La Tunisie Médicale

Effects of Heated Tobacco Products compared to Conventional Cigarettes on Cardiovascular System: Protocol for a Systematic Review

Soumaya Ben Saad, Nidhal BALOUMI , Amani BEN MANSOUR, Chahida HARIZI — Sat, 16 Aug 2025 00:00:00 +0000

Introduction
Heated tobacco products (HTPs) are increasingly marketed as a potentially less harmful alternative to conventional cigarettes. However, their cardiovascular effects compared to traditional smoking remain controversial. This protocol outlines the methodology for a systematic review aiming to assess the cardiovascular impact of HTPs in comparison to conventional cigarette smoking.

Methods
This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is registered with the International Prospective Register of Systematic Reviews (PROSPERO:CRD42024594334). We will search electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, and others, from inception to march 2025 . The search strategy will use medical subject heading (MeSH) terms such as "heated tobacco products" AND "cardiovascular health" AND "conventional cigarettes." Eligible studies will include randomized controlled trials and observational studies reporting on cardiovascular outcomes in adult HTP users compared to conventional smokers. Studies will be screened independently by two reviewers for inclusion, and data will be extracted using standardized forms. Quality assessment will utilize Cochrane Risk of Bias tools (MINORS and CONSORT), and evidence strength will be graded with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Data synthesis will include meta-analysis and meta-regression performed using SPSS version 2023.

Conclusions
This systematic review will provide a comprehensive synthesis of evidence on the cardiovascular effects of HTPs compared to conventional smoking. The findings aim to inform clinical guidelines, regulatory policies, and future research directions in tobacco harm reduction.

Cardiovascular and pulmonary response in gaming disorder: A systematic review protocol

hela cherif, Sabrine Louhaichi, Soumaya Debiche, Salma Mokaddem — Fri, 22 Aug 2025 00:00:00 +0000

Introduction: Internet Gaming Disorder (IGD) is a recognized mental health condition associated with autonomic nervous system (ANS) dysregulation. While heart rate variability (HRV) has been studied, ventilatory responses remain poorly explored. This systematic review aims to evaluate the impact of IGD on cardiovascular (HRV) and pulmonary (respiratory rate) parameters.

Methods: To conduct this systematic review, a literature search will be conducted on PubMed, Scopus, and Embase. We will include studies assessing HRV and respiratory rate in individuals aged ≥12 years with IGD. Excluded studies without objective ANS measurements or non-DSM-5-defined populations. Data extraction will focus on HRV (continuous ECG) and respiratory rate variations, stratified by gaming context and IGD severity. The risk of bias will be assessed using ROBINS-I.

Discussion: This review will clarify ANS dysregulation patterns in IGD, informing clinical monitoring strategies. Limitations may include heterogeneity in measurement methods.

Effect of TNF alpha inhibitors on atherosclerosis in psoriatic arthritis patients: a systematic review protocol

Fri, 22 Aug 2025 00:00:00 +0000

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by joint pain, stiffness, and swelling with typical skin manifestations of psoriasis. Chronic inflammation is a major cause of endothelial dysfunction, and atherosclerosis. In this optic, we conducted a systematic review of the literature to provide the most-up-to date literature regarding the effect of TNF alpha inhibitors on atherosclerosis in psoriatic arthritis patients. This systematic review was registered in prospero: CRD42023451234. We will follow the PRISMA guidelines and the search will be carried out using Pubmed, Scopus, Embase and Cochrane Library from inception until September 3th /2024. The search strategy, literature selection, and data extraction will be conducted independently by two investigator using a pre-piloted data extraction form. potential biases will be assessed using Newcastle Ottawa Scale (NOS) for the cohort and case control studies and the revised Cochrane risk-of-bias tool for randomized trials . Only studies that met high quality will belong to our final selection. The results will be publicly available and published in a peer-reviewed journal.

Continuing versus Withholding renin angiotensin aldosterone system antagonists before non-cardiac surgery: A protocol of a systematic review and meta-analysis

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Perioperative use of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) has been linked to early postinduction hypotension requiring vasopressor use under general anesthesia, potentially leading to complications like acute renal injury, myocardial injury, or stroke. However, the relationship between perioperative ACEI/ARB use and major morbidity remains uncertain.

Aim: This meta-analysis assessed the differences between the continuation or discontinuation of ACE inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) therapy during the perioperative period and hemodynamical instability, mortality, and major morbidity outcomes.

Methods: The protocol was registered in the PROSPERO database (ID: CRD42024519162). Literature searches of electronic databases and manual searches on the Medline, Embase, Scopus, and Web of Science databases up to August 30, 2024, will be performed. Case-control studies, cohort studies, non-randomized controlled trials, and randomized controlled trials (RCTs) involving adult patients aged over 18 years, who were chronically using ACEIs or ARBs due to chronic hypertension, undergoing non-cardiac surgery, where ACEIs or ARB therapy was either withheld or continued less than 10 hours before surgery will be included.

The primary outcome will be the incidence of intraoperative hypotension. Secondary outcomes will be the intraoperative use of vasoactive agent (incidence, dose of ephedrine (mg) and dose of phenylephrine (ng)), the incidence of severe hypotension, hospital length of stay, intraoperative and postoperative hypertension, the incidence of acute kidney injury, 30-day postoperative all-cause mortality and incidence of major cardio-cerebral events.

Conclusion: The results of this systematic review and meta-analysis should ...( abstract truncated at 250 words).

