La Tunisie Medicale[JOURNAL]
Sun
200 papers
Internal Medicine Knowledge Among Dental Practitioners in Monastir: A Cross-Sectional Study.
Barhoumi T, Ayedi L, Riahi Z … +2 more , Mejri O, Hadyaoui D
Tunis Med · 2026 Feb · PMID 42223465 · Publisher ↗
INTRODUCTION: The integration of internal medicine knowledge into dental practice is essential yet remains underexplored. AIM: This study aimed to assess the perceptions, challenges, and training needs of dental practiti...
INTRODUCTION: The integration of internal medicine knowledge into dental practice is essential yet remains underexplored. AIM: This study aimed to assess the perceptions, challenges, and training needs of dental practitioners in Monastir, Tunisia, regarding internal medicine knowledge in dentistry. METHODS: A descriptive and analytical cross-sectional study was conducted from March to June 2025. A structured, self-administered questionnaire consisting of 12 questions across four sections was distributed via social media and professional networks. The study targeted licensed dentists practicing in public and private healthcare facilities in Monastir. Data were analyzed using descriptive statistics and Pearson's Chi-square test in Jamovi, with a significance threshold set at p < 0.05. RESULTS: A total of 143 responses were analyzed. The majority (93%) of dentists identified internal medicine knowledge as crucial in dental practice. Cardiovascular diseases (94.4%) and endocrine disorders (93%) were reported as the most relevant medical fields. Moreover, 93.7% had encountered medically compromised patients whose conditions affected their dental treatment plans. The most frequently cited challenges included the need for collaboration with physicians (76.1%) and uncertainty in prescribing medications (52.9%). While 50.3% had not received formal training in internal medicine, 97.9% expressed a strong interest in further training, particularly through workshops (54.5%) and online courses (43.4%). CONCLUSION: This study highlights significant gaps in the integration of internal medicine knowledge in dental practice. The results support the urgent need to strengthen dental education and continuing training in internal medicine to enhance clinical preparedness, improve patient safety, and foster interdisciplinary collaboration.
Childhood Suicide in Tunisia: Forensic and Psychological Aspects.
Ben Soussia R, Mesrati MA, Grayaa M … +5 more , Kouada R, Melki R, Bouali W, Zarrouk L, Aissaoui A
Tunis Med · 2026 Feb · PMID 42223464 · Publisher ↗
AIM: In Tunisia, since revolution, suicide among children and adolescents has increased considerably, becoming the second manner of death in this age group. Therefore, our study proposes to describe the epidemiological c...
AIM: In Tunisia, since revolution, suicide among children and adolescents has increased considerably, becoming the second manner of death in this age group. Therefore, our study proposes to describe the epidemiological characteristics and the risk factors that could precipitate death by suicide among these categories. METHODS: Using the psychological autopsy method, we studied 57 cases of children under 18 years old of which 16 cases committed suicide and 41 cases made one or more suicide attempts in the governorate of Mahdia (Tunisia). Socio-demographic factors, characteristics of the suicide, family history and thanatological aspects were documented. RESULTS: Most of children and adolescents committing or attempting suicide were girls (75%). The majority of suicidal attempts were performed at the child/adolescent's home (62%) and history of previous suicide attempts were registered in 26% of cases. Furthermore, a dysfunctional family was the main risk factor (54%) that precipitates suicide among these categories. CONCLUSION: Studying our population, we identified multiple characteristics of adolescents and children who died by suicide or attempted suicide. Most of them, were dying at their houses and derived from dysfunctional families. One third of our population committed suicide and died from the first try without any notification or suicidal attempts. These characteristics and risk factors should be considered in the future to promote preventive programs and strategies in order to fight suicidal behaviors among Tunisian children.
Ten-year trends of of acetabular fractures profile in a trauma center.
Selmene MA, Boumaiza H, Messaoudi K … +3 more , Annabi H, Bahroun S, Zaraa M
Tunis Med · 2026 Feb · PMID 42223463 · Publisher ↗
INTRODUCTION: Acetabular fractures represent a major challenge in traumatology due to their significant functional impact. The patient profile, clinical and radiological characteristics, and treatment of this entity are...
INTRODUCTION: Acetabular fractures represent a major challenge in traumatology due to their significant functional impact. The patient profile, clinical and radiological characteristics, and treatment of this entity are likely to evolve over time. In Tunisia, data on these fractures are limited. AIM: To describe the epidemiological, clinical and therapeutic aspects of acetabular fractures in a trauma center. METHODS: A descriptive retrospective study, spanning 10 years (January 2014-December 2023), included patients treated for acetabular fractures in a trauma center. Demographic, clinical, radiological and therapeutic data were collected. RESULTS: The study included 297 patients. The mean age was 47.8 years. The sex-ratio was 3.8. Road traffic accidents were the predominant mechanism of injury (62%). The most common fractures were posterior wall fractures (21.9%), anterior wall fractures (19.2%) and both-column fractures (9.8%). Hip dislocation was present in 27.3% of cases. Surgical treatment was indicated in 35.4% of cases. An increase in the incidence of acetabular fractures was noted between 2014 and 2023 (23 to 40). Both surgical management and anterior approaches showed a significant increase over the years (p < 0.001). CONCLUSION: The increase in the incidence of acetabular fractures, the predominance of traffic accidents and the growing use of surgical treatment suggest the importance of developing recommendations on road safety, strengthening the capacity of trauma centers and optimising surgical resources.
