Tunisian Hospital Research Articles

High genotypic diversity of Rhinoviruses obtained from Tunisian children with severe acute respiratory infection.

Rhinoviruses (HRV) are among the leading causes of Severe Acute Respiratory Infection (SARI). Their burden and genetic diversity vary from one region to another and little is known in Northern African regions. This study describes epidemiological patterns and genotypic diversity of HRV in SARI cases during a two and half year's study, in Northern Tunisia. A total of 271 SARI cases, admitted into the Pediatric Intensive Care Unit of Bechir Hamza Children's Hospital in Tunis, were collected between September 2015 and December 2017. The investigation concerned 104 samples positive for HRV and/or HEV (Human Enterovirus) obtained among these cases. Specific HRV and HEV detections were assessed by real-time PCRs. The HRV molecular typing was based on the VP4-VP2 genomic region analyses. Among the viral SARI cases, 33.5% and 12.3% were positive for HRV and HEV respectively. Molecular investigations showed high prevalence of HRV-A (63.3%) followed by HRV-C (30.6%) and HRV-B (6.1%) and high genotypic diversity with 27 types. HRV cases were mostly detected in toddlers younger than 6 months. A total of 16 cases (28%) were found with bacterial and/or viral co-infection. HRV-C infection and HRV-A with bacterial co-infection were associated with complicated infection. Some of the detected types showed a continuous circulation or turnover during an extended period. HRV-A101 and HRV-C45 were the most frequently detected types. This study revealed, for the first time, the high HRV diversity in Tunisia, a North-African region. Specific phylogenetic investigations may help to evaluate their diversity and to trace their spread and epidemiological origin.

MO707MICROBIOLOGY, CLINICAL SPECTRUM AND OUTCOME OF INFECTIOUS PERITONITIS IN PATIENTS ON AUTOMATED PERITONEAL DIALYSIS

Abstract Background and Aims Automated peritoneal dialysis (APD) is a renal replacement therapy that offers patients various advantages such autonomy and comfort. Peritoneal dialysis-related infectious peritonitis (IP) is the most common and severe complication of APD. It is the main cause of technique failure and transfer to hemodialysis and can even be life-threatening. Given the seriousness of this complication, it is necessary to establish preventive strategies and adapt the therapeutic management.The aim of this study was to determine the microbiological and clinical profile of IP, to specify its causes its rate and outcome in patients treated by DPA at the unit of Charles Nicolle hospital in Tunis between January 2000 and December 2018. Method We conducted a single-center descriptive retrospective study in the peritoneal dialysis (PD) unit of Charles Nicolle Hospital in Tunis. We identified the episodes of IP occurring in patients treated with APD during the period from January 2000 to December 2018. We studied the clinical, biological and evolutionary aspects of IP. Results APD was used in 85% of patients treated at our PD unit during the study period. 322 episodes of IP occurred in 183 patients, that was an IP rate of 0.1 episodes/patient-year. 58% of patients treated with DPA have not presented IP. The mean age of the patients who presented PI was 43 years +/- 15(Extreme: 17-77) with a sex-ratio of 1.23. 74% of patients had a professional activity. 98% of patients had co-morbidities dominated by hypertension (88%), dyslipidemia(73%) and diabetes(16%) with a median Charlson score of 2[2-3] (Extremes: 2-9). Their average Body Mass Index was 24kg/m2+/-5. 33% of the patients were smokers. The average training duration before starting APD was 13days+/-5. The IP were evenly distributed according to seasons (27% occurred in autumn, 26% in spring, 25% in summer and 22% in winter). IP were: a 1st episode in 55% of cases, a new episode in 30% of cases, a relapse in 10% of cases, a recidivism in 3% of cases and a recurrence in 2% of cases. Fever was present in 34% of patients, abdominal pain in 75% of them. The dialysate was cloudy in 98% of cases. The median number of leukocytes in the PD fluid was 380/mm3(Range: 15-8000)with a mean% of neutrophils of 73%+/- 27. Dialysate culture was positive in 60% of cases, negative in 38% of cases and contaminated in 2% of cases. Among the positive cultures, only one was fungal (Candida albicans). Bacterial IP were distributed as follows: 64% Cocci Gram+ dominated by Staphylococcus aureus (48%), 34% Bacillus Gram- (mainly Klebsiella pneumoniae (21%) and Pseudomonas (21%)), 2 cases of Bacillus Gram+ (Corynebacterium afermentans and Lactobacillus) and 2 cases of polymicrobial culture (Cocci Gram+ and Bacillus Gram-).IP was of unknown cause in 48% of cases, related to an asepsis lack in 19% of cases, the orifice infection in 18% of cases and tunnelitis in 2% of cases. The other causes were essentially endogenous. Probabilistic antibiotic therapy was effective in 34% of cases. An adaptation according to the microbiological results was carried out in 19% of cases. Hospitalization was required in 10% of patients. 20% of peritonitis was refractory. Catheter ablation was performed in 14% of patients.IP caused the death of 8 patients and represented 37% of the causes of transfer to hemodialysis. Conclusion IPs are a turning point for the survival of the patient and the technique. Knowing the microbiological profile of these infections will make therapeutic interventions precocious and effective in order to preserve the prognosis of patients in APD at the short and long term.

