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La Tunisie Medicale[JOURNAL]

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Gastrointestinal bleeding due to portal hypertension in cirrhosis: Prognostic value of the CAGIB score.

Ben Mohamed A, Mnif A, Yakoubi M … +5 more , Gharbi G, Mahmoudi M, Khsiba A, Medhioub M, Hamzaoui ML

Tunis Med · 2026 Jan · PMID 42223434 · Publisher ↗

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) due to portal hypertension (PH) is a severe complication of cirrhosis. No specific score is currently validated to assess prognosis in this setting. We aimed to evalua... INTRODUCTION: Upper gastrointestinal bleeding (UGIB) due to portal hypertension (PH) is a severe complication of cirrhosis. No specific score is currently validated to assess prognosis in this setting. We aimed to evaluate the performance of the CAGIB score in predicting recurrence and early mortality following upper gastrointestinal bleedingin in cirrhotic patients. METHODS: We conducted a retrospective study including cirrhotic patients hospitalized for uppergastrointestinal bleedinginrelatedportal hypertension from 2012 to 2022. The following scores were calculated: CHILD-PUGH, MELD, MELD-Na, MELD 3.0, ALBI, ROCKALL, GBS, NLR, and CAGIB. Their performance in predicting early recurrence (≤5 days), short-term recurrence (≤6 weeks), and early mortality (≤6 weeks) was compared using ROC curves. RESULTS: A total of 105 patients were included (mean age 63 years; F/M ratio 1.05). Bleeding originated from oesophageal varices in 94.3% of cases. Endoscopic treatment was performed in 96 patients (endoscopic band ligation in 90 cases). Short-term recurrence occurred in 20%, early recurrence in 3.8%, and early mortality in 13.3%. The CAGIB score was the best predictor of early recurrence (AUC=0.995; sensitivity=83.3%; specificity=99.6%) and early mortality (AUC=0.891; sensitivity=85.7%; specificity=83.5%) at a threshold ≥ -4.648. CONCLUSION: The CAGIB score demonstrated superior prognostic performance for early recurrence and mortality following UGIB due to portal hypertension. It appears to be a reliable and reproducible tool for risk stratification in cirrhotic patients.
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[Not Available].

Bimegdi FZ, Belaiche A, Ahid S

Tunis Med · 2026 Jan · PMID 42223433 · Publisher ↗

OBJECTIVE: The study shows the evolution of the market for medicines sold in pharmacies following the price revisions published by the Ministry of Health after the reform of the pricing system adopted in December 2013. M... OBJECTIVE: The study shows the evolution of the market for medicines sold in pharmacies following the price revisions published by the Ministry of Health after the reform of the pricing system adopted in December 2013. METHODS: This is a retrospective study carried out following the crossing of lists of official price review bulletins published on the website of the General Secretariat of the Government and sales data for medicines between 2010 and 2018. RESULTS: Between 2010 and 2018, the total private market for generic and originator medicines recorded an average annual growth of +3% in volume and +3.7% in turnover. Between 2015 and 2018 and after the implementation of the reform, it rose from +1.1% to +3.9%. Once the price revisions were applied, the sales volume of generic medicines recorded an average annual growth of +3.5%, compared to +5.1% for their turnover (2015 and 2018). However, the sales volume of originator medicines recorded negative average annual growth (-0.7%). As for the segment of medicines affected by price reductions, between 2015 and 2018 it experienced negative average annual growth in volume (-0.8%), while its growth in turnover was positive (+3.3%). CONCLUSION: Following the adoption of the terms of Decree 2-13-852 and the application of the revisions, the private medicines market has seen variable growth.
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Risk factors for recurrence of pulmonary tuberculosis in properly treated patientsand declared healed.

Ben Jemia E, Trimech S, Ouertani H … +3 more , Rejaibi S, Ben Amar J, Zaibi H

Tunis Med · 2026 Jan · PMID 42223432 · Publisher ↗

INTRODUCTION: Despite the national tuberculosis control program in Tunisia, and the efforts made by the health authorities, a relapse-free cure for pulmonary tuberculosis (TB) remains elusive and not always guaranteed. T... INTRODUCTION: Despite the national tuberculosis control program in Tunisia, and the efforts made by the health authorities, a relapse-free cure for pulmonary tuberculosis (TB) remains elusive and not always guaranteed. This study aimed to identify risk factors for pulmonary tuberculosis recurrence among adequately treated patients who had been declared healed. METHODS: We collected records of patients treated for the first episode of TB in the pulmonology department of Charles Nicolle Hospital of Tunis between 2013 and 2021. Every patient had at least one year follow-up after the end of treatment. Two groups were identified: patients with TB recurrence (G1) and patients without TB recurrence (G0). RESULTS: We analyzed data of 140 patients treated for TB, and 12 patients had a TB recurrence (G1: 8.6%). G1 patients were significantly older (45 years vs 42 years, p=0.013). There was no significant difference between groups in terms of gender-ratio (p0.05), tobacco intoxication (p0.05), substance abuse (p0.05), nor comorbidities (p0.05). However, G1 patients had a more frequent history of incarceration (p0.001). Time to consult and time to bacteriological confirmation of TB didn't differ between groups. Evolution was characterized by a slower clinical improvement (p=0.006) and a longer time of bacilloscopic negativity in G1 (p=0.048). Multivariate analysis showed that the delay in clinical improvement beyond 30 days (OR=9.79; 95% CI=1.77-54.05; p=0.009) and the delay in bacilloscopic negativity (OR=4.93; 95% CI=1.06-22.92; p=0.042), were independent risk factors associated with TB recurrence. CONCLUSIONS: Pulmonary TB recurrence concerns mainly patients with a delayed time to bacilloscopic negativity and a slower clinical improvement, particularly beyond 30 days. These at-risk patients require specific follow-up to prevent this complication.
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Immune thrombocytopenia in children: An observation a study inTunisia.

