Libyan Journal of Medicine

A simple score for predicting urinary fistula in patients with renal hydatid cysts

2022-10-14T11:03:41+00:00

Hydatid cyst is a major health problem in developing countries. The kidney is in third position of organs affected by hydatid cyst. One of the complications of renal hydatid cyst is a urinary fistula. The purpose of this study is to identify preoperative predictive factors of urinary fistula in renal hydatid cyst and to develop a scoring system for this disorder. We retrospectively analyzed all patients operated for renal hydatid cysts between January 2000 and December 2020. We divided our patients into two groups according to whether or not the renal hydatid cysts opened in the urinary tract. Predictive factors of the presence of a urinary fistula have been studied to obtain a simple score to predict the presence of a urinary fistula. Differences were considered significant if p < 0.05. Urinary fistula was detected in 33 of 96 patients. Univariate analyses showed significant differences in patient age, cyst size, location, hydaturia, eosinophil count, and platelet count between patients with and without urinary fistula. In multivariate analyses, hydaturia (p < 0.005), eosinophil count >500/mm3, (p = 0.01), cyst diameter >5 cm (p = 0.02), and upper or lower renal pole location (p = 0.003) were significant and independent predictors of urinary fistula. A score was developed to predict the opening of the cyst in the urinary tract. The total score varies between 0 and 15. The resulting area under the receiver operator characteristic curve was 0.798 (95% CI, 0.726–0.866; p = 0.023). At a cutoff point ≥8, the specificity achieved was 100%. Preoperative detection and management of urinary fistula are important issues in the treatment of renal hydatid cyst. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with renal hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.

Age and clinical signs as predictors of COVID-19 symptoms and cycle threshold value

2022-10-13T09:30:43+00:00

Many COVID-19 infected people remain asymptomatic, and hence the diagnosis at first presentation remains a challenge. Assessment at a presentation in primary care settings is usually done by visual triaging and basic clinical examination. This retrospective study involved investigating the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar for July 2020. The presence (symptomatic group) or the absence (asymptomatic group) of symptoms along with objective vital examination (ie; heartrate (HR), temperature, haemoglobin saturation (SpO₂)) were analysed and linked to the viral load (ie; cycle threshold (Ct)) of COVID-19 positive patients. Four hundred eighty-one symptomatic (230 males) and 216 asymptomatic (101 males) patients were included. Compared to the asymptomatic male group, the symptomatic male group was older, had lower Ct value and SpO₂, and higher temperature and HR. Compared to the females asymptomatic group, the symptomatic females group had lower Ct value, and higher temperature. Compared to the asymptomatic group, the symptomatic group had lower Ct value and SpO₂, and higher temperature and HR. Compared to the asymptomatic group, the symptomatic group had lower Ct values (age groups [21–30], [31–40], [41–50] and [51–60]), higher temperature (age groups [21–30] and [31–40], Ct ranges [20.01–25.00] and [25.01–30.00]), higher HR (age groups [21–30] and [31–40], Ct range [15.01–20.00]); and lower SpO₂ (age groups [41–50] and [51–60], Ct ranges [15.01–20.00] and [35.01–40.00]). Compared with asymptomatic patients, symptomatic patients with COVID-19 are most likely to be febrile, tachycardic, hypoxic and having higher viral load. Higher viral load was associated with higher HR, higher temperature, lower SpO₂, but there was no relation between viral load and age.

Anatomical prognosis after idiopathic macular hole surgery: machine learning based-predection

2022-10-13T09:42:01+00:00

To develop a machine learning (ML) model for the prediction of the idiopathic macular hole (MH) status at 9 months after vitrectomy and inverted flap internal limiting membrane (ILM) peeling surgery. This single center was conducted at Department A, Institute Hedi Raies of Ophthalmology, Tunis, Tunisia. The study included 114 patients. In total, 120 eyes underwent optical coherence tomography (OCT) and inverted flap ILM peeling for surgery. Then 510 B scan of macular OCT was acquired 9 months after surgery. MH diameter, basal MH diameter (b), nasal and temporal arm lengths and macular hole angle were measured. Indices including hole form factor, MH index, diameter hole index (DHI) and tractional hole, MH area index and MH volume index were calculated. Receiver operating characteristic (ROC) curves and cut-off values were derived for each indices predicting closure or not of the MH. The area under the receiver operating characteristic curve (AUC) and kappa value were calculated to evaluate performance of the medical decision support system (MDSS) in predicting the MH closure. From the ROC curve analysis, it was derived that MH indices like MH diameter, diameter hole index (DHI), MH index, and hole formation factor were capable of successfully predicting MH closure while basal diameter, DHI and MH area index predicted none closure MH. The MDSS achieved an AUC of 0.984 with a kappa value of 0.934. Based on the preoperative OCT parameters, our ML model achieved remarkable accuracy in predicting MH outcomes after pars plana vitrectomy and inverted flap ILM peeling. Therefore, MDSS may help optimize surgical planning for full thickness macular hole patients in the future.