MO715PROFILE OF INFECTIVE ENDOCARDITIS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Infectious complications are the second leading cause of death in hemodialysis patients. This population is particularly exposed to bacteremia, on the one hand, because of the vascular access necessary for hemodialysis, which is a gateway to the various micro-organisms, and on the other hand, factors of susceptibility to infections. Infective endocarditis (IE) is the cardiac endothelium infection associated with bacteremia. It is a rare complication but its mortality remains high especially in patients on chronic hemodialysis. The aim of this study was to determine the microbiological profile, clinical and-biological profile, characteristics in the ultrasound, therapeutic modalities, and prognosis of IE in hemodialysis. Method This is a retrospective descriptive study of including chronic hemodialysis patients, admitted in the Nephrology and Internal Medicine Department A of the Charles Nicolle Hospital in Tunis for an IE during the period from 1973 to 2018. We used the modified Duke criteria to confirm the diagnosis of IE. Results Nineteen patients were included, including 12 men and 7 women (gender ratio=1.7). The average age was 49.1 years [29-66 years]. Seven of them (37%) were known to have a valvular disease, two of them had a double mitro-aortic valve replacement. Six of them (32%) were diabetic and two patients (11%) were on immunosuppressive therapy. The vascular access initially used for HD were arteriovenous fistula in 9 cases (47%), internal jugular catheter in 3 cases (16%), subclavian catheter in 1 case (5%), Canaud catheter in 3 cases (16%), and 2 patients were dialyzed by femoral catheter (11%). Clinically, all patients had an altered general condition, fever was present in 14 cases (74%) and a heart murmur in 10 cases (53%). Blood cultures were positive in 14 cases (74%). The isolated germs were Staphylococcus Aureus in 8 cases, Staphylococcus epidermidis in 4 cases, Pseudomonas aerogenosa in 3 cases, Enterobacterium in 1 case, enterococcus faecalis in 1 case, and Klebsielle oxytoca in one patient. On cardiac ultrasound, mitral valve damage was found in 10 patients, aortic sigmoid in 4 patients and tricuspid valve in 3 patients. The treatment included appropriate antibiotic therapy in all cases and a valvuloplasty was indicated in 7 patients. Nine patients (47%) died during their hospitalization. Conclusion Hemodialysis patients are particularly exposed to IE. The most appropriate preventive method is the strict observance of asepsis when handling the vascular access first and the rapid eradication of all infectious outbreaks.

