Publications by authors named "Mohamed Ben Rejeb"

29 Publications

  • Page 1 of 1

Successful treatment of angiolymphoid hyperplasia with eosinophilia with oral propranolol in two cases.

Dermatol Ther 2021 07 27;34(4):e14994. Epub 2021 May 27.

Dermatology Department, Hospital Hédi Chaker, Sfax, Tunisia.

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http://dx.doi.org/10.1111/dth.14994DOI Listing
July 2021

sQuiz your knowledge! A large bruise-like lesion of the nose in a 60-year-old man.

Eur J Dermatol 2021 Apr;31(2):298-300

Department of Pathology and Dermatology, Farhat. Hached University Teaching Hospital, Sousse, Tunisia.

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http://dx.doi.org/10.1684/ejd.2021.4039DOI Listing
April 2021

Mycoplasma pneumoniae-induced rash and mucositis: A new entity.

Indian J Dermatol Venereol Leprol 2021 Mar 12:1-5. Epub 2021 Mar 12.

Department Dermatology Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia.

Mycoplasma pneumoniae is a well-known cause of community-acquired pneumonia, mostly associated with dermatological manifestations especially with mucosal involvement and targetoid cutaneous lesions. For many years, it was considered among the spectrum of erythema multiforme. Recently, some authors have recommended the creation of a new syndrome called "mycoplasma-induced rash and mucositis." This new syndrome has distinct epidemiological, clinical and histological features making it different from drug-induced Stevens-Johnson syndrome, toxic epidermal necrosis and erythema multiforme. Herein, we report two patients with acute Mycoplasma pneumoniae respiratory tract infection presenting severe mucocutaneous lesions in accordance with this new syndrome.
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http://dx.doi.org/10.25259/IJDVL_660_19DOI Listing
March 2021

Evaluation of the Impact of Intraoperative Distractions on Teamwork, Stress, and Workload.

J Surg Res 2021 03 24;259:465-472. Epub 2020 Oct 24.

University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Faculty of Medicine, Laboratory of Research "Qaulité des soins et management des services de santé maternelle LR12ES03", Sousse, Tunisia.

Background: Within the operating rooms (ORs), distractions occur on a regular basis, which affect the surgical workflow and results in the interruption of urgent tasks. This study aimed to observe the occurrence of intraoperative distractions in Tunisian ORs and evaluate associations among distractions, teamwork, workload, and stress.

Methods: This observational cross-sectional study was conducted in four different ORs (orthopedic, urology, emergency, and digestive surgery) of Sahloul University Hospital for a period of 3 mo in 2018. Distractions and teamwork were recorded and rated in real time during the intraoperative phase of each case using validated observation sheets. Besides, at the end of each operation, stress and workload of team members were measured.

Results: Altogether, 50 cases were observed and 160 participants were included. Distractions happened in 100% of the included operations. Overall, we recorded 933 distractions that occurred once every 3 min, with a mean frequency of M = 18.66 (standard deviation [SD] = 8.24) per case. It is particularly noticeable that procedural distractions occurred significantly higher during teaching cases compared with nonteaching cases (M = 3.85, M = 0.60, respectively, P < 0.001). The mean global teamwork score was M = 3.85 (SD = 0.67), the mean workload score was M = 58.60 (SD = 24.27), and the mean stress score was M = 15.29 (SD = 4.00). Furthermore, a higher stress level among surgeons was associated with distractions related to equipment failures and people entering or exiting the OR (r = 0.206, P < 0.01 and r = 0.137, P < 0.01, respectively). Similarly, nurses reported a higher workload in the presence of distractions related to the work environment in the OR (r = 0.313, P < 0.05).

Conclusions: This study highlighted a serious problem, which often team members seem to ignore or underestimate. Taking our findings into consideration, we recommend the implementation of the Surgical Checklist and preoperative briefings to reduce the number of surgical distractions. Also, a continuous teamwork training should be adopted to ensure that OR staff can avoid or handle distractions when they happen.
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http://dx.doi.org/10.1016/j.jss.2020.09.006DOI Listing
March 2021

A Voxel-based lesion study on facial emotion recognition after circumscribed prefrontal cortex damage.

J Neuropsychol 2021 Sep 17;15(3):533-563. Epub 2021 Feb 17.

Laboratory of Psychology of Pays de la Loire (EA 4638), University of Angers, France.

