La Tunisie Medicale[JOURNAL]
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200 papers
Non-urgent consultations in polyvalent emergency department: Proportion and contributing factors.
Hebaieb F, Ayachi Y, Naggara I … +2 more , Houimli S, Sahli J
Tunis Med · 2025 Dec · PMID 41949930 · Publisher ↗
INTRODUCTION: Overcrowding in emergency departments (EDs) is a concerning global problem with negative repercussions for patients and caregivers. It is partly due to non-urgent consultations. The aims of our study wereto...
INTRODUCTION: Overcrowding in emergency departments (EDs) is a concerning global problem with negative repercussions for patients and caregivers. It is partly due to non-urgent consultations. The aims of our study wereto determine the proportion of non-urgent ED visits and to identify factorsassociated. METHODS: Cross-sectional study with an analytical aim including patients aged over 15 years consulted a polyvalent ED during14-day period. Consultations were coded from 1 to 5 according to the Clinical Classification of Emergency Patients (CCMU). We compared 2 groups: group 1 with urgent consultation (CCMU 3,4 and 5) and group 2 with non-urgent consultation (classified CCMU 1 and 2). RESULTS: N= 589, mean age=42years with a female predominance (54.5%). Group 1 included 149 patients and the second Group 440 patients (74.7%). Patients were significantly younger in group 2 and 60.8% had social security coverage (p=0.006). Reasons that motivated the EDvisitwereproximity, search for a quick solution and ignorance of the appropriate health facility to attend (p<0.05). Independent factors of non-urgent ED visit were single status, self-referral to the ED, perception of the symptom as not severe, no attending physician, no history of similar symptoms, search for a quick solution, and patient-perceived need for further investigations. CONCLUSION: Easy access to investigations in EDs leads patients to consult them for non-urgent reasons. Better communication between them and basic health centers is recommended for the management of patients in CCMU 1 and 2 to avoid ED overload.
Satisfaction and quality of life of patients rehabilitated by new complete prostheses: A cross sectional study.
Harti I, Bagui M, Jabbari W … +3 more , Sakout M, Bouziane A, Fajri L
Tunis Med · 2025 Dec · PMID 41949929 · Publisher ↗
INTRODUCTION: Edentulism impacts the quality of life and nutrition capacities especially of edentulous people. While conventional full dentures are commonly used as a treatment option, there is no consensus on the key fa...
INTRODUCTION: Edentulism impacts the quality of life and nutrition capacities especially of edentulous people. While conventional full dentures are commonly used as a treatment option, there is no consensus on the key factors that are essential in reducing the risk of patient dissatisfaction. The primary aim of this study is to assess the satisfaction and the short-term quality of life of Moroccan bimaxillary edentulous patients recently rehabilitated with bimaxillary removable complete denture and to identify factors associated. METHODS: This was a descriptive and analytical cross-sectional study targeting 40 bimaxillary total edentulous patients and was conducted at the odontology department of the Military Instruction Hospital Mohammed V in Rabat. All complete dentures were made by following the same protocol. A questionnaire was used to assess patients' overall satisfaction with dentures. Quality of life related to oral health was evaluated using a valid questionnaire represented by the OHIP-20 (Oral Health Impact Profile). Data were analyzed using ANOVA test and test post-hoc, an univariable and multivariable analysis using linear regression was conducted to examine the factors associated with the OHIP score. RESULTS: The satisfaction rate among edentulous patients was 80%, with 77.5% reporting satisfaction with aesthetic appearance, 67.5% with masticatory efficiency, and 70% with stability. The mean global OHIP-20 score was 40.58 ± 10.89. Our findings indicated a statistically significant discrepancy in OHIP-20 scores related to age in the social incapacity domain (p=0.014). Gender also showed a significant difference in OHIP-20 scores in the physical incapacity domain (p=0.006). Furthermore, there was a notable difference in OHIP-20 scores based on the type of resorption, with Class IV Atwood resorption exhibiting the highest scores in both the mandible (45 ± 20.87) and maxilla (42.50 ± 12.33). CONCLUSION: Patient satisfaction and quality of life with complete maxillary and mandibular dentures was found to be associated to age, gender, and degree of resorption.
Effectiveness of in-situ room-of-error simulation on anesthesia ventilator preparation among nurse anesthetist students: A quasi-experimental study.
Amechghal A, Takhdat K, Naciri A … +2 more , Lahlou L, Nassik H
Tunis Med · 2025 Dec · PMID 41949928 · Publisher ↗
BACKGROUND: Anesthesia ventilator preparation is essential for ensuring patient safety.The "Room ofError" (ROE) is a low-fidelity simulation method designed to improve patient safety skills. This study aimed to evaluate...
