INTRODUCTION: Perioperative use of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) has been linked to early postinduction hypotension requiring vasopressor use under general anesthesia, potentially lea...INTRODUCTION: Perioperative use of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) has been linked to early postinduction hypotension requiring vasopressor use under general anesthesia, potentially leading to complications like acute renal injury, myocardial injury, or stroke. However, the relationship between perioperative ACEI/ARB use and major morbidity remains uncertain. AIM: This meta-analysis assessed the differences between the continuation or discontinuation of ACE inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) therapy during the perioperative period and hemodynamical instability, mortality, and major morbidity outcomes. METHODS: The protocol was registered in the PROSPERO database (ID: CRD42024519162). Literature searches of electronic databases and manual searches on the Medline, Embase, Scopus, and Web of Science databases up to August 30, 2024, will be performed. Case-control studies, cohort studies, non-randomized controlled trials, and randomized controlled trials (RCTs) involving adult patients aged over 18 years, who were chronically using ACEIs or ARBs due to chronic hypertension, undergoing non-cardiac surgery, where ACEIs or ARB therapy was either withheld or continued less than 10 hours before surgery will be included. The primary outcome will be the incidence of intraoperative hypotension. Secondary outcomes will be the intraoperative use of vasoactive agent (incidence, dose of ephedrine (mg) and dose of phenylephrine (ng)), the incidence of severe hypotension, hospital length of stay, intraoperative and postoperative hypertension, the incidence of acute kidney injury, 30-day postoperative all-cause mortality and incidence of major cardio-cerebral events. CONCLUSION: The results of this systematic review and meta-analysis should provide evidence for withholding or continuing perioperative ACE-I or ARB in noncardiac surgery.
INTRODUCTION: JAK inhibitors, a newer class of medications, work by blocking specific enzymes (Janus kinases) that play a key role in inflammation. By inhibiting these enzymes, JAK inhibitors help alleviate inflammation...INTRODUCTION: JAK inhibitors, a newer class of medications, work by blocking specific enzymes (Janus kinases) that play a key role in inflammation. By inhibiting these enzymes, JAK inhibitors help alleviate inflammation and symptoms, providing an alternative treatment option to conventional therapies like NSAIDs and biologics. Considering the lack of updated findings on cardiovascular effects in SpA patients treated with JAK inhibitors, we will perform a systematic review of the literature to investigate the safety of JAK inhibitors in SpA patients. The aim of this review is to evaluate cardiovascular safety of JAK inhibitors. METHODS: We will search multiple databases, including PubMed, Embase, and the Cochrane Library, using specific keywords such as "Janus kinase inhibitors," "JAK inhibitors," "spondyloarthritis," and "cardiac risk." Our inclusion criteria will focus on randomized controlled trials, that reports Major Adverse Cardiovascular Events (MACE), in patients treated with JAK inhibitors for spondyloarthritis. We will exclude cohort studies, and those without relevant cardiac data, as well as animal studies or those outside the scope of JAK inhibitor treatment. After screening titles and abstracts, we performed a full-text review of the selected articles to ensure the inclusion of studies with high methodological quality and relevant data on cardiac risk factors. The various stages of this literature search will be summarized using the Preferred Reporting of Systematic Reviews and Meta-Analysis (PRISMA) flow chart format to visualize the processes and findings of the review. RESULTS: The preliminary results demonstrated that the existing data indicated no significant change in cardiovascular risk for JAK inhibitors-treated patients with SpA. Data analyze find no notable difference in the occurrence of MACE between the interventions and the placebo groups. These finding are to interpret with caution, given the limitations of the study numbers and duration. However, these findings provide a foundation for further investigation in this area. CONCLUSIONS: This systemic review highlights the safety of JAK inhibitors according to MACE occurrence in patients with SpA when compared to placebo. These results needs to be interpreted with caution regarding the limited long-term data and small sample sizes in clinical trials. Long-term studies are needed to clarify these risks.