Previous studies have shown inconsistent findings regarding the contribution of the different prefrontal regions in emotion recognition. Moreover, the hemispheric lateralization hypothesis posits that the right hemisphere is dominant for processing all emotions regardless of affective valence, whereas the valence specificity hypothesis posits that the left hemisphere is specialized for processing positive emotions while the right hemisphere is specialized for negative emotions. However, recent findings suggest that the evidence for such lateralization has been less consistent. In this study, we investigated emotion recognition of fear, surprise, happiness, sadness, disgust, and anger in 30 patients with focal prefrontal cortex lesions and 30 control subjects. We also examined the impact of lesion laterality on recognition of the six basic emotions. The results showed that compared to control subjects, the frontal subgroups were impaired in recognition of three negative basic emotions of fear, sadness, and anger - regardless of the lesion laterality. Therefore, our findings did not establish that each hemisphere is specialized for processing specific emotions. Moreover, the voxel-based lesion symptom mapping analysis showed that recognition of fear, sadness, and anger draws on a partially common bilaterally distributed prefrontal network.
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http://dx.doi.org/10.1111/jnp.12241DOI Listing
September 2021

Exploring patient safety culture in emergency departments: A Tunisian perspective.

Int Emerg Nurs 2021 01 17;54:100941. Epub 2020 Dec 17.

University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.

Background: Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors.

Methods: A cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire.

Results: In total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. 'Teamwork within units' scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions.

Conclusion: This study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.
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http://dx.doi.org/10.1016/j.ienj.2020.100941DOI Listing
January 2021

A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals.

Aust Crit Care 2021 Jul 26;34(4):363-369. Epub 2020 Oct 26.

University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia.

Introduction: Critical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings.

Objectives: This study aimed to assess critical care nurses' perception of PSC and to determine its associated factors.

Methods: This cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items.

Results: A total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension "frequency of events reported" and 50.1% for the dimension "teamwork within units". Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92-6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02-1.12]; p = 0.018).

Conclusion: This study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.
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http://dx.doi.org/10.1016/j.aucc.2020.09.004DOI Listing
July 2021

[Adverse events in a Tunisian university hospital: incidence and risk factors].

Sante Publique 2020 Mar Apr May Jun;32(2-3):189-198

Objective: To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital.

Method: We carried out a longitudinal observational study in 2016 over a period of 3 months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients.

Results: Overall, 1,357 patients were eligible. We identified 168 AEs in 131 patients with AEs incidence of 12.4% (95% CI: [7.41 – 17.38]), and patient incidence of 9.7% (95% CI: [4.63 – 14.76]). The incidence density of AEs was 1.8 events per 100 days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P = 0.013; RR = 1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P < 10–3; RR = 4.1 ; CI: [2.1-8]), tracheotomy (P = 0.001; RR = 21.8; CI: [3.7-127.8]), transfusion (P = 0.014; RR = 2.1; CI: [1.16-3.87]) and drug intake (P = 0.04; RR = 2.2; CI: [1.04-4.7]).

Conclusion: The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.
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http://dx.doi.org/10.3917/spub.202.0189DOI Listing
November 2020

[Adverse events in a Tunisian university hospital: incidence and risk factor]

Sante Publique 2020 Mar Apr May Jun;32(2):189-198

Objective: To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital.

Method: We carried out a longitudinal observational study in 2016 over a period of 3 months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients.

Results: Overall, 1,357 patients were eligible. We identified 168 AEs in 131 patients with AEs incidence of 12.4% (95% CI: [7.41 – 17.38]), and patient incidence of 9.7% (95% CI: [4.63 – 14.76]). The incidence density of AEs was 1.8 events per 100 days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P = 0.013; RR = 1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P < 10–3; RR = 4.1 ; CI: [2.1-8]), tracheotomy (P = 0.001; RR = 21.8; CI: [3.7-127.8]), transfusion (P = 0.014; RR = 2.1; CI: [1.16-3.87]) and drug intake (P = 0.04; RR = 2.2; CI: [1.04-4.7]).

Conclusion: The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.
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http://dx.doi.org/10.3917/spub.202.0189DOI Listing
October 2020

Prevalence of burnout among health sciences students and determination of its associated factors.

Psychol Health Med 2021 02 24;26(2):212-220. Epub 2020 Aug 24.

Faculty of Medicine of Sousse, Department of Community Health, Laboratory of Research LR12ES03 «Qualité des Soins et Management des Services de santé maternelle», University of Sousse, Sousse, Tunisia.

Burnout is a major issue among healthcare students and a public health issue in general. Indeed, the consequences of student burnout are as complex as other mental distress factors, such as those concerned with smoking and alcohol consumption, or an unhealthy lifestyle.  This study aimed to determine the prevalence of burnout among health sciences students and to determine its associated factors. This is a cross-sectional descriptive study conducted among 368 students of a Tunisian institution using the French validated version of the MBI-SS. The prevalence of burnout was 64.4%. The presence of a diagnosed health problem, a diagnosed mental disorder or sleep problems were associated with burnout. Students who live alone are significantly the most emotionally exhausted (p=0.010) and the most cynical (p=0.033). Students who had a low socio-economic level are significantly more cynical than those who had a medium or high socio-economic level (p=0.032). Performing leisure activities and practicing physical activities were associated with emotional exhaustion (p=0.007, p= 0.008, respectively).In our study, burnout is prevalent among Tunisian health sciences students. Many factors were found to be associated with this syndrome. These findings reinforce the need to establish early preventive strategies to encounter this problem and its consequent risks.
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http://dx.doi.org/10.1080/13548506.2020.1802050DOI Listing
February 2021

Multimodal intervention program to improve hand hygiene compliance: effectiveness and challenges.

