La Tunisie Médicale

Detection of atrial septal aneurysm on ECG based on Deep Learning algorithm (ANN)

Mohammed Marouane Saim, Omar Alami, Hassan Ammor, Mohamed Alami — Sun, 09 Nov 2025 00:00:00 +0000

Atrial Septal Aneurysm (ASA) is a real clinical challenge due to its possible association with other relevant conditions. The absence of specific symptoms or electrocardiogram (ECG) criteria explain why its diagnosis is very often qualified as incidental. The aim of this study is to assess ASA detection by Machine Learning (ML) on electrocardiogram (ECG) data. The study is a retrospective analysis of 233 individuals, including 123 with ASA confirmed by trans-thoracic Echocardiography (TTE) and 110 without ASA. Key ECG parameters were examined. An Artificial Neural Network (ANN) algorithm was trained on 80% of the dataset, with the remaining 20% for testing. Results demonstrated a model sensitivity of 73%, specificity of 84%, Positive Predictive Value (PPV) of 80%, Negative Predictive Value (NPV) of 73%, and an F-1 score of 0.79. The Receiver Operating Characteristic (ROC) curve exhibited an Area Under the Curve (AUC) of 0.8, indicative of excellent diagnostic test performance. This study shows that ASA detection by ECG using ML is possible, offering a potential opening for a broader clinical understanding and implications of this cardiac abnormality.

Chronic hyperglycemia-related central pontine myelinolysis: A case report and a literature review

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Central pontine myelinolysis (CPM) is a rare condition that has been reported to occur in association with rapid correction of hyponatremia. Chronic hyperglycemia is an extremely rare cause of CPM with no other metabolic disturbances. Our aim was to describe the case of a patient who presented with CPM associated with chronic hyperglycemia.

Observation: We report the case of a 55-year-old male with a personal history of diabetes mellitus who presented, over two months, gait disorders, slurred speech, and dysphagia. All laboratory tests were within normal limits except for glycated hemoglobin level which was high at 12%. Calculated serum osmolality level was normal at 309.8 mOsm/kg. Brain magnetic resonance imaging was consistent with the diagnosis of CPM. Patient’s medical condition improved by optimizing blood glucose levels, physical rehabilitation and speech therapy.

Conclusion: This case highlights the hypothesis of chronic hyperglycemia being the direct cause of CPM. The underlying mechanism might be the toxicity of varying blood glucose levels towards the oligodendrocytes.

Abstracts from the 14th Tunisian Congress of Nuclear Medicine, Tunis, 2 & 3 May 2025

Sun, 09 Nov 2025 00:00:00 +0000

Beyond the basics: exploring non-conventional treatment for fatigue in post-acute COVID-19 syndrome

Sun, 09 Nov 2025 00:00:00 +0000

Introduction. Post-acute 2019 coronavirus disease syndrome (PACS) is a multifaceted, multisystem disorder affecting an estimated 75 million individuals globally (in May 2024). Defined by symptoms persisting beyond four weeks post-infection, PACS manifests in subacute (4-12 weeks) and chronic (>12 weeks) phases, with fatigue being a prominent and debilitating feature. Comprehensive management of PACS-associated fatigue needs diverse therapeutic strategies extending beyond conventional rehabilitation.

Aim. This narrative review explored non-conventional interventions for PACS-related fatigue, focusing on treatments involving nutritional rehabilitation, physical modalities, and other innovative therapies.

Methods. Narrative review.

Results. Treatments reported in the literature include melatonin, QingjinYiqi, nutritional supplements, aromatherapy, antioxidants, Tai Chi, acupuncture, yoga, singing, hyperbaric oxygen therapy (HBOT), pulsed electromagnetic field therapy, and whole-body vibration. Melatonin and QingjinYiqi have shown notable improvements in fatigue and overall health. Nutritional supplements such as vitamin-minerals combinations have demonstrated enhancements in muscle strength, physical performance, and quality of life. Tai Chi, acupuncture, and yoga have shown positive effects on fatigue, muscle strength, and overall well-being. Aromatherapy, singing, HBOT, pulsed electromagnetic field therapy, and whole-body vibration effectively reduce fatigue while enhancing physical and cognitive functions.

Conclusion. These non-conventional treatments offer promising supplementary benefits to conventional rehabilitation.

Risk analysis applied to the sterilization process in a public health hospital center: Use of the “FMECA” method

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: The sterilization of reusable medical devices in healthcare establishments is an activity of enormous importance in the quality and safety of medical procedures. The methods of risk analysis are the means that will put into exercise the critical points of this process.

Objective: To identify by brainstorming the different failure modes, to prioritize by considering the average criticality indices, each step of this process, and to lead to the proposal of preventive and corrective operational actions.

Methods: To upgrade the sterilization circuit, an a priori risk analysis according to the Failure Modes, Effects and Criticality Analysis (FMECA) method was carried out.

Results: The application of the FMECA method made it possible to identify 135 of failure modes, and to classify, in descending order, the stages of the process, according to the average criticality index. The validation/storage stage was the most critical, followed by personnel, the packaging stage.