Prognostic factors for stage III/IV bronchopulmonary cancers in the North-West region of Tunisia.
Mahjoub N, Khiari H, Slama A … +5 more , Ben Hssine S, Boukhriss S, Fehri R, Rjiba R, Jaffel H
Tunis Med · 2026 Feb · PMID 42223462 · Publisher ↗
INTRODUCTION: Non-small cell bronchopulmonary cancer is a pathology of major severity on a global scale. In Tunisia, NSCLC represents the leading cancer in men. Despite diagnostic and therapeutic progress, the prognosis...
INTRODUCTION: Non-small cell bronchopulmonary cancer is a pathology of major severity on a global scale. In Tunisia, NSCLC represents the leading cancer in men. Despite diagnostic and therapeutic progress, the prognosis remains reserved. This poor prognosis could be explained in part by the advanced stage of the disease at the time of diagnosis. AIM: To identify the prognostic factors of NSCLC at advanced stages (III and IV) and to study their impacts on overall survival. METHODS: This was a retrospective study conducted over a period of 8 years 11 months from January 2013 to December 2020 and which collected 95 patients with advanced stage III/IV non-small cell bronchopulmonary cancer treated at the medical oncology department at the Sectorial Center for Cancer Diseases in Jendouba. RESULTS: The mean age was 64 years. The sex ratio was 9.6 with a male predominance (91%). The most common reason for consultation was cough (26%), followed by chest pain (21%). Five percent of patients presented with an emergency presentation (intracranial hypertension, spinal cord compression, and superior vena cava syndrome). The two main histological types were adenocarcinoma (54%) followed by squamous cell carcinoma in 39% of cases. At the end of the extension assessment, locally advanced stage IIIB observed in 30 patients (31.6%). For metastatic stages, stage IVB observed in 31 patients (32.6%). In terms of treatment, 7.4% of patients had received primary surgery, 46 patients had received radiotherapy, either curative or palliative depending on the indications. All patients had received chemotherapy. The median overall survival was 12 months ± 1.123 [3 to 75 months]. Overall survival at 1 year, 2 years and 5 years was 52.6%, 23.2% and 3%, respectively. In univariate analysis, the prognostic factors influencing overall survival were PS (p<0.003), number of metastases (p=0.024), radiological lymph node involvement (p= 0.05), histological type (p=0.034), primary surgery for immediately operable metastases (p=0.022), mediastinal-pulmonary radiotherapy (p=0.005) and CT induction time (P=0.017). CONCLUSION: As in the world, and despite therapeutic progress, non-small cell bronchopulmonary cancer in the North-West region of Tunisia remains of poor prognosis, particularly for advanced stages.
Management of Philadelphia chromosome-positive B-acute lymphoblastic leukemia in Tunisia.
Chaaouri W, Sahbani H, Kefi S … +11 more , Achour M, Ayed W, Laamouri A, Chaker H, Fekih S, Ben Lakhal F, Borgi W, Gouider E, Menif S, Ben Neji H, BenLakhal R
Tunis Med · 2026 Feb · PMID 42223461 · Publisher ↗
INTRODUCTION: The management of Philadelphia-chromosome positive B-cell acute lymphoblastic leukemia (Ph+ B- ALL) is continuously progressing. However, Tunisian data are limited. AIM: The objective was to describe the cl...
INTRODUCTION: The management of Philadelphia-chromosome positive B-cell acute lymphoblastic leukemia (Ph+ B- ALL) is continuously progressing. However, Tunisian data are limited. AIM: The objective was to describe the clinical and prognostic profile as well as the therapeutic outocomes of Ph+ B- ALL. METHODS: This was a retrospective and descriptive study conducted in the adult clinical hematology department of Aziza Othmana hospital over a period of 12 years. We included patients aged between 18 and 60 years, diagnosed with de novo or secondary Ph+ B- ALL and treated with a combination of chemotherapy and a tyrosine kinase inhibitor (TKI). RESULTS: We collected data on 36 patients with initial central nervous system involvement in only one case. The GRAAPH-2005 protocol was the most used regimen (n=29). Thirty-four patients received TKI: imatinib (n=28) and dasatinib (n=6). After induction, all patients achieved cytological remission. Molecular response was assessed in 21 of whom 52% achieved a molecular response. After consolidation, 17 had molecular response evaluation, with 13 achieving a molecular response. Seven patients underwent allogenic hematopoietic stem cell transplantation, and two underwent autologous stem cell transplantation. In terms of disease progression ,14 patients relapsed with a median time to relapse of 18 months [4-42] after TKI initiation. The 5- year overall survival in our series was 25%. The 5-year relapse free survival and event-free survival were 22% respectively. CONCLUSION: Our study highlighted the various obstacles encountered in the management of Ph+ B-ALL in Tunisia. Addressing these obstacles could improve therapeutic outcomes.
