La Tunisie Médicale

Abstracts of the 2nd Congress of Clinical Physiology

Sat, 27 Dec 2025 00:00:00 +0000

Training and Clinical Research Capacity Building in Low- and Middle-Income Countries: Addressing Unmet Needs

Chadli Dziri, Lilia Zakhama — Sat, 27 Dec 2025 00:00:00 +0000

The Middle East, Mediterranean, and Africa (MEMA) region, encompassing 68 countries and 20% of the global population, contributes only 6% of the world's registered clinical trials. This editorial identifies eight key barriers to clinical research in the region: (1) limited collaboration with high-income country (HIC) universities supporting low-income country (LIC) research, (2) insufficient specialized training programs, (3) inadequate laboratory and technological infrastructure, (4) lack of research methodology integration in medical curricula, (5) underdeveloped local institutional review boards, (6) insufficient and unsustainable funding, (7) limited technology transfer from HICs to LICs, and (8) migration of skilled professionals to HICs. These challenges hinder the region's research capacity and global contribution. Proposed solutions include fostering HIC-LMIC partnerships, enhancing training through scholarships and local research centers, improving infrastructure via international collaboration, and developing robust ethical review systems. By addressing these barriers, LMICs can increase their contribution to global clinical research, promoting equitable health outcomes.

Breastfeeding and Work in Tunisia: A Challenge to Overcome

Zahra Marrakchi — Sat, 27 Dec 2025 00:00:00 +0000

Effectiveness of flipped classroom in medical education: Protocol study of a systematic review

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: The flipped classroom (FC) integrates online content delivery with in-class activities focused on knowledge application, such as discussions and problem-solving. While increasingly prevalent in medical education field, the efficacy of FC remains a subject of debate.

Objective : This protocol outlines a systematic review (SR) to examine the scope and methodological quality of studies on the FC teaching approach in medical education.

Methods: The protocol was registered in PROSPERO (CRD420251008268) and adhered to the Preferred Reporting Items for SRs Protocols guidelines. A thorough literature search will be performed using Scopus, PubMed/Medline, the Cochrane Library, and Google Scholar. The review will consider comparative controlled studies that focus on FC in the medical learning field. Two independent reviewers will carry out a rigorous data extraction. The Medical Education Research Study Quality Instrument will be used to evaluate the study's quality. Synthetizing the findings of this SR will provide a thorough understanding of the impact of FC in academic performance and students’ satisfaction in medical learning.

Expected results: This qualitative summary will offer a narrative overview of the included papers, emphasizing interventions designed to evaluate the impact of FC. Results will be discussed according to the review's objectives, evaluating both study quality and consistency of findings, and will be clearly illustrated using tables and graphs.

Conclusion: The SR developed from this protocol will undoubtedly provide evidence of the effectiveness of FC in medical education and will effectively contribute to increasing the present body of information on FC interventions for improving outcomes.

Dermoscopic assessment of facial photoaging skin among north Morroccans. Protocol Design

Nadia Handous, Ouiame El Jouari, Karima Sammoud, Adil Najdi, Salim Gallouj — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Skin aging involves both chronological aging influenced by human genetics and extrinsic aging mainly caused by UV radiation and smoking. Dermoscopy is a non-invasive diagnostic tool that provides accurate aging assessment signs which may be invisible to the naked eye. This study aims to investigate and compare the dermoscopic features of facial photoaging in Moroccan females and males across various age groups. It also seeks to assess the impact of other factors associated with premature skin aging, notably smoking.

Methods: A descriptive and comparative study was conducted on 207 subjects with at least one hour of daily sun exposure. Participants were divided into three age groups: 35–49, 50–64, and 65+ years.

Results: In the group aged 35 to 49 years, a significant difference was observed between genders regarding yellowish discoloration, white lines, hypo-/hyperpigmented macules (P =0.003) and deep wrinkles (P = 0.02). For subjects aged 50 to 64 years, males exhibited a significantly higher prevalence of yellowish discoloration and skin atrophy compared to females. However, females had a higher prevalence of superficial wrinkles (P = 0.02). In the

group aged 65 years and older, significant differences were observed between females and

males regarding white lines/skin atrophy, actinic keratosis, and senile comedones, all of

which were more prevalent in males.

Conclusion: Dermoscopy is a straightforward method for better assessing facial aging and

detecting early signs of photoaging leading to ensure prevention of skin aging and to monitor

the effectiveness of therapeutic applications.

A comparative study of medical student performance and satisfaction in an in-person vs online chronic pain certificate program

Sat, 27 Dec 2025 00:00:00 +0000

Aim : This study aimed to compare student success rates between the in-person and hybrid learning phases of the chronic Pain Certificate (CPC) at the Faculty of Medicine of Tunis (FMT), and to assess student satisfaction with the hybrid model. Additionally, we evaluated the effects of platform modifications on students’ satisfaction.