Khirallah S, Azza E, Bahri M … +3 more , Hsasna R, Ben Abdennebi Y, Aissaoui L

Tunis Med · 2026 Jan · PMID 42223431 · Publisher ↗

Immunevthrombocytopenic purpura(ITP)in children is a heterogeneous condition,varying in Clinical features, need for treatment and outcome. Our study aimed to describe epidemiological, clinical and therapeutic data of ITP... Immunevthrombocytopenic purpura(ITP)in children is a heterogeneous condition,varying in Clinical features, need for treatment and outcome. Our study aimed to describe epidemiological, clinical and therapeutic data of ITP inourcenter.This study included patients aged between 2 and 18 years old,diagnosed with ITP duringa17-years period in the pediatric hematology department at Aziza Othmana hospital,in Tunisia. Thirty-one children were followed up for ITP during the study's period,with a mean age of 15 years old [2-18]. Eighteen patients(58%)had mild bleeding while 4patients(13%)had severe hemorrhage. Buchanan score was higherthan2 in12patients (39%).The median platelet count was 14 G/L[1-85]. No etiology was identified in any of them. Eighteen patients were treated by oral corticosteroids(1mg/kg),2 by intravenous corticosteroids and 4 by oral corticosteroids (4 mg/kg)in association with intravenous immunoglobulins.Therest of patients, were not in indication for medical treatment.Among the treated patients,63%had a complete response, 29% a partial response and8%were cortico-resistant. Seven patients were corticosteroid-dependent.Twelve patients relapsed(46%)with a median delay of relapseof31months [11-106].As a second line treatment, 10 patients were treated by corticosteroids(1 mg/kg), just one patient had a splenectomy.Management of ITP in children,represents are al challenge. Although corticosteroids and immunoglobulinare effective as first line therapy,the high rate of relapse high lights theneed to improve new therapeutic strategies for second-line treatment. 22.
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Evaluation of the prosthetic space in completely edentulous Moroccan patients: a cross-sectional study.

Hani A, Daoudi F, Bouklouze A … +2 more , Merzouk N, Fajri L

Tunis Med · 2026 Jan · PMID 42223430 · Publisher ↗

INTRODUCTION: In completely edentulous patients, the prosthetic space corresponds to the area available for denture integration. Its evaluation relies on inter-ridge height, ridge dimensions, and the degree of alveolar r... INTRODUCTION: In completely edentulous patients, the prosthetic space corresponds to the area available for denture integration. Its evaluation relies on inter-ridge height, ridge dimensions, and the degree of alveolar resorption, which condition the functional and esthetic outcome of prosthetic rehabilitation. OBJECTIVE: To assess prosthetic space parameters in completely edentulous Moroccan patients and identify associated factors. METHODS: A cross-sectional study was conducted on 50 completely edentulous patients consulting for bimaxillary rehabilitation at Ibn Sina Hospital, Rabat. After recording the maxillomandibular relationship, secondary casts were mounted on an articulator to measure inter-ridge height, ridge dimensions, and arch perimeters. Maxillary and mandibular resorption were classified using Cawood and Howell's classification. Data were analyzed with Jamovi 2.6.13. RESULTS: Inter-ridge height was greater at the median level [2 cm (1.7-2.2 cm) right; 1.95 cm (1.7-2.3 cm) left] and lower at the tuberosity-trigone level [0.95 cm (0.7-1.48 cm) right; 1.05 cm (0.8-1.48 cm) left] (p < 0.001). Maxillary resorption was predominantly classified as type III, whereas mandibular resorption mainly corresponded to classes IV and V, both anteriorly and posteriorly (p < 0.001). Age was significantly associated with anterior mandibular resorption (p < 0.05), and the duration of edentulism correlated with resorption in both arches (p < 0.05). CONCLUSION: The joint evaluation of inter-ridge height, ridge perimeters and dimensions, as well as resorption profiles allows for an objective and comprehensive analysis of prosthetic space in edentulous patients.
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[Not Available].

Mekni S, Mghirbi A

Tunis Med · 2026 Jan · PMID 42223429 · Publisher ↗

INTRODUCTION: Digital tools, particularly video capsules, offer a promising alternative to traditional methods for optimizing the learning of procedural skills, such as the monofilament test. Few studies have evaluated t... INTRODUCTION: Digital tools, particularly video capsules, offer a promising alternative to traditional methods for optimizing the learning of procedural skills, such as the monofilament test. Few studies have evaluated their relevance in this specific context. The objective of this study was to evaluate the impact of an educational video capsule on medical students' learning of the monofilament test. METHODS: A prospective study was conducted over a four-month period with second-cycle medical students (DCEM2). Student performance was assessed before and one week after viewing a video capsule detailing the monofilament test procedure. Student satisfaction was also gathered via a questionnaire (using a Likert scale assessment). RESULTS: Twenty-one students were included in the study. After viewing the video capsule, a statistically significant improvement in the median number of correctly performed steps was observed (7 [5.5; 10] vs 11 [10; 13], p 10⁻³). For half of the assessed steps, the increase in the number of students performing them correctly was statistically significant after viewing. After watching the video, 16 students were able to correctly interpret the test. The vast majority of students reported that the video helped them better understand both the procedural steps (n=20) and the test's interpretation (n=18). CONCLUSION: Our results suggest that the video capsule is a relevant and effective educational tool for teaching a procedural clinical skill such as the monofilament test.
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Agile Human Resource Management in Healthcare Organizations: A Scoping Review.