Mortality from cancer in Tunisia in 2020 and death certification quality.
Bennour MA, Rejaibi S, Aounallah Skhiri H
Tunis Med · 2026 Feb · PMID 42223460 · Publisher ↗
UNLABELLED: Introduction-Aim: According to the World Health Organization, cardiovascular disease and cancer figure among leading causes of death worldwide. This aim of our study was to identify the deadliest cancers in T...
UNLABELLED: Introduction-Aim: According to the World Health Organization, cardiovascular disease and cancer figure among leading causes of death worldwide. This aim of our study was to identify the deadliest cancers in Tunisia and to assess the quality of medical certification related to cancer deaths. METHODS: We led a descriptive observational study based on data from the national information system on causes of deaths in 2020. Were included all medical death certificates received by the National Institute of Health and related to deaths occurring in 2020. Causes of death were coded according to the International Classification of Diseases (ICD-10). The share of Garbage codes was determined by ANACONDA software. Data entry and analysis, were performed by SPSS software. RESULTS: In total, 45420 deaths were enrolled, including 7001 deaths from cancer, representing 15.1% of all deaths. The sex ratio (Male/Female) was to 1.7 with median age was 67 years ±0.2. The deadliest cancers were the following cancers: bronchopulmonary (22.8%), colorectal (7.9%), breast (7.4%), prostate (5.9%), liver (4.9%) and pancreas (4.8%). The share of garbage codes was 12%, dominated by cancers with "unspecified primary location" (6.1%), "primary cancers with multiple independent locations" (1.6%), uterine cancer of undefined location (1.3%), "cancer of the digestive tract of undefined location" (1.2%). CONCLUSION: Our study highlighted the important place of cancer among all deaths in Tunisia. We recommend training of certifying doctors on the rules of good quality certification, and the strengthening of primary prevention by fighting against risk factors and secondary prevention by screening and early diagnosis of cancers.
Uncontrolled asthma: Frequency and associated factors [cite: 115].
Maazaoui S, Moussa C, Chaouch N … +1 more , Maalej S
Tunis Med · 2026 Feb · PMID 42223459 · Publisher ↗
The real challenge with asthma consists essentially in the control of this one. [cite: 121] The objectives of our work were to describe the level of asthma control in a Tunisian population and to search the factors assoc...
The real challenge with asthma consists essentially in the control of this one. [cite: 121] The objectives of our work were to describe the level of asthma control in a Tunisian population and to search the factors associated with uncontrolled asthma. [cite: 122] Methods: This was a descriptive observational cross-sectional study that was conducted in a pneumology department over 2 months. [cite: 123] Were included patients seen at the allergology consultation aged 15 years or over with a confirmed diagnosis of asthma and under anti-asthmatic treatment for at least 6 months. [cite: 124] Uncontrolled asthma was defined by an asthma control test score under 20. [cite: 125] Results: One hundred and thirteen patients were included. The mean age of the population was 45 ± 15 years. [cite: 126] Thirteen percent of the patients were active smokers. The main comorbidities associated with asthma were obesity (34.5%), gastroesophageal reflux disease (GERD) (17%). [cite: 127] Thirty-seven patients (32.8%) were compliant with treatment. Asthma was classified as well controlled in 64 patients (56.6%). [cite: 128] Factors associated with poor asthma control according to the univariate study were: active smoking (p= 0.04); [cite: 129] exposure to passive smoking (p= 0.02); poor socio-economic conditions (p=0.003); [cite: 130] certain comorbidities such as GERD, obesity, younger age of onset of the disease (p= 0.008) as well as with therapeutic compliance (p= 0,008) and the technique of inhalation (p= 0,002). [cite: 131] Conclusion: Adequate management of asthma must necessarily be multidisciplinary considering comorbidities and tobacco control. [cite: 132].
Predictive Factors for Successful Testicular Biopsy in Azoospermia [cite: 100].
Raddaoui A, Abdelhedi O, Boujelben D … +1 more , Jalled S
Tunis Med · 2026 Feb · PMID 42223458 · Publisher ↗
Testicular biopsy represents a crucial procedure in the management of non-obstructive azoospermia, though its success remains variable. [cite: 106] Identifying predictive factors for successful sperm retrieval is essenti...
Testicular biopsy represents a crucial procedure in the management of non-obstructive azoospermia, though its success remains variable. [cite: 106] Identifying predictive factors for successful sperm retrieval is essential for patient selection. [cite: 107] Aim: To determine the clinical, hormonal and technical factors predictive of successful testicular biopsy in azoospermic patients [cite: 108] Methods: A retrospective analytical study was conducted over 5 years (2017-2021), including 28 patients. [cite: 109] Comparative analysis was performed between groups with successful (spermatozoa present) and failed biopsy. [cite: 110] Results: Significant predictive factors for successful biopsy included: testicular volume preservation (p=0.042), low FSH levels (p=0.002), low estradiol levels (p=0.018), excretory azoospermia type (p=0.023), and unilateral surgical approach (p=0.005). [cite: 111] Clinical varicocele and hydrocele showed no significant correlation. [cite: 112] Conclusion: Our study identifies a predictive profile for testicular biopsy success, enabling better patient selection and surgical strategy optimization in assisted reproductive technology. [cite: 113].