Method: A retrospective analysis was conducted over five years (2018–2024) involving medical students enrolled in the CPC. Success and failure rates were compared between the in-person phase (2018–2020) and the hybrid phase (2020–2024). Student satisfaction was assessed through surveys.

Results: Among the 301 students included, 115 (38.2%) participated in the in-person phase, and 186 (61.8%) in the hybrid phase. The overall success rate was 81.39%. The success rate in the hybrid phase (84.4%) was higher than in the in-person phase (76.5%), though the difference was not statistically significant (p=0.08). Among 70 students who completed the satisfaction survey, self-rated knowledge on chronic pain increased significantly after the course (p=0.013). Satisfaction with the platform improved post-modification in several aspects, including interest in modules 1, 2, 3, and 5 (p=0.036, p=0.047, p=0.004, p=0.025, respectively), resource usefulness in modules 1, 3, 4, and 5 (p=0.004, p=0.002, p=0.012, p=0.018, respectively), and clarity of Module 3 resources (p=0.05). The estimated average preparation time decreased from 96.2 hours to 87.1 hours post-modification, though this change was not statistically significant (p=0.6).

Conclusion: The integration of an online platform into the CPC at FMT was associated with improved student success rates and satisfaction.

When to Publish? Perspectives of North African researchers in the medical field

Rihem Dahmane, Rym Fakhfakh, Meriem Gaddas, Imen Ben Saida, Helmi Ben Saad — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Scientific publication plays a vital role in sharing research outcomes, enhancing knowledge, and fostering academic careers. However, researchers in low-income countries like Tunisia often face significant barriers, including limited access to funding, training, mentorship, and high-impact journals. These challenges can hinder their ability to publish effectively and at the right time. This study explored strategies for successful medical publication and examined the optimal timing for manuscript submission, 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 expert presentations, group discussions, and a review of relevant literature.

Results: Timing was highlighted as a key strategic factor: submitting a manuscript upon completion of data analysis, in response to a call for papers, ahead of a major scientific event, or when the topic is particularly relevant can significantly increase the visibility and impact of the publication. Scientific publication also plays a crucial role in academic recognition and career progression. Careful planning, strategic journal selection, and adherence to editorial and ethical standards were identified as essential elements for improving publication success.

Conclusion: Knowing when to publish can make all the difference. Submitting a manuscript at the right time — whether it is shortly after completing data analysis, when the topic is gaining attention, or in response to a specific call for papers — can significantly increase a study’s visibility and impact. However, timing alone is not enough. With the right training, thoughtful journal selection, and strong institutional support, researchers — especially those in low- and middle-income countries — can overcome many of the barriers they face and share their work more effectively with the global scientific community.

A decade of Non-Small Cell Lung Cancer management: threats and opportunities in resource-limited setting

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Non-small cell lung cancer (NSCLC) poses significant public health challenges in Tunisia.This study analyzes patient characteristics, management, and outcomes to identify improvement areas.

Methods: This retrospective multicenter study included 924 patients diagnosed with NSCLC between 2013 and 2022. The study reviewed clinical data, pathology reports, surgical records, radiation therapy summaries, and imaging findings. The study also examined trends in management features by dividing the study period into 2012-2017 vs 2018-2022.

Results: Median age was 60 years, with 78.7% being male, and the average tobacco consumption was 58 pack-years. Advanced-stage disease was highly prevalent, with 91% of patients presenting at stages III or IV. The median overall survival for the entire population was 32 months, varying significantly by disease stage: 52 months for stage I, 48 months for stage II, 22 months for stage III, and 14 months for stage IV. In advanced NSCLC, survival was notably higher among patients treated with targeted therapy (44 months) and immunotherapy (20 months) compared to chemotherapy alone (9 months). Over time, there was a significant increase in multidisciplinary discussions and biomarker testing rates; however, access to concurrent chemoradiation decreased. Despite some improvement, access to targeted therapy and immunotherapy remained limited. Among tested patients, a driver mutation was identified in 45.5%, but only 54% received targeted therapy. Furthermore, only 9.8% of advanced-stage patients received immunotherapy.

Conclusion: This study serves as a baseline for future studies and highlights critical gaps in NSCLC care in Tunisia, emphasizing the need for strategic directions to enhance outcomes.

Malnutrition among Pygmy children under five in Bafwasende (DRC), 2025: A cross-sectional study

Nono Mangaza , Bernard Kennedy Nkongolo, Marie-claire Muyer — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Malnutrition remains a major public health issue in the Democratic Republic of Congo, particularly affecting marginalized indigenous populations. Socioeconomic, cultural, and environmental factors contribute to their vulnerability. This study aims to identify factors associated with malnutrition among Pygmy children under five years of age in the Bafwasende territory.

