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Tunis Med 2018 Oct-Nov;96(10-11):847-857

In the 21st century, public health is not only about fighting infectious diseases, but also contributing to a "multidimensional" well-being of people (health promotion, non-communicable diseases, the role of citizens and people in the health system etc.). Six themes of public health, issues of the 21st century will be addressed. Read More

Tunis Med 2018 Oct-Nov;96(10-11):844-846

Tunis Med 2018 Oct-Nov;96(10-11):834-843

Background: As part of the preparatory work for the elaboration of a strategic plan for the development of scientific research in Mauritania, an overview of national biomedical research was recommended by the supervisory authorities.

Aim: Describe the bibliometric profile of biomedical scientific publications in Mauritania, indexed in Medline database, over the past 25 years.

Methods: A bibliometric study was carried out on Medline Database covering the period from 1 January 1992 to 31 December 2016. Read More

Tunis Med 2018 Oct-Nov;96(10-11):826-833

The Tunisian health care system is experiencing a significant period of change and needs reforms so as to adapt. The nursing profession, which is the main actor of this system, in terms of number and function, is barely known or utterly unknown. The present paper's authors, who are paramedical teachers, aim to shed light on the specificity of the nursing and the nursing profession based on data collecting, and rare articles and legislation texts. Read More

Tunis Med 2018 Oct-Nov;96(10-11):816-825

Background: The scarcity of trained teachers in charge of critical appraisal of medical literature is a major obstacle for the development of this learning in low-middle-income countries.

Objectives: The aim of the study was to show equivalence in providing training on critical appraisal by either junior or senior teacher in epidemiology.

Methods: Learners, volunteer teachers of all specialties at the medical school of Blida (Algeria), were randomized between the two teachers in an equivalence randomized controlled trial. Read More

Tunis Med 2018 Oct-Nov;96(10-11):808-815

Background: Training in public health, an essential lever for the success of health programs, mobilizes several disciplines, from the description of health situations to the study of their determinants, and to health management.

Objective: To compare postgraduate training programs in Public Health, provided in the countries of the Greater Maghreb.

Methods: Through a documentary study, various components of post-graduate training in Public Health in the Maghreb have been identified: offers and methods of training, learning objectives, program content and reference skills. Read More

Tunis Med 2018 Oct-Nov;96(10-11):789-807

Context: As part of its strategy of Universal Health Coverage (UHC), Tunisia has calculated, after its revolution, its Health Accounts (HA), in a standardized and interdepartmental way.

Objectives: Describe the current structure of care financing in Tunisia, through the HA reports, from 2012 to 2014, and assess its compliance with the principles of socialization of health insurance.

Methods: Crude data on health care expenditures were collected by a multi-departmental group that is responsible for calculating health accounts, using a methodology developed by WHO. Read More

Tunis Med 2018 Oct-Nov;96(10-11):774-788

Background: Despite the wealth of knowledge on hospital performance, the majority of health facilities in the Maghreb don't have yet a Balanced Scorecard for its measurement.

Objective: Elaborate, through a systematic review of the biomedical literature, a Balanced Scorecard for hospital performance, consisting of indicators of quality of care, highly recommended and suitable for the professional and managerial contexts of Greater Maghreb health systems.

Materials And Methods:   This is a "systematic review" study on the topic of indicators to measure hospital performance. Read More

Tunis Med 2018 Oct-Nov;96(10-11):760-773

Background: The Global Burden of Disease (GBD) is an objective method of measurement of disease disability, allowing the quantification of a population's health status, the identification of its health needs, and the determination of its public health priorities.

Objectives: To document the epidemiological transition in Maghreb countries (Tunisia, Morocco, Algeria) over the past three decades and to identify their priority health problems, which are responsible for a considerable burden of disability.