Circuit of Specific Medications at Aziza Othmana Hospital: The Case of Chemotherapy [cite: 82].
Bettoumia M, Cherif D, Jenhani E … +5 more , Jaoued E, Kolsi M, Hammadi N, Bousetta A, Bouattour H
Tunis Med · 2026 Feb · PMID 42223457 · Publisher ↗
The circuit of specific medicines at Aziza Othmana Hospital is a complex process involving various healthcare professionals. [cite: 88] The hospital pharmacy has implemented a dedicated system to ensure the management of...
The circuit of specific medicines at Aziza Othmana Hospital is a complex process involving various healthcare professionals. [cite: 88] The hospital pharmacy has implemented a dedicated system to ensure the management of these vital treatments. [cite: 89] Aim: The aim of this study was to examine the current circuit of specific medicines within a hospital pharmacy and to propose areas for improvement to enhance its safety. [cite: 90] Methods: A retrospective descriptive study was conducted within the pharmacy department of Aziza Othmana Hospital over a period extending from January 2024 to August 2024. [cite: 91] Results: The analysis of the circuit identified six main stages: procurement, ordering, receiving, storage, preparation, and dispensing. [cite: 92] Procurement, which depends on the type of health coverage (National Health Insurance (CNAM) or indigent patients), is often a source of delays. [cite: 93] A total of 230 patients treated with specific cytotoxic medicines and managed within the pharmacy department of Aziza Othmana Hospital in Tunis were included. [cite: 94] The mean age of patients was 53.75 years (SD = 17.89). The sex ratio (M/F) was 1.23. [cite: 95] The hospital pharmacy did not recover the treatment for 8% of patients (19 patients), for whom chemotherapy cycles had been advanced. [cite: 96] Conclusion: The circuit of specific medicines at Aziza Othmana Hospital presents weaknesses that compromise access to treatments. [cite: 97] Better coordination among stakeholders is required. Placing the patient at the center of the process will improve the quality of care and strengthen trust in the system. [cite: 98].
Percutaneous coronary intervention of chronic total occlusion: A 5-year monocentric experience [cite: 62].
Boudiche S, Bader M, Abbassi M … +19 more , Jebbari Z, Khader N, Rekik B, Zouari F, Ben Salem A, Ezzaouia K, Besbes B, Chedly M, Daly F, Ben Rejeb R, El Ayech F, Sebki D, Bounaoues I, Gouader M, Mghaieth F, Ouali S, Larbi N, Ben Halima M, Mourali MS
Tunis Med · 2026 Feb · PMID 42223456 · Publisher ↗
Chronic total occlusions (CTO) occur in 15-30% of coronary angiogram, yet this challenging lesion subset represents less than 10% of percutaneous coronary interventions (PCI). [cite: 69] Tunisian data are lacking. This s...
Chronic total occlusions (CTO) occur in 15-30% of coronary angiogram, yet this challenging lesion subset represents less than 10% of percutaneous coronary interventions (PCI). [cite: 69] Tunisian data are lacking. This study analyses a real-life Tunisian CTO-PCI immediate and long-term results. [cite: 70] Methods: Single-center, observational retro-prospective study, between 2018 and 2023. Primary endpoint was to assess technical success, major procedural complications, and target lesion failure (TLF) at 12-months. [cite: 71] Secondary endpoint was to identify factors associated to technical failure. [cite: 72] Results: 115 patients, 122 CTOs lesions, 133 CTO-PCIs. Mean age 62±14.4 years. Gender-Ratio=6. Mean J-CTO score was 1.47±1.12. [cite: 73] Dual injection (43.6%) and microcatheters (50.4%) were underused. Number of guidewires per procedure was 2.35±1.12. [cite: 74] Anterograde, retrograde and hybrid approaches were noted in 85%, 9% and 6%, respectively. [cite: 75] Technical success was 69.2% (of 133 procedures) and procedural success was 73.0% (of 115 patients). [cite: 76] Major complication rate stood at 3%. At 12 months, cardiovascular mortality was 7.0%, without difference according to procedural success. [cite: 77] TLF was 9.4% among successful CTO-PCIs. Associated factors to technical failure were bifurcation involvement (OR=5.83 [1.7-20.1]; p=0.005), use of more than 4 guidewires per-procedure (OR=6.83 [1.6-28.7]; p=0.009), de-novo CTO (HR=8.43 [1.9-36.6]; p=0.004), previous attempts (OR=8.87 [1.8-43.6]; p=0.007), and no microcatheter use (OR=11.4 [3.5-36.8]; p=0.001). [cite: 78] Conclusion: This real-life study fills a gap in Tunisian data on CTO-PCI outcomes with technical success, complications and TLF rates comparable to those reported in literature. [cite: 79] 12-month survival rates were similar between successful and failed procedure groups. [cite: 80].
Evaluation of Clinical Training in Pediatric Dentistry: Tunisian Student Perspectives from the Faculty of Dental Medicine [cite: 43].