INTRODUCTION: Role-playing are a subtype of simulation aimed at improving non-technical skills, such as delivering a cancer diagnosis. The use of this pedagogical method in teaching bad news delivery has been growing in...INTRODUCTION: Role-playing are a subtype of simulation aimed at improving non-technical skills, such as delivering a cancer diagnosis. The use of this pedagogical method in teaching bad news delivery has been growing in recent years. However, data, particularly from Tunisia, on this topic are limited. AIM: To evaluate learners' perceptions of the usefulness of role-playing in delivering cancer diagnoses. METHODS: We conducted a descriptive, cross-sectional study between January and October 2024. We included 4th-year medical students who had completed their gastroenterology rotations at Charles Nicolle Hospital. For each group, we conducted a role-playing session. A questionnaire was distributed to learners before and after the role-playing session to assess whether there was a change in students' opinions. RESULTS: We collected data from 61 students. According to the students, the most crucial step for successfully delivering a diagnosis was training doctors in delivering news about serious illnesses. Nearly half of the students (n=34) reported having difficulty communicating with patients or their families. All learners were convinced that simulation plays a major role in medical practice and medical education. Additionally, all students agreed that role-playing sessions are highly suitable for teaching the delivery of bad news, particularly cancer diagnoses. Participation in role-playing sessions allows doctors to understand patients better. The learners' responses before and after the role-playing session were comparable. CONCLUSION: Role-playing is a highly effective active learning method for teaching cancer diagnosis delivery. It helps learners approach reality more closely and acquire communication skills with patients and their families.
AIM: To develop procedural documents of three gestures taught in endocrinology and to assess their contribution in the procedural learning of students. METHODS: Prospective randomized controlled study, comparing a self-l...AIM: To develop procedural documents of three gestures taught in endocrinology and to assess their contribution in the procedural learning of students. METHODS: Prospective randomized controlled study, comparing a self-learning tool combining a video and a procedural document (PD), with a guided teaching (GT) of a technical gesture by a teacher. The study involved 89 students randomized into: an intervention group (I1;n=47) and a control group (I0;n=42). All the participants had GT regarding blood pressure measurement, thyroid examination, and waist circumference measurement. Then, the GroupI1 received three PD and three videos illustrating the same gestures. A week later, an assessment was performed. Group I0 received the documents after the assessment. The student satisfaction with the two methods was evaluated. RESULTS: The percentage of students who used PD and videos was comparable between the two groups (68to79% in groupI1 and 76to86% in groupI0, p between0.161and0.827). The mean evaluation score respectively at the thyroid examination station, blood pressure and waist circumference measurement was 8.07±1.28 in groupI1 versus7.94±1.01 in group I0(p=0.634),7.51±1.11versus7.68±0.96(p=0.466) and7.41±1.37versus6.94±1.34(p=0.132). The mean satisfaction score of the two teaching tools was respectively in group I1 versus I0, of (9.38±1.53 and 8.88±1.63; p=0.195), (9.39±1,65 and 9.25±0.76, p=0.658) and (9.43±1.59 and9.24±0.82,p=0.543).The GT satisfaction score was 9.34±1.40 in I1group versus 9.62±0.46 in I0group, p=0.227. The power of the statistical test was less than 10%. CONCLUSION: The lack of significant difference between the evaluation scores of the two groups could be explained by the low rate of consultation of the educational tools and the small sample size.