A machine learning framework for predicting long-term graft survival after kidney transplantation

Kidney transplantation (KT) is an optimal treatment for end-stage renal disease (ESRD). Currently, short-term KT outcomes are indeed excellent, but long-term successful outcomes are still difficult to achieve, and improving them is crucial for kidney recipients. An early and accurate prediction of long-term graft survival helps healthcare practitioners to create a more personalized treatment plans for patients and facilitates the performance of clinical trials. In this study, we propose a machine learning framework to early predict graft survival after five years of KT and determine the most influential parameters that affect the survival. Our dataset was collected from Charles Nicolle Hospital in Tunis in Tunisia and it included pre, peri, post KT aspects. We utilized four machine learning algorithms to select the most important features: the least absolute shrinkage and selection operator logistic regression (Lasso-LR), Random Forrest (RF), Decision Tree (DT), and Chi-square (Chi-sq). We utilized three Scikit-learn functions to implement those algorithms: SelectFromModel (SFM), Recursive Feature Elimination (RFE), and SelectKBest (SKB). Five algorithms were utilized to builds prediction models based on the data groups resulted from the feature selection step: logistic regression (LR), k-nearest neighbors (KNN), extreme gradient boosting (XGB), and artificial neural network (ANN). We evaluated the models using five performance measures: accuracy, sensitivity, specificity, F1 measure, and area under the curve (AUC). XGBoost resulted the best model with the highest AUC (89.7%). It was based ten features selected by RF algorithm and SFM function. The accuracy, sensitivity, specificity, and F1 of the best model were 91.5%, 91.9%, 87.5%, and 89.6%, respectively. This study proposes a novel approach for investigating long-term allograft survival while considering the complex relationship between all KT aspects and long-term outcomes. Our framework can be used as a decision support system for Nephrologists to early detect graft status, which helps in developing safer recommendations for kidney patients and consequently obtaining positive KT outcomes and mitigating the risks of graft failure.

Statut nutritionnel des personnes âgées hémodialysées en Tunisie

IntroductionThe nutritional status of old hemodialysis patients determines their prognosis. The aim of this study was to evaluate the spontaneous dietary intake of hemodialysis of elderly patients. MethodsThis cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle hospital in Tunis. All patients went through a clinical examination to specify anthropometric measurements and a dietary survey based on food registration for 3 consecutive days to obtain a nutritional assessment. ResultsThe evaluation of patients’ energy intake showed an average daily intake of 25.3±12.3kcal/kg of ideal weight/day. The average total energy intake of patients on dialysis and non-dialysis days was 29.7±17.7kcal/kg and 20.9±6.9kcal/kg, respectively, with a statistically significant difference (P=0.001). The average daily protein intake was 0.99±0.57g/kg on the day of no dialysis. It decreased statistically significantly (P=0.005) on the day of no dialysis at 0.73±0.28g/kg. Phosphorus consumption was excessive on dialysis and non-dialysis days respectively in 20% and 3% of cases. Deficiency of calcium intake affected the entire population studied on the day of non-dialysis. Only 6% of patients had a calcium intake satisfactory on the day of dialysis. ConclusionA lot of dietary errors were noticed in our study. The assessment of nutritional intake in elderly people with hemodialysis should be part of their management systematically.

Monocentric study of 28 cases of chronic inflammatory demyelinating polyneuropathy: first Tunisian study

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare affection of the peripheral nervous system. Its diagnostic criteria have evolved since 1975. The aim of our work is to study the epidemiological, clinical, and paraclinical aspects of CIDP. We conducted a retrospective study of 28 CIDP patients of the neurology department of the military hospital of Tunis between January 2000 and December 2017. All these patients met the European Federation of Neurological Societies/Peripheral Nerve Society(EFNS/PNS)2010 diagnostic criteria for definite CIDP. The average age was 50years with a gender ratio of 1.57. We found sensitivomotor symptoms in 66% of patients. Neurological assessment showed a proximal and distal motor weakness in 50% of cases, the involvement of superficial and deep sensory systems in 44% of patients with a generalized areflexia in all patients. Median Inflammatory Neuropthy Cause and Treatment (INCAT) score was 7. Concerning electrophysiology, all our patients met the EFNS/EPS 2010 diagnostic criteria for a definite CIDP. Screening for concurrent pathologies was positive in 11 patients. On the therapeutic side, there was no superiority of intravenous immunoglobin compared with pulsed methylprednisolone. Oral steroids were used as backup in about 50% of patients. There were good outcomes in 72% of patients who improved very well after treatment. CIDP is a rare and polymorphic disorder with a variety of concurrent pathologies. Our study is the first study in Tunisia and in Maghreb countries which included the most big series of patients. Our results were similar to literature. A multicentral study would be better profitable.