Cardiovascular risk and JAK inhibitor for the treatment of spondyloarthritis: A systematic review protocol

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: JAK inhibitors, a newer class of medications, work by blocking specific enzymes (Janus kinases) that play a key role in inflammation. By inhibiting these enzymes, JAK inhibitors help alleviate inflammation and symptoms, providing an alternative treatment option to conventional therapies like NSAIDs and biologics. Considering the lack of updated findings on cardiovascular effects in SpA patients treated with JAK inhibitors, we will perform a systematic review of the literature to investigate the safety of JAK inhibitors in SpA patients. The aim of this review is to evaluate cardiovascular safety of JAK inhibitors.

Methods: We will search multiple databases, including PubMed, Embase, and the Cochrane Library, using specific keywords such as "Janus kinase inhibitors," "JAK inhibitors," "spondyloarthritis," and "cardiac risk." Our inclusion criteria will focus on randomized controlled trials, that reports Major Adverse Cardiovascular Events (MACE), in patients treated with JAK inhibitors for spondyloarthritis. We will exclude cohort studies, and those without relevant cardiac data, as well as animal studies or those outside the scope of JAK inhibitor treatment. After screening titles and abstracts, we performed a full-text review of the selected articles to ensure the inclusion of studies with high methodological quality and relevant data on cardiac risk factors. The various stages of this literature search will be summarized using the Preferred Reporting of Systematic Reviews and Meta-Analysis (PRISMA) flow chart format to visualize the processes and findings of the review.

Results: The preliminary results demonstrated that the existing data indicated no significant.. (abstract truncated at 250 words).

Bibliometrics of scientific biomedical publications on Primary Immunodeficiency Diseases in the Arab World (2020-2024)

Fri, 01 Aug 2025 00:00:00 +0000

Objective: Describing the editorial, methodological and thematic profile of scientific publications on Primary Immunodeficiency Diseases in the Arab World during the five-year period 2020-2024.

Methods: Based on the MeSH descriptor ‘Primary Immunodeficiency Diseases’ (PID), combined with the names of 22 Arab countries, this bibliometric study was conducted on MEDLINE, via Web of Science, analyzing all available bibliographic fields. The number of authors was limited to researchers from the Arab world who had co-authored at least two publications during the study period. Visualization of author and research topic clusters was carried out using VOS Viewer.

Results: During the five-year study period, 156 publications from the Arab world were indexed under the PID descriptor, published by 86 scientific journals, and tagged with 479 MeSH descriptors. These publications, often of the ‘Case Reports’ (19%) and ‘Review Article’ (15%) type, were mainly categorized under ‘Immunology’ (62%), “Pediatrics” (47%) and ‘Genetics’ (39%). They were published particularly by the Journal of Clinical Immunology (15%) and Frontiers in Immunology (12%). Among the 119 co-authors of these publications, from 12 countries, the most prolific were AL-HERZ (Kuwait), BOUSFIHA (Morocco) and ADELI (Qatar). These studies were often retrospective in nature, focused on children and the problem of “Severe Combined Immunodeficiency”, particularly in Egypt, Saudi Arabia, Oman and Morocco. In addition to the ‘Genetics’ approach (39%), notably ‘Genetic Predisposition To Disease’ and ‘Genetic Diseases Inborn’, these publications also addressed “Immunology” (19%), including topics such as ‘Immunologic Deficiency Syndromes’ and ‘Acquired Immunodeficiency Syndrome’...(abstract truncated at 250 wordsà.

Comparative Effects of 16:8 Intermittent Fasting and Continuous Caloric Restriction on Metabolic Syndrome Components in obese Women: A Non-randomized Controlled Clinical Trial

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Intermittent fasting (IF) is gaining interest as an effective method to combat obesity

Objective : to compare the effects of 16:8 intermittent fasting (IF 16:8) and continuous caloric restriction (CCR) on anthropometric parameters and components of metabolic syndrome in obese women.

Methods : A non-randomized controlled clinical trial was conducted with obese women followed for three months. The patients were divided into two groups: IF (45 patients) and CCR (55 patients), each undergoing a 25% reduction in caloric intake. Anthropometric parameters, body composition and metabolic profile were evaluated.

Results : The average age was 34.10 ± 8.44 years in the IF group and 34.62 ± 8.80 years in the CCR group, with BMI values of 38.63 ± 5.15 kg/m² and 34.84 ± 6.69 kg/m², respectively. Both groups experienced significant weight loss after three months, with the IF group showing greater weight change (-7.38 ± 4.1 kg vs. -5.41 ± 3.84 kg, p=0.03). Fat mass and waist circumference reductions were more pronounced in the IF group (p=0.04 and p=0.0001, respectively). Furthermore, IF was more effective than CCR in reducing blood glucose (p=0.04) and triglyceride levels (p=0.02) and increasing HDL-cholesterol (p=0.01). The early feeding window (8h to 16h) in the IF group was associated with greater reductions in weight, fat mass, waist circumference and HOMA insulin resistance index (p=0.001 for all) compared to the 12h to 20h window.

Conclusion : The study suggests that 16:8 intermittent fasting could be a viable alternative to continuous ...(abstract truncated at 250 words).

Analysis of reliability between pharmacists when using the pediatric prescription optimization tool (GOPP Tool) in Ivorian hospital context

Doffou Elisée, Abrogoua Danho Pascal — Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Inappropriate prescriptions (IP) and omission of prescriptions (OP) are sources of adverse events in pediatrics. The pediatric prescription optimization grid (GOPP tool) was developed in the Ivorian pediatric environment for the detection and management of IP and OP. Our aim was to analyze the reliability between pharmacists, when using the GOPP tool for the detection of IP and OP in the Ivorian hospital context.