UNLABELLED: Introduction In the emergency department (ED), learning by simulation provides a safe acquisition of procedural skills. This study's objective was to evaluate the impact of the simulation-based learning on vi...UNLABELLED: Introduction In the emergency department (ED), learning by simulation provides a safe acquisition of procedural skills. This study's objective was to evaluate the impact of the simulation-based learning on videolaryngoscope (VL) orotracheal intubation (OTI) skills among residents practicing in ED. METHODS: evaluative, prospective study, including residents practicing in teaching hospitals ED in Tunis. They were novices in direct laryngoscopy. We scheduled a procedural simulation session. Residents were evaluated before and after the session. The primary endpoint was the rate of successful OTI after learning session. RESULTS: 32 residents were enrolled. The mean age was 28 ± 2.5 years. Gender ratio was 0.18. The mean exercise seniority was 1.53 ± 0.7 years. The rate of successful OTI before and after the training was observed in 4 residents (12.5%) vs 23 (71.8), p=0.689. The average time of OTI was respectively 149.81±108 seconds (sec) vs. 51±96 sec (p<0.001). The rate of esophageal intubation was n (%): 16 (50%) vs 9 (28%) (p=0.49) and the mean number of attempts was 3.81 vs. 1.84 (p<0.001). Intubation time after the session more than 12 sec was an independent factor of intubation failure (Adjusted OR= 3.5, p=0.001 and 95%CI [1.018-10.69]). CONCLUSION: Learning by simulation in the ED provides residents with a skill that allows complete OTI in less time and a smaller number of attempts. Intubation time is an independent factor predicting intubation failure among doctors learning intubation by VL.
Artificial intelligence is a rapidly evolving technology in higher education. It is being integrated into the sector through a wide range of applications, each of which has a significant impact on the educational process...Artificial intelligence is a rapidly evolving technology in higher education. It is being integrated into the sector through a wide range of applications, each of which has a significant impact on the educational process. This impact can be both positive and negative. On the one hand, artificial intelligence offers opportunities for personalizing learning and teaching, improving administrative services, and supporting mental health. However, its integration into higher education institutions raises challenges and ethical issues that threaten students' privacy. This literature review aims to explore the different applications of artificial intelligence, as an innovative technology, in the academic field while highlighting its advantages and disadvantages as well as the challenges and issues it raises. It also addresses the guidelines for an ethical integration of artificial intelligence in higher education, highlighting the fundamental principles to ensure a responsible and respectful adoption of human values.
INTRODUCTION: Psoriatic arthritis (PsA) is a chronic inflammatory condition associated with joint and skin involvement. Cardiovascular disease, particularly atherosclerosis, is a leading cause of morbidity and premature...INTRODUCTION: Psoriatic arthritis (PsA) is a chronic inflammatory condition associated with joint and skin involvement. Cardiovascular disease, particularly atherosclerosis, is a leading cause of morbidity and premature mortality in PsA patients, due to persistent systemic inflammation. Tumor necrosis factor-alpha (TNF-α) inhibitors have proven effective in reducing inflammation in PsA, and some evidence suggests they may also improve vascular health. However, their specific impact on atherosclerosis in PsA remains unclear. OBJECTIVE: This systematic review aims to evaluate the effect of TNF-α inhibitors on the progression of atherosclerosis in adults with PsA. METHODS: This review will follow the PRISMA guidelines. Systematic searches will be conducted in PubMed, Scopus, Embase, and the Cochrane Library using validated search strategies. We will include original observational studies and randomized controlled trials published in English that assess PsA patients treated with TNF-α inhibitors, with comparison groups receiving conventional DMARDs, placebo, or pre-treatment baselines. Studies focusing on direct measures of atherosclerosis or endothelial dysfunction were selected. Reviews, editorials, case reports, and non-English publications will be excluded. Two independent reviewers will conduct the study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale for observational studies and the RoB 2 tool for RCTs. Only high-quality studies will be included. A narrative synthesis will be employed due to expected heterogeneity in study designs and outcomes.