Conclusion: Within a hospital establishment, the implementation of a risk analysis tool for the sterilization process of reusable medical devices will ensure the safety of the patient and the staff.

From Concern to Control: Feedback from a quality improvement project to decrease Central-Line–Associated Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit"

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Infants admitted in Neonatal Intensive Care units (NICU) are frequently exposed to a high risk of contracting a central line-associated bloodstream infection (CLABSI). The study aims to reduce the CLABSI rate in the NICU to reach the Saudi Ministry of Health (MOH) benchmark.

Methods: It is a quality improvement project based on the Plan Do Check Act. This study was conducted in the Neonatal intensive care unit (NICU) at the Prince Sultan Military Medical City. The study was done from February 2023 to July 2023 in NICU. Sixteen evidence-based recommendations were assessed over the project. An assigned team enhanced the regular assessment of central line-related items and supplies.
Results: 38 staff members were selected as 'a vascular access team' for this project. Full compliance with updated recommendations increased from 25% to 56.3%, and overall care bundle compliance improved from 66.07% to 79.12%. The availability of supplies related to central lines improved throughout the CLABSI project. Consequently, the CLABSI rate decreased by 82.3%, from 10.42 (6 CLABSI, 576 central line days; February 2023) to 1.84 (1 CLABSI, 544 central line days; July 2023) CLABSI per 1,000 central line days after six months of quality improvement project implementation.
Conclusions: Reducing the CLABSI rate is achievable by QIP based on updated recommendations to improve the quality of care and outcomes for newborns. However, multiple challenges should be addressed to maintain a low CLABSI rate.

External auditory canal carcinomas: What does optimal management require?

Sun, 09 Nov 2025 00:00:00 +0000

Objective: Carcinomas of the external auditory canal (CEAC) are rare with poorly defined treatment guidelines. The aim of this study is to discuss the therapeutic management of patients with CEAC.

Methods: It was a retrospective study conducted over an 11-year period (2010-2021), including 8 patients with primary CEAC. Cases were recorded in terms of gender, age, symptoms, physical signs, radiological examinations, surgical methods and follow- up.

Results: Median age was 58 years with a sex ratio of 0.6. Main symptoms were hearing loss (n=6), otorrhea (n=4), otalgia (n=4), and peripheral facial palsy (n=2). According to the Pittsburgh classification, CEACs were classified as T1N0M0 in 3 cases, T4aN0M0 in 4 cases, and T4bN0M0 in one case. Surgery consisted of a local resection of the tumor in four cases. A lateral temporal bone resection with total ipsilateral parotidectomy and functional neck dissection was performed in three cases with, respectively, a resection of the ipsilateral pinna (2 cases) and of the temporomandibular joint (2 cases). Adjuvant radiotherapy was indicated in 4 cases. Exclusive radiation therapy was indicated in one case. Histopathological examination confirmed 5 cases of squamous cell carcinoma, 2 cases of basal cell carcinoma, and one case of adenoid cystic carcinoma. Surgical margins were negative in 5 cases. Follow-up was favorable without recurrence in six cases. In one case, a progressive disease with patient death was observed.

Conclusions: Optimal treatment requires early diagnosis and careful imaging assessment of tumor extension to tailor treatment, which often includes surgery and radiotherapy.

Pattern of children death in Sfax, Tunisia: A 14-year autopsy study

Sun, 09 Nov 2025 00:00:00 +0000

Introduction and aim: Child mortality is a critical indicator of public health. Identifying the causes and circumstances of death among children is the first step in preventing this tragedy. The purpose of this study was to investigate and analyse the epidemiological, social, and forensic characteristics of children deaths in Tunisia over a 14-year period and identify the leading causes of death.

Methods: We conducted a transversal descriptive study in the Department of Forensic Medicine at Habib Bourguiba University Hospital of Sfax over 14 years (January 1 st, 2008-December 31st, 2021) including all forensic autopsies carried out on children.

Results: A total of 436 cases were examined with a male predominance (Sex ratio:1.5) and a mean age of 8 ± 6 years. Accidents were the most prevalent manner of death (70%) followed by natural deaths (16%), suicides (7%) and homicides (2%). A significant association between sex, age group and the manner of death (natural/violent deaths) was observed (p<0.001). The majority of accidents were due to road traffic accidents (48%), followed by drowning (20%). For suicidal deaths, hanging was the most common method (65%) followed by self-immolation (16%) and, finally, ingesting pesticides (13%). The most frequent method of homicide was sharp force.

Conclusion: This study provides valuable data regarding child mortality patterns in Tunisia, which can help to implement adequate preventive measures.

Exploring surgical failures in primary hyperparathyroidism

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Parathyroidectomy is considered the most cost-effective treatment for primary hyperparathyroidism (PHPT), with a relatively low incidence of complications. Nonetheless, 5-10% of patients do not achieve cure after initial parathyroidectomy. We hereby report our experience to determine the causes of our uncured patients and explore factors that could be associated with failure.

Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for PHPT from 2004 to 2020. Cure was defined as re-establishment of normal calcium homeostasis lasting a minimum of 6 months. Persistent PHPT (perPHPT) was defined as ongoing hypercalcemia at any time within the 6 months after surgery.