Effects of a structured health education on prevention of HIV risky behaviours among adolescents in Nigeria – a pragmatic randomized controlled trial

2022-10-13T09:53:14+00:00

Infection with HIV/AIDS continues to be a major public health concern around the world, particularly in low- and middle-income nations. To assess the effectiveness of structured health education on the prevention of HIV/AIDS risky behaviours among adolescents in secondary school. A pretest- posttest-control group randomized controlled trial where a sample of 647 adolescents was drawn from the population of 2,890 secondary school students and was block-randomized into the intervention (n = 400) and control (n = 224) groups. Data were collected using a content-validated (CVI = 4.2/5) and reliable (k = 0.791) self-developed structured questionnaire. Data were analyzed using descriptive statistics and with inferential statistics of independent and paired t-tests at α = 0.05. Pre-intervention risky behaviours in both groups were below average though lower in the intervention than in the control group. Pre-intervention risky behaviour was significantly higher among males than females in the rural school (p < 0.001) and in both schools together (p < 0.001). Health education significantly affected risky behaviour with the intervention group being associated with lesser risky behaviour than the control group. There was no significant difference in the post-intervention risky behaviour between males and females in the rural (0.285), urban (0.179) and both schools together (p = 0.956). Post-intervention reduced risky behaviours more significantly in the intervention than in the control groups. HIV/AIDS health education should be part of schools’ curriculum, guidance and counsellor teachers should be trained as HIV counsellors.

Effects of Hatha yoga on cognitive functions in the elderly: a cross-sectional study

2022-10-13T10:07:06+00:00

This study aimed to investigate the effects of Hatha yoga practice on cognitive functions in the elderly. Thirty healthy older men participated in this study. They belonged to 2 groups. The first group included 15 Hatha yoga practitioners for at least 2 years. The control group involved 15 male older adults who shared the same characteristics (age, years of formal education, and level of physical activity) as the Hatha yoga group but were naive to yoga, meditation, or any mind-body intervention. Neuropsychological tests were applied to measure selective attention, sustained attention, episodic memory, and processing speed. The following tests were administered: The French adaptation of the Victoria Stroop test, the Zazzo’s Cancellation Task, the Five Word Test, and a battery of computerized tests to evaluate reaction time. Long-term Hatha yoga practice showed promising results related to executive functions and reaction time, but no significant difference was found between the two groups in episodic memory and sustained attention although a trend of improvement was observed in favor of Hatha yoga practitioners. In conclusion, long-term Hatha yoga practitioners have better cognitive abilities compared to the control group in certain aspects of cognitive functions. Further physiological and psychological variables need to be examined in order to highlight the correlation between yoga intervention and cognitive performance.

Effects of vitamin C and D on the mRNA expression of angiotensin converting enzyme 2 receptor, cathepsin L, and transmembrane serine protease in the mouse lungs

2022-10-13T10:21:14+00:00

Vitamins (Vit) C and D are widely used as immunogenic supplements among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. The SAR-CoV-2 virus enters into the pulmonary endothelial cells through attachment to angiotensin converting enzyme 2 receptor (Ace2) and the proteolytic activity of Cathepsin L (Ctsl) and transmembrane serine protease 2 (Tmprss2) enzymes. This study aimed to determine the influence of Vit C and D on the mRNA expression of Ace2, Tmprss2, and Ctsl genes in the mouse lungs. Vitamins C and D were administrated to different groups of mice through intra-peritoneal route in doses equivalent to human for 30 days. Then, the mRNA expression of SARS-CoV-2 entry gene was analyzed using qRT-PCR. It is found that Vit D, but not C, upregulated significantly (P < 0.05) the mRNA expression of Ace2 by more than six folds, while downregulated the expression of Ctsl and Tmprss2 genes by 2.8 and 2.2 folds, respectively. It can be concluded from this study that Vit D alters the mRNA expression of Ace2, Tmprss, and Ctsl genes in the mouse lungs. This finding can help us in understanding, at least in part, the molecular influence of Vit D on genes involved in the entry of SARS-CoV-2 into the cells.