Methods: A cross-sectional study with a descriptive aim was carried out. The treatments of 881 patients were analyzed using the GOPP tool by clinical pharmacists (reference group) for the detection of IP and OP. Thirty (30) cases with at least 1 IP or OP were selected. These cases were also examined independently using GOPP tool by ten (10) pharmacists and interns (evaluator group) having no prior experience with this tool. Inter-user reliability for PI and OP detection using the GOPP tool was determined using the kappa (κ) test of agreement.

Result: The selected cases concerned patients with a median age of 25.5 months. The numbers of PI lines and OP detected by pharmacists in the “reference” group were 50 and 6, respectively. The median levels of agreement for PI and OP detection were judged as very good (Kappa=0.92) and good (Kappa=0.77), respectively.

Conclusion: The GOPP tool is a reliable tool for the detection of PI and OP by pharmacists working in the Ivorian hospital context. Its use is relevant in routine for the pharmaceutical analysis of prescriptions in pediatric departments in Côte d'Ivoire.

Evaluation of the microbiological quality of some natural honeys and determination of their antibacterial activity

Fri, 01 Aug 2025 00:00:00 +0000

Antibiotic resistance is a major concern for health systems worldwide, due to the irrational use of antibiotics. Honey can be considered an alternative therapy to antibiotics. Our study aims to evaluate the microbiological quality and presumed antibacterial activity of 7 natural honeys of different floral origins. Aerobic bacteria grew in 3 samples of honey: (jujube honey (Bacillus subtilis), fig honey (Staphylococcus hominis, S. epidermidis, and S. pettenkoferi) and holm oak honey (Aerococcus viridans)). Only holm oak honey contained a yeast (Cryptococcus neoformans), while the other honeys were free of yeasts and molds. Holm oak honey was most effective on most bacterial strains studied, particularly S. pyogenes. The other honeys were mainly active against S. pyogenes. None of the honeys showed activity against P. aeruginosa, K. pneumoniae, S. aureus and C. albicans. The MIC was 25% for holm oak honey against the 5 bacterial strains which showed a response. For fig honey, the MIC varied between 50% (S. pyogenes, S. aureus and S. epidermidis) and 100% (S. hominis and E. coli). For most other honeys, the MIC was 100%, meaning only the pure form of honey could prevent bacterial growth. In this study, honey, consistent with its traditional use in the ENT sphere, was found to be effective against S. pyogenes, a bacteria often responsible for bacterial tonsillitis which can limit the inappropriate use of antibiotics. These results could guide pharmaceutical research aimed at extracting active ingredients from honey to develop new antibacterial agents.

Drug-Induced acute Pancreatitis: A Real-World Pharmacovigilance Study Using the Tunisian Databases

Fri, 01 Aug 2025 00:00:00 +0000

Background: Acute pancreatitis (AP) is acute inflammatory process of the pancreas, commonly attributed to biliary or alcoholic causes. Drug-induced AP, although rare, is increasingly recognized as a potential etiology. However, there is limited literature on this topic.

Aim: This study aims to review the epidemiological, clinical, radiological, and management characteristics of drug-induced AP based on data from Tunisian databases.

Methods: A retrospective study was conducted at the Department of Digestive and Visceral Surgery, spanning five years. Thirteen cases of drug-induced AP out of 1580 admitted patients with AP were analyzed. Data collection included clinical characteristics, diagnosis methods, therapeutic approaches, and outcomes.

Results: We report a series of 13 cases of drug-induced acute pancreatitis (AP). Due to the rarity of this event, our small sample size limits the statistical power of our findings. However, each case provides valuable insight into potential drug associations with AP.
The mean age of affected patients was 55.62 years, with a male predominance (77%). Common symptoms included sudden onset epigastric abdominal pain (100% of cases) and elevated lipase levels (92.3%). Implicated medications included captopril (38.5%), atorvastatin (23.1%), azathioprine (23.1%), metformin, and olanzapine (7.7% each). Management involved pain management and proton pump inhibitors, with favorable outcomes in 84% of cases.

Conclusion: Drug-induced pancreatitis is a recognized entity requiring multidisciplinary management. Early recognition and reporting of suspected cases are essential for improved pharmacovigilance.

Evaluation of epidemiological, clinical and paraclinical data of Rheumatoid arthritis in Guinea: registry year 2018 - 2022.

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Rheumatoid arthritis (RA) is a chronic, destructive inflammatory rheumatic disease reported in populations of African origin. The aim of this study was to evaluate the epidemiological, clinical and paraclinical data of RA in Guinea with a registry from 2018 - 2022.

Method: This was a longitudinal, retrospective study conducted in the rheumatology department of CHU Ignace Deen between January 2018 and December 2022. The diagnosis of RA was based on the ACR and EULAR 2010 criteria.

Results : During the study period we collected 528 cases of RA out of 4213 observations (12.5%). There were 433 (82%) women with an average age of 47.3 years. The average number of painful joints was 8, ranging from 4 to 28, and the average number of swollen joints was 2 (ranging from 2 to 20). Rheumatoid factors were positive in 396 (75%) of cases, while anti-CCP antibodies were positive in 380 (72%) of patients. With DAS28, remission was noted in 53 (10%) of our patients, activity was low in 137 (26%) of cases, moderate in 259 (49%) and high in 79 (15%). Quality of life was assessed by the HAQ score, the mean value of which was 48 out of 60 (range 0 to 60).

Conclusion: Rheumatoid arthritis is the most common form of arthritis in Guinea. It mainly affects housewives, with significant functional repercussions

Application of the Health Belief Model (HBM) in Understanding the Relationship Between Anemia and Academic Performance Among Junior High School Students in Lhokseumawe City, Indonesia

Fri, 01 Aug 2025 00:00:00 +0000

Abstract: Indonesia ministry of health data shows that 21.7% of the population has anemia, with a prevalence of 26.4% in the 5–14-year age group and 18.4% in the 15–24-year age group (Hb <12.0 g/dL). The Health Belief Model (HBM) is used to identify lifestyle patterns of anemic students and their risks to academic achievement.

