La Tunisie Médicale

Diagnostic and therapeutic approach to endobronchial metastases from extra-thoracic neoplasms: A report of three cases and brief review of literature.

Soumaya Debiche — 2024-12-01

Introduction: Endobronchial metastases (EBMs) are rare, with primary tumours predominantly of breast, renal, and colorectal origin. Bronchoscopy is the diagnostic gold standard, with histological confirmation through immunohistochemical study.

Cases: We presented three cases of EBMs, one secondary to colorectal cancer and two associated with renal tumours. EBM unveiled the extra-thoracic neoplasm in colorectal cancer and was incidentally discovered during renal cancer follow-up. Bronchoscopy revealed an obstructive endobronchial mass in two cases. Histological diagnosis was established via bronchial biopsies (collecting duct renal carcinoma), computed tomography-guided transparietal lung biopsy (clear cell renal carcinoma), and endobronchial mass resection through rigid bronchoscopy (colorectal adenocarcinoma).

Conclusion: In case of an endobronchial lesion, the diagnosis of EBM should be evoked especially when the medical history reports extra-thoracic neoplasms. This diagnostic hypothesis guides the histological diagnosis and leads to an appropriate treatment.

Dyslipidemia in Infants: Challenges in Diagnosis and Management

Asma Marzouk — 2024-12-01

Dyslipidemia in infants is a rare condition characterized by abnormal levels of lipids in the blood, such as cholesterol and triglycerides. Early diagnosis poses a challenge due to nonspecific symptoms and lipid criteria differing from adults. Through two clinical cases of familial dyslipidemia (Type 1 Familial Hypercholesterolemia and Type 2b Combined Familial Hyperlipidemia), we highlight the diagnostic and therapeutic challenges encountered in infants, emphasizing the importance of a multidisciplinary approach in care and early screening. In the first case, a 3-month-old boy with a family history of dyslipidemia was diagnosed during bronchiolitis, revealing milky serum, pseudohyponatremia, and abnormal lipid profile. His Type 1 familial hyperlipidemia was confirmed by lipid electrophoresis. Despite dietary management and breastfeeding, he developed severe pancreatitis, successfully treated with intensive care. The second case involved a girl who presented at 3 months with vomiting and irritability. Laboratory tests indicated pseudohyponatremia, hematologic abnormalities, and lipid disturbances. Her Type 2b familial hyperlipidemia was confirmed by lipid electrophoresis. She responded well to a specialized diet, experiencing few pancreatitis episodes without meeting clinical or radiological severity criteria.

Beyond Cochrane’s I²: Diverse Methods for Assessing Heterogeneity in Meta-Analysis

Abdullah Ashraf Hamad — 2024-12-01

Not applicable

We need a Prediction Interval to evaluate the heterogeneity of meta-analyses

Hela Cherif — 2024-12-01

The cover letter in the era of artificial intelligence (ChatGPT as an example)

Haifa Hachfi — 2024-12-01

not applied

Writing an effective and succinct cover letter: A practical guide

Helmi Ben Saad — 2024-12-01

Introduction. The cover letter is a critical component of medical journal submissions, often influencing acceptance decisions. However, authors frequently underestimate its importance. This narrative review aimed to provide guidance for authors on writing effective and succinct cover letters.

Methods. We conducted a narrative review of literature on the recommended structure and content for drafting a cover letter.

Results. An effective and succinct cover letter should include the names of the editor in chief and journal, submission details, ethical statements, authors' agreement, and contact information. Additional elements such as declarations of conflicts of interest, funding sources, and permissions may also be necessary. The cover letter should emphasize the manuscript's uniqueness without merely duplicating the abstract.

Conclusion. Cover letters remain pivotal for manuscript acceptance and must adhere to specific guidelines.

Adaptation of Clinical Reasoning Learning to Large Groups of students

Dalila Miraoui — 2024-12-01

Introduction: Clinical Reasoning Learning (CRL) is one of the most important methods of active learning in medicine. This instruction is designed for small groups of students.

Objectives and methods: We conducted a prospective descriptive study with the primary goal of adapting this instruction for large groups of students. The secondary objective was to compare two methods of adapting this instruction (fish bowl technique and whole-group participation), and the comparison was conducted using an evaluation questionnaire with a Likert scale.