J Egypt Public Health Assoc 2020 Mar 23;95(1):11. Epub 2020 Mar 23.

Department of Prevention and Care Safety, University Hospital Sahloul, 4011, Sousse, Tunisia.

Background: Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs).

Methods: We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers' workplace.

Results: Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038).

Conclusion: This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.
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http://dx.doi.org/10.1186/s42506-020-00039-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364722PMC
March 2020

Assessing patient safety culture in 18 Tunisian adult intensive care units and determination of its associated factors: A multi-center study.

J Crit Care 2020 04 8;56:208-214. Epub 2020 Jan 8.

University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia.

Purpose: This study aimed to assess patient safety culture (PSC) in intensive care units (ICUs) and to determine the factors affecting it.

Materials And Methods: This is a cross-sectional study, conducted from October to November 2017 among professionals practicing in the ICUs of the Tunisian center. After obtaining institutional ethics committee's approval and administrative authorizations, an anonymous paper-based questionnaire was distributed to the participants after obtaining their consent to take part in the study. The measuring instrument used is the French validated version of the "Hospital Survey on Patient Safety Culture" questionnaire.

Results: A total of 402 professionals, from 18 ICUs and 10 hospitals, participated in the study with a participation rate of 82.37%. All dimensions were to be improved. The most developed dimension was teamwork within the unit (47.87%) and the least developed dimension was the non-punitive response to error (18.6%). Seven dimensions were significantly more developed in private institutions than in public ones. Results also show that when workload is reduced, the PSC was significantly increased.

Conclusion: This study has shown that the PSC in ICUs needs improvement and provided a baseline results to get a clearer vision of the aspects of security that require special attention.
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http://dx.doi.org/10.1016/j.jcrc.2020.01.001DOI Listing
April 2020

Evaluation of antibody persistence after a four-dose primary hepatitis B vaccination and anamnestic immune response in children under 6 years.

J Med Microbiol 2019 Nov;68(11):1686-1693

LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.

Tunisia is an intermediate hepatitis B virus (HBV) endemic country. The vaccination against hepatitis B was introduced in 1995 including four doses with a first dose administrated at birth. Decreasing the level of antibodies against hepatitis B surface antigen (anti-HBs) over time can be alarming. This study was conducted to explore the anti-HBV immune response among children under 6 years old, vaccinated according to the national vaccination schedule, by evaluating the immunological response to primary vaccination and by exploring the anamnestic immune response to a booster dose. We conducted a cross-sectional prospective study from June 2016 to June 2017 (=180), based on voluntary participation. Children were recruited from the public pediatric ward sectors in Sahloul University Hospital of Sousse in Central Tunisia. An anti-HB titre was determined based on electro-chemiluminescence micro-particle immunoassay (ECLIA), using Elecsys Anti-HBs II kit, Roche. Mean age at the time of enrollment in the study was 33±14.8 months. The seroprotection rate was 77.2 %. The anti-HB titre differed significantly between the different age groups (=0.002). The predicting variable for having no seroprotective antibody level was older age. Children with anti-HB levels <10 IU l were offered an additional dose of HBV vaccine. Anamnestic response 1 month after the challenge dose was observed in 100 % of subjects. The probability of developing a high antibody response, following the booster dose increased in conjunction with an increased pre-booster antibody level. The response to a booster dose suggests the persistence of immune memory in almost all vaccinated individuals. Although a booster dose increases substantially anti-HB titre, the clinical relevance of such an increase remains unknown.
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http://dx.doi.org/10.1099/jmm.0.001086DOI Listing
November 2019

Does Ramadan Fasting Affect Spirometric Data of Healthy Adolescents?

Clin Med Insights Pediatr 2019 25;13:1179556519862280. Epub 2019 Jul 25.

Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie.

Purpose: Several studies raised the effects of Ramadan fasting on healthy adults spirometric data, but none was performed in children. The aim of this study was to compare the spirometric data of a group of faster adolescents (n = 26) with an age-matched non-faster one (n = 10).

Methods: This comparative quasi-experimental study, including 36 healthy males aged 12 to 15 years, was conducted during the summer 2015 (Ramadan: June 18 to July 16). Three sessions (Before-Ramadan [Before-R], Mid-Ramadan [Mid-R], After-Ramadan [After-R]) were selected for spirometry measurements. Spirometry was performed around 5.5 to 3.5 h before sunset and the spirometric data were expressed as percentages of local spirometric norms.