Aims: This study examines the relationship between hemoglobin levels and academic achievement and assesses the relationship between the HBM construct and anemia.

Methodology: This study is a cross-sectional study with a sample of 80 grade VIII students at SMP Negeri 1 Lhokseumawe. This study examines the relationship between hemoglobin levels and academic achievement and assesses the relationship between the HBM construct and anemia

Results: Chi-square test showed a significant relationship (p<0.05) between anemia and academic achievement, where students with normal hemoglobin levels had better achievements than those with anemia.

Conclusions: These findings confirm the impact of anemia on academic achievement, highlighting the importance of iron for brain function, concentration, and intelligence. The limited correlation of most HBM constructs with anemia suggests low student awareness, thus educational interventions are needed to improve preventive behavior.

Intra-articular infiltration of bupivacaine in arthroscopic knee surgery: Dexamethasone versus magnesium sulfate as adjuncts

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Knee arthroscopy is a common procedure in orthopedics due to its minimally invasive nature. However, it often leads to moderate to severe postoperative pain, especially within the first 24 hours. Several studies demonstrated the efficiency of intra-articular infiltration of analgesics but the optimal infiltration mixture remains a topic of debate.

Aim: The aim of our study was to assess the analgesic role of Dexamethasone or Magnesium Sulfate as adjuncts to intra-articular Bupivacaine after knee arthroscopic surgery.

Methods: It was a prospective randomized double-blinded study including 75 adult patients classified according to the American Society of Anesthesiology (ASA) I-II and undergoing arthroscopic knee surgery under spinal analgesia. They were divided into three groups of 25 each. All patients received intra articular infiltration at the end of surgery: group B received 10 ml of saline solution with 10 ml of bupivacaine 0.5%, group D received 4 mg of dexamethasone in combination with bupivacaine and group Mg received 1.5 g of magnesium sulfate in combination with bupivacaine. Postoperative rescue analgesia was insured by a patient-controlled analgesia (PCA) morphine. The primary outcome was morphine consumption during the first 24 hours after surgery.

Results: The cumulative morphine dose was higher in group B compared to group D and Mg (p=0.001 and p<0.001, respectively). Group D and group Mg showed comparable cumulative morphine doses (p=0.52). At 24 hours postoperatively, static visual analog scale (VAS) scores were higher in the control group compared to group Mg and group D ....( abstract truncated at 250 words).

Lacrimal tract trauma: Epidemiological aspects and prognostic factors in a population of southern Tunisia

Omar Feki, Mona Rekik, Sonda Kammoun, Mariam Sehli, Imene Kaibi, Amira Trigui — Fri, 01 Aug 2025 00:00:00 +0000

Introduction : The epidemiology and management of lacrimal tract trauma (LTT) vary depending on the populations, the skills, and resources of the healthcare team.

Aim : To examine the epidemiological and therapeutic aspects of LTT and their prognostic factors in southern Tunisia.

Methods : The study included 35 patients with LTT treated in the ophthalmology department of the Habib Bourguiba Hospital in Sfax. The postoperative result was evaluated functionally, anatomically, and aesthetically, and classified as good, average, or poor.

Results : Patients were aged 28±18 years, with a sex ratio of 3.4. Domestic and road accidents and fights represented 93% of the causes of LTT. The lesions affected more frequently both the left side (71%) and the inferior canaliculus (74%). Most patients (91%) were operated on within the first 48 hours. The internal fragment was identified by the Bowman probe (in 83% of cases) and sutured in all patients with true monocanalicular intubation by mini-Monoka probe in 94% of cases. The post-operative result was good in 83% of patients. Younger age, loss of eyelid substance, delay in surgical intervention, and lacrimal suture without intubation were associated with unsatisfactory postoperative results.

Conclusions : LTT affects mostly young male adults. Age under 20 years, post-traumatic operative delay above 48 hours, loss of eyelid substance, as well as suture of the wound without intubation are the main risk factors for a poor postoperative result. Good awareness and respect for the means of protection would make ...( abstract truncated at 250 words)

Exploring risk factors and survival rates in invasive cervical carcinoma: New perspectives

Amina Belhadj, Youssera Khadidja Boumeddane, Djihane Meddah, Tewfik Sahraoui — Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Cervical cancer is a public health issue in Algeria, it ranks at second position among female cancers.

Aim: This study sought to identify risk factors for cervical cancer and to determine their impact on patient survival

Methods: This is a retrospective study on 200 patients diagnosed during a 3-years period between January 1, 2016 and December 31, 2018. This study investigated cervical cancer risk factors and survival outcomes associations. The analysis was made by Chi Square test. The progression-free survival rate was estimated using the Kaplan–Meier method.

Results: Our study revealed that squamous cell carcinoma was the most frequent diagnosis (69.9%), it also points to early sexual activity as a significant associated risk factor (P=0.05). This finding contrasts with the relatively small proportion of cases (12.12%) linked to hereditary causes. Patients with adenocarcinoma had a lower progression-free survival (PFS) (Log-Rank test P = 0.04). Poorer PFS was associated with earlier FIGO stages (Breslow: P =0.04; Tarone-Ware: P =0.04). Age at first sexual encounter and parity, however, did not significantly predict PFS. PFS was substantially better in T1-T2 pathological stages (P = 0.000).