Laajimi S, Elelmi Y, Masmoudi F … +1 more , Baaziz A
Tunis Med · 2026 Feb · PMID 42223455 · Publisher ↗
In pediatric dentistry, self-assessment plays a pivotal role in students' professional development by enabling them to critically reflect on and evaluate their clinical competencies This study aimed to enhance clinical t...
In pediatric dentistry, self-assessment plays a pivotal role in students' professional development by enabling them to critically reflect on and evaluate their clinical competencies This study aimed to enhance clinical training in pediatric dentistry through structured student self-assessment, identification of educational gaps, and collaborative evaluation with educators to reinforce learning objectives and support continuous quality improvement. [cite: 50] Methods: A descriptive cross-sectional study was conducted over two weeks during the 2023/2024 academic year at Monastir Dental Clinic. [cite: 51] A total of 180 fifth-year Tunisian dental students completed a self-assessment questionnaire covering diagnostic confidence, clinical autonomy (5-point Likert scale), and overall preparedness/satisfaction (rated 1-10). [cite: 52] Gender data and open-ended feedback were also collected. Prior to deployment, the questionnaire was pretested for clarity and content validity. [cite: 53] Results: Of the 163 respondents (90% response rate; 73% female), diagnostic confidence varied: 22.1% for early childhood caries, 52.1% for malocclusion, and 40-50% for other conditions. [cite: 54] Autonomy in trauma management was reported by 67.5%, but only 4.9% felt fully autonomous in clinical protocols. [cite: 55] Preparedness averaged 6.3/10, and satisfaction was high (82.7% rated 5-8/10). [cite: 56] Data was analyzed using SPSS 22 and Excel 2020. Descriptive statistics were complemented by inferential analysis (Chi-square and Student's t-tests), revealing significant associations between satisfaction and both clinical preparedness (p < 0.001) and theoretical teaching adequacy (p = 0.001). [cite: 57] Female students reported significantly higher satisfaction (p < 0.001). [cite: 58] Conclusion: Students showed uneven diagnostic skills, especially with molar incisor hypomineralization (MIH) and early childhood caries (ECC.) Despite overall satisfaction, findings call for targeted pedagogical reforms to ease clinical transition and support skill development. [cite: 59].
Docimological analysis of criterion-referenced checklists in Objective Structured Clinical Examinations (OSCE) in acute medicine: Evaluation of validity and reliability [cite: 23].
Keskes S, Ghazali H, Chermiti I … +4 more , Ben Turkia H, Ben Salah N, Boujelbene N, Souissi S
Tunis Med · 2026 Feb · PMID 42223454 · Publisher ↗
The Objective Structured Clinical Examination (OSCE) is an essential tool for assessing clinical competencies. [cite: 28] It has been used at the Faculty of Medicine of Tunis since 1998, yet few studies have analyzed its...
The Objective Structured Clinical Examination (OSCE) is an essential tool for assessing clinical competencies. [cite: 28] It has been used at the Faculty of Medicine of Tunis since 1998, yet few studies have analyzed its psychometric quality, particularly in emergency medicine. [cite: 29] This study aims to evaluate the validity, reliability, and fairness of the OSCE, with a focus on the contribution of checklist-based evaluation grids. [cite: 30] Methods: A prospective descriptive study was conducted in 2024-2025 among 60 third-year medical students (DCEM3). [cite: 31] The examination included 12 stations covering knowledge, skills, and professional behavior, scored using standardized checklist-based grids. [cite: 32] Analyses focused on success rates, difficulty and discrimination indices, Cronbach's alpha, and score distribution parameters. [cite: 33] Results: Sixty student scripts were analyzed. The overall pass rate was 96 %, with a mean score of 12.50 ± 1.53/20. [cite: 34] The average difficulty index (0.58) indicated acceptable difficulty, and Cronbach's alpha (0.85) reflected good internal consistency. [cite: 35] The mean discrimination index was low (0.16), but stations S11 and S12 (technical and communication skills) showed satisfactory discriminative ability, unlike the cognitive stations S1, S6, and S8. [cite: 36] Items of moderate difficulty offered the best discrimination (D ≈ 0.21). [cite: 37] The correlation between difficulty and discrimination was negligible (r = -0.0316). [cite: 38] Conclusion: The OSCE in emergency medicine generally meets psychometric recommendations, showing balanced difficulty, good reliability, and standardization through checklist-based grids. [cite: 39] Certain stations and items require revision to enhance discriminative power and improve differentiation among students. [cite: 40].
Role of High-Sensitivity Troponins in Cardiovascular Risk Assessment in Asymptomatic Adults: A Systematic Review [cite: 3].
Sabri A, Omari M, Kechkar H … +2 more , Bousfiha AA, Kamal N
Tunis Med · 2026 Feb · PMID 42223453 · Publisher ↗
The causal relationship between high-sensitivity troponins (hs-cTn) and cardiovascular risk in asymptomatic adults remains incompletely established. [cite: 11] The objective of this systematic review is to evaluate the p...