Methodology: A cross-sectional descriptive study was conducted among children and their mothers/caregivers in Bafwasende, Tshopo province. Data were collected using KoboCollect and analyzed with SPSS. Nutritional status was assessed using WHO Anthro Z-Scores to evaluate underweight, stunting, and wasting. Descriptive statistics were applied, with absolute and relative frequencies used for categorical variables.

Results: Among 455 children, 28,4% suffer from acute malnutrition(wasting), 69,0% have stunting, and 47,3% have underweight. Children from low-food consumption households, with food expenditures of less than 5,000 CDF, as well as those aged 6 to 11 months, are most at risk. Malnutrition is also more common among children of very young, uneducated, or separated mothers.

Conclusion: The study highlights an alarming situation, requiring targeted interventions adapted to the cultural and socio-economic realities of indigenous peoples to improve their health and nutrition.

Synergistic Effect of Noise and Toluene Upon Hematological Alterations, Pulmonary Oxidative Stress and Inflammation.

Takwa Ben Attia, Noura Gannouni, Said Galai, Abada Mhamdi — Sat, 27 Dec 2025 00:00:00 +0000

Aim: Study the synergistic effects of noise-toluene co-exposure on hematological parameters, oxidative stress and pulmonary architecture in rats.

Methods: 24 male Wistar rats were divided into four groups: control, noise exposure, toluene exposure and co-exposure noise-toluene.

Biological analyses were performed to determine hematological parameters and evaluate markers of oxidative stress. Histopathological sections were observed to assess pulmonary tissue damage and the degree of inflammatory response.

Results: Hematological analysis revealed a significant decrease in red blood cells (RBCs), accompanied by an increase in white blood cells (WBCs) and platelets.

Histological examination of lung tissues revealed inflammation with alveolar wall damage and peribronchial immune cell infiltration in the co-exposed group, which correlated with increased vascular permeability and pulmonary edema.

Exposure to toluene and noise resulted in significant disruption of the pulmonary tissue structure accompanied by oxidative stress,

Conclusion: The results suggest that combined exposure to toluene and noise causes structural and functional changes in lung tissues and alterations in hematological parameters

Validation of the Arabic Version of Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA)

Khouloud Akrimi, Sana Ellini, Mejda Cheour, Rahma Damak — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Cognitive disorders can be early and persistent symptoms of bipolar disorder, even in the euthymic phase. These impairments significantly affect patients' quality of life. Early detection and regular follow-up are therefore crucial to effective, comprehensive management. To achieve this, it is essential to have validated tools adapted to the patient's language, guaranteeing accurate and reliable assessment. To facilitate this task, we chose to translate and validate the Arabic version of the COBRA scale.

Aim: The main objective of this study was to translate and validate the Arabic version of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale. Specifically, we aimed to evaluate the psychometric properties, including reliability, validity, and feasibility of the Arabic version of the COBRA in a sample of Arabic-speaking individuals with bipolar disorder and healthy controls.

Methods : This is a psychometric validation study of the Arabic version of the COBRA, obtained by a back-translation method of the original version, conducted on a sample of 161 participants, including 71 patients diagnosed with bipolar disorder and followed at Razi Hospital and 90 subjects with no personal or family psychiatric history, as assessed by the MINI International Neuropsychiatric Interview. The validity study was based on face and content validity, reliability, discriminative validity, construct validity and feasibility.

Results : The Arabic version of the COBRA demonstrated satisfying psychometric properties with excellent internal consistency (Cronbach's alpha=0.86) .....(abstract truncated at 250 words).

The role of CDX2 immunohistochemical marker in colorectal adenocarcinoma « CDX2 in colorectal adenocarcinoma »

Sarra Ben Rejeb, Dhouha Bacha, Haifa Rachdi, Khadija Bellil — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Caudal-type homeobox transcription factor 2 (CDX2), a marker of intestinal differentiation, has shown potential as a prognostic biomarker in colorectal cancer(CRC). Its loss is associated with aggressive disease features and poor survival, yet its routine clinical use remains limited. In this study, we aimed to explore the immunohistochemical expression of CDX2 in sporadic colorectal adenocarcinomas and to assess its prognostic significance.

Methods: This was a retrospective longitudinal study including patients with sporadic colorectal adenocarcinoma. CDX2 expression was assessed via automated immunohistochemistry on formalin-fixed, paraffin-embedded sections using monoclonal antibody CDX2-DAK (Dako, Glostrup, Denmark). Only nuclear staining was considered positive. Clinicopathological data, including tumor stage, differentiation, and survival, were collected over a 36-month median follow-up. Statistical analysis was performed using SPSS version 20 (p < 0.05).