El Faqir A, Loukili Idrissi L

Tunis Med · 2026 Jan · PMID 42223428 · Publisher ↗

This study aims to explore the application of Agile Human Resource Management (Agile HRM) practices within healthcare organizations, identifying key practices, their impact on healthcare performance, and existing researc... This study aims to explore the application of Agile Human Resource Management (Agile HRM) practices within healthcare organizations, identifying key practices, their impact on healthcare performance, and existing research gaps.A scoping review was conducted in accordance with PRISMA guidelines. From an initial set of 46 articles retrieved from major academic databases, 5 met the inclusion criteria and were analyzed in detail.The review highlights Agile HRM practices, including iterative planning, continuous improvement, evidence-based decision-making, and fostering self-organized, interdisciplinary teams. These practices are associated with improved service accessibility, reduced patient wait times, enhanced care quality, and higher staff engagement and productivity. However, significant research gaps remain, including the lack of robust empirical studies, limited longitudinal research, and the absence of healthcare-specific frameworks for Agile Human Resource Management.
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Epidemiological profile and risk factors of community-acquired caused by enterobacteria strains producing ESBL urinary tract infections in Tunisian children.

Nouir S, Mabrouk S, Mansar S … +6 more , Hannachi S, Azouzi F, Boukadida R, Harbi A, Mokni H, Ajmi H

Tunis Med · 2026 Jan · PMID 42223427 · Publisher ↗

INTRODUCTION: The rise in community-acquired urinary tract infections (UTI) caused by enterobacteria strains producing extended spectrum beta-lactamase (ESBL) in children has complicated treatment strategies. OBJECTIVE:... INTRODUCTION: The rise in community-acquired urinary tract infections (UTI) caused by enterobacteria strains producing extended spectrum beta-lactamase (ESBL) in children has complicated treatment strategies. OBJECTIVE: This study aimed to evaluate risk factors associated with ESBL-producing UTIs in pediatric patients and analyze the antibiotic resistance patterns of the causative pathogens. METHODS: A six-year cross-sectional study (January 2019-December 2024) was conducted at Sahloul University Hospital's pediatric department, including children under 15 years hospitalized with community-acquired UTIs. RESULTS: A total of 383 UTI were included with 20.4% of UTI caused by ESBL producing strains. Females represented 62.66% (sex ratio=0.59). The median patient age was 11 months [3-66]. Escherichia coli and Klebsiella pneumoniae were the most common isolates (80.4% and 12.27%). Common risk factors included prior antibiotic use (41%), hospitalization in the past year (30.81%), recurrent UTIs (20.89%), and the presence of malformative uropathy (8.62%). Multivariate analysis confirmed only prior hospitalization (≤12 months) as an independent factor with ESBL strains (p = 0.005). CONCLUSION: The increasing prevalence of ESBL-related UTIs in children calls for stricter antibiotic stewardship and ongoing surveillance of resistance trends in this population.
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Prevalence and Spectrum of Chromosomal Abnormalities in 1366 Infertile Tunisian Men: A retrospective observational study.

Bellil H, Kraoua L, Braham M … +13 more , Chakroun M, Maazoul F, Fadhlaoui A, Ben Mefteh M, Bouzouita A, Mathlouthi N, Bouguerra B, Chibani M, Ben Slama MR, Zhioua F, Ben Jemaa L, Mrad R, Trabelsi M

Tunis Med · 2026 Jan · PMID 42223426 · Publisher ↗

INTRODUCTION: Chromosomalabnormalities are a well-documented cause of male infertility, particularly in patients with severe sperm defects such as azoospermia. AIM: To assess the prevalence and types of chromosomalabnorm... INTRODUCTION: Chromosomalabnormalities are a well-documented cause of male infertility, particularly in patients with severe sperm defects such as azoospermia. AIM: To assess the prevalence and types of chromosomalabnormalities in infertile men referred for cytogenetic analysis over a 19-year period, and to explore genotype-phenotypecorrelation. METHODS: Were trospectively analyzed 1366 karyo types performed between 2006 and 2024 in patients with abnormal semen parameters, referred at the Genetics Department of Charles Nicolle Hospital in Tunis for genetic investigations. Data were collected from medical records and laboratory reports. Standard karyotypingwasperformed in all cases, supplemented by fluorescence in situ hybridization (FISH) and Y chromosome microdeletion analysis when indicated. RESULTS: A total of 117 chromosomalabnormalities were identified among the 1366 infertile men, corresponding to a global prevalence of 8.5%. The most frequent clinical presentation was azoospermia, accounting for 60.3% of patients with chromosomalabnormalities. Numerical chromosomalabnormalities accounted for 80.3% (n = 94) of all detected cases. The most prevalent was Klinefelter syndrome, foundin 85 patients, representing 72.6% of all anomalies. Among patients with Klinefelter syndrome, 96.4% had non-obstructive azoospermia. Structural abnormalitieswereobservedin 23 patients (19.6%), comprisingbalanced translocations, inversions, Robertsonian translocations, and unbalancedchromosomal anomalies such as Yqdeletions and supernumerary marker chromosomes. CONCLUSION: Cytogenetic abnormalities were detected in nearly 8.5% of infertile men. Thesefindings support the utility of systematickaryotype.
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[Not Available].

