Ajina M, Ajmi M, Aloui A
… +76 more, Aouni H, Athimni Z, Baccar A, Barick V, Belgacem E, Ben Abdessalem M, Ben Abdennebi H, Ben Hadj Slama F, Ben Lamine Z, Bouhlel F, Bouhlel M, Bouhoula M, Boujelbene F, Bousarsar I, Bouthaleb S, Brahem A, Chaouch A, Chatti S, Cherif O, Cherni K, Chouchane A, Dhaoui A, Dridi H, El Fani N, El Fekih H, El Maalel O, Ellefi A, Fatnassi R, Ferdousi F, Gaddas M, Gaddour A, Ganoun N, Gereisha R, Ghanmy M, Gharbi R, Ghzaiel I, Ghenim A, Ghodhbane E, Guerbej E, Habli B, Hammami M, Hammami S, Hochlaf K, Houichi H, Ibala-Romdhane S, Isoda H, Jarraye I, Jemmali I, Kacem I, Kahloul M, Kalboussi H, Karmi G, Kissi K, Laouani A, Makhloufi M, Mahdhaoui A, Marwen N, Mellouli A, Mgarrech I, Mlaouah J, Mosbah H, Mtaoua S, Mtiraouif F, Naija W, Nasrallah H, Neily C, Nouira M, Sabeima E, Saguem S, Saasi A, Sassi A, Zaouali M, Zairi A, Zarrouk A, Zemni R, Zorgui R
INTRODUCTION: Gastrointestinal (GI) pain is commonly treated with synthetic spasmolytic drugs, including anticholinergics, smooth muscle relaxants, calcium channel blockers, and opioid receptor modulators. However, these...INTRODUCTION: Gastrointestinal (GI) pain is commonly treated with synthetic spasmolytic drugs, including anticholinergics, smooth muscle relaxants, calcium channel blockers, and opioid receptor modulators. However, these treatments often lead to undesirable side effects. AIM: To evaluate the antispasmodic and anti-inflammatory potential of the aqueous extract from the brown seaweed Cystoseira compressa (Comp-AQ). METHODS: The antispasmodic activity of Comp-AQ was assessed in vitro using rat duodenum contractions induced by acetylcholine (A/Ch) and barium chloride (BaCl₂). The anti-inflammatory activity was evaluated in vivo using the carrageenan-induced paw edema model in rats. A phytochemical screening was performed to identify bioactive compounds, and antioxidant activity was assessed via the DPPH radical scavenging assay. RESULTS: Comp-AQ significantly and dose-dependently inhibited A/Ch- and BaCl₂-induced contractions (82.98 ± 1.5% and 84.06 ± 2.16%, respectively), with a relaxation-response profile similar to alverine, suggesting involvement of voltage-dependent calcium channels. In vivo , Comp-AQ reduced carrageenan-induced paw edema, reaching a maximal inhibition of 71.46% at 100 mg/kg after 3 hours. Phytochemical analysis revealed a high content of marine polyphenols and polysaccharides. The extract exhibited strong antioxidant activity with an IC₅₀ of 30 ± 2.66 µg/mL. CONCLUSION: The aqueous extract of Cystoseira compressa exhibits antispasmodic, anti-inflammatory, and antioxidant properties. Further structural characterization is needed to definitively identify the responsible bioactive compounds and to confirm the hypothesis of synergistic effects.