Results: Our sample included 130 students, divided into 2 groups: the Fish bowl CRL group (57 students) and the group with the participation of all students (73 students). Strengthening of prior knowledge, the working atmosphere, assimilation of information, and supervision were the strengths of this instruction. The negatives were related to insufficient time. The analysis found a statistically significant difference in averages between the 2 groups, and this difference pertained to the variables of participation and appreciation of the atmosphere, with a p-value of 0.01 for both.

Conclusion: CRL can be adapted for large groups in the form of fish bowl learning. Currently, it is challenging to measure the actual impact of educational activities on the development of clinical reasoning due to the lack of precise measurement instruments. Evaluation questionnaires can be a first step in measuring the impact of these instructions with modified structures. It would be interesting in future studies to create assessment tools for these restructured instructions.

Specific features of hypercalcaemia in patients of Cocody University Hospital - Côte d’Ivoire

Abidou Kawele Coulibaly — 2024-12-01

Aim: describe the epidemiological, clinical, etiological and therapeutic aspects of hypercalcemia seen in the rheumatology department of Cocody University Hospital.

Patients and method: Descriptive cross-sectional study carried out in the rheumatology department of Cocody University Hospital from January 2013 to July 2022 and covering the files of patients with hypercalcemia.

Results: The hospital frequency of hypercalcemia was 0.88%, or 60 cases out of 6771 hospitalizations during the study period. The workforce included 35 men and 25 women (M/F ratio=0.14), aged on average 56±11.52 years (range 25 and 80 years). The main reason for consultation related to the underlying disease was osteoarticular pain syndrome. The signs related to symptomatic hypercalcemia were digestive (23.33%), neurological (8.33%) and cardiovascular (5%). The main extra-articular signs were asthenia (90%) and weight loss (78.33%). On the biological level, there was a clear predominance of mild hypercalcemia (76.67%), followed by moderate hypercalcemia (10%) and severe hypercalcemia (13.33%). The etiologies were dominated by multiple myeloma (45%), followed by bone metastases (40%), granulomatosis (13.33%) and secondary hyperparathyroidism (1.67%). The molecules used for the treatment of hypercalcemia were corticosteroids and biophosphonates. The outcome was favorable in 18.33% of patients, and unspecified in 66.67% of cases due to the patient's transfer to another department. There were 9 deaths, or 15% of cases.

Conclusion: Hypercalcemia is rare and most often asymptomatic in rheumatological hospitalizations in Abidjan. Multiple myeloma is the main etiology.

Postpartum Septic Osteoarthritis: A case series study

Khadija Baccouche — 2024-12-01

Introduction-Aim: Postpartum septic osteoarthritis is a rare but serious condition often misdiagnosed due to overlap with common postpartum symptoms like pelvic pain and joint stiffness. This case series aims to describe the clinical, bacteriological, and radiological characteristics of postpartum septic osteoarthritis, as well as the treatment approaches and patient outcomes.

Methods: A retrospective case series was conducted at Farhat Hached University Hospital, from 2006 to 2022, involving patients with confirmed postpartum septic osteoarthritis. Clinical data, laboratory findings, imaging results, treatments, and outcomes were analyzed

Results: The mean age of the seven patients was 31.4 years. All patients presented with joint pain, with fever and functional impairment where each was observed in 85.7% of cases. The average diagnostic delay was 17 days. MRI findings revealed bone marrow edema in all patients, Abscesses in 28.5% of cases, periarticular soft tissue edema, and intra-articular effusions in 71.4% of cases. The pubic symphysis was the most commonly affected site (57.1%), followed by the sacroiliac joints (28.6%). Only one pathogen, Streptococcus pyogenes, was isolated. Nearly all patients received dual antibiotic therapy for an average duration of 4 to 6 weeks. Satisfactory clinical progress without sequelae was noted and maintained after an average follow-up of 5 to 6 months.