Ben Abdelaziz A, Zanina Y, Adaily N … +3 more , Moncer R, Khelil M, Ben Abdelaziz A

Tunis Med · 2026 Jan · PMID 42223425 · Publisher ↗

OBJECTIVE: To describe the editorial, methodological, and thematic typology of biomedical publications in the journal "La Tunisie Médicale" (Tunis Med) over a 20-year period. METHODS: This was a bibliometric study of pub... OBJECTIVE: To describe the editorial, methodological, and thematic typology of biomedical publications in the journal "La Tunisie Médicale" (Tunis Med) over a 20-year period. METHODS: This was a bibliometric study of publications in Tunis Med (ISSN 0041-4131) between 2000 and 2019, based on MEDLINE consultation (via Web of Science), using MeSH descriptors, in the two decades A (2000-2009) and B (2010-2019). RESULTS: Between 2000-2019, 4,135 publications (A=1,989;B=2,146) were published by Tunis Med by 12,402 authors (A=6,156;B=8,150), and indexed by 5,153 MeSH descriptors (A=3,554;B=3,616). Classified mainly in the research areas "Pediatrics" (30%) and "Geriatrics/Gerontology" (26%), their "MeSH Qualifiers" were mainly clinical: "diagnosis" (37%), "Etiology" (28%) and "Complications" (24%). While writing in English increased considerably (A=8%;B=54%), the measures "Survival" (A=29;B=16) and "Multivariate Analysis" (A=9;B=11) continued to be little applied. Biological factors ("Pregnancy", "Age", "Consanguinity") and those associated with health systems ("Hospitalization", "Patient Satisfaction", "Length Of Stay") were the most studied health determinants. Neoplastic and cardiovascular diseases were the most explored health problems, including "Lung Neoplasms" (A=32;B=51), «Kidney Neoplasms» (A:10; B:25), "Bone Neoplasms" (A=17;B=28), "Hypertension" (A=31;B=26), "Myocardial Infarction" (A=26;B=15), and "Heart Failure" (A=16;B=7). The most explored surgical procedures were: "Laparoscopy" (A=33;B=31), "Cesarean Section" (A=21; B=15), and "Kidney Transplantation" (A=10;B=14). CONCLUSION: Between 2000-2019, Tunis Med publications focused on non-communicable diseases. Despite transitioning to English, they rarely employed advanced statistical measures and high-level evidence-based study designs. Strengthening their methodological approaches is essential to enhance the journal's international visibility and reputation.
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[Not Available].

Ben Abdelaziz A, Zanina Y, Ben Ghorbel I

Tunis Med · 2026 Jan · PMID 42223424 · Publisher ↗

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Psychosocial and academic impact of blood transfusion-dependent diseases on children.

Maaloul I, Nakti M, Rekik T … +5 more , Ben Fraj I, Ouderni M, Chabchoub I, Aloulou H, Kamoun T

Tunis Med · 2026 Jan · PMID 42223423 · Publisher ↗

INTRODUCTION: Children with transfusion dependant diseases are confronted with multiple physical, psychosocial and cognitive obstacles, which touches significantly on their well-being and quality of life. AIM: to assess... INTRODUCTION: Children with transfusion dependant diseases are confronted with multiple physical, psychosocial and cognitive obstacles, which touches significantly on their well-being and quality of life. AIM: to assess the quality of life of children with transfusion-dependent diseases using the PedsQL 4.0 scale. METHOD: This was a descriptive and a cross-sectional study conducted on children with chronic regular transfusion therapy in the paediatric department A of Hedi Chaker Hospital in Sfax, Tunisia between December 2024 and Mai 2025. We collected demographic informations about the children and their families and the clinical characteristics of the disease. The quality of life was assessed using the PedsQL 4.0 Generic score scales for children aged over 5 years old. RESULTS: Fifteen children requiring chronic transfusion therapy were included. Eleven families belonged to a low socio-economic class. The mean score of the children's quality of life was 58.3%. The quality-of-life dimension with the highest score was the social function with a mean score of 67% while the dimension with the lowest score was the physical function with a mean score of 50.6%. CONCLUSION: Transfusion dependant diseases have major negative impact on the daily lives of affected patients. Understanding the challenges faced by these children and their families is important to guide management decisions aimed not only at prolonging life, but also at improving their overall quality of life.
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Clinical impact of a structured exercise-training program in a sample of North African male patients with stable angina: A pilot study.

Bouhlel I, Darragi D, Ben Ayed K … +4 more , Dardouri S, Ben Rejeb O, Ben Saad H, Latiri I

Tunis Med · 2026 Jan · PMID 42223422 · Publisher ↗

INTRODUCTION: No previous Tunisian or North African study, till September 2025, haveevaluated the value and necessity of an exercise-training program (ETP) as crucial therapeutic strategies for patients with stable coron... INTRODUCTION: No previous Tunisian or North African study, till September 2025, haveevaluated the value and necessity of an exercise-training program (ETP) as crucial therapeutic strategies for patients with stable coronary artery disorders. The main aim of the present study was to evaluate the effects of an ETP on exercise data determined during the 6-min walk test (6MWT) and treadmill stress test in patients with stable angina. METHODS: This prospective experimental pilot study was carried out at Farhat Hached cardiology, and physiology and functional explorations departments (Sousse, Tunisia). Eleven males who had stable angina for longer than three months were included in the study. The Karvonen formula was used to establish the intensity of the ETP, which included 24 sessions of combined endurance and resistance training (three sessions per week for eight weeks). Physical fitness data determined during the 6MWT and treadmill stress test were evaluated pre- and post- ETP. RESULTS: When comparing pre- and post-ETP assessments, there were significant changes in i)6-min walk distance (+ 61m), resting heart rate (-9 bpm), and end walk systolic blood pressure (+ 4.25 mmHg) determined during the 6MWT, and ii) maximal heart rate (+9 bpm), speed (+ 1.41 km/h), elevation of the treadmill slope (+ 2.25%), and bearing (+ 0.91) determined during the treadmill stress test. CONCLUSION: Patients with stable angina were able to exercise more effectively thanks to ETP.
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Unplanned Hemodialysis Initiation inTunisia: Clinical Profile and Predictors of Early Mortality in a Prospective Cohort.