INTRODUCTION: Internet Gaming Disorder (IGD) is a recognized mental health condition associated with autonomic nervous system (ANS) dysregulation. While heart rate variability (HRV) has been studied, ventilatory response...INTRODUCTION: Internet Gaming Disorder (IGD) is a recognized mental health condition associated with autonomic nervous system (ANS) dysregulation. While heart rate variability (HRV) has been studied, ventilatory responses remain poorly explored. This systematic review aims to evaluate the impact of IGD on cardiovascular (HRV) and pulmonary (respiratory rate) parameters. METHODS: To conduct this systematic review, a literature search will be conducted on PubMed, Scopus, and Embase. We will include studies assessing HRV and respiratory rate in individuals aged ≥12 years with IGD. Studies without objective ANS measurements or those with non-DSM-5-defined populations will be excluded. Data extraction will focus on HRV (continuous ECG) and respiratory rate variations, stratified by gaming context and IGD severity. The risk of bias will be assessed using ROBINS-I. CONCLUSON: This review will clarify ANS dysregulation patterns in IGD, informing clinical monitoring strategies. Limitations may include heterogeneity in measurement methods.
Introduction and importance: Arhinia syndrome (AS) is an extremely rare malformation characterized by typical clinical signs such as a lack of nose, with difficulty in breathing and inability to feed due to airway obstru...Introduction and importance: Arhinia syndrome (AS) is an extremely rare malformation characterized by typical clinical signs such as a lack of nose, with difficulty in breathing and inability to feed due to airway obstruction. The ortho-surgical management of AS is a big challenge and it requires an interdisciplinary relationship between the orthodontist and a maxillofacial surgeon. The authors reported a case of AS. Case presentation: The only case in Morocco among fewer than 30 cases described in the whole world, male child, 7-year-old. Clinical findings and investigations: Complete absence of the external nose, nasal cavities, and other characteristic signs. This diagnosis was genetically confirmed. Interventions and outcome: A LeFort II maxillary osteotomy was done in combination with a facemask and miniscrew followed by a parietal bone graft and maxillary expansion with a customer expander. An internal and external nasal reconstruction was undergone with orthodontic management of unerupted teeth. An acceptable morphology for the newly created external nose was obtained, this reconstruction was viable and esthetically acceptable. A slight external restenosis of a left nave was observed. This result was stable over three years. Relevance and impact: AS is a rare condition with a pathogenesis not been fully understood. The ideal treatment should have the lowest possible morbidity and a low relapse rate. The most difficulty in the approach is the creation and maintenance of a nasal cavity. These therapeutic aspects will be discussed through this case. The use of facemask therapy with a miniscrew potentiated the effect of osteotomy and stabilized the parietal bone graft which allowed nasal reconstruction and orthodontic management of unerupted teeth in this case.
INTRODUCTION: Intermittent fasting (IF) is gaining interest as an effective method to combat obesity Objective : to compare the effects of 16:8 intermittent fasting (IF 16:8) and continuous caloric restriction (CCR) on a...INTRODUCTION: Intermittent fasting (IF) is gaining interest as an effective method to combat obesity Objective : to compare the effects of 16:8 intermittent fasting (IF 16:8) and continuous caloric restriction (CCR) on anthropometric parameters and components of metabolic syndrome in obese women. METHODS: A non-randomized controlled clinical trial was conducted with obese women followed for three months. The patients were divided into two groups: IF (45 patients) and CCR (55 patients), each undergoing a 25% reduction in caloric intake. Anthropometric parameters, body composition and metabolic profile were evaluated. RESULTS: The average age was 34.10 ± 8.44 years in the IF group and 34.62 ± 8.80 years in the CCR group, with BMI values of 38.63 ± 5.15 kg/m² and 34.84 ± 6.69 kg/m², respectively. Both groups experienced significant weight loss after three months, with the IF group showing greater weight change (-7.38 ± 4.1 kg vs. -5.41 ± 3.84 kg, p=0.03). Fat mass and waist circumference reductions were more pronounced in the IF group (p=0.04 and p=0.0001, respectively). Furthermore, IF was more effective than CCR in reducing blood glucose (p=0.04) and triglyceride levels (p=0.02) and increasing HDL-cholesterol (p=0.01). The early feeding window (8h to 16h) in the IF group was associated with greater reductions in weight, fat mass, waist circumference and HOMA insulin resistance index (p=0.001 for all) compared to the 12h to 20h window. CONCLUSION: The study suggests that 16:8 intermittent fasting could be a viable alternative to continuous caloric restriction for managing obesity and associated metabolic disorders.
