing middle ear pathologies. Typically, labyrinthine fistula is managed by one stage total removal of cholesteatoma matrix on the fistula, leading to satisfactory auditory and vestibular outcomes.

A ten-year hemovigilance report in the regional blood transfusion center of Sfax (Tunisia)

Sat, 01 Feb 2025 00:00:00 +0000

Objectives: In Tunisia, despite hemovigilance regulations since 2007, transfusion adverse events (TAEs)

remain underreported. Here, we analyze and evaluate the reported TAEs over ten years in the

blood transfusion center of Sfax (Tunisia).

Methods: This is a ten-year (2012-2021) descriptive and exhaustive report on TAE from the second

largest blood center in Tunisia, where around 56,000 labile blood products are issued annually.

Results: Four-hundred-sixty-four TAEs were reported. The median age of the patients was 38 years (1

month to 94 years). The sex ratio was 0.68. The overall TAE annual incidence per issued labile

blood product was 0.77‰ and ranged from 0.47 to 1.43‰. The most common TAE was a

febrile non-hemolytic reaction (31.7%), followed by an allergic reaction (21.6%). The severity

degree was informed in 433 cases (93.3%). Grade 1 severity was the most common (80.8%),

followed by grades 3, 2 and 4 (10.6%, 1.3% and 0.6%, respectively). Packed red blood cells

were the most implicated labile blood product (81.5%). Standard platelet concentrates and fresh

frozen plasma accounted for 6.5% and 5% of the total adverse transfusion reactions,

respectively.

Conclusion: The TAE incidence in our study seems to be underestimated compared to worldwide reported TAEs.

The analysis of reported TAEs in our context illustrates the insufficiency of the regulation's

implementation alone.

Sudden cardiac death in hyperthrophic cardiomyopathy: Comparison of predictive models

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Sudden cardiac death (SCD) risk stratification for primary prevention in patients with sarcomeric hypertrophic cardiomyopathy (HCM) has recently been reinforced by the establishment of a new model by the American College of Cardiology (ACC). This algorithm was characterized by a different approach compared to the previous HCM Risk Score.

Aim: The objective of this study was to compare risk stratification using both the European society of cardiology (ESC) and the ACC risk scores.

Methods: This was an observational, cohort-type prognostic study with retrospective data collection. Patients were classified according to their rhythmic risk estimated by both models and followed for a period of at least one year.

Results: Forty-seven patients were followed over a mean period of 32,4 months. The mean age of our patients was 55 years ± 14 years. We found a weak concordance between the two models (Kappa = 0.28). Four patients (9 %) presented arrhythmogenic events. The ACC algorithm indicated the implantation of an implantable cardioverter defibrillator (ICD) for these four patients whereas the HCM Risk Score indicated only two. The American algorithm had a better predictive potency with an area under the ROC curve of 0.785 compared to 0.654 with the HCM Risk Score with an NRI of 0.35. However, the number of ICDs to be implanted according to this algorithm was increased by 1.6 times.

Conclusion: The ACC algorithm was more efficient in detecting high-risk patients, but it considerably increased the number of ICDs indicated.

Human infection by Trichostrongylus sp in Tunisia: case report

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Nematodes of the Trichostrongylus genus are primarily parasitic in herbivores, although sporadic zoonotic infections have been documented in various countries, including Iran, the Far East, and Australia. In Tunisia, one case has been reported, rendering this parasitic infection relatively unknown.

Observation: A 3-year-old female patient, congenitally monorenal, presented to the pediatric department at Charles Nicolle Hospital in Tunis with symptoms of anorexia, weight loss, and growth retardation. Hematological analysis revealed anemia concomitant with hypereosinophilia. The patient, originating from a rural region in Kasserin and currently residing in Tunis, had exposure to avian species, poultry, and sheep. Parasitological examination of stool samples, performed in our Parasitology and Mycology department, detected the presence of Trichostrongylus spp. eggs in two out of three specimens. A thorough family survey, including detailed interviews and stool parasitology, indicated no familial exposure to trichostrongylosis risk factors, and no parasitic eggs were found in the parents' samples.

Conclusion: Given the rarity or atypical nature of human infections with animal-derived hookworms, trichostrongylosis may be underrecognized, and the prevalence of common human hookworm infections might be overestimated. Enhancing environmental and personal hygiene and avoiding the consumption of raw vegetables in endemic regions are crucial preventive measures against this infection.

Agenesis of the Dorsal Pancreas: An Uncommon Cause of Pancreatic Diabetes in Young Adults. A Case Report

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Agenesis of the dorsal pancreas (ADP) is a rare congenital abnormality characterized by the absence of the body and tail of the pancreas. This condition is often asymptomatic. While many patients exhibit nonspecific symptoms, some may experience more severe manifestations complicating the diagnostic process.

Observation: We presented the case of a 27-year-old man who was diagnosed with type 1 diabetes mellitus three years ago. He was experiencing considerable weight loss, abdominal pain, and diarrhea despite effectively managed insulin therapy. The patient appeared emaciated and malnourished. Investigations revealed a normal thyroid function, negative celiac disease serology, and negative pancreatic antibodies. Abdominal imaging demonstrated ADP. After treatment with insulin and pancreatic enzymes, we noted a significant improvement in the patient's condition.

Conclusion: This case emphasizes diagnostic challenges in young patients presenting with pancreatic diabetes. Early recognition and appropriate management are crucial to prevent complications of both exocrine and endocrine deficiencies.