BACKGROUND: Anesthesia ventilator preparation is essential for ensuring patient safety.The "Room ofError" (ROE) is a low-fidelity simulation method designed to improve patient safety skills. This study aimed to evaluate the effectivenessof in-situ ROE simulation training in improving student nurse anesthetists' clinical performance in anesthesia ventilator preparation and to compare its impact with that of didactic lectures. METHODS: A quasi-experimental pilot study was conducted in a public hospital in Morocco.Thirty-nine nurse anesthesia students were randomly assigned to two groups: an experimental group (n = 20) that received in situ ROE simulation training and a control group (n = 19) that received only lecture-based instruction. Performance was assessed using an author-developed scale. Within- and between-group comparisons were performed using McNemar's and Fisher's exact tests (p < 0.05). RESULTS: TheROE simulation significantly improved the participants' performance in anesthesia ventilator preparation (p< 0.05).The experimental groupdemonstrated statistically significant differencesin onlythree anesthesia ventilator preparationprocedures: oxygen reserve checks (p< 0.001), anti-pollution system verification (p< 0.001), and suction device testing (p = 0.04). CONCLUSION: Students' performance improved after the simulation, indicating effective transfer of learning to the clinical setting.Compared to didactic lectures, the ROE method was more effective in developing critical technical skills related to anesthesia ventilator preparation.
Google Sites as an innovative e-learning tool for methodical electrocardiogram interpretation: a randomized study among pre-graduate students at the Faculty of Medicine of Tunis.
El Ayech Boudiche F, Boudiche S, Ben Halima M … +8 more , Neji S, Chetoui A, Jomni W, Elarbi M, Ouali S, Mghaieth F, Mourali MS, Bezdah L
Tunis Med · 2025 Dec · PMID 41949927 · Publisher ↗
UNLABELLED: Introduction-Aim: At the Faculty of Medicine of Tunis (FMT), several active learning methods are employed to teach electrocardiogram (ECG) interpretation to first year second-cycle medical students (tutorial...
UNLABELLED: Introduction-Aim: At the Faculty of Medicine of Tunis (FMT), several active learning methods are employed to teach electrocardiogram (ECG) interpretation to first year second-cycle medical students (tutorial sessions, ECG portfolio, clinical learning...). However, these approaches remain insufficient and are often dependent on learner's motivation and tutor's availability. This study aimed to evaluate the pedagogical value of a Google Sites platform as a complementary tool, alongside the conventional methods implemented by the FMT, for methodical ECG learning. METHODS: we conducted an open-label, single-center, cluster-randomized study involvingfirstyear second-cycle medical students completing their cardiology rotation at a university hospital of Tunis. Two parallel groups were compared: one had access to Google Sites designed for methodical ECG interpretation "Google Sites (+)", while the other followed conventional methods, "Google Sites (-)". The primary outcome was the score out of 20 on a post-rotation evaluation test, aligned with Level 2b of the modified Kirkpatrick model. RESULTS: A total of 46 students were included. The median number of ECGs interpreted on Google Sites was 28 (IQR:26-30). The mean evaluation score was 14.0±1.7 in the "Google Sites (+)" group and 9.3±2.7 in the "Google Sites (-)" group (p=9.10⁻⁹). The mean score difference between groups was 4.7±0.7 (p=9.10⁻⁹; 95%CI [3.4-6.0]). CONCLUSIONS: Google Sites offers flexibility, interactivity, and rich content support for ECG interpretation learning. We recommend the use of Google Sites as a central learning support tool, complementing tutorial sessions for direct supervision and the ECG portfolio for individualized progress monitoring.
Personalized Antipsychotic Therapy Based on Smoking Status: A Review of Olanzapine and Clozapine.
Ferhi M, Omri M, Ben Mamia M … +1 more , Mannai J
Tunis Med · 2025 Dec · PMID 41949926 · Publisher ↗
Smoking influences the pharmacokinetics of antipsychoticmedications, particularly olanzapine and clozapine, through the induction of cytochrome P450 1A2 (CYP1A2). This narrative review explores its impact on the metaboli...