Results: The two groups of fasters and non-fasters had similar ages and weights (13.35 ± 0.79 vs 12.96 ± 0.45 years, 46.8 ± 9.2 vs 41.7 ± 12.6 kg, respectively). There was no effect of Ramadan fasting on forced vital capacity (FVC), forced expiratory volume in 1 s (FEV), FEV/FVC, peak expiratory flow, and maximal mid-expiratory flow. For example, during the Before-R, Mid-R, and After-R sessions, there was no significant difference between the fasters and non-fasters mean FVC (101 ± 11 vs 99 ± 14, 101 ± 12 vs 102 ± 14, 103 ± 11 vs 104 ± 13, respectively) or FEV (101 ± 13 vs 96 ± 16, 98 ± 11 vs 97 ± 16, 101 ± 10 vs 98 ± 16, respectively).

Conclusions: Ramadan fasting had no interaction effect with the spirometric data of Tunisian healthy male adolescents.
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http://dx.doi.org/10.1177/1179556519862280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659188PMC
July 2019

[Burnout prevalence in Tunisian anesthesia and intensive care units].

Pan Afr Med J 2018 12;31:111. Epub 2018 Oct 12.

Service d'Anesthésie Réanimation, CHU Sahloul Sousse, Faculté de Médecine Ibn Al Jazzar, Sousse, Tunisie.

Introduction: burnout is a particular cause of concern in Anesthesia and Intensive Care Units. In addition to its socio-economic impact, it alters the quality of care and patients prognosis. This study aims to assess its prevalence among the staff members of the Tunisian Anesthesia and Intensive Care Units.

Methods: we conducted a multicenter cross-sectional study in the Anesthesia and Intensive Care Units of seven Tunisian University Hospitals. The study included the medical and paramedical staff who gave consent. The measuring instrument used was the Maslach burnout Inventory.

Results: the study included 283 staff members (72.19%). The average age of subjects was 40.2 ± 9.38 years, with a female predominance. Maslach scale revealed that 94.71% of the participants had burnout. The mean emotional exhaustion score, depersonalization score and professional achievement score were 28.65 ± 11.92; 8.62 ± 6.65 and 34.58 ± 8.07 respectively. High to moderate burn-out level were found in 13.3% and 26.2% of cases respectively. Burn-out effects were dominated by additive behaviors (52.65%) and suicidal ideations (4.59%).

Conclusion: burnout is becoming more and more a tangible reality for the staff members of the Anesthesia and Intensive Care Units, engendering serious social and personal consequences.
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http://dx.doi.org/10.11604/pamj.2018.31.111.10739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462373PMC
May 2019

Smoking dependence and anxio-depressive disorders in Tunisian smokers attending the smoking cessation clinic in a university hospital.

J Egypt Public Health Assoc 2019 Feb 20;94(1). Epub 2019 Feb 20.

Department of Prevention and Security of Care, Hospital of Sahloul, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.

Background: Smokers with comorbid anxio-depressive disorders are more prone to progress to a more severe level of dependence and to experience more severe nicotine withdrawal symptoms than smokers without anxio-depressive disorders.

Aim Of The Study: To determine the relationship between tobacco dependence and anxio-depressive disorders as well as assessing their impact on the withdrawal.

Methods: We conducted a cross-sectional study among attendees of the smoking cessation clinic of Sahloul University Hospital, Sousse, Tunisia, from December 2009 to May 2015. The monitoring of the attendees was performed through retrieving the records until May 2016 in order to verify their smoking cessation status at 1 year.

Results: Overall, 534 smokers were included. We identified 315 smokers (59%) presenting an anxio-depressive disorder. Based on the HAD scale, we found 231 patients (43.4%) with anxiety disorders, 200 (37.6%) patients with depressive disorders, and 116 (21.8%) patients with anxio-depressive disorder. In multivariate analysis, only a high number of consultation was associated with a better rate of tobacco cessation at 6 months. However, no factor was found linked to the relapse at 1 year.

Conclusion: According to our results, only a high number of consultation was revealed as an independent factor of withdrawal for anxio-depressed smokers. It is necessary to simultaneously use the nicotinic substitutions and anxio-depressive treatment to ensure the tobacco cessation.
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http://dx.doi.org/10.1186/s42506-019-0012-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364776PMC
February 2019

Effects of cold water immersion on aerobic capacity and muscle strength of young footballers.

Tunis Med 2018 Feb;96(2):107-112

Aims: The main aim was to compare aerobic performance data, determined before «period1» and after «period2» cold water immersion in two groups of footballers (CWI and no-CWI groups).