Results: The overall failure-to-cure rate was 6%. Of the 165 patients, 155 underwent successful surgical treatment of PHPT at the initial operation and perPHPT occurred in 10 patients. Baseline factors including age, sex, preoperative laboratory values, imaging, and surgical approach did not differ significantly between cured and non-cured groups. The sensitivity of intraoperative PTH measurement (iOPTH) as an indicator of operative success was 88,5%. Of the 10 patients with perPHPT, multi-gland disease (MGD) was present in 7 and ectopic adenoma in one. The lack of iOPTH use contributed to failure in 2 cases.

Conclusion: Our study underscores the critical role of MGD as a significant cause of perPHPT. Other etiologies may include ectopic glands or technical problems during surgery. The use of iOPTH is crucial in reducing the incidence of perPHPT and should be a routine practice.

Morbidity of implantation of a port-a-cath: Monocentric study conducted at the Salah Azaiez institute Tunis

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Port-A-cath (PAC), sinceits introduction in 1982, has seenrapid expansion in its use. However, its placement and use are not withoutrisk, as evidenced by the associated complication rate, which ranges from 10 to 38% in variousseries. Moreover, few Tunisianstudies have investigated ports and their complications. The aim of ourstudywas to evaluate the complications associatedwiththisdevice, identifyriskfactors for complications, and gather patient satisfaction.

Methods: Weconducted an observational, descriptive, and analyticalstudy, involving 112 patients whounderwent PAC implantation at the Salah Azaiez Institut (SAI) betweenFebruary and April 2021. These patients werethenfollowed up at day 0, 3 months, 9 months, and 15 months post-implantation.

Results: All our port placement procedureswereperformedusing the percutaneousmethodguided by anatomicallandmarks. The internaljugularveinwasusedin 98.2% of ourprocedures. Over the 16-month follow-up, 17 complications wereidentified, resulting in an incidence rate of 15%. Most complications (59%) occurredintraoperatively, corresponding to the formation of an intraoperativehematoma, graded Clavien-Dindo I. The main risk factor for complication wasseveralvenouspuncturesgreaterthantwo. Introducingultrasound guidance during placement reduces the complication rate. Regarding patient satisfaction withtheir care at SAI, only 8% reportedbeing "unsatisfied". The reasonsgiven for this dissatisfaction weremainlyrelated to organizationalfactorsinherent to SAI.

Conclusion: PAC placement is a safeprocedurewith a low rate of complications. However, implementing specific measures could reduce its morbidity.

Elastic Stable Intramedullary Nail Fixation for Pediatric Forearm Bone Fractures: Outcomes and Complications Rate

Sun, 09 Nov 2025 00:00:00 +0000

Background: Forearm shaft fractures are common among children. Elastic stable intramedullary nailing (ESIN) is generally considered the gold standard operative procedure. This study aimed to assess functional outcomes, axial alignment, bone healing, and complication rates in pediatric population.

Methods: This retrospective cohort study reviewed pediatric forearm fracture cases from January 2016 to December 2020 at Mouwasat Dammam Hospital, Saudi Arabia. The study included children aged 16 years and younger who were treated with elastic intramedullary nailing. Both clinical and radiological outcomes were assessed, along with the occurrence of complications.

Results: The study included 64 patients with a mean age of 8.3 years. In 60.93% of cases, both forearm bones were fractured, and in 60.09%, the fractures were located in the distal third of the forearm. Open reduction was needed in 20.03% of cases. None of the cases showed mean axial alignment values greater than 10°. The mean healing delay was 56.4 days, with a range of 38-73 days. The average time for nail removal was 4.5 months. From a clinical perspective, 92.18% of the cases (59 patients) had favorable outcomes. The complication rate was 23.43%.

Conclusion: ESIN has proven to be an effective method for stabilizing forearm fractures, ensuring proper alignment, promoting high union rates, and delivering satisfactory functional results. Although complications are relatively common, serious complications remain rare.

Evaluation of Endostatin Levels in COVID-19 Patients Admitted to the Emergency Department

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: The COVID-19 is defined as a respiratory and endothelial disease caused by Severe Acute Respiratory Syndrome Coronavirus 2. Endostatin is a molecule bound to collagen in the basal membrane of endothelial cells.

Objective: The aim of this study was to measure the serum endostatin levels of patients diagnosed with COVID-19 in the emergency department.

Methods: This study was conducted in the emergency department with two groups: COVID-19 PCR-positive patients and healthy adults. Complete blood count, serum biochemistry values, and radiological imaging results were evaluated. Serum endostatin levels were measured from venous blood samples collected during the emergency department visits. Data were analyzed using the SPSS 19.0 software.

Results: A total of 148 COVID-19 patients and 35 healthy controls were included in the study. The serum endostatin levels of the COVID-19 patient group were significantly lower compared to the healthy control group (p<0.05). The Chest CT Severity Score, 4C-Mortality Score, Quick SOFA, and Quick COVID-19 Severity Index were significantly higher in the patients with a fatal outcome compared to those who survived (p<0.001). Although serum endostatin levels were slightly higher in the fatal outcome group, no statistically significant difference was observed (p>0.05).