Forty-year Tunisian bibliometrics of general surgery theses in the four national faculties of medicine (1980–2019)

2022-10-13T10:50:17+00:00

The objective of this work was to establish the bibliometric profile of Tunisian theses in ‘general surgery’ and to describe their themes, their study designs, and their writing quality. This is a retrospective descriptive bibliometric study, covering all the theses in medicine in the specialty of ‘general surgery’, defended in the four medical faculties of Tunisia, during the forty last years from 1980 to 2019. During the study period, 739 theses in ‘general surgery’ were discussed in Tunisia, with an average of 19 theses per year. The most studied research topic was emergencies (41%), followed by common surgical pathologies (26%) and digestive oncology (21.5%). Descriptive studies and case studies represented the majority of study designs with respective proportions of 56.9% and 40.6%. Only 20.7% of these theses had a scientific writing quality deemed satisfactory. The least respected elements in writing their summaries were statistical (confidence intervals and standard deviations) and documentary (keywords). Despite the plethora of themes of Tunisian theses in ‘general surgery’, their basic methodology and their editorial non conformity require the educational reform of the dissertations, both doctoral students and supervisors, by strengthening their skills in research methodology and scientific communication written.

General practitioners should provide the cardiorespiratory rehabilitation’ ‘minimum advice’ for long COVID-19 patients

2022-10-13T11:10:27+00:00

No Abstract

Knee meniscal retears after repair: A systematic review comparing diagnostic imaging modalities

2022-10-13T12:01:30+00:00

The meniscus is a relatively avascular fibrocartilaginous structure that provides a key role in shock absorption and load transmission. However, accurate diagnosis of meniscal retear can present a clinical challenge. The purpose of this study was to conduct a systematic review on the available literature, which compare the sensitivities, specificities, and accuracies of different diagnostic modalities of diagnosing knee meniscal retears in patients who have undergone surgical meniscal repair, such as Magnetic Resonance Imaging (MRI), Magnetic Resonance Arthrography with intraarticular contrast (direct MRA), and a combination of MRI and direct MRA. Two authors independently searched two databases (PubMed and Scopus) for literature related to knee meniscus retear according to the PRISMA guidelines. Four studies were found, which resulted in 291 patients with 293 menisci. All studies were published in 2008 and 2014. In our analysis, we calculated sensitivity to be 78.79% (95% CI, 64.07–93.51), specificity to be 56.58% (95% CI, 20.21–92.94), and overall accuracy to be 66.25% (95% CI, 54.29–78.22) for MRI and sensitivity to be 87.84% (95% CI, 83.93–91.74), specificity to be 88.68% (95% CI, 81.93–95.43), and overall accuracy to be 87.22% (95% CI, 82.22–91.62) for direct MRA. We recommend the use of direct MRA for the diagnosis of meniscal retears due to its higher sensitivity, specificity, and accuracy as compared to MRI and its reduced cost and invasive nature as compared to second-look arthroscopy. However, our review is limited by the number of studies available on this topic. More studies using study designs such as randomized controlled trials, involving MRI, direct MRA, and combinations of such techniques, should be performed to accurately assess the different techniques and aid in designing guidelines to guide the diagnosis of meniscal retears following meniscal repair.

Knowledge, attitude, and practices of complementary and alternative medicine: a survey of physicians and nurses at an academic medical center in Beirut