Conclusion: Our results revealed that postpartum septic osteoarthritis requires prompt diagnosis and early treatment to prevent severe complications. MRI plays a critical role in early detection, while timely antibiotic therapy leads to favorable long-term outcomes

Type 1 Diabetes and Metabolic Syndrome: Exploring a Complex Relationship

Dhoha Ben Salah — 2024-12-01

Introduction: Metabolic syndrome (MS) is responsible for the increased cardiovascular risk in patients with type 2 diabetes. Few studies have focused on MS in type 1 diabetes mellitus (T1DM).

Aim: To describe the clinical, biochemical and therapeutic characteristics of T1DM patients affected by MS.

Methods: A retrospective study was carried out. It included 36 patients, suffering from T1DM and MS, hospitalized in the Endocrinology-Diabetology Department of the Hédi Chaker University Hospital of Sfax-Tunisia, from 1997 to 2020. MS was defined according to the NCEP-ATP III criteria.

Results: The mean age of the patients was 53 years. The mean duration of diabetes was 15 years. The MS appeared after a mean duration of diabetes of 13.7 years. Hypertension was reported in 21 patients (58.3%). The mean BMI was 26 kg/m². The mean total cholesterol level was 4.59 mmol/l ±1.18, and the mean triglycerides level was 1.67 mmol/l ±0.81. The mean HDL-cholesterol level was 0.96 mmol/l ±0.29. In the majority of cases (80%), MS was the combination of dyslipidemia, hypertension and diabetes. Therapeutically, the average dose of insulin used was 0.8 IU/kg/day. The combination of metformin was necessary in 18 cases (50%). Microvascular complications were present in all patients. The cardiovascular risk was very high in all patients.

Conclusion: The prevalence of MS during T1DM is increasing. It indicates an increased risk of micro and macrovascular complications.

Improving Septicemia Diagnostics: A Comparative Analysis of Direct and Post-Culture MALDI-TOF MS* Methods for Bacterial Identification

Fouad Assi — 2024-12-01

Introduction: Bloodstream infections are serious conditions requiring precise bacterial identification for effective treatment. Traditional culture-based methods, while reliable, are time-consuming. The direct identification method by MALDI-TOF MS promises rapid and accurate identification directly from positive blood cultures.

Aim: To evaluate and compare the direct MALDI-TOF MS identification method for positive blood culture samples with the post-culture MALDI-TOF MS method, which is currently recognized as the gold standard in bacteriological identification.

Methods: during the study period, 324 positive blood culture samples received at the Central Laboratory of Bacteriology, Serology, and Hygiene of the IBN SINA Hospital Center in Rabat were included in the study. Each sample was processed for microorganism identification by MALDI-TOF MS using both direct and post-culture methods.

Results: The direct identification method by MALDI-TOF MS showed a lower overall identification success rate (64.8%) compared to the post-culture method (100%). However, it allowed for bacterial identification in less than one hour without the need for a sub-culturing step, highlighting the technique’s potential to enhance the diagnostic process.

Conclusion: The direct identification method by MALDI-TOF MS has the potential to improve the speed of bacterial identification in positive blood cultures compared to the current gold standard of identification after culture. Despite its limitations, the direct method offers an opportunity to improve diagnosis and patient management, especially when combined with the standard method.

RS35705950 polymorphism of MUC5B Gene: Association with Rheumatoid Arthritis and Interstitial lung disease in Tunisian Population

Azza Saad — 2024-12-01

Introduction: Interstitial lung disease (ILD) is the most common extra-articular manifestation in rheumatoid arthritis (RA). Studies have concluded that there is an association between rs35705950 polymorphism of the MUC5B gene and RA-ILD.

Aim: To explore this polymorphism in a cohort of Tunisian patients suffering from RA with or without ILD and stufdy its association to ILD during RA.

Methods : A case-control study involving 61 patients followed for RA, 26 with ILD and 35 without pulmonary involvement and 62 healthy controls. This was an association study between genetic marker and RA-ILD by genotyping the rs35705950 polymorphism using PCR-RFLP.

Results: No association was found between rs35705950 polymorphism and RA. However, the comparison of RA-ILD patients with controls showed a significant association with the allele frequencies of rs35705950 polymorphism (p=0.008; OR=2.61; CI [1.2-5.66]). Indeed, the minor T allele increased the risk of developing ILD by 2.61 for RA patients compared to the controls. Comparison of allele frequencies in RA-ILD patients and RA patients without ILD showed a significant association between the minor T allele of the studied polymorphism and RA-ILD (p= 0.02; OR= 2.66; CI [1.09-6.5]). In the adjusted model, this risk increased in case of smoking (p=0.025; OR=3,84; CI [1,13-13,08]) and/or female gender (p=0.013; OR = 4,63; CI [1,33-16,17]).