POS-640 FUNGAL PERITONITIS IN AUTOMATED PERITONEAL DIALYSIS : AN 18-YEAR SINGLE CENTRE EVALUATION

Infectious peritonitis is the most serious complication of peritoneal dialysis (PD). Its origin is often bacterial. Fungal peritonitis (FP) is rare but always devastating, accounting for high rates of technique failure, morbidity and mortality. It is therefore important to know its microbiological and clinical profile and its evolution in order to establish preventive and therapeutic strategies. The aim of our study is to determine the FP frequency and to describe its clinical, microbiological and therapeutic aspects in patients treated with automated peritoneal dialysis (APD), APD being the most frequent PD modality in our centre. This was a single-centre retrospective study carried out in the PD unit of Charles Nicolle Hospital in Tunis from January 01, 2000 to December 31, 2018, on patients treated with APD and having presented at least one fungal peritonitis. Clinical, biochemical characteristics and detailed data on peritonitis episodes were recorded. Six cases of FP were identified, ie 3% of all infectious peritonitis that occurred during the study period. The patients' sex ratio was 2. Their mean Charlson score at onset of APD was 3 [Extremes: 2-6]. Only one patient was diabetic. Their mean age at the time of peritonitis was 40 +/- 16 years. Candida albicans was the most frequently (50%) detected yeast followed by candida non albicans (2 patients). Aspergillus has been isolated in one patient. This group experienced an average of 2 bacterial peritonitis before FP. All FP were preceded by bacterial peritonitis: In five patients, they were diagnosed following refractory peritonitis mainly due to Enterobacteria (4 patients). In one case, the patient had a history of three episodes of bacterial peritonitis, FP presented as a new episode of infectious peritonitis occurring 5 months after the third peritonitis. All Candida peritonitis were treated with intravenous fluconazole for an average of 13 days. Aspergillary peritonitis was treated with amphotericin B for 15 days. The PD catheter was removed in all cases. Four patients were transferred to hemodialysis. APD was retried in the other two patients. They were switched to hemodialysis after 1 and 7 months, respectively, of placement of the second PD catheter for loss of ultrafiltration and catheter dysfunction. FP are certainly rare, but they are an ineluctable cause of PD failure.

POS-009 PREVALENCE AND ETIOLOGIES OF ACUTE KIDNEY INJURY IN ELDERLY

Acute renal failure in the elderly is a common phenomenon. It is favored by functional modifications of the kidney and the repercussions of many chronic diseases such as diabetes, hypertension or obstructive urological pathologies which incidence increases with age. The aim of our work was to study the epidemiological and clinical characteristics, to specify the etiological circumstances and the different therapeutic and evolutionary modalities of AKI in the elderly. It was a retrospective descriptive study conducted on 70 AKI files identified in the Nephrology department of Charles Nicolle Hospital in Tunis among 380 patients hospitalized over a period of one year. The incidence of AKI in the elderly was 44.8%. It was classified AKIN 1, 2 and 3 in 25%, 25.6% and 49.4% of cases, respectively. The average age was 75 years. The sex ratio was 1.12. The pathological history was dominated by cardiovascular pathology. High blood pressure and diabetes were noted in 56% and 32% of the cases, respectively. Patients were hospitalized through the emergency room in 47.1% of the cases or outpatient in 14.3% of the cases. The discovery of AKI was systematic in the face of an increase in serum creatinine and / or urea numbers in 60% of cases. Signs of acute uremia and changes in diuresis revealed ARI in 57.1% and 30% of the cases, respectively. The mean creatinine level was 515 μmol / l. Hypokalemia and hyperkalemia were observed in 14.4% and 21.4% respectively. AKI was organic in 42.8% of the cases, functional in 31.8% of the cases and related to an obstacle in 24.8% of the cases. Correction of hydroelectrolytic disorders was performed in 61.4% of our patients. Diuretics were used in 17.4% of patients. Hemodialysis was performed only in 18% of our patients. It was performed prophylactically in 7 cases and in an emergency context in 6 cases. In the latter case, the indication for hemodialysis was primarily hyperkalemia and / or metabolic acidosis. The average hospital stay was 19 days. The evolution was favorable in 64.2% of the cases, unfavorable in 35.8% of the cases with a passage to chronicity in 32.6% and a death in 12.8% of the cases. In the elderly, acute renal failure is a common morbid event. The structural and functional alterations of the nephron and the increase in the incidence of certain pathologies expose these patients to nephrotoxic accidents. Hence the interest of preventive measures of this AKI and especially the importance of an early diagnosis based on new biomarkers of AKI, in order to establish the most suitable therapeutic means.