Methods: This is a data synthesis work of the Institute for Health Metrics and Evaluation (IHME) global burden of disease, through its project "GBD Compare Data Visualization". Read More

Tunis Med 2018 Oct-Nov;96(10-11):754-759

Tunisia, with its tradition of periodic general census of the population since 1921, has a database to describe and analyze the evolution of the population not only from a quantitative point of view, but also its structure (especially according to age) over time.This work aims to verify the process of the demographic transition and describe the aging of our population. The different demographic indicators were collected from INS data, local press and international sources. Read More

Tunis Med 2018 Oct-Nov;96(10-11):746-753

Background: Rationing in intensive care unit (ICU) beds is common and can leads to admission refusal. Understanding factors involved in triage practices is the first step towards an ethically optimal decision-making process.

Aim: To identify determinants and patients' characteristics associated with decisions to deny ICU admission. Read More

Tunis Med 2018 Oct-Nov;96(10-11):737-745

Introduction: Patient satisfaction is one of the most commonly used indicators in healthcare service quality evaluation. The aim of the study was to measure overall and specific patient satisfaction rates and to identify determinants of satisfactionin Sahloul University hospital during 2015 and 2016.

Methods: This is a cross-sectional study which included a random sample of patients hospitalized in Sahloul University Hospital between 2015 and 2016. Read More

Tunis Med 2018 Oct-Nov;96(10-11):731-736

Objectives: To determine the prevalence of Healthcare-Associated Infection (HAI) in medical Intensive Care Unit (ICU), risk factors for these infections and identify the predominant infecting organisms.

Methods: A 1-day point-prevalence study within all medical ICUs in Tunisia, all patients occupying an ICU bed over a 48-hour period were included. Rates of HAI, resistance patterns of microbiological isolates and potential risk factors for HAI were recorded. Read More

Tunis Med 2018 Oct-Nov;96(10-11):719-730

Introduction: With the aim of rebuilding the memory of the specialty of Preventive Medicine and Community Medicine (MPC) in Tunisia, through its indexed scientific publications, the objective of this work was to describe the thematic and methodological profile of indexed scientific research, of this specialty over four decades.

Methods: This is a descriptive bibliometric study of MPC articles, indexed in the Medline database over a 40-year period (1975-2014), and based on their Medline Material Safety Data Sheets (MSDS). All articles of which the first and / or last authors were MPC university hospital teachers, in one of Tunisia's four faculties of medicine, were included. Read More

Tunis Med 2018 Oct-Nov;96(10-11):706-718

Context: Following the Tunisian revolution of 2010/2011, a new Public Health literature emerged, by the ministerial departments as well as the civil society, which was marked by the transparency and the comprehensiveness of the approach.

Objective: To identify the key ideas of the new Tunisian Public Health discourse, reconciling the principles of a globalizing paradigm with the health problems of a country in transition.

Methods: During this qualitative research, a selected series of three Tunisian reports of Public Health, published in the first quinquennium of the revolution, was read by an independent team of experts in Public Health, not having contributed to their elaboration, to identify the consensual foundations of the new Public Health discourse. Read More

Tunis Med 2018 Oct-Nov;96(10-11):696-705

Background: Vaccination is the most cost-effective intervention for primary prevention. The Maghreb countries had joined the The Expanded Programme on Immunization (EPI). Tunisia had also introduced the vaccine against hepatitis B and Haemophilus influenzae type B (Hib). Read More

Tunis Med 2018 Oct-Nov;96(10-11):688-695

Background: The aim of screening is to improve individual health through an early detection of diseases at a stage where the prognosis of disease could be significantly. However, this kind of intervention is costly and it's necessary to respect criteria in selection of targeted diseases and screening tests.

Objective: The objective of this study was to describe public health screening policy in the Maghreb countries in order to identify the main barriers to the development of this type of intervention. Read More

Tunis Med 2018 Oct-Nov;96(10-11):672-677

Introduction: Primary Immunodeficiency (PIDs) is a set of 330 rare hereditary diseases that increase susceptibility to infections, allergies, autoimmunity, and neoplasia. North American registries give higher prevalence than Maghreb ones, whereas consanguinity is high. The purpose of this study is to compare prevalence and coverage rate of Maghreb PID registries with estimates based on USA. Read More

Tunis Med 2018 Oct-Nov;96(10-11):665-671

Introduction: Breast cancer is often diagnosed at a late stage in Tunisia with long delay in time to consultation and to diagnosis. The aim of the study was to identify explanatory factors to delayed diagnosis.