Conclusion: There is no increase in serum endostatin levels in patients with COVID-19 presenting to the emergency department. While a slight increase in endostatin levels was observed in patients with a fatal outcome, it is believed that endostatin will not be effective in predicting prognosis.

Knee prosthetic joint infection : Interest of early debridement, antibiotics, and implant retention strategy

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Peri joint infections (PJI) are terrible complications that result in high morbidity and a significant financial impact on healthcare costs. Management of PJI requires a multidisciplinary approach. Debridement, antibiotics, and implant retention (DAIR) with or without modular components exchange is attractive as it prevents the unnecessary removal of implants.

Methods: It was a single-center, observational, descriptive, and retrospective study, carried over a period of 7 years. DAIR was defined as successful if not followed by a revision surgery. the recovery is considered by the absence of and biological signs of infection during the follow up period. The necessity of re-revision or removal of the prothesis represents a failure of the DAIR.

Results: We included 15 patients. The mean age in our series was 69,8. The mean delay of infection onset was 24.8 days. Debridement and irrigation were used in all cases, while modular components were changed in 9 cases which represents 60% of cases. Intraoperative samples were positive in 11 patients which represents 73%. Staphylococcus aureus was the most implicated germ. The outcome was considered favourable in 11 patients which represents 73% of the cases. Patients who had modular components had higher success rates (78% vs 67%) without a significative difference. A delay higher than 3 weeks led to a higher percentage of unfavourable outcomes without a significative difference.

Conclusion: Multidisciplinary approach should be implemented to achieve favourable outcome. DAIR with modular components exchange is considered as an effective option for patients developing an early PJI.

Nutritional and Metabolic Characteristics of Overweight Women with Polycystic Ovary Syndrome (PCOS): A Case-Control Study

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Polycystic Ovary Syndrome (PCOS) is a common cause of menstrual disorders, infertility, and hyperandrogenism, often associated with insulin resistance and an increased risk of metabolic disorders. This study aimed to assess the metabolic and nutritional characteristics of overweight women with PCOS.

Methods: This was a descriptive, cross-sectional, and retrospective case-control study that included 61 overweight women, divided into two groups: 31 women with PCOS and 30 controls without PCOS. Data were gathered through review of the patients' medical records.

Results: High blood pressure, type 2 diabetes, dyslipidemia, and metabolic syndrome were significantly more frequent in the PCOS group compared to the control group (p<0.001; p<0.001; p=0.002; and p=<00001, respectively). Eating disorders were more frequently observed in women with PCOS, with a significantly higher occurrence of binge eating behaviors in these patients compared to the control group (p=0.009). The intake of saturated fatty acids was higher in women with PCOS (p=0.01). Regarding micronutrients, intakes of vitamin C and vitamin B1 were significantly lower in PCOS patients (p=0.01 and p=0.04, respectively). However, significantly more prevalent nutrient deficiencies in omega-6 fatty acids (p=0.001), vitamin C (p=0.002), vitamin B1 (p=0.03), vitamin B3 (p=0.003), vitamin B6 (p=0.03), and iron (p=0.02) were noted in the PCOS group.

Conclusions: Women with PCOS exhibit a higher occurrence of cardio-metabolic risk factors and multiple nutritional deficiencies. Early and personalized management is crucial to improve their long-term health outcomes and quality of life.

The WMA at a Crossroads: Confronting Medical Complicity and Preserving Ethics Amid Gaza War Crimes

Sun, 09 Nov 2025 00:00:00 +0000

Special issue “Heart Connections: Integrating Organ, Environmental, and Mental Health Impacts” Systematic reviews and meta-analyses

Saoussen Miladi, Lilia Zakhama — Sun, 09 Nov 2025 00:00:00 +0000

Tunisie Médicale 2009–2025: A Shift Toward Evidence-Based Medicine and the Empowerment of Young Scientists

Chadli Dziri, Lilia Zakhama — Sun, 09 Nov 2025 00:00:00 +0000

This issue of Tunisie Médicale has reserved a place for the topic of literature review methodology. In practice, seven systematic reviews without meta-meta-analysis and four systematic reviews with meta-analyses have been published. These systematic reviews, which used correct methodology, covered neonatology, cardiology, pulmonology, rheumatology, anesthesia and intensive care, and psychiatry. Here is a stimulus, created for the first time, intended to encourage our young people to become data producers.

The effect of Ambient heat exposure early in pregnancy on the frequency of congenital heart defects: A systematic review and meta-analysis

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Congenital heart defects (CHD) is the most common birth defect worldwide and is associated with several maternal risk factors, such as obesity, diabetes, smoking, and advanced maternal age, as well as environmental exposures, including heat and air pollution.
This systematic review aimed to evaluate the current evidence regarding the impact of maternal exposure to high ambient temperatures during pregnancy on the incidence of CHD in offspring.

Methods: We included comparative studies that directly assessed the relationship between high-temperature exposure during pregnancy and CHD. A comprehensive search of PubMed, Embase, Scopus, and Google Scholar was conducted on 11 December 2024.
All eligible studies were assessed for methodological quality using the MINORS scale, and the risk of bias was evaluated using the Newcastle-Ottawa Scale. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers.
The odds ratio (OR) was selected as the effect measure. A meta-analysis was conducted using Comprehensive Meta-Analysis Software (version 4), employing random-effects models to calculate pooled ORs with 95% confidence intervals (CIs).