INTRODUCTION: International guidelines for the management of coronary artery disease highlight the importance of LDL-C(low density lipoprotein-cholesterol)measurements in assessing cardiovascular risk and monitoring pati...INTRODUCTION: International guidelines for the management of coronary artery disease highlight the importance of LDL-C(low density lipoprotein-cholesterol)measurements in assessing cardiovascular risk and monitoring patients. In clinical practice,its direct measurement is complex and expensive. Therefore,calculating LDL-C using several formulas is simpler and less costly. AIM: T o evaluate the accuracy of LDL-C estimation formulas of Friedewald,Sampson and Martin/Hopkins compared to its direct measurement in Tunisian patients. METHODS: A cross-sectional study was conducted including patients following in the Endocrinology Department of Farhat Hached University Hospital of Sousse.Clinical data, metabolic parameters,and lipid profiles including Direct LDL-cholesterol measurement were analyzed. LDL-C was estimated using Friedewald,Martin/Hopkins, and Sampson formulas. RESULTS: A total of 148 patients were included in the study.The male-to-female ratio was 0.51.The mean age of the patients was 58 ± 14.8.The majority of our patients were diabetic (84.5%). Most patients had uncontrolled diabetes (81.8%).Type 2 diabetes was the predominant form (85.6%).The three formulas,Friedewald,Sampson,and Martin/Hopkins provided comparable fasting correlation values with measured LDL-C(r=0.52, 0.55, and 0.47, respectively). One hour after meal intake, LDL-C estimation using the three formulas was similar, showing a strong correlation with measured LDL-C (r > 0.7 for all three formulas). At two hours postprandial, the three formulas showed a moderate correlation with the measured LDL-C value. CONCLUSION: In this study,all three formulas Friedewald, Sampson, and Martin/Hopkins demonstrated acceptable accuracy in estimating LDL-C compared with direct measurement in Tunisian patients. Overall, these findings support the usefulness of formula-based LDL-C estimation as a practical and cost-effective alternative in routine clinical practice.
INTRODUCTION: Hepatitis B is a major global health problem. Assessment of liver fibrosis is important for treatment decision. Liver biopsy (LB) represents the "Gold Standard" in the assessment of fibrosis. Several parame...INTRODUCTION: Hepatitis B is a major global health problem. Assessment of liver fibrosis is important for treatment decision. Liver biopsy (LB) represents the "Gold Standard" in the assessment of fibrosis. Several parameters have been identified for predicting the development and progression of liver disease; among them, hematological parameters. The aim of our study was to assess the performance of these hematological parameters in the assessment of fibrosis in chronic hepatitis B. METHODS: We conducted a retrospective study involving all patients with chronic hepatitis B managed in Gastroenterology department of Mohamed Taher Maamouri hospital during the period from January 2013 to December 2022, who underwent a liver biopsy and routine laboratory tests. According to the METAVIR scoring system, patients were divided into two groups: patients without significant fibrosis (F0, F1) and patients with significant fibrosis (F2, F3, F4). The predictive accuracy for liver fibrosis was assessed by receiver operating characteristics (ROC) analysis. RESULTS: A total of 119 patients were included. Liver biopsy revealed significant fibrosis in 20.2% of the patients. The mean platelet count was significantly lower in patients with significant fibrosis, as compared to patients with non-significant fibrosis (p< 0.001). The AUROC of RDW was 0.857 with a cut-off value of 41.8 FL (sensitivity 88.9%; specificity 70.9%; Positive and negative predictive values 50% and 95.1% respectively). CONCLUSION: Blood count parameters are non-invasive markers of liver fibrosis in patients with chronic hepatitis B. Thus, significant fibrosis can be ruled out in patients with RDW < 41.8 FL, which could help avoid liver biopsy in these patients.
UNLABELLED: Introduction-Aim: Spondyloarthritis (SpA) is a chronic inflammatory disease associated with an increased cardiovascular (CV) risk that is not fully explained by traditional risk factors. This study aimed to i...UNLABELLED: Introduction-Aim: Spondyloarthritis (SpA) is a chronic inflammatory disease associated with an increased cardiovascular (CV) risk that is not fully explained by traditional risk factors. This study aimed to investigate the associations between oxidative stress markers, CV risk profile, and disease activity in a Tunisian cohort of patients with SpA. METHODS: We conducted a monocentric, cross-sectional study involving 101 patients diagnosed with SpA according to the 2009 ASAS criteria. We collected sociodemographic, clinical, and biological data. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP). The CV risk profile was evaluated through anthropometric measurements, lipid profile, homocysteine, and the SCORE2 index. Oxidative stress status was determined by measuring glutathione peroxidase (GPx) activity, serum levels of oligo-elements (copper, zinc, selenium). RESULTS: The cohort consisted of 101 patients with a mean age of 40.59 ± 11.41 years. A high prevalence of CV risk factors was observed, including overweight/obesity (57.4%), hypertension (31.7%), atherogenic dyslipidemia (73.3% with elevated non-HDL cholesterol), and hyperhomocysteinemia (58.4%). Patients with active disease (ASDAS-CRP ≥ 2.1) exhibited significantly lower GPx activity (p=0.024). Serum copper levels and the copper/zinc (Cu/Zn) ratio were significantly elevated in patients with systemic inflammation (p < 0.001). A significant negative correlation was found between GPx activity and disease activity scores (BASDAI and ASDAS-CRP). CONCLUSION: Oxidative stress is closely linked to systemic inflammation and disease activity, with decreased GPx activity and an elevated Cu/Zn ratio emerging as potential biomarkers of inflammatory status.