Methods: A case control analytical was performed from January 2013 to December 2014 in the department of Medical Oncology in FarhatHachedUniveristy Hospital. Read More

Tunis Med 2018 Oct-Nov;96(10-11):658-664

Breast cancer is the most common cancer diagnosed in women in the Maghreb and around the world. It's the most common cause of cancer deaths. It represents a major public health problem because of its frequency, morbidity and mortality that it generates as well as the cost of the therapies used. Read More

Tunis Med 2018 Oct-Nov;96(10-11):647-657

Introduction: Cervical cancer is a public health problem in the Maghreb countries with high mortality and socio-economic impact. The objective of this subject is exposed the epidemiological profile, programs of prevention and the support of cervical cancer in Maghreb (Morocco, Tunisia and Algeria).

Methods: To implement this work, we carried out research on morbidity and mortality; cancer plans for Maghreb countries (Morocco, Algeria and Tunisia); cervical cancer surveillance for each country; the prevention programs of cervical cancer including vaccination, screening, information campaigns, awareness and education; and research conducted in Morocco, Algeria and Tunisia. Read More

Tunis Med 2018 Oct-Nov;96(10-11):636-646

Background:   The management of the cardiovascular diseases, main public health problem in Tunisia, is generating many difficulties that a socially responsible research should reflect them. The aim of this study is to assess dimensions of public health of Tunisian research on the cardiovascular diseases during thirty last years.

Methods: we conducted a bibliometric study relating to the public health information of the Tunisian cardiovascular papers indexed in the Medline database between January 1st 1988 and December 31st 2017. Read More

Tunis Med 2018 Oct-Nov;96(10-11):628-635

Background: Prematurity is the leading cause of death in neonates, accounting for 75% of neonatal mortality, and the second leading cause of death among children under 5 years of age.

Objective: To study the extent of prematurity in the Great Maghreb, concerning its various aspects: frequency, risk factors and complications.

Method: We conducted a systematic review of the literature by searching for all data from the Greater Maghreb related to prematurity published between 2000 and 2018. Read More

Tunis Med 2018 Oct-Nov;96(10-11):620-627

The epidemiology of Maternal Mortality (MM) associated with practical field specificities led, inter alia, to adopt consensus approaches developed by international community in order to control the situation (MM in 2015 of  303000 with 830 daily deaths by perinatal complications). Application degree of these approaches, while based on scientific evidence, remains country-dependent, with emerging problems within large geographical entities. This is the case of the Maghreb countries* that are facing concrete realities requiring better state commitment, allocation of resources and time, and improved accessibility to the continuum of care. Read More

Tunis Med 2018 Oct-Nov;96(10-11):606-619

Introduction: Viral hepatitis represents a serious public health problem in the world especially in the Maghreb where the prevalence of the 5 viruses A, B, C, D, and E remains high and varies from one Maghreb country to another, there is few published studies on these infections in our Maghreb countries.

Method Of Study: Our work is a review of the literature about prevalence, the most common mode of transmission, and the most exposed population for these viruses in the Maghreb countries through published studies between 2011 and 2017.

Result: It has been found that the Maghreb countries are endemic for the five viruses with variable prevalence from one country to another, with sometimes heterogeneous data in the same country. Read More

Tunis Med 2018 Oct-Nov;96(10-11):599-605

Over the last two decades, many progress has transformed the profile of HIV infection and improved the survival and quality of life of people living with HIV (PLHIV). In addition to individual benefits, antiretrovirals allow through viral suppression to prevent HIV transmission. The dual benefit, curative and preventive, of antiretrovirals has propel HIV testing at the forefront of the global Fast Track strategy as principle access to care and prevention. Read More

Tunis Med 2018 Oct-Nov;96(10-11):590-598

Background: Faced with the challenges of immigration, the opening of the Trans-Saharan road and the increase in the volume of trade with sub-Saharan Africa, there is a steady increase in the number of malaria cases. An introduction of the disease in the Maghreb is possible.