The causal relationship between high-sensitivity troponins (hs-cTn) and cardiovascular risk in asymptomatic adults remains incompletely established. [cite: 11] The objective of this systematic review is to evaluate the prognostic value of hs-cTn (hs-cTnI and hs-cTnT) in the general population free of clinical cardiovascular disease, and their potential to enhance the prediction of future cardiovascular risk when incorporated into conventional cardiovascular risk stratification models. [cite: 12] Methods: The literature search was conducted in the following electronic databases: PubMed, Google Scholar, ScienceDirect, and SpringerLink, to identify prospective cohort studies published between January 1, 2016, and February 28, 2024, examining the relationship between hs-cTn and cardiovascular risk in asymptomatic adult populations. [cite: 13] The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). [cite: 14] Results: The 19 studies included in this review involved a total of 250,513 participants. [cite: 15] The results confirm a significant association between hs-cTn levels and cardiovascular events. [cite: 16] The addition of these biomarkers to traditional risk prediction models often enhances their predictive performance, as evidenced by increases in the C-index (Concordance index), Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI). [cite: 17] hs-cTnI and hs-cTnT were moderately or weakly correlated but complementary, as they were associated with different types of cardiovascular events. [cite: 18] Conclusion: The inclusion of hs-cTn in predictive scores slightly improves their predictive accuracy. [cite: 19] Nevertheless, it remains necessary to demonstrate their clinical benefit through randomized trials before incorporating them into routine practice. [cite: 20].
Polymer-based drug delivery systems: A bibliometric analysis.
Ben Saada R, El Khou EC, Yousfi MA
Tunis Med · 2026 Jan · PMID 42223441 · Publisher ↗
OBJECTIVE: The aim of this study was to provide researchers in the medical field with information about leaders, collaborations, and trends in the field of polymer-based drug delivery systems (DDS) using bibliometric ana...
OBJECTIVE: The aim of this study was to provide researchers in the medical field with information about leaders, collaborations, and trends in the field of polymer-based drug delivery systems (DDS) using bibliometric analysis. METHODS: a three-step process were followed: (1) data identification using PubMed. English papers published during the last five years (2018-2022) were included. (2) Data extraction and cleansing. (3) Data analysis based on publication-related metrics and science mapping using VOSviewer. RESULTS: A total of 1532 papers related to polymers in DDS were included. With 476 papers, China was the greatest contributor to this field as a source country. Kannan RM, by working on DDS in ocular and neurodegenerative diseases,was the most influential author in this field. Surprisingly, collaboration among organizations and countries were limited. Regarding key concepts, cancer and antineoplastic drugs have been extensively studied using various types of polymeric systems. CONCLUSION: By uncovering key concepts related to polymer-based DDS, our results can provide researchers with ideas for investigation and help them position their contributions to the field.
Depressive comorbidity in type 2 Diabetes: Prevalence and associated factors.
Mhalla H, Ben Mbarek M, Ounaissa K … +6 more , Betbout I, Ben Haouala A, Zaafrane F, Amrouche C, Amamou B, Mhalla A
Tunis Med · 2026 Jan · PMID 42223440 · Publisher ↗
BACKGROUND: The comorbidity diabetes depression is frequent and would have a synergistic effect. Depression is underdiagnosed in diabetology consultations. METHODS: This was a cross-sectional study that included 102 outp...
BACKGROUND: The comorbidity diabetes depression is frequent and would have a synergistic effect. Depression is underdiagnosed in diabetology consultations. METHODS: This was a cross-sectional study that included 102 outpatients with type 2 Diabetes mellitus (T2DM) recruited during April and May 2019. A pre-established form was filled out from the interview of the patients and the medical file review. Depression, Therapeutic adherence, self-esteem, temperament, satisfaction of treatment, quality of life and physical activity were assessed by validated questionnaires. RESULTS: The average age of the patients was 53.4± 8.5 years, sex-ratio was 0.7. 76.5% have exhibited depressive symptoms; 51% of the patients have had moderate to severe depression. Depression was associated with female gender (p=0.04) and psychiatric family history (p=0.01). Patients with depression have had significantly higher HbA1c levels (p=0.05) and significantly lower HDL-C levels (p=0.05). Regarding psychosocial factors, depression was associated with low self-esteem (p= 0.005) and significantly higher scores of depressive (p=0.002) and cyclothymic (p=0.003) temperaments. Depression was also associated with significantly lower treatment satisfaction (p=0.01) and poor quality of life. In multivariate study, factors independently associated with depression were female gender, low HDL-C, quality of life score without diabetes and low self-esteem score. CONCLUSION: This study showed, despite limitations, that depression is frequent in patients with T2DM and was associated with several sociodemographic, anamnestic, clinical and psychological characteristics.
Redefining learning in the digital era: Innovative tools shaping modern medical education.
Kchaou K, Khaldi S, Ben Khamsa Jameleddine S
Tunis Med · 2026 Jan · PMID 42223439 · Publisher ↗
The rapid development of digital tools for medical education and training has expanded the possibilities for flexible and personalized learning, but it has also created challenges in choosing the best tools to meet speci...