INTRODUCTION: Oral cancer is an increasing global health problem, and its early diagnosis is of great importance. Worldwide, several studies have assessed dentists' knowledge and practices regarding oral cancer. However,...INTRODUCTION: Oral cancer is an increasing global health problem, and its early diagnosis is of great importance. Worldwide, several studies have assessed dentists' knowledge and practices regarding oral cancer. However, there is a lack of available data on this subject in Tunisia. AIM: This study aimed to assess knowledge, attitudes, and practices related to oral cancer among dentists in Tunisia. METHODS: This was a cross-sectional study. A structured questionnaire was distributed to 350 dentists (255 females, 72.9%; 95 males, 27.1%) practicing in both public and private sectors across different regions of Tunisia. The mean age of participants was 30 years (range: 24-49), and their professional experience varied from less than 5 years to more than 20 years. Dentists' knowledge about risk factors and clinical presentations of oral cancer development, and their current practices were assessed. Associations between knowledge levels and sex, seniority, specialty, type of practice, and sources of information were examined using the χ² test and Fisher's exact test. RESULTS: The majority of participants identified tobacco (93.4%) and alcohol consumption (45.4%) as major risk factors for oral cancer. Oral medicine university specialists aged under 40 years had the best scores in identifying the floor of the mouth as the most common site for oral cancer, erythroplakia and leukoplakia as the most likely potentially malignant lesions, and squamous cell carcinoma as the most common histological type. CONCLUSION: Dentists have a crucial role in the early detection of oral cancer. This study revealed important gaps in Tunisian dentists' knowledge, particularly regarding risk factors beyond tobacco and alcohol, and highlighted the need to strengthen educational strategies for oral cancer detection and prevention.
AIMS: Health professionals are often confronted with new workplace risks that go beyond physical risks to include psychosocial risks. Moroccan healthcare professionals often experience burnout. Understanding the impact o...AIMS: Health professionals are often confronted with new workplace risks that go beyond physical risks to include psychosocial risks. Moroccan healthcare professionals often experience burnout. Understanding the impact of burnout is essential for creating a healthy work environment in healthcare institutions. This study aimed to systematically analyze: 1) the prevalence of burnout among Moroccan health care professionals. 2) the factors associated with burnout in the same population. METHODS: A systematic review of articles published in PubMed, Scopus, Science Direct, Web of Science, Medline, and ProQuest databases was conducted using keywords up to July 2024. This review included studies that used the Maslach Burnout Inventory (MBI) to evaluate burnout among Moroccan healthcare professionals in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. RESULTS: A total of 14 studies assessing burnout in 4382 Moroccan healthcare professionals were included. The average prevalence of burnout was 73.36%. The burnout prevalence for the three domains ranged from 29 % to 85.71% for high emotional exhaustion (EE), 17% to 79.70% for high depersonalization (DP), and 6% to 85.90% for low personal accomplishment (PA). Young age, female sex, single status, low job satisfaction, poor organization, poor communication, and work conflict were identified as risk factors for burnout. CONCLUSION: The identification of factors associated with burnout syndrome can help prioritize areas of intervention to prevent it. This will guarantee the work-life quality for health professionals in Morocco.