2022-10-13T12:12:53+00:00

The aim of this study is to assess the knowledge, attitudes, and practices of complementary and alternative medicine (CAM) among physicians and nurses at the American University of Beirut Medical Center (AUBMC) in Beirut, Lebanon. A web-based survey was emailed to 518 physicians and 423 registered nurses in all medical departments at AUBMC. Of the 94 physicians responding to the survey, 61% have never referred a patient to a CAM practitioner yet 33% reported that they would refer if available. Sixty-two percent of physicians believed that incorporating evidence-based CAM therapies will increase patient satisfaction and 66% thought that offering CAM would attract more patients. Of the 80 nurses who responded, 78.7% have never referred a patient to a CAM practitioner, yet half reported that they would likely refer if a CAM practitioner was available. Fifty-seven percent of nurses surveyed believed that offering CAM would attract more patients while 59% thought that it would increase patient satisfaction. Most nurses were uncomfortable counseling patients about CAM modalities. Favorable attitudes towards CAM were reflected by the physicians and nurses as signified by the above-average attitude means towards CAM (M = 4.01, SD = .16 and M = 3.25, SD = .59, respectively). The study findings demonstrate that despite the physicians’ and nurses’ limited knowledge and their discomfort in counseling on CAM, they expressed acceptability and willingness in using and incorporating CAM therapies into clinical practice at AUBMC. This is the first study conducted in Lebanon that assesses both nurses’ and physicians’ perspectives on the use of all CAM domains in general within the same healthcare setting. This study not only provides baseline data but also highlights the knowledge gap and learning needs among physicians and nurses with regards to CAM.

Magnesium and Zinc Intake Ratio Mediates the Increase of Coronary Artery Calcification through Upregulating Interleukin 6

2022-10-13T12:25:06+00:00

The relation between dietary minerals and coronary artery calcification (CAC) has been emphasized. However, the effects of multiple dietary minerals on CAC progression remain unclear. This study Investiagetes the effect of combined dietary mineral intake on the progression of CAC. We analyzed a population-based cohort with 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores were measured at baseline and subsequent follow-up examinations by Multi-detector computed tomography (MDCT) scans with Agatston scores. Then, the progression of CAC was defined through increased CAC scores in the follow-up from the baseline exam. The results revealed that the dietary intake of individual minerals did not show significant differences across CAC progression vs non progression groups. However, participants with CAC progression had an increased Magnesium (Mg):Zinc (Zn) ratio (P < 0.05). This effect was significant in logistic regression after adjusting for multiple established risk factors of CAC progression (OR 1.050; 95% CI 1.003, 1.099; P = 0.038). The increased risk of CAC associated with Mg/Zn was mediated through an increase level of IL-6, which increased with association to the Mg: Zn ratio. In conclusion, the dietary of Mg: Zn ratio, rather than individual mineral intake is associated with increased risk of CAC progression, which is mediated by pro-calcific IL-6. Therefore, the
consideration of dietary intake of Zn and Mg together would play a cardio protective role among CAC patients.

Oral health status in individuals with Down syndrome

2022-10-13T12:47:01+00:00

Down syndrome (DS) is a neurodevelopmental disorder of known genetic cause, with a wide array of oral and systemic manifestations. The aim of the present study is to determine the level of oral hygiene status and practice of a group of individuals with DS in Benghazi/Libya. In this cross– sectional study 124 individuals were recruited from The Rehabilitation Centre of Special Needs in the city of Benghazi, Libya. Questionnaires were distributed among the attendees, covering oral health aspects and diet habits. Oral examination was conducted to evaluate oral health status among individuals with DS. The data were analysed descriptively and inferentially (including Chi-square test and Fisher’s exact test) using the Statistical Package for Social Science version 20 (SPSS). Most of DS individuals brush their teeth once daily (62%), spending less than one minute in brushing (44%). For diet habits, more than half (55%) eat sweet snacks between meals. For the dental status, 47% of the subject had zero DMFT, followed by score 2 in 21%. The highest percentage in Oral hygiene Index (OHI) was scored 1 by 46% of participants. The zero CPITN score was seen in 54.5%. Our results have shown a weaker tendency of DS towards oral hygiene. This should strengthen our goal of guiding and encouraging parents of individuals with DS to be more cautious in providing help and supervision of their individuals’ practice of oral health care.

Parents’ concerns and attitudes towards school reopening during COVID-19 pandemic: a cross- sectional survey-Tripoli, Libya, 2021

2022-10-14T07:19:29+00:00

The issue of school reopening has raised several concerns; therefore, the parent’s opinion is essential to consider. This study aimed to evaluate the parent’s attitudes and concerns toward school reopening in the COVID-19 era. A cross-sectional survey was performed using inperson self- administered questionnaires, the data was collected in the period between January and April 2021 covering parents’ concerns and attitudes toward school reopening. A total of 402 parents participated in the survey. Analysis showed that 56.7% of parents have agreed with school reopening, but 54% have raised some legitimate concerns. Importantly, there was a strong correlation between parents’ opinions towards school reopening and their level of education, and their concerns about their children’s safety if the school was reopened. Despite parents’ concerns, it does seem that slightly over half were in favour of school reopening and would send their children to school only if the schools did apply strict precautions and restriction measures. Sharing parents’ views toward school reopening with school leaders and decision-makers is important to assess the feasibility and effectiveness of return to schools and to improve existing prevention programs.