Smoking influences the pharmacokinetics of antipsychoticmedications, particularly olanzapine and clozapine, through the induction of cytochrome P450 1A2 (CYP1A2). This narrative review explores its impact on the metabolism, efficacy, and safety of olanzapine and clozapine. Current evidence demonstrates that smokers require higher doses of theseantipsychotics to achieve the rapeutic serum concentrations due to accelerateddrug clearance, while non-smokers and thosewhocease smoking are at risk of adverse effects from elevated drug levels. Genetic variations in CYP1A2 activityfurthercomplicate dose recommendations, emphasizing the importance of individualizedtreatmentstrategies. The reviewunderlines the importance of careful monitoring and dose adjustments in smokers, non-smokers, and patients undergoing smoking cessation to prevent adverse effects and ensuretherapeuticefficacy. It also highlights the need for individualizedapproaches, consideringboth smoking habits and metabolic variations.
Evolution and Challenges of Human Resources Governance in Health in Morocco: Analysis of Reforms, Performances, and Future Perspectives.
Karsi M, Boughaleb A
Tunis Med · 2025 Dec · PMID 41949925 · Publisher ↗
INTRODUCTION: The reform of health workforce governance in Morocco (2021-2025) aims to address the shortage and territorial maldistribution of health personnel. This study assesses the reform's performance at mid-term. M...
INTRODUCTION: The reform of health workforce governance in Morocco (2021-2025) aims to address the shortage and territorial maldistribution of health personnel. This study assesses the reform's performance at mid-term. METHODS: The analysis is based on a review of official documents and the legal framework governing the health workforce reform. RESULTS: The findings show notable quantitative and administrative achievements, including an increase in training capacity and public sector staffing, as well as the modernization of human resource management processes. However, major structural challenges persist, particularly territorial maldistribution, the concentration of personnel in hospitals at the expense of primary health care, and an overall workforce density below the threshold recommended by the World Health Organization. CONCLUSION: The new governance architecture, based on regionalization and the establishment of the "Health Function," provides a promising legal framework. Nevertheless, the impact of financial incentives for underserved areas and performance-based remuneration remains to be fully assessed. While the reform has increased the volume of the health workforce and modernized its management, the main challenge remains achieving a more equitable distribution.
CEMIR Consensus guidelines among North Africa Rheumatologists for the use of Ultrasound in Rheumatoid Arthritis.
El Binoune I, Bahiri R, El Maghraoui A … +7 more , Haddouch A, Bencharif I, Slimani S, Miladi S, Boussaa H, Ajlani H, Ben Abdelghani K
Tunis Med · 2025 Dec · PMID 41949924 · Publisher ↗
Musculoskeletal ultrasound has become an essential tool in the management of rheumatoid arthritis (RA), particularly for early diagnosis, assessment of disease activity, treatment monitoring, and decision-making during r...
Musculoskeletal ultrasound has become an essential tool in the management of rheumatoid arthritis (RA), particularly for early diagnosis, assessment of disease activity, treatment monitoring, and decision-making during remission. It also contributes to improving the accuracy of interventional procedures. In Maghreb countries, its use has expanded significantly through local and international training initiatives. In this article, the Maghreb Committee of Experts in Rheumatologic Imaging (CEMIR) proposes practical recommendations, tailored to the regional context, to optimize the use of ultrasound in RA at all stages of patient management.
Association of systemic lupus erythematosus, Niemann-Pick disease type B, and probable granulomatosis with polyangiitis: A case report.
Mrad S, Thabet M, Kadri N … +4 more , Guiga A, Ben Yahia W, Ferchichi S, Gannouchi N
Tunis Med · 2025 Dec · PMID 41879707 · Publisher ↗
INTRODUCTION: Niemann-Pick disease type B (NPD B) is a rare autosomal recessive disorder. It is clinically characterized by hepatosplenomegaly, interstitial lung disease, and thrombocytopenia. Its clinical features may o...
INTRODUCTION: Niemann-Pick disease type B (NPD B) is a rare autosomal recessive disorder. It is clinically characterized by hepatosplenomegaly, interstitial lung disease, and thrombocytopenia. Its clinical features may overlap with those of autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Granulomatosis with Polyangiitis (GPA). OBSERVATION: In this context, we report the first documented case of a 51-year-old woman presenting with the association of NPD B, SLE, and probable GPA. Clinically, the patient exhibited dyspnea, severe anemia, hepatosplenomegaly, Jaccoud's arthropathy, and crusted rhinitis. Laboratory tests were positive for antinuclear antibodies and anti-neutrophil cytoplasmic antigens. Radiological examinations showed interstitial pneumonia and pansinusitis. NPD B was suspected based on the presence of sea-blue histiocytes in bone marrow biopsy and confirmed by sphingomyelinase deficiency. After six months of corticosteroid and hydroxychloroquine therapy, the patient showed significant improvement. CONCLUSION: This case highlights the importance of considering rare diseases in differential diagnosis, even when clinical signs suggest more common conditions.