Tokophobia or post-traumatic stress disorder ? about a tunisian case

IntroductionPregnancy and delivery are considered to be an important transition stage in a woman’s life. Although this experience is emotionally rich, it varies from one person to another and each woman goes through it in her own way.Objectivesdiscuss the psychiatric outcomes after a childbirth with somatic complications.Methodscase reportResultsMrs X is a 32 years old woman, she has no particular history of illness until she gave birth to her son. He is now three and a half years old and he is an outpatient at the child and teen psychiatry department in a Tunisian hospital. After her delivery, Mrs X had several physical and psychological complications. She was hospitalized in the cardiology department for cardiomyopathy of Meadows for three weeks among it one week in the medical reanimation ward because she needed respiratory assistance. Furthermore, she suffered of left femoral head’s necrosis for which she was operated, and a total hip prosthesis replacement was done. Psychologically, Mrs X. presented a postpartum depression which resolved in its own after 9 months. Ever Since the childbirth, the patient presents symptoms concording with post-traumatic stress disorder and symptoms that may be linked to a specific phobia (fear of birthchild or tokophobia).ConclusionsIn addition to the usual health care provided to women during pregnancy and after childbirth, looking for mental health disturbances and eventually referring them for psychiatric assessment is important specially for women who have experienced traumatic events during the pregnancy or the deliveryConflict of interestNo significant relationships.

La gestion de la douleur chez les patients atteints du cancer dans un hôpital tunisien

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30% of cases but under treatment. Relief opioids were prescribed in 43% of cases to relieve pain. Paracetamol was prescribed in 26% of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62% consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

Clinical and laboratory features of brucellosis in a university hospital in Tunisia

Aim of the studyThe increase in the number of brucellosis cases between 2014 and 2017 (14 and 90 cases respectively) led us to study the biological and clinical-epidemiologic characteristics patients hospitalized in Rabta hospital of Tunis. Material and methodsThis retrospective study was conducted in Rabta Hospital in Tunis between 2016 and 2017. It includes 131 patients who had a positive bacteriological diagnosis of Brucella between 2016 and 2017. Diagnosis of brucellosis was made in blood culture by using Bactalert (Biomerieux®). Identification of Brucella was realized by Gram staining, catalase, oxydase. Serological diagnosis was made by testing sera for brucellosis agglutinins with Rose Bengale and the standard agglutination test. The collected data were analyzed by SPSS softcare version 24. ResultsThe prevalence of Brucellosis in Rabta hospital increases from 14 cases in 2014 to 90 cases in 2017. The mean age was 45 years and ages range from 16 to 84 years. Rural origin was found in 75 cases (68%). Ninety-seven patients (89%) were hospitalized in the infectious diseases department. The average length of hospitalization was 17.25 days. Fifty-seven patients (52%) had a history of consuming unpasteurized dairy products and 45 (41%) were farmers. Fever was the predominant symptom in 104 cases (95%). Osteoarticular involvement is the most common complication of brucellosis and it occurred in 28% of patients. Blood cultures were 73 cases and 42 (57%) were positive for Brucella spp. Rose Bengale was positive in 100% of cases. High titles of the standard agglutination test (superior to 1/1280) were noted in 24 cases (22%). ConclusionBrucellosis is still endemic In Tunisia. Contact with domestic animals and consumption of raw milk and milk products seems to be the major mode of transmission. Control of animal infection by vaccination, occupational and personal hygiene, farm sanitation and preventive measures can reduce disease incidence.