Methods: This is an experimental study with matching and randomization. The 20 male footballers, aged 17 to 20 years, were divided into two groups (n = 10 for each) following a random draw. The two groups were age-, height- and weight matched. 1000-m race was made during the two periods. Heart-rate (HR, % of theoretical maximum HR) and hemoglobin oxygen saturation (Oxy-sat, %) were measured before and after the race, and the time of the race (min) was noted. An Oxy-sat decrease > 4 points retained the diagnosis of exercise-induced desaturation. Eight CWI sessions (one per week), until the hip in a standing position (10 min; temperature: 11-12 °C) were performed.

Results: The two groups were age-, height- and weight matched. Comparatively to the race time of «period1», this of «period2» was decreased in the CWI group (3.21±0.04 vs. 3.15±0.04 min) and was increased in the no-CWI group (3.23±0.05 vs. 3.27±0.07 min). Comparatively to the HRs (before, after the race) of «period1», these of «period2» were decreased in the CWI group (36±1 vs. 34±1%; 56±3 vs. 44±2%) and were increased in the no-CWI group (35±2 vs. 36±1%; 55±2 vs. 57±2%). Comparatively to the after race Oxy-sat' of the «period1», this of «period2» was increased in the CWI group (96±1 vs. 98±0%) and was decreased in the no-CWI group (96±1 vs. 95±1%). While in the CWI group, the percent of desaturators was decreased between «period1» and «period2» (30 vs. 0%), in the no-CWI group, percentages remained similar (50 vs. 90%).

Conclusion: CWI improves aerobic capacity and muscle strength of young footballers.
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February 2018

The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study.

Am J Mens Health 2018 11 17;12(6):2089-2103. Epub 2018 Aug 17.

5 Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.

No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 10/mm) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.
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http://dx.doi.org/10.1177/1557988318794304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199458PMC
November 2018

Relationships between executive function, working memory, and decision-making on the Iowa Gambling Task: Evidence from ventromedial patients, dorsolateral patients, and normal subjects.

J Neuropsychol 2019 09 17;13(3):432-461. Epub 2018 Apr 17.

Laboratory of Psychology of Pays de la Loire (EA 4638), University of Angers, France.

The results of previous studies are inconsistent in regard to the relationship between the Iowa Gambling Task (IGT), working-memory (WM), and executive tasks, and whether these cognitive processes could be considered as mechanisms underlying a decision-making deficit. Moreover, the relationship between the IGT and executive measures is examined based on a limited number of executive tasks, within different populations showing diffuse damage. In addition, there are fewer studies carried out within control participants, with those studies also being inconclusive. It is also suggested that the association of the IGT performance with executive tasks depends on whether the IGT was running under ambiguity or under risk. In this work, all of these issues are studied. Results showed that both patients with ventromedial (VMPFC, N = 10) and dorsolateral (DLPFC, N = 10) prefrontal cortex lesions are significantly impaired on almost all executive tasks, WM tasks, and the IGT. Furthermore, when the IGT is run under risk, there are significant correlations between executive measures and the IGT for the DLPFC patients and the control participants (N = 34) but not the VMPFC patients. No correlation was found between WM tasks and the IGT for both frontal subgroups and control participants. These findings suggested that the mechanisms underlying the IGT deficit differ according to the lesion locations.
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http://dx.doi.org/10.1111/jnp.12156DOI Listing
September 2019

Risk factors for mortality of children with zoonotic visceral leishmaniasis in Central Tunisia.

PLoS One 2017 29;12(12):e0189725. Epub 2017 Dec 29.

Pasteur Institute of Tunis, Tunis, Tunisia.

Background: Zoonotic visceral leishmaniasis (ZVL) caused by Leishmania infantum is endemic with an epidemiological profile of a paediatric disease in Tunisia. In the context of a high fatality rate, identifying risk factors for in-hospital mortality in children treated for ZVL is of major epidemiological importance.

Design: A retrospective (case-control) study included 230 immuno-competent children diagnosed and confirmed with primary ZVL in the paediatric department of the University Hospital of Kairouan between 2004 and 2014. Forty-seven per cent (47%) were children under 18 months of age, and with a male ⁄ female ratio of 1.01:1.

Results: The overall case-fatality was 6% (n = 14). The risk factors for in-hospital death identified by a multivariate analysis were: bleeding at admission (OR = 25.5, 95% CI: 2.26-287.4; p = 0.009), white cell count less than 4000/mm3 (OR = 5.66, 95% CI: 1.16-27.6; p = 0.032), cytolysis (OR = 28.13, 95% CI: 4.55-173.6; p < 0.001), and delay between onset of symptoms and admission ≥ 15 days (OR = 11, 95% CI: 1.68-72; p = 0.012).

Conclusion: The results strongly suggest that paediatric patients admitted 15 days after onset of symptoms, with bleeding, white cell counts below 4,000/mm3, and cytolysis at admission should be considered severe cases and subsequently, they are at high risk of mortality. A better understanding of factors associated with death of children from ZVL may contribute to decrease mortality.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189725PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747430PMC
January 2018

[Giant cell tumors of the tendon sheaths of the hand: about 50 cases].