Results: A total of 874 records were identified, and 14 studies were included in the final analysis. These included eight case-control and six cohort studies, predominantly conducted in the United States (n = 5) and China (n = 5). The meta-analysis revealed a statistically significant association between prenatal heat exposure and CHD, with a pooled OR of 1.079 (95% CI: 1.005–1.159). The 95% prediction interval ranged from 0.849 to 1.372. Subgroup analyses revealed a statistically significant association between heat exposure and CHD occurrence in cohort studies (pooled OR: 1.141; 95% CI: 1.005–1.296), whereas no significant association was found in case-control studies (pooled OR: 1.039; 95% CI: 0.934–1.156). Similarly, analysis based on exposure context showed a significant association in the ambient heat exposure subgroup (pooled OR: 1.080; 95% CI: 1.005–1.161), but not in the occasional exposure subgroup (pooled OR: 1.039; 95% CI: 0.634–1.700)

Conclusion: This systematic review and meta-analysis provide evidence that maternal exposure to high ambient temperatures during pregnancy may be associated with an increased risk of CHD in offspring. These findings highlight the importance of integrating counseling on climate-related health risks into both prenatal care and public health policy.

Long working hours and the risk of ischemic cardiac death: A systematic review and a meta-analysis

Sun, 09 Nov 2025 00:00:00 +0000

Introduction: The relationship between occupational stress, particularly long working hours, and health outcomes such as ischemic cardiac death has garnered increasing attention. Myocardial infarction, a primary cause of sudden cardiac death, is significantly influenced by workplace stress. This systematic review and meta-analysis aim to explore the association between long working hours and the risk of ischemic cardiac death, building upon the foundation of previous studies indicating a potential link between prolonged occupational stress and cardiovascular health issues.

Methods: We systematically searched several databases up to 30 November 2022 without language restrictions, using a comprehensive set of keywords related to occupational stress and ischemic heart disease. The selection criteria focused on clinical trials assessing the risk of occupational stress and cardiovascular disease in individuals of working age from diverse industrial settings. Quality assessment was performed using the STROBE scale, and statistical analysis was conducted using RevMan web software, considering hazard ratios and odds ratios as relative risk estimates.

Results: Our search yielded 20 trials, with 18 meeting the inclusion criteria. These studies encompassed a wide range of years (1992-2019) and involved a total of 288,278 individuals. Our meta-analysis revealed no significant risk increase for ischemic heart disease mortality for those working 41 to 49 hours per week compared to 35 to 40 hours. However, working more than 55 hours per week was associated with a 17% increased risk of ischemic heart disease mortality (RR=1.17, 95% CI [1.05 to 1.31]).

Conclusions: Extended working hours are associated with an increased risk of ischemic heart disease mortality, emphasizing the importance of addressing occupational health and safety standards. This study contributes to the growing body of evidence on the health implications of long working hours and underscores the necessity for preventive strategies to protect worker health in the modern work environment.

Continuing versus Withholding Renin–Angiotensin–Aldosterone System Antagonists Before Noncardiac Surgery: A Systematic Review and Meta-Analysis

Sun, 09 Nov 2025 00:00:00 +0000

Background: It remains unclear whether to continue or withdraw angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEI) before noncardiac surgery to reduce perioperative morbidity. This systematic review and meta-analysis aimed to analyze the consequences of continuing ARB or ACEi in the incidence of intraoperative hypotension and postoperative complications.

Methods: This systematic review and meta-analysis followed the PRISMA 2020 guidelines and was registered in the PROSPERO database. We conducted a comprehensive search in several bibliographic databases for studies comparing continuing versus withholding renin angiotensin aldosterone system antagonists before noncardiac surgery. Primary outcomes included the incidence of intraoperative hypotension, while secondary outcomes covered the intraoperative use of the vasoactive agent, the incidence of severe hypotension, intraoperative and postoperative hypertension, the incidence of acute kidney injury (AKI), 30-day postoperative all-cause mortality, and the incidence of major cardiocerebral events (MACCE).

Results: Five randomized controlled trials, three nonrandomized controlled trials, and four retrospective case-control studies were included that involved 50184 patients. Meta-analysis revealed that continuing ACEI or ARBs before surgery increased the incidence of intraoperative hypotension (OR = 1.96, 95%CI [1.30, 2.96] p=0.001). Heterogeneity was substantial across studies but was significantly reduced in subgroup analyses. Furthermore, the use of vasoactive agents and the incidence of severe hypotension were significantly higher in the continuing group. No significant differences in intraoperative hypertension and the incidence of AKI and MACCE at 30 days after the operation.

Conclusions: Continued ACEI or ARBs before non-cardiac surgery increases the incidence of intraoperative hypotension, without reducing the incidence of both AKI and MACCE postoperatively. More research is necessary to explore the appropriate perioperative management of ACE-I and ARB.