Conclusion: Our work has confirmed the role of the polymorphism of MUC5B promoter in the appearance of ILD during RA in Tunisian patients. This variant could be used to early detect preclinical ILD in patients with RA.

Annexin A1 expression in Lupus Nephritis

Fatma Dhaffouli — 2024-12-01

Introduction: Lupus nephritis (LN) is an immune complex glomerulonephritis, caused by systemic lupus erythematosus. It is associated with an increase of morbidity and mortality. In LN, the immune responses dysregulation is one of the crucial pathogenic pathways. Annexin A1 (AnxA1), as an anti-inflammatory mediator, plays a critical role in immune responses, in addition to a variety of pathological processes.

Aim: This study aimed to evaluate the AnxA1 expression in renal tissues, in order to explore its potential role in LN pathogenesis.

Methods: AnxA1 expression was performed by immunohistochemistry staining in renal biopsies of 24 LN patients compared to 8 controls.

Results: LN patient’s biopsies showed an increased distribution of AnxA1 in glomeruli compared to controls (p=0.00019). When comparing AnxA1 expression in different LN classes, a high AnxA1 intensity score was positively correlated with glomerular proliferation.

Conclusion: Our data suggest AnxA1 as a useful marker to differentiate between severe proliferative and non severe proliferative classes of LN.

Full-Polyethylene Glenosphere Reverse Shoulder Arthroplasty: Functional outcomes and notching rate at mid-term follow-up

Hamdi Kaziz — 2024-12-01

Introduction-Aim: Full-polyethylene glenosphere reverse shoulder arthroplasty (FP-RSA) known commonly as inverted-bearing concept utilizes a polyethylene glenosphere and metallic humeral liner. The aim was to assess mid-term outcomes of FP-RSA focusing on the incidence of scapular notching.

Methods: A retrospective analysis of 24 consecutive primary FP-RSA performed between 2017 and 2020 was conducted. At a minimum follow-up of 2 years, cases underwent clinical evaluation using Constant score (CS), Subjective Shoulder Value (SSV), American Shoulder and Elbow Score (ASES), pain assessment, range of motion (ROM) and radiological findings evaluating baseplate position, implant stability, and scapular notching.

Results: At a mean follow-up of 3.2 ± 0.6 years, all clinical parameters showed significant improvement except external rotation (p < 0.05). Scapular notching rate was 20.83% all grade1 and 2. High glenoid position (p < 0.001) was significantly associated with scapular notching, which is correlated with lower CS (69 ± 16 vs. 51 ± 19; p = 0.049), SSV (80 ± 15vs. 67 ± 22; p = 0.026), ASES (85 ± 16 vs. 71 ± 21; p = 0.033), and anterior elevation (147◦ ± 24◦vs. 116◦ ± 38◦; p = 0.007). The use of a large glenosphere compared to small glenosphere was associated with better CS (79 ± 10vs. 65 ± 19; p = 0.006), external rotation (21 ± 11◦vs. 13 ± 9°; p = 0.036).

Conclusions: FP-RSA demonstrates favorable safety and efficacy at mid-term follow-up. Scapular notching, associated with high baseplate position, negatively impacts range of motion and clinical outcomes.

The (1,3)-β-D-glucan use for invasive candidiasis diagnosis in non-neutropenic critically ill patients: a prospective cohort study

Badis Tlili — 2024-12-01

Introduction Invasive candidiasis (IC) is a widespread infection in intensive care. As culture-based diagnostic techniques take several days before positivity and leaks of sensitivity. (1,3)-β-D-glucan (BDG) was proposed as a mycological criterion for IC diagnosis in selected patients.