Pan Afr Med J 2017 7;26:128. Epub 2017 Mar 7.

Service de Chirurgie Orthopédique. Hôpital Sahloul, Sousse, Tunisie.

Giant cell tumors of the synovial tendon sheaths (GCTSTS) are a localized form of hemopigmented villonodular synovitis. They mainly affect the hands. This study aims to analyse the epidemiology, clinical and therapeutic characteristics of GCTSTS, to assess the results of surgical treatment and to identify risk factors for recurrences. We conducted a retrospective data collection from medical records of 50 patients with GCTSTS of the hand between 1992 and 2016 in the Department of Orthopaedics at the Hospital of Sahloul (Sousse-Tunisia). The clinical and epidemiological features of GCTSTS have been specified. The average age of patients was 33 years (9-69 years), the sex ratio was 0,6. Constant swelling (100%), joints inter-phalangeal mobilization trouble (6%) and digital pain (18%) were the most frequent reason for consultation. All tumors were located at the level of the digital region, especially at the level of the index (42%). It occurred on the palm of the hand in 66% of cases. All patients underwent surgery; macroscopically GCTTS appeared as an encapsulated polylobed and yellowish brown tumor, extending into the flexor tendons sheath(4 cases) and under the extensor tendon (2 cases). We noted a single case of recurrent cancer (2%) which was treated surgically. The functional results were good in all cases. The diagnosis of GCTTS should be evoked when there is evidence of digital swelling. Their management is based on surgery which is difficult and should be performed correctly to avoid recurrences.
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http://dx.doi.org/10.11604/pamj.2017.26.128.9514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429421PMC
June 2017

Assessing patient safety culture in Tunisian operating rooms: A multicenter study.

Int J Qual Health Care 2017 Apr;29(2):176-182

Faculty of Medicine Ibn El Jazzar, Department of Community Health-Laboratory of research LR12ES03, Qualité des soins et management des services de santé maternelle, Avenue Mohamed Karoui 4000, Sousse,Tunisia.

Objective: To assess the patient safety culture (PSC) in operating rooms (ORs) and to determine influencing factors.

Design: A cross-sectional descriptive multicenter study which was conducted over a period of 7 months (October 2014-April 2015) using the French validated version of the Hospital Survey On Patient Safety Culture questionnaire.

Setting: Of the note, 15 ORs of public and private healthcare institutions.

Participants: In total, there were 368 participants including surgeons, anesthesiologists, surgical and anesthesia technicians, nurses and caregivers, divided into 316 professionals exercising in public sector and 52 working in private one.

Main Outcome Measure(s): A self-administrated questionnaire investigating 10 dimensions of PSC (including 45 items), two items examining the staff perception of patient safety quality and reporting events, and five items regarding demographic characteristics of respondents.

Results: The participation rate in the study was 70.8%. All 10 dimensions were to be improved. The overall perception of patient safety had a score of 34.9%. The dimension that had the lowest score (20.5%) was the non-punitive response to error, and the one that had the highest score (41.67%) was teamwork in the ORs. Three dimensions were developed in private sector, and none in public hospitals.

Conclusion: This study showed that the level of the PSC needs to be improved not only in public hospitals but also in private ones. The obtained results highlight the importance of implementing quality management systems and developing PSC.
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http://dx.doi.org/10.1093/intqhc/mzw157DOI Listing
April 2017

Contribution of different regions of the prefrontal cortex and lesion laterality to deficit of decision-making on the Iowa Gambling Task.

Brain Cogn 2017 02 2;111:73-85. Epub 2016 Nov 2.

LUNAM Université, Université d'Angers, Laboratoire de Psychologie des Pays de la Loire (EA 4638), France. Electronic address:

Few studies have examined the contribution of different sub-regions of the prefrontal cortex and lesion laterality to decision-making abilities. In addition, there are inconsistent findings about the role of ventromedial and dorsolateral lesions in decision-making deficit. In this study, decision-making processes are investigated following different damaged areas of the prefrontal cortex. We paid particular attention to the contribution of laterality, lesion location and lesion volume in decision-making deficit. Twenty-seven patients with discrete ventromedial lesions, dorsolateral lesions or extended-frontal lesions were compared with normal subjects on the Iowa Gambling Task (IGT). Our results showed that all frontal subgroups were impaired on the IGT in comparison with normal subjects. We noted also that IGT performance did not vary systematically based on lesion laterality or location. More precisely, our lesion analysis revealed that decision-making processes depend on a large cerebral network, including both ventromedial and dorsolateral areas of the prefrontal cortex. Consistent with past findings, our results support the claim that IGT deficit is not solitarily associated with ventromedial prefrontal cortex lesions.
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http://dx.doi.org/10.1016/j.bandc.2016.06.010DOI Listing
February 2017

Periodontal bone height of exclusive narghile smokers compared with exclusive cigarette smokers.