Reconsidering isolated FEV₁ reduction: A case report of early-stage asthma with bronchial hyperreactivity and literature review.
Boubakri S, Barkous B, Ben Lazreg N … +3 more , Talbi I, Touré M, Ben Saad H
Tunis Med · 2025 Dec · PMID 41879706 · Publisher ↗
INTRODUCTION: Isolated low forced expiratory volume in one second (FEV1) spirometric impairment (ILFSI) is characterized by a decreased FEV1 while both forced vital capacity (FVC) and the FEV1/FVC ratio remain within nor...
INTRODUCTION: Isolated low forced expiratory volume in one second (FEV1) spirometric impairment (ILFSI) is characterized by a decreased FEV1 while both forced vital capacity (FVC) and the FEV1/FVC ratio remain within normal ranges. This pattern may hide an underlying respiratory disorder that warrants further examination. Notably, the 2022 European respiratory society/American thoracic society (2022-ERS/ATS) guidelines do not classify ILFSI as pathological, a stance that has sparked some controversy. This teaching report discussed the case of a woman with ILFSI who developed mild bronchial hyperreactivity after undergoing a methacholine bronchial challenge test (MBCT) and exhibited positive skin prick tests (SPTs) for dust mites. OBSERVATION: A 28-year-old professional interior designer, who has no history of smoking or exposure to wood smoke and allergens, and who previously experienced a mild case of coronavirus disease-2019, consulted a pulmonologist for chronic cough, sputum production, and recurrent sneezing episodes. Asthma was suspected, leading to the performance of SPTs, spirometry, and either a bronchodilator test (in case of an obstructive ventilatory impairment) or MBCT (in case of a normal spirometry) as requested in the pulmonologist referral letter. The spirometry results indicated ILFSI, with a low FEV1 (z-score = -1.74, 79%) while FVC (z-score = -0.97, 88%) and the FEV1/FVC ratio (z-score = -1.35) remained normal. According to the 2022-ERS/ATS guidelines, these findings are considered normal spirometry because of the maintained FVC and FEV1/FVC ratio. The MBCT confirmed mild bronchial hyperreactivity, showing a 20% drop in FEV1 at a dose of 96 µg. Furthermore, SPTs were positive for dust mites (Dermatophagoides pteronyssinus and farinae). CONCLUSION: The results of this report suggested a possible association between ILFSI and early allergic asthma, indicating that ILFSI should be re-examined in future revisions of the 2022-ERS/ATS guidelines for interpreting spirometric tests.
Malnutrition among Pygmy children under five in Bafwasende (DRC), 2025: A cross-sectional study.
Mangaza N, Nkongolo BK, Muyer MC
Tunis Med · 2025 Dec · PMID 41879705 · Publisher ↗
INTRODUCTION: Malnutrition remains a major public health issue in the Democratic Republic of Congo, particularly affecting marginalized indigenous populations. Socioeconomic, cultural, and environmental factors contribut...
INTRODUCTION: Malnutrition remains a major public health issue in the Democratic Republic of Congo, particularly affecting marginalized indigenous populations. Socioeconomic, cultural, and environmental factors contribute to their vulnerability. This study aims to identify factors associated with malnutrition among Pygmy children under five years of age in the Bafwasende territory. METHODOLOGY: A cross-sectional descriptive study was conducted among children and their mothers/caregivers in Bafwasende, Tshopo province. Data were collected using KoboCollect and analyzed with SPSS. Nutritional status was assessed using WHO Anthro Z-Scores to evaluate underweight, stunting, and wasting. Descriptive statistics were applied, with absolute and relative frequencies used for categorical variables. RESULTS: Among 455 children, 28,4% suffer from acute malnutrition(wasting), 69,0% have stunting, and 47,3% have underweight. Children from low-food consumption households, with food expenditures of less than 5,000 CDF, as well as those aged 6 to 11 months, are most at risk. Malnutrition is also more common among children of very young, uneducated, or separated mothers. CONCLUSION: The study highlights an alarming situation, requiring targeted interventions adapted to the cultural and socio-economic realities of indigenous peoples to improve their health and nutrition.
Psychological effects of coronavirus disease (COVID-19) lockdown on dental students in Tunisia: An online survey.
Chouchene F, Sboui N, Ouni I … +2 more , Masmoudi F, Baaziz A
Tunis Med · 2025 Dec · PMID 41879704 · Publisher ↗
AIM: The present study aimed to assess the impact of coronavirus disease (COVID-19) pandemic on the mental health of dental students. METHODS: The survey was designed as an online cross-sectional study conducted among de...