INTRODUCTION: Therapeutic drug monitoring (TDM) of valproic acid (VPA) for epileptic children aims to optimize treatment, hence promoting seizure control, and to detect refractory cases that should be managed early. We a...INTRODUCTION: Therapeutic drug monitoring (TDM) of valproic acid (VPA) for epileptic children aims to optimize treatment, hence promoting seizure control, and to detect refractory cases that should be managed early. We aimed to identify a ceiling dose and a trough serum level of VPA in epileptic children in remission. METHODS: This retrospective study was carried out at Clinical Pharmacology, involving epileptic children (2-18 years) who were referred at least two times for a VPA trough level measurement over a 13-year period (2009-2022). RESULTS: We included 88 children, of whom 67% (n=59) were in remission (G1) and 33% (n=29) did not meet remission criteria (G2). Ten children (11%) experienced adverse events, predominantly gastrointestinal and neuropsychological disturbances. Mean weight-based dose of VPA in G1 (21.53±7.95 mg/kg/day) was significantly lower than in G2 (26.81±9.99 mg/kg/day), p=0.009. Mean VPA trough serum level was 60.76±20.22 µg/mL in G1 and 62.47±23.04 µg/mL in G2 with no significant difference. The ceiling daily dose of VPA to achieve remission was 44.44 mg/kg/day. CONCLUSION: Our study showed that the average weight-based dose of VPA in children in remission was lower than that in G2. A ceiling dose of 44.44 mg/kg/day of VPA limiting treatment efficacy for achieving remission was identified.
Antibiotic resistance is a major concern for health systems worldwide, due to the irrational use of antibiotics. Honey can be considered an alternative therapy to antibiotics. Our study aims to evaluate the microbiologic...Antibiotic resistance is a major concern for health systems worldwide, due to the irrational use of antibiotics. Honey can be considered an alternative therapy to antibiotics. Our study aims to evaluate the microbiological quality and presumed antibacterial activity of 7 natural honeys of different floral origins. Aerobic bacteria grew in 3 samples of honey: (jujube honey ( Bacillus subtilis ), fig honey ( Staphylococcus hominis , S. epidermidis, and S. pettenkoferi ) and holm oak honey ( Aerococcus viridans )). Only holm oak honey contained a yeast ( Cryptococcus neoformans ), while the other honeys were free of yeasts and molds. Holm oak honey was most effective on most bacterial strains studied, particularly S. pyogenes . The other honeys were mainly active against S. pyogenes . None of the honeys showed activity against P. aeruginosa , K. pneumoniae , S. aureus and C. albicans . The MIC was 25% for holm oak honey against the 5 bacterial strains which showed a response. For fig honey, the MIC varied between 50% ( S. pyogenes , S. aureus and S. epidermidis ) and 100% ( S. hominis and E. coli ). For most other honeys, the MIC was 100%, meaning only the pure form of honey could prevent bacterial growth. In this study, honey, consistent with its traditional use in the ENT sphere, was found to be effective against S. pyogenes , a bacteria often responsible for bacterial tonsillitis which can limit the inappropriate use of antibiotics. These results could guide pharmaceutical research aimed at extracting active ingredients from honey to develop new antibacterial agents.