INTRODUCTION: Accurate preoperative evaluation of tracheal stenosis is essential for guiding treatment decisions. Bronchoscopy is considered the "gold standard," but computed tomography (CT) provides promising results. T...INTRODUCTION: Accurate preoperative evaluation of tracheal stenosis is essential for guiding treatment decisions. Bronchoscopy is considered the "gold standard," but computed tomography (CT) provides promising results. This study aims to compare the accuracy of CT and bronchoscopy in characterizing tracheal stenosis. METHODS: A descriptive and analytical study conducted over 10 years (2013-2023) included 20 patients with tracheal stenosis confirmed by CT and bronchoscopy. The evaluated parameters were the distance from the stenosis to the glottis, subglottic involvement, stenosis length, stenosis grade (Meyer-Cotton classification), and mucosal condition. RESULTS: The average distance from the stenosis to the glottis was 34 mm in both exams, with significant correlation (r=0.777, p=0.000). The mean stenosis length was 17.6 mm on CT and 15.8 mm on bronchoscopy, also with significant correlation (r=0.689, p=0.001). In two cases, the stenosis was complete and impassable by the bronchoscope. CT accurately predicted the stenosis grade in 70% of cases (r=0.736, p=0.000). Sensitivity for detecting subglottic involvement was 50%, and for granulomas, 25%, with specificities of 94.4% and 93.8%, respectively. CONCLUSION: CT correlates well with bronchoscopy in measuring the distance to the glottis, stenosis length, and grade but is less effective for detecting subglottic involvement and granulomatous lesions. Combining both techniques is recommended for optimal pre-treatment evaluation of tracheal stenosis.
UNLABELLED: Introducrion : Endothelial lipase gene (LIPG) is implicated in lipid metabolism particularly HDL-C metabolism and in inflammation. Several identified single nucleotide polymorphisms (SNPs) of LIPG were associ...UNLABELLED: Introducrion : Endothelial lipase gene (LIPG) is implicated in lipid metabolism particularly HDL-C metabolism and in inflammation. Several identified single nucleotide polymorphisms (SNPs) of LIPG were associated with lipoprotein and apolipoprotein metabolism. The implication of LIPG in a chronic inflammation due to multisystemic vasculitis has not been elucidated. OBJECTIVE: To assess the association between EL 2037 T/C (rs3744843) polymorphism and alterations in lipid profiles and biomarkers of endothelial dysfunction (such as high-sensitivity C-reactive protein and Homocysteine) in Tunisian patients with Behçet disease (BD). METHODS: A case-control study including BD patients with controls was performed. Lipid profile, high-sensitivity C-reactive protein and homocysteine were assessed to all subjects. The polymerase chain reaction-restriction fragment length polymorphism method was used. RESULTS: We included 116 BD patients and 102 healthy controls in this study. Overall, HDL-C levels were significantly lower in patients. While genotype and allele distributions did not differ significantly between groups, a distinct pattern emerged in HDL-C levels. In healthy controls, C allele carriers had higher HDL-C concentrations compared to TT individuals. In contrast, BD patients carrying the C allele had significantly lower HDL-C levels, particularly in the presence of hyperhomocysteinemia or a disease activity score >5. CONCLUSION: EL 2037 T/C polymorphism was correlated with lipid levels in BD patients and controls. No association was demonstrated between this polymorphism and BD.
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) in the elderly is common but underdiagnosed pathology due to the accumulated prevalence, atypical symptoms and associated comorbidities. The objective of our study was...BACKGROUND: Obstructive sleep apnea syndrome (OSAS) in the elderly is common but underdiagnosed pathology due to the accumulated prevalence, atypical symptoms and associated comorbidities. The objective of our study was to determine the clinical and polygraphy characteristics of OSAS in elderly subjects by comparing them to young subjects. METHODS: Retrospective and comparative study conducted in the pulmonology department of Charles Nicolle Hospital in Tunis, including 110 patients with OSAS. They were divided into two groups: Group 1 including 55 subjects aged 65 and over, and Group 2 including 55 young subjects aged between 18 and 64 years. Clinical, and polygraphy data were collected. RESULTS: The mean age of the elderly subjects was 71 ± 4.6 years, on the other hand the mean age of the young subjects was 50 ± 11 years. Predominance of female sex was in both groups, with less smoking among elders and the absence of alcohol consumption. Physical activity was low in both groups but younger patients were more active (p=0.05). Family obesity was more common among young patients. Comorbidities were more present in the elderly subjects predominantly dyslipidemia (AUC=0.66; p=0.003; CI [0.56-0.76]) followed by high blood pressure (AUC=0.65; p=0.005; CI [0.55-0.75]) and diabetes (AUC=0.62; p=0.021; CI [0.52-0.73]). There was no significant difference between the two groups regarding most of the symptoms but nycturia that was mainly observed among older patients (p=0.017). the AUC was high for the NoSAS score indicating a high discriminant value (0.6; CI [0.51-0.70]). But other screening tools such as the STOP-BANG, Pichot and Epworth scales showed no superiority among both groups with a confidence interval respectively [0.42-0.64], [0.39-0.61]and [0.36-0.58]. Analysis of the polygraphy recording of OSAHS did not differ between the 2 groups, nor did the severity of the pathology (p>0.05). Treatment of OSAHS did not differ between the 2 groups (p>0.05). Hygienic dietary rules were prescribed for all patients. Positive pressure ventilation was prescribed in more than a third of cases in the 2 groups, and mandibular advancement orthosis (MAO) in one young patient. CONCLUSION: Our study highlights the high prevalence of cardiovascular and metabolic co-morbidities in elderly patients being monitored for OSAHS, in addition to the performance of screening scores in the elderly population especially the NoSAS which justifies the importance of a more targeted early detection in this age group for better management.