Patient safety in medical education: Tunisian students’ attitudes

2022-10-14T07:47:57+00:00

Health care delivery continues to be unsafe despite major patient safety (PS) improvement efforts over the past decade. Medical school education plays an important role in promoting this culture during initial training. To determine undergraduate medical students’ attitudes toward PS at a Tunisian medical school. We carried out a cross-sectional study among undergraduate medical students at Ibn Al Jazzar Medical School in Sousse, Tunisia, using a self-administered questionnaire inspired from the valid tool: Attitudes to Patient Safety Questionnaire (APSQ III). A total of 178 medical students responded to the questionnaire. Medical students tend to have an overall positive perceptions of PS culture with a global mean score 5.33 ± 0.5. Among the individual domains ‘Working hours as a cause of error’ earned the highest score (6.38 ± 1.0) followed in order by ‘Team functioning’ (6.24 ± 0.8), ‘Error inevitability’ (5.91 ± 1.0) and ‘Patient involvement in reducing error’ (5.50 ± 1.0). The lowest score was for ‘Professional incompetence as a cause of error’ (4.01 ± 1.0). A PS domain’s mean scores comparison based on socio-demographic variables: gender, age, academic year and on PS training revealed a statistically significant difference (p < 0.05) for five PS key dimensions: ‘ Error reporting confidence ’, ‘ Working hours as a cause of error ’, ‘ Professional incompetence as a cause of error ’, ‘ Team functioning ’ and ‘PS training received’. Tunisian medical students showed positive attitude towards PS. Nevermore, intensive in terms of frequency and duration sessions, based on various teaching methods may be needed to fulfill students’ educational needs.

Predictors of assertive behaviors among a sample of first-year Tunisian medical students

2022-10-14T08:08:53+00:00

Assertiveness is a constructive interpersonal behavior alternative to manipulation and aggression. Medical students (MSs) have daily interpersonal interactions with colleagues, patients and families. Yet, communication deficiencies due to hesitancy to speak-up assertively lead to adverse patient outcomes. This study aimed to assess levels of assertive behaviors (ABs), and to determine its predictors within a sample of first-year Tunisian MSs. This was a cross-sectional survey including 125 first-year MSs from Tunisia. ABs were measured by the Rathus assertiveness scale. Potential independent predictors of AB were evaluated using the following questionnaires: Rosenberg self-esteem scale, interpersonal communication skills inventory short-form-36quality of life questionnaire, and general health questionnaire. In addition, some MSs’ characteristics were considered (eg; age, sex, living with family, assertiveness training, community work, personal medical field choice, smoking, and alcohol use). Univariate and multivariate analyses were performed. Among the 309 MSs, 125 (40.45%) responded to the survey. AB were found in 36.8% of MSs. Multiple linear regression models revealed that self-esteem global scores, sending clear messages, anxiety/depression and male sex were accountable for 31% in AB scores variance. Targeting self-esteem and interpersonal communication skills (sending clear messages) and identifying subgroups of students with anxiety/depression state would influence ABs.

Predictors of pulmonary hypertension among children with atrial septal defects (ASD)

2022-10-14T08:30:08+00:00

Introduction: Atrial septal defect (ASD) is a common congenital heart disease in children that uncommonly presents with pulmonary hypertension. Much is not known about the exact predictor of PAH in children with ASD. Objectives: This study aimed to determine the predictors of pulmonary hypertension in children with ASD.

Patients and Methods: This was a descriptive analysis of children with ASD carried out in three different institutions over a five-year period. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software, version 25.

Results: The majority of the participants, 52.2%, had pulmonary hypertension and 62.5% of them occurred as mild pulmonary hypertension. There was a very weak positive correlation between pulmonary hypertension and the size of atrial septal defect, increases in size of atrial septal defect correlate with increases in pulmonary hypertension and this was found not to be statistically significant (n = 67, r = 0.193, p = 0.118). There was a positive correlation between the size of atrial septal defect and the age of participants in months, increases in age correlate with increases in size of atrial septal defect and this was found to be statistically significant (n = 67, r = 0.357, p = 0.003). The highest proportion of respondents who had pulmonary hypertension, 64.7%, was seen among children less than 1 year old while the least proportion, 27.3%, was within 1–5 years, and the difference in proportions was found to be statistically significant (χ2 = 8.187, p = 0.017).