Sensitivity of Awaji Criteria and Revised El Escorial Criteria in the Diagnosis of Amyotrophic Lateral Sclerosis (ALS) at First Visit in a Tunisian Cohort.

Background Amyotrophic lateral sclerosis (ALS) is a fatal disease whose diagnosis and early management can improve survival. The most used diagnostic criteria are the revised El Escorial criteria (rEEC) and Awaji criteria (AC). The comparison of their sensitivities showed contradictory results. Our study aimed to compare the sensitivities of these two criteria in the diagnosis of definite ALS, at first visit, in a Tunisian hospital cohort. Materials and Methods This was a retrospective study including 173 patients diagnosed with ALS at the Department of Neurology of the Razi Hospital between January 2003 and April 2018.After studying the clinical features of the disease in our study population,each patient was categorized according to the rEEC and AC based on data collected in his medical record during his first visit to our department. Then, we compared the sensitivities of these two criteria in the diagnosis of definite ALS. Results Our Tunisian cohort was characterized by a slower disease progression. The sensitivity of the AC (69.4%) was significantly higher than that of the rEEC (40.5%) (p < 0.001). When the clinical signs evolved for less than 6 months, the sensitivities were 61% for AC and 12% for rEEC (p < 0.001). After 24 months of disease progression, the sensitivities were 78.2% for AC and 69.1% for rEEC (p = 0.063). It was impossible to categorize seventeen patients by the two criteria. Conclusion Our study demonstrated that patients in AC are more sensitive than rEEC in the early diagnosis of ALS in our Tunisian cohort. However, this superiority is gradually reduced during the evolution of the disease.

Hospitalizations in psychiatry during the month of Ramadan: A study at the Tunisian mental health hospital.

Muslims fast each year during the Holy Month of Ramadan. This rite has major socio-cultural consequences. The circadian rhythms, energy expenditure, body temperature and biological clock are also influenced by Ramadan fasting. The impact of fasting on patients with mental disorders has been little studied. The aim of this study was to assess the number of hospitalizations in psychiatry during Ramadan compared to the other months of the lunar year. A cross-sectional and retrospective study was conducted at Razi hospital, the psychiatric hospital in Tunis. The following data over the five lunar years (1434-1438) was checked for: The monthly and the annual number of hospitalizations in the different departments of Razi mental health hospital in Tunis as well as the monthly and annual rates of different legal modalities of admissions. An important decrease in the number of hospitalizations during Ramadan was observed each year followed by a constant increase during the following month.Ramadan was the only lunar month to have had a consistently below-average number of admissions. There has been a significant increase in the mean number of hospitalizations per month over the years. A general trend towards an increase in the proportion of enforced hospitalizations has been noted. Ramadan stands out not only on a religious but also on a social level. Our results add support to the usefulness of research on mental health and Ramadan in the psychiatric community.

Correlations between Gatectin 3 and clinical echocardiographic parameters during ST elevation myocardial infarction