Successes and Challenges Related to Community Participation in Primary Health Care and Health Programs in the IGAD Region: A Scoping Review

Farhan Houssein Ali, Mansour Njah , David-Martin Milot, Kenza Hassouni — Sat, 01 Feb 2025 00:00:00 +0000

For decades, community participation (CP) in primary health care (PHC) and health programs (HP) has played a crucial role in improving health services and their sustainability. This article examines the successes and challenges of CP in the Intergovernmental Authority on Development (IGAD) region, which includes Djibouti, Ethiopia, Eritrea, Kenya, Somalia, Sudan, South Sudan, and Uganda, focusing on the factors influencing and levels of community engagement. This study employs a scoping review based on the Arksey and O'Malley framework and the IAP2 public participation spectrum. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published up to April 2024. Relevant articles on CP mechanisms in PHC and HP in the IGAD region were selected. In total, 64 articles were included in this scoping review. The studies highlighted various forms and mechanisms of CP, such as the establishment of community health committees and the mobilization of volunteers. Successes included improvements in disease prevention, crisis management, community resilience, and access to maternal and child health services. However, challenges remain, such as communication gaps, resource limitations, cultural barriers, and political instability. Community participation is essential for the success of health programs in the IGAD region. Although significant progress has been made, persistent challenges must be addressed to optimize the impact and sustainability of CP initiatives.

Overhauling Morocco's healthcare system: Perception of healthcare professionals

Sakhr Ahizoune, Abdelali Bitar, Rajaa Khramez, Rim Abdellatifi — Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Healthcare systems in low- and middle-income countries have faced multiple performance challenges (quality, responsiveness, equity, and resilience). At various times during the COVID-19 pandemic, healthcare systems were unable to respond in time to the population's needs, prompting many countries to consider drastic changes to their healthcare systems. Like other countries, Morocco is resolutely embarking on a new era of progress in the healthcare sector. To implement this overhaul under the right conditions, we need to reconsider the human factor as the cornerstone of the healthcare system and examine how public establishments perceive this overhaul.

Aim: to describe healthcare professionals' perceptions of the Moroccan healthcare system overhaul.

Method: This is a descriptive study. We adopted a mixed-methods approach. For the qualitative approach, we conducted fifteen interviews, including six interviews with strategic-level managers, four interviews with intermediate-level managers, and five interviews with operational-level managers, all selected on a purposive basis. For the quantitative approach, we interviewed 71 healthcare professionals using a questionnaire distributed to all doctors and nurses in charge of health programs.

Results:

The description of healthcare professionals' perception of the Moroccan healthcare system revealed that it has made considerable progress but has not met national requirements and needs to be overhauled. However, in order to support and carry out this overhaul, it would be necessary to allocate the necessary resources, establish a transparent institutional communication process, a continuous training approach, an approach to integrating the various stakeholders, and finally. ...(abstract truncated at 250 words).

Training needs and learning objectives in Rehabilitation Practice for Family Medicine residents in Tunisia in 2024

Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Family Medicine (FM) is undergoing global reform to address healthcare challenges and improve patient outcomes. Rehabilitation is a crucial component of primary care, yet FM training often lacks adequate emphasis on this area.

Aim: To determine the needs of FM residents in rehabilitation training and formulate corresponding training objectives.

Methods: A cross-sectional observational descriptive study was conducted among FM residents and practitioners in Sousse, Tunisia. The Delphi method was used to identify and prioritize training needs, subsequently translated into specific learning objectives. First authors identified 15 needs presented to FM residents of Faculty of medicine of Sousse. Then, the most chosen 10 needs were validated by experts in rehabilitation and preventive medicine. Finally based on the participants choices, experts formulated learning objectives in rehabilitation practice for FM residents.

Results: We included 391 residents of FM and general practitioners. Ten key training needs were identified among FM residents, focusing on common musculoskeletal and neurological conditions such as chronic low back pain, neck pain, and urinary incontinence. Corresponding objectives were developed encompassing cognitive, psychomotor, and affective domains.

Conclusion: This study provides a foundation for incorporating rehabilitation into FM training in Tunisia. Addressing identified needs and defining clear objectives leads to a systemic planning of training. Future research should focus on implementing these objectives and evaluating their impact on patient outcomes.

Medical students’ evaluation by serious game in the era of Covid-19 infection

Ikram Chamtouri, Melek Kechida; Walid Jomaa, Khaldoun Ben Hamda — Sat, 01 Feb 2025 00:00:00 +0000

Introduction: Simulation using serious games (SG) has emerged in the field of training and assessment of medical students.

Aim: to compare the results of medical students’ evaluation by virtual simulation using online SG and clinical case-based multiple-choice questions (MCQ), and to assess the degree of satisfaction with these two evaluation methods.

Methods : Medical students from the same level of study participated in this study. SG group had an evaluation by SG dealing with “diagnosis and management of ST-segment elevation myocardial infarction (STEMI). MCQ group was evaluated by clinical case-based MCQ having the same topic as SG group. Results of the two groups were compared. A satisfaction questionnaire was filled out by the two groups. The satisfaction degree was compared between the two groups.

Results: A total of 64 medical students (G1:31 and G2: 33) were enrolled. Thirty learners (96.8%) in SG group obtained a total score ≥ 50% versus 69.7% in clinical case-based MCQ group (p = 0.004). The full score was obtained by three learners in SG group; however, no student scored 100% in clinical case-based MCQ group (p = 0.027). Medical evaluation using SG was reported to be more innovative, fun, and realistic compared to evaluation by clinical case-based MCQ.

Conclusion: Simulation by SG could be an innovative and effective method in evaluating medical students.