Results: Thirty cases were included with a mean age of 57 ± 2 years and a male-to-female ratio of 1.7. CDX2 expression was observed in 80% (24/30) of tumors. Its loss was significantly associated with poor differentiation (p=0.04),lymph node involvement (p=0.0027), advanced stage (p=0.043), and reduced overall survival (p=0.0024). Loss of CDX2 expression combined with pT4 stage identified a high-risk subgroup with worse disease-free and overall survival. Tumors were predominantly colonic (80%), with 90% adenocarcinomas and 10% mucinous carcinomas.

Conclusions: CDX2 loss is a robust prognostic indicator in CRC, particularly when combined with pT4 stage, highlighting its potential for risk stratification and treatment planning. Larger, prospective studies are needed to standardize CDX2 assessment and validate its clinical utility in colorectal adenocarcinoma.

Accidental exposures to blood among dental health care workers in five Referral Hospitals in Yaoundé, Cameroon.

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Dental healthcare workers are at risk of being infected during their work due to exposure to blood.

Aims: To determine the prevalence of accidental exposure to blood and body fluids, to assess the knowledge, attitudes, and practices of these dental healthcare workers, and to identify factors associated with this exposure.

Methods: A cross-sectional hospital-based study was conducted between December 1^st 2020 and June 1^st 2021 in the dental services of five referrals hospitals. Dental healthcare workers present at the time of the study were recruited. Data were analyzed with R software. Multivariate analysis was used to determine factors associated with blood exposure, with their adjusted odds ratios and p-values. A p value < 0.05 was considered statistically significant. Results: The frequency of accidental exposure to blood was 55% (95% CI: 47.9% - 67.2%), with needle stick injury (34.8%) being the main mechanism. Assessment of perceptions among victims revealed that those with average knowledge (84.6%), right attitudes (62.5%), and adequate practices (55.5%) were predominant. Factors statistically associated with accidental exposure were dental technician (adjusted Odds Ratio = 2.5; p = 0.02), length of employment greater than 10 years (adjusted Odds Ratio = 1.9; p < 0.01), insufficient knowledge (adjusted Odds Ratio = 2.5; p = 0.023), harmful attitudes (adjusted Odds Ratio = 3.5; p = 0.006), and inadequate practices (adjusted Odds Ratio =1.6; p = 0.008).

Conclusion: There is a high rate of accidental exposure to blood in dental units. Efficient strategies....(abstract truncated at 250 words)

Comparative Analysis of Dietary Habits and Nutritional Profiles: Sidi Ali Ben Aoun vs. Grand Tunis

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Tunisia is affected by the nutritional and dietary transition.

Aim: To compare dietary habits and nutritional profiles between a rural agricultural area Sidi Ali Ben Aoun and an urban area Grand Tunis.

Methods: This is a comparative cross-sectional study conducted on a sample of 220 participants, including 110 from Ben Aoun and 110 from Grand Tunis. Data were collected based on a pre-established questionnaire about dietary lifestyle and habits survey. Validated scores were used: Alimentary Diversity of Households (SDAM), the Food Consumption Assessment score (SCAM), MEDI-LITE and IPAQ.

Results: The mean age was 37.2±15.3 years for the urban population versus 38.7±13.8 years for the rural population (p=0.43). In the rural population, males were 54.5% vs 48.2%; p=0.34. The occurrence of non-communicable diseases was lower in Ben Aoun (p<0.001). The adopted diet in the region of Ben Aoun aligned with the principles of the Mediterranean diet (MEDI-LITE score was 13.2±1.76 versus 7.35±2.65 in Grand Tunis, p<0.001). Both studied regions had a similar level of food security as assessed by the SDAM (p=0.006). However, household dietary diversity was more present in the rural region: the average SCAM was 11.4±0.79 in the rural group compared to 10±1.31 in the urban group (p<0.001).

Conclusion: The rural region (Sidi Ali Ben Aoun) was characterized by a healthier and more diverse diet compared to the urban region (Grand Tunis).

Quality of life and Eating disorders in women with Polycystic Ovary Syndrome

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women worldwide, posing a major public health concern. This multifaceted condition significantly impairs quality of life (QOL) across multiple domains.

Aim: To assess QOL and eating disorders (EDs) in patients with PCOS.

