Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.5106
Meriem Gaddas, Helmi Ben Saad
{"title":"Challenges and Implications of Military Attacks on Hospitals: A Critical Analysis of International Legal Standards and the Pursuit of Accountability.","authors":"Meriem Gaddas, Helmi Ben Saad","doi":"10.62438/tunismed.v102i10.5106","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5106","url":null,"abstract":"<p><p>not applicable, this is an editorial.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.5119
Nour Faouel, Nadia Ghariani, Amjed Ben Haouala, Soukaina Maghfour, Maha Lahoual, Sana Mokni, Ahmed Mhalla, Mohamed Denguezli
{"title":"Depression among Alopecia Areata Patients: Prevalence and associated factors in a Tunisian sample.","authors":"Nour Faouel, Nadia Ghariani, Amjed Ben Haouala, Soukaina Maghfour, Maha Lahoual, Sana Mokni, Ahmed Mhalla, Mohamed Denguezli","doi":"10.62438/tunismed.v102i10.5119","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5119","url":null,"abstract":"<p><p>Introduction Alopecia areata (AA) is a common, chronic inflammatory, non-scarring form of hair loss affecting 0.1-0.2% of the population. It is a psychosomatic disease involving a T-cell-mediated immune reaction against hair follicle antigens during the anagen phase. Psychiatric morbidity in dermatological patients can significantly affect their quality of life and disease progression. Identifying and addressing these comorbidities in AA patients is crucial. Aim This study aimed to estimate the prevalence of depression and its associated factors among patients diagnosed with alopecia areata (AA). Methods The present study is a cross-sectional, descriptive, and analytical study conducted at Farhat Hached Hospital in Sousse, Tunisia, during the period from August to December 2019. Participants were recruited from the Dermatology Outpatient Department. The questionnaire covered socio-demographic characteristics, personal and family history, AA history, clinical presentation, disease severity (SALT score), nail involvement, and depression assessment using the Hamilton Depression Scale (validated Arabic version). Results A total of 60 AA patients were enrolled, with a mean age of 37.6 ± 12.9 years. Females exhibited a predominant representation, with a male to female ratio (M/F) of 0.76. According to the Hamilton Depression Scale (HAM-D), 31 cases (51.7%) were depressed, with a mean depression scale score of 11.33 (±6.57 SD). The presence of depression was significantly associated with younger age (p=0.018), the presence of the eyelashes/eyebrows form (p=0.035), nail involvement (p= 0.03), and a poor response to treatment (p=0.004). Conclusion Our research highlights the importance of providing psychological support to alopecia areata patients.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnosis of esophageal varices: Correlation between non-invasive tests and digestive endoscopy.","authors":"Asma Mensi, Amel Medhioub, Nouha Trad, Emna Bel Haj Mabrouk, Yosra Said, Radhouane Debbeche","doi":"10.62438/tunismed.v102i10.5168","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5168","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal variceal bleeding (EVB) is one of the main causes of mortality and morbidity in cirrhotic patients. Non-invasive tests (NIT) of liver fibrosis have been developed to predict the presence of esophageal varices (EV).</p><p><strong>Aim: </strong>To evaluate the performance of NIT of liver fibrosis such as liver transient elastography (TE) and serum scores in predicting EV.</p><p><strong>Methods: </strong>We conducted a retrospective collecting patients with chronic liver disease. TE and serum scores were evaluated for all patients and correlated with endoscopic data.</p><p><strong>Results: </strong>One hundred and fifty patients were included with an average age of 58.98 years and a sex ratio of 0.68. Sixty-seven patients were cirrhotic. Viral origin C was found in 72% of cases. Thirty-three patients had EV. NIT of liver fibrosis such as TE and serum scores were statistically correlated to the presence of EV. TE had the better performance for the prediction of EV with a Cut-off of 13.5 Kpa and AUC of 0.855. In multivariate analysis, TE, AST to ALT ratio and platelet count were independent predictors of EV.</p><p><strong>Conclusion: </strong>The performance of TE and serum scores in the diagnosis of EV and LEV was demonstrated. These results suggest that NIT of liver fibrosis make it possible to select patients who are candidates for gastroscopy.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.5068