Aim: To determine the performance of BDG assay in the early diagnosis of IC in non-neutropenic critically ill patients

Methods: We conducted a prospective evaluative study. All adults who were hospitalized in La Rabta Tertiary Hospital intensive care unit from January to June 2023 and at risk of IC were screened on a weekly basis. A true positive status corresponded to confirmed or highly probable IC and a positive BDG test (>80 pg/mL).

Results: A total of 123 BDG tests were performed on 85 patients with a median age of 58 years [41.5-67.5] and a median SOFA score=3 [2-5.5]. The median colonization index was 0.16 [0-0.33], and Candida albicans was the most common species isolated (71%). The median Candida score was 0.9 [0-2.9]. IC was retained in 30 cases. The median BDG level was 98 pg/mL [24-275]. Sixty-one patients had a positive BDG test, in whom only 21 had an IC. The performance of the BDG test in the diagnosis of IC was moderate (AUC/ROC=0.68 [0.575-0.788], p=0.003). The discriminatory power was better with the negative prediction (PNV=85.5%).

Conclusion: The major benefit of BDG test in intensive care seems to lie in its NPV allowing to roll out the invasive candidiasis diagnosis then withhold or interrupt antifungal therapy.

Evaluation of pediatric cochlear implantation results

Rachida Bouatay — 2024-12-01

Background: Cochlear implantation is an effective method of auditory rehabilitation. Nevertheless, the results show individual variations depending on several factors.

Aim: To evaluate cochlear implantation results based on the APCEI profile (Acceptance, Perception, Comprehension, Oral Expression and Intelligibility) and audiometric results.

Methods: This was a cross-sectional study including children under 18 years of age who had a unilateral cochlear implant and whose implants had been activated at least 1 year prior to the start of the study. During this study period, 75 children underwent unilateral cochlear implantation. Among them, 44 patients had reached one year after the activation of the implant at the time of the evaluation and were then included in the analytical part. A speech-language pathology assessment using the APCEI scale was conducted for 44 cases. Thirty-eight cases had an audiometric assessment (free-field tone audiometry and speech audiometry). We assessed the results of the APCEI profile based on various factors.

Results: The mean cochlear implantation age was 5 years and 2 months. The electrode insertion was complete in all cases. The APCEI profile average was 3.6. Four children had poor results, 27 children had good results, and 13 children had excellent results. The average hearing threshold in tonal audiometry was 39dB. In voice audiometry, the average intelligibility threshold was 65% with the cochlear implant versus 75% with the cochlear implant and the contra lateral hearing aid. According to the statistical study, only two factors were considered to have a positive influence ..(abstract truncated at 250 words)

Postoperative radiotherapy in the management of vulvar cancer

Souha Massoudi — 2024-12-01

background: Vulvar cancer is a rare tumor whose prognosis depends on early treatment.

Aim: The study aimed to evaluate the role of adjuvant radiotherapy (RT) in the treatment of vulvar cancer and to identify the prognostic factors influencing the tumor evolution.

Methods: descriptive and analytical study included 38 patients treated by adjuvant RT, during the period from 1995 to 2020, for vulvar cancer in the oncological radiotherapy department of Farhat Hached University Hospital in Sousse.

Results: All patients underwent adjuvant RT. After a median follow-up of 55 months, 24 patients are in complete remission (63.2%). We noted local and regional recurrences in 23.7% and 13.2% of cases. Two patients had distant bone progression. Overall survival (OS) was 72% at five years and 51% at ten years. The 5-year local (SSRL) and regional (SSRR) recurrence-free survival was 76% and 87%, respectively. In univariate analysis, the factors associated with OS were the size of the tumor (p=0.02), the quality of excision (p=0.000) and age (p=0.04). The quality of excision (p = 0.001) and inguinal dissection (p = 0.05) was associated with SSRL. In addition, those influencing the SSRR were lymph node invasion and the quality of excision.

Conclusion: vulvar cancer requires early diagnosis in order to consider less invasive treatment with advances in RT techniques.

Predictive factors for severe epistaxis in a tertiary center of Tunisia

Malika EL Omri — 2024-12-01

Introduction: Epistaxis is a prevalent clinical condition that can be associated with significant morbidity and places a considerable burden on the healthcare system.

Aim: To ascertain the prevalence of epistaxis in our center and to identify the predictive factors of severity.