The circulating Galectin 3 (Gal-3) emerged as a new biomarker involved in fibrosis and left ventricular remodeling. The aim of our study was to investigate correlations of Gal-3 levels with cardiac function and remodeling parameters evaluated by echocardiography, and with clinical, biological and angiographic parameters in patients hospitalized for ST elevation myocardial infarction (STEMI). We conducted a prospective longitudinal study, including consecutive patients hospitalized for STEMI at the Cardiology Department of the Charles Nicolle Hospital in Tunis. A Gal-3 assay and an echocardiography were performed at four times: admission (T0), one month (T1), three months (T2), and six months (T3). Our study collected 45 patients aged 58 + 12 years. The sex ratio was 10, 2. We found a significant correlation between Gal-3 assayed at T0 with age ( r = 0.311; P = 0.037), ALAT ( r = 0.4; P = 0.009) and CPK ( r = 0.384; P = 0.019); and between Gal-3 assayed at T3 and the infarction localization ( P = 0.007). At one month, Gal-3 correlated with the left ventricular ejection fraction ( r = 0.308; P = 0.042), left ventricular end-diastolic volume index (LVEDVi) ( r = 0.324; P = 0.032), and left ventricular end-systolic volume index (LVESVi) ( r = 0.378; P = 0.012). In addition, it had a predictive value on evolution. In fact, Gal-3 assayed at T1 was found to be significantly correlated with LVEDVi measured at T2 ( r = 0.312; P = 0.039) and with left ventricular end-diastolic diameter index (LVEDDi) measured at T2 ( r = 0.372; P = 0.014) and at T3 ( r = 0. 372; P = 0.032). Gal-3 correlates with remodeling parameters and cardiac function, and predicts structural changes when measured at one month of the acute episode of STEMI. Gal-3 can contribute to tissue repair, but excessive activation of its repair mechanisms may became harmful at a distance from the acute phase, it could then be a prognostic marker and a therapeutic target.

Forensic evaluation of initial medical certificates within health facilities in Northern Tunisia

Le certificat médical initial est un document médico-légal descriptif dont finalité est de prouver l´existence du dommage et de permettre à la victime d´obtenir ce que de droit. L´objectif de notre étude était d'étudier le contenu et d'évaluer la qualité de rédaction des certificats médicaux initiaux. Il s´agissait d´une étude rétrospective et descriptive sur une période de 18 mois allant de janvier 2015 à juin 2016. Nous avons colligé 450 certificats médicaux initiaux parvenus au service de médecine légale du centre hospitalier universitaire de Charles Nicolle à Tunis. La qualité des certificats médicaux initiaux a été évaluée grâce à un canevas qui a permis de leur attribuer une note sur 30. Les certificats médicaux initiaux évalués étaient majoritairement moyens. Les scores obtenus à partir du canevas que nous avons élaboré oscillaient entre 9,5 et 27,5/30 avec une moyenne de 18,59/30. Les médecins généralistes, les médecins ayant une spécialité d´organe comme les ophtalmologistes ou encore les neurochirurgiens et les médecins qui ont utilisé le support du ministère de la santé ont rédigé de meilleurs certificats. De même nous avons noté une qualité de rédaction meilleure lorsqu´il s´agit de coups et blessures volontaires. Notre étude a montré que la majorité des certificats médicaux initiaux ne sont pas conformes aux recommandations de rédaction. Ces insuffisances sont probablement liées au fait que les médecins n´ont jamais bénéficié d´une formation médico-légale adéquate.

“That Close and Contagious Death”: Symptomatology, Sociogeny, and Structural Oppression

Frantz Fanon’s writings on medicine and colonial violence seek to mark the functioning of structural oppression through the provision of health care. Fanon’s medical training and clinical practice in French, Algerian, and Tunisian hospitals, along with his work and support for the Algerian liberation movement, offer an invaluable context and set of resources regarding the functioning of colonial violence, structural racism, and trauma within the practice of clinical medicine. In this essay, I mark several prescient claims that Fanon raised in the 1950s regarding medical authority and structural oppression that distinguish his work as an important precursor to the radical health care efforts that would emerge decades later in 1970s France, particularly with Le Groupe d’information sur les prisons (GIP) and its sibling organization Le Group information santé (GIS).

Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic.

BackgroundAlthough efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning.AimTo describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI.MethodsThe current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors.ResultsOverall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98).ConclusionContrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

Acceptability of COVID-19 vaccine: a cross-sectional study in a Tunisian general hospital.

