Tunisie Medicale最新文献

{"title":"Patient-management problem in the evaluation of intensive medicine.","authors":"Ahlem Trifi, Aida Benzarti, Asma Mehdi, Eya Seghir, Lynda Messaoud, Sami Abdellatif","doi":"10.62438/tunismed.v102i4.4537","DOIUrl":"10.62438/tunismed.v102i4.4537","url":null,"abstract":"<p><strong>Introduction: </strong>In intensive care medicine (ICM), the use of Patient-Management Problem (PMP) remains limited and no feedback from students is available.</p><p><strong>Aim: </strong>To compare the feasibility of employing PMP referring to clinical cases (CC) as assessment tools for appraising the knowledge and competencies in ICM students; and to gather the students' perception regarding this experience.</p><p><strong>Methods: </strong>it was a cross-sectional randomized trial. Were included, external students in the 3rd year of the 2nd cycle of medical studies (3rd-SCMS) during their ICM externship. All the participants underwent two random draws (the 1st one for assessment tool to be started (PMP or CC) and the 2nd for the passage order for PMP. Two PMPs versus two grouped QCMs-CC were prepared and a satisfaction questionnaire was distributed. The main judgment criterion was the effect of each assessment tool on the students' decision-making process. This focused on the relevance of the elements provided by each technique, the implication and the difficulty felt. The secondary endpoint was the scores taken for each tool tested.</p><p><strong>Results: </strong>20 students were included. All participants had previous experience with PMPs and only nine were familiar with grouped MCQs-CC. PMP scores were 14.9 for the 1st theme and 15.8 for the 2nd theme. The median of the grouped MCQs-CC scores was 14 [12-16] for both. The scores didn't differ between the two techniques. For the 1st theme: the scores were negatively correlated (r=-0.58 and p=0.007). Students felt a better satisfaction for PMP evaluation (p<10-3), the elements provided by PMP were more relevant for decision-making process (p<10-3), the involvement was more felt with PMP (p<10-3) and difficulty was more felt with CCs (p<10-3). The effect of PMP was found to be significant on clinical reasoning (n=36), self-assessment (n=38), problem solving (n=40) and decision making (n=39). Students recommended strongly PMP as a tool of evaluation in ICM (p<10-3).</p><p><strong>Conclusion: </strong>scores were comparable between the two tested techniques. The positive perception of students regarding PMP encourages its generalization and teacher training must be strengthened.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological characteristics and tumor infiltrating immune cells associations of PD-L1 tumor expression in non-small cell lung cancer patients.","authors":"Oussama Aazzane, Fatima Zahra Bakhtaoui, Saida Stitou, Hassan Fellah, Mehdi Karkouri","doi":"10.62438/tunismed.v102i4.4688","DOIUrl":"10.62438/tunismed.v102i4.4688","url":null,"abstract":"<p><strong>Aim: </strong>Our study aimed to perform on Moroccan patients' non-small cell lung carcinoma (NSCLC) concerning the relationship between PD-L1 tumor expression, clinicopathological features and tumor infiltrating immune cells (ICs).</p><p><strong>Methods: </strong>This is a retrospective study (2019 to 2021) conducted on samples from Moroccan patients with NSCLC at the Pathological Anatomy Laboratory of Ibn Rochd University Hospital in Casablanca. Eligible participants for our study had to meet the following predefined criteria: age ≥18 years, histologically confirmed NSCLC, no prior therapeutic interventions, availability of clinical and pathological data, and a usable tumor sample for determining PD-L1 status. Exclusion criteria applied to patients with other types of lung cancer and unusable tumor samples. The evaluation of tumor and immune expression of PD-L1 was performed using immunohistochemistry (IHC), with the 22C3 clone on the Dako Autostainer Link 48 platform. Tumor PD-L1 expression was categorized into 3 levels: TPS <1% (negative expression), TPS 1-49% (low expression), and TPS ≥50% (high expression). ICs infiltrating the tumor expressing PD-L1 were considered positive when more than 1% of positive ICs were present.