Brahim Demnati, Zakaria Chabihi, El Mehdi Boumediane, Siham Dkhissi, Fahd Idarrha, Yassine Fath Elkhir, Mohamed Amine Benhima, Imad Abkari, Mohamed Rafai, Samir Ibn Moussa, Mohamed Rahmi
{"title":"Psychological impact of peri-implant fractures: A cross-sectional study.","authors":"Brahim Demnati, Zakaria Chabihi, El Mehdi Boumediane, Siham Dkhissi, Fahd Idarrha, Yassine Fath Elkhir, Mohamed Amine Benhima, Imad Abkari, Mohamed Rafai, Samir Ibn Moussa, Mohamed Rahmi","doi":"10.62438/tunismed.v102i10.5068","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5068","url":null,"abstract":"<p><strong>Introduction: </strong>Peri-implant fractures (PIFs) are uncommon yet critical complications following orthopedic surgery. These complications can significantly impact a patient's psychological well-being and overall quality of life.</p><p><strong>Aim: </strong>This study aimed to investigate the psychological effects of PIFs.</p><p><strong>Methods: </strong>This was a cross-sectional study that involved 136 patients who underwent surgery for PIFs between 2018 and 2022. We utilized various validated scales and questionnaires such as Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Impact of Event Scale Revised (IES-R), 36-Item Short Form Survey (SF-36), and Brief COPE Inventory (BCI) to assess their psychological state.</p><p><strong>Result: </strong>The results revealed that patients with PIFs experienced higher levels of anxiety, depression, stress, and post-traumatic stress compared to the general population. Additionally, they reported lower physical and mental health. Factors such as the number of surgeries, treatment delay, post-operative pain levels, and complications significantly influenced their psychological outcomes. Notably, acceptance, positive reframing, and seeking emotional support were the most common coping mechanisms employed by these patients. Conversely, denial, substance use, and self blame were the least employed strategies.</p><p><strong>Conclusion: </strong>This study suggests that psychological interventions could significantly benefit patients with PIFs, potentially reducing their distress and improving their quality of life.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.5139
Khaoula Magdoud, Abir Karoui, Nadia Boujelbene, Rim Ben Hmid
{"title":"Intravenous Leiomyomatosis of the Uterus: An Intriguing Case Revealed through Anatomopathological Examination.","authors":"Khaoula Magdoud, Abir Karoui, Nadia Boujelbene, Rim Ben Hmid","doi":"10.62438/tunismed.v102i10.5139","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5139","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous leiomyomatosis (IVL), a rare type of uterine leiomyoma (its incidence is about 0.25% to 0.40% of patients who present uterine fibroma), is characterized by the formation and growth of benign leiomyoma tissue within the vascular wall or lymphatic lumen. Herein, we presented a case of early stage of IVL successfully treated by surgical removal and a review of actual medical recommendations.</p><p><strong>Observation: </strong>A 49-year-old woman, gravida 2 para 2, presented to our department with hypogastric pain. On physical examination, a palpable mass in the hypogastrium was noted. Pelvic ultrasound showed a huge uterus with multiple heterogeneous leiomyomas. As the patient was symptomatic and as she had completed their family plan, the decision to perform a total abdominal hysterectomy with bilateral salpingo-oophorectomy was taken. On pathological examination, intravascular growth of benign smooth muscle cell was found within venous channels lined by endothelium. The diagnosis of IVL of the uterus without malignant transformation was confirmed. The patient was monitored for 14 months, and subsequent computed tomography did not reveal any evidence of tumor recurrence.</p><p><strong>Conclusion: </strong>IVL is a benign, rare and potentially lethal pathology. Clinical manifestations are nonspecific. IVL needs surgical treatment for diagnosis and therapeutic purposes. They require close and prolonged follow-up because of the high risk of recurrence.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Performance of GPR score for non-invasive assessment of liver fibrosis in chronic hepatitis B Tunisian patients.","authors":"Ikbel Ghachem, Lamine Hamzaoui, Asma Bachali, Chayma Rhimi, Mouna Medhioub, Moufida Mahmoudi, Amal Khsiba, Mohamed Msaddak Azouz","doi":"10.62438/tunismed.v102i10.5091","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5091","url":null,"abstract":"<p><strong>Introduction: </strong>Several non-invasive tests (NIT) have been reported for predicting liver fibrosis to avoid percutaneous liver biopsy (PLB).