AIM: The present study aimed to assess the impact of coronavirus disease (COVID-19) pandemic on the mental health of dental students. METHODS: The survey was designed as an online cross-sectional study conducted among dental students in Tunisia between May 2020 and January 2022 using a web-based questionnaire. Anxiety, depression, and stress were assessed using three standardized scales (validated French version); the Generalized Anxiety Disorder (GAD-7), the Patient Heath Questionnaire (PHQ-9) depression scale, and the Perceived Stress Scale (PSS-10). The independent t-test and analysis of variance were used to determine the significance of the continuous data. Chi-square and Fisher exact tests were performed for categorical data. RESULTS: A total of 366 dental students completed the questionnaire, 82.5% (302) were female and 17.5% (64) were male, with a mean age of 21± 6 years. Most participants (96.7%) were Tunisian and 25.7% were in the first grade. The mean scores for anxiety, depression, and stress were 11.48±5, 13.82±5.63, and 8.20±4.72 respectively. Female students were more likely to experience depression than male students ( P <0.05).A statistically significant difference was reported between students mental health status, GAD-7, PHQ-9, and PSS-10 scores ( P <0.05) and a statistically significant difference was found between students under medical care for mental health problems, GAD-7, PHQ-9, and PSS-10 scores (P<0.001). CONCLUSION: During the pandemic, increased stress and anxiety have been reported among dental students, and some experienced symptoms related to depression.
Evaluating public private partnerships in the healthcare sector: Scoping review.
Salim K, Azami AI, Sanae B
Tunis Med · 2025 Dec · PMID 41879703 · Publisher ↗
INTRODUCTION: Governments faced efficiency crises in healthcare between the 1980s and 1990s, leading to the adoption of Public-Private Partnerships (PPPs) as innovative solutions. This study explores evaluation methodolo...
INTRODUCTION: Governments faced efficiency crises in healthcare between the 1980s and 1990s, leading to the adoption of Public-Private Partnerships (PPPs) as innovative solutions. This study explores evaluation methodologies, criteria, and research gaps in the healthcare sector. METHODS: The study utilized Arksey and O'Malley's framework to conduct a scoping review of public-private partnerships in the health sector, identifying gaps, suggesting new research directions, and clarifying complex concepts using various databases and dictionaries. RESULTS: A study screened 21 255 papers for inclusion in an analysis, resulting in 26 studies selected for final review. The aim was to understand the contribution of Public-Private Partnerships (PPPs) to healthcare service quality, operational efficiency, and accessibility. The studies were categorized into four: access to quality care, strengthening health programs, improving communication, information, and awareness, and strengthening leadership and financial management. The studies were conducted in various countries, including Africa, Europe, Asia, North America, and South America. DISCUSSION: Public-private partnerships (PPPs) play a crucial role in the healthcare sector, improving efficiency and quality. They provide greater access to healthcare, especially for lowincome populations, and reduce financial burdens. However, their success depends on effective governance, accountability, and equitable cost-sharing arrangements. Effective communication and promotion are essential for PPP success. Resilient strategies are needed to overcome service disruptions and ensure transparency.
Diagnosis and management of esthesioneuroblastoma.
El Omri M, Mosbah L, Naouar M … +7 more , Bellakhdher M, Ghammem M, Houas J, Meherzi A, Kermani W, Mokni M, Abdelkefi M
Tunis Med · 2025 Dec · PMID 41879702 · Publisher ↗
INTRODUCTION: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor that develops in the nasal cavity. It accounts for only 1.2% of malignant nasosinus tumor and arises from the ol...
INTRODUCTION: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor that develops in the nasal cavity. It accounts for only 1.2% of malignant nasosinus tumor and arises from the olfactory epithelium. METHODS: This retrospective study presents olfactory neuroblastoma cases treated in our ENT department over a period of 36 years, from January 1986 to December 2023. RESULTS: The study results indicate that the series consisted of 10 cases of olfactory neuroblastoma, with seven females and three males, and a mean age of 40 years. Based on the Kadish classification, 6 cases were classified as stage B, 3 as stage C, and 1 as stage D. Of the 8 patients who underwent surgery, 6 patients also received radiotherapy, while 2 cases were inoperable. After surgery followed by radiotherapy, complete remission was observed in 3 cases. Tumor progression was observed in 2 cases, after 8 and 3 months respectively and tumour recurrence was observed in one patient. CONCLUSION: Although the imaging features of olfactory neuroblastoma are non-specific, there are patterns of disease that should strongly suggest and stage this disorder. This is fundamental for surgical planning.