Methods: A cross-sectional descriptive and comparative study was conducted on women with confirmed PCOS who were followed in the Endocrinology Department of Hedi Chaker Hospital, Sfax, Tunisia, and a targeted group of women with PCOS recruited through Google Forms. The PCOSQ-42 questionnaire for unmarried women, the PCOSQ-47 for married women, and the SCOFF questionnaire were used as assessment tools. Participants were divided into two groups: Group 1, consisting of French participants, and Group 2, consisting of Tunisian participants.

Results: A total of 71 French participants (Group 1) and 101 Tunisian participants (Group 2) were included in the study. All participants reported a compromised QOL. Among married women, the psychological well-being domain had the lowest score (2.86 ± 0.7), while the menstrual and fertility disorders domain was the most affected among unmarried women, with an average score of 2.84 ± 0.8. EDs were identified in 70.93% of participants, with a higher prevalence among unmarried women. A better QOL was observed among married women in Group 2 compared to their counterparts in Group 1.

Conclusion: The findings reveal a high prevalence of impaired QOL and EDs in women with PCOS, with cultural and marital status differences warranting tailored interventions.

Effects of low-dose botulinum toxin for the treatment of spastic children with cerebral palsy

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: The treatment of children with cerebral palsy (CP) with Botulinum toxin A (BTA) injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used dosage has escalated over the years. The aim was to analyze the efficacy and safety of a lower dose of BTA injections into lower limb in children with CP.

Material and Method: We analyzed retrospectively BTA injections for children with spastic CP aged between 2 and 14 years. Treatment results were evaluated with the modified Ashworth scale (MAS). Side effects, total dose and dose per body weight were analyzed.

Results: Fifty five children were included (21 girls (38.2%) and 34 boys (61.8%)). The total dosage was 105.4 ± 20.7 U Allergan for Botox® and 473.4 ± 79.9 U Speywood for Dysport®. Average MAS before treatment was 2.1±0,5. At the first post-injection follow up visit, this score had increased to 1±0.5. Symptoms potentially related to TBA were reported in 16 children (29.1%). In 39 cases, the injection of TBA passed without adverse events. Multiple side effects were observed with the same patient.

Conclusion: There is not yet a uniform strategy for TBA treatment in childre with CP and the doses used in the literature vary considerably over the years. It thus appears that the doses we use are within the range of the recommandations but remain by far lower than the doses used in the literature.

Clinical symptoms and radiological sequels after SARS-CoV-2 pneumonia: A longitudinal study

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: The long-term effects of COVID-19 have been recognized as a significant public health issue, particularly for hospitalized patients who may experience persistent symptoms and lung complications. This study aimed to determine the prevalence of persistent clinical symptoms and determine the predictive factors of persistent CT scan abnormalities (PCA) after COVID-19 pneumonia.

Methods: This was a longitudinal cohort study of patients followed up after being hospitalized for confirmed SARS-CoV-2 pneumonia. Patients were assessed for persistent clinical symptoms at one month and for PCA at four months. A logistic regression model was employed to assess the relationship between PCA and explanatory variables.

Results: A total of 240 patients were included. The sex ratio was 1.75, with a mean age of 57.6(± 11.5) years. The median length of stay was 10 [7–15] days. Initial CT scans revealed severe impairment in 23%. After one month, 75.8% had at least one persistent symptom. Hyperventilation syndrome was diagnosed in 15.4% of patients. At four-month follow-up, CT scan showed that 65% of patients had PCA.

Factors associated with PCA, included age (p=0.001), initial dyspnea (p=0.021), length of hospital stay (p=0.001), an initial CT Severity Score (CTSS)≥ 50 (p=0.047), a low FEV1 (p=0.022), a low Total Lung capacity (TLC) (p=0.035) and impairment in DLCO (p=0.012). Logistic regression identified older age (OR=1.05 [1.02;1.08], p= 0.01), longer hospital stay (OR=1.12 [1.04;1.21], p= 0.003), and dyspnea (OR=3.11 [1.28;7.52],p= 0.012) as independent predictive factors .....(abstract truncated at 250 words)

Tunisia's Heartbeat : Pioneering Isotopic Techniques in Cardiac Viability Among Resource Challenges

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: In Tunisia, where healthcare resources are often limited, nuclear imaging techniques are revolutionizing cardiac care. They provide critical information on myocardial perfusion, contractile function, and metabolic processes, transforming the ischemic heart disease management.

Aim: This study explores the essential role of isotopic examinations in assessing myocardial viability and evaluates their impact on therapeutic decision-making.