</p><p><strong>Aim: </strong>To evaluate the performance of NIT in Tunisian patients with chronic hepatitis B (CHB).</p><p><strong>Methods: </strong>We calculated the ASAT/platelet ratio index (APRI), GGT-to-platelet ratio (GPR), Fibrosis-4 score (FIB-4), and RDW/platelet ratio (RPR). The accuracy of NIT was compared with the Metavir score for the detection of liver fibrosis stage using the area under the ROC curves (AUROC).</p><p><strong>Results: </strong>Seventy-seven CHB patients were included. For predicting significant fibrosis, the AUROC of GPR (0.81; CI95% [0.68-0.93]; P < 0.001) was significantly higher than that of RPR (0.67; CI95% [0.52-0.82]; P = 0.03) and FIB-4 (0.746; CI95% [0.61-0.88]; P = 0.002), but was similar to APRI (0.88; CI95% [0.79-0.97]; P < 0.001). For advanced fibrosis, the AUROC of GPR (0.93; CI95% [0.84-1]; P < 0.001) was higher than that of RPR (0.83; CI95% [0.69-0.97]; P < 0.001) and FIB-4 (0.88; CI95% [0.76-0.99]; P < 0.001), but similar to APRI (0.93; CI95% [0.87-0.99]; P < 0.001). For predicting cirrhosis, the AUROC of GPR (0.98; CI95% [0.95-1]; P < 0.001) was higher than that of APRI (0.95; CI95% [0.90-1]; P = 0.02), similar to RPR (0.99; CI95% [0.98-1]; P < 0.001) but lower than that of FIB-4 (1; CI95% [1-1]; P < 0.001). In multivariate analysis, APRI (OR = 3.78; P = 0.002) and FIB-4 (OR = 2.65; P = 0.01) were independent predictors of significant fibrosis. GPR was the only independent predictor of advanced fibrosis (OR = 4.64; P = 0.001) and FIB-4 was the independent predictor of cirrhosis (OR = 2.85; P < 0.001).</p><p><strong>Conclusion: </strong>GPR does not demonstrate significant advantages over APRI, FIB-4, and RPR in identifying liver fibrosis in patients with chronic hepatitis B (CHB).</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.4881
Khouloud Ferchichi, Rim Charfi, Syrine Ben Hammamia, Mouna Ben Sassi, Emna Gaies, Mouna Daldoul, Riadh Daghfous, Sameh Trabelsi
{"title":"Factors influencing valproic acid trough levels in epileptic children.","authors":"Khouloud Ferchichi, Rim Charfi, Syrine Ben Hammamia, Mouna Ben Sassi, Emna Gaies, Mouna Daldoul, Riadh Daghfous, Sameh Trabelsi","doi":"10.62438/tunismed.v102i10.4881","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.4881","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed to assess main factors influencing the Valproic Acid (V.Acid) plasma trough levels (C0) and to determine their degree of influence on V.Acid C0 in children with epilepsy who had Therapeutic Drug Monitoring (TDM).</p><p><strong>Methods: </strong>We conducted an observational study in the Department of Clinical Pharmacology including patients with generalized seizures' epilepsy aged between two and 18 years. Only the children that had benefited from at least two V.Acid C0 determinations were included. First, we assessed daily dose optimization, performed by the practitioners. Then we divided our population into two groups: group A with a final V.Acid C0 in the therapeutic range (TR) and group B with a final V. Acid C0 outside the TR to find out factors influencing V.Acid C0 journey.</p><p><strong>Results: </strong>We included 805 patients (2537 V.Acid C0). The median age was 6.24 years and the sex ratio (M/F) was 1.45. The median V.Acid normalized daily dose was 27.27mg/kg/day and the median V.Acid C0 was 57µg/mL. The children's first V.Acid C0 was in the TR in 59.4% and V.Acid daily dose optimization was performed by the practitioners in 72.3%. Comparing GroupA and B, we found that age and the number of V.Acid C0 determinations increases the chance to reach the TR by respectively 3.79% and 7.39%.</p><p><strong>Conclusion: </strong>Older children who benefit from higher number of performed V.Acid C0 were more likely to reach the TR. In children who beneficiate from a TDM of V.Acid, close follow-up is mandatory to reach and maintain therapeutic V.Acid C0.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.4934
Elhem Jbebli, Yosra Jbeli, Rawia Ben Farhat, Samar Rhayem, Sarra Ben Ahmed, Rym Amdouni, Faten Fedhila Ben Ayed, Monia Khemiri