Libyan J Med 2016 30;11:31689. Epub 2016 Jun 30.

Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia.

Objective: To compare the periodontal bone height (PBH) of exclusive narghile smokers (ENS) with that of exclusive cigarette smokers (ECS).

Methods: Tunisian males aged 20-35 years who have been ENS for more than five narghile-years or ECS for more than five pack-years were recruited to participate in this comparative cross-sectional study. Information about oral health habits and tobacco consumption were gathered using a predetermined questionnaire. Plaque levels were recorded in four sites using the plaque index of Loe and Silness. The PBH was measured mesially and distally from digital panoramic radiographs of each tooth and expressed as a percentage of the root length. A PBH level ≤ 0.70 was applied as a cutoff reference value signifying bone loss. Student t-test and Chi(2) test were used to compare quantitative and qualitative data of both groups.

Results: There were no significant differences between the ENS (n=60) and ECS (n=60) groups regarding age and the consumed quantities of tobacco (28 ± 4 vs. 27 ± 5 years, 7 ± 3 narghile-years vs. 8 ± 3 pack-years, respectively). Compared with the ECS group, the ENS group had a significantly higher plaque index (mean ± SD values were 1.54 ± 0.70 vs. 1.84 ± 0.73, respectively). However, the two groups had similar means of PBH (0.85 ± 0.03 vs. 0.86 ± 0.04) and tooth brushing frequencies (1.1 ± 0.8 vs. 0.9 ± 0.6 a day, respectively) and had similar bone loss frequencies (15% vs. 12%, respectively).

Conclusions: Both ENS and ECS exhibited the same PBH reduction, which means that both types of tobacco smoking are associated with periodontal bone loss.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930549PMC
http://dx.doi.org/10.3402/ljm.v11.31689DOI Listing
January 2017

Mortality among Patients with Nosocomial Infections in Tertiary Intensive Care Units of Sahloul Hospital, Sousse, Tunisia.

Arch Iran Med 2016 Mar;19(3):179-85

Department of Surgical Intensive Care, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia.

Background: Nosocomial infections are public health issues that are associated with high mortality in intensive care units. This study aimed to determine nosocomial infection-associated mortality in Tunisian intensive care units and identify its risk factors.

Methods: A prospective cohort study was carried out in intensive care units of a Tunisian University Hospital. The ICUs-wide active surveillance of nosocomial infections has been performed between 1 July 2010 and 30 June 2011. Data collection was based on Rea-Raisin protocol 2009 of "Institut National de Veille Sanitaire" (InVS, Saint Maurice - France). We used Kaplan Meier survival analysis and Cox Proportional Hazard regression to identify independent risk factors of nosocomial infection-associated mortality.

Results: Sixty-seven patients presented nosocomial infection in the end of the surveillance. The mean age of patients was 44.71 ± 21.2 years. Of them, 67.2% were male and 32.8% female. Nosocomial bacteremia was the most frequent infection (68.6%). Nosocomial infection-associated mortality rate was 35.8% (24/67). Bacteremia (Hazard Ratio (HR)) = 3.03, 95% Confidential Interval (95% CI): [1.23 - 7.45], P = 0.016) and trauma (HR = 3.6, 95% CI: [1.16 - 11.2], P = 0.026) were identified by Cox regression as independent risk factors for NI-associated mortality.

Conclusions: Our rate was relatively high. We need to improve the care of trauma patients and intensify the fight against nosocomial infections especially bacteremia.
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http://dx.doi.org/0161903/AIM.005DOI Listing
March 2016

Antiphospholipid Antibodies and Procoagulant Profile in Tunisians With Inflammatory Bowel Diseases.

Clin Appl Thromb Hemost 2016 Nov 15;22(8):734-742. Epub 2015 Apr 15.

Laboratoire d'Hématologie et Banque du Sang, UR12ES05. CHU Sahloul, Sousse, Tunisie