Conclusion: Pulmonary hypertension in children with ASD occur usually in the mild form. Age is the only strong predictor of PAH in children with isolated ASD.

Prevalence and associated factors of perinatal depression among working pregnant women: a hospital-based cross-sectional study

2022-10-14T08:48:48+00:00

Perinatal depression is a major public health problem having serious negative impacts on personal, family, and child developmental outcomes. This study aimed to determine the prevalence of major depressive disorder (MDD) and its associated factors in working pregnant women. This descriptive, cross-sectional study was performed on 389 working pregnant women enrolled from four Tunisian public maternity hospitals. Data collection tools were the sociodemographic, obstetric, family relationships, and work environment questionnaire, and the Center for Epidemiologic Studies Depression Scale (CES-D). The mean score of depression was 27.39 ± 6.97 and 76.1% of women had major depressive symptoms using cutoff points on the CES-D ≥ 23. Family income, diagnosis with a chronic illness, history of depression, and employment categories were associated with major depressive symptoms. In multivariate analyses, family income and work posture were significantly associated with MDD. These results suggest an increased burden of MDD during pregnancy in Tunisian women. Prevention, early detection, and interventions are needed to reduce the prevalence of perinatal depression.

Prevalence and risk factors of functional gastrointestinal disorders in early period medical students: a pilot study in Tunisia

2022-10-14T09:08:56+00:00

Functional gastrointestinal disorders (FGIDs) are highly prevalent in medical students around the world. However, there is no specific data on FGIDs in Tunisia. The objectives of this study were to evaluate the prevalence of FGIDs in medical students according to the rome III criteria and to identify risk factors associated with these disorders. A self-administered questionnaire survey was carried out among the students from the first and the second year of medical studies. We studied the influence of socio-demographic characteristics, lifestyle, health care seeking, psychosomatic symptoms and hospital anxiety and depression scale on the prevalence of FGIDs among these students. Three hundred and forty-three students (20.3 ± 0.8years) were included in our study. The prevalence of FGIDs was 54.2%. The main FGIDs found were the unspecified functional bowel disorder (46.6%), functional constipation (11.6%), irritable bowel syndrome (7.6%) and functional dyspepsia (6.7%). In logistic regression, abnormal BMI (OR = 2.1, 95% CI= 1–4.3), living in school dormitory (OR = 3.7, 95% CI = 1.7–7.8), low water intake (OR = 2.2, 95% CI = 1.1–4.2), digestive medication use (OR = 3.4, 95% CI= 1.3–8.5), and probable or definite anxiety (OR = 2.5, 95% CI = 1.1–5.8) were the five risk factors associated with FGIDs. We demonstrate a high prevalence of FGIDs (54.2%) among our students. Risk factors for FGIDs were abnormal BMI, living in school dormitory, low water intake, digestive medication use and anxiety.

Reversibility of pancreatic β-cells dysfunction after vitamin D and calcium supplementation: a pilot study in a population of obese and prepubescent North-African children

2022-10-14T10:16:55+00:00

The mechanisms of diabetogenesis in children remain largely obscure. This study aimed to determine the impact of vitamin D and calcium supplementation on pancreatic β-cells function in terms of insulin secretion and sensitivity. This was a quasi-experimental study involving 30 obese and prepubescent Tunisian children (57% boys). During three months, the children received calcium and vitamin D supplementation at therapeutic doses. An oral glucose tolerance test (OGTT) was performed at the beginning and at the end of the study. The following metabolic definitions were applied: i) hyperinsulinism: insulinemia sum > 300 μ UI/ml during OGTT, ii) insulin-resistance: homeostatic model assessment of insulin-resistance > 2, iii) normal glycaemic profile: normal plasma levels during OGTT without any spike, and iv) pancreatic β-cells dysfunction reversibility: disappearance of the aforementioned disorders. The means ± standard-deviation of age and body mass index were 10.87 ± 1.9 years, and 30.17 ± 4.99 kg/m2, respectively. All children were at the stage of hyperinsulinism associated with insulin-resistance. These disturbances were noted even in children having a normal glycaemic profile at OGTT. After calcium and vitamin D supplementation, glycaemic profile as well as insulin-secretion improved significantly (p < 0.0001). Hyperinsulinism and insulin-resistance decreased significantly by 56.67% (p < 0.0001) and 70.00% (p < 0.0001), respectively. Complete reversibility of these two disorders was noted in 26.6% of children. To conclude, in obese and prepubescent children, vitamin D and calcium supplementation led to he reversibility of the pancreatic β-cells dysfunction.