Objective: The general objective is to take stock of the epidemiological situation and the malaria control strategy in the Maghreb countries. Read More

Tunis Med 2018 Oct-Nov;96(10-11):584-589

The fight against tuberculosis remains a priority for world leaders: a re-emerging disease in developed countries, endemic elsewhere, it was declared in 1993, as a "world emergency" by the World Health Organization (WHO). The aim of programs is to prevent infection from spreading and perpetuating; the recommended strategies were the subject of common consent by expert committees convened by international agencies, primarily the WHO. As a result, programs of the Maghreb countries have great similarities. Read More

Tunis Med 2018 Oct-Nov;96(10-11):571-583

Background: Studies conducted on characteristics of alcohol consumption and associated risk factors among health occupations students are scarce in the southern shore of the Mediterranean. The aim of this study was to assess the prevalence of alcohol use and misuse across a large sample of college students in Monastir university.

Methods: A cross sectional study was performed between April 2013 and September 2013. Read More

Tunis Med 2018 Oct-Nov;96(10-11):557-570

Objective: Measure the prevalence of smoking among students of health sciences Faculties in Monastir (Tunisia) and identify factors associated with smoking behavior.

Methods: A cross-sectional study based on a self-administered questionnaire conducted among students registered in their second, fourth and sixth year at the Faculties of Medicine and Pharmacy in Monastir, in 2013. Smoker was the subject who, at the time of the survey, smoked at least one cigarette per day. Read More

Tunis Med 2018 Oct-Nov;96(10-11):545-556

Introduction: Tobacco is the leading preventable cause of death in the world and kills up to seven million people each year. Monitoring its prevalence is important for prevention programs. The aim of this work was to summarize the literature on the prevalence of smoking in the Maghreb countries during the past two decades. Read More

Tunis Med 2018 Oct-Nov;96(10-11):541-544

Tunis Med 2018 Aug - Sep;96(8-09):536-539

Epiphyseal pseudotumor secondary to osteoarthritis are rare in patients under 50 years. We report here the case of a 48-year-old woman who complained of pain in the medial side of the left knee for three years. X-rays of the left knee showed a large lytic lesion containing multiple septae, with sclerotic margins at the upper end of the tibia, associated with knee osteoarthritis. Read More

Tunis Med 2018 Aug - Sep;96(8-09):532-535

Background: Pituitary tuberculosis is very rare. Its diagnosis is difficult unless a bacteriological or histological evidence of tuberculosis.

Observation: We report the case of a 54 years old woman who presented with a pituitary coma that occurred two weeks after the initiation of antituberculous therapy for cervical lymph node tuberculosis. Read More

Tunis Med 2018 Aug - Sep;96(8-09):528-531

Introduction: The identification of the epileptic syndrome is a challenge particularly in childhood epilepsies. In fact, the diagnosis may need several years to be fulfilled.

Observation: Our patient presented at the age of 3 years 6 months atypical absence. Read More

Tunis Med 2018 Aug - Sep;96(8-09):524-527

A 15-year-old male presented with decreased vision and nystagmus from childhood. Best-corrected visual acuity was limited to 0,05/10 in both eyes. Fundus examination revealed a well-demarcated macular excavation of 2 discs diameter, baring of the underlying sclera, surrounded by a pigmented rim and hypopigmented retinal areas. Read More

Tunis Med 2018 Aug - Sep;96(8-09):520-523

Introduction: necrotizing fasciitis of the chest wall is a rare condition in subcutaneous tissues and deep fascia. Primary thoracic involvement is exceptional and is a diagnostic and therapeutic emergency.

Aim: To report our experience in the management of this rare pathology of which clinical picture is unknown by most practitioners. Read More

Tunis Med 2018 Aug - Sep;96(8-09):514-519

Methods: This is a retrospective study including 47 patients with isthmic coarctation (CoA) diagnosed in ante et postnatal périod, hospitalized in pediatric cardiology departement of la Rabta Hospital-Tunisia during the period from 2000 to 2017.