The hypercoagulable state accompanying inflammatory bowel diseases (IBDs) is still poorly understood. The aim of this study was to assess antiphospholipid antibodies (APAs) and a large panel of inherited and acquired thrombotic markers simultaneously in a sample of Tunisian patients with IBD. In total, 89 consecutive patients with IBD (mean age 38 ± 15 years; 48 with Crohn disease and 41 with ulcerative colitis) and 129 controls were prospectively evaluated for immunoglobulin (Ig) G, IgM, and IgA antibodies against cardiolipin (aCL), β2glycoprotein I (aβ2GPI), and prothrombin (aPT); IgG and IgM antibodies against phosphatidic acid (aPA), phosphatidylinositol (aPI), and annexin V (aAnnV); lupus anticoagulant (LA); coagulation factors; natural inhibitors; and thrombotic genetic polymorphisms. Levels of fibrinogen, factors II, V, and VIII and von Willebrand factor, antithrombin, and protein C were significantly higher in patients with IBD than in controls (P < .05 for all comparisons). At least 1 APA subset was detected in 54 patients. The frequencies of antibodies against anionic phospholipids-aCL, aPI, and aPA-in patients with IBD were 15.9%, 21.3%, and 14.6%, respectively. The frequencies of antiphospholipid cofactor antibodies were 39.8% for aβ2GPI and 15.7% for both aAnnV and aPT. Isolated aβ2GPI IgA was detected in 22 patients, and 12 (13.5%) patients had LA. The IgA aβ2GPI antibodies were frequently detected in Tunisian patients with IBD. These results are of potential diagnostic, prognostic, and therapeutic interest.
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http://dx.doi.org/10.1177/1076029615581364DOI Listing
November 2016

Fraction of exhaled nitric oxide (FeNO ) norms in healthy Tunisian adults.

Biomed Res Int 2014 3;2014:269670. Epub 2014 Jun 3.

Department of Physiology and Functional Explorations, Farhat HACHED Hospital, 4000 Sousse, Tunisia ; Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia ; Research Unit: Secondary Prevention after Myocardial Infarction, N: 04/UR/08-18, Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia.

Aims: To establish FeNO norms for healthy Tunisian adults aged 18-60 years and to prospectively assess their reliability.

Methods: This was a cross-sectional analytical study. A convenience sample of healthy Tunisian adults was recruited. Subjects responded to a medical questionnaire, and then FeNO levels were measured by an online method (Medisoft, Sorinnes (Dinant), Belgium). Clinical, anthropometric, and plethysmographic data were collected. All analyses were performed on natural logarithm values of FeNO.

Results: 257 adults (145 males) were retained. The proposed reference equation to predict FeNO value is lnFeNO (ppb) = 3.47-0.56× height (m). After the predicted FeNO value for a given adult was computed, the upper limit of normal could be obtained by adding 0.60 ppb. The mean ± SD (minimum-maximum) of FeNO (ppb) for the total sample was 13.54 ± 4.87 (5.00-26.00). For Tunisian and Arab adults of any age and height, any FeNO value greater than 26.00 ppb may be considered abnormal. Finally, in an additional group of adults prospectively assessed, we found no adult with a FeNO higher than 26.00 ppb.

Conclusion: The present FeNO norms enrich the global repository of FeNO norms that the clinician can use to choose the most appropriate norms.
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http://dx.doi.org/10.1155/2014/269670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065671PMC
February 2015

Hemodialysis duration, human platelet antigen HPA-3 and IgA isotype of anti-β2glycoprotein I antibodies are associated with native arteriovenous fistula failure in Tunisian hemodialysis patients.

Thromb Res 2013 May 26;131(5):e202-9. Epub 2013 Mar 26.

Laboratoire d'Hématologie et Banque du Sang 03/UR/08-18, CHU Sahloul, 4000, Sousse, Tunisia.

Introduction: Arteriovenous fistula (AVF) failure is a major cause of morbidity and mortality in hemodialysis patients. We assessed the role of a large panel of acquired and inherited thrombophilic markers in cases of AVF thrombosis among 101 Tunisians on chronic hemodialysis, all with native AVF.

Materials And Methods: In this case-control study, we considered the levels of fibrinogen, factor II, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, von Willebrand factor, natural coagulation inhibitors, D-Dimer, homocysteine, IgG, IgM and IgA anticardiolipin and anti-β2glycoprotein I (anti-β2GPI), and anti-H/PF4 antibodies; the presence of Lupus Anticoagulant; and genetic markers (Factor V Leiden, prothrombin 20210G>A, MTHFR 677C>T and 1298A>C).

Results: Multivariate analysis indicated that dialysis for >69 months (OR=10.12; 95% CI, 2.53 to 40.52; p=0.001), HPA-3aa genotype (OR=3.58; 95% CI, 1.36 to 9.4; p=0.01) and anti-β2GPI IgA isotype (OR=3.4; 95% CI, 1.21 to 9.55; p=0.02) were independent risk factors for AVF thrombosis in Tunisian hemodialysis patients. Kaplan-Meier analysis showed that AVF survival was significantly lower for patients with anti-β2GPI IgA than for patients without this isotype (log-rank test, p=0.014).

Conclusions: IgA anti-β2GPI may be of clinical relevance among Tunisians. Further studies on the polymorphism of β2GPI and HPA systems would be helpful for identifying patient groups at high risk of AVF failure.
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http://dx.doi.org/10.1016/j.thromres.2013.03.003DOI Listing
May 2013
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