INTRODUCTION: Management of febrile neutropenia (FN) depends on several elements. Despite their importance, tunisian data were poor. AIM: To describe the clinical, microbiological and therapeutic profile of chemotherapy-...INTRODUCTION: Management of febrile neutropenia (FN) depends on several elements. Despite their importance, tunisian data were poor. AIM: To describe the clinical, microbiological and therapeutic profile of chemotherapy-induced FN during acute myeloblastic leukemia (AML). METHODS: This observational cohort study, conducted in hematology department of Aziza Othmana hospital, included all intensive chemotherapy-induced FN episodes observed in patients aged ≥18 years and diagnosed with AML in 2021. Data were retrospectively collected and descriptively analyzed. RESULTS: Among 33 patients, 121 FN episodes were studied. They were observed respectively during induction (52.1%), consolidation (38.8%) or salvage therapy (9.1%) cycles. Episodes were labeled as fever of unknown origin (29.8%), clinically documented infection (51.2%) and microbiologically documented infection (MDI) (19.0%). Clinical infectious sites were skin/soft tissue (44.6%), gastrointestinal tract (27.3%), respiratory tract (27.3%) and otorhinolaryngology tract (5.0%). Gram-positive cocci and Gram-negative bacilli were isolated respectively in 18 and 15 cases, with CoNS and Klebsiella pneumoniae being the commonest. Multidrug-resistant organisms were observed in nine episodes. Extended-spectrum-beta-lactamase was the most common resistance mechanism. An intensive care unit treatment was required in 13 episodes and noted in two episodes. Sepsis was observed in 28.1% of episodes. FN-related mortality was 7.4%, associated with sepsis, pneumonia and MDI. CONCLUSION: Better supportive care strategies may improve infectious outcome in AML patients undergoing chemotherapy.
INTRODUCTION: The use of social networks has grown exponentially and social media addiction has become a global concern. According to the literature, attachment disorders are described as predictors of this condition. Th...INTRODUCTION: The use of social networks has grown exponentially and social media addiction has become a global concern. According to the literature, attachment disorders are described as predictors of this condition. The main objective of this study was to assess the relationship between social network use and the quality of attachment among college students in Tunisia. METHODS: It was a cross-sectional study conducted among adolescents aged between 11 and 18, recruited from six colleges in Tunisia. Participants were selected by convenience sampling based on to the type of college (private or public) and socio-economic level. We used three instruments : a clinical file, the Bergen Social Media Addiction Scale (BSMAS) and the Inventory of Parent and Peer Attachment (IPPA-R). RESULTS: A total of 1008 adolescents were recruited. The average age of the participants was 13.4 years with a female-to-male ratio of 1.05. The prevalence of social media addiction was 7.5% according to the conservative approach and increased to 41.2% using the liberal approach. A negative and statistically significant correlation was demonstrated between the global BSMAS scores and IPPA scores corresponding to the parents (p<0.0001). CONCLUSION: Among Tunisian adolescents, lower quality of attachment was associated with increased levels of addiction to social networks. The implementation of preventive strategies is essential in order to mitigate this problematic use.