Results: They were 36 girls and 11 boys with an average age of 14 days. The diagnosis of CoA was suspected during the anténatalperiod in eight cases. Read More

Tunis Med 2018 Aug - Sep;96(8-09):510-513

Background: Extremely preterm infants are newborns born before 28 weeks of gestation. Survival of these immature newborns depends on resuscitation and the quality of care during hospitalization.

Objective: To determine survival and neurologic outcomes at2 years after extremely preterm birth. Read More

Tunis Med 2018 Aug - Sep;96(8-09):505-509

Aim: to analyze Edinburgh questionnaire (EQ) screening performance for peripheral artery disease (PAD) in type 2 diabetic patients.

Methods: Cross sectional study including 150 type 2 diabetic patients without PAD history. All patients responded to EQ and had peripheral pulse checkup and measurement of the ankle/brachial index (ABI). Read More

Tunis Med 2018 Aug - Sep;96(8-09):501-504

Objectives: To investigate the link between pain sensitivity in autism spectrum disorders (ASD) and self-aggressive behavior.

Methods: we performed a cross-sectional study which involved 50 children fulfilling DSM-V criteria for ASD; confirmed by the Autism Diagnostic Interview Revised. The severity of autism was determined using the Childhood Autism Rating Scale (CARS). Read More

Tunis Med 2018 Aug - Sep;96(8-09):495-500

Introduction: Xanthogranulomatous pyelonephritis (XGPN) is a particular form of chronic renal suppuration characterized by the destruction of renal parenchyma and its replacement by a granulomatous tissue containing xanthomatous cells.

Objective: To report and describe the main clinical, biological, radiological and therapeutic aspects of xanthogranulomatous pyelonephritis in adults in focal and diffuse forms.

Methods: This was a monocentric retrospective study involving 42 cases of XGPN operated and histologically confirmed between 2005 and 2015. Read More

Tunis Med 2018 Aug - Sep;96(8-09):490-494

Aim: We describe the clinical and etiological profile of patients with Fahr's syndrome (FS).

Methods: Charts of sixteen patients diagnosed with FS between 1999 and 2014 were retrospectively assessed.

Results:   The mean age at diagnosis was 44. Read More

Tunis Med 2018 Aug - Sep;96(8-09):483-489

Objectives: To determine the prevalence and to monitor the trends of resistance to broad-spectrum cephalosporins among various species of enterobacteria in the region of Mahdia (Tunisia) from 2002 to 2014.

Methods: A retrospective study was carried out in the microbiology laboratory at Tahar Sfar Teaching Hospital in Mahdia. Data concerning a thirteen-year period (2002-2014). Read More

Tunis Med 2018 Aug - Sep;96(8-09):477-482

Background: Smoking is an established risk factor of several respiratory and extra respiratory diseases. However, the effect of smoking on obstructive sleep apnea syndrome (OSAS) is not well characterized. The purpose of this work is to study the influence of smoking on the severity of OSAS. Read More

Tunis Med 2018 Aug - Sep;96(8-09):472-476

Background: Hypoparathyroidism is a rare pediatric endocrine disease, which is caused by low circulating levels of PTH or insensitivity to its action in the target tissues.

Aim: To report the clinical and biochemical characteristics and theoutcome of 8 patients with hypoparathyroidism.

Methods: We analyzed retrospectively the results of clinical, biochemical, radiological findings of patients with hypoparathyroidism diagnosed in pediatric department of Hedi Chaker Hospital during the period 1994-2013. Read More

Tunis Med 2018 Aug - Sep;96(8-09):465-471

Breast cancer is the first cancer in women worldwide. Since the previous estimates of WHO in 2008, incidence is increasing and it is estimated that 30% of women will develop immediately a metastatic form. However, advances in molecular biology and the discovery of new therapies have extended significantly the survival of patients and improved the quality of life of patients with metastatic breast cancer. Read More

Tunis Med 2018 Apr;96(4):183-258

Tunis Med 2018 Apr;96(4):177-182