Methods: A prospective descriptive and analytical study was conducted on 40 patients for whom myocardial viability studies were indicated. All patients underwent isotopic examinations and coronary angiographies performed between January 2022 and June 2023. Results: Myocardial viability scintigraphy (MVS) showed that 62.5% of myocardial territories were non-viable, while 37.5% were hibernating. These results perfectly matched those obtained by ¹⁸FDG PET-CT. MVS proved to be a highly reliable tool that significantly influenced therapeutic decisions. Revascularization was indicated in 40% of patients with viable myocardium, while medical treatment was prescribed for all patients with non-viable myocardium. During a follow-up period, a significant improvement in left ventricular ejection fraction (LVEF) was observed in the group of patients with hibernating myocardium treated with revascularization compared to those treated medically (p=0.02). Additionally, non-viable group had a higher mortality rate (12%) compared to viable group (6.7%). Survival rates were better in the group with viable lesions (93% vs 85%).

Conclusions: This is the first prospective study conducted in Tunisia assessing the contribution of isotopic examinations in evaluating myocardial viability. The diagnostic value of MVS is comparable to metabolic imaging. Furthermore, nuclear imaging techniques can influence therapeutic ....(abstract truncated at 250 words).

Psychological effects of coronavirus disease (COVID-19) lockdown on dental students in Tunisia: An online survey

Farah Chouchene, Nehed Sboui, Imed Ouni, Fatma Masmoudi, Ahlem Baaziz — Sat, 27 Dec 2025 00:00:00 +0000

Aim:

The present study aimed to assess the impact of coronavirus disease (COVID-19) pandemic on the mental health of dental students.

Methods:

The survey was designed as an online cross-sectional study conducted among dental students in Tunisia between May 2020 and January 2022 using a web-based questionnaire. Anxiety, depression, and stress were assessed using three standardized scales (validated French version); the Generalized Anxiety Disorder (GAD-7), the Patient Heath Questionnaire (PHQ-9) depression scale, and the Perceived Stress Scale (PSS-10). The independent t-test and analysis of variance were used to determine the significance of the continuous data. Chi-square and Fisher exact tests were performed for categorical data.

Results:

A total of 366 dental students completed the questionnaire, 82.5% (302) were female and 17.5% (64) were male, with a mean age of 21± 6 years. Most participants (96.7%) were Tunisian and 25.7% were in the first grade. The mean scores for anxiety, depression, and stress were 11.48±5, 13.82±5.63, and 8.20±4.72 respectively. Female students were more likely to experience depression than male students (P<0.05).A statistically significant difference was reported between students mental health status, GAD-7, PHQ-9, and PSS-10 scores (P<0.05) and a statistically significant difference was found between students under medical care for mental health problems, GAD-7, PHQ-9, and PSS-10 scores (P<0.001).

Conclusion:

During the pandemic, increased stress and anxiety have been reported among dental students, and some experienced symptoms related to depression.

Knowledge of Parents toward their Children’s Oral Health: A Survey in Monastir, Tunisia

Yamina Elelmi, Chayma Ben Arbia, Fatma Masmoudi, Ahlem Baaziz — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: The establishment and preservation of optimal oral health in children are largely contingent upon the active participation of their parents and caregivers. These primary figures are instrumental in shaping children's preventive practices and facilitating necessary treatment, highlighting a critical interface for health interventions. The aim of the study was to evaluate the knowledge of parents in Monastir city, Tunisia, toward their children’s oral health care and prevention of tooth decay and to determine the influence of parental socio-demographic variables on knowledge.

Methods: A cross-sectional study was conducted in the pediatrician’s waiting room in Monastir, Tunisia. Ethical Clearance was obtained. The sample was made up of 195 parents. The questionnaire was completed to obtain information regarding demographic and education variables, knowledge about oral health prevention, parents', children's oral hygiene habits, and risk behaviors. The data collected were subjected to statistical analysis using the Pearson chi-square test and the ANOVA test.

Results: Sixty-three percent of parents who participated in the study had an insufficient knowledge score (score<50%). The mean knowledge score among mothers was slightly greater than fathers. The parents having fewer than three children have better knowledge, and the parents with one child have better scores. Similar results with a higher educational level were statistically significant. The majority of parents recognized many preventive dental aspects like the number of daily brushings, the nature of toothbrush .....( abstract truncated at 250 words)

Diagnosis and management of esthesioneuroblastoma

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor that develops in the nasal cavity. It accounts for only 1.2% of malignant nasosinus tumor and arises from the olfactory epithelium.

Methods: This retrospective study presents olfactory neuroblastoma cases treated in our ENT department over a period of 36 years, from January 1986 to December 2023.

Results: The study results indicate that the series consisted of 10 cases of olfactory neuroblastoma, with seven females and three males, and a mean age of 40 years. Based on the Kadish classification, 6 cases were classified as stage B, 3 as stage C, and 1 as stage D. Of the 8 patients who underwent surgery, 6 patients also received radiotherapy, while 2 cases were inoperable. After surgery followed by radiotherapy, complete remission was observed in 3 cases. Tumor progression was observed in 2 cases, after 8 and 3 months respectively and tumour recurrence was observed in one patient.