Methods: This is a retrospective cross-sectional analytical study of patients who presented to and/or were admitted for epistaxis at our department of Ear, Nose and Throat (ENT) during the period from January 2015 to December 2022.

Results: A total of 720 patients were included out of a total of 100,378 consultations, resulting in a prevalence of 0.7%. The mean age of the patients was 51.6 years (±18,73 Standard Deviation (SD)) and the sex ratio H/F was 1.43. The majority (87.9%) of cases were benign and treated on an outpatient basis, while 12.1% of patients presented with severe epistaxis and required hospitalization. The median duration of hospitalization was 5 days. The outcome was favourable in 99.4% of cases. Nevertheless, two cases of death due to severe epistaxis complicated by hemorrhagic shock were observed. A multivariate analysis identified several independent factors associated with severe epistaxis. These included male gender, recurrent epistaxis, a history of hematological disorders, the use of anticoagulant therapy, and an increased International Normalized Ratio (INR) level.

Conclusion: These results have made a significant contribution to our understanding of the severity factors associated with epistaxis, enabling a more targeted and personalized approach to prevention and treatment.

Assessment of the correlation between the Vittel criteria and the ISS score: A novel approach to pre-hospital severe trauma patient’s triage

Sondes Laajimi — 2024-12-01

Introduction-Aim: Validated triage tools such as the Vittel criteria are essential to improve the care of trauma patients. The aim of this study was to evaluate the correlation between the Vittel triage criteria and the Injury Severity Score (ISS) to improve the accuracy of pre-hospital triage.

Methods: We conducted a longitudinal study of all trauma patients transported by EMS over a two-year period (November 2021- November 2023). Vittel and (ISS) scores were calculated on admission. Predictive Vittel criteria were defined by independent risk factors for ISS>15 using a multiple logistic regression model with p-value < 0.05 and/or sensitivity (se) >50%, with positive Youden index (Yi).

Results: A total of 461 trauma patients were transported by EMS during the study period were included. The sex ratio was 5.3 and road traffic accidents accounted for 77.2%. An ISS>15 was found in 41% of participants, 25% required ICU admission and 23.9% died within 30 days. Using the above selection criteria, we identified seven key predictive criteria (OR CI 95%, se%, Yi) Glasgow coma scale<13(3.16 [1.91 5.24],44,0.25); fall>6 m(4.031[1.61-10.08],10,0.07); severe burn(23.89[10.21-55.93],6,0.02); Pelvic fracture (4.93 [1.19-20.32], 28, 0.25),suspected spinal cord injury(6.89 [2.79-16.96], 6, 0.05); Fluid resuscitation>1000 ml(-, 60.0. 11); Catecholamine (2.02 [1.09-3.75],51.0.27). Physiological variables (se 30%, Yi 0.16) and pre-hospital resuscitation(se 46%, Yi 0.18) were among the most relevant categories for predicting severity, similar to the full Vittel score.

Conclusion: Seven criteria were associated with severe trauma (ISS score >15). Physiological variables and pre-hospital resuscitation were significant categories that ...(abstract truncated at 250 words).

Survival rate after osteoporotic proximal femur fractures

Saoussen Zrour — 2024-12-01

Objectives : To evaluate survival after osteoporotic fractures of the upper femur and determine its associated factors.

Methods : Cross-sectional study of patients hospitalized for fractures of the upper end of the femur during 2020 at Monastir University Hospital. Outcome was determined up to 2 years. The Kaplan-Meier curve is used for survival analysis.

Results : Eighty one patients with mean age of 77.46 ± 17,36 years and a sex ratio of 0.61 were evaluated. The femoral neck fracture was observed in54% of cases. Overall survival was 84.6% at 6 months, 75.4% at 1 year and 63.4% at 2 years. Median survival was 30 months. Patients older than 75 years had a shorter survival (68% versus 83% at one year and 55% versus 72% at 2 years ; p < 10^-3).

Conclusion : The osteoporotic fracture of the upper femur is serious due to its severe outcome. One-year mortality was aboutt 25%. Increased mortality was associated to elderly population.