</p><p><strong>Results: </strong>Among the 316 analyzed samples, 56.6% showed a negative expression of PD-L1, 16.8% displayed a low expression of PD-L1, and 26.6% exhibited a strong expression. Regarding the histological type, among patients with TPS ≥ 50%, 25.8% had adenocarcinoma. Among patients with TPS ≥ 50%, 24.81% were smokers. PD-L1 was also strongly expressed in the lung (28.2%) and bronchi (26.5%). PD-L1 expression (TPS ≥ 50%) was observed in 35.29% of early-stage patients. Concerning tumor cells (TCs), 27.5% of tumors infiltrated by ICs had TPS ≥ 50%. Furthermore, coexpression of PD-L1 on both TCs and ICs infiltrating the tumor was found in 27.8% of tumors. Statistical analysis demonstrated a significant association between tumor PD-L1 expression and smoking status (P=0.019). However, no significant difference was observed between PD-L1 expression and the presence of ICs infiltrating the tumor (P=0.652), as well as the IHC expression of PD-L1 on ICs (P=0.259).</p><p><strong>Conclusion: </strong>Our results demonstrate a significant association between PD-L1 expression and smoking status. However, no significant association was observed between PD-L1 expression and the presence of infiltrating ICs, nor with the IHC expression of PD-L1 on ICs. Our data underscore the importance of participating in the study of specific factors influencing PD-L1 expression in patients with NSCLC.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of diabetes self-management education on health-related quality of life of Tunisian children with type1 diabetes mellitus and their parents: A randomized controlled trial.","authors":"Imen Ben Abdesselem, Raoudha Kebaili, Khansa Derbel, Hichem Ben Said, Lamia Boughammoura, Sonia Rouatbi, Jihene Bouguila","doi":"10.62438/tunismed.v102i4.4846","DOIUrl":"10.62438/tunismed.v102i4.4846","url":null,"abstract":"<p><strong>Aim: </strong>To assess the effect of diabetes self-management education (DSME) on health related quality of life (HRQoL) of Tunisian children/adolescents with type 1 diabetes mellitus and their parents.</p><p><strong>Methods: </strong>This monocentral study used a randomized controlled trial design, during five-month intervention and five-month follow-up and including 110 patients (54 in the DSME intervention group and 56 in the Individual Education by Pediatrician (IEP) control group) and their parents. Pediatric Generic Core Quality-of-Life Inventory 4.0-Scale (PedsQL4.0) evaluated HRQoL.</p><p><strong>Results: </strong>At baseline, both groups had similar clinical features and PedsQL4.0 scores (p>0.05). In DSME, clinical outcomes were significantly improved from baseline to follow-up (p<0.001), while in the IEP group, which received no intervention, these outcomes remained unchanged. During follow-up, DSME showed higher PedsQL4.0 scores in parents' proxy-report and children/adolescents self-report (p<0.001). According to parents' proxy-report, PedsQL4.0 scores were significantly higher during follow-up compared to baseline in DSME (p<0.001) while they remained the same in IEP (p>0.05). DSME had higher percentage of change in the PedsQL4.0 scores than IEP (p<0.01). The median change varied from -5.01% to 0% vs 5.41% to 36.36% in IEP and DSME, respectively.</p><p><strong>Conclusion: </strong>Encouraging healthcare professionals to incorporate these interventions could enhance the HRQoL of diabetic children and bolster their self-esteem.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11387992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of anal fistulas in Crohn’s disease after failure of Infliximab.","authors":"Sarra Ben Azouz, Nour Elleuch, Wafa Dahmeni, Eya Hammami, Ahlem Braham, Hanene Jaziri, Aida Ben Slema, Mehdi Ksiaa, Ali Jmaa","doi":"10.62438/tunismed.v102i4.4699","DOIUrl":"10.62438/tunismed.v102i4.4699","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of complex perianal fistulas in Crohn's disease remains a challenge especially after the failure of Infliximab.</p><p><strong>Aim: </strong>Update on the different therapeutic alternatives for anal fistula in Crohn's disease after failure of Infliximab.</p><p><strong>Methods: </strong>A research in the medical literature on PubMed and Google Scholar was carried out. We included cohort studies, reviews and randomized double-blinded therapeutic trials. Case reports and fundamental research studies have been excluded.