{"title":"Impact of virtual reality on the perception of procedural pain in paediatric oncology.","authors":"Elhem Jbebli, Yosra Jbeli, Rawia Ben Farhat, Samar Rhayem, Sarra Ben Ahmed, Rym Amdouni, Faten Fedhila Ben Ayed, Monia Khemiri","doi":"10.62438/tunismed.v102i10.4934","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.4934","url":null,"abstract":"<p><strong>Introduction: </strong>Virtual reality is being used more and more in the healthcare field, particularly during treatment. In the context of pain management, the question arises as to the effectiveness of using virtual reality during care in reducing the perception of procedural pain.</p><p><strong>Aim: </strong>To study the impact of using virtual reality on the perception of procedural pain and on the course of care in pediatric oncology.</p><p><strong>Methods: </strong>A quasi-experimental, matched-case-control study conducted at the pediatric oncology unit of the Tunis Children's Hospital over a three-month period. Each child had two nursing care : with and without the use of virtual reality.</p><p><strong>Results: </strong>Thirty-two children were enrolled. The sex ratio was 0.88. The edia nage was 96 ± 49 months. The care provided was peripheral venous line insertion (53%), blood sampling (32%) and port-a-catheter puncture (15%). The use of virtual reality significantly reduced heart rate (p<0.0001), respiratory rate (p<0.0001) and pain perception (p<0.0001). Workload was reduced, as evidenced by a drop in the duration of nursing care (p<0.0001) and in the number of people needed to carry out care (p<0.0001).</p><p><strong>Conclusions: </strong>Virtual reality is a good non-pharmacological alternative for procedural pain control in a pediatric oncology unit.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tunisie MedicalePub Date : 2024-10-05DOI: 10.62438/tunismed.v102i10.5065
Hela Sahbani, Marwa Bahri, Emna Azza, Yosr Ben Abdennebi, Lamia Aissaoui
{"title":"Atypical presentation of systemic lupus erythematosus in a 16-year-old boy: Case report.","authors":"Hela Sahbani, Marwa Bahri, Emna Azza, Yosr Ben Abdennebi, Lamia Aissaoui","doi":"10.62438/tunismed.v102i10.5065","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.5065","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, characterized by a clear female predominance and a major clinical polymorphism. Some initial presentations, particularly in children and adolescents are exceptional. Our objective was to report an unusual initial presentation of SLE in a male adolescent.</p><p><strong>Observation: </strong>We reported the case of a 16-year- old tunisian boy who was referred to the hematology emergency department because of a hemorrhagic syndrome. The evolution was marked by pancytopenia, prolonged fever and an anasarca with recurrent cardiac tamponade. Explorations concluded to SLE. The patient was started on pulse therapy of dexamethasone followed by immunoglobulin. He was also provided with pericardiocentesis with a favorable outcome.</p><p><strong>Conclusion: </strong>SLE is characterized by clinical polymorphism, that's why diagnosis and management of complications could be difficult. SLE should be considered in differential diagnosis of many disorders, such as pancytopenia and cardiac tamponade.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"GAIA therapeutic farm: Prospective study on multidisciplinary care efficacy.","authors":"Soumaya Halayem, Faten Chennoufi, Uta Ouali, Yosr Lajmi, Raja Moumni, Asma Bouden, Leila Guesmi","doi":"10.62438/tunismed.v102i10.4959","DOIUrl":"https://doi.org/10.62438/tunismed.v102i10.4959","url":null,"abstract":"<p><strong>Introduction: </strong>The therapeutic farm \"GAIA\" in Sidi Thabet is a non-profit organization created in 2009, situated in the North-Western suburbs of the capital Tunis/Tunisia. Its main aims are the day-care for and the socio-professional integration of children and young adults between age 6 and 30 with diverse types of disability through multiple activities, such as pet assisted therapy and horticulture.</p><p><strong>Aim: </strong>to assess the potential benefits of therapeutic on-farm management.</p><p><strong>Methods: </strong>We conducted a prospective study including 50 children and young adults aged 7 to 30 years with intellectual disabilities and/or autism spectrum disorders. Study participants were evaluated before inclusion and after 10 months of care using a self-established questionnaire collecting socio-demographic and clinical variables, an evaluation of competences, and the Child Behavior Checklist (CBCL).</p><p><strong>Results: </strong>Mean sub scores (externalization/internalization) of CBCL decreased significantly (p<0.002). Competences were significantly improved in the following domains: understanding of verbal language, gross and fine motor skills, body hygiene, spatial and temporal orientation, preschool and school learning achievements and social integration.</p><p><strong>Conclusions: </strong>These positive initial results should encourage the further development of this initiative with support of the community.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}