Review of the current use of global lung function initiative norms for spirometry (GLI-2012) and static lung volumes (GLI-2021) in Great Arab Maghreb (GAM) countries and steps required to improve their utilization

2022-10-14T10:21:58+00:00

No Abstract

Saddle versus non-saddle pulmonary embolism: differences in the clinical, echocardiographic, and outcome characteristics

2022-10-14T10:29:24+00:00

The central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamic consequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed to evaluate the clinical presentation, hemodynamic and echocardiographic effects, as well as the outcomes of saddle PE, and compare the results with those of non-saddle type. This was a retrospective study of 432 adult patients with saddle and non-saddle PE. Overall, 432 patients were diagnosed with PE by computed tomography pulmonary angiography (CTPA). Seventy-three (16.9%) had saddle PE, and 359 had non-saddle PE. Compared to those with non-saddle PE, patients with saddle PE presented more frequently with tachycardia (68.5% vs. 46.2%, P= .001), and tachypnea (58.9% vs. 42.1%, P= .009) on admission, required more frequent intensive care unit (ICU) admissions (45.8% vs. 26.6%, P= .001) and thrombolysis/ thrombectomy use (19.1% vs. 6.7%, P= .001), and were at more risk of developing decompensation and cardiac arrest after their initial admission (15.3% vs. 5.9%, P= .006). On echocardiography, right ventricular (RV) enlargement (60% vs. 31.1%, P= .000), RV dysfunction (45.8% vs. 22%, P= .000), and RV systolic pressure (RVSP) of greater than 40 mmHg (61.5% vs. 39.2%, P= .003) were significantly more observed with saddle PE. The two groups did not differ concerning the rates of hypotension (17.8% vs. 18.7%, P= .864) and hypoxemia (41.1% vs. 34.3%, P= .336) on admission and mortality rates. A logistic regression model indicated that the use of oral contraceptive pills (OCP), RVSP > 40 mmHg, and development of hypotension and decompensation following admission were associated with an increased likelihood of having saddle embolus. Saddle PE accounts for a higher proportion among all PE cases than previously reported. Patients with saddle PE tend to present more frequently with adverse hemodynamic and echocardiographic changes and decompensate after their initial presentation. OCP use, development of hypotension, and decompensation following admission and RVSP > 40 mmHg are significant predictors of saddle PE. These characteristics should not be overlooked when managing patients with saddle PE.

Symptoms at disease onset predict prognosis in COVID-19 disease

2022-10-14T10:39:52+00:00

The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum, and dyspnea. However, a significant proportion of patients initially manifested non-respiratory symptoms, such as fever, myalgia, and diarrhea. Here, we compared the different characteristics and outcomes between the patients with respiratory symptoms and non-respiratory symptoms at illness onset. The patients admitted to the respiratory departments from eight hospitals in Hunan and Guangxi Province with nucleic acid-positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens, and outcomes data were recorded and analyzed. The median age of the recruited 541 subjects was 43 years (IQR, 33–55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had non- respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (8.7% vs 0.0%, P < 0.001), needed the intensive care unit more (9.7% vs 2.2%, P = 0.005), non-invasive ventilation more (7.2% vs 1.5%, P = 0.004), developed ARDS more (11.4% vs 2.2%, P = 0.001) and needed longer time to recover (18.5 vs 16.7 days, P = 0.003) compared to predominately non-respiratory COVID-19 subjects. The multivariate model showed that age (OR = 1.04, P = 0.01), dyspnea (OR = 4.91, P < 0.001) and secondary bacterial infection (OR = 19.8, P < 0.001) were independently associated with development of ARDS among COVID-19 patients. We identify COVID-19 subjects with dyspnea at disease onset who have a worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19.