</p><p><strong>Results: </strong>Anti-TNF therapy, notably Infliximab remain the therapeutic option of choice. Since Infliximab efficacy has been estimated at 60%, with a significant loss-of response rate, new therapeutic strategies have been evaluated and may offer new opportunities for the management of anal fistulas: for example, Ustekinumab could be effective after failure of anti-TNF therapy, although further studies are required. Recent guidelines suggest that injection of mesenchymal stem cells is an effective and safe treatment for complex fistulas. Other surgical options have been proposed, such as endorectal advancement flap, fibrin glue injection, anal fistula plug and ligation of the intersphincteric fistula tract, but all with limited and debatable efficacy. Given the failure rate of all these options, new strategies are currently being evaluated.</p><p><strong>Conclusion: </strong>Anal fistulas in Crohn's disease are a real therapeutic challenge. New medical and surgical therapies are currently being evaluated, with promising results.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of toll-like receptor 4 variations on nasopharyngeal carcinoma risk and survival in tunisian population.","authors":"Arij Ben Chaaben, Imen Ayadi, Hejer Abaza, Olfa Baroudi, Hayet Douik, Latifa Harzallah, Jihen Bouassida, Wahid Bouckouaci, Fethi Guemira, Amani Mankai, Maher Kharrat, Ryad Tamouza","doi":"10.62438/tunismed.v102i2.4270","DOIUrl":"10.62438/tunismed.v102i2.4270","url":null,"abstract":"<p><strong>Introduction: </strong>The Toll-like receptor 4 (TLR4), an important member of the host's innate immune response, is coded by a polymorphic gene. This polymorphism could be a predisposing factor for NasoPharyngeal Carcinoma (NPC).</p><p><strong>Aim: </strong>To determine the association between TLR4 gene polymorphisms and the susceptibility to NPC in a cohort of Tunisian affected patients.</p><p><strong>Methods: </strong>Genomic DNAs from 245 unrelated patients affected by undifferentiated carcinoma type (UCNT) and 264 unrelated healthy controls were genotyped for the five single nucleotides polymorphisms (SNPs) of TLR4 locus (4434 A>G (rs1927914),7263 G>C (rs10759932), 6134 A>G(rs4986790), 8851C>T (rs 4986791), 5272 T>C(rs11536889), +8469 T>C (rs11536891)) by Taqman® 5'-nuclease assay.</p><p><strong>Results: </strong>Among all polymorphisms studied, only the rs4986790 G and rs4986791 T alleles were significantly more prevalent in patients' group than controls (45% vs. 38%; p=0.03; pc=0.06) and increased the risk of the NPC (OR=1.3, 95% CI=1.01-1.69). Also, we found that the frequency of the rs4986790 AA and rs4986791 TT genotypes was significantly higher in controls than in patients (25.7% vs 37%; p=0.006, pc=0.02) and conferred a protector factor in NPC (OR= 0.59, 95% CI= 0.39-0.87). Further, based on the Kaplan-Meier survival curve we observed also the positive effect ofrs1927914 AA genotype on a prognostic of NPC (p=0.006; pc=0.01).</p><p><strong>Conclusion: </strong>Our study demonstrated that impaired production of TLR4 seems to be a risk factor of NPC development but functional studies are needed to confirm these findings. As to rs1927914 AA appears to be a good biomarker for better survival in a patient with NPC.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors of mortality in patients admitted to the emergency department for SARS-Cov2 pneumonia.","authors":"Sami Souissi, Héla Ben Turkia, Soumaya Saad, Syrine Keskes, Camilia Jeddi, Hanene Ghazali","doi":"10.62438/tunismed.v102i2.4659","DOIUrl":"10.62438/tunismed.v102i2.4659","url":null,"abstract":"<p><strong>Introduction: </strong>The overcrowding of intensive care units during the corona virus pandemic increased the number of patients managed in the emergency department (ED). The detection timely of the predictive factors of mortality and bad outcomes improve the triage of those patients.</p><p><strong>Aim: </strong>To define the predictive factors of mortality at 30 days among patients admitted on ED for covid-19 pneumonia.