BACKGROUND: Cervicogenic headache (CGH) is frequently associated with cervical radiculopathy (CR), but its prevalence and contributing factors in patients undergoing conservative treatment are not well established. AIM:...BACKGROUND: Cervicogenic headache (CGH) is frequently associated with cervical radiculopathy (CR), but its prevalence and contributing factors in patients undergoing conservative treatment are not well established. AIM: To assess the prevalence of CGH and identify the factors associated with it among patients with CR undergoing conservative treatment. METHODS: A cross-sectional analytical study was conducted from May 2023 to December 2023 in the Physical Medicine and Rehabilitation (PMR) of Monastir, Tunisia. Patients with CR consulting in PMR and Rheumatology departments were included. The prevalence of CGH was evaluated using the IHS diagnostic criteria, and associated factors were analyzed. RESULTS: CGH was diagnosed in 53 out of 86 patients (61.6%) with CR. Univariate analysis revealed that limitations in right cervical rotation, impaired cervical spine proprioception, reduced neck flexor and extensor strength, functional impairment, high anxiety levels, and lower scores in the physical and mental health domains of quality of life were associated with CGH. Multivariate analysis identified high anxiety score (OR=1.44; 95% CI 1.04-1.98; p=0.024), limitation of right cervical rotation (OR=0.80; 95% CI 0.70-0.90; p < 0.001), and impaired proprioception during flexion (OR=1.38; 95% CI 1.08-1.76; p=0.009) as independent factors associated with CGH. CONCLUSION: CGH seems to be highly prevalent in CR patients undergoing conservative treatment. This study suggests that key factors associated with CGH are proprioception deficit, anxiety, and reduced quality of life. Further large-scale studies are needed to confirm these findings.
Boudiche S, Chedly M, Saadi M
… +33 more, Ben Halima M, Charfeddine S, Abid L, Slim M, Neffati E, Kamoun S, Kraeim S, El Ayech F, Ben Ahmed H, Bezdah L, Azaiez F, Ben Ameur Y, Ben Ayed H, Noamen A, Fehri W, Ben Abdessalem A, Ben Halima N, Mahdhaoui A, Jomaa W, Ben Hamda K, Zakhama L, Kallel R, Denguir H, Ibn El Hadj Z, Jedaida B, Mrabet K, Hamza C, Bejar K, Kerkeni M, Hmem M, Battikh K, Boukhris M, Mourali MS
INTRODUCTION: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) but remains insufficiently characterized. This study aimed to evaluate early and long-term ou...INTRODUCTION: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) but remains insufficiently characterized. This study aimed to evaluate early and long-term outcomes of patients with SCAD. METHODS: A national wide, 25-year (since 2000), study with prospective (since 2017) inclusions of patients presenting for ACS with documented SCAD. Primary endpoint was in-hospital and long term major adverse cardiac and cerebrovascular events (MACCE). RESULTS: 87 patients. Mean age 47.5±11 years, 71% female, 84% had no or only one conventional cardiovascular risk factor. Pregnancy-associated (P-SCAD) accounted for 9%. ST-segment elevation myocardial infarction and cardiogenic shock were described in 51% and 7%. 101 SCAD lesions (60% type 1, 37% type 2 and 3% type 3) were noted. Left anterior descending was the most affected vessel (72%), multivessel involvement was observed in 26% and severe tortuosities were reported in 38%. Conservative strategy was possible in 84% of patients; among them 15% required subsequent urgent clinically driven revascularization. Coronary angiography and percutaneous interventions were associated with five major complications of which one was fatal. Six in-hospital deaths were reported (7%), 4 of them were P-SCAD. After 16-month median follow-up, overall major events and mortality rates were 17% and 9% respectively. Two SCAD recurrences were reported. CONCLUSIONS: SCAD affected a middle-aged, predominantly female population, with no or few conventional risk factors. In-hospital mortality was high especially in P-SCAD. Coronary angiography and interventions for SCAD were associated with frequent complications, and a conservative management should be preferred when possible.