Comparative Analysis of Dietary Habits and Nutritional Profiles: Sidi Ali Ben Aoun vs. Grand Tunis.
Ben Othman R, Bouguerra Z, Mizouri R … +4 more , Rachdi R, Mahjoub F, Berriche O, Jamoussi H
Tunis Med · 2025 Dec · PMID 41879701 · Publisher ↗
INTRODUCTION: Tunisia is affected by the nutritional and dietary transition. AIM: To compare dietary habits and nutritional profiles between a rural agricultural area Sidi Ali Ben Aoun and an urban area Grand Tunis. METH...
INTRODUCTION: Tunisia is affected by the nutritional and dietary transition. AIM: To compare dietary habits and nutritional profiles between a rural agricultural area Sidi Ali Ben Aoun and an urban area Grand Tunis. METHODS: This is a comparative cross-sectional study conducted on a sample of 220 participants, including 110 from Ben Aoun and 110 from Grand Tunis. Data were collected based on a pre-established questionnaire about dietary lifestyle and habits survey. Validated scores were used: Alimentary Diversity of Households (SDAM), the Food Consumption Assessment score (SCAM), MEDI-LITE and IPAQ. RESULTS: The mean age was 37.2±15.3 years for the urban population versus 38.7±13.8 years for the rural population (p=0.43). In the rural population, males were 54.5% vs 48.2%; p=0.34. The occurrence of non-communicable diseases was lower in Ben Aoun (p<0.001). The adopted diet in the region of Ben Aoun aligned with the principles of the Mediterranean diet (MEDI-LITE score was 13.2±1.76 versus 7.35±2.65 in Grand Tunis, p<0.001). Both studied regions had a similar level of food security as assessed by the SDAM (p=0.006). However, household dietary diversity was more present in the rural region: the average SCAM was 11.4±0.79 in the rural group compared to 10±1.31 in the urban group (p<0.001). CONCLUSION: The rural region (Sidi Ali Ben Aoun) was characterized by a healthier and more diverse diet compared to the urban region (Grand Tunis).
Validation of the Arabic Version of Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA).
Akrimi K, Ellini S, Cheour M … +1 more , Damak R
Tunis Med · 2025 Dec · PMID 41879700 · Publisher ↗
INTRODUCTION: Cognitive disorders can be early and persistent symptoms of bipolar disorder, even in the euthymic phase. These impairments significantly affect patients' quality of life. Early detection and regular follow...
INTRODUCTION: Cognitive disorders can be early and persistent symptoms of bipolar disorder, even in the euthymic phase. These impairments significantly affect patients' quality of life. Early detection and regular follow-up are therefore crucial to effective, comprehensive management. To achieve this, it is essential to have validated tools adapted to the patient's language, guaranteeing accurate and reliable assessment. To facilitate this task, we chose to translate and validate the Arabic version of the COBRA scale. AIM: The main objective of this study was to translate and validate the Arabic version of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale. Specifically, we aimed to evaluate the psychometric properties, including reliability, validity, and feasibility of the Arabic version of the COBRA in a sample of Arabic-speaking individuals with bipolar disorder and healthy controls. METHODS: This is a psychometric validation study of the Arabic version of the COBRA, obtained by a back-translation method of the original version, conducted on a sample of 161 participants, including 71 patients diagnosed with bipolar disorder and followed at Razi Hospital and 90 subjects with no personal or family psychiatric history, as assessed by the MINI International Neuropsychiatric Interview. The validity study was based on face and content validity, reliability, discriminative validity, construct validity and feasibility. RESULTS: The Arabic version of the COBRA demonstrated satisfying psychometric properties with excellent internal consistency (Cronbach's alpha=0.86) and all inter-item correlations significantly positive (p < 0.05). Bipolar patients showed significantly greater cognitive complaints than healthy controls, with a mean total score of 17.53 ± 5.21 versus 7.12 ± 1.7 respectively, suggesting high discriminative validity of the instrument. Convergent validity was confirmed by significant correlations (p<0.001) with cognitive tests. Factor analysis revealed a four-factor structure explaining 57.48% of the variance, with a dominant factor. The analysis yielded a cutoff score of 10.5 for identifying cognitive impairments with a sensitivity of 90% and a specificity of 97%. Furthermore, COBRA scores were significantly associated with age (r = 0.242, p = 0.002), duration of illness (r = 0.420, p < 0.05), and annual hospitalizations (r = 0.215, p = 0.042).The scale also demonstrated high feasibility. CONCLUSION: The Arabic version of the COBRA has very satisfactory psychometric properties and can be used to screen for cognitive complaints in patients with bipolar disorder.