Effect of Inotropes in Patients with Advanced Heart Failure: A Meta-Analysis of Randomized Trials

Racha Ghabara, Badreddine Ben Kaab, Saoussen Antit, Chadli Dziri, Lilia Zakhama — Sun, 09 Nov 2025 00:00:00 +0000

Introduction : Advanced heart failure (AHF) is associated with high morbidity and mortality. Inotropic agents such as dobutamine, levosimendan, and milrinone are commonly used to improve cardiac output, but their impact on mortality remains controversial due to limited head-to-head comparisons.

Aim : To compare the effectiveness of inotropes (dobutamine, levosimendan, milrinone) versus placebo or each other in reducing mortality in patients with AHF.

Methods : This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO (CRD42024584389). We searched Scopus, CENTRAL, Google Scholar, PubMed, and clinical trial registries up to December 2024 for randomized controlled trials (RCTs) published from 2000 onward. Eligible studies included adults (≥18 years) with AHF and cardiorenal syndrome. Risk differences (RD) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the Cochrane Q-test, Tau², and I². Subgroup analyses and meta-regression were performed. Publication bias was evaluated using funnel plots and Duval and Tweedie's trim-and-fill method.

Results : Twenty-four RCTs involving 2,862 participants were included. The pooled RD for mortality was -0.023 (95% CI: -0.046 to 0.000; p=0.055), indicating no significant difference. Subgroup analysis by control (inotropes vs. placebo) showed similar non-significant results. Meta-regression for moderators (age, LVEF, systolic blood pressure) did not explain heterogeneity. The funnel plot suggested asymmetry, indicating potential publication bias.

Conclusions : Inotropic agents showed a non-significant trend toward reduced mortality in AHF patients. Heterogeneity limits firm conclusions. Larger RCTs are needed to identify subgroups that may benefit.

Why publish? Perspectives of North African researchers in the medical field

Sun, 09 Nov 2025 00:00:00 +0000

The act of publishing research is not just a procedural step; it is a fundamental part of the scientific process. It ensures transparency, accountability, and the continuous evolution of knowledge. This perspective paper aimed to revisit the theoretical reasons/motivations that lead researchers in the medical field to engaging in the publication process, and to determine those of researchers from a low-income country (Tunisia). When researchers publish their findings, they provide a foundation upon which others can build. This iterative process is what drives innovation and discovery. Moreover, the global nature of scientific research means that publications often transcend borders, enabling international collaboration. In addition, the societal impact of research cannot be overstated. Publications often serve as the ridge between scientific discovery and real-world application. Finally, the ethical dimension of publishing is also significant. By sharing their work, researchers contribute to the democratization of knowledge, ensuring that scientific advancements are accessible to all, rather than being confined to a select few. This is particularly important in addressing global challenges such as climate change, pandemics, and inequality. The responses of a 44 university hospital doctors and doctoral students from a low-income country to the question “why publish?”, show a lack of awareness of the importance of publishing, both academically and economically. In summary, the publication of research is a multifaceted endeavor that serves both the scientific community and society. It is a testament to the collaborative and progressive nature of human inquiry, driving us toward a better understanding of the world and our place withinb it.

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

Hela Cherif, Soumaya Debiche, Sabrine Louhaichi, Salma Mokaddem — Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Internet Gaming Disorder (IGD) is a behavioral addiction characterized by impaired control over gaming. While its psychological aspects are well-documented, its physiological correlates, particularly those governed by the autonomic nervous system (ANS), are less well-synthesized. Heart rate variability (HRV) and pulmonary function are key indicators of cardiorespiratory health and ANS regulation. This systematic review aimed to evaluate the impact of IGD on chronotropic (as measured by HRV) and ventilatory responses, both at rest and during active gaming.

Methods: We searched PubMed, Embase, and Scopus from database inception to December 2024 seeking for observational studies published in English or French. We included studies that diagnosed IGD using formal criteria (DSM-5/ICD-11) and objectively measured HRV and/or pulmonary function in individuals with IGD compared to healthy controls. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the ROBINS-I tool.

Results: The search yielded 249 records, from which four case-control studies met the inclusion criteria, comprising 162 participants (77 IGD, 85 controls). The overall risk of bias was judged to be low. At rest (k=3 studies), baseline HRV parameters including the natural logarithm of high-frequency power (lnHF), root mean square of successive differences (RMSSD), and standard deviation of normal-to-normal intervals (SDNN) did not differ significantly between the IGD and control groups. During active gaming (k=2 studies), a blunted parasympathetic reactivity was observed in the IGD group, characterized by a significant drop in lnHF not observed in controls. Regarding pulmonary function (k=1 study), while lung volumes were similar, individuals with IGD showed significantly lower respiratory muscle strength compared to controls.

Conclusion: This review suggested that IGD is associated with preserved tonic autonomic function at rest but impaired phasic parasympathetic reactivity during gaming engagement. Furthermore, IGD may be linked to reduced respiratory ..(abstract truncated at 250 words).

Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) in Cardiac Amyloidosis: A Systematic Review

Rim Bourguiba, Saoussen Antit, Sarra Ben Rejeb, Syrine Bellakhal, Lilia Zakhama — Sun, 09 Nov 2025 00:00:00 +0000

Introduction : Cardiac amyloidosis is an underdiagnosed cause of heart failure characterized by extracellular deposition of misfolded proteins, most commonly transthyretin (ATTR) or immunoglobulin light chains (AL). Despite recent advances in disease-modifying therapies, prognosis remains poor. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits. However, evidence regarding their safety and efficacy in cardiac amyloidosis remains limited.

Aim: This systematic review aimed to synthesize current evidence on the clinical outcomes and safety of SGLT2 inhibitors in patients with cardiac amyloidosis.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library through June 2025, in accordance with PRISMA guidelines. Studies evaluating the use of SGLT2i in cardiac amyloidosis were included. Outcomes assessed were all-cause mortality, stroke, hospitalization for heart failure, and kidney failure. Data extraction and quality assessment were performed independently by two reviewers. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled when appropriate.

Results: Five studies comprising 17,416 patients met inclusion criteria. The mean age was 76.8 years, and 78% were male. Use of SGLT2 inhibitors was associated with a significant reduction in all-cause mortality (HR 0.64; 95% CI 0.57–0.71) and stroke risk (HR 0.64; 95% CI 0.54–0.77). For hospitalization due to heart failure, there was a trend toward benefit (HR 0.88; 95% CI 0.76–1.02), though this did not reach statistical significance. The risk of kidney failure was modestly reduced (HR 0.91; 95% CI 0.71–1.08). Overall study quality was moderate.

Conclusions: SGLT2 inhibitors appear to be a promising therapeutic option in cardiac amyloidosis, potentially improving survival and reducing cerebrovascular events while maintaining a favorable safety profile. However, current evidence is limited by observational study designs and heterogeneity. High-quality randomized controlled trials are needed to confirm these findings and guide clinical practice.

Cardiac Phenotypes and Endophenotypes in Schizophrenia : A systematic Review

Sun, 09 Nov 2025 00:00:00 +0000

Background: Schizophrenia is increasingly recognized as a multisystemic disorder. Cardiac anomalies, including autonomic, electrophysiological, and structural heart abnormalities, are frequently reported in patients with schizophrenia. However, the distinction between phenotypes and endophenotypes remains unclear.

Methods: In this review, we synthesized clinical, neurobiological, and genetic evidence to assess cardiac alterations in schizophrenia and evaluate their potential as endophenotypes.

Results: Autonomic dysfunction, especially reduced heart rate variability (HRV) and impaired parasympathetic regulation, emerged as the most consistent cardiac phenotype, and the only one that fulfills the criteria for an endophenotype. In contrast, electrophysiological anomalies such as QT/QTc prolongation, T-wave changes, and some structural heart anomalies show genetic associations with schizophrenia but lack sufficient heritability and longitudinal data to be classified as endophenotypes.

Conclusion: Among all cardiac anomalies reported in schizophrenia, autonomic dysfunction, particularly HRV impairment, was the only one that fulfilled the endophenotype criteria. However, most of the reviewed studies were observational, which limits the robustness of our conclusions. Future heritability and multi-omic studies are needed to understand the complex pathogenomic interlink between mental and heart diseases.

Effects of TNF-α Inhibitors on Subclinical Atherosclerosis and Endothelial Function in Patients with Psoriatic Arthritis: A Systematic Review

Sun, 09 Nov 2025 00:00:00 +0000

Background: Patients with psoriatic arthritis (PsA) are at increased risk of cardiovascular disease (CVD), largely driven by systemic inflammation and accelerated atherosclerosis. Tumor necrosis factor-alpha (TNF-alpha) inhibitors have transformed PsA treatment and may exert vascular protective effects. This systematic review aimed to evaluate the impact of TNF-alpha inhibitors on atherosclerosis and endothelial dysfunction in PsA patients.

Methods: This systematic review followed the preferred reporting items for systematic reviews guidelines. A systematic search of PubMed, Scopus, Cochrane Library and Embase databases was conducted, identifying original articles up to September 3^rd, 2024. Outcomes included carotid intima-media thickness (CIMT), endothelial function, carotid plaques, and biomarkers of inflammation, lipid metabolism, and coagulation. This systematic review was registered in prospero (CRD42023451234).

Results: Five studies met the inclusion criteria and were published between 2011 and 2020. TNF-alpha inhibitors were associated with a reduction in CIMT in one study (0.7±0.18 vs 0.8±0.26; p=0.002 for the CCA and 0.94±0.31 vs 1.24±0.52; p<0.001 for the bulb), particularly with longer treatment duration (B:-0.317, p<0.001), while two studies reported progression of CIMT over time. Carotid plaque prevalence was significantly lower in TNF-alpha–treated patients compared to those on csDMARDs (15.8% vs 40.4%; p<0.0001). No consistent improvement in endothelial function, assessed by flow-mediated dilation or reactive hyperemia index was observed. TNF-alpha inhibitors consistently reduced inflammatory markers (CRP, ESR) and some lipid parameters (LDL-C, triglycerides). One study showed significant improvement in fibrinolytic and hemostatic markers (p<0.001), especially among patients achieving minimal disease activity (p<0.005).