INTRODUCTION: Cervical cancer is a public health issue in Algeria, it ranks at second position among female cancers. AIM: This study sought to identify risk factors for cervical cancer and to determine their impact on pa...INTRODUCTION: Cervical cancer is a public health issue in Algeria, it ranks at second position among female cancers. AIM: This study sought to identify risk factors for cervical cancer and to determine their impact on patient survival Methods: This is a retrospective study on 200 patients diagnosed during a 3-years period between January 1, 2016 and December 31, 2018. This study investigated cervical cancer risk factors and survival outcomes associations. The analysis was made by Chi Square test. The progression-free survival rate was estimated using the Kaplan-Meier method. RESULTS: Our study revealed that squamous cell carcinoma was the most frequent diagnosis (69.9%), it also points to early sexual activity as a significant associated risk factor (P=0.05). This finding contrasts with the relatively small proportion of cases (12.12%) linked to hereditary causes. Patients with adenocarcinoma had a lower progression-free survival (PFS) (Log-Rank test P = 0.04). Poorer PFS was associated with earlier FIGO stages (Breslow: P =0.04; Tarone-Ware: P =0.04). Age at first sexual encounter and parity, however, did not significantly predict PFS. PFS was substantially better in T1-T2 pathological stages (P = 0.000). CONCLUSION: The prognosis depends on knowing these risk factors. Understanding these characteristics is crucial for improved therapy and results. We provide an up-to-date insight of current cervical cancer risk factors in oran city. These results highlight how crucial it is to comprehend risk variables and how they affect the prognosis of cervical cancer.
INTRODUCTION: The order on request is a legal procedure allowing a party to request a judicial decision quickly and without prior notification to the opposing party. This study aims to explore the legal framework governi...INTRODUCTION: The order on request is a legal procedure allowing a party to request a judicial decision quickly and without prior notification to the opposing party. This study aims to explore the legal framework governing the order on request in Tunisia, examine the medico-legal concerns and evaluate the associated risks and challenges for both healthcare professionals and patients. METHODS: This study employs a doctrinal and analytical methodology, focusing on an examination of Tunisian legislative texts, particularly the Code of Civil and Commercial Procedure. Additionally, a comparative approach will be used to analyze similar legal frameworks in other countries. RESULTS: In Tunisia, the order on request enables swift judicial decisions without adversarial proceedings in urgent matters. In this framework, the judge plays a crucial supervisory role to maintain a balance between expediency and the right to a fair trial. Physicians, bound by medical confidentiality, must navigate the tension between their duty of discretion and the obligation to comply with judicial orders. In cases where a physician believes a court order infringes on a patient's rights, they are not required to respond directly to the petitioner. Instead, they must address their concerns to the judge, reaffirming their duty to uphold medical confidentiality. CONCLUSION: While the order on request serves as a crucial legal tool for addressing urgent situations, its application must be handled with caution and in strict adherence to legal and ethical standards. Maintaining a balance between procedural urgency and the protection of fundamental rights is essential.
INTRODUCTION: Thyroid nodules are a frequent and mostly benign pathology. Failure to recognize a cancer remains a major concern for any physician confronted with this pathology. Fine needle aspiration cytology (FNAC) is...INTRODUCTION: Thyroid nodules are a frequent and mostly benign pathology. Failure to recognize a cancer remains a major concern for any physician confronted with this pathology. Fine needle aspiration cytology (FNAC) is the reference examination when managing thyroid nodules. The aim of our study was to evaluate the role of FNAC in determining the histological nature of thyroid nodules. METHODS: We conducted a cross-sectional, retrospective, and descriptive study, spread over a 5-year period from January 2016 to December 2020, carried out in our Department of Otolaryngology and Head and Neck Surgery. RESULTS: The median age of the 200 patients was 46 years. Female predominance was evident, with a sex ratio of 0.09. All our patients underwent FNAC followed by surgical excision. FNAC was non diagnostic in 8 cases (4%) and benign in 53 cases (20.50%). It revealed atypia of undetermined significance in 33 cases (16%), a follicular neoplasm in 45 cases (21.50%) and a malignant suspicion in 47 cases (22.50%). FNAC was malignant in 22 cases (10.5%). Pathological examination showed malignancy in 115 cases. FNAC has an overall sensitivity of 84% and a specificity of 71.6% in predicting thyroid nodules diagnosis. CONCLUSION: Combining clinical and ultrasonographic criteria with cytological results improves the sensitivity of thyroid carcinoma screening.