The global lung function initiative 2021 (GLI-2021) norms provide mixed results for static lung volumes (SLVs) in Algerian adults

2022-10-14T10:45:48+00:00

The validity of the GLI-2021 norms for SLVs in healthy Algerian adults has not been assessed. To ascertain how well do the GLI-2021 norms fit to contemporary SLVs data in Algerian adults. This was a cross-sectional study involving 481 (n = 242 females) healthy non-smoking adults recruited from the Algiers general population. All participants underwent a clinical examination and a plethysmography. Z-scores for slow vital capacity (SVC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), expiratory reserve volume (ERV), inspiratory capacity (IC), and RV/TLC were calculated. The mean difference between the determined and the predicted values (Δvalue) of SLVs were calculated. The GLI-2021 norms would be considered as reflective of contemporary Algerian SLVs if the total sample mean z-scores were in the normal range (ie; −0.5 to +0.5). The participants’ means ± SDs of age and height were 46.4 ± 16.4 years and 166 ± 10 cm, respectively. The determined SLVs were significantly different from those predicted (Δvalues means ± SDs were −170 ± 470 ml for IC, −100 ± 490 ml for SVC, 170 ± 400 ml for ERV, 240 ± 620 ml for TLC, 370 ± 340 ml for RV, 480 ± 480 ml for FRC, and 5.28 ± 4.38% for RV/TLC). The means ± SDs z-scores for IC, SVC, ERV, and TLC were in the normal range (−0.29 ± 0.88, −0.17 ± 0.94, 0.29 ± 0.77, and 0.35 ± 0.86, respectively), but those of RV, FRC, and RV/TLC were out of the normal range (0.74 ± 0.66, 0.75 ± 0.72, and 0.83 ± 0.75, respectively). In healthy Algerian adults, the GLI- 2021 norms fit well to SVC, TLC, ERV, and IC, but they do not fit to FRC, RV, and RV/TLC.

Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000–2019)

2022-10-14T10:50:51+00:00

Describe the epidemiology of tuberculosis in the last two decades (2000–2019) in the East region of Tunisia (city of Sousse). This was a descriptive retrospective analysis of notified incident cases of tuberculosis from 2000 to 2019 in Sousse Governorate, Tunisia. The data collection was done via the regional registry of tuberculosis. Stata software was used to characterize the socio-demographic and clinical profile of tuberculosis, to calculate its incidence, mortality and fatality rates and to determine predictive factors of mortality. R software was used to analyze the chronological trend of tuberculosis incidence and mortality. A total of 2606 incident cases of tuberculosis were declared from 2000 to 2019 in Sousse. The mean age was 39 ± 19 years with a sex ratio (male/female) of 1.19. Only one case was HIV positive among the total 2606 incident cases. Extra-pulmonary tuberculosis was the most recorded (1,534 cases, 58.9%). The mean annual case notification and deaths were 130 and four respectively. After adjusting for confounders, individuals with pulmonary tuberculosis were 1.9 significantly more likely to die from tuberculosis compared to those suffering from extra-pulmonary tuberculosis. There was a trend of increasing mortality with increasing age. The association was statistically significant only for those above 60 years’ old who had 12.5 times higher odds of dying compared to those below 60 years. After adjusting for age and gender, with every year there was an increase in the total incidence rate (+0.35 per 100,000) with p = 0.005 and in the extra-pulmonary incidence (+0.27 per 100,000), with p = 0.001. This study demonstrated the increasing trend of tuberculosis in Sousse, Tunisia from 2000 to 2019. The national program against tuberculosis should enhance community knowledge and centralize the national and regional epidemiological information for better epidemiological surveillance.

Variant-specific RT-qPCR for rapid screening of B.1.617 mutations in SARS-CoV-2

2022-10-14T10:59:41+00:00

The continuous emergence of new SARS-CoV-2 variants required rapid and reliable diagnostic methods for early detection and monitoring of the spread of the virus, especially in lowresource countries where whole genome sequencing is not available. We aimed to evaluate and compare the performance of two different RT-qPCR screening assays for the detection of B.1.617 lineage mutations. A total of 85 SARS-CoV-2 positive samples were collected between 9th August and 10 September 2021 and screened by two mutation-specific RT-qPCR assays for simultaneous detection of B.1.617.1 and B.1.617.2 lineage mutations. VIASURE Variant II PCR assay identified 2 Delta variant-specific mutations (L452R, and P681 R) in 80% of tested samples, while the PKamp™ Variant Detect™ assay was only able to detect one Delta variant specific mutation (L452R) in 75% of tested samples. This is the first report to show the Delta variant as the cause of the third wave in Libya. The use of multiplex RT-qPCR assays has allowed the identification of new variants for rapid screening. However, RT-qPCR results should be confirmed by whole genome sequencing of SARS-COV-2.