Conclusion: TNF-alpha inhibitors may offer vascular benefits in PsA by attenuating subclinical atherosclerosis and systemic inflammation. However, their effects on endothelial function remain unclear. Further large-scale, controlled, and long-term studies are warranted to confirm their cardioprotective role and define their impact on clinical cardiovascular outcomes in PsA patients.

Effect of Paracetamol on Blood Pressure: A Systematic Review

Sun, 09 Nov 2025 00:00:00 +0000

Background: Paracetamol is widely used as a first-line analgesic for chronic pain, primarily due to its presumed safety profile. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol has been for long time considered free of significant cardiovascular effects, particularly on blood pressure (BP). However, emerging evidence suggests that long terme paracetamol use may be associated with elevated BP, challenging its status as a risk-free alternative to NSAIDs.

This systematic review aimed to investigate the association between paracetamol intake and changes in BP by screening existing clinical and epidemiological data to clarify its potential hypertensive effects.

Methods: A comprehensive search of Medline, Cochrane Library, and Embase databases was conducted. Eligible studies included randomized clinical trials, interventional and longitudinal observational studi involving adults receiving standard doses of oral paracetamol. Exclusion criteria were studies on pregnant women, patients with preeclampsia/eclampsia, and those using supratherapeutic doses. The primary outcome was variation in systolic and diastolic BP.

Results: A total of 10 studies was included comprinzing observational studies (n = 4) and randomized controlled trials (n = 6). Two observational studies reported a significant association between regular paracetamol use and an increased risk of hypertension particularly with high-dose (> 3 g/day) or prolonged use (> 30 days). The remaining two studies found no significant association, though one noted a trend toward elevated BP in older adults

Four RCTs demonstrated a small but consistent increase in systolic blood pressure (SBP), ranging from +0.2 to +4.0 mmHg. The effect appeared dose-dependent, with higher doses (> 2 g/day) linked to greater BP elevation.

Conclusion: Paracetamol may cause slight elevations in BP, with potential clinical implications in high- risk patients. Caution is warranted, and further prospective studies using ambulatory BP monitoring are needed to clarify this relationship.

Effects of Heated Tobacco Products compared to Conventional Cigarettes on Cardiovascular System: A Systematic Review

Soumaya Ben Saad, Chahida Hrizi, Nidhal Balloumi, Amani Ben Mansour — Sun, 09 Nov 2025 00:00:00 +0000

Introduction: Heated tobacco products (HTPs) are marketed as reduced-risk alternatives to conventional cigarettes, yet their true cardiovascular safety profile remains unclear. This systematic review aimed to evaluate the acute and short-term cardiovascular effects of HTPs compared to traditional cigarettes.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Embase from inception to March 2024. Eligible studies included randomized controlled trials and observational studies reporting on cardiovascular outcomes in adult users of HTPs compared to conventional smokers. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Data were synthesized qualitatively; a meta-analysis was not feasible due to heterogeneity.

Results: Five studies (n = 460 participants) met the inclusion criteria. Risk of bias ranged from low to serious, with one industry-sponsored study. Acute HTP exposure induced hemodynamic and vascular changes comparable to those observed with conventional cigarettes. Endothelial dysfunction and persistent oxidative stress were reported across studies. One study (Ikonomidis et al.) suggested a minor reduction in oxidative biomarkers with HTP use, though clinical significance was uncertain. No study assessed mid- or long-term outcomes.

Conclusions: HTPs do not appear to offer meaningful cardiovascular benefit over conventional cigarettes in the short term. The similarity in acute harmful effects raises concern over their widespread use and marketing. These findings underscore the urgent need for independent, long-term studies assessing clinically relevant cardiovascular endpoints.

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

Sun, 09 Nov 2025 00:00:00 +0000

Objective: The aim of this review is to evaluate cardiovascular safety of Janus Kinas (JAK) inhibitors in patients with spondyloarthritis (SpA).

Methods: Applying the PRISMA methodology, we searched PubMed, Embase, and the Cochrane Library databases using the following search terms: Janus kinase inhibitors, spondyloarthritis, cardiac risk and major adverse cardiovascular event. Randomized controlled trials that reported Major Adverse Cardiovascular Events (MACE) in patients treated with JAK inhibitors for SpA were included.

Results: Ten radomized controlled trials conducted between 2017 and 2024 were analyzed, encompassing 2671 patients with an active SpA and treated with JAK inhibitors (tofacitinib, upadacitinib and filgotinib). The follow-up duration ranged from 12 to 104 weeks. Only three MACE were reported with upadacitinib (15 mg/day) : one non-fatal haemorrhagic stroke after 52 weeks of treatment in a patient with a history of smoking and a myocardial infarction and a cerebral hemorrhage after 104 weeks in the same population, corresponding to an incidence rate of 0.3 per 100 patient-years (95% CI: 0.0–1.1).

Conclusions: This systemic review highlights the safety of JAK inhibitors according to MACE occurrence in patients with SpA when compared to placebo. These results need to be interpreted with caution regarding the limited long-term data and small sample sizes in clinical trials. Long-term studies are needed to clarify these risks.