The rapid development of digital tools for medical education and training has expanded the possibilities for flexible and personalized learning, but it has also created challenges in choosing the best tools to meet specific learning needs. This article presents a functional framework that assists educators and learners in selecting tools based on their needs and the learning context. By categorizing tools into synchronous and asynchronous types, we aim to simplify the decision-making process and optimize educational experiences. Synchronous learning tools like YouTube Live, PathCast, Zoom and Microsoft Teams support real-time participation and promote communication, collaboration and responsiveness in the learning environment. These tools are especially useful for live streaming, Q&A, and discussions where instant feedback can support learning outcomes. Asynchronous learning tools such as YouTube, Canvas, Elicit and Quizlet, give learners the flexibility to learn material at their own pace, encouraging independent learning and memorization. Asynchronous platforms allow for pausing, reviewing and repeating material as needed, making them ideal for complex courses that require effective repetition. Hybrid models, especially the flipped classroom approach, blend these modes effectively. Tools like Edpuzzle and Nearpod make it possible to create interactive lessons and exercises in the classroom. The integration of innovative technology in medical education is not solely about adopting new tools but also about promoting adaptability and a culture of continuous learning. Blending synchronous and asynchronous tools with a human-centered approach, can build flexible, responsive learning environments that empower educators and learners to make informed choices, creating adaptive and effective learning environments that meet diverse needs.
Albendazole Therapy in Postoperative Spinal Cystic Echinococcosis: Evaluating Recurrence and Survival Outcomes Between Short and Long-Term Protocols.
Gader G, Gharbi MA, Chaabouni M
Tunis Med · 2026 Jan · PMID 42223438 · Publisher ↗
INTRODUCTION: The spine is a rare location in cystic echinococcosis even in endemic regions. Surgery is the treatment of choice. There are still uncertainties regarding anthelminthic treatment protocol and duration. AIM:...
INTRODUCTION: The spine is a rare location in cystic echinococcosis even in endemic regions. Surgery is the treatment of choice. There are still uncertainties regarding anthelminthic treatment protocol and duration. AIM: To evaluate the impact of Albendazole therapy duration on the functional outcome, overall survival and recurrence-free survival in patients operated for spinal cystic echinococcosis (SCE) Methods: We retrospectively selected patients operated for SCE and collected their epidemiological, clinical, imaging, surgical, and outcomes data. These patients were categorized into two groups: a 6-month Albendazole therapy after surgery group and an indefinite treatment group. Statistical tests were applied to compare the outcomes. RESULTS: Thirty-two patients were included, predominantly male (68%) with a mean age of 40 years. The thoracic level was involved in 56%, lumbar in 31% and cervical in 13% of cases. According to Dew/Braithwaite and Lees, 69% of our patients had dumbbell formation, 22% had type 2 and 9% had type 4 lesions. Complete resection was achieved in 50% of cases.18 patients received a 6-month Albendazole therapy while 14 patients received an indefinite treatment. All patients had a recurrence in a mean delay of 17.7 months. The only statistical difference between the two groups was the recurrence-free survival with a mean of 11.4 months for 6-month therapy patients and 27 months for long-term therapy patients (p=0.047). CONCLUSION: Post-operative SCE Albendazole treatment duration might not affect neither the functional outcome nor the overall survival. Otherwise, our findings suggest indefinite Albendazole therapy following SCE surgery could not prevent local recurrence but might delay it compared with 6-month therapy.
Arabic Translation and Adaptation of the CVID_QoL Questionnaire to Measure Health-RelatedQuality of Life of Adultswith Common Variable Immune Deficiency.
Zridi S, Errami A, Baraket L … +3 more , Moudatir M, Bousfiha AA, Benhsain I
Tunis Med · 2026 Jan · PMID 42223437 · Publisher ↗
INTRODUCTION: Common Variable Immune Deficiency (CVID) is the most frequent symptomatic inborn error of immunity, associated with recurrent infections, autoimmunity, and malignancy. These complications substantially impa...
INTRODUCTION: Common Variable Immune Deficiency (CVID) is the most frequent symptomatic inborn error of immunity, associated with recurrent infections, autoimmunity, and malignancy. These complications substantially impair health-related quality of life (HRQoL). To date, no disease-specific HRQoL instrument has been validated in Arabic. This study aimed to translate, culturally adapt, and validate the CVID_QoL questionnaire for Arabic-speaking patients. METHODS: The CVID_QoL was translated and adapted into Arabic according to international cross-cultural guidelines. A pilot test was performed, followed by administration of the pre-final version to 20 adults with CVID at Abderrahim El Harouchi Hospital, Casablanca. Internal consistency was assessed using Cronbach's alpha, and test-retest reliability with intraclass correlation coefficients (ICC). Construct validity was evaluated through Pearson's correlations with the General Health Questionnaire-12 (GH-12) and the Short Form-36 (SF-36). Discriminant validity was tested using the Mann-Whitney U test across clinical subgroups. RESULTS: The Arabic CVID_QoL showed high internal consistency (Cronbach's α = 0.91) and excellent test-retest reliability (ICC = 0.88). Convergent validity was confirmed by significant correlations between CVID_QoL domains and GH-12 and SF-36 scores (e.g., emotional functioning with SF-36 mental health, r = 0.65, p< 0.001). Discriminant validity was established by significantly lower scores among patients with recurrent infections, pulmonary complications, or autoimmunity (p< 0.05). CONCLUSION: The Arabic CVID_QoL is a reliable and valid tool for measuring HRQoL in Arabic-speaking adults with CVID. It provides a valuable contribution for both clinical care and research. Larger, multicenter studies are recommended to further confirm its utility.