Conclusion: Although the imaging features of olfactory neuroblastoma are non-specific, there are patterns of disease that should strongly suggest and stage this disorder. This is fundamental for surgical planning.

Is dabigatran a good alternative to warfarin in patients with atrial fibrillation accompanied by valvular and non-valvular heart diseases? A systematic review and meta-analysis

Eman Youssef, Mohanad Daher, Abanoub Milad, Aliaa Gamal, Rafeek Elmezayen — Sat, 27 Dec 2025 00:00:00 +0000

Background: There is ongoing discussion regarding the terminology used when atrial fibrillation (AF) is present alongside either valvular heart disease (VHD) or non-valvular heart disease (NVHD). We conducted this meta-analysis to assess the effectiveness and safety of dabigatran compared to warfarin in AF patients with VHD and NVHD.

Methods and results: Online databases were searched for eligible studies. Ten RCTs (22981 patients) were included. In NVHD subgroup, dabigatran 150 mg showed no statistically significantly difference in stroke (S) and systemic embolism (SE) (risk difference (RD) -0.01,95% confidence interval(CI):-0.01,0.0), and death (RD -0.00,95% CI -0.01,0.00) except for intracranial hemorrhage (ICH) (RD -0.01,95% CI -0.01,-0.01), and major bleeding (RD -0.02,95% CI -0.04,-0.00), similarly ,110 mg showed a low risk of ICH (RD -0.01,95% CI -0.01,-0.01), and no significant differences in S/SE and death compared to warfarin. In VHD subgroup, dabigatran showed no significant differences in S/SE (RD 0.02,95% CI -0.03,0.07), major bleeding (RD 0.01,95% CI -0.02,0.04), and death (RD -0.01,95% CI -0.04,0.01) compared to warfarin. In the catheter ablation subgroup, dabigatran reduced only groin hematoma (RD -0.02,95% CI -0.03,-0.00).

Conclusion: Dabigatran 150 mg and 110 mg was superior to warfarin in AF patients with NVHD in reducing bleeding particularly ICH; However, no significant difference in reducing S/SE, and mortality. In catheter ablation, dabigatran reduced only groin hematoma. In the VHD subgroup, dabigatran did not show superiority or inferiority to warfarin; further studies are needed. “Non-valvular AF” should be replaced with “type II VHD” to distinguish it from other valvular heart diseases.

Impact of Artificial Intelligence on academic competence in medical research: A Scoping Review

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: The effect of Artificial Intelligence on scientific research is currently controversial (over-use, refusal). The objective of this scoping review was to summarize the impact of Generative Pre-Trained Bots (ChatGPT) on medical research, for optimal use.

Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, three electronic databases (MEDLINE, Web of Science, and Scopus) were searched for publications on the use of ChatGPT in medical research up to September 30, 2024. The inclusion criteria encompassed systematic reviews, meta-analyses, and reviews published in English or French. A synthesized and consensual perspective was then derived using the SWOT (Strengths, Weaknesses, Opportunities, and Threats) approach.

Results: Among the 120 articles identified during the study period, 33 publications were reviewed to describe the impact of ChatGPT on medical research skills. It emerged that ChatGPT was considered a tool for generating innovative ideas and analyzing "Big Data," helping researchers execute manually time-consuming processes. However, its responses may be accompanied by "hallucinations," posing a threat to the scientific integrity of medical research.

Conclusion: ChatGPT serves as a valuable aid in medical research, particularly in its conceptualization and writing phases. However, its potential drawbacks, such as "hallucinations," highlight the need to strengthen young researchers' skills in the proper use of Artificial Intelligence.

Evaluating public private partnerships in the healthcare sector. Scoping review

Khadija Salim, Amina Idrissi Azami, Belabbes Sanae — Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Governments faced efficiency crises in healthcare between the 1980s and 1990s, leading to the adoption of Public-Private Partnerships (PPPs) as innovative solutions. This study explores evaluation methodologies, criteria, and research gaps in the healthcare sector.

Methods: The study utilized Arksey and O'Malley's framework to conduct a scoping review of public-private partnerships in the health sector, identifying gaps, suggesting new research directions, and clarifying complex concepts using various databases and dictionaries.

Results: A study screened 21 255 papers for inclusion in an analysis, resulting in 26 studies selected for final review. The aim was to understand the contribution of Public-Private Partnerships (PPPs) to healthcare service quality, operational efficiency, and accessibility. The studies were categorized into four: access to quality care, strengthening health programs, improving communication, information, and awareness, and strengthening leadership and financial management. The studies were conducted in various countries, including Africa, Europe, Asia, North America, and South America.