Conclusion: The prognosis depends on knowing these risk factors. Understanding these characteristics is crucial for improved therapy and results. We provide an up-to-date insight of current cervical cancer risk factors in oran city. These results highlight how crucial it is to comprehend risk variables and how they affect the prognosis of cervical cancer.

Forensic aspects of the order in request in Tunisia

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: The order on request is a legal procedure allowing a party to request a judicial decision quickly and without prior notification to the opposing party. This study aims to explore the legal framework governing the order on request in Tunisia, examine the medico-legal concerns and

evaluate the associated risks and challenges for both healthcare professionals and patients.

Methods: This study employs a doctrinal and analytical methodology, focusing on an examination of Tunisian legislative texts, particularly the Code of Civil and Commercial Procedure. Additionally, a comparative approach will be used to analyze similar legal frameworks in other countries.

Results: In Tunisia, the order on request enables swift judicial decisions without adversarial proceedings in urgent matters. In this framework, the judge plays a crucial supervisory role to maintain a balance between expediency and the right to a fair trial. Physicians, bound by medical

confidentiality, must navigate the tension between their duty of discretion and the obligat ion to comply with judicial orders. In cases where a physician believes a court order infringes on a

patient’s rights, they are not required to respond directly to the petitioner. Instead, they must

address their concerns to the judge, reaffirming their duty to uphold medical confidentiality.

Conclusion: While the order on request serves as a crucial legal tool for addressing urgent situations, its application must be handled with caution and in strict adherence to legal and ethical standards. Maintaining a balance between procedural urgency and the protection of fundamental rights is essential.

50-Year Bibliometrics of International Scientific Biomedical Publications on "Parasitic Diseases": MEDLINE (1970-2019)

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: The objective of this bibliometric study, spanning half a century of international biomedical research (1970-2019), on “parasitic diseases”, was to describe the editorial profile; methodological and thematic of these scientific publications.

Methods: The data were collected from the MEDLINE database, through a documentary query based on the descriptor “Parasitic Diseases”, and analyzed according to their main editorial characteristics (types of publication, scientific journals, etc.), methodological (country, parasitic diseases, etc.) and themes (key words), deduced particularly from the fields of its Medical Subjects Heading (MeSH), following a stratification into two periods: A (1970-1994) and B (1995-2019). “Highly Cited” papers were identified through Web of Science.

Results: A total of 337157 publications were identified (A: 110,062; B: 227095) and indexed by 20881 MeSH descriptors (A: 11 817; B: 19640). Published in 6470 scientific journals, these publications particularly covered the specialties of “Infectious Diseases” (37%), “Gastrology/Hepatology” (22%) and “Pediatrics” (20%). Conducted particularly in Brazil (2.6%), these studies were often “retrospective” (2.8%). The descriptor “Intestinal Diseases Parasitic” was the most explored thematic category (2.8%). In addition to “Malaria” (11.3%), the most studied diseases were “Echinococcosis” (2.9%), “Visceral Leishmaniasis” (2.7%) and “Toxoplasmosis” (2.5%). Bibliometric trends were characterized by an increase in “Reviews” (12.4% versus 7.5%), a switch from an “immunology” approach (24261 publications) to another “epidemiology” (70012 articles) and more focus on “Malaria Falciparum”. Only 329 articles were qualified as “Highly Cited” (1‰).

Conclusion: The bibliometric profile of international publications on “Parasitic Diseases”, over the last half century, ...( abstract truncated at 250 words).

Fine needle aspiration cytology in the diagnosis of thyroid nodules

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Thyroid nodules are a frequent and mostly benign pathology. Failure to recognize a cancer remains a major concern for any physician confronted with this pathology. Fine needle aspiration cytology (FNAC) is the reference examination when managing thyroid nodules. The aim of our study was to evaluate the role of FNAC in determining the histological nature of thyroid nodules.

Methods: We conducted a cross-sectional, retrospective, and descriptive study, spread over a 5-year period from January 2016 to December 2020, carried out in our Department of Otolaryngology and Head and Neck Surgery.

Results: The median age of the 200 patients was 46 years. Female predominance was evident, with a sex ratio of 0.09. All our patients underwent FNAC followed by surgical excision. FNAC was non diagnostic in 8 cases (4%) and benign in 53 cases (20.50%). It revealed atypia of undetermined significance in 33 cases (16%), a follicular neoplasm in 45 cases (21.50%) and a malignant suspicion in 47 cases (22.50%). FNAC was malignant in 22 cases (10.5%). Pathological examination showed malignancy in 115 cases. FNAC has an overall sensitivity of 84% and a specificity of 71.6% in predicting thyroid nodules diagnosis.

Conclusion: Combining clinical and ultrasonographic criteria with cytological results improves the sensitivity of thyroid carcinoma screening.

Epidemiological and Clinical Aspects of Early-Onset Colorectal Cancer: A Comparative Study of 180 Cases

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: The incidence of early-onset colorectal cancer (EO-CRC), defined as occurring before 50 years, is rising significantly. While genetic syndromes account for a minority of cases, the majority are sporadic and influenced by both genetic and environmental factors. This study aimed to identify the epidemiological and clinical characteristics of EO-CRC.
Methods: We conducted a single-center, retrospective, comparative study over seven years, including all patients diagnosed with colorectal cancer (CRC). Patients were classified into two groups: <50 years (G1) and ≥50 years (G2). Clinical data, tumor characteristics, and treatment strategies were compared.
Results: Among 180 patients, 26.1% were under 50 years (G1). No significant differences were observed in sex ratio, smoking, alcohol consumption, obesity, or family history of cancer. Both groups presented with bowel transit disorders and general health deterioration, but diarrhea (p = 0.015) and rectal bleeding (p = 0.026) were more frequent in G1. Rectal localization was significantly more common in G1 (p < 0.001). Histologically, EO-CRC was more often poorly differentiated, exhibited greater lymph node involvement, and was diagnosed at more advanced stages, though differences were not statistically significant. A curative approach was more frequently proposed in younger patients, without significant difference.
Conclusion: EO-CRC represented over one-quarter of CRC cases in our cohort. It was predominantly rectal and frequently diagnosed at an advanced stage. These findings highlight the need for increased awareness, early diagnosis, and tailored management strategies for younger patients.