Hadj Brahim M, El Ati Z, Ayed A … +4 more , Mlouki I, Dahmane R, Hadhri A, Jaballah L

Tunis Med · 2026 Jan · PMID 42223421 · Publisher ↗

AIM: Unplanned hemodialysis (HD) initiation is associated with increased mortality. This study aimed to characterize clinical profiles and identify predictors of early mortality in Tunisian HD patients. METHODS: A prospe... AIM: Unplanned hemodialysis (HD) initiation is associated with increased mortality. This study aimed to characterize clinical profiles and identify predictors of early mortality in Tunisian HD patients. METHODS: A prospective cohort study was conducted at Tahar Sfar University Hospital, Mahdia, Tunisia, between June 2022 and June 2023, with follow-up until June 2024. A total of 125 adult patients initiating chronic HD were enrolled. Data on demographic, clinical, biochemical, and dialysis-related parameters were collected. Survival analysis was performed using Kaplan-Meier and Cox regression methods. RESULTS: The mean age was 59 ± 15years, with male predominance (57.6%). Diabetic nephropathy (36.8%) and chronic tubulointerstitial nephropathy (26.4%) were the leading causes of ESRD. Only 13.2% of patients-initiated HD in a planned manner; 50.4% started due to uremic symptoms and 28.1% due to volume overload. Vascular access was predominantly central venous catheters(70.4%), with only 20% having a mature arteriovenous fistula (AVF). The mean eGFR at HD initiation was 6.2 ± 2.4 mL/min/1.73 m². During follow-up (median: 15 months), 20.8% of patients died, with 34.6% of deaths occurring within the first three months. On univariate analysis, heart failure, AVF thrombosis, fewer than three HD sessions per week, and lack of prior nephrology referral were associated with higher mortality. Multivariate analysis identified dialysis frequency <3 sessions/week as the sole independent predictor of mortality (HR: 0.19; 95% CI: 0.042-0.9; p = 0.036). CONCLUSION: Unplanned HD initiation remains common in our setting, with high early mortality. Inadequate dialysis frequency significantly impacts survival......( abstract truncated at 250 words).
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Surgical site infections: A prospective study in a pediatric surgery center in resource-limited setting.

Belhassen S, Toumi A, Ben Fredj M … +9 more , Mosbahi S, Ben Youssef S, Ben Hawala I, Sfar S, Ksia A, Mekki M, Belghith M, Chakroun S, Sahnoun L

Tunis Med · 2026 Jan · PMID 42223420 · Publisher ↗

AIM: This study aimed to measure the incidence of surgical site infections (SSI) in pediatric population, identify the primary characteristics and risk factors associated with SSI, and propose practical recommendations f... AIM: This study aimed to measure the incidence of surgical site infections (SSI) in pediatric population, identify the primary characteristics and risk factors associated with SSI, and propose practical recommendations for controlling and preventing these infections. METHODS: A prospective study was conducted over a 4-month period from February 1 to June 1, 2024, in the Pediatric Surgery Department of Monastir. All patients admitted, operated on, and followed up in the department during this period were included, with specific exclusions. Data on patient demographics, surgical details, and outcomes were collected daily. Statistical analysis involved both univariate and multivariate approaches to identify significant risk factors. RESULTS: Among the 414 pediatric patients included in the study, the incidence of surgical site infection (SSI) was 3.3%, with an incidence density of 11.9 cases per 1,000 hospital days. The analysis of individual and surgical risk factors for SSI identified several significant associations: Neonates and infants (<2 years) were at higher risk (p=0.039), as were patients with drains (p=0.000) or gastric tubes. In terms of surgical risk factors, non-ambulatory surgeries (p=0.002), emergency procedures (p=0.013), surgeries classified as Altemeier class III or IV (13% vs. 2%, p=0.000), a higher NNIS score, and extended postoperative hospital stays compared to home discharges (p=0.001) were all associated with increased risk. Multivariate analysis revealed that the presence of a drain, age under 2 years, and an NNIS score of 1 or higher were independent risk factors for developing SSI....( abstract truncated at 250 words).
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Percutaneous mitral commissurotomy in pregnant women: Immediate and long-term outcomes.

Boudiche S, Farhati A, Haboubi S … +17 more , Abbassi M, Chedly M, El Ayech Boudiche F, Jebbari Z, Ben Salem A, Ezzaouia K, Besbes B, Daly F, Ben Rejeb R, Sebki D, Bounaoues I, Gouader M, Mghaieth F, Ouali S, Larbi N, Ben Halima M, Mourali MS

Tunis Med · 2026 Jan · PMID 42223419 · Publisher ↗

BACKGROUND: Rheumatic mitral stenosis (MS) is prevalent in developing countries. Poorly tolerated during pregnancy, MS is often requiring urgent intervention. OBJECTIVES: This study aimed to evaluate immediate and long-t... BACKGROUND: Rheumatic mitral stenosis (MS) is prevalent in developing countries. Poorly tolerated during pregnancy, MS is often requiring urgent intervention. OBJECTIVES: This study aimed to evaluate immediate and long-term outcomes after percutaneous (PMC) in pregnant women. METHODS: Observational retrospective study of pregnant women who underwent PMC for severe MS between January 2008 and December 2018. Primary endpoint was procedural success (mitral valve area > 1.5 cm²) without complications. RESULTS: 39 patients. Mean age 34.2±5.1 years. Mean gestational age 28.2±4.9 weeks. PMC was successful in 37 patients (94.8%). There was no maternal mortality. Two procedures failed (1 transseptal puncture failure and 1 severe traumatic mitral regurgitation requiring emergent surgery). If successful, PMC allowed the pursue of pregnancy until full term and vaginal delivery in 36 (92.3%) and 20 (51.3%) patients, respectively. One in utero foetal demise and one neonatal death occurred. At 56.1-month, after exclusion of three patients with prompt surgical valve replacement, there were 7 cases of mitral restenosis (19.4%) with Wilkins score >8, suboptimal result (valve area between 1.5 and 1.8 cm²) and incomplete bicommissural splitting as predictive factors. All babies maintained normal growth and development. CONCLUSION: This study confirmed effectiveness and safety of PMC during pregnancy when performed by an experienced team with a procedural success of 94.8% but at the cost of a restenosis rate of 19.4% at 56.1 months. These were predicted, in addition to Wilkins score, by a suboptimal but accepted immediate result of the procedure, still allowing a step forward.
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Investigation of inflammatory cytokines and new biomarkers in ischemic heart diseases.