Discussion: Public-private partnerships (PPPs) play a crucial role in the healthcare sector, improving efficiency and quality. They provide greater access to healthcare, especially for lowincome populations, and reduce financial burdens. However, their success depends on effective governance, accountability, and equitable cost-sharing arrangements. Effective communication and promotion are essential for PPP success. Resilient strategies are needed to overcome service disruptions and ensure transparency.

Polyphenols as Epigenetic Modulators of Health: A Holistic Approach to the Therapy and Prevention of Chronic Diseases

Sara Gheribi — Sat, 27 Dec 2025 00:00:00 +0000

Background: The rising prevalence of chronic diseases, including cancer, metabolic disorders, neurodegenerative, and cardiovascular conditions, presents a growing challenge to modern medicine and public health.

Aim: This article investigates the potential of polyphenols as modulators of epigenetic mechanisms in the context of chronic disease.

Methods: A comprehensive review of scientific literature was conducted, with emphasis on key epigenetic processes such as DNA methylation, histone modifications, and microRNA regulation.

Results: Polyphenols like resveratrol, curcumin, quercetin, and catechins exert protective actions by modulating gene expression, counteracting harmful epigenetic changes, and supporting cellular health.

Conclusion: Advancing our understanding of how polyphenols influence epigenetic pathways may lead to innovative therapeutic strategies combining conventional and personalized approaches.

Reconsidering isolated FEV₁ reduction: A case report of early-stage asthma with bronchial hyperreactivity and literature review

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Isolated low forced expiratory volume in one second (FEV₁) spirometric impairment (ILFSI) is characterized by a decreased FEV₁ while both forced vital capacity (FVC) and the FEV₁/FVC ratio remain within normal ranges. This pattern may hide an underlying respiratory disorder that warrants further examination. Notably, the 2022 European respiratory society/American thoracic society (2022-ERS/ATS) guidelines do not classify ILFSI as pathological, a stance that has sparked some controversy. This teaching report discussed the case of a woman with ILFSI who developed mild bronchial hyperreactivity after undergoing a methacholine bronchial challenge test (MBCT) and exhibited positive skin prick tests (SPTs) for dust mites.

Observation: A 28-year-old professional interior designer, who has no history of smoking or exposure to wood smoke and allergens, and who previously experienced a mild case of coronavirus disease-2019, consulted a pulmonologist for chronic cough, sputum production, and recurrent sneezing episodes. Asthma was suspected, leading to the performance of SPTs, spirometry, and either a bronchodilator test (in case of an obstructive ventilatory impairment) or MBCT (in case of a normal spirometry) as requested in the pulmonologist referral letter. The spirometry results indicated ILFSI, with a low FEV₁ (z-score = -1.74, 79%) while FVC (z-score = -0.97, 88%) and the FEV₁/FVC ratio (z-score = -1.35) remained normal. According to the 2022-ERS/ATS guidelines, these findings are considered normal spirometry because of the maintained FVC and FEV₁/FVC ratio. The MBCT confirmed mild bronchial hyperreactivity, showing a 20% drop in FEV₁ at a dose of 96 µg. Furthermore, SPTs were positive for dust mites (Dermatophagoides pteronyssinus and farinae).

Conclusion: The results of this report suggested a possible association between ILFSI and early allergic asthma, indicating that ILFSI should be re-examined in future revisions of the 2022-ERS/ATS guidelines for interpreting spirometric tests.

Association of systemic lupus erythematosus, Niemann-Pick disease type B, and probable granulomatosis with polyangiitis: A case report

Sat, 27 Dec 2025 00:00:00 +0000

Introduction: Niemann-Pick disease type B (NPD B) is a rare autosomal recessive disorder. It is clinically characterized by hepatosplenomegaly, interstitial lung disease, and thrombocytopenia. Its clinical features may overlap with those of autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Granulomatosis with Polyangiitis (GPA).

Observation: In this context, we report the first documented case of a 51-year-old woman presenting with the association of NPD B, SLE, and probable GPA. Clinically, the patient exhibited dyspnea, severe anemia, hepatosplenomegaly, Jaccoud's arthropathy, and crusted rhinitis. Laboratory tests were positive for antinuclear antibodies and anti-neutrophil cytoplasmic antigens. Radiological examinations showed interstitial pneumonia and pansinusitis. NPD B was suspected based on the presence of sea-blue histiocytes in bone marrow biopsy and confirmed by sphingomyelinase deficiency. After six months of corticosteroid and hydroxychloroquine therapy, the patient showed significant improvement.

Conclusion: This case highlights the importance of considering rare diseases in differential diagnosis, even when clinical signs suggest more common conditions.