INTRODUCTION: Systemic sclerosis is a rare autoimmune disease characterized by microcirculation abnormalities and fibrosis of the skin and/or internal organs. Both genetic and environmental factors are recognized contrib...INTRODUCTION: Systemic sclerosis is a rare autoimmune disease characterized by microcirculation abnormalities and fibrosis of the skin and/or internal organs. Both genetic and environmental factors are recognized contributors to AID development. Vitamin D, through its receptor, plays a role in immune regulation, and the VDR gene has been identified as a candidate for AID susceptibility. However, studies examining the relationship between VDR polymorphisms and AIDs have yielded conflicting results, often varying by ethnic background. OBJECTIF: The purpose of this study was to investigate the association of FokI and BsmI polymorphisms of the VDR gene with systemic sclerosis in a Tunisian population. METHODS: A case-control study was conducted, involving 68 SSc patients and 190 healthy controls. Genotyping of the two polymorphisms was performed using restriction fragment length polymorphism polymerase chain reaction, and data analysis was conducted via SPSS for Windows (version 28.0). RESULTS: Results showed significant differences between SSc patients and controls for both polymorphisms. The BsmI bb genotype (0.28 vs. 0.12; p=0.004) and b allele (0.49 vs. 0.36; p=0.014) were more frequent in SSc patients. Conversely, the FokI Ff (0.54 vs. 0.41; p=0.007) and ff (0.15 vs. 0.06; p=0.008) genotypes, along with the f allele (0.42 vs. 0.26; p<0.001), were more common in the control group. CONCLUSION: The BsmI polymorphism was associated with increased genetic predisposition to SSc, whereas the FokI polymorphism appeared to confer protection in the studied population.
INTRODUCTION: Serious games are playing an increasingly important role in medical education. However, their use in pathology remains limited, despite the complexity and high level of rigor of this discipline, which poses...INTRODUCTION: Serious games are playing an increasingly important role in medical education. However, their use in pathology remains limited, despite the complexity and high level of rigor of this discipline, which poses a significant challenge for students. OBJECTIVE: To evaluate Patho-Play, a scenario-based serious game for pathology training, by assessing short-term knowledge gains and learner perceptions among third-year medical students. METHODS: In a prospective single-arm study over two academic years (2023-2025), 28 third-year medical students completed a 45-minute Patho-Play session comprising 12 sequential levels. Knowledge was assessed using a 20-item multiple-choice pre-test and post-test aligned with the internship logbook. Student perceptions were collected via an anonymous questionnaire. In-game performance scores were recorded to measure engagement. RESULTS: Pre-test mean scores increased from 12.25 (SD 1.75) to 17.68 (SD 0.95) out of 20 (p < 0.001; Cohen's d = 3.85). All participants improved by ≥3 points; 50% achieved ≥18/20 post-test. In-game scores (900-1230/1280) reflected task accuracy and hint usage. Student feedback indicated high acceptability: 89% reported added educational value, 86% reported increased engagement, and 79% found the experience immersive. Only 18% perceived enhanced teamwork. CONCLUSIONS: Patho-Play demonstrated potential effectiveness for short-term knowledge gains and high learner acceptability. Given the single-arm design and MCQ-based assessment, results should be interpreted cautiously. Future randomized studies are needed to confirm efficacy, evaluate long-term retention, and explore collaborative and adaptive features.
Abid M, Abdennadher A, Abdelhaedi F
… +127 more, Abdelmoula S, Abidi H, Aguir W, Amdouni R, Arfaoui R, Attar S, Ayari F, Baati A, Bahlous O, Balhoudi N, Ben Ahmed S, Ben Ahmed Y, Ben Aba N, Ben Ayed N, Ben Brahim I, Ben Dhia M, Ben Elhaj Rhouma E, Ben Ghalia M, Ben Halima A, Ben Hamad A, Ben Hamida H, Ben Hamouda H, Ben Khalifa M, Ben Khalifa S, Benlamine Z, Ben Mansour H, Ben Mohamed W, Ben Salah F, Benali M, Blibech S, Boubakker R, Bouchaala W, Bouguizene S, Boujelben I, Boukettaya M, Bouzidi N, Bouziri A, Borgi A, Brahem D, Braham D, Charfi M, Chargui A, Cherif E, Cherif H, Chkili R, Chouikha M, Chourou H, Dahmen R, Day N, Dridi S, El Guerchi S, El Ghali M, El Ouaer M, Elouer M, Elguerchi S, Elleuch A, Fendri O, Fedhila F, Fraj H, Ghali M, Ghith A, Ghoudi T, Green J, Guellim I, Guerrioui A, Haddad S, Haj Ltaief M, Hamida N, Hannachi S, Hedhili S, Hriz C, Ismail M, Jaouadi H, Jaouhari S, Jbebli E, Jlidi S, Kamoun D, Kamoun H, Kamoun M, Kacem S, Kaabia O, Khelifa R, Khemakhem M, Khemakhem N, Kolsi N, Karray H, Koumi Y, Landolsi H, Letaief C, Mahdhaoui N, Mahjoub K, Maatalah A, Mansour H, Mansour K, Marzouki M, Mghirbi O, Miraoui A, Mhiri R, Mlouki I, Monastiri K, Nasralli D, Nabiha Mahdhaoui N, Nouira F, Nouira K, Outtay A, Regaieg C, Regaieg R, Rhaiem W, Rhouma R, Romdhane H, Rouis C, Saidane M, Samaali K, Sabkha NH, Salah S, Sfaihi L, Taamli M, Tammli M, Tarhouni N, Tigorti M, Tobji A, Trabelsi M, Tounsi MK, Toumi H, Youssef M, Zairi R, Bel Haj W