Bouhlel I, Jaoued F, Ben Youssef Y … +6 more , Amer MH, Esmail AA, Saoudi W, Ellini H, Ernez Hajri S, Mahdhaoui A

Tunis Med · 2026 Jan · PMID 42223418 · Publisher ↗

UNLABELLED: Introduction-Aim: Ischemic heart disease is a leading cause of global mortality and morbidity,resulting from reduced blood supply to the heart. Biomarkers are pivotal in diagnosing and under standing the dise... UNLABELLED: Introduction-Aim: Ischemic heart disease is a leading cause of global mortality and morbidity,resulting from reduced blood supply to the heart. Biomarkers are pivotal in diagnosing and under standing the disease. This study explores the utility of new biomarkers(cytokines,PLA2(phospholipase A2),hs-CRP (high-sensitivityC-reactiveprotein),PCT(procalcitonin),H-FABP(Heart-type fattyacid-bindingprotein)) for diagnosing ischemic heart diseases. METHODS: Conducted at Nasiriyah Heart Hospital,Iraq,from October 2021 to October 2022,the study Included 86 stable angina patients,50 acute myocardial infarctions(MI)(myocardial infarction) patients, and healthy controls.Serum levels of biomarkers and inflammatory cytokines(TNF α(tumornecrosisfactoralpha),IL-1β(interleukin-1beta),IL-6(interleukin-6),IL-9 (interleukin-9))were measure dusing ELISA(enzyme-linkedimmunosorbentassay) and immunoassays. RESULTS: Instable angina,the study showed that the level of troponinI didn't significantly change in patients with stable angina. However, compared with healthy controls, patients showed a significant increase in serum levels of CK-MB(creatinekinase-MB),myoglobin,hs-CRP,H- FABP,Lp-PLA2(lipoprotein-associated phospholipaseA2),and PCT.Significantly elevated levels of serum IL-6,IL-1ß, IL-9, andTNF-αwere also recorded in patients with stable angina compared to healthy controls. In IMI group, the study revealed that serum troponin I level was insignificantly changed.However,compared with controls, a significant increase in the level of myoglobin,CK-MB,hs-CRP,Lp-PLA2,PCT,andH-FABPwere recorded.Significantly elevated levels of serumTNF-α,IL-9,IL-6,andIL-1β were also noted in the patients in comparison with healthy controls. CONCLUSION: Novel biomarkers suchas H-FABP,PCT, Lp-PLA2,andcytokines are valuable diagnostic tools for ischemic heart disease, along side traditional markers like TroponineI,CK-MB,and myoglobin.Targeting cytokines with monoclonal antibodies could enhance therapeutic strategies.
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STSM 2025 & 2nd African Medical Writing Congress.