The association of Maternal obesity with cesarean section and macrosomia outcomes among Moroccan women from the province of kenitra, Morocco

Fri, 01 Aug 2025 00:00:00 +0000

Introduction Obesity is a common problem with increasing prevalence and health consequences. In pregnant patients, its impact seems equally worrying affecting large population. Some obesity complications in pregnant women have not been examined, in particular link with fetal macrosomia.

Aim: The study aimed to assess the obesity factor associated with cesarean section and birth-weight infants.

Methods In a retrospective study, 174 women were recorder in the period from 2021 to 2022 in the Hospital El Idrissi of Kenitra, Morocco. For each patient, age, newborn weight, number of grosses, body mass index (BMI) prepregnancy and before delivering were recorded, univariate and bivariate analyses was performed for all parameters.

Results The occurrence of maternal complications during attempted vaginal delivery of a child weighing more than 4000 g is 6%. Risk factors for maternal complications, in addition to the child's birth weight (p=0.004, attributable risk (AR)=10%), are the mother's origin (p=0.04; AR=3%), a long duration of labor (p=0.02; AR=12%), and a cesarean section during labor (p=0.004; AR=17%). Multiparous patients who had already given birth vaginally to a macrosomic child had a reduced risk of maternal complications (p=0.03). The prevalence of obesity was 2% (p<0.001). Obesity was significantly associated with an increased risk of cesarean delivery and macrosomia (p<0.0001). The prevalence of macrosomia remained higher in the overweight group than in the normal weight group (aOR=2.01, 95% CI: 1.13-3.58, p<0.05).

Conclusion The study shows a significant relationship between obesity and macrosomia outcome in Moroccan women.

Tuberculosis Meningo-encephalitis in Casablanca, Morocco

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Neuromeningeal tuberculosis remains the most serious form of Mycobacterium tuberculosis infection. The wide clinical polymorphism and lack of specificity of radiological signs make diagnosis difficult and lead to delays in management.

Aim: To describe the epidemiological profile of confirmed Tuberculous Meningo-encephalitis.

Methods: This is a monocentric, retrospective, descriptive and analytical study of patients followed for confirmed tuberculous Meningo-encephalitis in Infectious diseases department at the Ibn Rochd University Hospital in Casablanca between January 2015 and December 2018. Analytical and multivariate logistic regression analyses were performed to identify predictors of mortality and neurological sequelae.

Results: 90 patients were included, 58% were male with an average age of 38 years. The main risk factors were low socioeconomic status (90%) and recent tuberculosis contact was observed in 13.3%. Onset of symptoms was progressive (92.2%) with average evolution of 25.4 days. Predominant clinical signs were fever (97.4%), headache (70%) and stiff neck (58%). Clinical forms were Meningo-encephalitis (59.9%) and meningitis (36.8%). Predominant Brain radiological sign was leptomeningeal contrast (35%). Cerebrospinal fluid (CSF) abnormalities: White cells mean: 128 white cells/mm³ with lymphocytic predominance (79.1%); Proteinorachia mean: 1.27g/l, Glycorrachia mean: 0.32g/l (88%). Culture on Lowenstein positive in 85% and RT- Polymerase Chain Reaction (PCR) performed in 17.7% and positive in 87.5%. All patients had received standard antituberculosis drugs combining Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. Evolution was favorable with symptom resolution patient rate of 62.5%, 10% mortality, 7.8% neurological sequelae. In multivariate analysis, delayed diagnosis, hydrocephalus and Meningo-encephalitis form were ...(abstract truncated at 250 words).

Predictive factors of poor nutritional status in children and young adults on chronic hemodialysis: A single center experience

Abir Boussetta, Nesrine Abida, Manel Jellouli, Taher Gargah — Fri, 01 Aug 2025 00:00:00 +0000

Introduction-Aim: Children with kidney failure (KF) are prompt to undernutrition with subsequent growth failure. The aim of this study was to assess probable correlates of normalized protein catabolic rate (nPCR) in children on chronic hemodialysis (HD).

Methods: This prospective study included all 20-year-old or less patients undergoing chronic HD at our pediatric HD unit between 1st January 2024 and 30^th April 2024. Patients included had been on HD for more than 3 months and were clinically stable. For each patient, baseline characteristics were recorded along with their echocardiogram findings. Mean nPCR was calculated and potential predictive factors were simultaneously evaluated. Our study included a univariate and a multivariate analysis. A p value less than 0.05 was considered statistically significant.

Results: A total of 40 patients were included with a mean age of 14.4 ± 3.7 years old and a sex-ratio M/F of 1.9. Twenty-two (55%) had a mean nPCR <1g/kg/day. A strong positive correlation between nPCR and the 3-months body mass index variation percentage was found with a correlation ratio of 0.82. On multivariate analysis, Patients with a single pool KT/V < 1.2 and those exhibiting left ventricular hypertrophy were more likely to have a nPCR value <1g/kg/day (OR: 7.2 and 11.1, 95% CI: 2.28 – 75.23 and 5.5-98,08, respectively). A first hour refill index > 1.7 ml/kg/h/% was also correlated with a low nPCR (Adjusted OR:5.5- 95% CI: 3.2-65.2).