Urinary Cytology: The DxU-850 Iris automaton versus Microscopic Examination

Hasnae Lekfif — 2024-12-01

Introduction: The use of urine cytobacteriological examination is a common and essential practice in medicine which helps guide therapeutic management in case of urinary tract infection. The cytological examination of urine samples can be done using the manual (microscopic) or automated technique. The automated approach, which involves the use of artificial intelligence, is faster, more reliable, and more efficient for laboratories.

Aim: This work aims to evaluate the performance of the DxU-850 Iris automate by comparing it to the microscopic method.

Methods: Using a four-month prospective study from May to August 2023, we analyzed urine samples received during this period by the Microbiology laboratory of Mohammed VI University Hospital in Oujda. Strict quality standards were respected when obtaining the results. Several elements were analyzed, and various parameters calculated to evaluate the performance of this automaton.

Results: The present study investigated 1000 CBEU samples, mainly from outpatient clinics (46.34%) and emergency departments (21.72%). Most patients were males (50.58%) and asymptomatic (72.9%). The samples’ culture showed varied results: concordance between the results of automaton and microscopic count was satisfactory except for crystals and yeasts in turbid samples.

Conclusion: Automation has advantages like speed, traceability, error reduction, and time optimization. The results reveal a satisfactory concordance between the two methods despite discordances occurring mainly with crystals and yeasts, especially in turbid urine samples. The DxU-850 Iris automaton is an effective way to screen for urinary tract infections. We recommend that automated and manual techniques be considered complementary.

Tobacco, alcohol and drugs use among high school students

Hamida Kwas — 2024-12-01

Introduction: Information on the use of tobacco and other illicit substances by young people is an essential element for the implementation of appropriate preventive measures.

Aim: To estimate the prevalence of smoking, alcohol and drug use among high school students in the city of Gabes.

Methods: Cross-sectional survey carried out in 2022 in 5 schools in the city of Gabes, southern Tunisia, by a self-administered questionnaire.

Results : We included a total of 507 students (47% male) with an average age of 15.6 years. The overall smoking prevalence was 22.1%. The respondents were daily smokers in 22.1% of cases with an average consumption of 10 cigarettes/day in 62.5% of cases. The age of onset of smoking was less than 10 years in 31.2% of cases. The prevalence of electronic cigarette use was 12%. The prevalence of chewing tobacco consumption (Neffa) was 9.1%. Seventy-four of the respondents (14.6%) used hookah. The prevalence of alcohol consumption was 5.9%. Twenty-four students (4.7%) used drugs: cannabis (87.5%) and psychotropic drugs without a medical prescription (12.5%).

Conclusion: The prevalence of smoking among high school students in the city of Gabes was high. This behavior was associated with the consumption of alcohol and psychoactive substances. These results should be used to set up primary prevention programs for young people in order to minimize the scourge of tobacco and psychoactive substance use in schools.

Foreign body ingestion in children: Clinical features and complications

Ines Trabelsi — 2024-12-01

Introduction : The ingestion of foreign body (FB) is a common problem in paediatrics. Children are curious by nature and tend to explore environment by inserting objects into their mouths.

Aim: To update our epidemiological and clinical data and adapt clinical management in order to limit morbidity associated with this fairly frequent accidental pathology.

Methods: Retrospective descriptive study including children aged less than 15 years, hospitalized in the Children's Medicine Department B of the Tunis Children's Hospital from 1 January 2016 to 31 December 2021 having ingested a FB.

Results : Forty-four children were included and admitted for foreign body ingestion, with a sex ratio of 1.4. The mean age was 4 years 4 months. Most children were asymptomatic on admission. In the others, digestive forms predominated (n=19). The average consultation time was 10.8 hours. The FBs were mainly foams and corrosives (75%), represented by batteries in 52% of cases and coins in 22% of cases. Thoraco-abdominal X-rays carried out on all patients revealed a radio-opaque foreign body in 95% of cases. The most frequent location was the colon (n=17). Endoscopy was chosen in 14 patients and was extractive in five. The mean time from admission to endoscopic extraction was 10.6 hours. The mean time to expulsion by natural route was 49 hours. Complications were noted in two patients: ulceration of the oesophageal mucosa and dyspnoea following rigid endoscopy in one case.

Conclusion : This study has shown that the ingestion of foreign body ...( abstract truncated at 250 words)