Knowledge of Parents toward their Children's Oral Health: A Survey in Monastir, Tunisia.
Elelmi Y, Ben Arbia C, Masmoudi F … +1 more , Baaziz A
Tunis Med · 2025 Dec · PMID 41879699 · Publisher ↗
INTRODUCTION: The establishment and preservation of optimal oral health in children are largely contingent upon the active participation of their parents and caregivers. These primary figures are instrumental in shaping...
INTRODUCTION: The establishment and preservation of optimal oral health in children are largely contingent upon the active participation of their parents and caregivers. These primary figures are instrumental in shaping children's preventive practices and facilitating necessary treatment, highlighting a critical interface for health interventions. The aim of the study was to evaluate the knowledge of parents in Monastir city, Tunisia, toward their children's oral health care and prevention of tooth decay and to determine the influence of parental socio-demographic variables on knowledge. METHODS: A cross-sectional study was conducted in the pediatrician's waiting room in Monastir, Tunisia. Ethical Clearance was obtained. The sample was made up of 195 parents. The questionnaire was completed to obtain information regarding demographic and education variables, knowledge about oral health prevention, parents', children's oral hygiene habits, and risk behaviors. The data collected were subjected to statistical analysis using the Pearson chi-square test and the ANOVA test. RESULTS: Sixty-three percent of parents who participated in the study had an insufficient knowledge score (score<50%). The mean knowledge score among mothers was slightly greater than fathers. The parents having fewer than three children have better knowledge, and the parents with one child have better scores. Similar results with a higher educational level were statistically significant. The majority of parents recognized many preventive dental aspects like the number of daily brushings, the nature of toothbrush of the child's dental, effective brushing time, and caries as an infectious disease. However, it was revealed that there was limited knowledge among parents about the importance of early oral health prevention. CONCLUSION: The oral health knowledge among the participants was relatively low. Parents should get better education in oral health knowledge in order to influence their children to gain better oral health.
A decade of Non-Small Cell Lung Cancer management: threats and opportunities in resource-limited setting.
Mejri N, Haouari AA, Saadi M … +6 more , Berrazaga Y, Haddeoui S, Ghorbel L, Boussen H, Rachdi H, Hamdi Y
Tunis Med · 2025 Dec · PMID 41879698 · Publisher ↗
INTRODUCTION: Non-small cell lung cancer (NSCLC) poses significant public health challenges in Tunisia.This study analyzes patient characteristics, management, and outcomes to identify improvement areas. METHODS: This re...
INTRODUCTION: Non-small cell lung cancer (NSCLC) poses significant public health challenges in Tunisia.This study analyzes patient characteristics, management, and outcomes to identify improvement areas. METHODS: This retrospective multicenter study included 924 patients diagnosed with NSCLC between 2013 and 2022. The study reviewed clinical data, pathology reports, surgical records, radiation therapy summaries, and imaging findings. The study also examined trends in management features by dividing the study period into 2012-2017 vs 2018-2022. RESULTS: Median age was 60 years, with 78.7% being male, and the average tobacco consumption was 58 pack-years. Advanced-stage disease was highly prevalent, with 91% of patients presenting at stages III or IV. The median overall survival for the entire population was 32 months, varying significantly by disease stage: 52 months for stage I, 48 months for stage II, 22 months for stage III, and 14 months for stage IV. In advanced NSCLC, survival was notably higher among patients treated with targeted therapy (44 months) and immunotherapy (20 months) compared to chemotherapy alone (9 months). Over time, there was a significant increase in multidisciplinary discussions and biomarker testing rates; however, access to concurrent chemoradiation decreased. Despite some improvement, access to targeted therapy and immunotherapy remained limited. Among tested patients, a driver mutation was identified in 45.5%, but only 54% received targeted therapy. Furthermore, only 9.8% of advanced-stage patients received immunotherapy. CONCLUSION: This study serves as a baseline for future studies and highlights critical gaps in NSCLC care in Tunisia, emphasizing the need for strategic directions to enhance outcomes.
The role of CDX2 immunohistochemical marker in colorectal adenocarcinoma « CDX2 in colorectal adenocarcinoma ».
Ben Rejeb S, Bacha D, Rachdi H … +1 more , Bellil K
Tunis Med · 2025 Dec · PMID 41879697 · Publisher ↗
INTRODUCTION: Caudal-type homeobox transcription factor 2 (CDX2), a marker of intestinal differentiation, has shown potential as a prognostic biomarker in colorectal cancer(CRC). Its loss is associated with aggressive di...