Introductionthe year 2020 was marked by the COVID-19 pandemic that killed more than one million people. Several vaccines have been developed and vaccination campaigns started in December 2020. The objective of our study was to assess the acceptability of the COVID-19 vaccine by hospital staff.Methodscross-sectional study conducted on a representative sample drawn at random from the staff of the Military General Hospital of Tunis. Data was collected between August and September 2020 by a clinical psychologist. We studied the associations between the different characteristics of our population and the decision to accept or refuse vaccination against COVID-19.Resultsa total of 398 hospital staff agreed to answer our questionnaire. Our sample was composed of 9% (n=36) physicians, 0.9% (n=3) pharmacists, 41.3% (n=164) paramedics, 16.1% (n=64) cleaning staff and 32.7% (n=131) administrative staff. The rapid discovery of the vaccine was hoped by 97% (n=386). Vaccination was considered a means of collective protection by 84.7% (n=337). However, only 58% (n=231) agreed to be vaccinated by the COVID-19 vaccine. The main factors significantly associated with acceptance of the COVID-19 vaccine was previous influenza vaccination (aOR: 2.58, 95% CI 1.69-3.94; p=0.000).Conclusionapprehension about vaccination does not appear to be sparing the future COVID-19 vaccine. Fear of vaccine side effects outweighs fear of the disease, even among hospital staff. To achieve vaccination coverage, several awareness and communication activities must be carried out.

Unnoticed surgical gloves perforation: A multicentric study of the leading factors.

Background Surgical gloves act as protective barrier against blood-borne pathogens transmission from patients to healthcare workers and vice versa. The aim of this study was to assess the rate of surgical gloves intraoperative perforation and to highlight its leading factors. Methods A descriptive cross-sectional multicentric study was conducted at three different Tunisian university hospitals: Charles Nicolle, La Rabta and Mongi Slim. Four different surgical departments were involved: cardiovascular surgery, urology, general surgery and otorhinolaryngology. The gloves were collected and tested immediately at the sterilization units using the leak test as described in European Norm EN 455-1.19. Results were produced using the statistical package for social sciences version 19.0 and the X2 was used with a significance threshold of 5%. Results A total of 320 gloves were collected. Seventy-two were found to be perforated (22.5%). The majority of the perforated gloves were collected after cardiovascular procedures (40%, p=0.001), on the non-dominant hand (71%, p=0.0001), when the duration of the procedure exceeded 90 minutes (p=0.0001) and for thinner gloves (61%,p=0.018). The left index finger of the surgeon’s glove is more likely to be perforated (38%). Conclusion This study showed considerable gloves perforation rate during surgical procedures that could indicate the implementation of new rules and policies in the operating theater practices. Key words Perforation, surgical gloves, operating theater, associated factors.

Evaluation of teamwork in operating rooms in a Tunisian university hospital

Abstract Background Teamwork is fundamental to ensuring the quality of care and patient safety in operating rooms. It has been shown that the occurrence of adverse events is closely linked to a poor quality of teamwork in these settings. Thus, this study aimed to assess teamwork in different operating rooms of the university hospital of Sahloul Sousse (Tunisia). Methods It is a descriptive cross-sectional study with convenience sampling, conducted in operating rooms of the university hospital of Sahloul Sousse (Tunisia) between February and April 2018. The measuring instrument was the validated observation grid 'Communication and Teamwork Skills Assessment Tool (CATS) '. Teamwork is assessed through 4 domains (Situation awareness, Coordination, Communication, Cooperation). Behaviors are marked in rows each time they occur and are rated for quality in columns labeled “Observed and Good,” “Variation in Quality” (meaning incomplete or of variable quality), and “Expected but not Observed.” Results A total of 51 interventions were observed. Good coordination between the team members was noted, as well as good cooperation within the teams. A variation of quality level of communication with the patient was noted in 31.4% of cases, also communication about the context, the situation and recommendation among caregivers is not quite good with a percentage of 39.2%. Moreover, the work environment was rated as good in 84.3% of cases. Conclusions Some failures in teamwork were noted, hence it is important to take corrective measures for better practice and better patient management in such a complex environment, the operating rooms, where there is a strong need for team coordination. Key messages There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to eliminate the barriers to communication, in order to prevent adverse events.