Conclusion: Pressure and volume control along with dialysis adequacy are promising factors in improving....(abstract truncated at 250 words).

The impact of socio-economic and demographic factors on non-communicable diseases in Morocco

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: By 2030, non-communicable diseases (NCDs) are expected to overtake all other causes of death in Africa. The prevalence of NCDs and related risk factors are influenced by gender and socioeconomic disparities.

Aim: Thus, this study aimed to determine the impact of socio-economic and demographic factors on non-communicable diseases in Morocco.

Methods: Cross-sectional data were analysed from 4766 adults who participated in the 2017 STEPS survey in Morocco. Data collection included assessment of behavioural and biochemical risk factors. The Kolmogorov-Smirnov, Chi-square and the Kruskal-Wallis tests were performed.

Results: There was a significant difference between genders in NCDs. Men had higher rates of tobacco and alcohol use (21.2%, 13.9%, respectively, with a p <0.001)), while women had higher obesity prevalence (31.2% (p <0.001)). Individuals with no formal education showed the highest prevalence of hypertension (38.9%), diabetes (10.1%), and obesity (27.9%) compared to those having primary education or more. Adults aged 70 years or older showed higher prevalence of hypertension and diabetes than the other age groups.

Conclusion: Morocco has a high prevalence of NCDs. The incidence of NCDs is significantly associated with sociodemographic and behavioral factors. A multisectoral and integrated strategy, focusing on sociodemographic and behavioral factors is necessary to prevent and control NCDs.

Epileptic child in remission: Ceiling effect of valproic acid

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Therapeutic drug monitoring (TDM) of valproic acid (VPA) for epileptic children aims to optimize treatment, hence promoting seizure control, and to detect refractory cases that should be managed early. We aimed to identify a ceiling dose and a trough serum level of VPA in epileptic children in remission.

Methods: This retrospective study was carried out at Clinical Pharmacology, involving epileptic children (2-18 years) who were referred at least two times for a VPA trough level measurement over a 13-year period (2009-2022).

Results: We included 88 children, of whom 67% (n=59) were in remission (G1) and 33% (n=29) did not meet remission criteria (G2). Ten children (11%) experienced adverse events, predominantly gastrointestinal and neuropsychological disturbances.

Mean weight-based dose of VPA in G1 (21.53±7.95 mg/kg/day) was significantly lower than in G2 (26.81±9.99 mg/kg/day), p=0.009. Mean VPA trough serum level was 60.76±20.22 µg/mL in G1 and 62.47±23.04 µg/mL in G2 with no significant difference.

The ceiling daily dose of VPA to achieve remission was 44.44 mg/kg/day.

Conclusion: Our study showed that the average weight-based dose of VPA in children in remission was lower than that in G2. A ceiling dose of 44.44 mg/kg/day of VPA limiting treatment efficacy for achieving remission was identified.

Ortho-surgical management of Arhinia syndrome: A case report

Abdelali Halimi, Fatima Zaoui, Mohamed El-Okeily, Nawal Bouyahyaoui — Fri, 01 Aug 2025 00:00:00 +0000

Introduction and importance: Arhinia syndrome (AS) is an extremely rare malformation characterized by typical clinical signs such as a lack of nose, with difficulty in breathing and inability to feed due to airway obstruction. The ortho-surgical management of AS is a big challenge and it requires an interdisciplinary relationship between the orthodontist and a maxillofacial surgeon. The authors reported a case of AS.

Case presentation: The only case in Morocco among fewer than 30 cases described in the whole world, male child, 7-year-old.

Clinical findings and investigations: Complete absence of the external nose, nasal cavities, and other characteristic signs. This diagnosis was genetically confirmed.

Interventions and outcome: A LeFort II maxillary osteotomy was done in combination with a facemask and miniscrew followed by a parietal bone graft and maxillary expansion with a customer expander. An internal and external nasal reconstruction was undergone with orthodontic management of unerupted teeth. An acceptable morphology for the newly created external nose was obtained, this reconstruction was viable and esthetically acceptable. A slight external restenosis of a left nave was observed. This result was stable over three years.

Relevance and impact: AS is a rare condition with a pathogenesis not been fully understood. The ideal treatment should have the lowest possible morbidity and a low relapse rate. The most difficulty in the approach is the creation and maintenance of a nasal cavity. These therapeutic aspects will be discussed through this case...( abstract truncated at 250 words).

Paraneoplastic Raynaud’s phenomenon revealing lung adenocarcinoma

Fri, 01 Aug 2025 00:00:00 +0000

The silent genocide in Gaza: The fragility of international law and institutional inaction

Meriem Gaddas, Helmi Ben Saad — Fri, 01 Aug 2025 00:00:00 +0000

The Global Cost of Silencing Science

Fri, 01 Aug 2025 00:00:00 +0000

Artificial Intelligence in Higher Education: Literature Review

Maram Selmi, Nour El Houda Ben Fatma, Meriem Chedly — Fri, 01 Aug 2025 00:00:00 +0000

Artificial intelligence is a rapidly evolving technology in higher education. It is being integrated into the sector through a wide range of applications, each of which has a significant impact on the educational process. This impact can be both positive and negative.

On the one hand, artificial intelligence offers opportunities for personalizing learning and teaching, improving administrative services, and supporting mental health. However, its integration into higher education institutions raises challenges and ethical issues that threaten students' privacy.

This literature review aims to explore the different applications of artificial intelligence, as an innovative technology, in the academic field while highlighting its advantages and disadvantages as well as the challenges and issues it raises. It also addresses the guidelines for an ethical integration of artificial intelligence in higher education, highlighting the fundamental principles to ensure a responsible and respectful adoption of human values.