INTRODUCTION: Caudal-type homeobox transcription factor 2 (CDX2), a marker of intestinal differentiation, has shown potential as a prognostic biomarker in colorectal cancer(CRC). Its loss is associated with aggressive disease features and poor survival, yet its routine clinical use remains limited. In this study, we aimed to explore the immunohistochemical expression of CDX2 in sporadic colorectal adenocarcinomas and to assess its prognostic significance. METHODS: This was a retrospective longitudinal study including patients with sporadic colorectal adenocarcinoma. CDX2 expression was assessed via automated immunohistochemistry on formalin-fixed, paraffin-embedded sections using monoclonal antibody CDX2-DAK (Dako, Glostrup, Denmark). Only nuclear staining was considered positive. Clinicopathological data, including tumor stage, differentiation, and survival, were collected over a 36-month median follow-up. Statistical analysis was performed using SPSS version 20 (p < 0.05). RESULTS: Thirty cases were included with a mean age of 57 ± 2 years and a male-to-female ratio of 1.7. CDX2 expression was observed in 80% (24/30) of tumors. Its loss was significantly associated with poor differentiation (p=0.04),lymph node involvement (p=0.0027), advanced stage (p=0.043), and reduced overall survival (p=0.0024). Loss of CDX2 expression combined with pT4 stage identified a high-risk subgroup with worse disease-free and overall survival. Tumors were predominantly colonic (80%), with 90% adenocarcinomas and 10% mucinous carcinomas. CONCLUSIONS: CDX2 loss is a robust prognostic indicator in CRC, particularly when combined with pT4 stage, highlighting its potential for risk stratification and treatment planning. Larger, prospective studies are needed to standardize CDX2 assessment and validate its clinical utility in colorectal adenocarcinoma.
[Effects of low-dose botulinum toxin for the treatment of spastic children with cerebral palsy].
Boudokhane S, Belhadj Youssef I, Zaouali F … +4 more , Borgi O, Kalai A, Migaou H, Ben Salah Z
Tunis Med · 2025 Dec · PMID 41879696 · Publisher ↗
INTRODUCTION: The treatment of children with cerebral palsy (CP) with Botulinum toxin A (BTA) injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used d...
INTRODUCTION: The treatment of children with cerebral palsy (CP) with Botulinum toxin A (BTA) injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used dosage has escalated over the years. The aim was to analyze the efficacy and safety of a lower dose of BTA injections into lower limb in children with CP. MATERIAL AND METHOD: We analyzed retrospectively BTA injections for children with spastic CP aged between 2 and 14 years. Treatment results were evaluated with the modified Ashworth scale (MAS). Side effects, total dose and dose per body weight were analyzed. RESULTS: Fifty five children were included (21 girls (38.2%) and 34 boys (61.8%)). The total dosage was 105.4 ± 20.7 U Allergan for Botox® and 473.4 ± 79.9 U Speywood for Dysport®. Average MAS before treatment was 2.1±0,5. At the first post-injection follow up visit, this score had increased to 1±0.5. Symptoms potentially related to TBA were reported in 16 children (29.1%). In 39 cases, the injection of TBA passed without adverse events. Multiple side effects were observed with the same patient. CONCLUSION: There is not yet a uniform strategy for TBA treatment in childre with CP and the doses used in the literature vary considerably over the years. It thus appears that the doses we use are within the range of the recommandations but remain by far lower than the doses used in the literature.
Polyphenols as Epigenetic Modulators of Health: A Holistic Approach to the Therapy and Prevention of Chronic Diseases.
Gheribi S
Tunis Med · 2025 Dec · PMID 41879695 · Publisher ↗
BACKGROUND: The rising prevalence of chronic diseases, including cancer, metabolic disorders, neurodegenerative, and cardiovascular conditions, presents a growing challenge to modern medicine and public health. AIM: This...
BACKGROUND: The rising prevalence of chronic diseases, including cancer, metabolic disorders, neurodegenerative, and cardiovascular conditions, presents a growing challenge to modern medicine and public health. AIM: This article investigates the potential of polyphenols as modulators of epigenetic mechanisms in the context of chronic disease. METHODS: A comprehensive review of scientific literature was conducted, with emphasis on key epigenetic processes such as DNA methylation, histone modifications, and microRNA regulation. RESULTS: Polyphenols like resveratrol, curcumin, quercetin, and catechins exert protective actions by modulating gene expression, counteracting harmful epigenetic changes, and supporting cellular health. CONCLUSION: Advancing our understanding of how polyphenols influence epigenetic pathways may lead to innovative therapeutic strategies combining conventional and personalized approaches.
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