Predictive factors of recurrence and chronic pain in inguinal hernia repair in a tertiary multicenter study: Lichtenstein versus transabdominal preperitoneal versus totallyextraperitoneal approach.
Chaouch MA, Zayati M, Saidani A … +10 more , Hadj Taieb A, Noomen M, Ben Jabra S, Ben Letaifa R, Ben Slimane A, Korbi I, Gafsi B, Ben Salem F, Chebbi F, Noomen F
Tunis Med · 2026 Jan · PMID 42223436 · Publisher ↗
OBJECTIVE: To compare the postoperative outcomes of inguinal hernia repair using Lichtenstein, transabdominal preperitoneal(TAPP), and totallyextraperitoneal (TEP) techniques, focusing on the incidence and predictive fac...
OBJECTIVE: To compare the postoperative outcomes of inguinal hernia repair using Lichtenstein, transabdominal preperitoneal(TAPP), and totallyextraperitoneal (TEP) techniques, focusing on the incidence and predictive factors of recurrence and chronic postoperative pain. METHODS: This cohort study included patients operated on for inguinal hernia at Monastir and Ariana University Hospitals between January 2020 and November 2023. The primary outcomes measured were postoperative morbidity and its risk factors, with secondary endpoints including chronic pain and recurrence. Data were analyzed using Pearson's chi² test, Student's t-test, Mann-Whitney test, and multivariate analysis. RESULTS: This cohort study included 308 patients. The patientswere divided into three groups: Lichtenstein (n=124), TAPP (n=117), and TEP (n=67). The Lichtenstein patients were older (52.02±11.11 years) and had a higher BMI (26.45±3.60 kg/m²) compared to TAPP (48.02±15.62 years, 20.89±5.1 kg/m²), and TEP (46.19±13.52 years, 20.11±2.13 kg/m²). Lichtenstein had the highest morbidity (12.09%) compared to TAPP (8.54%) and TEP (7.46%). Grade II and III complications were significantly more frequent in the Lichtenstein group. Recurrence was higher in the Lichtenstein group (8.06%) compared to TAPP (3.41%) and TEP (2.98%). Chronic pain was more common in Lichtenstein (9.67%) compared to TAPP (1.70%) and TEP (0%). For predictive factors, age >50 years (OR=1.7), BMI >30 kg/m² (OR=1.9), and comorbidities (OR=1.8) were significant predictors of recurrence. The Lichtenstein technique (OR=5.5), wound complications (OR = 3.2), and smoking (OR=2.0) were key predictors of chronic pain. CONCLUSIONS: In this retrospective study, statistically significant differences were observed between groups: the Lichtenstein ....( abstract truncated at 250 words).
Prevalence of Zygomatic Air Cell Defects in the Tunisian Population: A Retrospective Study.
Ghadhab N, Kammoun R, Jaziri R … +4 more , Gharbi M, Zaghden O, Chaabani I, Ben Alaya T
Tunis Med · 2026 Jan · PMID 42223435 · Publisher ↗
OBJECTIVES: Zygomatic Air Cell Defect (ZACD) is an anatomical variation that may complicate surgical procedures involving the temporomandibular joint. This retrospective study aimed to determine the prevalence, location,...
OBJECTIVES: Zygomatic Air Cell Defect (ZACD) is an anatomical variation that may complicate surgical procedures involving the temporomandibular joint. This retrospective study aimed to determine the prevalence, location, and morphological characteristics of ZACD in a Tunisian population and to compare the findings with previously reported data. METHODS: A total of 3,988 digital panoramic radiographs from patients aged 4-94 years were independently assessed by three oral and maxillofacial radiologists. Demographic characteristics, ZACD laterality (unilateral/bilateral), and morphology (unilocular/multilocular) were recorded. Statistical analysis was performed using the Chi-Squared test, and the results were contextualized through a comprehensive literature review. RESULTS: ZACD was detected in 2.28% of cases, with a mean age of 37.4 years (range: 7-67). Most cases were unilateral (69/92), predominantly on the left side, while bilateral involvement was noted in 23 patients. Unilocular (56.5%) and multilocular (43.5%) patterns were almost equally distributed. No significant associations were observed between ZACD presence and patients' age, sex, laterality, or locularity. CONCLUSION: The prevalence of ZACD in the Tunisian population is comparable to that of other populations, but it tends to occur in younger individuals. Recognizing ZACD on panoramic radiographs is clinically relevant, as its presence may pose challenges during surgical or endoscopic procedures of the temporomandibular joint. Awareness of this variation can therefore help clinicians anticipate potential complications and improve preoperative planning.
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