Adaily N, Abbassi A, Abbes M … +559 more , Abdeljabbar A, Abdeljelil M, Abderrahim M, Abdellatif S, Abidi M, Achour M, Achour R, Achour W, Ackari K, Akacha A, Akremi S, Aloui A, Aloui F, Aloui H, Alouani H, Allouche H, Allouche M, Amri MS, Ammar A, Ammar MA, Ammous A, Anoun J, Annabi H, Antit S, Arbaoui I, Ardhaoui M, Arfaoui B, Arrari F, Atitallah S, Ayadi Dahmane I, Ayadi S, Ayari M, Ayedi Y, Ayed W, Ayoub R, Azzaz S, Baccar M, Baccouche K, Bahlouli E, Bahria MA, Bahri G, Bakir A, Baklouti S, Balhi S, Balti Y, Bamri MA, Bani M, Baradai N, Baradai S, Baroudi A, Bayar C, Baya W, Bejaoui M, Beji R, Bekakria FZ, Bekir O, Belgaroui L, Bel Hadj I, Belhaj Mabrouk E, Belhajmabrouk E, Bellali M, Bellakhal S, Bellil M, Ben Abdallah H, Ben Abderrahim S, Ben Abid H, Ben Achour T, Ben Afia L, Ben Abdelghani K, Ben Akacha A, Ben Ali H, Ben Ali M, Ben Amar W, Ben Amara I, Ben Ammar L, Ben Aoun H, Ben Aoun S, Ben Arbia N, Ben Ayed H, Ben Ayed M, Ben Azouz C, Ben Azouz S, Ben Chaalia C, Ben Charef E, Ben Chihi F, Ben Dhafer H, Ben Fatma NE, Ben Ftima A, Ben Ftima MA, Ben Fredj F, Ben Fredj H, Ben Haj Slimen N, Ben Hamadou H, Ben Hamida E, Ben Hamida M, Ben Hassine D, Ben Hassine H, Ben Hassine I, Ben Houria B, Ben Jabra S, Ben Jaafer S, Ben Jeddou K, Ben Jmeaa M, Ben Kadhi A, Ben Khaled M, Ben Khalifa MO, Ben Khalifa MB, Ben Lahouel S, Ben Mansour K, Ben Mahmoud N, Ben Masoud N, Ben Messaoud M, Ben Mehrez C, Ben Mrad M, Ben Moussa M, Ben Othmen M, Ben Othmen W, Ben Rahma S, Ben Romdhane F, Ben Romdhane M, Ben Saad H, Ben Saidane S, Ben Saleh M, Ben Safta A, Ben Slimen NE, Ben Slimene L, Ben Turkia H, Benabdallah A, Benammar C, Benayed H, Benhaj Slimen N, Beni Kaab B, Berkhaies D, Bettaieb H, Béchir K, Bibi M, Bibani N, Bizid M, Blagui O, Boucherb M, Bornaz S, Bou Okkez N, Bouafif Ben Alaya N, Bouafsoun A, Bouajina E, Bouallegue L, Bouasker I, Bouaziz A, Bouaziz M, Bouaziz Y, Bouguerra B, Bouguerra S, Bouhafs K, Boukhzar R, Boukthir S, Boumaiza A, Bounatirou C, Boussaa H, Boussabon M, Boussabeh E, Boussebeh I, Boussetta K, Boussetta S, Bouzgarou L, Bouzgarrou L, Bouzidi A, Braham R, Brahem A, Brahem M, Brahim D, Bradai S, Braday Y, Chabene A, Chaabouni W, Chaabene A, Chaouch MA, Chaouech N, Chaouki M, Chabra K, Chabbou A, Chagra I, Charrada K, Charfi F, Charfi MR, Chebbi A, Chebbi R, Chebil D, Chehaider A, Cheikhrouhou Abdelmoula L, Chekili W, Cherif D, Cherif H, Cherif K, Chermiti I, Chennoufi C, Chikhaoui B, Chine O, Chkili W, Chmak J, Chourabi C, Chourabi S, Chouchane C, Chouchane S, Chroufa M, Chtioui H, Dabbebi H, Daghsni S, Dalleli A, Daoud F, Debbabi H, Debbiche A, Debbiche R, Debiche S, Debbeche R, Derbala W, Derbel B, Derbel O, Derbali H, Dhaheri R, Dhahri R, Dhieb A, Dhaouadi S, Dhaouhi N, Dhaoui S, Dlensi A, Doghri S, Douggui H, Dribek W, Drira A, Drira C, Ebdelli I, Elaid R, El Amri N, El Ayech F, El Kara F, El Mhamdi S, Elmalel O, Ellouze I, Elmansouri Y, Erray R, Essafi A, Essadam L, Fadhel R, Fakhfekh R, Fazaa A, Fazaa I, Fehri W, Fekih M, Fenniche I, Ferchichi S, Fermas N, Fitouri S, Fitouri Z, Fourati H, Frikha H, Frigui S, Gabteni L, Gaied H, Gamara FZ, Gamara K, Gargouri D, Gargouri M, Gannoun N, Gassara Z, Gattoussi M, Gharbi G, Gharbi R, Ghedira T, Ghadhoune H, Gharsallah I, Gharsallah N, Ghazali H, Ghenim A, Ghenimi A, Gherissi O, Ghozzi A, Gmati S, Gnaba I, Gongi Y, Goucha R, Grami N, Grissia S, Guedria A, Guibene W, Guissouma J, Hafsa M, Hafyene A, Haggui A, Hajji H, Hajjaji M, Hajlaoui A, Hajlaoui N, Hammami I, Hammami MA, Hammami O, Hammami R, Hamzaoui L, Hamzaoui L, Hannachi MA, Harizi C, Harrath M, Harrathi C, Hasni N, Hasni Y, Hassad A, Hassine H, Hebaieb F, Hechaichi A, Hentati H, Hidouri S, Hidoussi S, Houimli S, Houatmi A, Hrairi A, Hrizi H, Ibtissem K, Iheb C, Jabri MA, Jaouadi J, Jalleli J, Jarboui N, Jarraya E, Jebri A, Jebri R, Jedidi L, Jelassi D, Jemli S, Jenhani E, Jerbi A, Jerbi S, Jlidi S, Jmal A, Jmal L, Jmal Hammami K, Jomaa O, Jomni T, Jouini Z, Jrad K, Jridi M, Kadri Y, Kadhi A, Kacem I, Kahloul M, Kaabi L, Kallala R, Kamoun C, Kamergi T, Kammoun J, Karmous J, Karoui S, Karrat G, Kchir H, Khedher R, Khedhiri N, Khemissia F, Khemiri W, Khezami MA, Khaskhoussy M, Khallouli A, Khouildi A, Khsiba A, Khribiche A, Kitar M, Kooli J, Korbi I, Kort I, Kotti N, Kraoua I, Kristou F, Krifa N, Laabidi A, Laabidi S, Laamiri G, Laatar A, Ladhari N, Langar E, Lazzem A, Lebib S, Letaief H, Louati C, Loukil H, Louzir B, Loussaief C, Maalej A, Maalej I, Maamri H, Maamouri N, Maaoui R, Mabrouk R, Mahmoudi M, Mahmoudi W, Mahfoud A, Mahfoudhi A, Mahfoudhi H, Majdoub W, Majoul MS, Majouli G, Malek M, Malek M, Malouche S, Mallek Z, Mannai MC, Manoubi SA, Marai AE, Marai A, Marzouk G, Marzouk I, Massoudi C, Massoudi Y, Meddeb T, Meddeb S, Medhioub M, Meherzi M, Mechergui N, Mefti K, Mezri S, Mersni M, Mesbahi M, Messelmani M, Mhamdi S, Mhamdi A, Mighri MG, Miladi A, Miladi S, Mizouni R, Mkhinini H, Mlaieh S, Mlayah S, Mokaddem S, Mokhtar A, Monastiri S, Mosbahi B, Mouelhi D, Mouelhi G, Mouelhi L, Mouhli N, Mouli N, Moussi M, Mrazguia C, Msalhi M, Mtaouaa S, Mnasria S, Mzabi A, Naceur I, Naffouti A, Nalouti K, Nasri S, Nayet Mohamed K, Neji K, Nouicer M, Nouira R, Nouira Y, Oualha O, Ouerfelli N, Ouerghi R, Oueslati A, Oueslati Y, Oumaya M, Ouni M, Ounissi M, Ouini A, Rachdi I, Rakez K, Rahali H, Randaline A, Rania H, Rabhi E, Rezgui A, Rezgui E, Riahi S, Ridane D, Ridene I, Rim Dhahri R, Rmadi N, Saad H, Saad L, Saafi J, Safta F, Safta O, Said F, Saidani A, Sallem OK, Salleoui L, Samaali I, Samaali K, Sarraj R, Sboui I, Sefrihi FE, Seddik A, Sebai H, Sebai S, Selma D, Selmi J, Sellami F, Sellami N, Siala H, Sioud S, Sidi C, Skhiri A, Skhiri H, Slama F, Slaoui S, Smida H, Smiti M, Soltana E, Snène H, Souha B, Souli E, Soumaya S, Souissi S, Soussi Y, Somai M, Somri B, Sridi C, Taktak I, Tabka A, Tabka L, Tabka M, Taj M, Taamallah M, Tekiki S, Tebourbi Y, Tilouche S, Tlili S, Thaljawi W, Thabti R, Toumi A, Touinsi H, Trabelsi A, Trabelsi B, Trabelsi E, Trabelsi I, Trabelsi MM, Trabelsi Y, Trigui M, Turki E, Turki H, Yaakoub H, Yaakoub S, Yaakoubi C, Yaich S, Yacoub H, Yahyaoui N, Yahyaoui R, Yahyaoui S, Yangui F, Younes M, Youssef A, Zaafouri H, Zaidi B, Zaouche K, Zaouali F, Zaouali J, Zariat S, Zbiba W, Ziedi H, Zmantar I, Zribi M, Zouaghi MK