</p><p><strong>Methods: </strong>This was a prospective, monocentric, observational study for 6 months. Patients over the age of 16 years admitted on the ED for hypoxemic pneumonia due to confirmed SARS-COV 2 infection by real-time reverse-transcription polymerase chain reaction (rRT-PCR) were included. Multivariate logistic regression was performed to investigate the predictive factors of mortality at 30 days.</p><p><strong>Results: </strong>463 patients were included. Mean age was 65±14 years, Sex-ratio=1.1. Main comorbidities were hypertension (49%) and diabetes (38%). Mortality rate was 33%. Patients who died were older (70±13 vs. 61±14;p<0.001), and had more comorbidities: hypertension (57% vs. 43%, p=0.018), chronic heart failure (8% vs. 3%, p=0.017), and coronary artery disease (12% vs. 6%, p=0.030). By multivariable analysis, factors independently associated with 30-day mortality were age ≥65 years aOR: 6.9, 95%CI 1.09-44.01;p=0.04) SpO2<80% (aOR: 26.6, 95%CI 3.5-197.53;p=0.001) and percentage of lung changes on CT scan>70% (aOR: 5.6% 95%CI .01-31.29;p=0.04).</p><p><strong>Conclusion: </strong>Mortality rate was high among patients admitted in the ED for covid-19 pneumonia. The identification of predictive factors of mortality would allow better patient management.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unprecedented complexity of six coexisting autoimmune diseases: A case report.","authors":"Jihed Anoun, Nourhen Guedri, Imen Ben Hassine, Wafa Baya, Anis Mzabi, Fatma Ben Fredj","doi":"10.62438/tunismed.v102i2.4647","DOIUrl":"10.62438/tunismed.v102i2.4647","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune disorders often exhibit interconnectedness, although encountering multiple autoimmune conditions in a single patient is uncommon. Multiple autoimmune syndrome is characterized by the presence of at least three distinct autoimmune diseases in an individual. This report outlines the case of a middle-aged woman diagnosed with autoimmune thyroiditis, Sjögren's syndrome, scleroderma, autoimmune hepatitis, primary biliary cirrhosis, and antisynthetase syndrome. Additionally, it includes a literature review encompassing multiple autoimmune syndromes involving five or more autoimmune diseases.</p><p><strong>Observation: </strong>A 57-year-old woman, with no previous medical history, presented with fever, extensive muscle weakness, progressive exertional dyspnea, inflammatory polyarthralgia, dysphagia, and dry mouth. Clinical examination revealed muscular deficit in the scapular and pelvic girdles, distal muscular deficit, synovitis in the wrists, and features indicative of \"mechanic's hand\". Laboratory examinations showed cytolysis, cholestasis, elevated muscle enzymes, hypergammaglobulinemia and elevated thyroid stimulating hormone. Immunoassays showed positive results for antinuclear antibodies, anti-histidyl-t-RNA synthetase, anti-Sjögren's-syndrome-related antigen A, anti-ribonucleic-acid-polymerase-III-RP155, anti-fibrillarin, anti-mitochondrial, anti-liver/kidney microsomal type 1, anti-glycoprotein 210, and anti-thyroid peroxidase antibodies. Further investigations led to the diagnosis of a multiple autoimmune syndrome involving autoimmune thyroiditis, Sjögren's syndrome, scleroderma, autoimmune hepatitis, primary biliary cirrhosis, and antisynthetase syndrome. The patient received treatment with intravenous immunoglobulins, corticosteroids, azathioprine, and ursodeoxycholic acid, which resulted in favorable clinical and biological outcomes.</p><p><strong>Conclusion: </strong>This patient presented with six concurrent distinct autoimmune disorders, categorizing this case as a type two multiple autoimmune syndrome. The identification of antisynthetase syndrome notably distinguishes this case.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of tumor suppressor protein p53 in prostate cancer.","authors":"Sarra Ben Rejeb, Nadia Kouki, Sirine Elfekih, Ines Cherif, Hassen Khouni","doi":"10.62438/tunismed.v102i2.4730","DOIUrl":"10.62438/tunismed.v102i2.4730","url":null,"abstract":"<p><strong>Introduction: </strong>The p53 gene mutation is one of the most common genetic alterations in many cancers. In prostate cancer (PCa), it has been associated with a poor prognosis, tumor progression and aggressiveness. P53 mutation induces an abnormal protein expression in related tissues.