Imaging of sinonasal inverted papillomas: A literature review

Rachida Bouatay, Jamel Koubaa — Fri, 01 Aug 2025 00:00:00 +0000

The sinonasal inverted papilloma is a rare benign tumor which is distinguished from the other sinonasal tumors by some characteristics such as a slow developement, local aggressiveness, a high rate of recurrence after surgical resection and the possibility of malignant transformation. It should be considered in the presence of any unilateral polypoid symptomatology or lesion. Its treatment is surgical.

In this update, we discuss the radiological specificities of sinonasal inverted papillomas as well as the contribution of imaging in the diagnosis and post-treatment monitoring of these tumors.

Learning technical gestures by medical students: development and contribution of a written procedural document associated with a video

Ines Kammoun, Sonia Mazigh, Marwa Chiboub, Mariem Adel, Hajer Kandara — Fri, 01 Aug 2025 00:00:00 +0000

Aim: To develop procedural documents of three gestures taught in endocrinology and to assess their contribution in the procedural learning of students.

Methods: Prospective randomized controlled study, comparing a self-learning tool combining a video and a procedural document (PD), with a guided teaching (GT) of a technical gesture by a teacher. The study involved 89 students randomized into: an intervention group (I1;n=47) and a control group (I0;n=42). All the participants had GT regarding blood pressure measurement, thyroid examination, and waist circumference measurement. Then, the GroupI1 received three PD and three videos illustrating the same gestures. A week later, an assessment was performed. Group I0 received the documents after the assessment. The student satisfaction with the two methods was evaluated.

Results: The percentage of students who used PD and videos was comparable between the two groups (68to79% in groupI1 and 76to86% in groupI0, p between0.161and0.827).

The mean evaluation score respectively at the thyroid examination station, blood pressure and waist circumference measurement was 8.07±1.28 in groupI1 versus7.94±1.01 in group I0(p=0.634),7.51±1.11versus7.68±0.96(p=0.466) and7.41±1.37versus6.94±1.34(p=0.132).

The mean satisfaction score of the two teaching tools was respectively in group I1 versus I0, of (9.38±1.53 and 8.88±1.63; p=0.195), (9.39±1,65 and 9.25±0.76, p=0.658) and (9.43±1.59 and9.24±0.82,p=0.543).The GT satisfaction score was 9.34±1.40 in I1group versus 9.62±0.46 in I0group, p=0.227. The power of the statistical test was less than 10%.

Conclusion: The lack of significant difference between the evaluation scores of the two groups could be explained by the low rate of consultation .. . (abstract truncated at 250 words).

The role of role-playing in learning how to break bad news

Fri, 01 Aug 2025 00:00:00 +0000

Introduction: Role-playing are a subtype of simulation aimed at improving non-technical skills, such as delivering a cancer diagnosis. The use of this pedagogical method in teaching bad news delivery has been growing in recent years. However, data, particularly from Tunisia, on this topic are limited.

Aim: To evaluate learners' perceptions of the usefulness of role-playing in delivering cancer diagnoses.

Methods: We conducted a descriptive, cross-sectional study between January and October 2024. We included 4th-year medical students who had completed their gastroenterology rotations at Charles Nicolle Hospital. For each group, we conducted a role-playing session. A questionnaire was distributed to learners before and after the role-playing session to assess whether there was a change in students' opinions.

Results: We collected data from 61 students. According to the students, the most crucial step for successfully delivering a diagnosis was training doctors in delivering news about serious illnesses. Nearly half of the students (n=34) reported having difficulty communicating with patients or their families. All learners were convinced that simulation plays a major role in medical practice and medical education. Additionally, all students agreed that role-playing sessions are highly suitable for teaching the delivery of bad news, particularly cancer diagnoses. Participation in role-playing sessions allows doctors to understand patients better. The learners' responses before and after the role-playing session were comparable.

Conclusion: Role-playing is a highly effective active learning method for teaching cancer diagnosis delivery. It helps learners approach reality more closely and acquire communication skills with patients and their families.

Simulation learning in the emergency department: Impact on VideoLaryngoscope Intubation Skills

Fri, 01 Aug 2025 00:00:00 +0000

Introduction In the emergency department (ED), learning by simulation provides a safe acquisition of procedural skills. This study’s objective was to evaluate the impact of the simulation-based learning on videolaryngoscope (VL) orotracheal intubation (OTI) skills among residents practicing in ED.

Methods: evaluative, prospective study, including residents practicing in teaching hospitals ED in Tunis. They were novices in direct laryngoscopy. We scheduled a procedural simulation session. Residents were evaluated before and after the session. The primary endpoint was the rate of successful OTI after learning session.

Results: 32 residents were enrolled. The mean age was 28 ± 2.5 years. Gender ratio was 0.18. The mean exercise seniority was 1.53 ± 0.7 years. The rate of successful OTI before and after the training was observed in 4 residents (12.5%) vs 23 (71.8), p=0.689. The average time of OTI was respectively 149.81±108 seconds (sec) vs. 51±96 sec (p<0.001). The rate of esophageal intubation was n (%): 16 (50%) vs 9 (28%) (p=0.49) and the mean number of attempts was 3.81 vs. 1.84 (p<0.001). Intubation time after the session more than 12 sec was an independent factor of intubation failure (Adjusted OR= 3.5, p=0.001 and 95%CI [1.018-10.69]).

Conclusion: Learning by simulation in the ED provides residents with a skill that allows complete OTI in less time and a smaller number of attempts. Intubation time is an independent factor predicting intubation failure among doctors learning intubation by VL.