BACKGROUND: Multiple myeloma (MM) is a plasma cell malignancy with diverse clinical manifestations. Beyond the classic CRAB features (hypercalcemia, renal insufficiency, anemia, and lytic bone lesions), extramedullary in...BACKGROUND: Multiple myeloma (MM) is a plasma cell malignancy with diverse clinical manifestations. Beyond the classic CRAB features (hypercalcemia, renal insufficiency, anemia, and lytic bone lesions), extramedullary involvement is rare and often life-threatening. This case highlighted atypical and severe pulmonary-pleural manifestations, emphasizing the diagnostic complexity of extramedullary disease. CASE PRESENTATION: A 67-year-old hypertensive man was admitted with fever, dyspnea, and hemoptysis. He presented with pleural effusion, biologically confirmed alveolar hemorrhage, nephrotic-range proteinuria, and osteolytic lesions. Cytology demonstrated pleural plasmacytic infiltration, and bone marrow aspiration showed 100% plasmacytosis. He was diagnosed with immunoglobulin G-kappa MM with pulmonary and pleural extramedullary disease and achieved partial remission with melphalan-dexamethasone, maintaining clinical improvement for 12 months. CONCLUSION: This case illustrated rare, severe extramedullary manifestations of MM with renal dysfunction as a key clinical clue. It underscored the importance of early recognition and comprehensive diagnostic evaluation. Prognosis remains poor in aggressive variants despite timely treatment.
AIM: The aim of this study was to evaluate roots and root canal morphology of mandibular first and second permanent molars in a Tunisian population using cone-beam computed tomography (CBCT), providing detailed anatomica...AIM: The aim of this study was to evaluate roots and root canal morphology of mandibular first and second permanent molars in a Tunisian population using cone-beam computed tomography (CBCT), providing detailed anatomical data to support clinical endodontic practice. METHODS: This retrospective, descriptive study included 100 CBCT scans from patients referred to the University Dental Clinic of Monastir between January and December 2024. A total of 400 mandibular molars (200 first and 200 second molars) were analyzed. Only teeth with fully developed roots and no prior endodontic treatment were included. Morphological features were assessed in axial, sagittal, and coronal CBCT views. The number of roots, number of canals per root, and canal configurations were recorded based on Vertucci's classification. The presence of radix entomolaris and radix paramolaris was also noted. Statistical analysis was performed using the Chi-square test (p ≤ 0.05). RESULTS: Mandibular first molars exhibited predominantly two-rooted anatomy (98%), with 2% presenting a third distolingual root (radix entomolaris). Second molars displayed more variation, with 5% showing a single root, 4% with three roots, and 1% with four roots. Canal configuration analysis revealed that the mesial root of first molars most commonly exhibited Vertucci Type IV (83.7%), while distal roots showed a predominance of Type I (60.2%). In second molars, mesial roots also frequently presented Type IV (51.1%), whereas distal roots overwhelmingly exhibited Type I (94.4%). Three- and four-rooted molars were more commonly found in second molars. Sex and side differences were not statistically significant (p = 0.579 and p = 0.4, respectively), but root morphology was significantly associated with tooth type (p = 0.003). CONCLUSION: This CBCT-based study provides the first comprehensive analysis of mandibular molar root and canal morphology in a Tunisian population. The findings confirm substantial anatomical variability, particularly in second molars, and underscore the importance of population-specific data for improving diagnostic accuracy and enhancing the outcomes of endodontic therapy.