</p><p><strong>Aim: </strong>This study aimed to assess p53 expression using immunohistochemistry in PCa and to discuss its prognostic value.</p><p><strong>Methods: </strong>We have retrospectively collected all cases of PCa diagnosed in our pathology department between 2012 and 2022. An automatized immunohistochemical analysis was performed using monoclonal p53 antibody. For each case, we assessed the proportion of positive cells and the intensity of staining. P53 expression was considered abnormal when it was totally negative or overexpressed (>=50% of positive cells).</p><p><strong>Results: </strong>Twenty-four cases have been selected. Abnormal p53 expression was found in 42% of cases (P53 was overexpressed in 6cases and totally negative in 4 cases). Mean age of patients with p53 abnormal expression was 70years old. Patients with p53 abnormal expression had Gleason score >7 in 5 cases, ISUP grade >2 in 3 cases, peri-neural invasion in 8cases, capsule invasion in 9cases. All patients with p53 overexpression developed androgen resistance (p<0.01).</p><p><strong>Conclusion: </strong>An aberrant expression profile of the p53 protein was observed in 42% of cases, and a statistically significant association was found with androgen resistance. Our results suggest a potential prognostic role of p53 in PCa.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update on the access to inpatient rehabilitation facilities across Tunisia in 2023.","authors":"Rihab Moncer, Ines Loubiri, Sarra Melki, Sinene Frigui, Walid Ouannes, Ahmed Ben Abdelaziz, Sonia Jemni","doi":"10.62438/tunismed.v102i2.4679","DOIUrl":"10.62438/tunismed.v102i2.4679","url":null,"abstract":"<p><strong>Introduction: </strong>Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated.</p><p><strong>Aim: </strong>To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023.</p><p><strong>Methods: </strong>Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites.</p><p><strong>Results: </strong>The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia.</p><p><strong>Conclusion: </strong>This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of preoperative diffusion restriction in glioblastoma.","authors":"Emna Labbène, Maha Mahmoud, Linda Marrakchi-Kacem, Mohamed Ben Hamouda","doi":"10.62438/tunismed.v102i2.4746","DOIUrl":"10.62438/tunismed.v102i2.4746","url":null,"abstract":"<p><strong>Introduction: </strong>Although glioblastoma (GBM) has a very poor prognosis, overall survival (OS) in treated patients shows great difference varying from few days to several months. Identifying factors explaining this difference would improve management of patient treatment.</p><p><strong>Aim: </strong>To determine the relevance of diffusion restriction in newly diagnosed treatment-naïve GBM patients.</p><p><strong>Methods: </strong>Preoperative magnetic resonance scans of 33 patients with GBM were reviewed. Regions of interest including all the T2 hyperintense lesion were drawn on diffusion weighted B0 images and transferred to the apparent diffusion coefficient (ADC) map. For each patient, a histogram displaying the ADC values within in the regions of interest was generated. Volumetric parameters including tumor regions with restricted diffusion, parameters derived from histogram and mean ADC value of the tumor were calculated. Their relationship with OS was analyzed.</p><p><strong>Results: </strong>Patients with mean ADC value < 1415x10-6 mm2/s had a significantly shorter OS (p=0.021). Among volumetric parameters, the percentage of volume within T2 lesion with a normalized ADC value <1.5 times that in white matter was significantly associated with OS (p=0.0045). Patients with a percentage>23.92% had a shorter OS. Among parameters derived from histogram, the 50th percentile showed a trend towards significance for OS (p=0.055) with patients living longer when having higher values of 50th percentile. A difference in OS was observed between patients according to ADC peak of histogram but this difference did not reach statistical significance (p=0.0959).</p><p><strong>Conclusion: </strong>Diffusion magnetic resonance imaging may provide useful information for predicting GBM prognosis.</p>","PeriodicalId":38818,"journal":{"name":"Tunisie Medicale","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}