Tunis Med · 2026 Jan · PMID 42223417 · Publisher ↗

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Effect of combined Pain Neuroscience Education with Conventionnel Physiotherapy for patients with Chronic Low Back Pain: A Study Protocol for a Randomized Controlled Trial.

Iken A, Karkouri S, Messouber A

Tunis Med · 2025 Nov · PMID 41949972 · Publisher ↗

BACKGROUND: Chronic low back pain (CLBP) presents a major challenge for healthcare systems due to its significant physical, psychological, and economic impacts. Most affected patients have already tried various treatment... BACKGROUND: Chronic low back pain (CLBP) presents a major challenge for healthcare systems due to its significant physical, psychological, and economic impacts. Most affected patients have already tried various treatment methods, including physiotherapy, without significant benefit [1]. Thus, determining the best treatment method for these patients has always been a priority in clinical research. AIM: to determine whether a conventional physiotherapy program (CPP) combined with pain neuroscience education (PNE) is superior to a CPP alone in patients with CLBP. METHODS: This study is a single-blind randomized controlled clinical. Forty participants (n = 40) with CLBP will be randomly assigned equally between the two study groups (intervention group: "PNE + CPP," and control group: "CPP alone") according to the inclusion criteria. The primary outcome measure of the clinical trial is pain intensity. Secondary outcome measures will assess functional disability, kinesiophobia, pain catastrophizing, and quality of life. Results will be evaluated at baseline and at 4 weeks post-intervention. EXPECTED RESULTS: PNE, as a complementary therapy, is expected to have a positive impact on pain in patients with CLBP. The authors anticipate that PNE, when combined with a CPP, could improve functional capacity, reduce kinesiophobia and catastrophizing, and contribute to the overall improvement of quality of life in patients with CLBP.
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Congenital thrombopathies in southern Tunisia : A multicenter study.

Maaloul I, Charfi M, Ben Amor I … +6 more , Mejdoub Y, Hsairi M, Safi F, Gargouri L, Kamoun T, Elloumi M

Tunis Med · 2025 Nov · PMID 41949971 · Publisher ↗

INTRODUCTION: congenital thrombopathies (CTs) are rare bleeding disorders resulting from platelet dysfunction which may also be associated with thrombocytopenia. To date, the prevalence of CT in Tunisia has not been esta... INTRODUCTION: congenital thrombopathies (CTs) are rare bleeding disorders resulting from platelet dysfunction which may also be associated with thrombocytopenia. To date, the prevalence of CT in Tunisia has not been established. AIM: The aim of this study was to describe the various types of CT and the associated hemorrhagic manifestations observed in a cohort from southern Tunisia. METHODS: We retrospectively collected clinical and laboratory data of patients with CT who were followed up over 43 years (1982 - 2024) in the pediatric and hematology departements of a university hospital center in southern Tunisia. The diagnosis of thrombopathy was established based on flow cytometry analysis and/or light transmission aggregometry and/or molecular analysis. RESULTS: We identified 60 patients (35 men and 25 women). The mean age at diagnosis was 61.7 months (1 month-70 years). Consanguinity was noted in 71.6% of cases (n=43). A family history of thrombopathy was reported in 51.6% of cases (n=31). The presenting symptoms at diagnosis were spontaneous or provoked bleeding (n=56) and easy bruising associated with thrombocytopenia within the first 48 hours of life (n=1). The etiologies of the thrombopathies were as follows : Glanzmann thrombasthenia (n=54), Bernard Soulier syndrome (n=5) and Wiskott Aldrich syndrome (n=1). CONCLUSION: Glanzmann thrombasthenia was the most prevalent thrombopathy in our cohort, likely attributed to the high rate of consanguinity in our region.
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